\AJ6 


THIS  WORK 

TO    THE 

MEDICAL  PROFESSION  OF  THE  UNITED  STATES 

BY    THKIIl     OBEDIENT,    HUMBLE    SERVANT, 

THE    AUTHOR. 


PREFACE  TO  THE  FIEST  EDITION. 

The  Author  of  this  work  has  endeavoured  to  keejD  before  him  the 
difficult  objects  of  adapting  it  to  the  student  in  medicine  and  to  the 
more  advanced.  For  the  advantage  of  the  former,  therefore,  he  has 
aimed  at  such  method  as  he  might  command,  and  such  illustration  as 
might  not  seem  irksome  to  the  latter.  With  a  view  to  the  former, 
also,  he  has  endeavoured  to  indicate  the  intimate  manner  in  which  all 
the  topics  embraced  in  the  work  are  related  to  each  other,  and  their 
mutual  dependences,  by  constant  references  from  one  part  to  others ; 
and,  what  is  unusual,  the  Author  has  made  these  connecting  refer- 
ences in  a  prospective  as  well  as  retrospective  manner.  With  a  view, 
also,  to  the  same  objects,  the  Author  had  designed  a  more  copious 
Index ;  but  as  the  stereotype  was  completed  as  long  ago  as  the  mid- 
dle of  November,  and  as  the  state  of  his  health,  and  other  avocations, 
have  not  permitted  him  to  complete  the  Index,  in  its  regular  order, 
beyond  the  125th  page,  he  has  concluded  to  print  it  as  it  now  stands, 
and  to  extend  it  in  a  future  edition.  Many  subjects,  however, 
throughout  the  work,  are  now  incidentally  carried  out  in  the  Index ; 
but  many  of  the  most  important  receive  only  a  general  reference,  ex- 
cepting as  they  are  related  to  others  which  are  more  amply  noticed. 

New  York,  Jan.  1,  1847. 


^      PREFACE  TO  THE  FOURTH  EDITION. 

Three  Editions  of  these  Institutes,  the  first  of  which  w^as  pub- 
lished in  1847,  having  been  exhausted,  the  Author  now  submits  a 
fourth  to  his  medical  brethren,  in  which  he  has  endeavoured  to  incor- 
porate, in  an  Appendix,  the  most  important  of  the  recent  discoveries 
in  Physiology,  Pathological  Anatomy,  Therapeutics,  Organic  Chem- 
istry, and  Microscopy  that  are  relative  to  the  principles  about  which 
this  work  is  interested,  and  he  has  connected  the  Appendix  intimate- 
ly with  the  main  body  of  the  work  by  copious  references  to  the  sec- 
tions embraced  in  the  former,  while  the  same  system  is  carried  out 
reciprocally  in  the  latter.  It  is  also  gratifying  to  the  Author  to  pay 
his  humble  tribute  of  admiration  particularly  to  the  immense  labors 
of  the  microscopist,  who,  through  the  great  improvements  of  the  in- 
strument, is  now  enabled  to  analyze  Avith  surprising  accuracy  the  ul- 
timate and  varying  conditions  of  the  solids  and  fluids.  The  Author 
has  also  fulfilled  his  design,  as  expressed  in  the  Preface  to  the  first 
edition,  of  extending  the  original  Index,  a  second  one  being  now 
added,  in  which  he  has  endeavoured  to  present  an  epitome  of  the 
whole  work.  It  is  proper,  however,  to  suggest  that  the  Reader  will 
find  an  advantage  in  consulting  simultaneously  the  original  Index,  as 
it  is  more  particularly  analytical.  An  Essay  upon  the  Soul  and  In- 
stinct forms  a  part  of  the  Appendix. 

New  York,  Novemhei-^  1857. 


PKEFACE  TO  THE  FIFTH  EDITION. 

The  Supplement  which  is  added  to  the  present  edition  embraces 
observations  that  go  to  corroborate  some  of  the  Author's  principal 
views  in  medical  philosophy ;  but  he  is  not  aware  of  any  discoveries 
in  Physiology,  or  of  any  new  facts  in  Pathology,  or  of  any  improve- 
ments in  Therapeutics  since  the  late  edition  to  affect  adversely  any 
of  his  doctrines.  Indeed,  as  a  work  of  principles,  and  as  a  consistent 
whole,  should  any  doctrine  of  importance  be  shown  to  be  fallacious, 
the  entire  fabric  must  be  abandoned.  But  if,  on  the  contrary,  its 
principles  be  foimded  in  Nature,  they  can  not  be  affected  by  any  fu- 
ture accumulation  of  facts — no  more  than  the  law  of  gravitation  was 
rendered  more  absolute  by  the  successful  calculation  of  the  periodic 
time  of  Halley's  comet.  That  achievement  was  simply  a  corrobora- 
tion of  a  great  discovery.  It  is  of  no  importance,  therefore,  to  the 
essential  objects  of  this  work  to  mtroduce  new  discoveries  till  some 
one  or  more  may  present  themselves,  that,  Hke  chlorine,  iodine,  &c., 
in  their  relation  to  Lavoisier's  theories  of  oxygen,  shall  invalidate  the 
system  of  medical  philosophy  herein  embraced ;  by  which  the  Author 
means  such  facts  as  can  be  undeniably  shown  to  contradict  that  phi- 
losophy. This,  it  is  true,  will  appear  strange  to  those  (and  of  such 
there  are  many)  who  look  upon  principles  as  "liable  to  exceptions" 
— as  having  no  stability — exposed  to  daily  fluctuations — as  consisting 
•even  of  isolated  facts ;  such  philosophers,  particularly,  as  see  no  dis- 
crepancy between  the  conflicting  laws  of  organic  and  inorganic  be- 
ings, and  who,  therefore,  are  ever  ready  to  engraft  them  mdiscrim- 
inately  upon  organic  philosophy,  or  as  one  or  the  other  may  have  its 
chance  in  the  irresistible  pronimciations  of  organic  life,  or  in  the  spu- 
rious analogies  of  simple  matter.  To  muiltiply  facts  in  this  work 
which  merely  contribute  to  the  validity  of  its  principles,  or  to  incor- 
porate others  that  may  be  speciously  arrayed  against  those  principles, 
would  constitute  a  defect  for  the  most  ordinary  criticism.  Never- 
theless, some  things,  both  of  the  former  and  latter  nature,  have  been 
admitted  into  the  Appendix,  although  precisely  parallel  facts  occur 
in  the  body  of  the  work.  But  they  were  said  to  be  new,  and  the 
Author  yielded  to  this  general  belief,  though  he  concedes  that  the 
facts  are  more  fully  displayed  in  the  latter  than  in  the  former  cases, 
and  that  he  therefore  contemplated  an  advantage  from  their  corrob- 
orating effect.  But  their  exclusion  would  not  have  otherwise  affected 
the  work,  though  it  might  have  been  regarded  by  some  as  a  defect. 
The  same  may  be  also  afiirmed  of  the  Supplement,  where,  for  exam- 
ple, some  late  observations  relative  to  absorption  by  the  intestinal 
villi  are  stated,  although  they  simply  confirm  what  had  been  long 
ago  ascertained ;  but  they  are  more  precise  and  complete,  and  place 
the  doctrine  in  these  Institutes  beyond  question.. 

New  York,  August,  1859. 


PREFACE  TO  THE  SIXTH  EDITION. 

A  CAREFUL,  attention  lias  been  bestowed  upon  this  sixth  edition,  as 
will  be  sufficiently  manifest  in  the  numerous  references  which  have  been 
added  to  the  sections  wherever  the  subjects  under  consideration  are  allied 
to  other  parts  of  the  work  and  may  derive  illustration  through  this  re- 
lationship. These  new  references  (which  occupy  mostly  the  former  va- 
cant spaces  at  the  end  of  sentences)  are  prospective  as  well  as  retro- 
spective, and  amount  to  more  than  seventeen  hundred  ;  and  the  Indexes 
have  been  improved  in  a  similar  manner.  The  Author  has  also  en- 
deavored to  simplify  the  exposition  of  some  of  the  most  difficult  prob- 
lems, and  to  thus  render  them  of  more  easy  comprehension  by  the  young 
medical  student.  For  this  purpose  he  could  have  equally  desired  great- 
er amplification,  and  especially  to  protect  himself  against  misapprehen- 
sion or  misrepresentation  (from  the  latter  of  which,  however,  he  is  not  so 
unwise  as  to  hope  for  escape) ;  but  the  vastness  of  the  field,  the  immensity 
of  the  labyrinth  which  he  has  explored,  has  rendered  it  necessary  to  em- 
ploy as  much  brevity  xis  such  variety  and  intricacies  would  admit,  and 
he  has  considered  it  most  expedient  to  carry  into  the  Appendix  and 
Supplement  the  same  compactness  that  characterizes  the  body  of  the 
work.  Of  the  Supplement  it  is  said  that  "it  is  very  brief,  but  speaks 
a  volume." 

But  whatever  advantages  in  respect  to  detail  and  perspicuity  may  at- 
tend a  work  upon  the  principles  of  medicine  as  founded  in  Nature,  it  -can 
have  but  little  chance  with  other  systems  unless  the  student  be  ambitious 
of  knowledge,  and  disposed  to  grapple  at  the  very  beginning  of  his  career 
with  the  difficulties  of  truth  as  distinguished  from  the  fascinating  sim- 
plicity of  error.  The  latter  once  impressed  upon  his  imagination,  or  once 
productive  of  mental  indolence,  fetters  his  aspirations  and  decides  his 
destiny.  Hence  the  incalculable  importance  of  a  right  beginning. 
Whatever  the  apparent  obstacles,  they  may  be  soon  surmounted.  The 
task  will  have  been  the  best  possible  mental  discipline  for  the  young  in- 
quirer. He  will  have  learned  the  important  art  of  thinking  for  himself; 
and  when  once  inducted  into  the  true  philosophy  of  medicine  he  can  not 
help  thinking,  and  into  the  very  depths  of  that  philosophy.  He  will  have 
also  shielded  himself  against  the  seductions  of  artificial  systems.  He  will 
quickly  distinguish  what  is  true  in  Nature  from  factitious  analogies.  He 
is  not,  however,  to  be  discouraged  from  informing  himself  of  spurious 
doctrines ;  and  with  this  object  in  view  the  Author  of  these  Institutes 
has  incorporated  in  the  work  a  copious  exposition  of  the  offsprings  of 


X  PREFACE    TO    THE    SIXTH    EDITION. 

error.  But,  as  he  has  also  endeavored  to  indicate  their  fallacies,  the 
student  has  the  double  advantage  of  learning  the  inventions  of  art  and 
at  the  same  time  the  infirmities  which  are  so  apt  to  commend  them  to 
our  natural  indolence.  The  Author's  method,  therefore,  if  he  be  right 
in  his  premises,  is  not  open  to  the  objection  alleged  by  Burke  (but  on 
the  contrary  defeats  it),  that — "  When  education  takes  in  error  as  a  part 
of  its  system  there  is  no  doubt  that  it  will  operate  with  abundant  ener- 
gy and  to  an  extent  indefinite."  ' 

Much  has  been  recently  said  by  a  few  writers  upon  the  recuperative 
law  of  Nature,  and  presented  in  such  a  manner  as  to  convey  an  impres- 
sion that  now,  for  the  first  time,  the  old  doctrine  of  the  vis  medicatrix  na- 
turce  has  been  distinctly  announced.  The  Orator,  for  example,  of  the  Lon- 
don Hunterian  Society  for  the  present  year  remarks  that — "  From  time 
immemorial  the  professors  of  the  healing  art,  with  one  or  two  exceptions, 
seem  to  have  known  nothing  of  the  course  and  termination  of  diseases, 
save  in  connection  with,  and  as  modified  by,  special  therapeutical  agents. 
Nearly  all  their  reasoning  upon  the  action  of  medicines  has,  in  conse- 
quence, been  based  upon  comparisons  of  one  method  of  treatment  with 
another.  They  seem  never  to  have  thought  of  taking  as  the  basis  of 
their  reasoning  the  curative  resources  of  Nature  herself,  as  ascertained 
by  study  of  the  natural  course  of  disease." 

It  is  evident  that  they  who  have  lately  written  in  the  foregoing  man- 
ner have  had  their  attention  divei'ted  from  Hippocrates,  Celsus,  Galen, 
&c.,  and  if  they  will  turn  to  the  mottoes  at  page  661  of  this  work  they 
will  find  that  those  early  masters  '•'  took  as  the  basis  of  their  reasoning" 
what  is  supposed  to  be  of  such  very  recent  origin.  And  the  Author  of 
these  Institutes,  unwilling  to  be  excluded,  may  be  permitted  lo  assure 
these  reformers  that  throughout  the  work  he  has  "  taken  as  the  basis 
of  his  reasoning  the  curative  resources  of  Nature  herself,  as  ascertained 
by  study  of  the  natural  course  of  disease."  It  is  the  absolute  foundation 
of  all  his  Therapeutics,  and  the  foi'egoing  mottoes  were  employed  to  in- 
dicate the  fact.  But  these  reformers  have,  also,  nearly  as  large  a  reli- 
ance upon  Nature  as  the  homoeopath,  Avith  much  less  regard  for  the 
noble  science,  and  appear  to  be  of  Magendie's  opinion  that  "the  nurse 
can  prescribe  equally  well"'  (§  744) ;  and  perhaps  this  may  be  what  is 
intended  by  claiming  for  the  honor  of  the  present  age  the  discovery  of 
the  175  medicatrix  natwce.  In  that  aspect  of  the  subject  the  Author  of 
these  Institutes  does  not  sympathize  (excepting  as  it  respects  a  few  "  self- 
limited"  diseases,  and  multitudinous  cases  in  which  there  is  no  pi'ofound 
derangement,  results  of  mechanical  injuries,  «fcc.),  although  he  endeavors 
to  expose  the  errors  of  excessive  medication,  and  agrees  with  the  abo7'- 
tive  disciples  of  Nature  that  wherever  this  practice  obtains  (as  it  does 
with  the  mass  of  the  profession)  the  whole  work  of  cure  is  supposed  to 
devolve  upon  art;  and  this,  he  maintains,  is  the  inevitable  effect  of  the 
chemical  and  Immoral  doctrines. 


PREFACE    TO    THE    SIXTH    EDITIOIS".  XI 

Nature,  in  the  foregoing  sense,  is  nothing  but  a  system  of  laws, 
a  proper  conformity  with  which  is  as  much  at  the  foundation  of 
therapeutics  as  of  hygiene.  The  physician,  tlierefore,  should  be 
alone  employed  in  applying  to  his  use  the  laws  by  which  organic 
beings  are  governed.  A  A'ital  principle,  or  vital  force  (as  may  be 
preferred),  in  connection  with  organic  structure,  forms  the  basis  of 
those  laws. 

Such  i§  a  glance  at  some  of  the  objects  of  this  work,  and  to  which  the 
Author  invites  especially  the  impartial  attention  of  the  young  student  of 
medicine,  and  with  the  assurance  that  he  will  meet  with  no  timid  or  un- 
fair concealment  of  doctrines  that  ai-e  opposed  to  those  of  the  Institutes. 

There  remains  to  be  noticed  what  may  seem  to  be  an  isolated  subject, 
but  which  is  essentially  relative  to  physiology — the  essay  upon  the  Soul 
and  Instinctive  Principle  (incorporated  in  the  Appendix),  in  which  the 
Author  endeavors  to  demonstrate  the  substantive  existence  and  self-act- 
ing nature  of  the  Soul  and  Instinct  upon  strictly  physiological  principles. 
If  this  have  been  accomplished  by  the  Author,  who  believes  the  demon- 
stration to  be  conclusive,  then  is  there  an  end  to  materialism  ;  and  even 
he  who  doubts  not  the  probabilities  of  the  metaphysical  inductions,  or 
relies  with  greater  confidence  upon  Revelation,  must  realize  a  new  sat- 
isfaction in  that  tangible  proof  which  no  ingenuity  can  invalidate,  no 
misrepresentation  pervert,  and  no  sophistry  evade. 

As  to  the  Author's  reference  to  his  essay  upon  "  Theoretical  Geology" 
(p.  908,  927),  it  will  be  seen  that  the  work  embraces  many  facts  that  are 
allied  to  organic  philosophy ;  but  it  is  now  his  object  to  state  that  the 
discussion  proceeds  upon  recognized  grounds  in  natural  philosophy,  chem- 
istry, geology,  &c.,  and  without  departing  from  the  rules  j)rescribed  by 
"  positive  science ;"  and  as  the  Author's  aim  is  simply  the  development 
of  truth,  he  entertains  the  hope  that  the  essay  may  be  scrutinized  accord- 
ing to  its  supposed  philosophical  premises.  The  issue  must  ultimately 
turn  upon  this  mode  of  investigation,  not  upon  the  usual  ground  of  geo- 
logical hypotheses,  which,  indeed,  are  the  veiy  things  in  question.  It 
must  be  decided  in  tTie  open  field  of  those  various  sciences  which  consti- 
tute the  physiology  of  Nature ;  since  the  near  aflSnities  among  the  facts 
in  geology  constantly  bring  them  under  the  collective  interpretation  of 
the  different  departments  of  knowledge,  and  no  one  who  has  not  direct- 
ed his  attention  to  the  whole  circle  of  the  sciences  is  qualified  to  grapple 
with  the  subject. 

New  York,  September,  1860. 


PEEFACE  TO  THE  EIGHTH  EDITION. 

A  SEVENTH  edition  of  this  work  was  published  in  1861,  which,  as 
stated  in  a  Preface,  "  is  distinguished  from  the  preceding  editions  by 
the  addition  of  several  brief  foot-notes  and  some  other  improve- 
ments." In  1862  appeared  another  edition,  but  under  the  designa- 
tion of  the  seventh  edition,  though  distinguished  from  that  by  the 
addition  of  twenty  pages  of  Notes  appended  at  the  end  of  the  Sec- 
ond  Index^  and  by  frequent  references  to  them  in  the  text,  and  also 
by  the  addition  of  several  brief  foot-notes,  and  by  many  references 
to  sections  throughout  the  work.  Doubtless  it  had  been  better  to 
have  entitled  that  edition  the  eighth. 

The  present  edition  is  distinguished  from  the  last  particularly  by 
an  extension  of  the  Notes  at  the  end  of  the  Second  Index,  and  by 
numerous  references  to  them  in  the  text.  Several  of  the  former 
Prefaces  are  reproduced  as  memoranda  of  the  progressive  condition 
of  the  work.  In  the  Preface  to  the  seventh  edition,  which  is  now 
omitted,  there  occurs  the  following  explanatory  statement:  "The 
fiuthor  embraces  this  opportunity  to  say  (what  may  not  be  obvious 
to  all)  that  the  fractions  which  appear  in  many  of  the  numerical  des- 
ignations of  the  sections,  as  §  303^  «,  are  intended  for  sections  that 
were  made  after  the  original  completion  of  the  manuscript,  by  which 
the  labor  of  a  revision  of  the  entire  work  was  saved.  The  addition 
of  letters  to  a  series  of  figures  of  the  same  denomination  indicates 
distinct  sections,  but  that  they  are  either  closely  allied,  or  are  intend- 
ed as  substitutes  for  fractional  parts." 

New  York,  1865. 


PEEFACE  TO  THE  NINTH  EDITION 

An  Eighth  Edition  Revised  of  this  Avork  was  published  in  1867 
and  1868,  in  which  improvements  were  introduced.  The  present 
or  Ninth  Edition  has  also  been  carefully  revised,  and,  although  the 
text  has  been  in  no  essential  respect  altered,  some  notes  have  been 
added. 

The  Author,  in  concluding  this  brief  Preface,  thinks  it  but  just 
to  himself  to  say  that  during  the  fifty-four  years  of  his  professional 
life  he  has  at  no  time  intermitted  his  professional  labors,  either  sci- 
entific or  practical,  and  that,  therefore,  he  does  not  offer  this  new 
edition  of  his  work  in  ignorance  of  the  latest  contributions  to  med- 
icine, or  when  it  might  be  supposed  that  his  interest  in  the  great 
subject  Avas  not  as  ardent  as  ever. 
New  York,  1870. 


TABLE  OF  CONTENTS. 


PRELIMINARY  REMARKS 

PHYSIOLOGY 

Composition 

Structure     

Vital    Principle    and    its 

Properties       .     .     .     . 

Vital  Principle      .... 

Irritability 

Scjisibility 

Mobility 

Vital  Affinity 

Vivification 

Nervous  Power     .... 
General  Remarks  upon  the 

Philosophy  of  Life  . 
The  Mind  and  Instinct,  and 

their  Properties 
Functions,  Co.mmon 

Motion 

Absorption 

Assimilation 

Distributio7i 

Appropriation 

Excretion 

Calorification 

Gcjieration 

Functions,  Peculiar  .     .     . 

Sensation 

Sympathy 

Its  general  relations  to 

the  nervous  system    . 

Experiments  illustrative 

of 

Varieties  or  kinds  of.     . 
Laws  of,  applied  patho- 
logically and  therapeu- 
tically .  .... 
In  its  relation  to  special 
tissues  and  organs 
Relative  to  the  Mental  Prin- 
ciple and  Instinct   . 

Vital  Habit 

Age 

Infancy  

Childhood 

Youth 

Manhood 

Old  Age 

Temperament,  Constitu- 
tion, Idiosyncrasy  . 
The  Sanguine  . 
The  Melancholic 
The  Choleric  . 
The  Phlegmatic 
The  Nervous    . 


1-15 

15^12 

23-49 

50-73 

73-125 

73-89 

89-100 

100-103 

103, 104 

105 

105 

106-111 

111-122 

122-125 
125-280 
126-128 
128-134 
134 
207-217 
217-227 
227-234 
234-279 
279, 280 
280-362 
280-283 
283-362 

284-295 

295-321 
321-335 


335-353 

353-362 

382 
363-372 
373-383 
373-375 
375,  376 
376-380 
380,381 
382, 383 

383-391 

386,  387 
387-389 

389 
389, 390 

390 


Physiology — continued. 

Races  of  Mankind  ....  391-393 

Sex 393,394 

Climate     394-396 

Habits  AND  Usages      .     .     .  396,397 
Relations   of  Organic  Be- 
ings  to   External   Ob- 
jects    398-400 

Death 401-404 

Summary  Conclusion  in 
Physiology,  or  its  Uni- 
ty OF  Design  ....  405-412 

PATHOLOGY 413-540 

Remote  Causes       ....  414-427 
Pathological  or  Proximate 

Cause 427-434 

Symptoms  134-455 

The  Pulse ,  443^48 

The  Tongue 448^50 

Secretions  and  Excretions   .  450-455 
Morbid  Anatomy    ....  456-463 

Inflammation 464-489 

Description  of 464-480 

Remote  Causes  of  .  .  .  480, 48 1 
Pathological  Cause  of  .  .  482-489 
Active  and  Passive    .     .     .  486-489 

Fever 489-499 

Description  of 489-497 

Remote  Causes  of      .     .     .  497-498 

Pathological  Cause  of    .     .  498-499 

Venous  Congestion     .     .     .  500-513 

Humoralism 514-540 

THERAPEUTICS     ....  541-777 
General  Consideration  of     541-563 

Cathartics 563-570 

Astringents 570-578 

Tonics  and  Diffusible  Stim- 
ulants    583-590 

Antispasmodics 590-593 

Cinchona,  and  its  Alka- 
loids    593-607 

Arsenic 607-612 

Iodine  612-620 

Ergot 620-628 

Emmenagogues 628,  629 

Diuretics 630-633 

Expectorants    633-642 

Counter-irritants      .     .     .  642-660 
Remedial  Action,  its  Gen- 
eral Philosophy  .     .     .   661-689 
The  Seton    ......  679-681 

Local      Sedatives,       Warm 

Poultices,  <^c 681-683 

Genito-urinary  Agents  .  .  683-689 
Uterine  Agents     ....   683-C8i) 


Tlierapeulics — continued. 

Bloodletting     690-777 

Leeching 692-698 

General  BloodleUins-  ■     .     ■  698-702 


TABLE    OF   CONTENTS. 

P.ige 


Therapeutics — continued. 
Bloodletting — continued. 

Simple    Intermittent    Fe- 
ver         736-739 

Cuvving 702-703  |  In  the  Cpld  Stage  of  Fever    739-741 

The  Nervous  Power  in  its  In  Apoplectic  Affections  .     .  741-747 

Relation  to  the  Effects  of  I  Expericjice  and  Opinions  of 

distinguished   Physiciayis 
as  to  Bloodletting  in  In- 
flammatory,   Congestive, 
and  Febrile  Diseases  .     .  747-766 
In  the  Diseases  of  Infancy 

and  Old  Age  ....  768-770 
Spontaneous  Hemorrhage  .  770-772 
Misapplied  and  Excessive  .  772-776 
General  Conclusions  as  to  .  IIQ-ITI 


Loss  of  Blood    ....  703-711 

General  and  Practical  Obser- 
vations upon      ....  711-777 

General  Extent  of  Bloodlet- 
ting        711-724 

In  Congestive  Fevers     .     .  724-732 

7?*  the  recognized  Forms  of 

Iiiflammation     ....  732-736 

In   Simple    Continued    and 


CONTENTS  OF  APPENDIX. 

Progress  of  Physiological  and  Pathological  Chemistry      ....  779-802 

Production  of  AnIiMal  Sugar 783-794 

Progress  of  Physiology 801-816 

Structure  of  Organs 801-803 

Of  the  Spinal  Cord 802-803 

The  Nervous  Power  and  Organic  Properties 803-806 

Animal  Heat  in  its  connexion  with  the  Nervous  System 807-812 

The  Primordial  Cell 812-814 

The  Boundary-line  between  Animals  and  Plants 815 

Hybrid  Animals 816 

Absorption  and  Circulation  in  Plants 817-824 

Experiments  to  ascertain  whether  the  quantity  of  Blood  circulat- 
ing IN  the  Brain  may  be  reduced  artificially 824-828 

Sedatives — a  farther  exposition  of  their  uses  and  of  the  philosophy  relative 

to  their  effects 828-835 

Alteratives — their  uses  and  mode  of  action  considered  practically,  &c.     .  835-851 

Jalap,  p.  851-853 — Saline  Cathartics,  p.  853-854 — Rhubarb,  Scammony, 
Aloes,  Colocynth,  Senna,  Colchicum,  p.  855-862. 

Of  the  action   of  Chloroform    and  analogous  agents  in  producing 

Insensibility  when  inhaled 862-864 

Oi''  the  Influence  of  the  Mind  upon  the  Action  of  Remedial  Agents  865-868 

Have  Diseases  undergone  Changes   of  Type  within  the  last  forty 

Years,  or  have  new  ones  appeared  1 868-872 

Physiology  of  the  Soul  and  Instinct,  or  Demonstration  of  their 

substantive  existence  and  self-acting  nature 873-911 

Rights  of  Authors    912-920 


SUPPLEMENT. 

Correlation  of  Forces. — The  Glycogenic  Function  of  the  Liver. — The  Cause 
of  the  Blood's  Fluidity. — Modus  Operandi  of  Remedies. — Absorption  by  the 
Skin. — Transfusion  of  Remedies. — Intestinal  Absorption  and  Lacteal  Circula- 
tion.— The  Forces  which  circulate  the  Blood 921 

Indexes 935 

Notes 1111 


INSTITUTES    OF   MEDICINE. 


PRELIMINARY  REMARKS. 

"  Until  it  is  proved  that  the  forces  which,  in  a  living  body,  interrupt  the  play  of  the  natu- 
ral chemical  affinities,  maintain  a  proper  temperature,  and  preside  over  the  various  actions 
of  organic  and  animal  life,  are  analogous  to  those  admitted  by  natural  philosophy,  we 
shall  act  consistently  with  the  principles  of  that  science,  by  giving  distinct  names  to 
THESE  TWO  KINDS  OF  FORCES,* and  employing  ourselves  in  calculating  the  different 
LAWS  they  OBEr." — Andral's  Pathological  Anatomy.  See,  also,  Medical  and  Physio- 
logical Commentaries,  vol.  i.,  p.  626-632. 

"  Our  notion  of  life  involves  something  more  than  mere  reproduction,  namely,  the  idea 
of  an  ACTIVE  POWER,  exercised  by  virtue  of  a  definite  foiTn,  and  production  and  genera- 
tion in  a  definite  form.  The  production  of  organs,  the  co-operation  of  a  system  of  organs, 
and  their  power  not  only  to  produce  their  component  parts  from  the  food  presented  to 
them,  but  to  generate  themselves  in  their  original  fonn  and  with  their  properties,  are 
characters  belonging  exclusively  to  organic  life,  and  constitute  a  form  of  reproduction  in- 
dependent OF  CHEMICAL  POWERS.  This  VITAL  PRINCIPLE  Is  Only  known  to  us  through 
the  peculiar  form  of  its  instroments  ;  that  is,  through  the  organs  in  which  it  resides.  Its 
LAW'S  must  be  investigated  just  as  we  investigate  those  of  the  other  powers  which 
EFFECT  MOTION  AND  CHANGES  IN  MATTER." — Liebig's  Organic  Chemistry  applied  to 
Physiology,  p.  355. 

"Simple  views,  whether  of  health  or  disease,  however  ingenious,  can  seldom  be  just. 
They  have  their  origin  in  the  spirit  of  system,  not  in  the  careful  study  and  faithful  ena- 
meration  of  the  complicated  circumstances  which  concur  in  the  production  of  all  vital  phe- 
nomena."— Thompson,  on  Infiamination. 

1,  a.  SoLiDisM  and  vitalism  will  form  the  basis  of  these  Institutes. 
If  consistent  in  all  their  parts,  without  a  violation  of  facts,  it  is,  frima 
facie,  a  proof  of  their  foundation  in  Nature.  To  show  this  consist- 
ency, and  to  develop  the  great  principles  and  laws  of  organic  beings, 
and  erect  a  substantial  fabric  of  Institutes  which  shall  guide  the  hand 
of  art,  we  must  ascend,  progressively,  along  the  fundamental  facts  in 
physiology,  pathology,  and  therapeutics ;  till,  at  last,  we  proceed  to 
convert  the  great  system  to  practical  uses,  in  the  preservation  of 
health,  and  a  just,  intelligible,  and  philosophical  application  of  the 
materia  medica  to  morbid  states  of  the  body. 

To  render  this  work,  therefore,  most  practical,  and  to  simplify  as 
far  as  possible  the  highest  department  of  knowledge,  I  shall  adopt  an 
analytical  method.  I  have  also  endeavored  to  arrange  the  various 
topics  in  their  most  natural  order,  or  as  each  successive  one  may  ap- 
pear to  emanate  from,  or  to  depend  upon,  the  preceding.  The  stu- 
dent, therefore,  to  understand  the  last,  must  comprehend  all  the  pre- 
ceding, and  so  of  each  in  succession.  We  have  thus  a  connected  link 
throughout;  a  difficult  achievement,  and  the  more  difficult  as  it  is  the 
first  effort  that  has  been  made  to  present  the  natural  relations  of  my 
.  whole  subject  in  their  just  order,  to  point  out  the  affinities,  and  to  ex- 
hibit throughout  the  important  laws  and  essential  foundations  of  vital- 
ism and  solidism,  and  to  maintain  throughout  a  consistency  of  facts 
and  of  laws  that  shall  stamp  the  whole  as  the  PJiilosopJiy  of  Medicine. 

In  making  this  claim  for  the  Institutes,  I  am  prepared,  as  in  the 

case  of  the  Commentaries,  to  invite  the  most  rigid  scrutiny.*  If  there 

be  any  where  a  collision  in  principles  or  iacts,  or  any  contradictions 

of  myself,  let  them  be  pointed  out.     My  aim  is  truth,  and  I  desire 

*  Medical  and  Physiological  Commentaries,  New  York,  1840. 

A 


3  INSTITL'TE.S    OF    MEDICINE. 

nothing  for  myself  Avliich  I  do  not  yield  to  others.  If  there  be  minor 
imperfections  I  would  gladly  know  them.  Many  of  the  original  doc- 
trines which  appear  in  this  work  are  presented  in  various  connections 
in  the  ISIedical  and  Physiological  Commentaries.  The  spirit  of  the 
Commentaries  will  pen'ade  the  Institutes,  as  being,  in  my  judgment, 
the  only  stable  foundation.* 

1,  b.  In  the  farther  prosecution  of  this  work  it  will  still  be  my 
object  to  speak  of  such  errors  as  have  usurped  the  rights  or  blighted 
the  interests  of  rational  medicine.  It  is  not  now  the  time  for  a  simple 
expression  of  facts,  of  experience,  and  of  philosophical  doctrines. 
The  errors  which  surround,  them  must  be  also  exposed  and  refuted,  or 
the  foe  of  truth,  or  the  ambitious  aspirant,  or  the  lover  of  indolence, 
will  gain  something  from  an  indulgence  which  they  know  how  to  seek 
and  appi'opriate.  Nor  is  any  one  more  aware  of  the  tendencies  of 
free  discussion  or  unsparing  of  physiologists  than  he  who  has  been 
most  successful  in  the  propagation  of  error,  or  who  would  sooner  stifle 
inquiry  into  factitious  systems.     Thus,  it  is  said  by  Liebig,  that 

"  It  is  too  frequently  forgotten  by  physiologists  that  their  duty 
really  is,  not  to  refute  the  experiments  of  others,  nor  to  show  that  they 
arc  erroneous,  but  to  discover  tnith,  and  that  alone." — Lieeig's  Organic 
Chemistry  applied  to  Physiology,  Sfc. 

Now  this  obvious  sophistry  betrays  its  motive,  since  it  is  utterly  at 
variance  with  the  habits  of  him  who  would  enjoin  the  fiction  upon 
others.  Truth  should  be,  indeed,  the  ultimate  object  of  pursuit ;  but 
the  first  and  most  important  step  toward  its  attainment  is  the  removal 
of  obstacles  that  may  lie  in  its  way  (§  820).  It  is  allowed,  indeed, 
by  one  of  Liebig's  most  zealous  advocates,  the  editor  of  the  London 
Lancet,  that  "  the  removal  of  error  claims  a  place  next  to  the  establish- 
ment of  truth"  (Dec,  1S44);  and  it  has  grown  into  a  proverb,  that  "  it 
is  more  difficult  to  subdue  a  prejudice  than  to  build  a  pyramid." 

Although,  therefore,  the  contemplated  method  must  be  sometimes 
arorumentative  and  controversial,  it  has  the  advantage  of  leading  more 
immediately  to  a  knowledge  of  the  truth  upon  disputed  questions, 
than  any  other  which  is  not  demonstrative.  There  can  be  no  doubt, 
indeed,  that  the  "establishment  of  truth"  in  medical  philosophy  can 
be  effected  only  by  a  simultaneous  refutation  of  the  errors  which  sur- 
round it.  The  mind  will  not  surrender  a  favorite  doctrine,  however 
false,  to  the  force  of  truth  alone.  Even  its  practical  disasters,  as  we 
every  where  witness,  are  an  inadequate  demonstration.  But,  when 
error  and  truth  are  presented  in  forcible  contrast,  it  is  the  pride  of 
reason  to  embrace  the  latter.  AVhat  is  also  important,  the  reader 
will  have  been  presented,  as  in  the  Commentaries,  with  the  great 
rival  doctrines  in  medicine,  and  in  their  proper  relations  to  each 
other  (§  3501). 

2,  a.  The  Institutes  of  Medicine  are  natural  inductions  of  principles 
and  laws  from  the  healthy  and  morbid  phenomena  of  living  beings. 
They  relate  to  Physioloory,  Patholog}',  and  Therapeutics,  and  to  noth- 
ing else.  All  other  systems,  therefore,  must  be  spurious.  The  sub- 
stitutes have  no  depth,  no  principle,  no  laws,  and  are  recommended 
alone  by  their  naked  simplicity.  "Gentlemen,"  says  Bacon,  "nature 
is  a  labyrinth,  in  which  tlie  very  haste  with  which  you  move  will  make 
you  lose  your  way." 

2,  h.  The  immediate  objects  of  physiology  are  a  critical  analysis  of 

*  Tbe  autlior  has  seen  no  reason  to  modifj-  this  statement,  made  more  than  twenty 
A-ears  ago — 1870. 


PBELLMINAKY    REMARKS.  3 

the  vital  conditions  and  results  of  organic  beings,  as  manifested  in 
different  organs,  and  in  tbeir  relations  to  each  other.  It  contemplates 
organic  nature,  therefore,  in  its  natural  state ;  and  the  laws  which 
it  obeys  are  its  highest  end.  Patholog^y  is  to  the  physician  the  oreat 
final  object  of  physiology.  It  investigates  the  causes  which  disturb  the 
physiological  conditions,  and  inquires  into  the  phenomena,  and  the 
nature  of  the  vital  and  structural  changes.  These,  in  connection, 
form  the  ground-work  of  Therapeutics,  which  considers  the  indica- 
tions to  be  fulfilled,  and  the  means  and  the  manner  by  which  they 
are  to  be  accomplished,  and  nature  thus  aided  in  the  process  of  cure. 
The  Materia  Medica  comes  last,  and  is  the  subordinate  object  of  all 
the  rest.  It  investigates  the  composition  and  physical  character  of  the 
material  objects  by  which  the  therapeutical  intentions  are  fulfilled,  and 
interrogates  especially  their  relations,  as  vital  and  alterative  agents, 
to  pathological  conditions.  Disease,  being  a  modification  of  the  phys- 
iological or  natural  condition,  produces  new  relations  between  the 
properties  of  life  and  the  natural,  morbific,  and  remedial  agents;  and 
these  are  ascertained  by  observation  of  their  effects  upon  morbid 
states  alone.  It  is  thus  that  remedies  become  beneficial  when  thev 
would  be  morbific  in  health;  and  what  is  salubrious  in  health  is  ren- 
dered morbific  by  diseased  conditions.  The  principle  is  in  beautiful 
harmony  %vith  the  instability  of  the  vital  properties  ;  and  the  final 
cause  of  this  instability  is  the  preservation  of  organic  being  (^  133,  c, 
153-156,  63S). 

2,  c.  Nevertheless,  each  of  the  four  great  departments  of  medicine 
possesses  so  many  peculiar  characters  that  they  may  be  severally  con- 
sidered as  constituting,  to  a  large  extent,  distinct  parts  of  one  great 
symmetrical  whole  (^  83,  c).  Pathological  conditions  could  never  have 
been  inferred,  a  priori^  from  any  extent  of  physiological  inquiries, 
nor  could  the  effects  of  therapeutical  agents,  or  the  natural  termina- 
tion of  disease  in  health  or  in  death,  from  any  knowledge  of  anatomy, 
physiology,  or  pathology.  The  whole  is  originally  the  Avork  of  ob- 
servation ;  and  we  come  to  learn  the  relations  of  the  four  great 
branches  of  medicine  by  comparing  the  phenomena  which  are  pre- 
sented under  the  various  conditions  of  health  and  disease,  and  as 
these  phenomena  may  be  affected  by  artificial  influences. 

Anatomy,  however,  affords  no  such  standard  of  comparison.  And 
yet  it  is  obvious,  as  will  more  distinctly  appear  hereafter  (§  83-163), 
that  anatomy  is  the  basis  of  medicine.  It  is,  however,  of  the  svstem 
of  organic  life  that  I  mainly  speak.  All,  at  least,  that  is  superficial 
in  animal  life,  the  voluntary-  muscles,  &c.,  abstracted  from  their  rela- 
tions to  the  organic  condition,  belongs  to  the  domain  of  surgerv,  and 
is,  therefore,  of  little  importance  to  the  physician. 

2,  d.  XotAvithstanding,  therefore,  the  foregoing  qualifications,  it 
Avill  be  seen,  in  our  inquiries  into  the  great  fundamental  points,  that 
the  science  of  medicine  is,  throughout,  a  perfectly  connected  chain ; 
beginning  with  the  laws  which  govern  the  modes  in  which  the  ele- 
ments of  matter  are  combined  in  org^anic  beingfs, — advancingr  to  the 
union  of  organic  compounds  mto  cells  and  tissues, — to  the  laws  which 
respect  the  various  processes  which  are  conducted  by  these  tissues, 
and  by  the  organs  into  which  they  are  combined, — to  those  laws  as 
affected  by  the  contingencies  of  disease, — and,  lastly,  to  the  laws 
which  regulate  the  changes  through  which  the  morbid  statPK  return  tc 


4  INSTITUTES    OF    MEDICINE. 

the  natural  conditions  of  life.  All  are  connected  together  by  intimate 
dependencies,  and  are  determined  by  the  natural  or  by  the  varying 
states  of  the  vital  properties  in  their  operation  through  material  parts. 
The  ground-work  of  the  whole  is,  evidently,  perfectly  simple ;  since 
the  laws  by  which  the  whole  is  regulated  are  established  upon  the 
constitution  of  the  organic  properties  (§  169,^  638). 

2,  e.  To  the  eye  of  the  philosopher,  therefore.  Nature,  in  her  or- 
ganic department,  as  in  every  other,  appears  in  an  aspect  of  astonish- 
ing simplicity,  when  he  contrasts  her  forces  and  laws  with  the  diver 
sity  of  their  phenomena;  nor  does  he  confound  the  principles  and 
laws  which  distinguish  the  different  departments  of  nature.  To  every 
other  eye  the  phenomena  of  life  appear  confused,  and  seem  referable 
to  no  common  powers  or  laws.  But  he  who  has  obtained  the  key 
to  the  true  philosophy  of  life,  by  a  wide  observation  of  nature,  lays 
open  at  once  the  apparent  secrets  of  all  its  results,  whether  in  health 
or  disease.  Whatever  he  sees  has  its  individuality,  and  stands  in  re- 
lief from  all  the  rest.  He  knows  at  a  glance  from  whelice  this  or  that 
springs,  how  it  is  related  to  others,  and  he  traces  the  whole  directly  up 
to  a  few  simple  principles.  To  all  but  such  an  eye,  however,  the 
phenomena  of  life,  and  more  especially  of  life  diseased,  appear  as 
does  a  field  to  all  but  the  botanist.  The  common  observer  sees  nothing 
but  a  confused  assemblage  of  grasses,  and  probably  will  tell  you  there 
is  but  one  species  where  the  botanist  will  as  instantly  discover  fifty. 
Each  species  has  to  the  latter  a  distinct  individuality,  and  he  cannot 
regard  them  in  that  state  of  confusion  which  is  seen  by  the  ignorant. 
He  has  studied  each  plant,  knows  its  specific  characters,  its  relations 
to  others,  its  habits,  &c.  By  these  modes  of  observation  he  has  also 
acquired  the  knowledge  that  nature  has  pursued  a  common  plan  of 
organization,  and  linked  the  whole,  by  close  analogies,  throughout  the 
vegetable  kingdom.  Were  the  botanist,  therefore,  to  range  simulta- 
neously among  the  100,000  species  of  plants,  he  would  see  nothing 
but  individuality,  and  the  greatest  simplicity  in  the  principles  upon 
which  the  whole  are  constituted.  And  just  so  it  is  with  a  philosophi- 
cal observation  of  the  healthy  and  morbid  phenomena  of  the  animal 
kingdom. 

3,  The  organic  and  inorganic  kingdoms  have,  respectively,  their 
peculiar  properties  and  laws.  Such  as  appertain  to  life,  in  its  nat- 
ural, as  well  as  morbid  aspects,  are  denoted  by  an  incomparably 
greater  variety  of  phenomena  than  those  of  the  external  world  ;  and 
as  their  only  intelligible  foundation  is  the  phenomena  evinced,  we 
attain  our  knowledge  of  either  according  to  the  extent  and  variety  of 
the  phenomena.     We  know  nothing  more  of  matter  itself. 

Without  a  comprehensive  knowledge  of  the  properties  and  func- 
tions of  living  beings,  and  especially  of  the  laws  by  which  they  are 
governed  in  their  healthy  and  morbid  states,  the  practice  of  medicine 
is  mere  empyricism.  The  ignorant,  alone,  undei-value  causes  and 
piinciples,  and  depend  upon  unconnected  facts. 

4,  a.  In  medicine,  therefore,  we  must  concern  ourselves  with  some- 
thing besides  effects.  We  must  understand  the  laws  under  which 
they  take  place,  and,  as  far  as  possible,  trace  up  the  effects  to  the  pri- 
mary causes.  This  is  always  done  in  other  sciences  and  in  the  arts. 
Why,  then,  should  it  be  neglected  in  that  science  whose  practical  ap- 
plication relates  to  the  highest  welfare  of  man? 


PRELIMINARY    REMARKS.  5 

The  human  mind  will  have  its  theories  upon  all  subjects ;  and  cho 
whole  history  of  medicine  is  a  perpetual  exemplification  that  in  no 
inquiries  do  theory  and  hypothesis  abound  so  universally  as  in  the 
healing  art  (§  819,  960).  This  arises,  m  part,  from  the  intricacies  of 
the  subject,  but  mostly  so  from  the  constitution  of  the  mind  itself. 
The  Almighty  designed  it  for  theoretical  conclusions,  and  set  us  the 
example  in  those  stupendous  theories  upon  which  the  universe,  and 
all  it  contains,  are  founded.  And  what  else  are,  or  should  be,  our 
inquiries  and  our  theories,  than  finding  out  and  adopting  those  of 
which  He  is  the  author  ]  What  other  theory  in  the  natural  world 
can  there  be  than  such  as  are  instituted  by  the  Almighty  Being? 
And  shall  we  hesitate  to  embrace,  and  to  act  upon  such  theories'? 
And  yet  it  is  one  of  the  pretended  improvements  of  the  day  to  insist 
upon  nothing  but  facts,  and  to  denounce  all  principles  in  medicine  ;  as 
if  the  Almighty  had  not  ordained  principles  and  laws  as  well  as  facts, 
which  are  mere  emanations  from  the  former. 

4,  h.  The  ignorant  pretender  will  tell  us  that  all  this  is  unimport- 
ant ;  though  no  one  is  so  much  directed  by  hypothesis,  or  theory,  as 
this  very  pretender  himself  (§  884).  Does  not  every  empiric  in  the 
land  prescribe  his  drastic  cathartics  for  the  purpose  of  cleansing  the 
blood  of  its  supposed  impurities  %  Are  they  not  exactly  on  a  par,  in 
their  doctrines,  and  in  their  practice,  with  the  most  speculative  of  our 
enlightened  humoralists  %  Nay,  have  the  ignorant  portion  of  that 
sect,  our  Brandreths,  our  Morrisons,  et  id  oinne  genus,  any  reference 
v^rhatever  to  facts  or  experience  %  Is  it  not  all  hypothesis,  and,  there- 
fore, all  a  reckless  waste  of  human  life  \  Mount  up  the  scale,  and 
you  shall  find  at  every  step  of  your  ascent,  from  him  who  prowls  about 
the  outskirts  of  the  profession,  to  him  who  directs  the  all-potent  drug 
with  the  most  consummate  skill,  that  each  and  all  rely  mainly  upon 
their  conceptions  of  the  philosophy  of  disease.  But  you  shall  also 
find,  that  in  proportion  as  Nature  has  been  taken  for  their  guide,  and 
as  medical  principles  are  founded  upon  the  absolute  phenomena  of 
life,  in  their  healthy  and  morbid  aspects,  there  will  always  be  the 
greatest  reference  to  facts  and  experience. 

Hence,  again,  the  importance  of  looking  Avell  to  our  theories,  and 
of  seeing  that  they  are  established  on  well-grounded  facts,  or  on  the 
analogy  to  which  they  conduct  us.  Could  we,  as  we  cannot,  direct 
the  treatment  of  disease  without  principles,  we  never  should ;  and  it 
should  therefore  be  the  business  of  the  practitioner  to  enlighten  his 
mind  upon  the  philosophy  of  medicine,  or  his  unavoidable  disposition 
to  theorize  may  prove  a  scourge  to  mankind.  Of  this,  indeed,  the 
records  of  medicine  abound  with  examples  (§  801,  h,  819,  &c.,  960, 
1005,  1068).— Notes  F  p.  1114,  Ee  p.  1133,  Ff  p.  1135,  Gg  p.  1138. 

It  will  therefore  be  my  agreeable  task  to  expose,  in  these  Insti- 
tutes, the  fallacies  of  the  prevailing  physical  doctrines  of  life  and  dis- 
ease, as  well  as  to  inculcate  principles  which  exalt  our  science  above 
the  mere  world  of  matter,  render  it  consistent  in  all  its  details,  and 
present  it  to  the  profession  as  a  department  of  knowledge  fundament- 
ally distinct  from  all  other  pursuits. — See  Rights  &c.  p.  912. 

Differences  of  opinion  on  questions  of  great  moment  to  mankind 
are  apt  to  be  strongly  conveyed,  and  apparent  error  to  be  censured  in 
no  measured  terms.  This,  perhaps,  is  often  admissible,  considering 
the  obstinacy  of  error,  and  so  long  as  it  is  the  doctrine,  and  not  its  au- 


6  INSTITUTES    OF    MEDICINE. 

tiior,  which  is  assailed.  We  may  revere  the  names  of  Voltaire,  of 
Hume,  and  of  Gibbon,  yield  them  a  proud  rank  in  the  scale  of  intel- 
lect, and  gratefully  acknowledge  the  rich  legacies  they  have  left  be- 
hind. But,  who  of  us  would  hesitate  to  speak  of  their  infidelity  ac- 
cording to  its  nature  and  tendencies  1  This  is  even  demanded  by 
what  we  believe  of  the  jarecepts  of  religion.  And  so  of  the  principlen 
of  medicine,  which  hold  as  high  a  relation  to  the  temporal  interests  of 
man  as  do  the  precepts  of  religion  to  his  spiritual  welfare.  The  high- 
est order  of  intellect  is  often  devoted  to  the  dissemination  of  error, 
and  perhaps  more  frequently  in  religion  and  medicine  than  in  any 
other  of  the  great  interests  of  mankind.  This  must  be  fully  and  firm- 
ly met,  not  only  by  evidences  of  the  truth,  but  by  an  exposure  of  its 
perversions  and  cori'uptions. 

4^,  a.  The  physiological  world  has  been  lately  divided  into  three 
schools.  One  of  these  sects  virtually  regards  organic  nature  as  a  part 
only  of  inorganic,  endowed  with  the  same  properties  and  governed  by 
the  same  laws.  It  maintains,  in  short,  that  there  is  no  essential  dif- 
ference between  a  man  and  a  stone.  At  the  head  of  this  school  stands 
Liebig,  the  distinguished  and  able  chemist.  It  is  a  great  and  power- 
ful school,  but  is  falling,  daily,  beneath  the  weight  of  its  vast  ei'rors 
and  corruptions.     It  is  denominated  the  chemical  school  of  medicine. 

4|,  h.  Contrasted  with  this  is  the  school  of  vitalism,  which  regards 
organic  and  inorganic  nature  as  distinct  in  their  most  essential  attri- 
butes. It  supposes  that  each  department  is  governed  by  properties 
and  laws  peculiar  to  itself.  It  regards  the  organic  being  as  funda- 
mentally distinct  from  the  inorganic  in  its  elementary  constitution,  in 
the  aggregation  of  its  molecules,  in  the  structure  of  its  parts,  in  its 
condition  as  a  whole,  and  in  every  phenomenon  which  it  evinces.  It 
sees  design  in  every  part  of  the  living  being — eloquent  even  in  the 
dry  bones  of  a  skeleton ;  a  design  peculiar  to  every  part,  while  all 
concur  together  to  the  common  ends  of  the  more  universal  designs  of 
procuring  the  means  of  sustenance,  of  maintaining  life,  of  perpetua- 
ting the  species,  &c.  On  the  other  hand,  this  school  discerns  no  cor- 
responding design  in  the  constitution,  or  in  the  condition  of  inor- 
ganic matter.  It  sees  nothing  here  but  mere  vis  inertice,  which, 
however,  is  supposed  by  the  chemical  school  to  be  capable  of  evolv- 
ing from  simjjle  matter  every  variety  of  organization,  with  all  its  spe- 
cific designs,  even  instinct  and  reason,  while,  at  the  same  time,  we 
hear  from  the  depth  of  materialism  that  "  organic  nature  is  the  mys- 
tery of  mysteries" — the  Creator  being  the  only  "mystery"  about  it. 

Again,  the  vitalists,  in  consideration  of  the  facts  now  stated,  main- 
tain, in  the  language  of  Liebig,  the  gi-eat  head  of  the  school  of  mere 
physics,  "  the  existence  of  a  principle  distinct  from  all  other  powers 
of  nature,  namely,  a  vital  principle ;^^  which  organizes  and  governs 
all  living  beings,  and  which  is  the  fundamental  cause  of  all  their  phe- 
nomena in  health  and  disease.  I  say,  in  the  language  of  Liebig,  "a 
principle  distinct  from  all  other  powers  of  nature ;"  for  this  mere 
chemist,  in  his  conflicts  with  living  nature,  concedes  the  existence  of 
such  a  principle  as  at  the  foundation  of  all  vital  phenomena,  yet,  in 
the  same  general  manner,  and  on  all  specific  questions  where  he  had 
introduced  its  direct  and  exclusive  agency,  he  as  unequivocally  de- 
clares that  there  is  no  such  principle,  and  that  every  result  of  life  and 
disease,  even  thought  itself,  are  entirely  owing  to  chemical  agenciesi 


PRELIMINARY    REMARKS.  7 

His  whole  system,  as  set  forth  in  his  "  Organic  Chemistry  applied  to 
Physiology,"  and  in  his  "Animal  Chemistry"  as  applied  to  Pathol- 
ogy and  Therapeutics,  is  a  tissue  of  similar  contradictions,  and  of  the 
boldest  assumptions.  Yet,  with  deep  mortification  I  say  it,  he  has 
been  hailed  with  an  enthusiasm  before  unknown  in  the  annals  of  med- 
icine, as  the  only  true  expounder  of  physiology  and  of  medical  phi- 
losoph3^  The  world,  however,  is  fast  awaking  from  its  spell-bound 
delusion,  and  the  doctrines  of  this  "  reformer"  will  soon  be  mingled 
with  the  same  and  more  original  chimeras  which  did  their  part  in 
"the  dark  ages  of  science"  (§  350,  1029,  1030,  1034). 

41,  c.  Finally,  the  third  school,  or  that  of  chemico-vitalism,  en- 
deavors to  form,  as  it  were,  a  bond  of  union  between  the  schools  of 
pure  vitalism,  and  of  pure  chemistry ;  though  such  an  alliance  be  as 
unnatural  as  human  brains  in  a  block  of  granite.  The  chemico-phys- 
iologist  makes  a  compromise  with  philosoj^hy,  and  takes  for  his  rule 
"  in  medio  tutissivius  ihis.'"  It  is  as  regardless  as  the  school  of  pure 
chemistry  of  the  universal  consent  with  which  physiology  has  been 
hitherto  restricted  to  the  condition,  functions,  results,  and  laws  of  liv- 
ing beings,  and  chemistry  to  the  condition  and  laws  of  dead  matter. 
This  school,  therefore,  mingles  the  doctrines  of  vitalism  and  chemis- 
try ;  allotting  to  the  former  one  half  of  the  phenomena  of  life,  and  the 
other  half  to  the  latter.  This  is  the  school  to  which  the  young  student 
has  the  greatest  chance  of  becoming  the  victim;  for  it  is  apparently 
recommended  by  the  conciliatory  principle  which  I  have  stated  in  the 
form  of  its  motto,  and  by  many  of  the  most  distinguished  members 
of  our  profession. 

4^,  d.  I  have  said  that  it  is  a  remarkable  characteristic  of  the  medi- 
cal school  of  pure  chemistry,  that  its  doctrines  are  in  perfect  conflict 
with  each  other,  as  shown  in  a  work  (Liebig's  "Animal  Chemistry") 
which  is  assumed  as  the  basis  of  the  chemical  philosophy  of  life — as 
the  great  foundation  on  which  the  school  itself  has  been  erected. 
And  how  could  it  be  otherwise,  seeing  that  this  school,  and  this  writer, 
are  constantly  employed  about  two  subjects  which  have  no  affinities ; 
that  is  to  say,  the  philosophy  of  life  and  the  philosophy  of  chemistry? 
I  shall  think  it  of  sufficient  importance  to  substantiate  the  foregoing 
fact  by  many  proofs  in  the  course  of  this  work  ;  and,  as  an  example  of 
the  whole,  I  shall  adduce  the  contradictory  views  which  are  put  forth 
upon  the  most  important  principles  which  lie  at  the  foundation  of 
organic  life,  and  at  the  basis  of  medical  science.  On  the  very  subject 
of  a  vital  principle  itself  the  genius  of  the  school  is  as  flatly  contra- 
dictory as  on  the  most  unimportant  doctrine ;  for  at  one  moment  he 
avows  the  existence  of  such  a  principle  "  distinct  from  all  other  pow- 
ers of  nature,"  and  calls  it  "the  vital  principle,"  which,  he  says,  gov- 
erns all  the  processes  of  living  beings  (§  59,  60),  and  at  the  next  moment 
he  asserts  that,  "  in  the  animal  body  we  recognize,  as  the  ultimate 
CAUSE  OF  ALL  FORCE,  Only  ONE  CAUSE,  the  clicmical  action  which  the 
elements  of  the  food  and  the  oxygen  of  the  air  mutually  exercise  on 
each  other.  The  only  known  ultimate  cause  of  vital  force,  either  in 
animals  or  in  plants,  is  a  chemical  process T 

He  renders,  as  will  be  seen  by  ensuing  quotations  (§  350),  what  he 
assumes  as  an  original  fundamental  cause  of  life  the  indispensable 
source  of  another  cause,  which  he  avows  to  be  equally  original  and 
fimdamental ;  and  what  is  yet  more  indicative  of  the  chaotic  state  of 


INSTITUTES    OF    MEDICINE. 


the  chemical  speculations  relative  to  living  beings,  this  author  (as  I 
have  shown  in  the  Medical  and  Physiological  Commentaries  of  many 
others)  assumes,  at  one  time,  the  chemical  force  to  be  the  sole  cause 
of  all  vital  processes  and  results,  while,  at  another  time,  he  regards  the 
vital  principle  as  the  only  power  concerned  in  the  same  phenomena. 
It  will  be  gratifying  to  curiosity,  for  example,  to  observe  how  Liebig 
entangles  his  reader,  as  it  respects  the  physiology  of  digestion,  by 
making  that  process  to  depend  on  a  purely  chemical  action,  and  to 
evolve  that  vital  principle  which  he  as  unequivocally  declares  to  be 
the  only  power  concerned  in  chymification  (§  350,  nos.  3,  17,  51,  58). 

5.  Chemical  and  mechanical  philosophy,  as  we  have  already  seen, 
are  strangers  to  the  philosophy  of  medicine.  There  is  a  natural  con- 
flict between  the  subjects  of  each.  They  have  no  relationship,  no  sym- 
pathies, but  caiTy  on  a  pei-petual  hostility.  The  organic  being  is  for- 
ever converting  to  its  own  uses  the  inorganic,  and  changing  its  very 
nature  into  its  own.  The  inorganic  is  fruitless  in  resistance  and  in 
assault,  till  the  former  is  passive.  It  then  lays  waste  the  fabric  by 
which  it  had  been  wrought  into  a  great  system  of  designs,  and  de- 
gi'ades  the  whole  to  its  own  level.  Chemistry,  therefore,  begins  where 
physiology  ends ;  and  physiology  begins  with  organic  influences  upon 
the  elements  of  matter,  or  where  chemistry  leaves  off".  No  depart- 
ment of  medicine  has  any  thing  to  hope  from  chemistry  beyond  its 
power  of  analysis  (§  1029,  1030). 

And  yet  do  the  labors  of  chemists  aspire  at  a  substitution  of  the 
ever-fluctuating  principles  of  chemical  science  for  all  that  has  been 
hitherto  founded  upon  the  phenomena  of  life  and  disease.  Their  oft 
repeated  effort  to  carry  a  science  which  is  mainly  analytical  and  me- 
chanical into  that  which  is  eminently  intellectual  and  overflowing 
with  the  most  sublime  institutions,  and  distinguished  by  the  most  pro- 
found principles  and  laws  of  nature,  and  therefore  seductive  to  an  am- 
bition which  is  restif  under  the  practical  manipulations  of  the  labor- 
atory, would  raise  no  inquiry  as  to  motive,  or  end,  did  not  the  proper 
guardians  of  the  science  not  only  abandon  their  old  and  rich  dom.ain 
at  the  very  approach  of  the  enemy,  but,  with  most  unnatural  distrust 
of  self,  invite  the  destroyer  (§  349,  d,  433,  p.  719,  §  960,  a). 

The  late  publication  of  Liebig's  "Animal  Chemistry"  has  abund- 
antly proved  the  truth  of  what  I  sufficiently  established  in  the  '•  Med- 
ical and  Physiological  Commentaries,"  that  the  recent  application  of 
chemistry  to  physiology  and  medicine  is  not  a  partial,  but  a  complete 
substitution  of  that  science.  In  justification  of  all  this,  we  are  now 
told  that  the  means  of  investigation,  of  analysis,  and  of  creation,  have 
received  an  extension  of  which  our  predecessors  had  no  knowledge. 
Such,  however,  has  always  been  the  pretext  of  chemistry  for  its  inva- 
sions upon  the  science  of  life.  Take,  for  example,  the  words  of 
Fourcroy,  who  wrote  more  than  sixty  years  ago,*and  who,  like  Lie- 
big  and  his  school,  attempted  to  substitute  chemistry  for  physiology, 
and  to  rear  up  a  fabi-ic  of  medicine  upon  that  imaginary  foundation ; 
and  this,  too,  in  the  case  of  either  of  the  masters,  without  having  ever 
read  a  medical  book,  or  having  ever  prescribed  for  a  disease.  The 
language  of  Fourcroy  is  exactly  such  as  we  now  hear  from  the  lips 
of  Liebig  and  his  followers ;  who  cheerfully  allow  that  nothing  flow- 
ed from  the  labors  of  Fourcroy  to  illuminate  the  dark  ways  of  or- 
ganic life  (§  1029, 1080). 

*  Now  more  than  eighty  years — 1870. 


PRELIMINARY   REMARKS.  9 

So  identical  are  the  language,  and  ambition,  and  hope  or  confi- 
dence, and  the  visionary  speculations,  of  the  older  and  recent  chem- 
ists, that  a  space  may  be  well  assigned  to  this  exposure  of  chemical 
pretensions.  We  read,  then,  in  Fourcroy,  what  we  read  in  the  works 
of  Liebig  and  his  cotemporary  chemists.     Thus  : 

"  The  errors  of  the  chemical  physicians  of  the  last  century,  and  the 
indifference  many  practitioners  of  the  present  time  seem  to  have  for 
chemistry,  have  produced  a  disadvantageous  opinion  in  the  minds  of 
many  persons,  which  time  alone  can  remove.  If  the  enthusiasm  of 
those  physicians,  who  cultivated  chemistry,  misled,  them,  it  does  not 
follow  that  any  conclusion  can  be  drawn  from  thence  that  may  he  ap- 
plied to  the  present  time.  The  exactness  which  the  moderns  have 
introduced  into  every  part  of  experimental  philosophy  ought  to  re- 
move the  apprehensions  of  such  as,  for  want  of  acquaintance  with  the 
subject,  are  apt  to  imagine  that  chemistry  is  still  the  dark,  mysterious 
science  it  was  a  century  ago."  "  It  is  chemistry  alone  that  can  throw 
any  light  on  the  composition  of  the  fluids,  and  the  changes  they  under- 
go by  the  processes  that  are  carried  on  during  life.  We  cannot  avoid 
having  recourse  to  this  science,  in  our  endeavors  to  discover  the  true 
mechanism  of  the  animal  functions  ;  the  properties  of  the  fluids  separ- 
ated by  the  different  viscera ;  or  the  alterations  such  fluids  undergo." 
♦'  It  will  be  necessary  to  enlarge  and  multiply  these  researches  on 
subjects  of  different  age,  size,  and  temperament,  in  various  climates 
and  seasons,  and  to  pursue  them  among  the  different  classes  of  ani- 
mals," &c.  "  We  think  it  equally  necessary  to  examine  the  solids, 
by  chemical  methods,  as  well  in  the  sound  as  in  the  diseased  state, 
and  hy  a  comparison  of  their  properties,  endeavor  to  discover  to  which 
of  the  fluids  they  owe  their  formation  ;  and  this  being  known,  we  may 
proceed  to  conjecture,  in  morbific  dispositions,  the  solid  or  fluid  that 
has  suffered  a  change. 

"  If  it  be  thus  established  that  the  theory  of  medicine  is  capable  of 
receiving  the  most  essential  advantages  from  chemistry,  it  is  equally 
certain  that  the  practice  is  no  less  in  need  of  the  same  assistance ; 
since  both  must  of  necessity  accompany  each  other,  and  are  promoted 
by  the  same  means."  "  Nothing  can  be  more  evident  than  that  the 
choice  of  aliments,  and  of  air,  cannot  be  made  with  any  certainty,  but 
in  consequence  of  chemical  researches  into  the  nature  of  foods,  and  the 
properties  of  the  atmospheric  fluid"  (§  18). — Fourcroy's  Medical 
Chemistry,  1782.— Also,  Appendix  §  1028-1030,  1034,  Lehmann. 

I  have  said,  in  the  Commentaries,  that  "  a  prosperous  harvest"  was 
promised  from  Fourcroy's  reformation.  But,  again  I  reiterate,  where 
is  the  evidence  ?  since  which  time,  also,  chemistiy  has  made  greater 
advances  than  any  other  science,  has  had  its  unmolested  sway,  and 
Fourcroy's  example  has  been  followed  with  a  corresponding  diligence. 
Can  you  point  to  a  solitary  instance  in  which  organic  chemistry,  ex- 
cept in  a  negative  sense,  has  advanced  the  science  of  life  or  disease  ? 
Do  not  the  veiy  chemists  of  this  day  incidentally  allow  the  perfectly 
abortive  nature  of  their  science  in  relation  to  physiology  and  medi- 
cine ]  Consult  the  quotations  in  section  350,  b,  1,  &c.,  and  350^— 
3503-.  Or  take  the  affirmations  of  the  distinguished  Mulder  (§  350f), 
which  go,  with  the  rest,  to  establish  the  truth  of  my  former  assertion, 
that  " chemistry  has  been  a  perfect  incubus  upon  medicine;  and  the  time 
is  not  distant  when  it  will  have  proved,  by  its  own  shotving,  its  want  of 


10  INSTITUTES    OF     MEDICINE. 

relation  to  our  subject,  if  it  have  not  done  so  already.'" — Commtat.,  voL 
i.,  p,  586,  note. — See  Appendix  §  1028-1030. 

5i,  a.  I  agree  with  the  chemical  physiologist  that  "facts  are  slub- 
bovn  things,"  and,  with  the  analogy  which  reposes  upon  them,  are 
at  tV.e  foundation  of  all  philosophy  ;  but  it  does  not  equally  follow 
that  facts  are  always  philosophically  or  even  honestly  applied,  nor 
that  he  who  devotes  himself  to  the  laboratory  is  the  best  qualified  to 
apply  his  own  facts  to  organic  natui'e.  "  Wc  can  have  no  very  high 
idea  of  experiments  made  by  gentlemen,"  says  Hunter,  "  who,  for 
want  of  anatomical  knowledge,  have  not  been  able  to  pursue  their 
reasoninf  even  beyond  the  simple  experiment  itself"  Least  of  all 
can  the  chemist  be  permitted  to  charge  upon  the  vitalist  a  neglect  of 
chemical  facts ;  since  it  is  as  well  by  these  as  by  the  phenomena  of 
life  that  the  vitalist  overthrows  the  artificial  system  (§  S50-350|). 
Nor  let  it  be  forgotten  that  it  is  purely  by  an  appeal  to  certain  false 
analogies,  and  by  a  disregard  of  the  phenomena  of  living  beings,  that 
the  physical  and  chemical  hypotheses  of  life  and  disease  have  obtained 
their  ascendency  (§  733,  d). 

All  our  theories  and  principles  in  medicine,  it  cannot  be  too  often 
reiterated,  should  rest  upon  well-ascertained  facts.  The  great  diffi- 
culties with  which  truth  has  had  to  contend  since  the  restoration  of 
the  proper  method  of  observing  nature  consists  in  the  mistaken  nature 
of  facts,  or  of  false  conclusions  from  admitted  facts.  What  is  often 
assumed  to  be  fact  is  just  otherwise,  and,  where  the  premises  are 
sound,  they  have  frequently  led  to  spurious  theories  (§  350^-3503, 
433,  &c.,  493,  823,  &c.). 

5i,  h.  The  phenomena  of  nature  are  the  facts  about  which  all  phi- 
losophy is  concerned,  and  therefore  form  the  substantial  ground  of  all 
intellectual  acquirements.  As  they  relate  to  organic  beings,  to  their 
laws,  their  properties,  their  functions,  whether  morbid  or  healthy, 
they  are  to  be  found  in  the  organic  being  himself,  not  in  the  work- 
shops of  the  chemist  or  of  the  mechanical  philosopher.  But,  even 
where  the  mind  admits  this  proposition,  if  prone  to  speculation,  it  too 
often  regards  each  fact  by  itself,  and  rears  up  hypotheses  wrong  in 
themselves,  and  in  conflict  with  each  other.  Facts  should  therefoi^e 
be  compared  before  they  are  reduced  to  theory  ;  or,  where  they  may 
conflict  with  acknowledged  principles  they  should  remain  in  an  iso- 
lated state  till  their  true  nature  may  be  better  understood,  or  till  the 
principles  which  they  appear  to  contradict  may  be  shown  to  be  erro- 
neous. Should  some  fact,  for  example,  appear  to  indicate  the  depend- 
ence of  life  upon  chemical  or  any  other  physical  forces,  the  evidence 
to  the  contrary  is  so  various  and  conclusive,  that  that  fact  must  be 
considered  as  deficient  in  some  of  its  elements,  which,  if  known,  would 
readily  bring  it  under  a  well-established  principle  in  physiology. 
These  absent  elements  are  some  other  facts  which  escape  our  obser- 
vation ;  and  thus  what  is  truly  fact,  in  an  abstract  sense,  is  made  the 
ground-work  of  important  error. 

5^,  c.  It  is  the  peculiar  misfortune  of  science  to  generalize  too 
hastily ;  and  it  often  happens  that  the  explosion,  or  the  introduction, 
of  one  error,  is  the  parent  of  many  others.  It  is  also  astonishingly- 
true  that  a  few  phenomena  are  abstracted  from  the  whole,  of  which 
they  may  bo  only  sequences  of  the  others,  and  are  made  the  ground 
of  conflicting  doctrines,  and  substitutes  for  the  theories  that  are  insli- 


PRELIMINARY    REMARKS.  11 

tuted  upon  the  more  fundamental  facts  ;  and  thus  a  blind  disregard 
of  consistency  is  permitted  to  prevail  till  a  most  incongruous  series  of 
assumptions,  as  in  Liebig's  Animal  Chemistry,  is  presented  to  us  as 
the  science  which  Nature  teaches. 

Again,  there  is  a  proneness  of  the  human  mind  to  admit  of  no  real- 
ities but  such  as  make  a  strong  demonstration  upon  the  senses;  and 
hence  it  is  that  the  physical  and  chemical  philosophers  of  life  prefer 
the  facts  of  the  laboratory  to  such  as  are  supplied  by  organic  beings. 
The  former  are  therefore  assumed  as  the  foundation  for  principles 
and  laws  in  physiology  and  medicine  ;  and  when  it  is  considered  how 
large  a  proportion  of  mankind  have  not  the  ability  to  distinguish  the 
true  from  the  false,  especially  when  the  latter  is  set  forth  in  a  confi- 
dent and  dogmatic  manner,  it  ceases  to  be  remarkable  that  what  is 
comparatively  simple,  and  comes  plausibly  recommended  by  the  tangi- 
ble and  visible  attributes  of  matter,  should  command  their  confidence 
beyond  those  realities  which  can  be  appreciated  only  by  an  exercise 
of  the  understanding  in  connection  with  the  revelations  of  sense,  and 
which  form  the  ground-work  of  principles  of  difficult  penetration. 
There  are  few,  indeed,  who  ai'e  capable  of  reasoning  beyond  their 
senses  and  the  facts  themselves,  and  this  is  equally  true  of  the  chem- 
ist, both  as  to  the  facts  of  the  laboratory  and  the  phenomena  of  living 
beings,  whenever  he  attempts  an  exposition  of  the  properties  and  laws 
of  a  department  of  nature  which  lies  not  within  his  sphere  of  investi- 
gation. "  Truth,  whether  in  or  out  of  fashion,  is  the  measure  of 
knowledge  and  the  business  of  the  understanding.  Whatever  is  be- 
side that,  however  authorized  by  consent  or  recommended  by  variety, 
is  nothing  but  ignorance  or  something  worse'*  (§  1034). 

5i,  d.  It  cannot  but  be  conceded,  that,  as  knowledge  advances,  and 
the  subjects  of  inquiry  become  more  or  less  exhausted,  ambition  is 
likely  to  depart  from  an  observation  of  nature  to  seek  gratification 
and  renown  in  artificial  expedients.  This  is""  becoming  a  prevailing 
propensity  in  medicine;  and  many  have  left,  and  are  leaving,  the  bul- 
wark of  knowledge  to  rear  up  hypotheses  upon  distortions  of  nature, 
which,  for  their  better  success,  they  dignify  by  the  name  of  "  experi- 
mental philosophy"  (§  1085).— Note  Pp  p.  1142. 

51,  e.  In  medicine,  at  least,  there  is  but  one  kind  of  experimental 
observation,  which  consists  in  the  simple  study  of  the  phenomena  of 
nature.  Or,  if  art  be  applied  to  give  them  a  fuller  development,  the 
means  must  be  such  as  shall  elicit  results  conformable  to  the  institu- 
tions of  nature.  But  aside  from  chemistry,  it  has  been  the  fatality  of 
the  physiological  department  of  medicine  to  have  been  encumbered 
with  rude  experiments,  giving  the  wildest  distortions  to  the  features 
of  nature.  When  we  consider  the  wonderful  susceptibility  of  the 
properties  of  life,  how  readily  their  actions  and  results  are  influenced 
by  natural  agents,  how  a  drop  of  hydrocyanic  acid,  or  of  the  alcoholic 
extract  of  nux  vomica,  applied  to  the  tongue  of  an  animal,  will  ex- 
tinguish life  in  an  instant ;  or  that  the  same  may  be  done  by  thrust- 
ing a  needle  into  the  medulla  oblongata ;  or  how  concentrated  mias- 
ma may  almost  as  instantly  induce  an  attack  of  fever ;  or  how  a  little 
excess  in  eating  may  bring  on  an  attack  of  apoplexy  as  immediately 
fatal  as  a  blow  on  the  region  of  the  stomach — fatal,  perhaps,  in  either 
case,  as  the  aitillery  of  the  clouds  ;  or  how  simple  irritations  of  a 
nerve  may  be  followed  by  death  from  tetanus ;  or  how  all  the  veg- 


12  INSTITUTES    OF    MEDICINE. 

etable  and  animal  poisons,  as  well  as  all  things  else  which  do  not  pos- 
sess natural  relations  to  the  properties  of  life,  will  variously  change 
those  properties  and  all  their  results, — when,  I  say,  we  consider  all 
these  things,  we  may  well  imagine  the  difficulty  of  imitating  nature  by 
the  most  cautious  experiments,  or  of  developing  her  laws  by  mutila- 
ting the  structure  of  organic  beings,  or  of  illustrating  those  modifica- 
tions which  spring  up  in  disease,  by  resorting  to  processes  which  are 
foreign  to  natural  influences.  Even  the  greatest  experimentalist  in 
modern  times,  he  who  has  performed  more  vivisections  than  any 
other  man,  has  placed  it  upon  record,  that  it  is  one  of  the  most  diffi- 
cult things  in  physiology  to  perform  an  experiment  that  shall  not  be 
liable  to  objection.  Yet  no  man  ever  ventured  more  hastily  upon 
conclusions  from  such  experiments,  and  none  has  thrown  gi'eater  ob 
stacles,  in  consequence,  in  the  way  of  physiology  and  pathology. 

^\,f'  The  limits  which  restrain  the  interposition  of  art  are  very 
narrow:  and  whenoraranic  nature  is  brouijht  under  the  influence  of  arti- 
ficial  causes  with  a  proper  reference  to  these  limits,  the  resulting  phe- 
nomena may  form  a  safe  ground  of  reasoning  as  to  the  laws  by  which 
organic  beings  are  governed.  Much  has  been  accomplished,  in  this 
way,  as  to  the  physiological  connections  of  the  nervous  system  with 
organic  actions,  the  part  which  it  takes  in  the  morbid  processes,  the 
sympathetic  communications  which  it  establishes  throughout  the  or- 
ganization, and  the  interpretation  which  it  supplies  of  the  operation 
of  remedial  agents.  Nevertheless,  the  most  important  part  of  our 
knowledge  upon  these  great  and  intricate  questions  is  abundantly 
supplied  by  the  natural  phenomena  of  life,  as  manifested  under  the 
varying  conditions  of  health  and  disease.  And  that  this  is  so,  is  suffi- 
ciently evident  fi-om  the  fact,  that  but  Yittie  practical  information  of  the 
foregoing  nature  has  been  added,  by  recent  experiments,  to  what  had 
been  known  centuries  ^ago.  The  late  experiments,  however,  upon 
the  nervous  system  have  confirmed  what  had  been  deduced  from  the 
more  natural  process  of  observation,  and  have  developed  some  useful 
facts  which  it  might  have  been  impossible  to  have  known  by  any 
other  method.  Such,  for  example,  is  the  difference  of  function  be- 
tween the  component  parts  of  the  spinal  nerves  ;  one  part  being  de- 
signed for  the  transmission  of  sensation  and  sympathetic  influences, 
the  other  for  the  operation  of  the  will  and  the  development  of  motion. 
And  yet,  if  analogy  were  allowed  its  proper  weight  in  physiological 
inquiries,  as  it  must  be  in  reality  the  great  basis  of  medical  science, — 
if  there  had  been  less  pertinacity  as  to  the  necessity  of  abstract  facts 
for  every  conclusion,  we  might  have  come,  by  a  process  of  analogy 
founded  upon  ultimate  facts,  to  a  knowledge  of  the  constitution  of 
the  compound  nerves.  This  could  have  been  inferred  from  their 
complex  functions  as  evinced  by  their  phenomena,  and  by  associating 
them  with  the  simple  elements  of  cerebral  nerves,  where  it  is 
plainly  seen  that  some  of  the  nerves  have,  individually,  a  specific 
function,  and  whose  phenomena  are  destitute  of  complexity. 

5i,  a.  But  the  reign  of  "  experimental  philosophy"  which  so  lately 
appeared  in  the  mutilations  of  animals  to  discover  their  natural  func- 
tions ;  in  the  injection  of  corrosive  and  putrid  substances  into  the  cir- 
culatory apparatus  of  animals  to  illustrate  the  pathology  of  human 
disease;  in  the  transfusion  of  remedial  agents  into  the  same  order  of 
beings,  and  even  into  plants,  to  asceitiin  the  virtues  of  remedies,  their 


PKELIMINARY    REMARKS.  13 

modus  operandi  as  curative  agents,  and  the  right  treatment  of  human 
maladies,  has  given  place  to  an  "  experimental  philosophy"  in  which 
organic  life  has  no  participation.  This  is  the  "  philosophy"  against 
Avhich  the  observer  of  nature  is  now  called  upon  to  contend;  fraught 
with  far  greater  evils  than  the  spiyrious  systems  which  it  has  so  sud- 
denly surprised  and  superseded.  It  is  impossible  to  calculate  the 
mischief  which  must  result  to  mankind  from  its  unrestrained  popular- 
ity. Something  may  be  gathered  from  its  former  effects  when  chem- 
istiy  was  young ;  and  something  from  the  progress  of  error  under  the 
fresh  spur  of  Liebig's  Animal  Chemistry  (§  350-350|,  821).  We  all 
know  how  common  the  enthusiastic  belief  that  this  "  Reformer"  had 
overthrown  all  former  systems  in  every  department  of  medicine  ;  and 
we  may  take  the  following  editorial  passage  from  the  London  Lancet 
as  expressing  a  very  common  opinion  of  the  profession  as  to  the  ap- 
plication of  chemistry  at  the  bedside  of  disease  : 

"As  organic  chemistry  marches  on  the  basis  of  an  improved  system 
of  medical  practice,"  says  the  veteran  editor,  "  it  will  prove  impera- 
tive that  a  rigorous  examination  of  the  products  of  the  animal  frame, 
the  several  humors  and  excretions  of  the  body,  should  be  employed  in 
the  investigation  of  disease.  The  period  approaches  when  it  will  be 
incumbent  on  us,  not  perhaps  invariably,  but  still  very  often,  in  pre- 
scribing,— say,  for  typhus,  or  purpura,  or  any  of  the  numerous  vari- 
eties of  cutaneous  affections,  that  by  a  chemical  analysis  we  should  first 
ascertain  the  constituents  and  proportions  of  the  proximate  elements 
of  the  urine,  the  saliva,  the  expired  breath,  the  perspired  matter,  per- 
haps the  blood,  the  faeces  of  the  patient,  before  applying  our  remedies; 
and  this  process  may  have  to  be  gone  through  not  once  only,  but  sev- 
eral times  in  the  progress  of  the  malady."  "  The  time  is,  we  repeat 
it,  approaching  when  the  foundation  op  practice  on  the  laws  of 
Organic  Chemistry  will  form  the  distinction  between  the  enlight- 
ened physician  and  the  mere  pretender"  (§  851,  863,  e;  883,  h).— 
London  Lancet,  April  2^,  1843.    (Also,  §  1029,  1030.) 

5i,  h.  In  the  foregoing  quotation  we  have  essentially  what  is  now 
extensively  denominated  "  the  progress  of  medical  science,"  and  the 
nature  of  the  doctrines  to  which  these  Institutes  are  opposed.  These 
Institutes  will  be  found  mainly,  so  far  as  physics  are  alleged  to  be 
concerned,  by  the  side  of  all  the  most  illustrious  physiologists  from 
Hippocrates  to  us,  whose  general  views  are  thus  summarily  express- 
ed by  Bichat : 

"  The  organic  chemistry  of  the  laboratory,"  says  Bichat,  "  is  the 
dead  anatomy  of  the  fluids,  not  a  physiological  chemistry.  The 
physiology  of  the  fluids  should  be  composed  of  the  innumerable 
variations  which  they  experience  according  to  the  different  (vital) 
states  of  their  respective  organs."  "  The  instability  of  the  vital  pow- 
ers is  the  quicksand  on  which  have  sunk  the  calculations  of  all  the 
physicians  of  the  last  hundred  years.  The  habitual  variations  of  the 
living  fluids,  dependent  on  the  instability  of  the  powers  of  life,  one 
would  think,  should  be  no  less  an  obstacle  to  the  chemical  physicians 
of  the  present  age." 

"  Again,  had  physiology  been  cultivated  by  men  before  physics,  I 
am  persuaded  that  many  applications  of  the  former  would  have  been 
made  to  the  latter.  Rivers  would  have  been  seen  to  flow  from  ihe 
tonic  action  of  their  banks,  crystals  to  unite  from  the  excitement 


14  INSTITUTES    OP    MEDICINE. 

which  they  exercise  upon  their  reciprocal  sensibilities,  and  planets 
to  move  because  they  mutually  irritate  each  other  at  vast  distances. 
All  this  would  appear  unreasonable  to  us,  who  think  of  gravitation 
only  in  consideration  of  these  phenomena.  And  why  should  we  not, 
in  fact,  be  as  ridiculous  when  we  come  with  this  same  gravitation, 
with  our  chemical  affinities  and  chemical  compositions,  and  with  a 
language  established  upon  their  fundamental  data,  to  treat  of  a  sci- 
ence with  which  they  have  nothing  whatever  to  do  ]" — Bichat's  Gen- 
eral Anatomy  and  Physiology. 

6.  We  may  now  readily  perceive  the  reason  why,  chemistry  has 
undergone  changes  within  a  few  years,  while  all  that  relates  essen- 
tially to  the  properties  and  laws  of  organic  beings  may  have  been 
long  since  known.  The  chemist  operates,  and  makes  all  his  discov- 
eries, through  the  forces  and  laws  of  inorganic  matter.  These  he 
may  carry  into  his  laboratory,  turn  into  his  test  glasses,  or  involve  in 
his  crucible.  He  can  therefore  oblige  nature  to  form  the  same  inor- 
ganic compounds  as  she  forms  spontaneously.  He  can  then  separate 
the  elements  again,  and  again  oblige  nature  to  recombine  them  after 
their  original  manner.  But,  can  he  do  the  same  thing  with  organic 
beings  ?  He  cannot  form  the  most  simple  organic  compound — can- 
not even  recombine  the  elements  when  they  are  once  separated ; — 
although  he  has  then  the  necessary  elements,  and  in  their  exact  pro- 
portions. The  reason  is  obvious.  The  chemist  has  not  at  his  com- 
mand in  this  case,  as  in  the  other,  the  necessary  powers ;  or,  as  the 
chemist  expresses  it,  "  he  cannot  place  them  in  the  same  circumstan- 
ces as  Nature  does." 

It  is  clear,  therefore,  that  while  the  laboratory  is  the  proper  place 
for  the  study  of  the  inorganic  kingdom,  we  must  go  to  the  organic 
being  itself  to  learn  the  nature  of  the  powers  and  laws  by  which  it  is 
governed.  These,  then,  are  the  reasons  why  the  laws  of  organic  be- 
ings have  been  long  so  much  better  understood  than  those  of  chemis- 
try. Every  thing  is  artificial  in  the  laboratory,  so  far  as  experiments 
are  concerned ;  and,  if  these  be  not  the  right  ones,  or  be  imperfectly 
conducted,  they  will  either  fail  to  represent  nature  correctly,  or  will 
give  her  a  wrong  interpretation.  Hence  the  great  instability  of  this 
science ;  and  yet  we  are  told  that  every  new  theory  in  chemistry  is 
applicable  to  physiology  and  medicine. 

But,  it  is  quite  otherwise  with  organic  beings.  Here  all  the  ex- 
periments are  carried  on  by  Nature  herself,  and  they  cannot  deceive. 
The  various  results  and  phenomena  are  seen  in  the  being  itself,  and 
can  be  seen  nowhere  else.  They  must,  therefore,  be  the  true  guide, 
and  the  only  guide,  to  the  powers  and  laws  by  whicli  organic  beings 
are  governed.  These  phenomena,  too,  are  astonishingly  multiplied 
in  any  given  being,  and  new  ones  are  presented  as  the  being  may 
come  under  new  influences.  But,  this  variety  is  extended  almost  to 
infinity  when  we  consider  that  every  distinct  species  of  plants  and 
animals  has  its  peculiar  manifestations  of  life.  It  is  also  true  that 
each  one  of  this  endless  variety  is  utterly  different  from  any  of  the 
phenomena  of  the  inorganic  world.  And  when  we  take  all  the  phe- 
nomena of  organic  beings  in  connection,  and  find  a  perfect  harmony 
among  the  whole,  the  nature  of  the  proof  is  so  various  and  immense 
as  to  conduct  us  to  a  right  knowledge  of  the  principles  and  laws  of 
life  in  all  their  aspects. 


PHYSIOLOGY.  15 

Now  all  this  variety  has  been  perpetually  before  the  observation 
of  mankind,  and  always  presented  to  our  observation  by  nature  her- 
self.  It  therefore  ceases,  I  say,  to  be  remar-kable  that  the  science  of 
life  had  so  greatly  outstripped  that  of  chemistry ;  and  it  will  proba- 
bly forever  remain  better  understood ;  since  nature  is  the  experi- 
menter in  one  case,  and  man  in  the  other. 


PHYSIOLOGY. 


7.  The  sensible  world  is  composed  of  animate  and  inanimate  be- 
ings, which,  with  their  difference  in  composition  and  structure,  has  led 
to  their  division  into  the  organic  and  inorganic  or  mineral  kingdoms. 

8.  The  relations  between  the  two  gi-eat  kingdoms  of  nature,  and 
their  conti-adistinctions,  render  a  general  reference  to  the  inorganic 
indispensable  to  our  physiological  and  higher  branches  of  inquiry. 

9.  Animals  and  plants,  wliich  make  up  the  organic  kingdom,  are 
essentially  dependent  on  the  inorganic ;  but  the  latter  kingdom  is  per- 
fectly independent  of  the  organic. 

10.  The  beginning  of  organization  is  in  plants,  which  are  the  pri- 
mary source  of  nourishment  to  animals. 

11.  From  the  foregoing  law  arises  the  great  fundamental  distinc- 
tion between  plants  and  animals — that  the  former  subsist  on  the  ele- 
ments of  matter,  while  the  latter  are  nourished  by  those  elements  in 
an  organic  state.  It  appears,  therefore,  that  vegetables  are  more 
creative  than  animals  (§  303). 

12.  All  organic  substances  are  compounds  of  the  simple  elements 
of  matter.  They  are  combined  by  the  vital  powers,  while  inorganic 
compounds  are  produced  by  chemical  forces. 

13.  As  organization  begins  in  vegetables,  it  is  obvious  that  a  de- 
compounded organic  substance  can  be  restored  to  an  organic  state 
only  by  that  vegetable  kingdom  which  was  created  for  the  specific 
purpose  of  organizing  the  mineral  Icingdom,  for  the  ultimate  final 
cause  of  supplying  food  to  animals.  The  plant  reduces,  the  animal 
consumes  (§  303).— Notes  N  R  pp.  1121,  1123. 

14.  a.  If  an  animal  compound  be  decompounded,  the  reunion  of 
the  elements  into  an  animal  substance  requires  the  agency  of  both 
vegetable  and  animal  organization ;  and,  not  only  so,  but  nothing  can 
reproduce  any  given  animal  compound  but  the  precise  part  of  the 
same  species  of  animal  which  gave  origin  to  the  part  so  decompound- 
ed (§  12).— Note  R  p.  1123. 

14,  b.  Owing  to  this  universal  law,  by  which  the  animal  is  rendered 
so  perfectly  dependent  on  the  vegetable  kingdom,  the  Creator  has 
given  a  striking  perfection  to  the  grand  design  in  the  institution  of 
an  invisible  world  of  animalcula  for  the  cfmsumption  of  that  vast  pro- 
portion of  organic  matter  which  is  passing  through  the  process  of 
maceration  to  its  elementary  state.  Thus  airested  by  these  econo- 
mists of  nature,  it  advances  through  an  ascending  series  of  animals, 
till,  at  last,  it  becomes  the  food  of  man  (§  151,  1052). 

The  foregoing  distinction  is  fundamental  in  nature ;  and  hore,  at 
the  very  threshold,  we  are  met  by  a  barrier  which  the  chemist  and 


16  INSTITUTES    OF    MEDICtNE. 

physical  philosopher  cannot  pass  from  one  side,  nor  the  pihysiologist 
from  the  other  (§  1052). 

14.  c.  I  may  also  say,  that  it  is  no  small  proof  of  a  Creator,  that  the 
elements  of  all  combinations  which  are  generated  by  animals  and 
plants  are  derived  from  the  inorganic  kingdom,  which  will  be  allowed 
to  be  less  productive  than  the  organic.  And  since,  especially,  no  or- 
ganic being  can  generate  any  elementary  substance,  nor  the  ele- 
ments unite,  of  themselves,  into  organic  compounds,  it  follows  that 
the  whole  was  created  by  a  Being  of  greater  power.  "We  can  go  no 
farther  back  than  the  elements  of  matter.  Here  the  atheist  himself 
pauses  in  dismay.  They  proclaim  a  God,  and  reason  submits  to  this 
limit  of  its  powers. 

I  may  also  propose  another,  and  perhaps  greater  proof  of  the  en-or 
of  spontaneous  generation.  The  kingdoms  of  nature  are  governed  by 
inherent  powers,  and  the  organic  possess  powers  peculiar  to  them- 
selves ;  but  the  existence  of  matter,  whether  organic  or  inorganic,  is 
also  indispensable  to  their  respective  forces.-  These  forces,  therefore, 
did  not  create  matter ;  and  since  matter  cannot  create  matter,  and 
therefore  did  not  create  itself,  it  follows  that  its  associate  powers  did 
not  create  themselves.  Whence  it  is  obvious  that  some  greater  Power 
exists  by  which  the  powers  of  nature  were  created  in  union  with 
matter  (1079  &,  1083,  1085).— Notes  Pp  p.  1142,  aQ  p.  1145. 

These  arguments,  therefore,  may  be  taken  in  connection  with  those 
which  I  formerly  adduced  for  the  purpose  of  exposing  the  fallacy  of 
the  doctrine  implied  by  Carpenter,  Pritchard,  Fletcher,  and  others, 
by  assuming  that  the  vital  properties  exist  in  the  elements  of  matter, 
and  that,  therefore,  the  elements  are  capable  of  arranging  themselves 
into  organic  beings.  (See  my  Exainination  of  Reviews,  p.  37,  and 
my  Notice  of  Revieics.    Also,  §  1051,  1052.) 

15.  Exact  analyses  are  readily  made  of  mineral  compounds,  and 
the  elements  may  be  recombined  into  the  same  or  other  mineral  com- 
pounds. 

The  precise  analysis  of  the  most  simple  organic  compound,  solid  or 
fluid,  as  fibrin  or  albumen,  is  very  difficult,  and  always  liable  to  doubt. 

16.  Excepting  the  earths,  plants  subsist  upon  the  atmosphere  and 
what  it  contains  (§  303) ;  but  they  immediately  derive  much  of  their 
nourishment  from  decaying  organic  substances  that  are  incorporated 
with  the  soil.  But,  before  such  compounds  can  be  appropriated  by 
plants,  they  must  be  resolved  into  their  elementary  state.  They  can 
be  taken  into  the  organization  of  plants  only  in  the  condition  of  min- 
eral substances ;  and  even  then  the  most  simple  binary  compound 
must  be  decompounded  before  organization  can  begin.  All  the  re- 
combinations, as  constituting  parts  in  the  vegetable  economy,  are  es- 
sentially unlike  any  substance  in  the  mineral  kingdom. 

17.  If  animal  organization  resolve  an  organic  compound  into  a  min- 
eral condition,  such  compound  is  useless  in  the  animal  economy  (§  13, 
14).  There  is  never  present,  therefore,  in  the  animal  organization, 
as  a  part  of,  or  as  a  source  of  supply  to  that  organization,  any  mineral 
substance  (§  360).  Whatever  mutations  the  materials  of  supply  may 
undergo,  they  must  always  exist  in  an  organic  state,  or  be  permanent- 
ly restored  to  the  mineral  kingdom. — Notes  N  R  pp.  1121,  1123. 

18,,.«.  We  learn  from  the  foregoing  premises  (§  17),  that  food  does 
not  lose  its  organic  state  during  the  process  of  digestion  ;  and  since  it 


PHYSIOLOGY.  17 

becomes  more  and  more  nearly  assimilated  to  the  living  solids  fi'om 
the  earliest  action  of  the  gastric  juice,  it  is  evident  that  chemical 
agencies  have  no  connection  with  the  transformations  to  which  it  is 
subjected  in  the  alimentary  canal  (§  350-376). 

18,  h.  Hence,  also,  the  fallacy  of  attempting,  by  chemical  analysis, 
to  indicate  the  proper  sustenance  of  man  and  animals.  "  To  deter- 
mine^'' says  Liebig,  "  what  substances  are  capable  of  affording  nour- 
ishment, it  is  only  necessary  to  ascertain  the  composition  of  the  food,  and 
to  compare  it  with  that  of  the  ingredients  of  the  bloods  He  then  pro- 
ceeds to  a  practical  application  of  this  principle  by  setting  forth  the 
chief  elements  of  the  blood.  The  difficult  subject,  also,  of  identifying 
hay  with  the  flesh  of  animals,  and  all  the  vegetable  substances  which 
enter  the  human  stomach  with  the  various  tissues  of  the  body,  is  so 
far  disposed  of  as  to  require  no  other  interposition  between  the  nutri- 
ment and  its  conversion  into  living  animal  compounds  than  the  chem- 
ical forces.     This  chemical  doctrine  is  thus  set  forth  by  Liebig : 

"  The  most  recent  and  exact  researches  have  established  as  a  univer- 
sal fact,  to  which  nothing  yet  knoion  is  opposed,  that  the  nitrogenized 
constituents  of  vegetable  food  have  a  composition  identical  xoith  that  of 
the  constitxients  of  the  bloods — Liebig's  Animal  Chemistry. 

18,  c.  And  such,  too,  is  a  common  example  not  only  of  the  assump- 
tions of  this  writer,  but  of  that  positive  manner  which  has  inspired 
such  universal  confidence  (§  3501-3505).  There  are,  of  course,  in 
nitroo^enized  vegetable  food  certain  combinations  more  or  less  analo- 
gous  to  what  are  called  the  constituents  of  the  blood,  though  never 
the  same,  and  but  comparatively  few  in  many  that  are  appropriate  as 
means  of  nourishment ;  nor  could  it  be  doubtful  that  the  elements  of 
the  flesh  and  blood  of  animals  subsisting  on  vegetables  must  exist  in 
their  food.  But  the  identity  of  elements  in  any  given  vegetable  and 
animal  compounds  is  very  different  from  identity  of  compounds,  and 
this,  too,  with  every  imaginary  latitude  of  the  isomeric  and  polymeric 
problems.  Nor  have  any  two  chemists  agreed,  as  yet,  in  their  analy- 
sis of  blood,  or  of  any  animal  compound  ('J  1029,  1030,). 

But  we  have  from  the  laboratory  most  ample  admissions  of  the 
groundless  nature  of  the  preceding  statement.     Thus,  again,  Liebig  : 

"  As  far  as  our  researches  have  gone,  it  may  be  laid  down  as  a  law, 
founded  on  experience,  that  vegetables  produce,  in  their  organism, 
compounds  of  proteine;  and  that  out  of  these  compounds  of  proteine 
the  various  tissues  and  parts  of  the  animal  body  are  developed  by  the 
VITAL  FORCE,  icith  the  aid  of  the  oxygen  of  the  atmosphere  and  of  the 
elements  of  water. 

"  Now,  although  it  cannot  be  demonstrated  that  proteine  exists 
ready  formed  in  vegetable  and  animal  products,  and  although  the  dif- 
ference in  their  properties  seems  to  indicate  that  their  elements  are 
not  arranged  in  the  same  manner,  yet  the  hypothesis  of  the  jne-exist- 
ence  of  proteine,  as  a  point  of  departure  in  developing  and  comparing 
their  properties,  is  exceedingly  convenient.  At  all  events,  it  is  certain 
that  the  elements  of  these  compounds  assume  the  same  arrangement 
wJien  acted  on  by  potash  at  a  high  temperature''*  !  ! — Liebig'?  Animal 
Chemistry. 

Nor  is  this  the  end  of  the  contradiction ;  for  we  also  read  in  the 
same  work,  that 

"  We  cannot,  ir.deed,  maintain  that  the  animal  organism  has  no 

B 


18  INSTITUTES    OF    MEDICINE. 

power  to  form  other  compounds,  for  we  know  that  it  is  capable  of 
producing  an  extensive  series  of  compounds,  differing  in  composition 
frowj  the  chief  constituents  of  the  blood"  (§  409,  b,  and  53,  b). 

But,  if  the  foregoing  quotations  be  conclusive  of  the  specific  inqui- 
ries before  us,  the  following  admitted  facts  not  only  establish  the  same 
conclusions,  but  prove  that  chemistry  is  entirely  incompetent  to  any 
one  of  its  pi'etensions  as  to  a  proximate  analysis  of  the  blood,  or  of 
other  organic  compounds,  and  that  it  is  strictly  limited  to  a  mere  ele- 
mentary decomposition,  while  they  also  concede  the  existence  of  a 
vital  principle  as  an  "  immaterial"  governing  power,  wholly  different 
from  any  attribute  of  inorganic  nature,  and  therefore  render  it  certain 
in  another  aspect,  that  the  chemist,  from  want  of  this  agent,  can,, at 
most,  only  effect  the  elanentary  analysis  of  organic  compounds.  Thus, 
then,  the  organic  chemist : 

"  If  the  problem  to  be  solved  by  organic  chemistry  be  this,  namely, 
to  explain  the  changes  which  the  food  undergoes  in  the  animal  body; 
then  it  is  the  business  of  this  science  to  ascertain  what  elements  must 
be  added,  what  elements  must  be  separated,  in  order  to  effect,  or,  in 
general,  to  render  possible,  the  conversion  of  a  given  compound  into 
a  second  or  third ;  but  we  cannot  expect  from  it  the  synthetic  proof 
of  the  accuracy  of  the  views  entertained,  because  every  thing  in.  the  or 
ganization  goes  on  under  the  influence  of  the  vital  force,  an  immate- 
rial AGENT  ivhicJt  the  chemist  cannot  employ  at  will" — Liebig's  An- 
imal Chemistry. 

18,  d.  If  we  now  tuni  to  section'409,  b,  we  shall  there  find  that  it 
is  in  the  blood  alone  that  the  reputed  proximate  principles  of  vegeta- 
bles are  assumed  to  exist,  and  that  many  proximate  compounds  ars 
allowed  by  the  chemist  to  be  elaborated  from  the  blood  to  which 
there  is  nothing  at  all  analogous  in  the  vegetable  kingdom,  or  even  in 
the  blood  itself 

This,  then,  is  the  sum  of  the  whole  subject:  1st.  The  chemist  hashia 
favorite  doctrine  of  digestion,  as  an  important  foothold  for  material- 
ism, forever  present,  to  be  extended  as  far  as  the  obscurities  of  the 
subject  will  admit,  and  to  borrow  an  apparent  confirmation  from  these 
predicated  assumptions.  The  absolute  amount  of  that  doctrine  is 
thus  expressed  by  Liebig: 

"  In  the  natural  state  of  the  digestive  process,  the  food  only  under- 
goes a  change  in  its  state  of  cohesion,  becoming  fluid  without  any 
other  change  of  properties." — Liebig's  Animal  Chemistry. 

2d.  Now,  the  food  undergoing  no  other  change  "  in  the  digestive 
process"  than  that  of  becoming"  fluid,"  it  is  the  easiest  matter  to  find 
it  all  in  the  blood  just  as  it  was  taken  into  the  stomach, — vegetable  as 
well  as  animal ;  while,  in  so  finding  it,  a  pretended  confinnation  is  set 
up  of  the  "  universal  fact,  to  which  nothing  yet  known  is  opposed, 
that  the  nitrogenized  constituents  of  vegetable  food  have  a  compo- 
sition identical  with  that  of  the  blood,"  and  vice  versa.  Or,  as  Liebig 
also  has  it,  "  vegetables  produce  in  their  organism  the  blood  of  all 
anitnals"  (§  350,  no.  76). 

But,  6d.  We  are  assured  by  chemists,  that  nothing  is  more  diffi- 
cult of  analysis  than  the  blood,  even  as  it  respects  its  elementary  com- 
position; while  it  is  well  known  that  the  analyses  of  this  fluid  are 
always  discrepant.  Hence  the  impracticability  of  instituting  unex- 
ceptionable comparisons  between  even  the  elementary  composition  of 


PHYSIOLOJ3Y. 


19 


"  In  the  natural  state  of  the 
digestive  process,  the  food 
only  undergoes  a  change  in 
its  state  of  cohesion,  becom- 
ing fluid  without  any  other 
change  of  properties." — Lie- 
big's  Animal  Chemistry. 


blood  and  the  nitrogenized  constituents  of  plants ;  while  the  very 
nature  of  the  chemical  influences  exerted  upon  a  vital  compound  of 
17  or  18  elements  vi^ith  a  view  to  its  analysis  is  conclusive  of  the  arti- 
ficial condition  of  all  the  chemical  compounds  which  may  be  thus 
fymed  out  of  the  homogeneous  fluid.   And  so  Lehmann,  ^  1029, 1030. 

Again,  4th  It  is  finally  said  that  many  substances  elaborated  from 
the  blood  are  utterly  difterent  from  any  thing  discovered  in  plants,  or 
in  the  blood  itself  (§  409,  h).  Here,  the  composition  of  the  organic  sub- 
stances being  simple,  readily  leads  to  an  exposure  of  the  assumptions 
which  have  taken  refuge  under  the  greater  difficulties,  and  obscu- 
rities, and  disagreements,  attending  the  analysis  of  the  most  complex 
substance  known  in  nature  {§  53). 

18,  e.  But  we  shall  see,  farther  on,  that  the  chemical  school  main- 
tain, through  their  principal  chief,  those  doctrines  of  digestion,  to 
suit  other  hypotheses  in  organic  chemistry,  which  are  fundamentally 
opposed  to  each  other,  and  which  I  shall  now  arrange  in  connection, 
that  the  reader  may  see,  at  a  glance,  not  only  the  speculative  nature 
of  organic  chemistry,  but  the  feebleness  of  the  assumption  as  to  the 
identity  of  the  blood  and  the  nitrogenized  constituents  of  plants 
Thus  : 

B. 

"  The  VITAL  FORCE  CAUSES 

A  DECOMPOSITION  of  the  con- 
stituents of  food,  and  destroys 
the  force  of  attraction  which 
is  continually  exerted  be- 
tween their  molecules.  It 
alters   the   direction  of   the 

CHEMICAL    FORCES     in    SUch 

wise,  that  the  elements  of 
the  constituents  of  the  food 
arrange  themselves  in  an- 
other form,  and  combine  to 
produce  7iew  compounds.  It 
forces  the  new  compounds 
to  assume  forms  altogeth- 
er DIFFERENT  from  those 
which  are  the  result  of  the 
attraction  of  cohesion  when 
acting  freely,  that  is,  without 
resistance." — Liebig's  Ani- 
mal Chemistry. 

It  will  be  therefore  seen  by  the  quotations  B  and  C,  that  the  state- 
ment is  admitted  to  be  a  mere  assumption ;  while  it  necessarily  fol- 
lows, by  adopting  either  of  the  contradictory  statements,  B  or  C, 
that  the  veo^etable  substances  undergo  a  radical  chana;e  during:  the 
process  of  digestion,  and,  therefore,  that  we  cannot  find  those  sub- 
stances in  the  blood,  but  their  elements,  only,  in  new  and  peculiar 
combinations.  The  differences,  indeed,  are  probably  often  much 
greater  than  between  calomel  and  corrosive  sublimate  (§  3501). 

What,  also,  gives  to  the  whole  of  this  subject  its  proper  interpre- 
tation is  the  parallel  which  is  drawn  by  Liebig  between  the  assimila- 
tion of  the  most  virulent  poisons  and  the  most  appropriate  food,  as 
set  forth  in  Section  350,  Nos.  41  and  42.  The  looseness  of  the  clos- 
ing sentence  of  No.  41,  abstracted  from  all  the  surrounding  evidence 
of  hypothesis,  is  abundantly  conclusive  of  the  conjectural  natui'e  of 
the  whole  of  this  pretended  mathematical  demonstration. 

There  is  no  difliculty,  however,  in  comprehending  the  source  of 
the  mistake   which    honest  chemists  have    made  in  attempting,  by 


C. 
"The  most  decisive  ex- 
periments of  physiologists 
have  shown  that  the  process 
of  CHYMiFiCATioN  is  inde- 
pendent of  the  vital  force  ; 
that  it  takes  place  in  virtue 
of  a  PURELY  chemical  ac- 
tion, exactly  simitar  to 
those  processes  of  decom- 
position or  ti'ansformation 
which  are  known  as  putre- 
faction, fermentation,  or 
decay." — Liebig's  Animal 
Chemistry. 


20  INSTITUTES    OF    MEDICINE. 

chemical  analysis,  to  indicate  the  proper  sustenance  of  man  and  ani 
mals.  It  lies  in  a  wrong  conception  of  the  economy  of  vegetable 
life,  and  thence  reasoning  from  a  mistaken  coincidence  of  princi- 
ples, which  exist  in  the  two  departments  of  the  organic  kingdom  in 
a  strikingly  modified  state,  to  their  more  analogous  results  {§  1^, 
13-17).— Notes  N  R  pp.  1121,  1123. 

Since,  however,  plants  subsist  upon  mineral  substances,  in  their 
elementary  state,  the  chemist  may  often  successfully  indicate  those 
inorganic  or  organic  compounds  which  will  yield  to  any  given  species 
of  plant  (whose  general  elementary  composition  may  be  known)  the 
elements  that  go  especially  to  its  nutritive  economy.  But,  from  a  fun- 
damental distinction  between  plants  and  animals  (§  11,  13-17),  it  is  ob- 
vious that  no  such  thing  can  be  done  in  relation  to  the  latter.  No 
better  practical  proof  of  this  can  be  wanted  than  the  perfectly  indiges- 
tible nature  of  many  compounds  which  contain  the  requisite  elements. 
Such  compounds,  upon  the  chemical  philosophy,  as  I  have  said,  and 
as  admitted  by  Liebig,  include  many  virulent  poisons  in  the  vege- 
table kingdom,  and  many  inorganic  substances  whose  binary  com- 
pounds embrace  numerous  elements.  We  need  not,  indeed,  go  any 
farther  than  the  recent  experiments  by  Dr.  Beaumont  upon  the  va- 
rieties of  food,  as  will  be  subsequently  noticed  (366),  and  Magendie's 
analogous  experiments  with  the  food  of  animals,*  to  show  that  the 
whole  of  this  subject  must  be  left  to  natural  experience. 

Nor  does  it  appear  to  have  occurred  to  the  chemical  physiologist, 
in  the  foregoing  inquiries,  that  the  elementary  composition  of  animals 
is  greatly  alike,  at  least  in  all  mammalia.  It  should  follow,  there- 
fore, upon  the  chemical  philosophy,  that  the  practical  distinctions 
should  not  exist  between  the  food  of  man  and  animals,  but  that  a 
common  diet  should  be  as  universally  adapted  as  atmospheric  air. 
To  this  conclusion  it  may  be  also  added,  that  the  same  chemical  phi- 
losophy refers  chymification  to  a  purely  chemical  pi'ocess ;  or,  in  the 
language  of  Liebig,  "  it  takes  place  in  virtue  of  a  purely  chemical 
action,  exactly  similar  to  those  processes  of  decomposition  or  trans- 
formation which  are  known  ?i&  putrefaction, fervientation^  or  decay y — 
Animal  Chemistry^  p.  16.  And  since,  therefore,  chymification  is 
"  independent  of  the  vital  force"  {ibid.),  and  as  chemistry  identifies 
the  gastric  juice  of  man  and  quadrupeds,  and  even  the  chyme,  it  is 
obvious  that  chemistry  can  predicate  nothing,  upon  this  subject,  of 
any  difference  in  the  vital  constitution  of  man  and  animalst  (§  409, 
350,  d). 

19.  In  respect  to  their  general  structui'e,  inorganic  bodies  are  ho- 
mogeneous, organic  beings  heterogeneous.  This  applies  as  well  to 
the  elementary  constituents  in  their  modes  of  combination  as  to  the 
compound  structure  of  the  whole  being.  Each  particle  of  a  mineral 
compound  is  as  much  a  whole  as  the  gi-eater  mass,  and  has  the  same 
combination  of  elements.  Each  element  is  as  perfect  as  the  com- 
jiound  conditions.  Animals  have  muscles,  glands,  nerves,  vessels, 
&;c.,  with  an  endless  variety  in  the  elementary  combinations  in  the 
same  individual.  All  these  parts  are  necessary  to  make  a  whole,  and 
depend,  mutually,  upon  each  other  for  their  existence.     The  same 

*  See  Medical  and  Physiological  Commentaries,  vol.  i.,  p.  697,  &c. 
t  See  my  article  on  the  foregoing  subject  in  the  Boston  Medical  and  Surgical  Journal 
December  27,  1843. 


PHYSIOLOGY.  21 

general  principle  is  applicable  to  plants.  Nevertheless,  apparent  ex- 
ceptions occur  in  both  animated  kingdoms,  as  in  ])arts  of  many  plants 
and  of  polypi.  But,  in  these  instances,  each  part  possesses  essential- 
ly the  whole  apparatus  of  organic  life. 

20.  Organic  beings  grow  from  within  by  interstitial  deposition  of 
molecules  derived  from  the  blood  or  sap,  according  to  the  exact  na- 
tui'e  of  each  part.  Inorganic  bodies  do  not  grow,  but  increase  only 
by  a  superficial  juxtaposition  of  parts,  which  may,  also,  be  wholly 
unlike  the  original  crystal,  or  other  nucleus,  in  their  elements. 

In  the  process  of  growth  and  nutrition  the  new  material  is  con- 
veyed within  from  without,  and  subjected  to  many  specific  changes, 
till  it  is  resolved  into  one  homogeneous  fluid.  Atmospheric  air  is 
also  indispensable  to  all  organic  beings,  Thex'e  is  nothing  analo- 
gous in  the  inorganic  world ;  while  these,  and  an  endless  series  of 
other  facts,  establish  the  similitude  of  the  organic  life  of  plants  and 
animals. 

21.  A  peculiar  action  of  certain  agents  upon  the  whole  organism 
of  plants  and  animals,  called  vital  stimuli,  entirely  unlike  the  action 
of  chemical  agents,  is  necessary  to  the  growth  and  existence  of  or- 
ganic beings.  They  are  both  internal  and  external,  and  give  rise  to 
all  the  phenomena  in  organic  life,  and  maintain  the  whole  in  one  ex- 
act condition ;  while  the  action  of  agents  upon  inorgaisic,  or  on  dead 
organic,  substances,  does  not  elicit  one  of  these  multifarious  phenom- 
ena (§  74,  1881). 

22.  Every  part  of  an  animal  or  vegetable  is  forever  distinguished 
by  the  same  vital  phenomena  and  physical  results ;  and  the  action  of 
vital  stimuli  is  forever  the  same  on  each  part,  respectively,  but, 
like  the  vital  phenomena  and  physical  results,  different  in  each ;  the 
whole  being  liable  to  invariable  modifications  at  different  stages  of 
life,  and  according  to  temperament,  and  according,  also,  to  every 
other  modifying  influence. 

23.  Unlike  inorganic  bodies,  organic  beings  require  the  coexist- 
ence of  solids  and  fluids  in  their  composition. 

24.  All  organic  beings  have  the  power  of  generating  motion  within 
all  their  parts.  Mineral  compounds  have  no  such  endowment.  If 
motion  take  place  in  their  internal  constitution,  it  depends  upon  in- 
fluences which  have  no  existence  in  living  beings.  Nor  is  this  all ; 
for  motion  is  always  generated  in  living  beings  by  the  operation  of  a 
power  implanted  in  their  constitution,  and  this  power  is  brought  into 
action  by  the  mind,  and  by  internal  and  external  physical  agents. 

25.  The  solids  and  certain  fluids  of  organic  beings  act  upon  each 
other.  But  the  fluids  act  only  upon  the  organic  properties  of  the 
solids,  while  the  solids  transmute  the  most  important  fluid  into  their 
own  substance.  The  stimulant  action  of  the  blood  upon  the  organic 
properties,  and  the  reaction  of  the  solids  upon  the  blood,  are  design- 
ed for  a  common  end.  The  concurrence  of  the  whole  fabric  is  ne- 
cessary to  these,  as  to  all  other,  results.  There  is  nothing  analogous 
in  the  mineral  kingdom. 

26.  When  external  or  internal  agents  produce  motion  in  organic 
beings,  they  do  not  affect  the  composition,  in  the  natural  state.  It  is 
quite  otherwise  with  inorganic  or  dead  organic  compounds. 

27.  Organic  beings  are  perpetually  subject  to  a  vital  decomposition 
and  removal  of  old  parts,  while  the  old  are  exactly  replaced  by  new 


22  INSTITUTES    OF    MEDICINE. 

ones.  It  is  essential  to  mineral  compounds  that  they  remain  without 
change.  Any  disturbance  of  their  molecules  deranges  their  structure 
or  composition. 

"While,  therefore,  inorganic  compounds  are  forever  the  same,  or- 
ganic beings  are  subject  to  an  unceasing  loss  of  identity  as  respects 
their  present  component  parts. 

28.  The  external  foi-ms  of  plants  and  animals  are  variously  and 
greatly  contradistinguished  from  those  of  inorganic  bodies.  The 
condition  of  one,  also,  is  uniform ;  that  of  the  other,  even  when  crys- 
talized,  is  vat'iable. 

29.  "  The  only  character,"  says  Muller,  "  that  can  be  possibly 
compared  in  organic  and  inorganic  bodies,  is  the  mode  in  which  sym- 
metry is  realized  in  each ;  that  is  to  say,  the  character  which  miner- 
als possess  in  their  state  of  crystalization."  Yet  there  is  not,  in  this 
respect,  the  slightest  analogy ;  since  no  true  organic  compound  ever 
approaches  the  condition  of  a  crystal.  Here  we  may  trust  the  au- 
thority of  Liebig,  who  says  of  the  "vital  principle  of  the  animal 
ovum,  as  well  as  the  seed  of  a  plant,"  that, 

"  Entering  into  a  state  of  motion  or  activity,  it  exhibits  itself  in  the 
production  of  a  series  of  forms,  which,  although  occasionally  bounded 
by  right  lines,  are  yet  widely  distinct  from  geometrical  forms,  such  as 
we  observe  in  crystalized  minerals.  This  force,"  he  goes  on,  "  is  the 
vital  force,  vis  vitae,  or  vitality." 

30.  The  foregoing  considerations,  each  and  all  (§  8-29),  demon- 
strate a  radical  difference  between  the  forces  and  laws  of  organic  and 
inorganic  beings,  and  a  remarkable  modification  of  such  as  are  com- 
mon to  plants  and  animals.  But,  as  the  institutions  of  organic  life  lie 
at  the  foundation  of  medical  science,  they  should  be  still  farther 
sought  in  the  contradistinctions  between  the  organic  and  inorganic 
kingdoms,  and  in  those  diversified  phenomena  which  indicate  a  com- 
mon but  modified  government  of  animals  and  plants.  All  organic- 
beings  possess  in  common  the  most  essential  conditions  of  life,  though 
existing  in  the  two  great  departments  of  living  nature  under  specific 
modifications  or  varieties  ;  not,  how^ever,  very  dissimilar,  but  inti- 
mately connected  by  a  gradation  of  analogies,  as  we  descend  along 
the  chain  of  either,  till  we  arrive  at  their  more  absolute  connecting 
link  in  the  lowest  being  of  one  and  the  other.  Other  conditions  are 
superadded  to  the  nobler  dej^artment,  which,  with  the  differences  of 
structure  and  the  modifications  of  their  common  properties  of  life,  and 
their  modes  of  subsistence,  distinguish  the  two  living  kingdoms  from 
each  other. 

31.  Physiology  may  be  divided  into,  1st.  The  composition  of  or- 
ganic beings  ;  2d.  Their  structure  ;  3d.  Their  properties ;  4th.  Their 
functions  ;  5th.  Modifications  of  properties  and  functions  which  arise 
from  sex,  temperament,  climate,  habits,  age,  &c. ;  6th.  The  relations 
of  organic  beings  to  external  objects  ;  7th.  Death. 

These  several  topics  will  be  considered  with  a  special  view  to  the 
great  principles  which  form  the  Institutes  of  Medicine. 


PHYSIOLOGY.- — COMPOSITION.  23 

FIRST  DIVISION  OF  PHYSIOLOGV. 

COMPOSITION. 

32.  The  principal  object  contemplated  by  this  work  in  ascertaining 
the  facts  relative  to  the  composition  of  organic  beings  is  to  settle  the 
principles  and  laws  upon  which  such  beings  are  constituted,  by  tracing 
them  out  in  the  fundamental  conditions  of  organic  matter. 

33.  Composition  is  subdivided  into  ultimate  or  elementary,  and  the 
proximate  parts;  the  latter  being  compounded  of  the  former. 

34.  Of  the  sixty-six  known  elementary  substances,  the  following 
seventeen  have  been  found  in  the  composition  of  plants  :  carbon,  oxy- 
gen, hydrogen,  nitrogen,  potassium,  calcium,  ii'on,  manganese,  phos- 
phorus, sulphur,  silicium,  magnesium,  aluminum,  chlorine,  sodium, 
iodine,  bromine. 

35.  The  same  elements  (34),  with  the  addition  of  fluor,  and  the 
probable  exception  of  aluminum,  occur  in  animals.  Arsenic  is  also 
often  found  in  man.*  Although  animals  are  exposed  to  various 
sources  from  which  other  elements  might  be  derived,  they  reject  ev- 
ery other  elementary  principle ;  or,  rather,  are  incapable  of  their 
assimilation. — Notes  N  R  pp.  1121,  1123. 

36.  The  foregoing  coincidence  in  the  common  nature  of  the  ele- 
ments of  plants  and  animals  supplies  no  small  proof  of  the  peculiar 
properties  and  laws  of  organic  beings.  Others,  however,  more  stri- 
king, lie  at  the  foundation,  and  form,  also,  contradistinctions  with  the 
inorganic  world. 

37.  Animal  and  vegetable  substances  are  mostly  composed  of  car- 
bon, oxygen,  hydrogen,  and  nitrogen,  four  out  of  the  sixty-six  ele- 
ments that  go  to  the  formation  of  inorganic  compounds.  The  main 
bulk  of  plants,  indeed,  such  as  the  cellular  and  vascular  tissues,  is 
probably  composed  of  carbon,  hydrogen,  and  oxygen  alone,  as  the 
essential  elements ;  though  nitrogen  is  indispensable  to  many  of  the 
products  of  vegetable  organization,  and  Liebig  says  it  is  found  in  all 
parts  of  a  plant  (§  62, y,  note).  The  three  or  four  indispensable  ele- 
ments compose  90  or  more  parts  of  100  of  all  the  soft  textures  of  an- 
imals, and  of  all  plants.  These  are  selected,  universally,  by  the  veg- 
etable kingdom,  as  if  by  instinct.  This  circumstance  increases  great- 
ly the  force  of  the  conclusion  in  the  foregoing  section  (§  36). 

38.  The  elements  of  mineral  compounds  are  always  united  in  a 
binary  manner ;  those  of  organic  in  a  ternary,  quater-nary,  &c.,  being 
always  intimately  blended  with  each  other.  This  distinction  involves 
an  absolute  difference  in  the  powers  and  laws  of  the  two  kingdoms. 

39.  No  two  elements,  therefore,  can  form  a  true  organic  compound. 
The  rare  exceptions  which  have  been  made  by  the  chemists  are  not 
organic  substances,  nor  can  they  be  rendered  such  by  the  animal  or- 
ganization. They  belong  to  the  mineral  kingdom,  from  which  they 
cannot  be  elevated  but  by  the  properties  of  vegetable  life  (§  14, 16, 17). 

All  mineral  compounds  may  be  resolved  into  their  elements,  which 
are  as  perfect  minerals  as  when  united.  Indeed,  the  most  natural  con- 
dition of  a  mineral  is  the  state  of  a  simple  element. 

*  Whence  coiri«  Uio  fluor  aiid  the  arsenic,  unless  through  plants?  ($  14-18.) 


24  INSTITUTES    OP    MEDICINE. 

40.  What,  therefore,  is  so  fundamental  in  oi-ganic  beings  as  ex- 
pressed in  sections  38  and  39,  and  universally  admitted,  allows  of  no 
introduction  of  powers,  principles,  laws,  &c.,  which  shall  conflict  with 
the  poweis  and  laws  upon  which  the  simplest  organic  compound  is 
constituted.*  In  the  progress  of  this  work  it  will  be  seen  that  this 
position  is  every  where  substantiated.  Unity  and  harmony  prevail 
throughout  each  department  of  nature,  respectively ;  and  while  the 
powers  and  laws  of  the  organic  are  as  fully  contradistinguished  from 
those  of  the  inorganic  kingdom  as  are  their  physical  and  all  other  attri- 
butes, we  shall  find  that  the  former  are  apparently  embarrassed  by  a 
great  diversity  of  phenomena  as  manifested  in  health  and  disease,  but 
that,  in  reality,  all  the  variety  goes  to  the  conclusion  that  the  funda- 
mental principles  are  the  same  throughout  (§  638,  733,  d). 

41.  Again,  we  may  suppose  at  least  some  20,000,000  of  distinct  or- 
ganic compounds  in  the  various  species  of  plants,  and  some  30,000,000 
more  in  the  animal  kingdom,  formed  greatly  out  of  four  elements 
(§  37),  wliile  these  same  elements  yield  scarcely  a  dozen  combina- 
tions in  the  mineral  kingdom. 

42.  The  foregoing  organic  compounds  are  formed  in  each  individ- 
ual, respectively,  out  of  one  common  homogeneous  fluid,  composed  of 
about  seventeen  elements.  No  chemical  hypothesis  can  interpret 
this  universal  characteristic  of  the  organic  kingdom ;  while  all  the 
relative  facts  of  inorganic  chemistry  are  totally  opposed  to  this  almost 
endless  and  undeviating  variety  of  new  combinations  out  of  a  common 
fluid,  according  to  the  species  of  animal  or  plant,  and  according  to  the 
nature  of  every  particular  part.  If  chemical  agencies  operated,  there 
would  be  no  uniformity  in  any  secreted  product  at  any  two  successive 
moments  (§  741,  b,  1052). 

It  is  one  of  the  frequent  concessions  of  the  distinguished  chemico- 
vitalist,  Miiller,  that 

"  The  opinion  that  the  component  principles  of  the  organs  exist  in 
the  blood  in  their  perfect  state  cannot  be  possibly  adopted.  The  com- 
ponents of  most  tissues,  in  fact,  present,  besides  many  modifications 
of  fibrin,  albumen,  fat,  and  ozmd.z.omG,  other  perfectly  peculiar  matters, 
nothing  analogous  to  which  is  contained  in  the  blood."  "  Even  the 
fibrin  of  muscle  cannot  be  considered  identical  with  the  fibrin  of  the 
liquor  sanguinis." — Muller. — So,  also,  Lehmann,  §  1029-1031. 

John  Hunter  also  laid  down  the  following  doctrine,  as  expressed  by 
his  editor,  Mr.  Palmer  : 

"  It  is  highly  probable  that  the  different  proximate  principles  of 
vegetable  and  animal  substances  hold  different  ranks  in  the  scale  of 
organized  substances,  in  the  same  manner  that  one  animal  ranks  high- 
er in  the  scale  of  organized  beings  than  another." — Huntek. 

And  thus  Liebig,  as  a  vitalist,  in  opposition  to  himself,  as  a  chemist : 

"  In  that  endless  series  of  compounds,  which  begins  with  carbonic 
acid,  ammonia,  and  water,  the  sources  of  the  nutrition  of  vegetables, 
and  includes  the  most  complex  constituents  of  the  animal  brain,  there 

is  NO  BLANK,  NO  INTERRUPTION.  TlIE  FIRST  SUBSTANCE  CAPABLE  OF 
AFFORDING  NUTRIMENT  TO  ANIMALS  IS  THE  LAST  PRODUCT  OF  THE  CRE- 
ATIVE ENERGY  OF  VEGETABLES." — Liebig's  Animal  Chemistry. 

*  Since  the  foregoing  sentence  was  written,  tlie  new  doctrine  of  the  "  Correlation  of 
Physical  and  Vital  Forces"  has  induced  Chemistry  to  exalt  a  multitude  of  its  fabrica- 
tions out  of  inorganic  substances  to  the  condition  of  organic  compounds.  But  this  will 
probably  soon  "mark  a  past  epoch  in  Organic  Chemistry."  See  Note  1>f  p.  1150; 
also  LiiiLMANX,  p.  779-782. 


rKYSIOLOGY. COMPOSITION.  25 

43.  Although  it  be  generally  true  that  it  is  the  wonderful  province 
of  organization  to  elect  only  four  elements  from  the  homogeneous  fluid 
(§  42)  in  the  formation  of  organic  compounds,  yet  there  are  some  com- 
pounds which  embrace  a  greater  number,  though  unlike  the  elements 
of  inorganic  compounds,  in  intimate  union  with  each  other  (§  38). 
The  blood,  indeed,  has  not  less  than  seventeen  or  eighteen  elements 
thus  united;  a  circumstance  in  itself  conclusive  that  other  powers  than 
the  chemitial  must  preside  over  the  elaboration  of  the  very  limited 
number  of  elements  that  go  uniformly  to  the  formation  of  all  other 
organic  compounds.  And,  although  the  metallic  and  earthy  sub- 
stances form  no  part  of  the  essential  organs  of  life,  they  are  yet 
vitally  united  with  the  indispensable  organic  compounds  in  particu- 
lar parts,  and  are  elaborated  from  the  blood  or  sap  by  those  parts 
only,  and  with  an  astonishingly  relative  proportion  to  the  other 
elements,  as  sulphur  by  the  brain,  phosphate  of  lime  by  the  bones, 
fluate  of  lime  by  the  teeth,  phosphate  of  magnesia  by  wheat,  silex  by 
the  stem  of  wheat,  and  by  the  skeletons  of  many  poriferi,  &c.  We 
shall  not  regard  these  substances  as  accidental,  or  as  introduced  by 
a  physical  process,  but,  as  contributing  a  subordinate  part  with  the 
essential  organic  elements  toward  the  perfection  of  an  unfathomable 
system  of  Designs,  whose  moving  power  is  only  short  of  the  Creative 
Energy,  in  being  substituted  for  that  Great  First  Cause,  with  limita- 
tions that  chain  it  to  the  fulfillment  of  secondary  ends  (§  847). 

44.  Organic  compounds  are  forever  the  same,  in  health,  in  any  given 
part  of  any  species  of  being  at  each  stage  of  existence,  but  liable 
to  be  moi"e  or  less  modified  in  an  exact  manner  at  the  several  stages 
(§  153-159). 

And  so  of  disease.  The  same  morbid  state  of  any  given  part,  ccete- 
ris  paribus,  always  produces  the  same  modifications  of  the  organic 
compounds  of  which  it  may  be  composed,  the  same  alterations  of  the 
secreted  fluids,  and  the  same  new  formations.  All  this  is  distinctly 
seen  in  the  phases  of  scrofula,  in  small-pox,  cow-pox,  lues,  measles,  hy- 
drophobia, &c. 

It  is  opposed,  to  all  facts,  that  any  chemical  influences  can  decom- 
pound a  fluid  composed  of  seventeen  or  eighteen  elements,  not  only  in 
the  exclusive  manner  represented  in  the  last  section,  but  according, 
also,  to  the  exact  vital  constitution  or  vital  modification  of  each  part, 

45.  Nevertheless  (§  44),  the  general  composition  of  animals  is  the 
same,  whether  they  subsist  upon  grass,  or  flesh,  or  whatever  be  the 
nature  and  variety  of  the  food.  So  of  the  chyme,  the  chyle,  and  the 
blood.  There  is  nothing  in  chemistry  that  will  throw  any  light  upon 
these  coincidences  (§  18,  409). 

46.  Contrary  to  what  has  been  seen  of  the  variety  of  organic  com- 
pounds out  of  four  simple  elements  (§  41),  only  a  few  hundred,  at  most, 
of  distinct  inorganic  compounds  can  be  formed  out  of  the  66  elements 
which  compose  the  mineral  kingdom  (§37).  Those  few  compounds, 
however,  make  up  the  great  mass  of  the  globe,  while  the  organic  are 
only  scattered  over  its  surface.  Nor  is  there  a  globe  in  the  universe 
that  would  not  be  as  worthless  as  space,  did  it  not  administer  to  the 
purposes  of  life. 

47.  Different  combinations  of  carbon,  oxygen,  hydrogen,  and  nitro- 
gen, constitute,  mainly,  the  whole  vegetable  and  animal  materia  medi- 


i26  INSTITUTES    OF    MEDICINE. 

ca;  while  their  inorganic  compounds  do  not  contribute  one  remedial 
agent  of  any  importance. 

48.  It  is  evident  that  the  four  principal  elements  of  organic  com- 
pounds combine  not  only  in  different  proportions,  but  so  variously,  in 
respect  to  the  proportions,  among  themselves,  as  to  bevv'ilder  the 
imagination  (§41).  Chemistry  can  give  us  no  light  upon  these  sub- 
jects but  what  is  purely  analytical ;  while,  in  respect  to  their  mineral 
compounds,  the  same  elements  unite  only  in  a  small  number  of  pro- 
portions, upon  which  chemistry  throws  its  light  with  a  brilliancy  that 
may  be  said  to  penetrate  the  unfathomable  recesses  of  their  organic 
compounds.  This  fundamental  distinction  is  necessarily  conceded ; 
and  it  were  well  for  science  if  chemistry  did  not  overstep  the  limit. 
But,  the  chemist  shall  always  speak  for  himself.     Thus  Liebig  : 

"  6  eq.  tartaric  acid,  by  absorbing  6  eq.  oxygen  from  the  air, 
form  grajje  sugar,  with  the  separati(jn  of  12  eq.  carbonic  acid.  We 
can  explain,  in  a  similar  manner,  the  formation  of  all  the  component 
substances  of  plants,  which  contain  no  nitrogen,  whether  they  are  pro- 
duced from  carbonic  acid  and  water,  with  separation  of  oxygen,  or  by 
the  conversion  of  one  substance  into  the  other,  by  the  assimilation  of 
oxygen  and  separation  of  carbonic  acid.  We  do  not  know  in  lohat 
form  the  froduction  of  these  constituents  takes  place.  In  this  respect 
the  representation  of  their  formation  which  we  have  given  must  not  he 
received,  in  an  ahsolute  sense,  it  being  intended  only  to  render  the  na- 
ture of  the  process  more  capahle  of  comprehension.  But,  it  must  not  be 
forgotten,  that,  if  the  conversion  of  tartaric  acid  into  sugar,  in  grapes, 
he  considered  a  fact,  it  must  take  place  vmder  all  circumstances  in  the 
same  proportions''''  ! — Liebig's  Organic  Chctnistrij  applied  to  Physi- 
ology. 

The  reader  should  never  lose  sight  of  the  foregoing  hypotheses 
and  admissions.  They  should  be  ever  ready  to  chasten  his  credulity 
as  to  the  chemical  interpretation  of  every  organic  compound.  They 
stamp  the  whole  "  science  of  organic  chemistry,"  in  its  synthetical 
aspects,  as  one  of  pretension,  and' unworthy  the  confidence  of  an  intel- 
ligent mind  (§  350-350^). 

And  this  is  farther  confirmed  by  the  statements  in  the  two  next 
following  sections. 

49.  "  The  particles  of  matter,"  says  Liebig,  "  called  equivalents  in 
chemistry,  are  not  infinitely  small,  for  they  possess  a  weight,  and  are 
capable  of  arranging  themselves  in  the  most  various  ways,  and  of  thus 
forming  innumerable  compound  atoms.  The  properties  of  these 
compound  atoms  differ  in  organic  nature,  not  only  according  to  the 
form,  but,  also,  in  many  instances,  according  to  the  direction  and 
place  which  the  simple  atoms  take  in  the  compound  molecules. 

"  When  we  compare  the  composition  of  organic  compounds  with 
inorganic,  we  are  quite  amazed  at  the  existence  of  combinations  in 
one  single  molecule,  of  which  ninety  or  several  hundred  atoms  or 
equivalents  are  united.  Thus,  the  compound  atom  of  an  organic  acid 
of  very  simple  composition,  acetic  acid,  for  example,  contains  12 
equivalents  of  simple  elements ;  1  atom  of  kinovic  acid  contains  33 ; 
1  of  sugar,  36  ;  1  of  amygdalin,  90  ;  1  of  stearic  acid,  138  equivalents. 
The  component  parts  of  animal  bodies  are  infinitely  more  complex 
even  than  these." — Liebig's  Organic  Chemistry,  &c. 

»50.  "  Inorganic  compounds  differ  from  oi'ganic  in  as  great  a  degree 


PHYSIOLOGY. COMPOSITION.  27 

in  their  other  characters  as  in  their  simplicity  of  constitution.  Thus, 
the  decomposition  of  a  compound  atom  of  sulphate  of  jaotash  is  aided 
by  numerous  causes,  such  as  the  power  of  cohesion,  or  the  capability 
of  its  constituents  to  form  solid,  insoluble,  or,  at  certain  temperatures, 
volatile  compounds  with  the  body  brought  into  contact  with  it ;  and, 
nevertheless,  a  vast  number  of  other  substances  produce  in  it  not  the 
slightest  change.  Now  in  the  decomposition  of  a  complex  organic 
atom  there  is  nothing  similar  to  this." — Liebig's  Organic  Chemistry . 
&c. 

51,  "An  essential  distinction  between  organic  and  inorganic  com- 
pounds is,  that  in  organic  products  the  combining  proportions  of  their 
elements  do  not  observe,  as  in  mineral  compounds,  a  simple  arith- 
metical ratio." 

52,  An  interesting  corollary  flows  from  the  foregoing  facts  (§  22, 
41-50),  namely,  that  all  animal  and  vegetable  poisons,  all  remedial 
agents  of  an  organic  nature,  and  all  the  varieties  of  food,  depend  upon 
the  mode  and  proportions  in  which  a  few  particular  elements 
unite  with  each  other.  It  is  evident,  also,  from  §  41,  that  uo  two  re- 
medial agents  generated  by  different  species  of  plants  or  animals, 
however  similar,  can  be  exactly  alike  in  their  morbific  or  remedial 
virtues.  Hence  the  differences  among  cathartics,  emetics,  &c.  As 
composition,  especially  of  the  sap,  also  varies  more  or  less  at  the  dif- 
ferent ages  of  plants  and  at  diflerent  seasons,  and  also  from  unhealthy 
conditions,  so  will  corresponding  differences  arise  in  their  remedial 
and  morbific  virtues.  In  all  the  cases,  however,  the  characteristics  of 
organic  products  as  vital  agents  are  uniformly  the  same  under  any 
given  condition  of  the  organic  being;  and  so  of  each  simple  element, 
and  of  the  physiological  effects  of  all  vital  agents  (§  188^,  d).  The 
precise  natural  or  morbid  states  of  the  organic  properties  lie  at  the 
bottom  of  the  whole  philosophy,  since  these  properties,  through  their 
instruments  of  action,  combine  the  elements  exactly  according  to  their 
existing  state  (§  650,  741  5,  Note  Fff  p.  1150). 

53,  a.  From  the  facts  now  stated  (§  38-51),  it  is  evident  that  the 
organic  chemist  can  do  no  moi'e  than  effect  an  analysis  of  organic 
compounds.  He  can  only  present  each  simple  element  by  itself, 
without  the  possibility  of  acquiring  a  knowledge  of  the  modes  and 
pi'oportions  in  which  they  combine  with  each  othei*. 

53,  b.  So,  also,  if  the  aggregate  compounds,  such  as  blood,  sap, 
muscle,  gastric  juice,  &c.,  be,  in  reality,  made  up  of  more  simple 
compounds,  or  "  proximate  principles,"  by  the  union  of  compound 
atoms,  chemistry  can  give  us  no  information  as  to  the  conditions  in 
which  they  naturally  exist.  Those  combinations  which  are  most 
alike  are  different  from  each  other  in  eveiy  distinct  part  of  the  or- 
ganic being,  and  different  in  the  same  parts  of  distinct  species.  This 
is  so  from  the  first  development  of  the  germ  ;  and  what  is  then  begun 
is  perpetuated  through  the  life  of  the  individual,  and  transmitted  to  all 
succeeding  generations  (§  63-81 , 1 55).  The  differences,  as  we  have 
seen,  result  from  the  different  proportions  in  Avhich  some  three  or 
four  principal  elements  are  itnited  together,  and  from  the  proportions 
of  different  compound  atoms  which  may  enter  into  the  entire  combi- 
nation, and  from  the  manner  in  which  they  and  their  elements  are 
combined  among  themselves.  It  must  be  obvious,  therefore,  that  we 
can  never  reach  the  secret  of  these  combinations.   We  should  neces- 


28  INSTITUTES    OF    MEDICINE. 

sarily  expect,  even  from  the  shades  of  elementally  distinctions,  that 
chemistry  would  confound  and  even  identify  many  compounds  that 
are  totally  unlike  in  their  nature.  And  this  it  actually  does,  in  pre- 
senting to  us  sugar,  vinegar,  starch,  gum-arabic,  wood,  &c.,  as  the 
same  substance  ;  and  in  identifying  pus  and  cheese,  and,  again,  the 
albumen  of  eggs,  lymph,  mucus,  and  the  pi'oduct  of  certain  cancerous 
affections.  Nor  is  there  generally  any  agreement  among  the  chem- 
ists in  their  analyses  of  organic  compounds.  It  is  as  true  now,  as 
when  Bostock  (a  chemical  physiologist)  affirmed,  ih^t  "  every  subse- 
quent attempt  to  discover  the  elements  of  organized  substances  differs 
moi'e  or  less  from  those  that  preceded  it"  (s^  1029,  1030). 

The  moment  chemical  agencies  begin  their  operation,  artificial 
transformations  necessarily  ensue,  and  the  nature  of  the  organic  com- 
pound is  changed  in  a  corresponding  manner.  A  large  proportion  of 
the  resulting  products  are  perfectly  new  formations,  particularly  all 
,  tliG  binary  compounds  (§  38,  39).  Nor  can  there  be  any  doubt  that  the 
reputed  "  proximate  principles"  are  intimately  incorporated  in  any 
given  compound,  and  have  no  such  separate  existence  as  chemistry 
teaches.  It  lies  at  the  very  basis  of  chemistry,  that  all  the  elaborations 
ax'e  the  artificial  results  of  affinities  which  have  been  set  in  motion  by 
the  agents  employed,  and  which  are  employed  for  that  very  purpose. 
This  I  have  already  endeavored  to  demonstrate  in  the  Medical  and 
Physiological  Commentaries  (vol.  i.,  p.  674-682),  even  so  far  as  to 
show  that  urea  may  not  be  formed  by  the  kidneys,  but  is  the  result 
of  spontaneous  changes  after  the  elaboration  of  urine,  as  it  is  of 
artificial  influences  (§  54,  a).  But,  attentive  observation  will  gen- 
erally detect  the  chemist  in  the  admission  of  facts  which  are  subver- 
sive of  his  speculative  doctrines  (§  18,  350) ;  and  so  it  is  in  the  case 
before  us.  The  admission  covers  the  whole  ground  as  to  the  preten- 
sions of  organic  chemistry  beyond  the  most  simple  elementary  anal- 
ysis.   Thus  (Note  Fff  p.  1150), 

53,  c.  "  Were  we  able  to  produce  taurine  and  ammonia  directly 
out  of  uric  acid  or  allantoine,  this  might  perhaps  be  considered  as 
an  additional  proof  of  the  share  which  has  been  ascribed  to  these 
compounds  in  the  production  of  bile.  It  cannot,  however,  be  viewed 
as  any  objection  to  the  views  above  developed  on  the  subject,  that 
with  the  means  we  possess,  we  have  not  yet  succeeded  in  effecting 
these  transformations  out  of  the  body.  Such  an  objection  loses  all  its 
force,  when  we  consider  that  we  cannot  admit,  as  proved,  the  pre-ex- 
istence  of  taurine  and  ammonia  in  the  bile;  nay,  that  it  is  not  even 
PROBABLE  that  those  compounds,  which  are  only  known  to  us  as  the 
products  of  the  decomposition  of  the  bile,  exist  ready  formed,  as 
ingredients  of  that  fluid.  By  the  action  of  muriatic  acid  on  bile,  we, 
in  a  manner,  force  its  elements  to  unite  in  such  forms  as  are  no 
longer  capable  of  change  under  the  influence  of  the  same  re-agent." 
— Liebig's  Animal  Chemistry. 

By  the  admissions,  also,  in  §  18,  42,  and  350,  it  will  be  seen  that 
the  Utopian  nature  of  organic  chemistry  is  equally  established  in  all 
its  pretensions  by  its  own  founders  and  advocates  (§  1030). 

54,  a.  Organic  substances  alone  undergo  fermentation  and  putre- 
faction ;  and  this  shows  us,  also,  in  the  language  of  Tiedemann,  that 
"  even  when  the  life  of  organic  bodies  is  extinct,  we  should  consider 
the  qualities  which  they  possess,  from  the  time  of  death  to  the  com 


PHYSIOLOGY. COMPOSITION.  29 

plete  resolution  of  organization,  asfthe  result  of  the  vital  powers 
which  have  been  active  in  them." 

This  obvious  principle  conducts  us  at  once  to  the  whole  philoso- 
phy of  those  numerous  transformations  of  which  organic  compounds 
are  susceptible  from  chemical  agencies,  while  they  still  retain  their 
elementary  combinations,  and  appear  under  uniform  aspects  when 
subjected  to  the  same  chemical  influences,  and  often  analogous  to  the 
natural  condition  of  the  compound.  "  It  is  the  power  of  formation," 
says  Tiedemann,  "  which,  after  the  extinction  of  the  individual  life  of 
organized  bodies,  renders  the  organic  matters,  separated  from  their 
organization,  capable,  provided  they  have  not  been  reduced  to  their 
elements  by  external  physical  or  chemical  actions,  of  assuming  new 
and  more  simple  forms,  according  to  the  diversity  of  external  in- 
fluences, such  as  heat,  light,  water,  &c.,  which  determine  them  in 
taking  on  this  new  form.  This  power  appears,  therefore,  to  be  a  prop- 
erty inherent  in  organic  matters  in  general,  rendering  them  able  to 
take  other  more  simple  configurations  when  detached  from  the  com- 
binations of  living  bodies"  (§  1029,  1030). 

Some  organic  compounds  undergo  transformations  of  the  foi'egoing 
nature  as  soon  as  separated  from  the  organic  being.  The  homo- 
geneous blood  is  immediately  reduced  into  three  principal  compounds, 
which  have  no  natural  existence  as  such.  Nor  is  this  all;  for  there 
is  a  fundamental  change  among  the  elements  and  the  compound 
atoms  of  the  entire  mass.  The  changes  arise  from  the  loss  of  the 
vital  properties,  and  the  subsequent  operation  of  chemical  influences. 
Such,  too,  is  the  constitution  of  organic  compounds  that  there  may 
be  a  remarkable  uniformity  in  the  resulting  products  when  the  same 
chemical  agents  operate  upon  any  given  compound ;  as  exemplified 
in  the  various  transformations  to  which  sugar  is  liable,  and  as  seen  in 
the  uniform  production  of  morphia,  narcotina,  quinia,  cinchonia,  &c. 

54.  I).  It  is  obvious,  however,  from  the  premises  which  I  have  set 
forth,  that  chemistry  can,  at  most,  present  but  a  few  compounds  as  appa- 
rently distinct  from  each  other  in  their  elementary  composition;  for,  al- 
though there  are  many  millions  of  these  distinct  combinations  in  organic 
beings  (§  41),  they  commonly  possess  such  analogies  that  chemistry 
is  obliged  to  confound  all  but  a  few  which  have  strong  characteris- 
tics. These  few,  which  are  denominated  proximate  principles,  are 
supposed  by  the  chemist  to  make  up  the  entire  composition  of  organic 
beings.  But,  a  greater  proportion  even  of  these  few  are  so  inscruta- 
bly different  from  each  other  in  their  elementary  combinations,  that 
they  are  classed  under  common  denominations,  not  only  for  the  fore- 
going reason,  but  on  account  of  certain  resemblances  in  their  physical 
properties ;  while  it  is  by  these  last,  and  by  their  differences  in  re- 
sults as  vital  agents,  we  come  to  know  that  broad  distinctions  may 
exist  among  them.  Such,  for  example,  are  the  various  acids,  oils, 
resins,  &c. — Note  Fff  p.  1150. 

55.  All  organic  substances,  while  endowed  with  life,  resist  the  de- 
composing influences  of  all  surrounding  agents.  All  inorganic  com- 
pounds yield  to  these  influences. 

56.  As  soon  as  organic  beings  are  dead,  the  very  agents  that  had 
contributed  to  their  growth  and  nourishment  now  become  the  causes 
of  breaking  up  their  elementary  combinations,  and  with  a  rapidity  un- 
known in  the  ordinary  decomposition  of  mineral  compounds.     In  the 


30  INSTITUTES    OF    MEDICINE. 

former  case,  it  is  allowed  by  Dlebig,  that  the  "  vital  principle  op- 
poses to  the  continual  action  of  the  atmosphere,  moisture,  and  tem- 
perature, upon  the  organism,  a  resistance  which  is  in  a  certain  degree 
invincible^ 

57.  In  the  seed  and  ovum  the  properties  of  life  are  in  a  state  of  ac- 
tion which  maintains  their  elementary  combinations  against  the  chem- 
ical forces.  They  resist  degrees  of  cold  which  operate  destructively 
upon  their  composition  when  their  life  is  extinct.  Those  agents,  too, 
as  heat  and  moisture,  which  speedily  resolve  the  eg^  and  seed,  when 
deprived  of  life,  into  their  ultimate  elements,  will  in  the  same  de- 
grees of  intensity  develop  from  the  germ,  when  alive,  a  perfectly 
organized  being.  In  the  former  case  the  operation  of  the  principle  of 
life  is  generally  mistaken  for  "  a  force  in  a  state  of  rest.'"  Thus,  Lie- 
big : 

"  In  the  animal  ovum,  as  well  as  in  the  seed  of  a  plant,  we  recog- 
nize A  CERTAIN  REMARKABLE  FORCE, the  SOURCE  of  grOWth,  S>CC.,aforce 

in  a  state  of  rest ^ — Liecig's  Animal  Chemistry,  first  sentence.  See, 
also,  my  Examination  of  Reviews,  p.  7-28. 

58.  It  follows,  therefore,  that  the  power  which  resists  the  decom- 
posing forces  and  agents  in  living  beings  combined  the  elements  of 
such  beings,  and  that  death  is  an  extinction  of  that  power.  The  chem- 
ical forces  can  have  no  connection  with  the  combinations,  since  they 
are  held  together  by  a  power  in  direct  composition  to  '"hemical  influ- 
ences. 

What,  therefore,  unites  the  elements  and  maintains  them  against 
the  action  of  chemical  agents,  being  the  fundamental  power,  must  ne- 
cessarily preside  over  all  the  processes  and  results  to  which  organic 
beings  are  liable. 

59.  "  The  elements  of  dead  organic  matter,"  says  Liebig,  in  his  Or- 
ganic Chemistry,  "  seem  merely  to  retain  passively  the  position  and 
condition  in  which  they  had  been  placed."  "  The  atoms  exist  only 
by  the  vis  inertice  of  their  elements."  So,  also,  Mulder,  §  350|,  n,  and 
other  chemical  physiologists.  This  shows  that  the  original  union  is 
effected  by  other  powers  than  the  chemical,  which,  otherwise,  woiild 
still  operate  after  death,  and  prevent  decomposition.  We  also  thus 
learn  why  dead  organic  compounds  so  readily  undergo  fermentation 
and  putrefaction,  and  from  the  slightest  influences.  All  of  which, 
indeed,  appears  to  be  abundantly  conceded  by  the  chemical  philoso- 
pher when  he  yields  to  the  force  of  facts.  For  what  can  be  more 
ample  than  Liebig's  aflSrmation,  that 

"  The  VITAL  FORCE  is  manifested  in  the  form  of  resistance,  inas- 
much as  by  its  presence  in  the  living  tissues,  their  elements  acquire 
the  power  of  withstanding  the  disturbance  and  change  in  their  form  and 
composition,  which  external  age^its  tend  to  produce  ;  a  ]}Otver,which, 
as  chemical  compounds,  they  do  not  possess.^' — Liebig's  Animal  Chem- 
istry. 

And  yet  again  may  I  press  into  the  service  of  truth  the  organic 
chemist,  when  he  temporarily  loses  sight  of  the  laboratory,  and  con- 
tradicts those  speculations  which  impart  to  his  writings  the  zest  of 
novelty.  In  his  Lectures  for  the  winter  of  1844,  Liebig  appeal's  to 
have  been  alarmed  for  the  safety  of  his  empire,  and  we  have  here  an 
unusual  amount  of  "  vitality." 

The  work  on  Anitnal  Che?nistry  applied  to  Pathology  a?id  Thera- 


PHYSIOLOGY. COMPOSITION.  31 

peutics  wus  more  of  a  distillation  froin  the  laboratory  than  its  prede- 
cessor, Organic  CJiemistnj  applied  to  Physiology ;  and,  as  many  of 
the  most  eminent  physiologists  in  Europe,  who  were  inclined  to  min- 
gle chemistry  with  vitalism,  were  nauseated  by  the  dose  which  was 
last  administered,  Liebig  came  out  in  his  Lectures  with  the  following 
placebo  for  the  vitalists,  and  the  chemico-vitalists.  Were  it  not  con- 
tradicted by  the  lecturer,  it  should  place  him  in  the  very  front  rank  of 
vitalism.  The  doctrines  are  of  the  most  fundamental  nature,  and  lie 
at  the  basis  of  these  Institutes,  and  of  my  "  Medical  and  Physiological 
Commentaries."  It  will  be  seen  that  they  are  strictly  relative  to  my 
present  subject,  and  inculcate  all  that  the  most  transcendental  vital- 
ist  can  desire  as  to  the  distinct  nature  oj"  tJic  vital  j^rinciple, its  full  con- 
trol over  the  processes  of  life,  its  extinction  at  death,  and  an  absolute 
distinction  hetiveen  vital  and  chemical  j^rocesses  and  results,  tvJiHe  those 
frocesses  and  results  are,  respectively ,  referred  to  forces  of  a  totally  dis- 
tinct nature.     Thus : ' 

"After  the  extinction  of  the  vital  principle,"  says  Liebig,  "  in  or- 
ganic atoms,  they  maintain  their  form  and  properties,  the  state  into 
which  they  have  been  brought  in  living  organisms,  only  by  reason  of 
their  inherent  inertia.  It  is  a  great  and  comprehensive  law  of  matter, 
that  its  particles  possess  no  self-activity,  no  inherent  power  of  origin- 
ating motion,  when  at  rest ;  motion  must  be  imparted  by  some  exter- 
nal cause ;  and,  in  like  manner,  motion  once  imparted  to  a  body  can 
only  be  ari'ested  by  external  resistance. 

"  The  constituents  of  vearetable  and  animal  substances  havinq-been 
formed  under  the  guidance  and  power  of  the  vital  j)rincij)le,  it  is  this 
principle  which  determines  the  direction  of  their  molecular  attraction. 
The  vital  principle,  therefore,  must  be  A  motive  power,  capable  of 
imparting  motion  to  atoms  at  rest,  and  of  opposing  resistance  to  other 
forces  producing  motion,  such  as  the  chemical  force,  heat,  and  elec- 
tricity. We  are  able  to  reliquefy  and  redissolve  albumen,  after  it  had 
been  coagulated  by  heat,  but  the.  vital  principle  alone  is  capable  of 
restoiing  the  original  order  and  manner  of  the  molecular  arrangement 
in  the  smallest  particles  of  albumen.  Coagulated  albumen  is  again 
converted  into  its  original  form,  it  is  transformed  into  flesh  and  blood 
in  the  animal  organism. — Notes  N  R  pp.  1121,  1123. 

"  In  the  formation  of  vegetable  and  animal  substances,  the  vital 
principle  opposes,  as  a  force  of  resistance,  the  action  of  the  other 
forces, — cohesive  attraction,  heat,  and  electricity, — forces  which  ren- 
der the  aggregation  of  atoms  into  combinations  of  the  highest  order 
impossible,  except  in  living  organisms. 

"  Hence  it  is,  that  when  those  comjjlex  combinations  which  consti 
tute  organic  substances  ai'e  withdrawn  from  the  influence  of  the  vita 
force, — when  this  no  longer  is  opposed  to  the  action  of  the  other  dis- 
turbing forces,  great  alterations  immediately  ensue  in  their  properties. 
and  in  the  an-anojement  of  their  constituents.  The  sliojhtest  chemical 
action,  the  mere  contact  of  atmospheric  air,  suffices  to  cause  a  transpo- 
sition of  their  atoms,  and  to  produce  new  arrangements  ;  in  one  word 
to  excite  decomposition.  Those  remarkable  phenomena  take  plac( 
which  are  designated  by  the  terms  fermentation,  putrefaction 
and  decay  ;  these  are  the  processes  of  decomposition,  and  their  ulti 
mate  results  are  to  reconvert  the  elements  of  organic  bodies  into  thai 
Rtate  in  which  they  exist  before  they  participate  in  the  processes  of  life." 


32  INSTITUTES    OF    MEDICINE.- 

The  reader,  however,  will  be  more  astonished  to  learn  that  he  h&s 
not  discovered,  amid  the  multitude  of  conflicting  statements  and  doc 
trines,  a  passage  in  the  work  on  Animal  Chemistry  which,  even  more 
than  the  preceding,  identifies  "  the  Reformer"  with  the  most  exclu 
sive  vitalists,  and  completely  annuls  all  his  chemical  and  physical 
speculations  as  to  organic  life,  and  his  radical  distinctions  between 
plantsand  animals  (§  350,  nos.  12,  15,20).  It  will  be  also  seen  with 
what  pretense  he  has  been  denominated  "  the  Reformer,^'  and  "  tlic 
author  of  a  neiv  and  the  greatest  era  in  physiology ^  The  extract  in- 
culcates the  doctrines  of  an  independent  vital  principle,  its  identity 
in  plants  and  animals,  the  action  of  stimuli  upon  that  principle,  its 
susceptibility  of  influences  from  the  nervous  power  in  animals,  the 
absence  of  that  influence  in  plants,  and  the  dependence  of  all  organic 
processes  and  results,  equally  in  plants  and  animals,  upon  that  piin- 
ciple. 

Now  these  are  exactly  the  doctrines  which  are  also  fundamental 
throughout  the  Medical  and  Physiological  Commentaries  and  these 
Institutes.  They  are  relative  to  the  constitution  and  processes  of 
organic  beings  as  a  whole,  while  the  foregoing  quotations  from  Lie- 
big's  Lectures  comprehend  the  principles  by  which  I  have  interpret- 
ed the  elementary  condition  of  organic  bodies.     Thus  our  author : 

"  The  activity  of  vegetative  life  manifests  itself  in  vegetables,  ?tf?YA 
the  aid  of  external  influences  ;  in  animals,  hy  means  of  influences  pro- 
duced within  the  organism.  Digestion,  circulation,  secretion,  are,  no 
douht,  under  the  influence  of  the  nervous  system;  hut  the  force  which 
gives  to  the  germ,  the  leaf  and  the  radical  fihres  of  the  vegetable  the 
SAME  WONDERFUL  PROPERTIES,  is  the  SAME  as  that  residing  in  the  se- 
creting memhranes  and  glands  of  animals,  and  which  enables  every 
animal  organ  to  perform  its  own  proper  functions." — Liebig's  Ani- 
mal Chemistry. 

60.  "  The  diversity  of  the  transformations  and  of  the  resulting 
products,"  says  an  able  advocate  ©f  Liebig's  physical  doctrines  of 
life,  "  indicate  most  certainly  the  complexity  of  an  organic  product" 
(§  41).  "  The  metamorphoses  which  occur  after  organic  substances 
are  rexnowedi  from  the  influence  of  the  vital  force,  constitute  a  separa- 
tion, or  splitting  up  into  new  and  less  complex  compounds"  (§  54). — 
Mr.  Ancell,  in  London  Lancet,  Nov.  26,  1842. 

Thus,  again  and  again,  does  the  chemical  physiologist  unavoidably 
concede  that  the  elements  of  organic  beings  are  held  together  by  a 
vital  principle,  and,  therefore,  that  they  are  originally  united  by  that 
principle. — Note  Fff  p.  1150. 

Vitalism  becomes  established  in  all  its  aspects,  even  in  what  has 
been  denominated  "  transcendental  vitalism,"  when  it  may  be  shown 
that  the  elements  of  organic  beings  are,  in  the  language  of  Liebig, 
"united  by  a  peculiar  viode  of  attraction,  resulting  from  the  existence 
of  a  pjoiocr  distinct  from  all  other  j^owers  of  nature,  namely,  a  Vital 
Principle  :''^  since,  as  I  have  said,  the  powers  and  laws  which  regu- 
late the  composition  must  be  at  the  foundation  of  all  the  subsequent 
results.  Concessions  of  fundamental  principles  overthrow  all  oppos- 
ing "facts,"  and  all  secondary  doctrines  of  a  conflicting  nature. 
These,  therefore,  may  be  advantageously  connected  with  demonstra- 
tions of  the  truth.  There  are  few  intelligent  minds  that  do  not  right- 
ly appreciate  those  grand  phenomena  of  Nature  which  conduct  us  to 


PHYSIOLOGY. COMPOSITION.  33 

a  knowledge  of  her  fundamental  laws,  or  do  not  incidentally  betray 
their  conviction  of  the  right,  however  the  enticements  of  fame  may 
beguile  them  into  ingenious  substitutions.  I  shall,  therefore,  as  on 
all  former  occasions,  continue  to  bring  to  the  aid  of  my  conclusions 
the  powerful  concessions  of  the  most  eminent  men  who  belong  to  the 
adverse  schools  in  organic  philosophy.  It  is  manifest  that  such  au- 
thorities must  weigh  with  the  force  of  demonstration,  since  it  is  obvi- 
ous that  their  admissions  can  flow  only  from  convictions  that  have 
been  obtained  in  the  school  of  Nature.  Among  the  most  illustrious 
of  the  adverse  school  is  Liebig,  and  standing  intermediate  is  the  pro- 
found and  erudite  Miiller.  And  having  thus  refeiTed  again  to  this 
great  philosopher,  I  will  not  lose  the  opportunity  of  obtaining  from 
him  an  important  contribution  to  the  doctrines  of  vitalism  as  they  re- 
late to  the  very  composition  of  organic  beings,  and  in  which  he  insti- 
tutes a  broad  contrast  between  the  affinities  which  unite  the  elements 
of  organic  and  inorganic  compounds.     Thus  : 

"  Chemical  substances,"  says  Miiller,  "  are  regulated  by  the  intrin- 
sic properties  and  the  elective  affinity  of  the  substances  uniting  to 
form  them.  In  organic  bodies,  on  the  contraiy,  the  power  which  in- 
duces, and  maintains,  the  combination  of  their  elements,  does  not 
consist  in  the  intrinsic  properties  of  those  elements,  but  in  something 
else,  which  not  only  counteracts  those  affinities,  but  effects  combina- 
tions in  direct  opposition  to  them,  and  conformahhj  to  the  laws  of  its 
own  operation." — Muller,  Elements  of  Physiology ,  p.  4. 

Liebig,  also,  variously  inculcates  the  same  great  principle.  Take, 
in  the  first  place,  a  demonstration  the  converse  of  Miiller's.  It  is  tho 
last  paragraph  in  the  work  on  Organic  Chemistry.     Thus  : 

"  The  same  nutnerous  causes  which  are  opposed  to  the  formation  of 
complex  organic  violecules,  under  ordinary  circumstances,  occasion 
their  decomposition  and  transformations  when  the  only  antagonist 

POWER,  THE  VITAL  PRINCIPLE,  NO  LONGER  COUNTERACTS  THE  INFLU- 
ENCE OF  THESE  CAUSES.  Ncw  compounds  are  formed  in  which  chem- 
ical AFFINITY  HAS  THE  ASCENDENCY,  and  opposes  any  farther  change, 
while  the  conditions  under  which  these  compounds  were  formed  re- 
main unaltered." 

Again,  we  are  informed  by  this  chemist,  that 

"  The  equilibrium  in  the  chemical  attractions  of  the  constituents  of 
food  is  disturbed  by  the  vital  principle,  as  we  know  it  may  be  by 
many  other  causes.  But'the  union  of  the  elements,  so  as  to  produce 
NEW  combinations  and  forms,  indicates  the  presence  of  a  peculiar 

MODE  OF  attraction  AND  THE  EXISTENCE  OF  A  POWER  DISTINCT  FROM 
ALL  OTHER  POWERS  OF   NATURE,  namely,  the  VITAL   PRINCIPLE."       "  If 

the  food  possessed  life,  not  merely  the  chemical  forces,  but  this  vi- 
tality would  offer  resistance  to  the  vital  force  of  the  organism  it 
nourished."  "  The  individual  organs,  such  as  the  stomach,  cause  all  the 
organic  substances  conveyed  to  them,  which  are  capable  of  transfor- 
mation, to  assume  new  forms.  The  stomach  compels  the  elements  of 
these  substances  to  unite  into  a  compound  fluid  for  the  formation  of 
blood." — Liebig's  Organic  Chemistry,  p.  356,  357,  346,  384. 

61.  It  is  a  remarkable  characteristic  of  organic  beings  that  they  aie 
composed  chiefly  of  combustible  substances,  properly  so  called,  and  a 
supporter  of  combustion  ;  with  the  principal  exception  of  that  anom- 
aly in  the  inorganic  kingdom,  nitrogen  gas  {^  37). 


34  INSTITUTES    OF    MEDICINE. 

62,  a.  The  general  introduction  of  nitrogen  gas  into  the  constitution 
of  animal  compounds,  and  into  many  of  a  vegetable  nature,  while  it  is 
excluded  from  mineral  compounds,  is  one  of  the  most  striking  distinc- 
tions between  the  two  kingdoms  of  Nature.  Upon  that  distinction  I 
have  founded  an  argument,  in  my  Essay  on  the  "  Philosophy  of  Vital- 
ity," in  proof  of  the  difference  in  the  powers  and  laws  by  which  the 
two  kingdoms  are  governed.  It  appeal's  also  appropriate  to  this  work 
that  the  proof  should  be  here  introduced. 

62,  b.  I  have  said  in  the  foregoing  Essay,  that  it  is  abundantly  ev- 
ident that  living  beings  are  endowed  with  2)ropertie3  which  protect 
their  elementary  composition  against  all  those  decomposing  agencies 
which  are  perpetually  separating  the  elements  of  all  mineral  com 
pounds.  This  shows  that  the  properties,  by  which  the  elements  of 
living  beings  are  united,  are  utterly  different  from  such  as  combine 
the  elements  of  inorganic  compounds.  Nevertheless,  the  living  or- 
ganization is  undergoing  a  systematic  change,  a  perpetual  decomposi- 
tion, surpassing  any  mutations  that  are  in  progress  in  the  surrounding 
world.  These  decompositions  are,  also,  of  a  peculiar  nature,  govern- 
ed by  established  laws,  various  in  different  parts  of  the  same  individ- 
ual, yet  forever  the  same  in  any  given  part  (§  44).  I  shall  not  stop 
to  ghow  how  the  old  are  replaced  by  new  materials,  and  how  the  pro- 
cesses go  Giifari  passu,  and  in  opposition  to  all  the  philosophy  which 
chemistry  teaches,  but  only  say  that  the  decompositions  must  be  effect- 
ed by  properties  as  peculiar  to  the  living  compound  as  are  the  results  ; 
and  that  these  results  conspire  with  the  peculiar  modes  in  which  the 
elements  are  combined  in  j)roving  the  existence  of  specific  properties, 
which  are  the  common  cause  of  all  the  harmonious  phenomena  of  liv- 
ing beings  (§  38-42). 

62,  c.  When,  however,  the  organic  being  dies,  a  new  order  of  de- 
composition begins,  eminently  of  a  chemical  nature,  and  in  forcible 
contrast  with  that  which  concerns  the  vital  process  of  renewal.  This 
is  due  to  the  special  element,  nitrogen  gas,  which  may  be  called  the 
principle  of  dissolution.  Wherever  present,  it  gives  rise  to  ti'ansfor- 
mations  and  disunion  of  all  the  other  elements  after  the  properties  of 
life  have  lost  their  sway.  The  moment  these  cease,  chemical  decom- 
position begins, — confusedly,  violently;  and  such  are  the  nature  and 
combinations  of  the  elements,  that  their  disrujDtion  would  go  on  with 
no  other  contribution  from  surrounding  agents  than  water  alone. 
Hence  the  more  rapid  transformations  and  dissolution  of  animal  than 
of  vegetable  tissues,  and  of  sap  and  other  substances  which  are  gen- 
erated by  vegetable  organization. 

62,  d.  Liebig  says  of  nitrogen  gas,  that  "there  is  some  peculiarity  in 
its  nature,  which  gives  its  compounds  the  power  to  decompose  sponta- 
neously with  so  much  facility.  Now,  nitrogen  is  known  to  be  the 
most  indifferent  of  all  the  elements.  It  evinces  no  particular  attrac- 
tion to  any  OTieof  the  simple  bodies,  and  this  character  it  preserves  in 
all  its  combinations  ;  a  character  which  explains  the  cause  of  its  easy 
separation  from  the  matter  with  which  it  is  united."  And  again, 
"  When  those  substances  are  examined  which  are  most  pifone  to  fer- 
mentation and  putrefaction,  it  is  found  that  they  are  all,  ivithout  ex- 
ception, bodies  which  contain  nitrogen." — Liebig's  Organic  Chemistry 
app)lied,  &c.,  p.  241. 

G2,  c.  In  the  inorganic  kingdom,  nitrogen  is  mostly  confined  to  the 


PHYSIOLOGY. COMPOSITION.  35 

aJmosphere,  where  it  probably  exists  in  a  state  of  simple  intermixture 
with  oxygen.  "  All  bodies  which  have  an  affinity  for  oxygen  abstract 
it  from  the  atmosphere  with  as  much  facility  as  if  the  nitroo-en  were 
absent  altogether  ;"  and  we  have  striking  examples  of  the  disposition 
of  nitrogen  to  separate  from  its  compounds,  "  in  the  easy  transposi- 
tion of  atoms  in  the  fulminating  silvers,  in  fulminating  mercury,  and 
In  all  fulminating  substances,"  whose  ready  explosion  is  owino-  to  the 
presence  of  nitrogen.  "  All  other  substances,"  says  Liebig,  "  con- 
taining nitrogen  acquire  the  same  power  of  decomposition  when  the 
elements  of  water  are  brought  into  play." 

62,/!  Now  the  foregoing  characters  belong  to  nitrogen  only  as  it 
exists  in  inorganic  or  in  dead  organic  compounds,  while  the  former, 
also,  are  artificial,  or  due  to  accidental  causes.  In  living  beino-s, 
where  it  abounds,*  it  adheres  to  its  associated  elements  with  a  tena- 
city which  no  agent  can  impair  till  it  destroys  the  life  of  the  part ;  or, 
in  other  words,  till  it  destroys  those  vital  properties  by  which  the  ele- 
ments were  truly  united.  It  is  then,  however,  that  the  forces  of  chem- 
istry take  possession,  and  the  elements  may  explode,  I  had  almost 
said,  with  the  facility  of  the  fulminating  compounds. 

62,  g.  "  There  is,"  says  Liebig,  "  in  the  nature  and  constitution  of 
the  (inanimate)  compounds  of  nitrogen,  a  kind  of  tension  of  their 
component  parts,  and  a  strong  disposition  to  yield  to  transformations, 
which  effect  spontaneously  the  transposition  of  their  atoms  07i  the  in- 
stant that  water  or  its  elements  are  brought  in  contact  with  them." 
On  the  contrary,  "  it  is  found  that  no  body  destitute  of  nitrogen  pos 
sesses,  when  pure,  the  property  of  decomposing  spontaneously  while 
in  contact  with  water." — Liebig. 

But,  although  dead  animal  compounds  readily  pass  into  sponta 
neous  decomposition  under  slight  degrees  of  moisture,  yet,  composed 
as  they  are,  in  part,  of  the  elements  of  water,  and  very  largely  im- 
pregnated with  aqueous  substances  in  their  living  state,  neither  those 
elements,  this  water^  nor  any  other  agent,  can  disturb  the  exact  com- 
binations. 

But,  when  the  oi'ganic  being  dies,  chemical  agencies  have  their 
play,  and  it  is  then  that 

"  The  result  of  the  known  transformations  of  substances  containin" 
nitrogen  proves,"  according  to  Liebig,  "  that  the  water  does  not  mere- 
ly act  as  a  medium  in  which  motion  is  permitted  to  the  elements  in 
the  act  of  transposition,  but  that  its  influence  depends  on  chemical 
affinity.  "When  the  decomposition  of  such  substances  is  effected  with 
the  assistance  of  water,  the  nitrogen  is  in^riably  liberated  in  the  form 
of  ammonia." — Liebig. 

In  respect  to  the  inorganic  world,  had  nitrogen  been  incorporated 
in  its  compounds,  there  would  have  been  no  stability  among  them. 
They  would  have  been  perpetually  undergoing  decomposition,  until 
finally  the  whole  of  the  nitrogen  would  fly  off  by  itself,  and  nothing 
of  the  original  compound  would  remain  ;  and  it  could  never  be  re- 
combined. 

62,  k.  Besides  the  disposition  of  nitrogen  to  tear  asunder  the  ele- 

*  Niti-ogen  is  well  known  to  abound  in  all  the  tissues  of  animals.  Of  vegetables,  Lie- 
big  says,  that,  "  Estimated  by  its  proportional  weight,  niti'ogen  fonns  only  a  very  small 
part  of  plants,  but  it  is  never  entirely  absent  from  ani/  part  of  them.  Even  when  it  does 
not  enter  into  the  composition  of  a  particular  part  or  organ,  it  is  always  to  be  found  in  the 
fluids  vrbich  pervade  it." — Liebig's  Organic  Chemistry  applied  to  Physiology,  &c.,  p.  4. 


36  INSTITUTES    OF    MEDICINE. 

meiits  with  which  it  may  be  combined,  the  complexity  of  these  ele- 
ments in  organic  beings  contributes  to  the  disorganizing  results  after 
death,  and  is  another  principal  cause  of  spontaneous  fermentation  and 
putrefaction  (§  38,  41,  46,  48,  52,  53). 

62,  i.  From  the  foregoing  facts,  especially  from  the  universality 
and  fixedness  of  nitrogen  in  organic  beings,  I  amve  at  the  conclusion 
that  the  elements  of  their  compounds  are  united  by  forces  as  peculiar 
as  the  facts  which  relate  to  these  compgunds,  and  that  the  forces  of 
chemistry  have  no  agency  in  combining  the  elements,  or  in  effecting 
changes  of  their  combinations  during  life.  It  is  also  abundantly  man- 
ifest from  my  premises,  that  Liebig's  declaration  that  "  by  chemical 
agency  we  can  produce  the  constituents  of  muscular  fibre,  skin,  and 
hair,"  is  without  the  slightest  foundation  (§  12,  13,  14). 

62,  k.  The  whole  labyrinth  of  combinations  in  organic  beings,  and 
their  ultimate  return  to  binary  compounds,  are  full  of  the  most  stu- 
pendous design.  The  final  cause  of  the  reduction  of  the  organic  being, 
when  its  own  specific  purposes  are  ended,  is  that  of  again  supplying 
the  means  of  growth  to  vegetables  yet  alive,  that  the  elements  may  be 
again  elaborated  into  ternary  and  quaternary  compounds,  to  carry  out 
the  final  purpose  of  the  vegetable  kingdom  in  supplying  nutriment  to 
animals  (§  303).— Note  C  p.  1113. 

63.  In  the  Essay  to  which  I  have  referred  in  the  last  section,  I  have 
endeavored  to  deduce  the  principles  of  vitalism  from  the  phenomena 
ihat  attend  the  development  of  the  incubated  egg,  as  had  been  briefly 
set  forth  in  my  "  Examination  of  Reviews."  The  considerations 
there  made  are  peculiarly  appropriate  to  the  present  work,  and  to 
the  place  at  which  I  have  now  arrived.    It  was  my  object  to  considei', 

1st.  The  constitutional  nature  of  the  ovum. 

2d.  To  show  by  the  philosophy  of  generation,  and  by  the  nature  of 
the  powers  which  are  universally  admitted  to  be  alone  concerned  in 
developing  the  germ  or  ovum,  and  in  forming  the  organs  of  the  new 
being,  that  the  same  powers  are,  also,  alone  concerned  in  carrying  on 
forever  afterward  the  processes  of  life,  and,  of  course,  that  no  new 
powers,  or  principles,  are  introduced. 

3d.  To  consider  the  manner  in  which  the  germ  is  impregnated,  or 
its  vital  propeities  so  stimulated  into  action  as  to  result  in  the  devel- 
opment of  the  germ,  and  in  unfolding  the  various  attributes  of  the 
new  being. 

4th.  To  show  that  we  may  find  in  the  physiology  of  generation,  or 
the  principles  through  which  the  ovum  is  impregnated,  the  whole  phi- 
losophy of  organic  life,  or  ^e  principles  through  which  the  actions  of 
life  are  forever  carried  on. 

5th.  To  state  the  manner  in  which  the  natural  peculiarities  of  each 
parent,  whether  as  it  respects  the  properties  of  life,  or  the  physical 
conformation,  are  infused  into  the  germ  and  combined  in  the  full- 
grown  offspring. 

6th.  To  show  that  hereditary  diseases  are  transmitted  in  the  same 
way  as  those  more  natural  peculiarities  which  belong  to  parents. 

7th.  To  show,  also,  that  the  principles  which  are  concerned  in  the 
transmission  of  hereditary  diseases  are  the  same  as  concur  in  the  pro- 
duction of  ordinary  diseases. 

8th.  To  deduce  fi'om  the  philosophy  of  generation  the  vital  nature 
of  hereditary  diseases  ;  or,  in  other  words,  to  show  that  the  morbid 


PHYSIOLOGY. COMPOSITION.  37 

impression  is  established  upon  the  vital  properties  of  the  ovum,  and 
of  course,  upon  those  of  the  new  being  ;  and  that  the  hereditary  vitia- 
tion does  not  consist  in  any  transmitted  impurity  to  the  blood  or  other 
fluids  of  the  offspring,  as  is  now  supposed  by  the  humoralists. 

If  the  foregoing  propositions  be  true  in  relation  to  man,  they  will, 
of  course,  be  equally  so  of  animals,  and  of  the  whole  vegetable  king- 
dom (§  169/,  1051,  1052). 

64,  a.  If  it  be  universally  conceded,  as  a  matter  of  course,  that  not 
only  the  elementary  constitution  of  the  ovum,  but  its  whole  develop- 
ment, depends  entirely  upon  a  vital  principle  or  vital  properties,  it  will 
follow  that  the  same  principle  or  properties  are  forever  afterward 
concerned  in  organic  processes,  and  alone  concerned. 

Let  us  hear,  in  the  first  place,  the  most  eminent  in  the  school  of 
vitalism,  but  who  are  inclined  to  lean  upon  chemistry  after  the  full 
development  of  the  ovum. 

64,  h.  It  is  said,  for  example,  by  Tiedemann, 

"  That  it  is  the  vital  power,  which  in  the  fecundated  germinative 
liquid,  brings  the  molecules  of  the  organic  combinations  to  the  solid 
form,  and  calls  the  first  lineaments  of  the  vegetable  and  animal  em- 
bryo into  existence.  All  the  parts  and  tissues  that  are  formed  in  it, 
according  to  a  definite  order  of  succession,  are  products  of  the  power 
of  formation,  and  on  this  they  depend  in  all  that  relates  to  their  first 
appearance,  their  development,  aggregation,  configuration,  and  ar- 
rangement. The  phenomena  exhibited  in  the  act  of  formation  of  an 
embryo,  are  placed^ar  above  all  the  mechanical  and  chemical  acts  we 
ibserve  in  bodies  not  endowed  with  life." — Tiedemann,  ComiKirative 
Vhysiology. 

64,  c.  By  the  illustrious  Miiller,  it  is  said, 

"  The  creative  force  exists  already  in  the  germ,  and  creates  in  it  the 
essential  parts  of  the  future  animal.  The  germ  is  potentially  the 
loliole  animal.  During  the  development  of  the  germ,  the  essential 
parts  which  constitute  the  actual  whole  are  produced."  "  The  en- 
tire vital  principle  of  the  e,^^  resides  in  the  germinal  disk  alone ; 
and  since  the  external  influences  which  act  on  the  germs  of  the 
most  different  organic  beings  are  the  same,  we  must  regard  the 
simple  germinal  disk  as  the  potential  xoliole  of  the  future  animal, 
endowed  with  the  essential  and  specific  force  or  principle  of  they^- 
ture  being,  and  capable  of  increasing  the  very  small  amount  of  this 
specific  force  and  matter  which  it  already  possesses,  by  the  assimila- 
tion of  new  matter."  And  again  he  says,  "  This  force  exists  hcfore 
the  harmonizing  parts,  which  are,  in  fact,  formed  by  it  during  the 
development  of  the  embryo."  "  The  vital  force  inherent  in  organic 
beings  itself  generates  the  essential  organs  which  constitute  the  whole 
being."  "  The  formative  or  organizing  principle  is  a  creative  pow- 
er, modifying  matter  blindly  and  unconsciously;"  yet  with  such  won- 
derful precision  that  Miiller  also  says,  that  "  this  rational  creative 
FORCE  is  exerted  in  every  animal  strictly  in  accordance  with  what  the 
nature  of  each  requires."  "The  vital  principle,"  he  says,  "is  in  a 
quiescent  state  in  the  fi-g^  before  incubation." — Mijller,  Elements  of 
Physiology. 

64,  d.  Passing  from  the  chemico-physiological  school  to  that  of 
pure  chemistry,  we  shall  find  the  same  admissions  as  to  the  exclusive 
agency  of  a  vital  principle  in  the  formation  and  development  of  the 


SS  INSTITUTES    OF    MEDICINE. 

seed  and  ovum.  The  extraordinary  contradictions,  which  will  aston- 
ish the  reader,  necessarily  abound  in  all  authors  who  are  employed 
in  identifying  two  subjects  that  have  no  relation  to  each  other. 

64,  c.  Take  Liebig,  as  a  first  example;  and  take,  in  the  first  place, 
his  chemical  doctrine  of  life. 

"  In  the  animal  body,"  he  says,  "  we  recognize,  as  the  ultimate 
cause  of  all  force,  only  one  cause,  ilie  chemical  action  which  the  ele- 
ments of  the  food  and  the  oxygen  of  the  air  mutually  exercise  on  each 
other.  The  only  known  ultimate  cause  of  vital  force,  either  in  ani- 
mals or  in  plants,  is  a  chemical  process.  If  this  be  prevented,  the 
phenomena  of  life  do  not  manifest  themselves.  If  the  chemical  action 
be  impeded,  the  vital  phenomena  must  take  new  forms." 

And  yet  only  a  few  sections  before,  and  in  the  very  first  sentence 
of  Liebig's  work  on  "  Animal  Chemistry  applied  to  Physiology  and 
Pathology,"  we  read, 

"  In  the  animal  ovum,  as  well  as  in  the  seed  of  a  plant,  we  recog- 
nize A  CERTAIN  REMARKABLE  FORCE,  the  SOURCE  of  growtli  or  increase 
in  the  mass,  and  of  reproduction,  or  of  supply  of  the  matter  consumed; 
a  force  in  a  state  of  rest*  By  the  action  of  external  influences,  by 
impregnation,  by  the  presence  of  air  and  moisture,  the  condition  of 
static  equilibrium  of  this  force  is  disturbed.  Entering  into  a  state 
of  motion  or  activity,  it  exhibits  itsef  in  the  j^roduction  of  a  series  of 
forms,  &c.  This  force  is  called  the  vital  force,  vis  vitcs,  or  vitality." 
— Liebig's  uini?nal  Chemistry. 

Turning  back  to  the  same  author's  work  on  "  Organic  Chemistry 
applied  to  Physiology,"  we  meet  not  only  with  a  similar  contradiction 
of  his  grand  doctrine  of  the  entire  dependence  of  life  upon  chemical 
processes  (and  as  we  had  before  seen  in  respect  to  digestion,  section 
GO),  but  with  that  which  is  particularly  apposite  to  my  present  inquiry. 

"  Our  notion  of  life,"  says  Liebig,  "  involves  something  more  than 
mere  reproduction,  namely,  the  idea  of  an  active  power  exercised,  by 
virtue  of  a  definite  form,  and  production  and  generation  in  a  definite 
form  (§  59).  The  production  of  organs,  the  co-operation  of  a  system 
of  organs,  and  their  power  not  only  to  pi'oduce  their  component  parts 
from  the  food  presented  to  them,  but  to  generate  themselves  in  their 
original  form  and  with  their  jjroperties,  are  characters  belonging  ex- 
clusively to  organic  life,  and  constitute  a  form  of  reproduction  inde- 
pendent OF  CHEMICAL  POWERS.     The  chcmicul forccs  are  subject  to 

the  INVISIBLE  CAUSE  BY   WHICH    THIS  FORM   IS    PRODUCED.       This   VITAL 

PRINCIPLE  is  only  known  to  us  through  the  peculiar  form  of  its  instru- 
ments ;  that  is,  through  the  organs  in  which  it  resides.  Its  laws 
must  be  investigated  just  as  we  investigate  those  of  the  other  pow- 
ers WHICH  effect  motion  AND  CHANGES  IN  MATTER." LiEBIg's  Or- 
ganic Chemistry ,  &c.,  p.  355. 

64, yi  Roget,  of  high  authority,  maintains  that, 

"  However  the  laws  which  regulate  the  vital  phenomena  may  ap- 
pear, on  a  superficial  view,  to  differ  from  those  by  which  the  physical 
changes  taking  place  in  inorganic  matter  are  governed,  still  there  is 
really  no  essential  difference  between  them."  "  It  may,  in  like  man- 
ner, be  contended,  that  the  affinities  which  hold  together  the  elements 
of  living  bodies,  and  which  govern  the  elaboration  of  organic  products, 
ARE  THE  SAME  vvitli  those  wliicli  preside  over  inorganized  compounds." 
*  See  my  Examination  of  Reviews  p.  7-28. 


PHYSIOLOGY. COMPOSITION.  'Si) 

"  Hence  it  becomes  every  day  more  and  more  probatle  that  the  forces 
immediately  concerned  in  the  production  of  chemical  changes  in  the 
body  ARE  THE  SAME  as  those  which  are  in  constant  operation  in  the 
inorganic  world ;  and  that  we  are  not  warranted  in  the  assertion  that 
the  operations  of  vital  chemistry  are  directed  by  distinct  laws,  and  are 
the  results  of  new  agencies." 

"  However  natural  it  may  he  to  conceive  the  existence  of  a  single 
and  presiding  principle  of  vitality,  we  should  recollect  that  this,  in  the 
present  state  of  our  knowledge,  is  only  a  fiction  op  the  mind,  not 

WARRANTED    BY    THE    PHENOMENA    THEMSELVES." RoGEt's     Outlines 

of  Physiology. 

Let  us  now  hear  this  able  writer  on  the  subject  of  foetal  development. 

"A  portion  of  the  vital  power  of  the  parent,"  he  says,  "is  for  this 
purpose  employed  to  give  origin  and  birth  to  the  offspring.  The  ut- 
most solicitude  has  been  shown  in  every  part  of  living  nature  to  se- 
cure the  perpetuity  of  the  race,  by  the  establishment  of  laavs,  of  which 
the  operation  is  certain  in  all  contingent  circumstances.^'' 

Roget  ultimately  describes,  in  his  usual  felicitous  manner,  the  de- 
velopment of  the  ovum ;  and  here  we  have  nothing  from  our  author 
/)ut  the  agency  of  the  vital  powers. 

"  The  foundations  of  the  edifice,"  he  says,  "  are  laid  in  the  homo- 
geneous jelly  hy  the  efforts  of  the  vital  powers."  "  At  first,  all 
the  energies  of  vitality  are  directed  to  the  raising  of  the  fabric,  and 
to  the  extension  of  those  organs,  which  are  of  greatest  immediate  util- 
ity; but  still  having  a  prospective  view  to  farther  and  more  impor- 
tant ends," — and  so  on  throughout  the  chapter ;  the  whole  work  of 
developing  and  fashioning  the  foetal  organs  being  assigned,  exclu- 
sively, to  "  the  efforts  of  the  vital  powers,"  and  to  the  "  energies  of  vi- 
tality."—  Roget's  Animal  and,  Vegetable  Physiology,  Bridgeivater 
Treatise. 

64,  g.  Finally,  let  us  hear,  also.  Dr.  Carpenter,  who  advocates  the 
chemical  doctrines  of  life  so  far  as  to  lay  down  the  following  princi- 
ple no  less  than  twice  within  six  pages,  and  in  nearly  the  same  words. 
Thus : 

"  Reason,"  he  says,  "has  been  already  given  for  the  belief  that  the 
affinities  which  hold  together  the  elementary  particles  of  organized 
structures  are  not  different  from  those  concerned  in  the  inorganic 
world  ;  and  it  has  been  shown  that  the  tendency  to  decoxMposition 
after  death  bears  a  very  close  relation  with  the  activity  op  the 

CHANGES   which    TAKE    PLACE   IN   THE    PART   DURING    LIFE." CaRPEN- 

ter's  Principles  of  General  aiid  Comparative  Physiology,  jj.  140  ; 
also,  p.  146. 

Now  the  authority  of  such  a  writer,  and  a  prominent  leader  in  the 
purely  chemical  school  of  physiology,  must  be  allowed  to  be  impor- 
tant when  any  unavoidable  concession  is  made  to  vitalism.  Let  us 
then  hear  him  in  the  matter  of  the  ovum : 

"Organization,  and  vital  properties,''  he  says,  "  are  simultaneously 
communicated  to  the  germ  by  the  structures  of  its  parent.  Those 
VITAL  PROPERTIES  CONFER  upon  it  THE  MEANS  of  itself  assimilating, 
and  THEREBY  ORGANIZING  AND  ENDOWING  WITH  VITALITY  the  materials 
supplied  by  the  inorganic  world." — Carpenter's  Principles,  &c.,  p. 
138. 

And  again,  this  mere  chemist,  in  his  general  views  of  the  philosojihy 
of  life,  observes,  that 


40  INSTITUTES    OP    MEDICINE. 

"  The  AGENCY  of  VITALITY,  as  Dr.  Prout  justly  remarks,  does  not 
change  the  properties  of  the  elements,  but  simply  combines  them 
[the  elements]  in  modes  which  we  cannot  imitate." — Carpenter's 
Principles,  &c.,  p.  146. 

64,  h.  Dr.  Prichard  is  strictly  of  Dr.  Carpenter's  school  (see  my 
"  Examination,"  &c.,  p.  37),  between  whom  there  is  a  point  of  agree- 
ment which  is  worth  noticing  in  its  connection  with  the  subject  now 
before  us,  and  to  which  I  have  referred  in  a  former  work,  in  its  rela- 
tion to  Dr.  Carj)enter.  Both  of  these  writers  see  so  much  of  peculiar 
design  in  organic  nature,  and  find  it  so  impossible  to  interpret  the 
phenomena  of  organic  beings  upon  the  chemical  and  physical  princi- 
ples which  they  have  so  strenuously  set  forth,  and  in  their  aversion  to 
any  other  principles,  and  to  the  obvious  rule  of  analogy  as  to  second 
causes,  that,  in  the  end,  they  assign  the  functions  and  phenomena  of 
life  to  the  imviediate  action  of  the  Deity. 

"  The  theory  of  a  vital  principle,"  says  Dr.  Prichard,  "  has  been 
applied  in  a  different  manner,  to  account  for  the  phenomena  displayed 
at  the  beginning  of  life  in  animals  and  vegetables,  and  to  get  rid  of 
the  mystery  which  attends  the  gradual  evolution  of  organic  structure 
from  ova  and  germs.  Here  the  vital  principle  is  no  longer  considered, 
a  chemical  agent,  but  assumes  the  character  of  a  plastic  and  formative 
power,"  &c. 

Now  Dr.  Prichard  "cuts  the  knot"  and  "gets  rid  of  the  mystery" 
after  the  following  manner  : 

"  We  may,"  he  says,  "  if  we  choose  to  do  so,  tei'm  the  cause  which 
governs  the  organization  and  vital  existence  a  plastic  principle ;  but 
it  is  a  principle  endowed  with  intelligence  and  design  [  !  ]  It  is, 
in  fact,  nothing  more  than  the  Energy  of  the  Deity."  "  The  devel- 
opment of  forms,  according  to  their  generic,  specific,  and  individual 
diversities,  not  less  in  the  vegetable  than  in  the  animal  world,  can 
only  be  accounted  for  by  ascribing  it  to  the  universal  energy  and 
wisdom  of  the  Creator." — Prichard's  Preview  of  the  Doctrine  of  a 
Vital  Principle.  See,  also,  Paine's  Commentaries,  vol.  i.,  p.  10,  25  ; 
and  his  Exainination  of  Reviews,  p.  37,  41,  43,  44. 

This  is  a  far  greater  admission  than  the  vitalist  can  desire ;  since, 
if  the  development  and  growth  of  the  germ  depend  immediately  upon 
Almighty  Power,  so  must  all  the  analogous  processes  of  the  living 
being  at  all  stages  of  its  existence,  and  science  would  be  merged  in 
the  direct  manifestations  of  that  Power.  But,  while  this  doctrine  is 
utterly  exclusive  of  all  the  assumed  chemical  agencies  at  all  periods 
of  life,  and  overlooks  the  analogy  between  the  development  of  the 
germ  and  the  subsequent  processes,  there  can  be  no  hesitation  as  to 
the  disposition  which  should  be  made  of  it,  without  any  reference  to 
its  prevaricating  nature  (§  175  d,  699  c,  740). 

65.  Having  now  before  us  a  plain  statement  of  our  necessary  prem- 
ises as  they  respect  the  exclusive  agency  of  the  "  vital  principle," 
or  "  organic  force,"  or  "  creative  power,"  or  "  vital  properties,"  or 
"vital  powers,"  or  "vitality"  (whichever  term  may  be  preferred),  in 
carrying  out  the  full  development  of  the  embiyo,  it  may  be  interesting 
to  know  the  details  of  that  development  and  growth,  which  is  thus 
allowed,  on  all  hands,  to  be  conducted  by  powers  utterly  distinct  from 
the  chemical  and  physical,  and  in  which  these  have  no  agency. 

"  The  development  of  the  separate  parts,"  says  Miiller,  "  out  of 


PHYSIOLOGY. COMPOSITION.  41 

the  simple  mass,  is  observable  in  the  incubated  egg.  All  the  parts 
of  the  egg,  except  the  germinal  membrane,  are  destined  for  the  nu- 
trition of  the  germ.  The  simple  germinal  disk  is  the  potential  whole 
of  the  future  animal,  endowed  with  the  essential  and  specific  force, 
or  principle  of  the  future  being,  and  this  germ  expands  to  form  the 
germinal  membrane,  which  grows  so  as  to  surround  the  yolk;  and  by 
transformation  of  this  germ,  the  organs  of  the  future  animal  are  pro- 
duced. The  rudiments  merely  of  the  nervous  and  vascular  systems, 
and  of  the  intestinal  canal,  are  first  formed  ;  and  from  these  rudi- 
ments the  details  of  the  organization  are  afterward  more  fully  devel- 
oped ;  so  that  the  Jirst  trace  of  the  central  parts  of  the  nervous  sys- 
tem must  be  regarded  neither  as  brain  nor  as  spinal  marrow,  but  as 
still  the  potential  whole  of  the  central  parts  of  the  nervous  system. 
In  the  same  manner,  the  different  parts  of  the  heart  are  seen  to  be 
developed  from  a  uniform  tube ;  and  the  first  trace  of  the  intestinal 
tube  is  more  than  the  mere  intestinal  tube  ;  it  is  the  j^otential  whole, 
— the  representative  of  the  entire  digestive  apparatus ;  for,  as  Baer 
first  discovered,  liver,  salivary  glands,  and  pancreas,  are,  in  the  far- 
ther progress  of  the  vegetative  process,  really  developed  from  that 
which  appears  to  be  merely  the  rudiment  of  the  intestinal  canal.  It 
can  be  no  longer  doubted  that  the  germ  is  not  the  miniature  of  the 
future  being,  with  all  its  organs,  as  Bonnet  and  Haller  believed, 
but  is  merely  potentiall]/ this  being,  with  the  specific  vital  force 
of  which  it  is  endowed,  and  which  it  becomes  actually  by  develop- 
ment, and  by  the  production  of  the  organs  essential  to  the  active 
state  of  the  actual  being.  A  high  magnifying  power  is  not  necessary 
to  distinguish  the  first  rudiments  of  the  separate  organs,  which,  from 
their  first  appearance,  are  distinct  and  very  large,  but  simple.  So 
that  the  later  complicated  state  of  a  particular  organ  can  be  seen  to 
arise  by  transformation  from  its  simple  rudiment.  These  remarks 
are  now  no  longer  mere  opinions,  but  facts;  and  nothing  is  more  dis- 
tinct than  the  development  of  glands  from  the  intestinal  tube,  and  of 
the  intestinal  tube  itself  from  a  portion  of  the  germinal  membrane." 
— MiJLLER,  ihid—{^  1051,  1052). 

Such,  then,  is  the  history  of  the  development  of  the  germ  in  birds, 
and  in  all  the  higher  animals ;  and  the  whole  work  is  ascribed  by 
physiologists  of  every  denomination  exclusively  to  principles  un- 
known in  the  inorganic  world,  and  wholly  distinct  from  any  of  a 
chemical  nature.  They  are  called,  indiscriminately,  vital  properties, 
vital  powers,  vital  principle,  organic  force,  creative  force,  &c.,  to  distin- 
guish the  principle,  or  properties,  from  every  thing  that  has  any 
known  existence  in  inorganic  substances,  or  as  the  source  of  any  in- 
organic results.  But,  physiologists  of  the  chemical  school  stop  here, 
and  ascribe  all  organic  compounds  after  the  being  is  fully  formed  to 
chemical  agencies.  It  is  remarkable,  however,  that  it  has  not  occur- 
red to  these  philosophers,  that  precisely  the  same  elementary  combi- 
nations, the  same  formation  into  tissues,  and  the  same  secretions,  take 
place  at  all  stages  of  the  rudimentary  development  as  at  all  future 
periods  of  life,  and  that  the  rudimentary  development  consists  in 
these  formations  of  simple  compounds  and  their  union  into  tissues ; 
and  if  the  early  or  rudimentary  growth  of  the  being,  all  its  secreted 
products,  all  its  elementary  combinations,  be  determined  by  the  vital 
properties,  so  are  the  same  results  determined  by  the  same  propertie.a 


42  INSTITUTES    OF    MEDICINE. 

or  power's  forever  aftei-ward.  To  call  in  the  agency  of  chemical  or 
physical  forces,  to  accomplish  precisely  the  same  results  at  any  future 
stage  of  the  organic  being  as  are  admitted  to  be  performed  in  the  de- 
velopment of  the  "essential  parts"  of  that  being  by  the  "vital  prin- 
ciple" or  "  vital  properties"  alone,  is  a  violation  not  only  of  the  plain- 
est rule  in  philosophy,  but  of  the  clearest  facts  (§  41,  42,  55-58). 

66.  We  have  thus  before  us  a  peculiar  order  of  powers  by  which 
the  organic  being  is  developed,  fashioned,  and  forever  exclusively 
governed.  It  is  these  powers  about  which  physiology,  pathology, 
and  therapeutics,  are  essentially  concerned.  We  may,  therefore, 
seek  in  the  composition  of  organic  beings,  and  in  the  laws  of  their 
development, yor  the  great  rudimentary  j^rinciples  of  medicine.  The 
vital  principle  has  also  the  extraordinary  task  of  laying  out,  in  the 
ovum,  the  whole  organization  of  the  future  being ;  so  that  its  subse- 
quent labor  must  be  comparatively  simple,  and  it  is  then,  least  of  all, 
that  it  can  require  any  help  fi'om  the  forces  of  the  inorganic  king- 
dom, or  that  it  would,  permit  a  violation  of  the  great  principle  in  na- 
ture  of  avoiding  an  unnecessary  multiplication  of  causes. 

67.  It  may  be  farther  shown  by  the  incipient  development  of  the 
ovum,  that  the  vital  powers,  or  properties,  are  more  concerned  in  the 
growth,  nutrition,  and  all  the  subsequent  physical  results,  throughout 
the  whole  existence  of  the  being,  than  is  generally  supposed  by  even 
the  exclusive  vitalists.  The  usual  supposition  is  that  the  vessels  or 
instruments  of  action,  which  are  moved  by  the  vital  powers,  perform 
the  work  of  decomposing  the  blood  and  other  parts,  and  recombining 
them  again  in  other  proportions  and  forms,  according  to  the  particu- 
lar organization  of  parts,  and  the  modification  of  their  vital  states. 
It  has  been  the  doctrine  of  most  physiologists  till  a  recent  day,  that 
the  ovum,  in  its  germinating  part,  is  a  mere  organic  fluid,  destitute 
of  vessels,  and  all  other  parts  of  the  future  apparatus.  Later  re- 
searches, however,  have  disclosed  the  existence  of  a  rudimentary 
cell;  and  it  is  said  by  Miiller  (1835)  that  "in  the  incubated  egg  the 
s-ole  material  for  the  first  formation  of  blood  is  the  substance  of  the 
germ  or  germinal  membrane,  which  itself  grows  by  assimilation  of 
the  fluid  of  the  egg^  or  the  yelk.  It  may  be  distinctly  observed  that 
the  blood  is  generated  in  the  germinal  membrane  before  the  vessels 
are  formed  ;"*  from  which  it  appears  that  t*he  first  "assimilation  of 
new  matter"  must  take  place  without  the  agency  of  vessels,  or  of 
any  parts  which  are  subsequently  formed  ;  and,  therefore,  the  same 
powers  which  enabled  the  cell  to  generate  vessels,  nerves,  <fcc.,  con- 
tinue to  make  the  same  conversion  out  of  blood  ;  and  as  all  this  was 
originally  done  Avithout  the  aid  of  vessels,  so  must  the  same  powers 
be  forever  operative  with  their  subsidiary  agency  only.f  As  the 
ovum  possesses  the  potential  Avholo,it  is  equivalent  to  the  mature 
structure. 

We  see,  therefore,  that  Miiller,  reasoning  upon  other  grounds,  may  not 
have  been  altogether  hypothetical  in  his  inference  that  the  "  vital  prin- 
ciple exerts  its  influence  even  beyond  the  surface  of  an  organ,  as  shown 
by  its  effects  on  the  chyle,  in  maintaining  the  fluidity  of  the  blood,"  &c. 

By  the  same  rule,  it  may  be  at  once  shown  that  the  only  ingenious 
chemical  hypothesis  ever  invented  to  interpret  organic  results, — the 
catalytic, — is  purely  an  assumption ;    since  this  hypothesis  is  predica- 

*  Kclliker  states  that  "  the  membrane  of  animal  cells,  the  largest  of  which  are  3-elk- 
cclls,  exhibit  no  structure  of  any  land." — Ulicroscojncal  Anatomy,  Wurzburg,  1852. 

f  So  far  as  this  the  author  had  inculcated  more  than  twenty  years  ago  what  is  now 
known  as  the  cell-theorij — 1870. 


PHYSIOLOGY. COMPOSITION.  43 

ted  of  the  bioocl-vessels.  But,  if  there  be  no  vessels  in  the  germ,  the 
first  vessels  must,  of  course,  be  produced  without  the  supposed  chem- 
ical influence  of  vessels,  and,  by  my  showing,  therefore,  as  to  the 
subsequent  formation  of  vessels  and  other  parts,  the  supposed  agency 
of  the  catalytic  forces  is  a  mere  assumption  (§  41,  42,  1051;  also, 
Medical  and  Physiological  Commentaries,  vol.  i.,  p.  74-7G). 

On  this  subject,  too,  chemistry  must  abide  by  admissions  which  are 
made  in  the  very  face  of  consistency ;  so  imperative  is  fact,  and  so 
imbecile  is  hypothesis.  Thus,  it  is  said  by  the  distinguished  chemico- 
physiologist.  Dr.  Prout,  that 

"  The  most  determined  sceptic  cannot  assert  that  there  is  any  ne- 
cessary relation,  or,  indeed,  any  relation  whatever,  between  the 
mechanical  arrangements  and  the  chemical  properties  to  which  they 
administer.  There  is  no  reason  why  the  chemical  changes  of  or- 
ganization should  result  from  the  mechanical  arrangements  by  which 
they  are  accomplished  [ !  ] ;  neither  is  there  the  slightest  reason 
why  the  mechanical  arrangements,  in  the  formation  of  organized  be- 
ings, should  lead  to  the  chemical  changes  of  which  they  are  the  inst.ru- 
ments"  ! — Dr.  Prout's  Bridgetoater  Treatise. — Such  is  the  proof 
which  chemistry  offers. 

68.  The  question  then  arises  as  to  what  is  the  particular  ofiice  of 
those  vessels  where  the  elementary  combinations  and  decompositions 
take  place]  Simply  this:  to  convey,  and  eliminate  through  the  agen- 
cies of  the  vital  properties,  those  parts  from  the  blood  out  of  which 
the  vital  properties  effect  the  new  elementary  combinations,  whether 
solid  or  fluid, — to  aid  in  arranging  the  new  molecules,  and  to  carry 
forward  those  fluid  products  which  may  be  destined  for  other  ends. 

69.  But,  have  not  the  nerves  an  indispensable  agency  in  effecting 
the  elementary  combinations  and  decompositions  %  Certainly  not, 
as  I  shall  endeavor  to  show.  But  the  sympathetic  nerve  exerts  an 
influence  upon  all  organic  functions,  and  impresses  a  special  condition 
upon  all  organic  compounds,  and  this  physiological  law  is  extensively 
involved  in  patholoay  and  therapeutics  ('§  22G,  232,  233,  399,  446  a, 
461,  461i  488-L,  489,  512,  639,  746  c). 

70.  But,  all  the  vessels,  and  all  the  solid  parts  of  the  organism,  have 
their  various  specific  offices.  Here,  in  every  part,  reside  the  vital 
properties,  which  had  been  fully  developed  in  the  ovum,  and  here 
are  they  modified  according  to  the  exact  nature  of  the  organization 
and  the  peculiar  final  causes  of  "  the  properties  of  the  vital  principle" 
in  each  part.  Hence  they  manifest  peculiarities  in  parts  that  are 
apparently  alike.  The  modifications  vai-y,  for  instance,  in  the  serous 
membranes,  and  more  remarkably  in  the  mucous,  as  known  by  the 
influence  of  foreign  agents,  their  phenomena,  their  products,  &c. 
The  vital  properties  differ  in  different  parts  of  one  and  the  same  con- 
tinuous tissue,  as  in  the  mucous  tissue  of  the  nose,  lungs,  stomach, 
&c.  Hence  one  of  the  important  objects  of  studying  the  structure  of 
organs,  and  the  nature  of  their  tissues ;  for,  as  the  vital  properties  are 
naturally  modified  in  different  parts,  so  will  their  alterations  in  the 
same  disease  be  different  in  different  tissues  of  one  organ,  and,  for 
the  same  reason,  even  of  different  parts  of  one  continuous  tissue. 

These  natural  modifications  of  the  vital  properties  in  different  parts 
have,  at  least,  three  great  final  causes.  The  first  is  what  I  have  al- 
ready stated,  namely,  to  separate  from  the  blood,  through  the  agency 
of  the  capillary  vessels,  that  exact  part  which  is  to  be  decompounded 


44  INSTITUTES    OF    MEDICINE. 

at  any  given  point ;  the  second  is,  by  these  modifications,  to  enable 
"  the  properties  of  the  vital  principle"  to  decompound  and  recombine 
the  elements  according  to  the  exact  nature  of  the  combinations  which 
belong  to  the  part ;  and  the  third,  to  qualify  the  properties,  through 
the  medium  of  the  capillary  vessels,  to  shape  and  unite  the  new  mole- 
cules to  the  old.  It  is  easy  to  apply  this  principle,  under  its  different 
aspects,  to  all  other  vessels,  as  the  veins,  the  secretory  and  excretory 
vessels  of  the  glands,  and  the  absorbents. 

71.  Now,  at  the  first  start  of  the  development  of  the  germ,  "  the 
properties  of  the  vital  principle"  (as  they  are  well  designated  by  Miil- 
ler)  are  but  very  imperfectly,  if  at  all,  aided  by  any  of  the  foregoing 
physical  means,  though  they  come  into  operation  at  the  moment  they 
are  successively  produced.  "  The  properties  of  the  vital  principle," 
therefore,  must  exist  in  that  potential  cell  in  a  modification,  and  with 
a  formative  energy  which  they  do  not  possess  in  any  of  the  new  de- 
velopments ;  and  herein  it  will  have  been  seen  that  the  very  chemist 
has  come  to  this  conclusion  (§  64  y,  190  b). 

72.  The  process  of  generation  presents  a  varied  and  most  impres- 
sive illustration  of  the  peculiarities  of  the  vital  properties,  and  of  the 
manner  in  which  they  are  liable  to  be  imj^ressed  and  permanently 
modified  in  their  nature.  It  results  in  the  production  of  organic  be- 
ings similar  to'  those  which  exercise  the  generative  faculty.  This  fac- 
ulty is  therefore  manifested  with  as  many  specific  modifications  as 
there  are  different  species  of  organic  beings.  If  we  allow  to  the  globe 
one  million  of  distinct  species  of  animals,  the  specific  modifications  of 
the  germinal  product  will  be  as  numerous,  and  these  are  more  or  less 
influenced  by  the  semen  of  the  male.  The  seminal  or  productive 
principle  of  the  male  exerts  its  special  influences  upon  the  living  prop- 
erties of  the  germ,  and  according  to  the  special  constitution  of  the 
ovum  directs  their  operation  in  such  a  maimer  that  none  but  beings 
of  the  same  kind  with  the  parents,  where  both  are  of  the  same  species, 
are  produced.  That  the  various  modifications  which  distinguish  each 
species  are  determined  by  both  parents  is  fully  demonstrated  in  hybrid 
animals,  and  is  sufficiently  obvious  in  the  transmission  of  the  peculiai'- 
ities  of  the  male  or  female,  where  the  individuals  are  of  the  same  spe- 
cies. And,  notwithstanding  our  supposed  million  of  distinct  species 
of  animals,  and  the  specific  variations  in  all  the  parts  of  each  species 
(§  41),  this  almost  endless  variety  is  made  up  by  successive  deposi- 
tions of  elementary  compounds  out  of  mainly  four  simple  substances 
(§  37,  42,  46),  three  of  which  are  gaseous,  united  in  modes  unknown 
to  chemistry  (38-40,  48),  and  which  chemistry  cannot  detect,  and  for- 
ever uniting  in  different  modes  and  proportions  according  to  the  ex- 
act nature  of  every  part  (§  43,  44).  The  act  of  generation  establishes 
the  essential  modifications  which  are  to  be  continued,  without  varia- 
tion, throughout  the  life  of  the  new  being  ;  and  this  new  individual,  be- 
coming in  its  turn  the  agent  of  procreation,  pei-petuates  all  the  specif- 
ic modifications  which  appertain  to  itself  and  to  its  ancestors.  The 
intermino-linf  of  species,  which  results  in  hybrid  animals,  proceeds 
upon  the  same  plan.  It  must  therefore  necessarily  be,  that  the  vital 
properties  of  the  ovum  are  so  impressed  by  the  exciting  influences  of 
the  semen  that  those  peculiar  elementary  combinations  and  aggrega- 
tions are  started  which  ultimately  make  up  the  hybrid.  "  These  vital 
properties,"  says  Dr.  Caipenter,  "  confer  upon  it  the  means  of  itsel/ 


PHYSIOLOGY. COMPOSITION  45 

assimilating,  and  thereby  organizing,  and  endowing  with  vitality,  the 
materials  of  the  inorganic  world  ;"  leaving  it,  also,  clear  to  all  minds 
that  the  action  of  the  semen  must  be  exerted  directly  upon  the  vital 
properties  of  the  ovum  (§  189,  1051). 

That  this  important  question  as  to  the  direct  action  of  the  semen  % 
upon  the  vital  properties  of  the  ovum,  and  its  capability  of  establish- 
ing certain  modifications  of  these  properties,  and  that  the  humoral  in- 
terpretation of  transmitted  peculiarities  is  an  unfounded  assumption, 
may  be  definitively  settled,  I  will  also  add, 

"  The  well-kno\vn  fact,  that  when  the  Earl  of  Morton's  Arabian  mare 
was  covered  by  the  quagga,  not  only  did  the  mule  so  begotten  partake 
of  the  character  of  the  sire,  but  when  the  mare  was  subsequently  sub- 
mitted to  an  Arabian  stallion,  by  whom  she  had  three  foals  at  differ- 
ent times,  the  first  two  continued  to  exhibit  some  of  the  distinctive 
peculiarities  of  the  quagga  conjoined  with  the  characters  of  the  Ara- 
bian breed." — Montgomery,  ow  the  Signs  and  Symptoms  oj^  Pregnan- 
cy, p.  17.     This  should  overthrow  the  whole  fabric  of  humoralism.* 

The  author  of  the  foregoing  statement  supposes  that  the  semen 
"  may  influence  several  ova,  and  so  continue  to  manifest  its  effect  in 
the  offspring  of  subsequent  conceptions  when  impregnation  has  been 
effected"  by  males  of  another  species.  The  reader  will  also  not  fail 
to  remark  that  the  history  of  this  case  is  in  direct  conflict  with  the  late 
attempts  to  revive  the  old^doctrine  of  referring  the  germ  to  the  male 
parent  (§  67,  1051,  1052,  1078). 

73,  a.  The  semen,  then,  is  a  vital  stimulus,  and  so  far  on  a  par  with 
the  ordinary  stimuli  of  life.  These  may  be  natural,  like  air,  food, 
heat,  &c. ;  or  they  may  be  morbific,  like  malaria,  poisons,  &c. ;  or  cu- 
rative, like  medicines.  In  all  the  cases,  their  action  is  upon  the  vital 
properties  ;  and  it  is  in  consequence  of  these  influences  that  the  ovum 
is  developed,  that  life  is  maintained,  health  preserved  or  impaired,  or 
disease  removed.  The  ova  of  oviparous  animals  show  the  analogy  in 
respect  to  stimuli,  and  the  principles  involved,  more  impressively  than 
those  of  viviparous  ;  since  by  an  admirable  design,  in  respect  to  the 
former,  the  impression  of  the  semen  has  a  limited  operation,  when  the 
vital  properties  of  the  ovum  return  to  their  quiescent  state,  but  may 
be  again  roused  into  action  by  the  simple  stimulus  of  heat.  (See  Med. 
and  PJiys.  Gomm.y  vol.  i.,  p.  21,  &c.) 

73,  h.  The  action  of  the  semen  upon  the  properties  of  the  vital  prin- 
ciple of  the  germ  is  a  type  of  all  the  influences  that  are  produced  upon 
the  same  vital  properties  during  the  life  of  the  animal,  and  from  which 
all  its  organic  actions,  and  all  their  results,  arise.  And  so  of  the  ger 
mination  and  growth  of  plants ;  which,  by-the-way,  evinces  the  com- 
mon nature  of  the  principle  of  life,  and  of  organic  actions,  in  the  two 
departments  of  the  animated  kingdom  (§  18Sj,  d).  It  is  the  whole  es- 
sential philosophy  of  physiology.  It  is  the  alterations  produced  in 
the  vital  properties  which  constitutes  the  philosophy  of  disease,  and 
in  which,  indeed,  all  disease  virtually  consists.  It  is  the  art  of  finding 
out  the  remote  causes,  and  the  nature  of  the  alterations  they  produce, 
and  of  adapting  to  the  altered  condition  of  the  properties  of  life  such 
agents  as  shall  establish  new  impressions  upon  them,  and  thus  enable 
them  to  return  to  their  natural  state,  which  forms  the  basis  of  thera- 
peutics in  its  connection  with  pathology. 

74.  a.  Here  I  shall  digress  for  a  moment,  to  consider  certain  anal- 

*  The  same  is  stated  of  Sir  G.  Ousley's  mare  and  a  zebra,  and  of  a  mare  and  an  ass, 
and  the  subsequent  foals  bj'  stallions. 


46  INSTITUTES   OF    MEDICINE. 

ogies  ill  the  development  of  special  organs,  tlirough  the  influence  of 
specific  stimuli,  with  that  general  evolution  of  the  organic  fabric 
which  is  started  by  the  action  of  the  seminal  principle  upon  the  germ. 
These  analogies  are  to  be  found  in  the  organs  of  animal  life.  The 
senses,  for  example,  sometimes  manifestly  require  for  their  full  de- 
velopment the  prolonged  operation  of  the  stimuli  which  are  natural 
to  each.  This  is  habitually  observed  in  the  young  of  some  animals, 
and  is  seen  conspicuously  in  the  subteiTanean  fish  of  Kentucky.  In  v 
this  last  instance  organic  life  is  perfectly  developed  ;  but,  owing  to  the 
exclusion  of  the  natural  stimulus  of  the  eye  from  the  very  outset  of 
life,  that  organ  I'emains  in  its  rudimentary  state. 

A  fortiori,  therefore,  the  reputedly  first  inhabitants  of  this  globe,  such 
as  the  trilobite,  attest  the  existence  of  the  same  light  at  their  crea- 
tion as  is  enjoyed  at  the  present  day;  geologists  to  the  contrary  not- 
withstanding (^  1079,  h). 

Superficial  observers  of  nature,  either  through  inattention  to  the 
moral  consequences,  or  through  infidelity,  are  apt  to  believe  that  phys- 
ical agents  are  the  real  creative  forces  of  ors^anic  beingrs,  from  ob- 
serving  that  particular  parts  are  clearly  dependent  for  their  develop- 
ment upon  the  action  of  certain  specific  stimuli.  But,  in  all  these  cases, 
the  rudiment  is  there,  and  has  been  perpetuated  ever  since  the  original 
species  came  from  the  Hand  of  Creative  Power.  That  Power  is  en- 
titled to  all  the  praise,  as  the  Author  of  tl|e  rudiment,  of  its  endow- 
ment with  peculiarly  modified  properties  of  life,  of  the  existence  of 
the  physical  agents,  and  of  the  mutual  adaptation  of  these  modified 
properties  of  the  rudiment  and  the  virtues  of  the  physical  causes,  so 
that  the  operation  of  the  latter  upon  the  former  shall  result,  for  exam- 
ple, in  vision,  and,  under  certain  circumstances,  as  when  the  ovum  is 
developed  and  matured  out  of  the  body,  the  physical  agent,  in  the  ex- 
ample supposed,  shall  be  necessary  to  the  development  of  the  rudi- 
mentary organ  of  sight  (§  350|,  /i-350|,  Z).  The  principle  is  much 
the  same  as  that  which  applies  to  the  necessity  of  exten;al  heat  and 
light  to  the  development  and  growth  of  plants.  The  specific  stimu- 
lus of  light  by  which  the  vital  properties  and  actions  of  the  leaf  are 
enabled  to  decompound  carbonic  acid,  and  to  assimilate  the  carbon,  is 
manifestly  a  parallel  example  with  my  supposed  influence  of  light  in 
developing  an  animal  organ  in  which  the  nervous  system  is  extensive- 
ly incorporated  for  the  final  cause  of  the  whole  organ ;  although  it  be 
certainly  true  that,  in  the  case  of  the  eye  as  of  the  leaf,  the  essential 
influences  of  light  are  exerted  upon  the  organic  properties  of  either 
part,  and  that  the  nervous  system,  in  the  former  case,  is  only  a  medi- 
um of  transmitted  influences  to  the  organic  properties  (§  188,  188j, 
189,  202,  203,  222,  223,  226,  227,  514  k,  1072  a,  note). 

It  would  be  an  interesting  inquiry  to  ascertain  whether,  by  a  total 
exclusion  of  light  from  the  ovum  of  fish,  after  fecundation,  the  pecu- 
liarity of  the  Kentucky  wonder  may  not  be  established  in  the  first 
generation ;  and  whether,  also,  an  exclusion  of  light  for  a  series  of 
years  would  not  be  followed  by  a  failure  of  the  balance  of  absorption 
and  nutrition  in  the  eyes,  and  consequently  a  wasting  of  diose  organs. 
The  general  law  of  absorption  operates  universally,  without  the  aid 
of  any  specific  stimulus ;  while  it  is  clearly  otherwise  in  respect  to 
nutrition,  and  especially  in  regard  to  certain  organs.  The  voluntary 
muscles  become  emaciated  from  want  of  the  stimulus  of  exercise,  &c 


THYSIOLOGY. COMPOSITIOX.  47 

We  see,  therefore,  how  it  happens  that  fishes  with  and  without  eyes 
may  exist  together  in  subterranean  caverns  as  extensive  as  that  of 
Kentucky;  the  latter  inhabiting  the  dark  regions,  while  the  former 
exist  in  springs  near  the  crevices  of  the  cave  (§  136,  137,  548  a,  649  (Z. 
733  i). 

74.  b.  Such,  then,  is  my  philosophy  of  this  subject,  and  such  the  full 
extent  of  the  gi'ound  upon  which  infidelity  would  plant  its  stand  ai'd. 
Nor  will  I  dismiss  this  subject  without  referring,  now  and  hereafter, 
to  the  calm  indifference  with  which  this  infidelity  is  regai'ded  even  by 
the  religious  world,  by  adducing  not  a  few  of  the  present  popular 
treatises  on  theoretical  geology  (^  350|,  g-k,  1085). 

75.  Let  us  now  see  if  the  beginning  of  individual  existence  does 
not  supply  a  key  to  the  whole  jihilosophy  of  disease,  as  it  does  to  that 
of  physiology.  We  have  seen  that  all  the  actions,  and  all  the  results 
of  life,  are  merely  effects  which  arise  from  the  operation  of  the  vital 
properties  through  their  organic  instruments  (§  65-67,  133,  &c.,  188, 
&c.).  •  These  properties  must  be  constantly  excited  into  action  by 
foreign  agents,  as  by  food,  blood,  &c.,  or  the  properties  will  become 
extinct,  and,  of  course,  the  effects  will  cease  (§  ISSj,  h).  Now,  the 
actions  in  disease  are  nothing  more  than  the  altered  actions  of  health, 
and  the  same  rule  applies  to  all  the  morbid  products.  It  follows,' 
therefore,  that  the  properties  of  life,  ujjon  which  these  altered  condi- 
tions depend,  are  modified  or  altered  in  a  corresponding  manner. 
As  a  consequence  of  this,  it  also  results  that  the  vital  properties  have 
been  varied  from  their  natural  state  by  agents  or  causes  capable  of 
producing  the  change.  These  agents  make  their  impressions  in  the 
same  way  as  the  natural  stimuli  of  life,  only  the  moi'bific  agents  at 
the  same  time  affect  the  nature  of  the  vital  properties,  and  bring  them 
into  a  new  condition.     This  new  condition  constitutes  disease. 

76.  The  type  of  all  this  may  be  found  in  the  impregnated  ovum. 
The  properties  which  animate  the  germ  before  conception  are  deter- 
mined entirely  by  the  vital  constitution  of  the  female  parent.  But  we 
have  seen  that  the  new  being  may  partake  of  the  physical  characters 
of  the  male  as  well  as  of  the  female,  and  it  happens  not  unfrequently 
that  the  characteristics  of  the  male  are  predominant.  Hence  it  fol- 
lows that  the  semen  so  far  establishes  changes  in  the  original  consti- 
tution of  the  vital  properties  of  the  germ. 

Since,  therefore,  all  the  foetal  developments,  all  their  physical  pe- 
culiarities, depend  upon  the  precise  modifications  and  actions  of  the 
vital  properties  (§  70),  and  since  these  properties  in  the  unimpregnated 
ovum  are  determined  entirely  by  the  female  parent,  their  nature  after 
impregnation  must  be  more  or  less  affected,  and  assimilated  to  the 
peculiar  nature  of  the  male  parent  in  all  the  cases  where  the  offspring 
manifest  any  of  the  male  characteristics.  This  is  entirely  analogous, 
in  principle,  to  the  modifications  which  are  produced  in  the  properties 
of  life  by  morbific  causes;  but  with  this  difference  in  contingencies: 
in  the  case  of  the  impregnated  ovurn  the  modifications  are  perma- 
nently established,  and  can  never  be  altered,  so  far  as  the  vital  prop- 
erties, in  either  parent,  upon  which  the  modifications  depend,  are  fun- 
damental in  their  nature.  In  the  case  of  the  morbific  agent,  or  the 
cause  of  disease,  the  vital  properties  are  diverted  from  the  healthv 
state,  and  from  such  modified  conditions  they  commonly  possess  the 
ability  of  escape,  and  of  returning  again  to  their  natural  standard  (§ 


4S  INSTITUTES    OF    MEDICINE. 

S53,  858,  898).  In  the  case  of  the  impregnated  ovam  a  modifying 
agent  operates,  whose  properties  are  intended  to  confer  on  the  new 
being  a  stable  condition,  however  they  may  modify  the  exact  consti- 
tution of  the  impregnated  germ.  This  vital  stimulus,  the  semen, 
therefore,  in  virtue  of  its  specific  properties,  bestows  upon  the  corre- 
sponding vital  properties  of  the  ovum  the  peculiarities  which  belong 
to  itself;  and  these  being  natural,  vital,  and  determinate,  the  trans- 
mitted peculiarities  should  be  equally  so.  Or,  where  the  male  parent 
enjoys  a  perfectly  natural  constitution,  the  innate  predispositions  to 
disease  depend  upon  special  peculiarities  in  the  vital  state  of  the  ovum, 
which  may  be  as  permanently  established,  through  the  modified  con- 
stitution of  the  female  parent,  as  any  of  the  natm-al  characteristics. 
In  the  case  of  disease,  however,  the  morbific  agents  have  none  of  the 
properties  of  life  which  are  natural  to  the  fecundating  semen,  and  the 
modifications,  therefore,  which  they  may  determine  may  be  different, 
even  if  we  suppose  them  to  act,  as  in  the  case  of  the  germ,  upon  the 
whole  constitution.  Whatever  modifications,  therefore,  may  arise 
from  their  action,  they  must  consist  of  deviations  from  the  standard 
of  health.  But,  it  does  not  necessarily  follow  that  certain  artificial 
modifications  may  not  be  as  permanent  as  the  natural  ones ;  and  it  is 
from  observation  alone,  that  we  learn  that  they  are  so,  or  neai'ly  so ; 
as  in  the  case  of  artificial  "temperaments,"  the  effects  of  domestica- 
tion upon  animals,  the  changes  which  are  wrought  in  the  vegetable 
kingdom  by  cultivation  and  by  change  of  climate  (§  535,  &c.). 

77.  In  the  case,  however,  of  the  ■  formation  of  temperaments  by 
change  of  climate,  and  the  more  remarkable  alterations  produced  in 
animals  by  domestication,  and  in  plants  by  cultivation,  &c.,  the  results 
are  brought  about  by  the  new  and  habitual  influences  to  which  the 
properties  of  life  are  exposed ;  and,  in  all  these  cases,  a  radical,  and 
often  permanent  modification  is  established,  approximating  closely 
the  modifications  which  are  bestowed  upon  the  germ  by  the  fecunda- 
ting semen.  Now,  it  is  also  true,  that  what  is  denominated  predispo- 
sition to  disease  is  entirely  analogous,  in  principle,  to  the  permanent 
temperaments  of  which  I  have  just  spoken.  Both  are  results  of  phys- 
ical agents,  modifying  the  properties  of  life  ;  and  this  chain  of  analo- 
gies conducts  us  to  those  predispositions  to  disease  which  are  im- 
pressed upon  the  germ  by  the  fecundating  semen,  and  by  which  I 
show  that  the  philosophy  of  the  operation  of  morfibic  causes  is  vari- 
ously, and  even  exactly  exhibited  in  the  impregnation  of  the  germ  (§ 
63,  75,  535,  539,  559). 

78.  Take  the  scrofulous  subject  as  supplying  an  example  of  hered- 
itaiy  predisposition  to  disease.  If  it  exist  in  the  female,  her  ova  will 
partake  of  this  peculiar  modification  of  the  vital  properties,  and  it  is 
in  this  way  that  her  progeny  inherits  the  scrofulous  diathesis  (§  144- 
147).  In  this  case,  as  in  all  transmitted  predispositions  to  disease, 
the  peculiarities  induced  in  the  parent  have  arisen,  originally,  from 
the  operation  of  deleterious  agents — imbuing  the  ovum  with  the  mod- 
ifications belonging  to  the  female,  or  imparting  to  the  semen  the  whole 
concentrated  force  of  what  may  have  been  the  slow  work  of  numerous 
causes  upon  the  male  parent. 

Here,  then,  we  see  illustrated  in  the  very  ovum,  even  before  im- 
pregnation, the  whole  pi-inciple  which  concerns  artificial  tempera- 
raentG,  and  those  influences  of  morbific  agents  which  establish  predis- 


PHYSIOLOGY. — COMPOSITION.  49 

positions  to  disease  in  the  full-grown  subject.  It  frequently  hap- 
pens, also,  that  this  natural  diathesis  is  so  great,  that  it  results  in 
actual  disease  before  the  birth  of  the  offspring,  as  manifested  by- 
tuberculous  affections  of  the  lungs,  syphilis,  and  small-pox  in  new- 
ly-born infants. 

79.  But,  to  make  the  philosophy  of  this'subject  more  obvious,  let  us 
consider  the  germ  when  it  derives  its  scrofulous  diathesis  from  the  male 
parent.  Before  impregnation  its  vital  condition  is  perfectly  natural. 
The  semen  of  the  male  parent  establishes  upon  it  the  modification 
which  constitutes  the  predisposition  to  scrofula,  just  as  malaria  deter- 
mine those  modifications  which  result  in  fever,  &c.  And  here  we 
may  readily  detect  a  perfect  analogy  between  the  alterative  influences 
of  the  semen  and  of  remedial  agents,  and  come  to  understand  how  it 
is  that  the  latter  produce  their  effects  (§  904,  d).  We  have  only  to 
observe  those  instances  where  some  of  the  offspring  inherit  the  scrof- 
ulous diathesis  of  the  female  parent,  while  others  are  as  entirely  ex- 
empt as  the  male  parent ;  the  natural  condition  of  the  semen  having 
altered  the  vital  constitution  of  the  ovum  in  the  latter  case,  and  im- 
pressed a  disposition  to  a  development  of  the  new  being  in  its  perfect 
state. 

80.  The  subject  may  be  pursued  under  a  variety  of  aspects,  and 
with  various  illustrations,  whether  physiologically  or  pathologically- 
Other  exemplifications  will  occur  under  the  subjects  of  vital  habit 
and  the  temperaments.  The  same  principle  is  concerned  throughout, 
whether  in  respect  to  the  physiological  conditions  impressed  upon  the 
ovum  by  the  seminal  fluid,  or  as  those  conditions  are  modified  in  he- 
reditary scrofula,  gout,  &c.,  or  whether  it  concern  the  temperaments 
and  other  permanent  changes  that  are  induced  by  climate,  domestica- 
tion, &c.,  or  as  malaria  may  establish  their  peculiar  modifications  of 
the  properties  of  life.  Nor  can  such  conclusions  be  unexpected  to 
those  who  duly  consider  the  simplicity  of  nature  in  her  elementary 
principles  and  laws  (§  561). 

81.  Could  the  doctrine  entertained  by  Walker,  Elliotson,  and  oth- 
ers, that  the  imagination  of  the  parents  influences  the  physical  organ- 
ization of  the  offspring,  be  shown,  the  philosophy  which  I  have  set 
forth,  though  not  rendered  more  clear,  would  be  yet  fortified.  But, 
this  is  at  best  but  speculation.  I  could,  however,  turn  to  the  myste- 
rious production  of  the  soul.  This  remarkable  principle  is  doubtless 
developed  at  the  very  outset  of  foetal  life,  as  evinced  by  its  often  com- 
bining the  intellectual  peculiarities  of  both  parents,  or,  again,  of  man- 
ifesting chiefly  those  of  the  male.  But  here  we  have  no  other  fact  to 
guide  us,  and  all  beyond  has  been  involved  in  an  impenetrable  mys- 
tery by  the  great  Creator.  Here  it  is  a  pride  and  a  help  of  philoso- 
phy to  rest  on  faith  alone  (§  433). 

82.  For  an  examination  of  vital  phenomena,  and  relative  facts,  in 
proof  of  the  existence  of  properties  peculiar  to  organic  beings,  and  of 
the  abstraction  of  such  beings  from  the  laws  of  the  inorganic  world, 
see  Essay  on  the  "  Vital  Powers,"  in  Medical  and  Phyiiological  Com- 
mentaries, vol.  i. 

D 


50  INSTITUTES    OF    MEDICINE. 

SECOND  DIVISION  OF  PHYSIOLOGY. 

STRUCTURE. 

83,  a.  There  are  certain  details  in  respect  to  the  structure  of  or- 
gans which  must  be  stated,  now  and  hereafter,  to  enable  us  to  com- 
prehend the  laws  which  govern  the  healthy  and  morbid  states  of  man 

Perhaps  few  things  can  impress  us  more  forcibly  with  the  impor- 
tance of  a  correct  analysis  not  only  of  the  physical  organization  of  all 
parts  of  the  body,  but  more  especially  of  the  vital  characteristics  of 
each  part,  than  the  continued  propagation  from  high  sources  of  doc- 
trines like  the  following  ;  while  they  equally  prove  my  position  as  to 
the  appropriate  sources  of  knowledge  (§  51-51,  &c.),  and  the  tenden- 
cies of  the  microscope.* 

83,  h.  The  eiTors  in  doctrine  to  which  I  have  referred  are  I'cvealed 
sufficiently  in  the  following  extract  from  an  article  by  the  distinguish- 
ed Mr.  Paget,  contained  in  the  27th  volume  of  the  Transactions  of  the 
Royal  Medical  and  Chirurgical  Society,  London,  1844.  The  article 
is  entitled  "An  Account  of  the  Examination  of  a  Cyst  containing 
Seminal  Fluid;"  in  the  course  of  which  Mr.  Paget  observes, 

"  If,  with  the  aid  of  these  observations,  we  endeavor  to  find  an  ex- 
planation of  the  occurrence  of  spermatozoa  in  the  fluid  of  cysts  con- 
nected with  the  testicle,  we  may  suppose  either  that  the  fluid  part  of 
the  semen  has  permeated  from  the  seminal  tubes  into  the  cysts,  and 
been  farther  organized  in  them ;  or,  that  the  cyst  itself  secretes  a  fluid 
in  which  the  organic  structures  of  the  semen  may  be  developed." 
"  The  most  probable  explanation  of  these  cases,  therefore,  seems  to 
be,  that  certain  cysts,  seated  near  the  organ  which  naturally  secretes 
the  materials  for  semen,  may  possess  a  power  of  secreting  a  similar 
fluid"!  (s^  251). 

I  cannot  doubt  that  before  I  shall  have  parted  with  the  reader  in 
what  I  shall  have  said  of  the  peculiarities  of  structure,  and  the  more 
remarkable  modifications  of  vital  properties  and  functions,  there  will 
be  a  disposition  to  concede  the  importance  of  the  subject,  and  that 
this  importance  is  rendered  more  manifest  by  the  prevalence  of  opin- 
ions analogous  to  those  in  the  foregoing  extract. 

83,  c.  As  I  have  already  intimated,  however  (§  2,  c),  anatomical 
science  can  lead,  originally,  to  no  conceptions  of  the  properties  and 
functiuns  of  life,  and  therefore  to  none  of  their  modifications  in  dis 
ease.  The  most  that  we  can  infer,  abstractedly,  from  a  knowledge  of 
structure,  are  certain  general  results  that  are  denoted  by  the  constitu- 
tion of  organs,  or  assemblages  of  organs,  upon  the  known  principles 

*  See  Medical  and  Physiological  Co^nimentarics,  vol.  i.,  p.  699-712.  Also,  my  Exam- 
ination of  Rericwti,  p.  6,  89,  90. 

t  The  Me'dicoChirurgical  Heview  for  January,  1845,  quotes  this  paragraph,  and  ob- 
serves of  it,  that  "  Mr.  Paget's  explanation  of  the  %'icai-ious  appearance  of  the  spermatozoa, 
which  has  of  late  so  much  puzzled  the  members  of  the  society,  has  the  merit  of  being  in- 
genioHx  and  original." — I  cannot  acquiesce  in  this  decision.  The  docti'ine  is  old,  though 
recently,  for  the  first  time,  enforced  by  the  deceptive  report  of  the  microscope.  It  is  thus 
noticed  in  the  Medical  and  Physiological  Commentaries :  "  True,  we  know  that  the  an- 
cient belief  is  even  maintained  at  this  day,  by  Sir  A.  Cooper,  and  others,  that  the  testis 
is  of  no  special  use,  but  that  the  semen  is  the  product  of  those  simple  resei-v'oirs,  the  vesi- 
culas  seminalcs.  But,  whtit  does  this  show?"  &c.  See,  also,  my  comments  on  this  sub- 
ject, in  vol.  i.,  p.  588,  and  on  the  supposed  vicarious  secretion  of  miUi,  urine,  cf-c..  p.  601-  (it)3. 


PHYSIOLOGY. STRUCTURE.  51- 

of  Design.  The  construction  of  the  eye,  for  example,  evinces  some 
great  final  cause  relative  to  light  ;  that  of  the  urinary  apparatus,  that 
a  fluid  is  produced  by  the  kidneys,  and  conveyed  to  a  receptacle 
where  it  accumulates,  and  is  finally  evacuated  through  the  urethra ; 
and  so  of  many  other  parts.  We  thus  infer,  also,  the  uses  of  each 
part,  individually,  from  their  relations  to  each  other  as  a  system  of 
Design.  In  other  cases  the  function  of  a  part  may  be  inferred  from 
the  known  uses  of  other  parts  to  which  it  is  related  ;  as  the  valves  of 
the  vehis,  for  example,  were  supposed  by  Harvey  to  be  designed  for 
giving  the  blood  a  direction  toward  the  right  cavities  of  the  heart; 
and  this  induction  from  anatomical  Design  conducted  him  to  a  full 
exposition  of  the  circulation.  But,  in  respect  to  the  great  processes 
of  life,  no  conclusions  can  be  originally  drawn  but  through  their  phe- 
nomena, nor  does  structure  denote  even  the  principle  of  vision  (§  251). 
Having,  however,  acquired  a  knowledge  of  structure  in  a  particular 
species  of  animal,  as  man,  for  example,  and  learned  the  uses  of  each 
particular  part  by  a  study  of  its  phenomena,  so  perfect  is  the  system 
of  Design  throughout  organic  nature,  and  so  harmonious  are  the  anal- 
02:ies  of  function  among-  ortjans  that  bear  certain  resemblances  of 
structure,  or  of  relations  to  each  other,  in  all  species  of  animals,  al- 
though the  differences  in  respect  to  structure,  particulai'ly,  may  be 
very  great  (§  107,  409,  e),  yet  illustrated  by  greater  analogies  of  relation, 
we  may  generally  infer,  by  this  analogical  process  (§  5i),  the  absolute 
uses  of  every  part  in  any  species  of  animal  that  may  be,  for  the  first 
time,  subjected  to  the  knife  of  the  anatomist.  And  this  process  of  in- 
duction may  be  carried  to  a  great  extent  from  an  established  standard 
of  comparison  in  the  animal  to  the  vegetable  kingdom.  But  the  prin- 
ciple is  equally  comprehensive  in  respect  to  plants,  when,  as  with  an- 
imals, a  complex  being  is  marked  out,  as  a  standard,  in  all  its  struc- 
tures and  functions. 

The  same  is  also  true,  though  in  a  far  more  limited  extent,  of  the 
modifications  of  structure,  and  the  corresponding  modifications  of  func- 
tion, at  the  different  eras  of  life  (§  153-162).  And  when  we  come  to 
the  variations  of  function  in  morbid  states,  though  unattended  by  any 
appreciable  alteration  of  structure,  and  consider  how  various  must  be 
the  treatment  according  to  the  nature  of  the  affected  tissue,  we  are 
deeply  impressed  Avith  the  indispensable  importance,  to  the  physician, 
of  an  accurate  knowledge  of  all  that  is  relative  to  the  sensible  organ- 
ization of  the  material  part  of  organic  life  (§  2,  c).  Though  the  struc- 
ture, itself,  reflect  no  light  upon  pathology,  excepting  through  its  mor- 
bid alterations,  an  obsen^ation  of  its  morbid  phenomena  leads  us  to  a 
knowledge  of  the  parts  diseased,  and  this  knowledge  is  important  to 
a  just  interpretation  of  the  phenomena,  and  to  a  right  method  of  treat- 
ment (§  131). 

832-.  We  have  now  seen  that  the  composition  of  organic  beings  is 
formed  by  properties  peculiar  to  organic  structure,  and  that  what  is 
thus  at  the  foundation  presides  over  all,  and  is  the  cause  of  all  that  is 
•superinduced  upon  that  composition.  The  structure  of  organic  be- 
ings, which  is  comprehended  under  our  second  division  of  physiology, 
is  therefore  dependent  on  the  same  creative  cause. 

84.  The  greatest  physical  characteristic  of  organized  structure  id 
supposed  to  be  its  arrangement  into  cells.  Here  all  analogy  with  in- 
organic substances  disappears  entirely.     The  chemico-physiologists 


52  INSTITUTES    OF    MEDICINE. 

imagine  that  the  contradistinction  between  organic  and  inorganic  be- 
ings commences  at  this  step  in  the  ascending  series  of  organic  results 
(§  42).  But  we  have  seen  suiiiciently  that  all  that  relates  to  the  com- 
position  of  plants  and  animals  is  equally  significant  of  a  radical  dis- 
tinction between  the  simplest  organic  compound  and  those  of  an  inor- 
ganic nature  ;  .the  same  powers  being  equally  concerned  in  the  forma, 
tion  of  organic  compounds  as  in  their  aiTangement  ilnto  tissues. 

85.  The  general  structure  of  organic  beings  is  made  up  of  tissues. 
A  knowledge  of  the  vital  characteristics  of  the  different  compound  tis- 
sues, of  the  same  tissue  in  separate  parts,  of  the  different  parts  of  one 
and  the  same  continuous  tissue  as  it  may  pass  through  different  com- 
pound organs,  of  the  whole  as  they  may  be  combined  into  complex 
organs,  of  their  vital  relations  to  each  other,  and  of  all  parts  to  each 
other,  is  indispensable  to  a  knowledge  of  the  laws  in  physiology,  pa- 
thology, and  therapeutics. 

86.  Bichat  analyzed  the  tissues  more  ably  than  others,  and  arranged 
them  as  follows : 

1.  Cellular. 

,^    T-T  i  cerebro-spinal. 

2.  JXervous {  r      • 

{  ganghonic. 

3.  Muscular [  involuntary. 

(  voluntary. 
C  arterial. 

4.  Vascular    .     .     .    '      .      <  venous. 

(  lymphatic. 

5.  Osseous. 

I  fibrous. 

6.  Fibrous <  fibro-cartilaginous. 

(  dermoid. 

7.  Erectile. 

8.  Mucous. 

9.  Serous. 

10.  Synovial. 

11.  Glandular. 

12.  Epidermous,  or  corneous. 

87.  Until  the  era  of  Bichat,  the  tissues  were  limited  to  three,  as 
designated  by  Haller;  namely,  the  cellular,  muscular,  and  nervous. 
The  cellular  was  supposed  to  form  a  large  proportion  of  other  tissues. 

88.  There  was  a  great  error,  physiological  and  pathological,  in  the 
foregoing  limitation  (§  87),  since  it  took  no  note  of  the  modifications 
of  the  vital  properties,  and  of  the  particular  functions  of  the  tissues  as 
arranged  by  Bichat.* 

89.  The  several  tissues  are  distinguished  by  differences  of  internal 
structure,  as  well  as  by  modifications  of  their  properties  and  func- 
tions. They  are  called  simple  organs,  when  considered  in  their  func- 
tional character;  and  when  two  or  more  go  to  the  formation  of  more 
complex  parts,  they  are  called  compound  organs.  Certain  compound 
organs,  which  concur  together  in  some  general  function,  are  called 
an  apparatus  ;  as  the  urinary,  the  digestive,  the  ciixulatory,  &c.  As 
the  whole  exist  in  the  universal  body,  they  are  called  an  organism. 
Each  tissue,  collectively,  is  also  a  system  ;  as  the  mucous,  serous, 
muscular,  &c 

*  For  practical  purposes  Biohafs  analysis  has  not  been  improved,  nor  probably  can  be — 18T0. 


PHYSIOLOGY. STRUCTURE.  .^.S 

91.  The  simple  tissues  rarely  occur  in  a  separate  state,  but  are 
more  or  less  connected  together  into  complex  organs. 

92.  The  simple  textures  are,  themselves,  compound  organs,  so  far 
as  their  organization  is  made  up  of  various  tissues.  The  union  of 
tissues,  therefore,  in  the  simple  textures,  is  quite  different  and  far 
more  intricate  than  when  the  simple  textures  form  what  is  called, 
specifically,  a  compound  organ. 

93.  The  structure  of  the  general  body,  and  of  its  different  parts,  is 
radiated.  The  ray??,  or  branches,  of  certain  parts,  as  the  vessels  and 
nerves,  are  called  ramifications.  The  rays  increase  in  number  and 
diminish  in  size,  as  they  go  off  from  the  centres  of  radiation. 

94.  The  trunks  of  vessels  and  nerves,  and  their  ramifications,  unite, 
respectively,  in  various  ways  with, each  other.  This  is  anastomosis, 
and  subserves  very  important  uses.  It  promotes  circulation  in  the 
vessels,  and  through  the  nerves  it  contributes  especially  to  bind  all 
the  organs  together  in  one  harmonious  action  and  common  depend- 
ence. Through  the  last,  also,  the  play  of  reflex  nervous  actions  is  pro- 
moted when  the  nervous  power  is  developed  in  the  central  parts  of  the 
cerebro-spinal  and  ganglionic  systems  by  morbific  or  remedial  agents. 

95.  The  animal  organism  is  symmetrical  as  a  whole,  and  in  its  va- 
rious parts.  This  symmetry  is  conducive  to  uniform  results,  is  im- 
portant to  the  great  processes  of  life,  is  always  the  same  in  the  natu- 
ral conformation,  is  indicative  of  great  Design,  and  of  peculiar  proper- 
ties and  laws. 

96.  Bichat,  "  following  the  path  marked  out  by  nature  herself,"  di- 
vided the  animal  organism  into  two  great  systems  or  classes ;  the  dis- 
tinction having  been  already  indicated  by  Aristotle. 

97.  The  first  class  relates  to  the  individual  being ;  the  second  to 
the  species. 

98.  The  first  class  is  divided  by  Bichat  into  the  organs  and  func- 
tions o^  animal  life,  and  the  organs  and  functions  o?  organic  life. 

99.  "  The  two  classes  have  nothing  in  common,  but  the  general 
connection  that  unites  all  the  phenomena  of  living  bodies ;  but  a  va- 
riety of  distinctive  attributes  characterize  them,  which  cannot  be  sep- 
arated from  them." — Bichat. 

100.  The  organs  of  animal  life  are  those  whose  functions  connect 
us  sensibly  with  external  objects,  are  peculiar  to  animals,  and  distin- 
guish them  from  vegetables. 

101.  The  organs  of  organic  life  consist  of  such  as  perform  functions 
that  are  common  to  animals  and  plants.  "  The  only  condition  of  en- 
joying this  life  is  organization."  It  forms  an  indisputable  boundary 
between  orojanic  and  inorganic  bodies. 

102.  Animals  have  two  states  of  existence,  sleeping  and  wakmg  \ 
but  the  former  applies  only  to  the  division  which  embraces  the  func- 
tions of  animal  life.  The  animal  powers  are  subject  to  fatigue,  and 
require  repose ;  the  organic  are  not,  and  are  in  perpetual  operation. 

103.  The  foetus  has  only  the  organic  functions  in  operation ;  but  all 
its  animal  faculties  and  the  soul  exist  in  a  passive  state.*  The  latter 
are  brought  only  gradually  into  exercise. 

104.  The  great,  immediate,  office  of  the  organs  of  organic  life  is  to 
maintain  a  constant  vital  composition  and  vital  decomposition  of  or- 
ganic matter ;  or  nutrition  and  vi^aste. 

*  See  Medical  and  Physiological  Commentaries,  vol.  i.,  p.  13. 


54  INSTITUTES    OF    ftlEDICINE. 

105.  The  organs  of  digestion,  absorption,  circulation,  resjiiration, 
and  secretion,  compose  organic  life.  Secretion  comprehends  nutrition, 
exhalation,  calorification,  and  excretion ;  which  four  are  often  ranked 
as  distinct  functions. 

106.  "  Animal  life  is  composed  of  the  organs  of  sense  which  receive 
impressions,  of  the  brain  which  perceives  them,  reflects,  and  wills,  of 
the  voluntaiy  muscles,  and  larynx,  that  execute  this  volition,  and  of 
the  ners'es  which  are  the  organs  of  transmission." — Bichat. 

107.  The  organs  of  organic  life  are  quite  analogous  in  the  lowest 
animals  and  plants ;  but  each  has  peculiar  characteristics.  In  ani 
mals  a  little  higher  in  the  scale,  the  common  functions  are  performed 
by  organs  of  greater  complexity,  and  this  complexity  increases  in  the 
ratio  of  the  development  of  animal  life.  Nevertheless,  in  most  ani- 
mals above  the  rudimentary  there  are  the  same  subsidiary  functions, 
whatever  the  difference  in  organization.  There  is  in  most,  for  exam- 
ple, the  secretion  of  gastric  juice,  saliva,  bile,  &c.,  which  subserve  the 
common  function  of  assimilation. 

108.  No  organ  of  animal  life,  in  a  philosophical  sense,  is  necessary 
to  the  individual.  But,  no  part  of  the  animal  can  exist  without  all 
parts  of  the  organic  system,  or  an  equivalent;  which  is  also  true  of  the 
organic  viscera.  If  the  heart,  for  example,  be  wanting  in  the  foetus, 
the  blood-vessels,  as  an  equivalent,  carry  on  the  circulation. 

109.  a.  The  indispensable  organs,  of  which  no  one  can  he.  abstracted 
without  destroying  the  whole,  are  generally  single  in  animals  (§  128). 
The  same  is  true  of  plants,  if  we  regard  those  organs  which  perform 
a  common  function  in  the  light  of  a  single  organ.  If  the  leaves  fall 
spontaneously  and  abruptly  in  cold  climates,  no  injury  results  to  the 
plant,  because  it  is  passing  into  a  torpid  state. 

109.  h.  Nevertheless,  neither  the  action  of  the  heart  by  which  the 
blood  is  circulated,  nor  that  of  the  lungs  by  which  the  blood  is  oxy- 
genized, nor  that  of  the  brain  by  which  the  harmony  of  organs  is  main- 
tained, nor  that  of  the  kidneys  and  skin  by  which  redundancies  are 
excreted,  nor  that  of  the  liver  by  which  bile  is  generated,  nor  that  of 
any  other  compound  organ,  constitutes  the  real  functions  of  life.  They 
are  only  secondary  or  suboi'dinate  to  others  in  which  the  absolute  pro- 
cesses of  life  consist ;  and  these  are  carried  on  by  those  extreme  vessels 
which  perform  the  immediate  work  of  nutrition  and  vital  decomposi- 
tion. This  is  exemplified  in  the  development  of  the  ovum  (§  63-72), 
and  throughout  the  vegetable  kingdom.  Indeed,  life  may  be  continu- 
ed after  removal  of  the  brain  merely  by  inflating  the  lungs  ;  and  could 
we  substitute  a  machine  for  the  heart,  and  the  process  of  transfusion, 
both  the  heart  and  the  lungs  could  be  dispensed  with  for  awhile. 

These  facts  are  important  in  showing  the  nature  of  the  organic 
properties ;  how  it  is,  and  thi'ough  what  influences,  the  compound  or- 
gans contribute,  and  are,  each  one,  indispensable,  to  thelife  of  animals  ; 
and  that  it  is  to  the  fundamental  organization  that  we  must  look  for 
all  the  absolute  processes  of  life,  and  for  the  essential  conditions  of 
disease  (s^  1041). 

110.  The  parts  by  which  life  is  carried  on  in  the  organic  viscera  are 
blended  in  the  organs  of  animal  life,  and  in  those  of  the  species. 

111.  The  cerebro-spinal  system  is  assigned  both  to  animal  and  or- 
ganic life.  The  sympathetic,  like  the  cerebro-spinal,  goes  to  the  or- 
ganic life  of  animals,  and  therefore  pen'ades  the  organization  in  ani 
mal  as  in  organic  life  (§  110). 


PHYSIOLOGY. STRUCTURE.  OO 

The  cerebro-spinal  nerves  and  the  sympathetic  interchange  con- 
tributions, in  all  parts,  by  which  important  influences  of  the  former 
are  established  in  the  organs  of  organic  life  (§  452,  &c.,  500,  512, 
514J-530,  889,  891^,^,  k,  893,  a,  c-e,  902-905,  940-952). 

112.  Nevertheless,  the  cerebro-spinal  system  is  especially  designed 
for  the  uses  of  animal  life ;  but  an  important  final  cause  is  answered 
in  making  it  subservient  to  the  common  interests  of  the  whole  being 
(§  455). 

113.  The  sympathetic  system  is  added  especially  to  the  oi'ganic 
life  of  animals  on  account  of  the  complexity  of  the  organs,  and  to 
unite  them  in  harmonious  action,  through  circles  of  sympathy,  and 
thus  render  them,  each  in  its  place,  conducive  to  a  common  end. 
The  cerebro-spinal  system  contributes  to  this  result  (§  111,  112) ;  and 
each  system,  unitedly,  or  independently,  exerts  special  influences  on 
the  specific  actions  of  organs,  though  these  actions  are  carried  on  es- 
sentially through  properties  inherent  in  the  several  tissues  (§  226-233, 
485).  The  nervous  influence  thus  also  bestows  upon  animal  com- 
pounds peculiarities  that  do  not  obtain  in  plants  (^  461,  489,  493  cc). 

114.  The  most  important  common  end  (§  113),  as  it  respects  the  in- 
dividual, relates  to  the  functions  of  animal  life.  The  organic  system, 
then,  in  animals,  though  physiologically  the  most  important,  must  be 
held  subordinate  to  the  uses  of  aiiimal  life.  In  plants,  organic  life  is 
the  whole  being. 

115.  The  foregoing  union  of  organic  life  with  all  other  parts  (§  110- 
114)  establishes  mutual  relations  between  all  parts  of  the  organism, 
and  brings  the  animal  and  sexual  systems  under  the  laws  which  ap- 
pertain to  the  organic  system  (§  455). 

116.  The  same  intimacy  of  parts  confounds,  in  a  degree,  the  dis- 
tinction in  the  two  lives  (§  115). 

117.  An  important  consequence  of  the  foregoing  vital  union  of  or- 
ganic with  animal  life  (§  110-114)  is  a  general  coincidence  in  the 
pathological  as  well  as  physiological  condition  of  the  whole.  The  dis- 
eases of  each  react  mutually  on  each  system  of  organs,  each  requires 
common  methods  qf  treatment,  and  remedial,  as  well  as  morbific, 
agents  operate  upon  the  universal  body  through  any  given  organ 
(§  455,  524,  no.  1,  647),  by  exciting  reflex  nervous  influences. 

Nevertheless,  diseases  of  the  animal  organs  more  readily  derange 
the  organic  viscera  than  the  latter  the  former ;  but,  remedial  agents 
operate  far  more  powerfully  in  the  opposite  relation.  The  sympa- 
thies in  the  two  lives,  therefore,  are  not  exactly  reciprocal. 

The  foregoing  apparent  want  of  harmony  in  the  physiological, 
pathological,  and  therapeutical  relations  of  the  two  systems  of  life  is 
reconciled  by  the  consideration  that  nature  has  ordained,  fc^r  the  pro- 
tection of  the  organs  of  animal  life,  that  their  wants  shall  be  emphat- 
ically made  known  to  those  of  the  life  on  which  they  depend,  and,  on 
the  other  hand,  their  dependence  on  organic  life  has  placed  them  un- 
der the  special  therapeutical  control  of  that  life  ;  wliile  the  organic 
viscera  being  Independent  of  the  organs  of  animal  life,  therapeutical 
influences  are  but  feebly  propagated  from  the  latter  to  the  former. 
Such  are  the  final  causes  in  the  great  plan  of  Unity  of  Design. 

118.  The  second  class  of  organs  and  functions,  which  relate  to  the 
species,  ai-e  divided  into  three  orders  :  1st,  such  as  belong  to  the  male  ; 
2d,  to  the  female ;  3d,  the  functions  relative  to  Impregnation. 

119.  The  several  organs,  and  reproduction,  belong  both  to  plants 


56  INSTITUTES    OF    MED.  CINE. 

and  animals.     They  are  not  necessaiy  to  the  individual,  though  the 
whole  oi'ganic  system  is  necessary  to  their  existence. 

120-  Although  the  organs  of  generation  be  not  necessary  to  the  in- 
dividual, they  exert  many  natural  vital  influences  upon  the  animal 
functions.  Their  full  development  has  also  certain  influences  in  or- 
ganic life,  which  illustrate  some  important  laws  as  to  the  vital  prop- 
erties. Their  diseases  may  also  give  rise  to  great  derangements  of 
the  organic  functions.  They  fail  earlier  than  the  animal  functions 
(§117,  .578).  .  _  _ 

121.  In  the  great  sense  of  ultimate  Design,  all  organic  processes 
have  for  their  final  cause  the  development  of  the  generative  organs, 
and  the  production  of  germs  ;  that  similar  beings  may  be  maintained 
in  one  unvarying  round  of  development  and  growth.  Many  beings 
die  as  soon  as  this  end  is  attained,  and  return  to  the  mineral  kingdom 
to  be  again  reorganized  by  plants,  and  again,  and  again,  refitted  for 
the  nutriment  of  animals,  and  carry  out,  in  both  organic  kingdoms, 
the  final  cause  of  their  regeneration  from  the  mineral. 

122.  It  is  necessary  that  the  ovum  of  mammiferous  animals  should 
lemain  connected  with  the  parent  till  the  organs  of  organic  life  are 
developed.  The  law  of  dismemberment  (§  108,  109)  does  not  apply 
to  the  ovum  of  oviparous  animals,  nor  to  the  seed.  They  are  en- 
dowed with  the  whole  essential  organization,  and  maturity  of  the  vital 
principle,  for  independent  life.  The  former  gets  its  nutriment  from 
the  parent,  till  the  organs  are  brought  forth.  The  latter  are  supplied 
with  nutriment  from  within  themselves.  In  this  case,  also,  the  spe- 
cies are  destined  for  gi'eat  multiplication  and  distribution  ;  in  the 
other,  their  numbers  and  sphere  are  more  circumscribed. 

Nevertheless,  the  germ  of  all  animals  contains  within  itself  the  prin- 
ciple of  carrying  out  the  full  development  of  a  being  similar  to  the 
parent,  in  all  its  complicated  parts,  which,  however,  have  no  rudi- 
mentary existence  in  the  ovum.  The  progress,  too,  of  foetal  devel- 
opment is  always  the  same  in  each  species,  and  every  part  is  brought 
forward  in  the  order  of  its  importance  in  the  organic  life  of  the  foetus, 
and  of  its  future  uses.     It  is  the  same  in  the  vegetable  kingdom. 

123.  The  history  of  the  seed  and  egg  probably  supplies  one  of  the 
most  remarkable  illustrations  of  Design  that  can  be  found  in  nature ; 
especially  that  of  the  seed.  They  are  the  only  instances  where  the 
entire  properties  of  life  cease  their  ordinary  operation  without  be- 
coming extinct ;  and  were  it  not  for  this  interval  of  repose,  the  spe- 
cies would  probably  disappear ;  since,  even  if  the  properties  of  life 
carried  out  the  development  of  the  seed  into  the  plant,  the  chances  of 
preservation,  and  especially  of  multiplication,  would  be  vastly  dimin- 
ished (§  633,  1051,  1052). 

124.  Besides  the  foregoing  general  division  of  the  organs  and  func- 
tions of  living  beings,  another  arrangement  of  the  organs  is  founded 
upon  the  relation  of  special  functions.  Each  component  part,  each 
group  of  organs,  and  the  whole  collectively,  are  replete  with  various 
and  wonderful  Design  ;  each,  and  all,  having  peculiar  ends,  all  con- 
spiring to  common  ends,  and  in  one  harmonious  Unity  of  Design 
maintaining  the  life  of  each  other. 

125    The  followins:  is 


PHYSIOLOGY. STRUCTURE. 


51 


1.  Nervous  System. 


2.  Vascular  System.  < 


Direct  circulatory  or- 
gans. 

>  Destined  for  waste. 

)  Conveying  the  means 
)      of  repair. 


The  Arrangement  of  Organs  according  to  tlieir  relative  Functions. 
C  Brain  and  cerebral  nerves. 
<  Spinal  cord  and  its  nerves. 
^  Sympathetic  ganglia  and  sympathetic  nerve 
C  Heart  and  its 

Pericardium. 

Arteries. 

Veins. 

Lymphatics. 

Lymphatic  glands 

Lacteals. 

i  Lacteal  glands. 
Mouth,  stomach,  intestine 
Salivary  srlands  and  pancreas. 
JO 
Spleen. 

!  Larynx  and  vocal  system. 
Trachea. 
Lungs. 
Diaphragm. 
Muscles  of  thorax  and  abdomen. 
System  of  voluntary  muscles. 

C  Derma,  or  main  portion. 
J  Papillary  tissue. 
[  Rete  mucosum. 
[^  Epidermis, 
r  Kidneys. 
J  Ureters. 
S  Bladder. 
)  Urethra. 
(  Organ  of  hearing. 
3       "  sight. 

(      "  smell. 

Bones. 
Cartilage. 
Ligaments. 
Synovial  capsules. 
Testes.  ") 

Ductus  defei'ens. 
Seminal  vesicles. 
Prostate  gland. 
Penis. 

Muscles  of  perinaeum 
Ovaries. 

Fallopian  tubes. 
Uterus. 
Vagina. 
Hymen. 
Clitoris. 
Nymphce. 

Labia.  I 

Constrictor  vaginae,     j 
^.  Mammae, — accessory  parts.  ^ 


Respiratory  Sys- 
tem. 


6.  Cutaneous  Sys 
tem. 


7.  Urinary  System. 


8.  Special  Sensitive 
System. 


9.  Osseous  System. 


■) 


10  Genital  System.    < 


>  Formative. 
\  Copul 


ative. 


Formative. 


•Copulative. 


>  Male. 


Female. 


as  INSTITUTES    OF    MEDICINE. 

126.  The  organic  and  animal  functions  are  also  naturally  subdivi« 
tied  into, 

1st.  Those  which  operate  from  without  inward,  as  in  digestion  ;  and, 
2d.  Those  which  operate  from  within  outward,  as  in  circulation,  se- 
cretion, &c. 

127,  There  are  generally  two  sets  of  organs  for  the  animal  func- 
tions, having  a  harmony  of  action  in  their  natural  and  healthy  states. 

128.  When  the  organs  of  organic  life  are  in  pairs,  as  the  kidneys, 
concerted  action  is  not  necessary;  and  here  one  organ  may  supply 
the  place  of  both  (§  109). 

129,  a.  The  whole  assemblage  of  organic  viscera  act  together  in 
concert ;  but  the  animal  organs,  as  a  general  system,  act  more  or  less 
independently  of  each  other. 

129,  b.  The  mutual  relations  which  subsist  between  the  various  or- 
gans and  their  several  functions  are  of  two  principal  kinds;  namely, 
the  vital,  and  the  mechanical. 

129,  c.  The  first  class  of  relations  may  be  distributed  into  tlnee  dif- 
ferent orders.  The  first  order  consists  of  the  relations  between  the 
organs  of  sense.  The  second  order  embraces  those  between  the  brain 
and  voluntary  muscles.  The  third  order  comprises  the  relations 
which  are  especially  maintained  by  sympathy.  It  is  the  last  subdi- 
vision, mostly,  which  is  relative  to  our  present  subject.  It  concerns, 
therefore,  the  organization  by  which  organic  life  is  carried  on  in  ani- 
mals, and  depends  upon  the  nervous  power  in  its  function  of  sympa- 
thy, and  upon  a  principle  independent  of  the  nervous  power,  called 
continuous  sympathy,  and  which  is  probably  also  an  important  princi- 
ple in  plants  (§  111-113,  222,  233,  495-500,  6381,  81 8i).— Note  U. 

129,  d.  The  vital  relations  of  a  general  nature  evince  the  highest 
order  of  Design.  They  refer  to  the  mutual  co-operation  of  distinct 
systems  of  organs  in  the  production  of  particular  results,  and  of  these 
various  systems  in  the  maintenance  of  universal  life ;  while  the  sev- 
ei'al  individual  organs  possess  distinct  and  specific  offices  that  are 
more  or  less  dependent  upon  the  principle  of  sympathy  (§  222-233, 
455),  that  is,  reflex  action  of  the  nervous  system. 

129,  e.  The  sympathetic  relations  are  most  strongly  pronounced 
among  organs  which  concur  together  in  the  performance  of  special 
functions,  as  the  circulatory,  the  digestive,  the  urinary,  the  sexual 
systems,  &:c.  [^  124).  Other  special  relations  subsist  between  the 
brairi  and  the  organs  of  animal  life  through  the  medium,  in  pait,  of 
the  mental  functions.  Such  is  seen  between  the  brain  and  voluntary 
muscles  in  the  production  of  voluntary  motion  (§  500,  d).  .Thus, 
also,  the  senses  aid  each  other ;  the  sight  being  most  independent. 
In  this  way,  too,  a  concurrence  is  established  between  the  teeth,  mus- 
cles, eyes,  nose,  &c.,  in  procuring  food  and  supplying  the  stomach  , 
each  individual  part  having  been  also  constituted  with  a  reference  to 
the  nature  of  the  food,  and  the  mode  of  obtaining  it  (§  323). 

129,  Jl  Plants  are  devoid  of  all  that  intimate  association  of  parts 
which  is  owing  to  reflex  nervous  influence  in  animals,  as  well  as 
to  peculiarities  of  structure  and  special  modifications  of  the  common 
properties  of  life.  But,  a  general  relation  of  functions  obtains  to  a 
certain  extent  in  plants  through  the  ]a\v  of  continuous  sympathy,  which, 
as  I  have  endeavored  to  show,  depends  upon  the  organic  jn-opertiea 
and  which  1  would  designate  as  continuous  influence  (§  498). 


PHYSIOLOGY. STRUCTUKi:.  59 

1^9,^.  The  sympathetic  relations  in  organic  life  are  of  the  very 
highest  moment  in  medicine.  Disease  is  propagated,  is  maintained, 
and  removed,  very  greatly,  through  these  natural  relations. 

129,  li.  The  sympathetic  relations  are  variously  modified  by  dis- 
ease, and  are  often  more  strongly  pronounced  than  in  health,  though 
more  or  less  diverted  from  their  natural  condition.  Remedies  also 
operate  with  greater  effect  through  these  modified  relations,  as  well 
as  through  the  greater  susceptibility  of  the  organic  properties  (§137,  d). 
For  the  same  reason,  natural  stimuli,  as  food,  often  prove  morbific 
in  diseased  conditions  (§  152,  h).  The  sympathies  which  grow  out 
of  morbific  agents  depend  upon  the  natural  principle,  of  wliicli  they 
are  only  modifications.  And  so  of  those  which  spring  from  remedial 
agents ;  these  agents  giving  rise  to  greater  influences  in  consequence 
of  the  morbid  state  of  sympathy  and  of  the  organic  properties,  as 
well  as  in  consequence  of  their  own  intrinsic  virtues  (§  718,  901). 

129,  i.  It  appears,  thei-efore,  to  be  a  most  important  law,  that  mor- 
bid states  call  into  operation  reflex  nervous  actions  among  organs, 
which,  in  their  natural  state,  manifest  but  feeble,  and  perhaps  no  di- 
rect relations  whatever;  and  that,  in  consequence  of  morbid  changes, 
remedial  agents  will  operate  sympathetically  through  the  stomach, 
&c.,  upon  remote  parts,  when  they  would  have  no  such  effect  in  the 
healthy  state  of  the  organs.  This  principle  is  demonstrated  in  every 
case  of  disease,  and  constitutes  our  first  position  against  the  humoral 
pathology,  and  the  doctrine  of  the  operation  of  remedial  agents  by 
absorption  (§  819,  &c.).  New  vital  relations  being  developed  by 
disease,  our  remedies  continue  to  operate  through  those  acquired  re- 
lations so  long  as  they  exist;  while,  also,  the  remedies  themselves 
may  institute  analogous  sympathetic  relations,  and  thus  simultane- 
ously induce  reflex  nervous  actions  of  a  salubrious  nature  in  organs 
not  morbidly  affected  (§  74,  117,  137,  143,  155,  156,  387,  422,  514  7i, 
524  A,  525,  528,  733  &,  905,  980). 

129.  k.  The  mechanical  relations  are  equally  common  to  plants  and 
animals.  They  are  maintained  by  the  motion  of  matter  from  one  or- 
gan, or  part,  to  another ;  as  the  transmission  of  blood  from  the  heart 
through  the  blood-vessels,  sap  from  the  roots  to  the  leaves  of  plants, 
food  through  the  intestinal  canal,  urine  from  the  kidneys  to  the  blad- 
der, and  from  the  bladder  through  the  urethra,  &c.  But,  the  move- 
ment of  the  matter  is  effected  by  the  vital  properties  operating  through 
the  various  organs. 

130.  Every  part  is  a  perfect  labyrinth,  anatomically  considered. 
It  is  a  labyrinth,  also,  of  perfect  designs ;  while  the  harmonious  con- 
currence of  these  designs  in  the  aggregate  organs  and  tissues  is  too 
profoundly  complex  for  any  exact  analysis.  The  deep  intimacy  of 
parts  in  each  tissue  coiTOsponds  with  the  union  of  the  wliole,  with 
the  dominion  of  common  laws,  and  with  that  concerted  action  of  all 
parts,  which,  in  a  popular  sense,  makes  up  the  life  of  the  organic 
being. 

131.  It  has  already  been  stated,  that  a  knowledge  of  the  minuteness 
of  structure  which  is  supplied  by  the  microscope  is  practically  use- 
less, while  the  deceptions  of  that  instrument  have  led  to  many  im- 
portant errors  in  physiology  and  pathology  (§  83).  It  cannot  be  de- 
pended upon,  especially,  in  exploring  soft  structures.  If  it  lead  to 
unimportant  facts,  it  is  equally  liable  to  betray  us  into  error  and  fal- 


60  INSTITUTES    OF    MEDICINE. 

lacious  hypotheses.  The  whole  history  of  that  instrument,  so  far  aft 
physiolofry  is  concerned,  has  gone  to  confirm  the  foregoing  conclu- 
sions, which  were  originally  advanced  in  another  work,  and  has  con- 
clusively sustained  the  opinion  of  one  of  the  most  profound  observers 
of  the  present  age.     Thus  : 

"Authors,"  says  Bichat,  "have  been  much  occupied  with  the  in- 
timate structure  of  glands.  Let  us  neglect  all  these  idle  questions, 
in  which  neither  inspection  nor  experiment  can  guide  us.  Let  us 
begin  the  study  of  anatomy  where  the  organs  can  be  subjected  to  the 
senses."  "  No  methodical  mind  will  attend  to  the  minute  nature  of 
the  muscular  fibre,  upon  which  so  much  has  been  written.  The  ex- 
act progress  of  the  sciences  in  this  age  is  not  accommodated  to  those 
hypotheses,  which  made  general  anatomy  and  physiology  a  frivolous 
romance  in  the  last." 

Microscopical  information,  so  far  as  correct,  goes  to  the  amount  of 
human  knowledge,  and  to  the  perfection  of  science,  though  it  may 
not  contribute  to  useful  ends.  But  experience  shows  us  that  we 
may  not  depend,  as  it  respects  the  microscope,  upon  the  vision  of  oth- 
ers, especially  where  a  high  magnifying  power  is  required.  Each 
must  observe  for  himself;  and,  as  allowed  by  Ehrenberg,  long  prac- 
tice, alone,  can  assure  him  of  any  general  accuracy.  The  laborious 
student  may  attend  to  this  accomplishment.  But,  vita  hrevis,  ars 
longa ;  and  he  will  be  likely  to  live  the  subject  of  deluded  sense 
rather  than  of  enlightened  understanding. 

"  Enough  is  left  besides  to  search  and  know. 
But  knowledge  is  as  food,  and  needs  no  less 
Her  temperance  over  appetite,  to  know 
In  measure  what  the  mind  may  well  contain ; 
Oppresses  else  with  surfeit,  and  soon  turns 
Wisdom  to  folly,  as  nourishment  to  wind." — Milton. 

The  following  is  another  example  in  illustration  of  Milton'g  prin- 
ciple, and  another  instance*  of  the  revolutionary  spirit  of  the  micro- 
scopic observers.  I  quote  from  Wagner's  "  Elements  of  Physiology 
for  the  Use  of  Students.^' 

"  The  study,"  he  says,  "  of  the  varieties  of  form  presented  by 
the  seminal  animalcules  ought  not  to  be  held  as  any  trifling  matter,  or 
as  tending  to  accumulate  superfluous  details.  Most  important  phys- 
iological CONCLUSIONS  may  be  based  on  the  information  thus  ac- 
quired" (§  83,  b). 

It  is  one  of  the  few  correct  physiological  conclusions  to  be  found 
in  the  writings  of  Liebig,  that 

"  The  most  exact  anatomical  knowledge  of  the  structure  of  tissues 
cannot  teach  us  their  uses  ;  and  from  the  microscopical  examination 
of  the  most  minute  reticulations  of  the  vessels,  we  can  learn  no  more 
as  to  their  functions  than  we  have  learned  concerning  vision  from 
counting  the  surfaces  on  the  eye  of  a  fly." — Liebig's  Animal  Chem- 
istry.—{k  83  c,  251,  699  c  and  d). 

When  we  consider,  therefore,  the  constant  deceptions  of  the  micro- 
scope, especially  in  all  explorations  of  soft  substances,  and  the  abso- 
lute uselessness  of  any  knowledge  it  may  convey  as  to  the  recesses 
of  organization,  it  may  be  reasonably  expected  that  the  time  is  not 

•  See  ai-ticle  on  the  Microscope,  in  Medical  and  Physiclogical  Commeniaries,  vol.  i .  p 
699-712;  and  my  Examination  of  Reviews,  p.  6,  89;  also,  this  work,  §  515. 


PHYSIOLOGY. STRUCTURE.  61 

distant  when  all  this  lumber  will  be  excluded  from  practical  woi'ka 
on  physiology,  and  turned,  at  least,  into  a  channel  by  itself.* 

132.  Each  simple  texture,  when  united  into  compound  oi'gans,  has 
as  much  its  own  specific  function  as  the  aggregate  compound.  It  is 
even  more  important,  in  a  pathological  sense,  to  regard  the  individ- 
ual textures  than  the  compound  organ  which  they  may  form. 

133,  a.  A  consideration  of  the  tissues  in  respect  to  their  special 
character  and  functions,  as  well  as  their  obvious  anatomical  differen- 
ces, being  of  the  vqry  highest  importance  to  the  physiologist  and  phy- 
sician, they  can  be  studied  advantageously  only  in  these  several  as- 
pects. Much  must,  therefore,  be  now  anticipated  as  to  what  will  be 
subsequently  stated  more  circumstantially  in  regard  to  the  properties 
and  functions  of  life.  The  student  must  be  prepared  with  that  anal- 
ysis before  he  can  approach  the  tissues  with  any  hope  of  enlightened 
knowledge.  A  simple  statement  of  their  apparent  anatomical  charac- 
teristics and  relations,  and  of  their  products,  would  present  a  barren 
field.  Nor  is  it  alone  their  vital  attributes  which  should  most  entja^e 
the  attention  of  the  medical  philosopher,  but  he  should  be  equally 
and  simultaneously  employed  in  learning  how  these  conditions  are 
modified  in  disease.  Such,  therefore,  is  my  projected  plan  in  relation 
to  the  tissues  (§  83,  c). 

133,  h.  Every  distinct  tissue,  and  often  the  same  tissue  as  it  occurs 
in  different  places  and  connections,  and  even  the  different  parts  of  one 
and  the  same  continuous  tissue,  possess,  respectively,  special  modifi- 
cations of  the  vital  properties  and  functions.  Upon  these  modifica- 
tions depend  the  vai-iety  of  the  natural  vital  phenomena,  as,  also,  very 
greatly,  those  which  are  morbid. 

133,  c.  But  there  would  be  no  disease  were  there  not  another  im- 
poitant  condition  in  the  constitution  of  the  vital  properties ;  and  this 
is  their  mutability.  Its  final  cause  is  the  well-being  of  organic  nature  ; 
since,  as  organization  changes  in  the  progress  of  the  plant  or  of  ani- 
mals to  a  state  of  maturity,  so  must  there  be  an  antecedent  change  in 
the  properties  which  conduct  the  development  of  organs,  &c.  The 
same  principle  is  displayed  in  gestation,  lactation,  &c.  It  is  this,  in 
connection  with  the  susceptibility  of  the  properties  of  life  to  the  action 
of  blood  and  other  vital  agents,  which  renders  them  liable  to  morbid 
changes  when  other  causes  operate.  Such,  therefore,  is  a  necessary 
consequence  of  the  final  cause  of  the  adaptation  of  the  properties  of 
life  to  the  influence  of  salutary  agents,  and  to  the  varying  exigencies 
of  organic  nature. 

Nor  would  there  be  any  recovery  fi-om  disease,  but  for  the  same 
mutability  of  the  organic  properties,  and  their  liability  to  other  chan- 
ges when  yet  other  causes  operate  (§  177,  &c.,  901). 

134.  Owing  to  the  peculiarities  in  the  vital  constitution  of  the  dif- 
ferent tissues,  a  common  disease,  as  inflammation,  is  characterized  by 
many  peculiarities  of  symptoms,  &c.,  in  the  several  tissues,  respect- 
ively. Differences  also  arise  in  their  constitutional  influences,  and 
they  may  require  corresponding  variations  of  treatment  (§718).  This 
is  even  true  of  different  paits  of  a  continuous  tissue,  as  the  alimentary 
and  pulmonary  mucous  membrane  ;  where  inflammation  of  this  mem- 
brane in  the  nose,  larynx,  trachea,  lungs,  fauces,  stomach,  and  intes- 
tines, is  distinguished  by  ahnost  as  striking  peculiarities  in  the  vital 
signs,  and  in  their  constitutional  influences,  as  are  the  physiological 

*  jSTot  one  disclosure  has  been  j'et  made  bj-  the  microscope  that  can  affect  a  doctrine 
in  these  Institutes — 1870. 


62  INSTITUTES    OF    MEDICINE. 

functions  of  the  different  compound  organs  which  it  traverses  (§  140 
752-754,  7S0,  783). 

135,  a.  The  special  modifications  of  the  vital  properties  in  differ- 
ent parts  of  one  and  the  same  continuous  tissue  is  often  strikingly  de- 
noted by  the  character  of  the  natural  product  of  the  several  portions, 
respectively ;  as  in  the  tissue  last  mentioned.  Nothing,  for  example, 
can  be  more  unique  than  the  gastric  juice,  a  product  of  all  complex 
animals,  while  it  can  be  generated  by  nothing  but  the  mucous  tissue 
of  the  stomach.  Again,  in  the  lungs  we  meet  wiUi  this  tissue  per- 
formino-  the  office  of  excretion ;  being  the  only  example  in  which  an 
organ  eliminates  truly  effete  matter  from  venous  blood.  And  here  an 
important  analogy  occurs  to  show  that  the  elaboration  of  carbon  is  a 
vital  process  (§  316,  419,  827  h).  In  the  uterus  the  same  membrane 
appears  as  an  organ  of  excretion  in  relation  to  the  arteria]  blood,  but 
for  the  uses  of  the  uterus  alone ;  nor  is  there  any  thing  else  in  nature 
that  is  capable  of  generating  a  similar  product.  But,  in  all  the  cases, 
the  analogy  which  is  indicated  by  the  coincidence  of  anatomical  struc- 
ture is  farther  confirmed  by  the  universal  production  of  mucus  by  this 
remarkable  tissue.     The  anatomical  differences  are  microscopical. 

135,  h.  All  the  foregoing  is  delicately  exemplified  by  the  great 
variety  of  formations  which  are  generated  by  the  granulations  that 
spring  from  ulcers ;  since,  although  in  all  the  cases  the  granulations 
appear  to  be  identical  in  character,  we  know  from  their  production  of 
parts  analogous  to  such  as  had  been  removed  by  the  ulcerative  pro- 
cess, that,  in  every  instance,  the  granulations  must  have  been  endow- 
ed, respectively,  with  specific  modifications  of  the  organic  properties 
and  shades  of  diflerence  in  organic  structure  (^  733  c). 

136.  In  consequence,  also,  ofthe  foregoing  peculiarities  of  vital  con- 
stitution, every  tissue,  and  often  continuous  parts  of  a  tissue  (as  in  the 
last  example),  are  determined  in  their  results  by  special  vital  influ- 
ences, as  well  as  by  any  peculiarities  of  organization.  This  is  denoted 
by  the  phenomena  where  structures  are  most  alike.  Owing,  also,  to 
the  general  coincidence  in  the  vital  constitution  of  all  parts  there  are 
certain  general  stimuli  adapted  to  the  whole,  especially  the  stimulus 
of  heat.  The  blood  has  been  regarded  as  a  universal  stimulus  ;  but, 
it  is  only  so  in  relation  to  the  sanguineous  system.  This  fact,  it  may 
be  now  remarked,  evinces,  what  is  shown  by  diseases,  a  near  identity 
in  the  vital  constitution  of  all  that  part  of  the  arterial  system  which 
conveys  red  blood ;  while,  on  the  other  hand,  the  difference  between 
arterial  and  venous  blood  shows  a  difference  in  the  organic  proper- 
ties ofthe  aiterial  and  venous  systems.  This  has  its  deep  foundation 
in  the  whole  physiological  condition  of  man  and  animals,  and  I  may 
also  add,  in  the  whole  vegetable  tribe  (§  847,  c).  While  every  sur- 
face has  some  secreted  product  adapted  to  its  own  special  modifi- 
cation of  initability,  many  of  these  products  may  be  offensive  to 
other  parts.  Again,  the  special  irritability  of  one  part  may  be  exactly 
suited  to  some  product  of  another  part,  and  this  may  or  may  not  be  a 
natural  vital  stimulus,  and  perfectly  inoffensive,  to  the  second  part, 
while  it  may  excoriate  all  other  parts.  Bile,  for  instance,  is  the  nat- 
ural stimulus  of  the  intestine,  but  will  injure  other  parts.  Venous 
blood  is  harmless  in  the  veins,  and  excites  them,  more  or  less,  to  a 
contractile  action  ;  but  is  rapidly  fatal  within  the  arteries  (§  849). 
Urine  is  the  natural  stimulus  of  the  bladder,  but  will  excoriate  most 
other  parts  (§  74,  188^  d,  Mb\,  500  m,  514/,  6471,  650,  847  e). 


PHYSIOLOGY. STRUCTURE.  63 

137,  a.  In  this  relative  sense   the  animal  is  filled  with  poisons;, 
each  one  of  which,  however,  in  its  proper  place,  is  not  only  inoffen- 
sive, but  indispensable.     Here  is  the  principle. 

137,  b.  It  is,  also,  upon  the  foregoing  organic  constitution  of  differ- 
ent parts,  and  which  gives  rise  to  a  mutual  relation  of  the  different 
vital  agents  and  products  of  organs  and  of  the  various  parts  of  the  or- 
ganism, that  the  difference  in  the  effects  of  remedial  as  well  as  mor- 
bific agents  upon  different  parts  is  essentially  founded.  Wine  in- 
flames the  mucous  tissue  of  the  bladder,  &c.,  but  may  be  good  for 
the  stomach.  Tobacco  smoke  is  inoffensive  when  inspired  in  the  or- 
dinary mode ;  but  it  is  a  violent  poison  when  introduced  within  the 
ahmentary  canal.  Other  agents  affect  the  stomach,  or  intestines,  or 
livei',  or  uterus,  or  bladder,  &c.,  each  organ  more  than  the  others,  and 
more  than  other  parts  (§  233f ,  872  c,  838.) 

137,  c.  From  not  duly  regarding  these  important  facts,  or  fi'om  an 
ignorance,  or  a  disregard  of  physiology,  many  agents  which  have  a 
specific  relation  to  the  vital  constitution  of  some  tissue  in  a  particular 
part  of  the  body,  as  the  mucous,  for  example,  are  supposed  to  have 
the  same  relation  to  the  tissue  in  all  other  parts.  Hence  the  oil  of 
turpentine,  copaiva,  naphtha,  &c.,  have  been  abortively  or  injui'iously 
employed  in  pulmonary  catarrh,  phthisis  even,  diarrhoea,  dysentery, 
&c.,  mostly  for  the  reason  that  they  exert  a  specific  efi'ect  u^Jon  the 
mucous  tissue  of  the  urinary  organs. 

This  great  law  of  adaptation  is  so  universal  as  to  extend  through- 
out the  whole  domain  of  medicine,  reaching  as  fully  into  pathology 
and  therapeutics  as  it  is  conspicuous  in  physijology.  If  the  blood  be 
rendered  morbid  by  morbid  states  of  the  solids  it  never  becomes 
morbific,  since  there  is  a  progressive  adaptation  of  the  vital  changes 
in  the  solids  to  such  as  the  solids  induce  in  the  blood.  And  so  of  va- 
rious morbid  secretions  in  relation  to  the  parts  by  which  they  may  be 
produced.  These  results,  in  which  the  vital  properties  of  the  solids 
are  always  concerned  as  the  primary  cause,  ai-e  founded  in  an  all- 
pervading  law  of  the  animal  economy,  and  by  which,  and  which  alone, 
nature  is  enabled  to  throw  off  disease  (§  524  d,  944  c,  847  a-h). 

137,  d.  Again,  it  is  one  of  the  most  im^iortant  laws  in  medicine, 
that  the  susceptibility  of  tissues  and  organs  to  the  action  of  remedial 
agents  is  more  or  less  affected  by  disease.  Many  agents  which  oper- 
ate powerfully  in  certain  morbid  states,  and  in  certain  doses,  both  lo- 
cally and  sympathetically,  may  be  perfectly  inert  in  the  natural  states 
of  the  same  organs.  And  so  of  the  natural  agents  of  life.  The  great- 
ness of  the  effects,  also,  will  depend  very  much  upon  the  nature  and 
intensity  of  disease.  The  same  principle  applies  to  the  impressions 
which  are  made  by  many  remedial  agents  upon  existing  states  of  dis- 
ease, or  upon  organs  in  their  state  of  integrity  ;  by  which  the  diseased 
or  healthy  parts  are  increased  in  their  susceptibility  to  the  subsequent 
action  of  the  same  or  other  remedies,  or  to  morbific  causes  (§  143,  c). 

137,  e.  It  is,  therefore,  one  harmonious  system  of  laws  throughout. 
Were  it,  indeed,  otherwise,  remedial  agents  could  have  no  existence,, 
and  disease,  of  course,  could  receive  no  help  from  art.  These,  also^ 
are  the  beginning  of  a  long  series  of  facts  which  show  us  that  the' 
effects  of  all  agents,  whether  morbific  or  remedial,  may  be  traced  to 
the  peculiar  impression  which  they  exert  upon  parts  with  which  they 
come  in  contact;  and  by  which,  also,  we  overthrow  the  whole  systtnr. 


64  INSTITUTES   OF    MEDICINE. 

of  chemical  physiology,  the  humoral  pathology,  and  the  doctrines  of 
debiUty,  and  of  cure  by  the  absorption  of  remedies  (§  847,  e). 

138.  The  natural  modifications  of  the  vital  properties  and  functions, 
or  the  special  vital  constitution,  of  any  particular  tissue,  or  parts  of  a 
continuous  tissue,  and,  therefore,  their  special  modifications  in  any 
given  disease,  conform  to  the  general  nature  of  the  complex  organ  of 
which  the  tissue  may  form  a  component  part. 

Certain  tissues  of  a  compound  organ  are  far  more  liable  to  disease 
than  its  other  tissues.  Thus,  the  mucous  tissue  of  the  stomach  is 
quite  liable,  the  serous  rarely,  and  the  muscular  more  rarely  (§  764,  a) 

139.  Disease  of  any  particular  tissue,  or  parts  of  a  tissue,  is  apt  to 
be  most  severe,  in  its  local  and  general  character,  according  to  tho 
importance  of  the  functions  of  the  conipou7id  organ  of  which  it  may 
form  a  component  part.  This,  however,  is  less  true  of  the  constitu- 
tional influence,  than  of  the  local  intensity  of  disease. 

140.  The  sympathetic  influences  of  disease  are  also  greatly  detei- 
mined  by  the  nature  of  the  affection,  especially  the  constitutional  ef- 
fects. Inflammation  of  the  serous,  venous,  and  ligamentous,  tissues, 
disturb  the  constitution  far  more  than  the  same  degrees  of  inflamma- 
tion affecting  the  mucous,  arterial,  and  muscular,  tissues.  But  much, 
also,  as  already  said,  will  depend  upon  the  nature  of  the  compound 
organ  with  which  the  tissue,  or  part  of  a  continuous  tissue,  may  be 
associated  ;  though  sometimes,  where  the  compound  organ  is  compar- 
atively unimportant,  inflammation  of  one  of  its  tissues  may  give  rise 
to  great  constitutional  disturbances.  Such,  for  example,  is  true  of 
some  inflammatory  affeptions  of  the  mucous  tissue  of  the  throat;  and 
few  diseases  are  more  intractable  than  laryngitis.  Much,  also,  will  often 
depend  upon  the  special  modification  of  disease;  as  in  acute  articular 
rheumatism  (§  525-530). 

141.  a.  Tissues  of  the  same  organization  are  most  allied  in  their 
vital  properties,  and  hence  are  most  liable  to  sympathize  with  each 
other  in  their  diseases. 

141,  h.  When  a  tissue  of  an  organ  becomes  diseased  the  proper- 
ties and  functions  of  the  others  are  more  or  less  disturbed  ;  though 
the  primary  disease  is  not  apt  to  be  propagated  to  them  from  the  tis- 
sue first  affected.  It  continues  rather  in  the  tissue  first  invaded.  In- 
flammation, for  example,  beginning  in  the  mucous  tissue  of  the  stom- 
ach, will  extend  along  that  tissue,  so  far  at  least  as  its  connection 
relates  to  the  stomach,  without  being  often  propagated  to  the  other 
tissues  of  the  compound  organ.  This  principle  has  a  broad  founda- 
tion, and  is  owing  to  the  general  coincidence  in  the  vital  constitution 
of  all  parts  of  the  same  tissue,  and  to  the  differences  between  the  vital 
states  of  that  and  the  associated  tissues.  Exceptions,  however,  occur 
more  frequently  in  some  parts  than  in  others ;  as  in  the  lungs,  where 
pleuro-pneumonia  is  not  unfrequent.  Nevertheless,  in  these  cases, 
the  simultaneous  affection  of  two  distinct  tissues  of  a  compound  or- 
gan may  be  rather  owing  to  a  general  predisposition  effected  by  some 
remote  cause  than  to  morbific  influences  exerted  by  one  tissue  upon 
the  other.  In  other  cases,  especially  of  specific  inflammation,  the  dis- 
ease is  propagated  directly  from  one  tissue  to  another,  as  in  scrofula, 
heumatism,  &c. ;  but  in  most  other  instances  by  reffex  nervous  action. 
142.  For  reasons  stated  in  §  133-136,  morbific  agents  may  readily 
excite  disease  in  one  part  of  a  continuous  tissue  when  they  would  have 


PHYSIOLOGY. STRUCTURE.  65 

110  effect  on  another  part  of  it ;  or  may  operate  more  profoundly  on 
one  part  than  on  another.  And  this  holds  true  of  the  action  of  rerae. 
dial  agents.  The  same  is  also  true  of  the  sympathetic  influences 
which  may  be  exerted  by  disease  ;  and  a  like  principle  applies  to  cer- 
tain sympathies  that  fall  upon  special  parts  which  are  immediately 
continuous  with  each  other,  but  Avhich  are  determined,  also,  by  cer- 
tain special  vital  relations  of  the  diiFerent  parts.  Thus,  the  vital  rela 
tions  of  the  tongue  to  the  alimentary  canal  being  far  greater  than  to 
the  lungs,  and  as  the  canal  readily  sympathizes  with  other  chylopoi- 
etic  viscera,  the  tongue  is  far  more  sensitive  to  abdominal  than  to  pul- 
monary derangements  (§  129  c,  i,  689  ^,  694f). 

143,  a.  A'gain,  there  may  be  varying  susceptibilities  of  the  differ- 
ent parts  of  a  continuous  tissue  (arising  from  numerous  causes  not 
positively  morbific),  when  the  same  morbific,  or  remedial,  cause  will 
affect  one  part  or  the  other  more  in  conformity  with  the  acquired  sus- 
ceptibilities, than  with  the  natural  modifications,  of  the  vital  proper- 
ties in  the  several  parts,  respectively.  This  is  also  more  applicable 
to  the  tissue  as  it  occurs  in  compound  organs  not  anatomically  con- 
nected, and  to  tissues  which  differ  in  their  organization  (§  783). 

143,  h.  Hence  it  follows,  that,  if  all  the  organs  be  rendered  preter- 
naturally  susceptible,  a  general  explosion  of  disease  may  follow  the 
operation  of  some  cause,  which,  in  sounder  health,  would  be  harm- 
less. Under  these  circumstances,  however,  disease  is  most  apt  to 
spring  up  more  or  less  sympathetically,  and  successively,  in  one  part 
after  another,  till  all  parts  may  ultimately  be  brought  into  some,  though 
variable,  forms  of  disease  (§  514  h,  660,  666,  905).  But,  in  these 
cases,  it  generally  happens  that  some  of  the  morbid  states  abate,  or 
subside,  as  new  ones  come  forward,  the  new  ones,  perhaps,  subduing 
sympathetically  the  older  in  the  series  (§  804,  905).  The  system, 
therefore,  is  rarely  universally  invaded  by  disease,  except  in  idiopathic 
fever  (§  148,  783).    Reflected  nervous  action  applies  in  all  the  cases. 

Nevertheless,  it  probably  does  not  often,  if  ever  happen,  except  in 
fever,  that  the  primary  is  the  efficient  predisposing  cause  of  universal 
disease,  but  that  disease  of  one  organ  proves  the  predisposing  of  dis- 
ease in  another ;  and  as  one  organ  after  another  becomes  affected  in 
this  manner,  they  co-operate  together  in  rendering  other  parts  suscep- 
tible of  disease  (§  644,  &c.,  715-719). 

143,  c.  In  proportion,  therefore,  as  the  susceptibility  of  the  system 
at  large  is  increased  by  morbid  changes,  or  predisposed  by  morbific 
influences,  so,  in  a  general  sense,  will  the  alterative  action  of  reme- 
dial agents  be  felt  in  a  corresponding  manner  (§  137  d,  152  b,  715). 
By  the  law  of  adaptation  as  set  forth  in  the  Medical  and  Physiological 
Commentaries  (vol.  i.,  p.  649,  653-655,  &c.),  and  in  various  parts  of 
the  present  work,  the  sympathetic  influence  of  any  local  disease 
which  is  felt  by  distant  organs  modifies  the  vital  states  of  those  parts 
in.  a  manner  that  institutes  harmonious  relations  to  the  part  more  pro 
foundly  affected ;  and  thus  remedial  agents  will  extend  their  salutary 
alterative  action  to  such  distant  parts,  and  render  them  the  source  of 
salutary  effects  upon  the  essential  seats  of  disease  (§  73,80, 117, 1292, 
133-137,  140, 155, 156, 169/,  387,  399,  422,  514  Ji,  524  d,  525,  528, 
638,  649  (Z,  811,  848, "902/,  905).  "When  the  whole  system  is  inva- 
ded by  disease,  as  in  idiopathic  fever,  the  alterative  action  of  rem- 
edies is  felt  over  the  universal  body   (§  148,  152  i,  222-232,  500, 

E 


66  INSTITUTES    OF    MEDICINE. 

904  d).  It  is  owing,  also,  to  the  same  law  of  adaptation,  the  same 
universal,  however  partial  modifications  of  the  vital  states  which  local 
diseases  often  induce,  that  parts  remote  from  the  direct  seat  of  dis- 
ease are  protected  against  all  morbific  effects  from  any  changes  which 
the  blood  may  undergo  as  a  consequence  of  morbid  action  (§  845,  &c.). 
Independently,  however,  of  any  increased  susceptibility  of  organs,  the 
action  of  numerous  agents  upon  the  stomach  may  determine  influences 
upon  distant  parts  whose  natural  state  is  unimpaired,  and  these  influ- 
ences may  become  the  source  of  other  impressions  upon  other  parts. 
Circles  of  reflex  nervous  action  may  be  thus  engendered  universally, by 
which  all  parts  shall  concur  in  the  effects  of  the  gastric  irritation  which 
the  remedies  may  institute.  In  this  manner  a  cathartic  or  an  emetic 
may  bring  the  whole  organism  to  bear  with  favorable  influences  upon 
some  slight  inflammation  of  the  throat  which  had  exerted  no  mod- 
ifying effects  upon  other  parts  (§  514  h,  692  a,  902  g). 

143.  d.  Again,  there  are  some  remedial  agents  possessing  general 
vital  relations  to  the  whole  body,  especially  the  several  preparations 
of  mercury,  and  others  whose  specific  relations  are  more  limited,  like 
cantharides,  which  will  affect  profoundly  the  entire  organization,  or 
certain  individual  parts,  and  alter  the  condition  of  their  vital  states,  in 
the  most  healthy  conditions.  These  agents,  therefore,  approach  most 
nearly  the  truly  morbific  ones,  while  they  possess  the  grand  charac- 
teristic of  the  Materia  Medica  of  instituting  morbid  changes  which  are 
of  transient  existence  (§  1059,  854  d). 

144.  Many  acquired  conditions  may  be  transmitted  fi-om  parents  to 
child,  which  may  thus  form  a  constitutional  predisposition  to  disease  ; 
being  a  permanent  and  more  or  less  universal  modification  of  the  vital 
properties  (though  of  some  parts  more  than  others),  which  does  not 
properly  belong  to  them ;  as  in  scrofula.  Here,  the  absolute  remote 
cause  has  operated  upon  the  ancestor  (§  75-80,  661). 

145.  Subjects  thus  constituted  (§  144)  are  liable  to  morbific  influ- 
ences which  the  more  natural  do  not  feel ;  and  such  causes  as  would 
produce  in  the  natural  subject  common  inflammation  of  the  nose, 
trachea,  &c.,  will  excite  scrofulous  inflammation  in  the  lungs  of  the 
acquired  constitution  (§  650,  659). 

146.  Hereditary  predisposition  to  disease  manifests  itself  in  certain 
tissues  and  organs  more  than  in  others,  according  to  the  nature  of  the 
transmitted  constitution  (^  143,  a). 

147.  Sympathetic  diseases  may  spring  up  in  unusual  constitutions, 
when  they  would  not  in  the  more  natural.  Thus,  in  certain  heredi- 
tary conditions  indigestion  gives  rise  to  scrofulous,  rheumatic,  and 
gouty  inflammation  of  parts  distant  from  the  chylopoietic  viscera. 
The  same  principle  is  also  in  operation  when  the  vital  constitution  of 
parts  is  modified  by  habits,  climate,  age,  the  development  of  the  gen- 
erative organs,  &c.  (§  542),  all  depending  upon  reflex  nervous  action. 

148.  Certain  causes  appear  to  be  capable  of  affecting,  directly  and 
indirectly,  all  the  tissues  of  the  body,  as  in  idiopathic  fever;  though, 
in  these  cases  the  primary  morbific  effect  is  on  particular  parts,  from 
which  it  is  disseminated  by  morbific  reflex  nervous  action  (§  649, 
665,  666,  760).  In  these  cases,  however,  it  appears  not  to  be  a  posi- 
tive state  of  disease  in  the  part  upon  which  the  morbific  agents  may 
exert  their  primary  effects,  as  on  the  mucous  surfaces,  which  brings 
the  iost  of  the  system  into  a  predisposition  to  disease;  but  a  predis- 


PHYSIOLOGY. STRUCTURE.  67 

position  being  established  in  those  primary  parts,  the  impression  is  of 
such  a  nature  as  to  be  propagated  sympathetically  over  the  universal 
body;  just  as  when  many  remedial  agents  acting  upon  the  mucous 
surface  of  the  stomach  exert  powerful  influences  upon  remote  organs, 
but  without  inducing  disease  in  the  gastric  mucous  membrane.  It  is, 
therefore,  in  idiopathic  fever,  as  well  as  in  numerous  local  affections, 
that  the  parts  on  which  the  morbific  agents  exert  their  direct  effects 
may  not  manifest  any  signs  of  disease  till  the  explosion  of  fever  takes 
place  ;  or  as  when  pneumonia,  or  catarrh,  is  induced  by  the  action  of 
cold  upon  the  skin  ;  while  it  often  happens  that  the  parts  thus  origin 
ally,  but  imperceptibly  impressed,  become  sympathetically  the  seats 
of  alDsolute  disease  by  the  reacting  influence  of  the  diseases  which  had 
been  sympathetically  produced  through  these  parts.  Very  complex 
circles  of  reflex  nervous  action  may  thus  arise.  These  general  af 
fections  may  be  also  broken  up  by  the  action  of  a  single  remedy,  as 
by  an  emetic,  or  mercury,  &c.  (557,  559,  712,  715-719). 

149.  It  is  a  great  and  important  law,  resulting  from  the  physiolog- 
ical considerations  now  made  (§  133-148),  that  morbific  causes,  ex- 
ternal or  internal,  determine  disease  upon  the  tissues  of  one  com- 
pound organ  or  another  according  to  the  particular  virtues  of  the 
morbific  causes,  and  in  accordance,  also,  with  the  natural  modifica- 
tions of  the  vital  properties  in  every  part,  and  the  susceptibilities 
which  they  may  acquire  from  other  causes  (§  642  Z>,  722  d,  725, 
794,  795,  SOS).  Hence  it  follows  that  many  of  the  natural  stimuli  of 
^afe  may  become  morbific. 

150,  a.  It  is  a  great  fundamental  law,  that  a  genei-al  coincidence 
exists  between  the  natural  susceptibilities  of  the  properties  of  life  to 
their  ordinary  stimuli  (§  136),  and  to  those  of  a  morbific,  and  of  a  re- 
medial, nature,  according  to  the  natural  modifications  of  the  vital 
properties,  whether  in  a  general  sense  (§  148),  or  in  their  relation  to 
particular  parts  (§  136)  ;  the  influences  produced  conforming,  of 
course,  to  the  natural  modifications  of  the  properties  of  life  and  the 
special  virtues  of  the  several  agents,  though  modified  by  the  tran- 
sient or  permanent  influences  which  spring  from  other  sources,  espe- 
cially from  disease  (584,  644-674,  772  c,  826,  &c.,  847  e,  904).  _ 

Such  is  the  inevitable  result  of  the  constitution  of  the  properties  of 
life  (§  177).  It  is,  as  it  were,  the  great  focal  point  from  which  all  di- 
verges that  is  embraced  in  medicine ;  the  bond  which  unites  every 
branch  of  the  science. 

150,  h.  All  that  is  here  said,  and  in  §  149,  is  equally  applicable  to 
the  nervous  power,  in  all  its  modifications,  as  an  agent  in  the  produc- 
tion and  cure  of  disease,  as  to  agents  of  a  physical  nature  (§  222- 
233J,  &c.). 

151.  It  is  through  the  foregoing  law  (§  150)  that  the  natural  stim- 
uli of  life  maintain  all  parts  in  their  precise  conditions ;  through 
which,  also,  morbific  agents  alter  those  conditions  in  certain  uniform 
ways,  and  through  which  remedial  agents  establish  certain  other 
changes  which  enable  the  properties  and  actions  of  every  part  to  re- 
turn spontaneously  to  their  natural  states.  The  law  involves  an  im- 
mense range  of  facts  in  physiology,  pathology,  and  therapeutics,  and 
groups  many  other  fundamental  principles.  It  should  be  the  point  of 
departure  in  all  our  medical  researches  and  reasonings ;  for  it  is,  as  it 
were,  the  polar  star  which  will  guide  us  safely  upon  our  difl^icult  aijd 
dap^erous  vovase  (\  794,  795,  &c.). 


68  INSTITUTES    OF    MEDICINE. 

J  52,  a.  It  follows,  therefore,  from  §  150,  151,  that  the  operation  of 
all  things  upon  the  living  organism,  whether  food,  heat,  cold,  blood 
poisons,  the  nei-vous  power,  or  remedies  for  disease,  is  upon  one  com- 
mon principle,  which  is  relative  to  the  natural  constitution  of  the  or- 
ganic properties.  Food  stimulates  the  stomach,  and  throws  a  genial 
sympathetic  influence  over  the  whole  organism,  warming  the  cold 
surface  as  soon  as  it  enters  its  appropriate  receptacle ;  blood  main- 
tains, in  the  same  way,  the  actions  of  all  parts  ;  poisons  and  morbific 
agents,  put  into  the  stomach,  affect  the  vital  properties  of  that  organ 
injuriously,  when,  unlike  the  case  of  food,  pernicious  reflex  nervous  ac- 
tions are  determined  upon  other  parts,  or  the  same  food  in  excess  • 
may  do  the  same.  We  then  introduce  into  the  same  organ  another 
class  of  morbific  agents  that  are  less  profound  in  their  operation,  and 
which  prove  remedial  in  certain  doses,  and  therefore  establish,  through 
the  same  piinciple,  a  salutary  change  in  the  same  properties  which 
other  poisons  had  affected  injuriously  (§  638,  642  h,  854). 

152.  h.  It  is  also  worthy  of  repetition,  that  such  is  the  analogy  be- 
tween morbific  and  remedial  impressions,  that  the  organs  which  sus- 
tain the  former  are  thus  rendered  susceptible  of  the  latter,  when  they 
might  be  otherwise  insensible  to  the  same  remedial  agents,  in  their 
appropriate  remedial  doses.  Such  is  the  harmony  of  the  laws  of  na- 
ture ;  such  their  great  final  causes  (§  524,  no.  3,  d).  For  the  same 
reason,  also,  many  of  the  natural  agents  of  life,  such  as  the  ordinary 
kinds  of  food,  may  be  intensely  morbific  in  most  of  the  diseases  of 
man  (§  849).  Or,  again,  the  agents  which  heal  in  their  remedial  dosea 
may  establish  severe  forms  of  disease  when  administered  in  health. 

153.  Through  the  law  of  development,  the  tissues  undergo  natural 
modifications  in  their  structure  and  vital  endowments  at  many  periods 
of  life.  In  infancy,  the  organs  are  imperfectly  developed,  though  the 
projDorties  and  functions  of  organic  life,  unlike  those  of  animal  life, 
are  strongly  pronounced  in  many  of  the  viscera.  A  relation  obtains, 
however,  in  organic  life,  between  the  properties  and  functions  and 
the  relative  size  of  organs  (§  159). 

In  childhood,  there  is  another  well-marked  change.  In  adoles- 
cence, another ;  when  the  organs  become  mature.  .  In  old  age,  an- 
other; when  life  is  naturally  on  the  decline. 

154.  The  foregoing  stages  of  development  (§  153)  are  not  sudden, 
but  gradually  progi'essive. 

15o.  The  changes  of  organization  (§  153,  154)  are  preceded  by 
corresponding  changes  in  the  vital  properties,  upon  which  the  former 
depend  (§  445, y).  This  principle,  too,  like  all  others  which  relate  to 
organic  life,  whether  in  health  or  disease,  is  universally  ti'ue  under 
any  given  combination  of  circumstances.  It  is  true  of  the  develop)- 
ment  of  all  tissues  and  all  organs,  and  all  other  products,  from  the  be- 
ginning of  conception  to  the  end  of  life.  Hence,  also,  the  variety  in 
the  remedial  or  morbific  virtues  of  many  plants,  at  different  stages  of 
their  growth.  As  structure  varies,  the  vital  properties  have  under- 
gone modifications,  in  conformity  with  that  order  of  Design  which  was 
instituted,  that  where  one  specific  end  is  accomplished,  and  others  are 
to  be  fulfilled,  the  powers  by  which  these  final  causes  are  to  be  ac- 
complished shall  have  their  necessary  adaptations.  And  while,  also, 
the  vital  properties,  under  all  their  natural  modifications,  are  so  con- 
stituted as  to  receive  certain  exact  impressions  from  the  natural  stim- 


PHYSIOLOGY. STRUCTURE.  '  69 

uli  of  life,  that  vital  actions  may  be  determined  according  to  the  pur- 
poses ordained,  so  also  will  morbific  and  remedial  agents  be  varied  in 
their  influences  (§  129  i,  387,  980). 

156,  a.  The  foregoing  variations  (§  153-155),  therefore,  give  rise 
to  new  dispositions  to  disease  in  many  parts,  and  are  productive  of 
modifications  of  former  diseases,  or  the  latter  disappear.  This,  as 
we  have  seen,  is  a  necessary  consequence  of  the  physiological  chan- 
ges, since  the  same  properties  which  carry  on  nutrition  and  growth 
carry  on  all  diseases.  The  relations  of  vital  and  morbific  agents  move 
on,  j)a7-i  -passu,  with  the  natural  changes  in  the  properties  of  life  ;  and 
remedial  agents  undergo  corresponding  modifications  of  action. 

156.  h.  The  great  law  of  adaptation  is  forever  present  to  the  eye 
of  the  naturalist;  and  when  the  same  subjects  are  contemplated  in  a 
moral  sense,  the  same  evidences  of  Design  meet  him  at  every  glance 
of  the  mind.  Take  an  example  of  a  compound  nature,  a  universal 
physiologico-moral  phenomenon  in  which  our  present  topic  is  involv- 
ed. Thus,  no  sooner  was  man  created  than  he  was  doomed  to  obtain 
his  subsistence  by  the  sweat  of  his  brow.  Roots,  grains,  fruits,  «&c., 
were,  therefore,  as  far  as  the  wants  of  animals  would  allow,  created 
mostly  in  an  unedible  condition,  but  rendered  susceptible  of  the  re- 
quisite improvement  by  cultivation  ;  and  to  carry  out  the  great  pur- 
pose, the  nature  of  soils,  air,  water,  &c.,  were  made  subservient  (§ 
74,  80,  117,  137,  143,  155,  169/;  266,  384,  385,  387,  399,  409/,  422 
514  I,  524  d,  525,  526  d,  528,  638,  733  h,  847  g). 

157.  Organs  are  sofl:est  and  most  fluid  at  the  beginning  of  their  de- 
velopment, and  increase,  progi'essively,  in  density  through  life.  The 
animal  ovum  is  scarcely  more  than  an  organic  fluid  (^  67). 

158.  Vascular  action  is  promoted  by  the  greater  fluidity  of  or- 
gans, and  vice  versa  (§  142).  Inflammation  is  in  part,  therefore, 
more  intense  and  rapid  in  infancy  and  childhood  than  at  later  peri- 
ods, which,  with  other  causes,  gives  rise  to  the  necessity  of  great 
promptitude  of  remedies.  Other  causes  attending  the  vital  condi- 
tions of  old  age  render  equally  important  a  decisive  treatment  of  the 
severe  diseases  that  may  befall  that  age  (§  574,  &c.,  1009,  &c.). 

159.  The  proportional  size  of  organs  varies  at  different  stages  of 
life.  The  cerebro-spinal  system,  for  example,  is  largest  in  child- 
nood.  Hence  a  greater  development  of  the  organic  properties  in  those 
parts,  and  a  greater  consequent  liability  of  the  brain  to  inflammatory 
and  congestive  affections,  and  to  hydrocephalus.  The  large  propor- 
tional size  of  the  nervous  and  arterial  systems  affects  the  physiolog- 
ical and  pathological  condition  of  all  other  parts ;  giving  activity  to 
nutrition,  and  susceptibility  and  intensity  to  disease.  « 

The  glandular  tissue  of  the  liver  has  the  largest  proportional  size 
in  infancy ;  but  not  so  the  venous  system  of  the  liver.  Hence,  again, 
♦^he  glandular  function  of  that  organ  is  especially  liable  to  derange- 
ment in  infancy,  and  its  venous  tissue  to  congestion  at  more  advanced 


It  is  also  important  to  understand,  that  the  veins,  in  a  general 
sense,  "  have  a  real  inferiority  as  it  respects  the  arteries,  during  the 
first  periods  of  life." — Bichat.  There  are  some  exceptions,  espe- 
cially in  the  brain. 

160.  What  has  now  been  said  of  the  m.odifications  of  the  vital  con- 
Btitution  of  different  tissues  and  organs  may  be  illustrated  by  the  rel 


70  INSTITUTES    OF    MEDICINE. 

ative  liability  of  different  tissues,  and  parts  of  common  tissues,  to 
some  given  disease,  by  the  relative  danger  of  that  disease  as  it  may 
affect  the  different  parts,  and  by  the  eff'ects  of  some  remedial  agent 
ujjon  the  various  parts,  respectively.  The  remedy  may  be  loss  of 
blood,  and  the  supposed  disease  inflammation.  The  statement  may 
be  conveniently  made  in  a  tabular  form,  while,  also,  it  may  be  con- 
verted to  practical  uses  (^  711). 

161.  The  tables  are  intended  in  a  general  sense,  and  suppose  the 
constitution  to  be  naturally  sound.  If  hereditary  predispositions  to 
disease  exist,  as  in  scrofula,  or  if  the  constitution  be  affected  by  in- 
temperance, or  by  pre\'ious  diseases,  &c,,  the  order  of  liabilities  to 
inflammation,  &c.,  as  marked  in  the  first  table,  will  be  more  or  less 
affected.  In  the  scrofulous  constitution,  for  example,  instead  of  the 
mucous,  the  lymphatic  tissue  may  be  most  liable. 

162.  The  tables  will  be  more  or  less  modified  by  age.  Thus,  the 
veins  of  the  pia  mater  are  more  liable  to  congestion  in  infancy  and 
childhood  than  any  other  part  of  the  venous  texture.  This  liability 
afterward  decreases,  and  returns  at  the  age  of  fifty  and  upward,  re- 
sulting in  cerebral  hemon'hage  (§  805). 


PHYSIOLOGICAL  AND  PRACTICAL  SUGGESTIONS. 

Tissues  most  liable  to  disease,  especially  to  inflammation,  in  the 
order  of  arrangement : 


1.  Mucous. 

2.  Venous  {venous  congestion). 

3.  Cellular. 

4.  Serous. 

5.  Ligamentous  and  dennoid  [Jibrous). 

6.  Glandular. 

7.  Lymphatic. 

8.  Nervous. 

9.  Synovial. 

10.  Periosteum  {Jibrous). 

11.  Osseous. 

12.  Tendons,  cartilage,  dura  mater,  and  peiicardium  (Jibrous). 

13.  Muscular. 


14.  Arterial. 


1.  Mucous  texture 


TABLE   II. 

''  of  the  nose. 

"      lungs,  fauces. 
"     eyes. 

(  Ilium, 
*'      small  intestine,  <  Jejunum, 


Duodenum. 


stomach, 
large  intestine, 
uterus  and  vagina, 
bladder. 


PHYSIOLOGY.—  STRUCTURE. 


71* 


2.  Venous  texture  (forai- 
ing,  mostly,  venous 
congestion) 


3.  Cellular  texture 


4.  Serous  texture    . 


5.  Glandular  texture , 


6.  Lymphatic  texture  . 

7.  Fibrous  texture  .  .  •  .  < 

8.  Nervous  texture    .  . 

9.  Synovial  texture    .  . 
1 0,  Osseous  texture  .  .  , 


of  pia  mater,  in  infancy  and  childhood. 
*'  liver. 

"  small  intestine. 
*'  pia  mater  of  adults. 
"  rectum  implies). 
"  uterus  [phlebitis). 
"  lungs  {congestive  asthma). 
"  lower  extremities  [varix). 
"  spermatic  cord  {circocele). 
sub-cutaneous, 
of  the  lungs. 

"      pia  mater. 

"      voluntary  muscles, 
of  the  lungs. 

"      parietes  of  thorax. 

"      parietes  of  abdomen. 

"      liver. 

"      small  intestine. 

"      large  intestine. 

"      heart  and  pei'icardium. 

"      cerebral  ventricles. 

"      kidneys. 

"      stomach, 
lymphatic  glands, 
mammae  [puerperal). 
salivary  glands, 
liver, 
testis. 

lacteal  glands, 
kidney. 

thyroid  gland  [goitre). 
thymus  gland, 
pancreas, 
of  the  lower  extremities. 

"      upper  extremities. 

"      uterus  (see  Comm.,  vol.  ii.,  p.  470) 
others  rarely, 
ligaments, 
dermoid, 
periosteum, 
cartilage, 
tendons, 
pericardium, 
dura  mater, 
brain.  • 

nerves. 

ganglia  of  sympathetic, 
spinal  cord, 
of  the  knee-joints. 

"      ankle. 

"     joints  of  upper  extremities, 
spongy  bone, 
solid  bone. 


72  INSTITUTES    OP    MEDICINE. 

^  of  the  brain. 

,  -      .    ^     .  ,  ,     ^  ]  arch  of  aorta. 

11.  Arterial  texture .  .  .  .<        ,, 

}        "       extremities. 

(^rare  in  other  parts. 

TABLE  in. 

Relative  danger  of  high  inflammation  affecting  the  tissues  of  dif 
ferent  organs,  according  to  the  order  of  arrangement : 

1.  All  textures  of  the  brain. 

2.  All  textures  of  the  heart  and  pericardium. 

3.  Venous  and  lymphatic  textures  of  the  womb,  iliac  and  other 

veins. 

4.  Peritoneum  of  abdomen  [piterjyeral  women). 

5.  Serous  membrane  of  small  intestine. 

6.  Veins  of  the  liver  (^venous  congestion  i?i  congestive  Jevers). 

7.  Parenchyma  of  lungs. 

8.  Glandular  texture  of  liver. 

9.  Mucous  texture  of  small  intestines. 

10.  Mucous  texture  of  stomach. 

11.  Serous  texture  of  large  intestine. 

12.  Textures  of  kidney. 

13.  Mucous  texture  of  large  intestine. 

14.  Serous  texture  of  lungs  and  thorax. 

15.  Serous  texture  of  liver. 

16.  Serous  texture  of  abdominal  paiietes  [common  inflammation). 

17.  Veins  of  lungs  (lore,  or  sub-active,  forming  congestive  asthma. 

See  Comm.,  vol.  ii.,  p.  494). 

18.  Textures  of  bladder. 

19.  Mucous  texture  of  uterus. 

20.  Ligaments. 

21.  Bone  and  cartilage. 

22.  Lymphatics  of  extremities. 

TABLE   IV. 

Tissues  which  require  the  greatest  extent  of  general  blood-letting, 
when  affected  with  high  inflammation, — according  to  the  organs  in 
which  they  are  associated,  and  in  the  order  of  arrangehient.  The 
remedy  is  supposed  to  be  applied  eai'ly. 

1.  All  textures  of  the  brain. 

2.  All  textures  of  the  heart  and  pericardium. 

3.  Serous  texture  of  small  intestine. 

4.  Peritoneum  of  abdomen  (in  puerperal  women).  Note H p.  1117. 

5.  Parenchyma  of  lungs. 

6.  Serous  texture  of  storfiach. 

7.  Serous  texture  of  large  intestine. 

8.  Veins  and  lymphatics  of  uterus.     [Early.) 

9.  Serous  and  glandular  texture  of  liver. 

10.  Venous  texture  of  liver.     [Sub-acute,  congestion  in  congestive 

fever.      Often  more  largely.) 

11.  Mucous  texture  of  small  intestine. 

12.  Uterus. 

13.  Textures  of  kidney. 


PHYSIOLOGY. VITATi    TROPERTIES.  73 

14.  Mucous  texture  of  stomach. 

15.  Mucous  texture  of  large  intestine, 

16.  Serous  texture  of  lungs  and  chest. 

17.  Serous  texture  of  abdominal  parietes.   (  Common  injlamviation.) 

18.  Ligaments.     [Often  more  largely.) 

19.  Bladder. 

20.  Mucous  texture  of  bronchiae. 

21.  Mamma,  testis,  parotid  gland. 

22.  Absorbents  of  extremities. 

163.  In  the  treatment  of  disease,  therefore,  we  should  consider  the 
precise  pathology  of  each  affected  tissue,  the  natural  vital  peculiari- 
ties of  the  affected  tissue  in  the  compound  organ,  its  general  character 
as  well  |s  that  of  the  compound  organ  in  the  animal  economy,  the  in- 
fluences which  its  morbid  state  exerts  upon  the  other  tissues  in  a 
compound  organ,  its  own  morbific  influences  and  the  combined  influ- 
ences of  the  compound  organ  upon  other  parts,  and  how  the  remote 
sympathizing  parts  may  react,  or  shed  an  influence  on  yet  other  parts. 
And  then  follows  not  only  the  general  plan  of  treatment,  but  all  that 
nice  discrimination  of  cathartics,  emetics,  alteratives,  and  other  gi'oups 
of  agents  possessing,  in  their  individualities,  respectively,  analogous 
virtues,  their  combinations,  altei'nations,  precise  dose,  frequency  of 
repetition,  &c.  (§  675,  685,  686).  The  same  variety  of  considerations 
are  to  be  made  when  the  condition  of  diseased  parts  may  undergo 
changes,  favorable  or  unfavorable,  from  the  operation  of  remedial 
agents. 

We  are  mostly  assisted  in  the  foregoing  inquiries  by  comparisons 
of  the  morbid  with  the  natural  vital  phenomena  and  physical  products 
of  each  part,  and  the  whole  collectively.  We  also  acquire  much  of 
our  knowledge  of  the  natural  constitution  of  individual  parts  by  ob- 
serving the  deviation  of  their  phenomena  when  acted  upon  by  mor- 
bific or  remedial  agents.  The  phenomena  are  then  more  strongly 
pronounced  than  in  health,  or  new  ones  are  developed.  Indeed,  it  is 
sometimes  through  morbid  conditions  only  that  we  acquire  a  knowl- 
edge of  some  of  the  important  physiological  conditions ;  as,  for  ex- 
ample, the  existence  of  common  sensibility  in  all  parts.  Hence  a 
corollary,  that  none  but  an  observer  of  disease  can  expound  the  nat- 
ijral  conditions  and  laws  of  life  (§  685,  686,  848). 


THIRD  DIVISION  OF  PHYSIOLOGY. 

PROPERTIES  OR  POWERS  OF  LIFE. 

164.  A  VITAL,  or  peculiar  governing  principle  or  power,  in  organic 
beings,  has  been  recognized  by  all  the  most  distinguished  medical 
philosophers  at  all  ages  of  the  science.  It  is  the  fundamental  cause 
of  growth,  nutrition,  and  of  all  other  phenomena  of  organic  beings. 
It  is,  in  all  but  the  vulgar  acceptation,  synonymous  with  the  term  life  ; 
and  Ife,  therefore,  is  a  cause,  and  not  an  effect,  as  has  been  assumed 
by  many  distinguished  physiologists,  and  as  taught  by  chemistry. 


7'4  INSTITUTES    OP     MEDICINE. 

165,  a.  "  Until  it  is  proved,"  says  Andral  (the  rastorer  of  the  hu 
moral  pathology),  "  that  the  forces  which,  in  a  living  body,  interrupt  the 
play  oi"  the  natural  chemical  affinities,  maintain  a  proper  temperature, 
and  pieside  over  the  various  actions  of  organic  and  animal  life,  are 
analogous  to  those  admitted  by  natural  philosophy,  we  shall  act  con- 
sistently with  the  principles  of  that  science,  by  giving  distinct  names 
to  those  two  kinds  of  forces,  and  employing  ourselves  in  calculating 
the  different  laws  they  obey." — Andral's  Pathological  Anatomy. 

And,  to  the  same  effect,  the  distinguished  organic  chemist,  Liebig, 
the  chief  of  the  school  of  pure  chemistry  (§  4|) : 

"  There  is  nothing  to  prevent  us  from  considering  the  vital  force 
as  a  PECULIAR  property,  which  is  possessed  by  certain  material  bodies, 
and  becomes  sensible  when  their  elementary  particles  are  combined 
in  a  certain  arrangement  or  form.  This  supposition  takes  ^rom  the 
vital  phenomena  nothing  of  their  wonderful  peculiarity.  It  may, 
therefore,  be  considered  as  a  resting  point  from  which  an  investi- 
gation into  these  phenomena,  and  the  laws  which  regulate  them,  may 
be  commenced ;  exactly  as  we  consider  the  properties  and  laws  of 
LIGHT  to  be  dependent  on  a  certain  luminiferous  matter  or  ether, 
which  has  no  farther  connection  with  the  laws  ascertained  by  investi- 
gation."— Liebig's  Animal  Chemistry. 

So,  also,  Carpenter,  Roget,  and  other  eminent  chiefs  of  the  physical 
school  (§  64). 

And  thus,  the  eminent  Miiller,  who  leads  in  the  school  of  chemico- 
vital  physiology  : 

"  The  only  character  that  can  be  possibly  compared  in  organic  and 
inorganic  bodies,  is  the  mode  in  which  symmetry  is  realized  in  each." 
"  Whether  the  vital  principle  is  to  be  regarded  as  imponderable  mat- 
ter, or  as  a  force  or  energy,  is  just  as  uncertain  as  the  same  question 
in  reference  to  several  phenomena  in  physics.  Physiology,  in  this 
case,  is  not  behind  the  other  natural  sciences  ;  for  the  properties  of  this 
principle  in  the  functions  of  the  nerves  are  nearly  as  well  kno^yn  as 
those  of  light,  caloric,  and  electricity,  in  physics." — Muller's  Physi- 
ology. 

Finally,  we  have  the  pure  vitalist,  teaching  the  same  doctrine ; 
though,  with  greater  consistency.     Thus  : 

"  Physiology,"  says  Bichat,  "  would  have  made  much  greater  prog- 
ress, if  all  those  who  studied  it  had  set  aside  the  notions  which  are 
Dorrowed  from  the  accessory  sciences,  as  they  are  termed.  But,  these 
sciences  are  not  accessory  ;  they  are  wholly  strangers  to  physiology, 
and  should  be  banished  from  it  wholly."  "  To  say  that  physiology 
is  made  up  of  the  physics  of  animals,  is  to  give  a  very  absurd  idea  of 
it.  As  well  might  we  say  that  astronomy  is  the  physiology  of  the 
stars." — Bichat's  General  Anatomy,  Sfc. 

Tiedemann,  too,  was  right  in  saying  that, 

"  All  the  qualities  of  organic  bodies  should  be  looked  upon  as  the 
effects  of  the  vital  powers.  Even  those  phenomena  seen  in  them, 
which  they  exhibit  in  common  with  inorganic  bodies,  undergo  modifi- 
cations of  their  specific  action,  and  should  be  considered  subordinate 
to  the  vital  powers." — Tiedemann's  Physiology,  Sfc. 

There  is  not,  indeed,  in  the  whole  range  of  medical  literature,  one 
author,  however  devoted  to  the  physical  and  chemical  views  of  life, 
who  does  not  evince  the  necessity  of  admitting  a  governing  vital  prin- 


PHYSIOLOGY. VITAL    PROPERTIES.  75 

ciple  as  a  distinct  entity,  distinct  from  all  other  things  in  naUire.  I  say, 
there  cannot  be  produced  one  author  of  any  consideration,  who  does 
not  summon  to  the  aid  of  his  discussion  a  vital  principle  whenever  he 
touches  upon  the  abstract  phenomena  of  life.  And  this  I  have  abun 
dantly  shown  by  an  extensive  range  of  quotations  in  my  various  pub- 
lications {Except  ^  1034). 

165,  b.  We  are  constantly  asked,  how  we  know  the  existence  of 
the  vital  properties  or  powers  ]  Again,  I  say,  precisely  by  the  same 
means  as  the  advocates  of  the  chemical  and  physical  philosophy 
of  life  defend  their  knowledge  of  the  forces  which  govern  the  inor- 
ganic world.  The  question  is  important,  as  implying  that  physiolo- 
gists either  do  not  ai'rive  at  their  knowledge  of  causes  through  their 
effects,  or,  that  there  is  nothing  different  in  the  phenomena  of  organic 
and  inorganic  beings.  What  would  the  metaphysician  say,  were  we 
to  ask  him  for  any  other  demonstration  of  mind  than  its  manifesta- 
tions ;  or  the  mechanical  or  chemical  philosopher,  should  we  demand 
any  other  evidence  of  gravitation,  magnetism,  chemical  affinity,  &c., 
than  the  effects  which  they  supply  1  And  do  we  not  distinguish  one 
from  the  other,  and  regard  them  as  wholly  distinct  forces,  by  the  dif- 
ference in  their  effects  ?  The  proof  is  clear  and  tangible,  in  all  the 
cases.  Where  the  results  of  power  differ  so  materially  from  each 
other,  it  is  as  good  a  ground  of  ai'gument,  that  the  phenomena  depend 
upon  specific  powers  in  one  case  as  in  the  other ;  and,  if  it  be  "  a 
cloak  of  ignorance"  in  either  case  to  assume  the  existence  of  powers, 
it  must  surely  appertain  to  him  who  attempts  an  explanation  of  the 
phenomena  by  assuming  forces  with  which  such  phenomena  have  no 
known  connection  (§  175,  hh^  1085). 

166,  Many  of  the  eminent  ancient  physicians  considered  the  vital 
principle  an  intelligent  agent;  and  even  Hunter  has  been  supposed, 
though  erroneously,  to  have  been  of  that  opinion.  Some  distinguish- 
ed physiologists,  of  the  present  day,  are  inclined  to  regard  the  soul  as 
that  agent.  Others  confound  it  with  the  Deity  ;*  while  yet  others, 
confounding  the  Deity  with  Nature,  fall  into  a  labyrinth  of  absurdi- 
ties.t  Others  suppose  the  vital  functions  alone  to  constitute  life.| 
The  ancient  physicians  generally  distinguished  the  vital  principle  from 
the  soul,  and  regarded  both  as  immaterial  (§  175  d,  350^  k). 

167,  a.  The  vital  principle  was  early  known  underthe  names  o£  An- 
ima  and  Calidum  Innatum.  It  was  gi'eatly  lost  sight  of  in  the  "  dark 
ages,"  but  reappeared  among  the  earliest  restorers  of  learning,  when 
it  took  the  name  of  Anima  Vegetans,  as  significant  of  its  organizing 
power  in  plants  and  animals.  The  eccentric  philosopher,  Paracelsus, 
substituted  the  name  of  Sidereal  Spirit,  to  suit  his  dogmas  of  plane- 
tary and  demoniac  influence.  Then  came  Van  Helmont  with  his  in- 
novation of  a  Spiritus  Archceus,  an  immaterial  principle,  which  he  lo- 
cated in  the  upper  orifice  of  the  stomach.  It  presided  over  the  body 
in  a  general  sense,  and  had  under  its  command  several  subordinate 
spirits  (one  for  each  organ),  to  execute  the  orders  of  the  great  spirit. 
But,  like  Paracelsus,  he  expounded  much  of  his  physiological  results 
upon  chemical  principles,  and  had  no  definite  conceptions  of  the  office 
of  his  Archaaus.     Stahl  followed  Van  Helmont  with  his  Rational  Soul, 

*  See  my  article  on  the  "  Vital  Powers,"  in  Medical  and  Physiological  Commentaries 
vol.  i. ;  and  my  "  Essays  on  the  Philosophy  of  Vitality." 

t  See  my  "  Examination  of  Reviews,  '  p.  43.  t  Comm.,  ut  supra 


76  INSTITUTES    OF    MEDICINE. 

and  Lord  Bacon  had  entered  the  field  in  defense  of  a  vital  principle, 
Then  came  Haller,  with  his  great  philosophical  and  practical  distinc- 
tion of  the  Vis  Insita  and  Vis  Nervca.  Here  we  enter  into  the  midst 
of  the  profound  theories  of  irritability  and  sensibility,  which  had  been 
suggested  by  Galen  (§  476,  b).  Grlisson,  too,  had  forced  his  way  into 
the  laws  of  irritability  ;  and  Baglivi  had  already  dealt  his  fatal  blows 
upon  the  humoral  pathology.  We  may,  therefore,  date  the  progress- 
ive and  substantial  foundation  of  vitalism  and  solidism  from  Baglivi 
to  Haller ;  a  period  of  about  one  hundred  years. 

167,  b.  Whytt  modified  the  Stahlian  doctrine;  and  the  visionary 
Des  Cartes  led  the  way  in  rejecting  altogether,  for  awhile,  the  vital 
powers,  in  which  he  was  aided  by  the  hypothesis  of  a  nervous  fluid, 
which  appeared  about  his  time.  The  doctrine  then  followed,  as  a 
consequence,  that  matter  acquires  vitality  in  virtue  of  a  peculiar  or- 
ganization, and  this  became  an  easy  step  to  the  atheistical  doctrine  of 
spontaneous  generation.  Then  came  up  the  view  as  set  forth  by 
Monro,  Sir  Humphrey  Davy,  and  others,  analogous  to  the  Cartesian, 
that  a  living  principle  pervades  the  universe,  and  governs  all  things. 
Some  of  this  school  suppose  the  universal  principle  to  be  subordinate 
to  the  Deity;  but  a  greater  number,  like  Carpenter,  Prichard,  and 
especially  many  of  our  present  geologists,  as  Lyell,  &c.,  regard  it  as 
the  Deity  Himself,  whereby  the  latter,  either  directly  or  by  implica- 
tion, confound  nature  with  God.  The  doctrine  becomes,  here,  either 
atheistical  or  of  a  direct  atheistical  tendency ;  and  we  have,  as  a  re- 
newed consequence,  the  assumption  of  spontaneous  generation.* 

167,  c.  Those  gi'eat  luminaries.  Hunter  and  Bichat,  came  forward 
in  good  time  to  rescue  the  philosophy  of  medicine  from  the  degrada- 
tion with  which  it  was  threatened  by  chemistry  and  physics,  and  have 
left  an  impregnable  shield  to  all  future  ages. 

167,  d.  Tiedemann,  too,  soon  after  appeared  with  his  "  Physiology 
of  Man,"  in  which  the  doctrines  of  life  are  ably  expounded,  and  which 
must  be  ranked  as  one  of  the  productions  of  an  original  mind.  Tiede- 
mann could  not  believe  that  there  was  any  sincerity  in  the  absolute 
rejection  of  a  peculiar  governing  principle  of  living  beings.  "  How- 
ever different,"  he  says,  "  may  be  the  names  chosen  by  physiologists 
and  physicians  to  designate  this  power,  however  various  the  ideas 
they  attach  to  it,  yet  all  must  agree  on  the  essential  point,  that  of  re- 
garding it  as  intended  to  maintain  living  bodies,  vegetable  and  animal, 
and  all  their  parts,  during  a  certain  space  of  time,  in  a  state  of  integ- 
rity, in  the  composition,  organization,  and  vital  properties  that  are 
peculiar  to  them,  and  to  render  those  bodies  capable,  at  a  certain  pe- 
riod of  their  existence,  of  producing  beings  of  the  same  species  as 
themselves,  which  beings  are  confined  to  the  same  determinate  mode 
of  formation  and  development,  and  exhibit  similar  phenomena." 
"  We  are  bound,  therefore,  to  consider  the  principle  which  presides 
over  those  different  acts,  as  a  power  inherent  in  all  parts  of  living  be- 
ings, and  we  cannot  assume  that,  either  in  vegetables  or  animals,  it  is 
limited  to  any  one  part  or  parts.  All  the  parts  of  a  plant,  the  roots, 
stem,  branches,  leaves,  flowers,  wood,  and  bark,  are  nourished.  Nu- 
trition takes  place  in  all  the  tissues  and  organs  of  animals.     The  con- 

*  See  Medical  and  Physiological  Commentaries,  vol.  i.,  p.  25,  and  vol.  ii.,  p.  124-.140. 
Also,  "Examination  of  Reviews,"  p.  43  ;  "Notice  of  Reviews,"  p.  4;  "Essays  en  Vital' 
itj',"  &c.,  p.  17. 


PH"J3I0L0GY. VITAL    PROPERTIES.  7") 

tinual  tendency  of  this  power  to  preserve  the  individual  and  all  its 
parts,  forms  the  prominent  character  of  individual  life,  and  is  present- 
ed to  us  as  the  most  important  internal  condition  of  life.  This  power 
not  only  converts  the  alimentary  matters,  drawn  from  without,  into  nu- 
tritive fluids,  endowed  with  special  properties  and  assimilated  by  it, 
but  it  also  introduces  them  into  the  solid  organic  form,  determines  and 
regulates  the  composition,  the  organization,  and  the  vitality  of  parts. 
Every  living  body  is  exposed  to  externaV  influences,  which  urge  it  to 
manifestations  of  activity.  Every  one,  however,  under  certain  exter- 
nal circumstances,  retains  its  form,  its  composition,  and  activity.  Cer- 
tain external  impressions,  however,  of  a  mechanical  or  chemical  na- 
ture, and  divers  organic  matters,  vegetable  and  animal  poisons,  are 
able  to  ANNIHILATE  tliis  power*  and  thus  to  cause  the  death  of  the 
living  bodies  on  which  they  opel'ate." 

167,  e.  Next  came  the  illustrious  Miiller  to  aid  in  arresting  the  al- 
most universal  onslaugh,  in  Europe,  that  seemed  to  threaten  the  ex 
tinction  of  every  sage  in  medicine  from  Hippocrates  to  the  exit  of 
Bichat.  Under  the  magic  wand  of  Andral  the  venerable  doctrine  of 
humoralism  reared  its  portentous  form  ;  while  Louis  substituted  mor- 
bid anatomy  for  the  science  of  pathology,  and  Liebig,  and  his  school 
with  fire  and  acids,  overrun  the  whole  domain  of  medicine. 

Although  Miiller  employs  the  language  of  Stahl,  in  relation  to  a 
vital  principle,  I  think  it  rather  designed  as  a  forcible  mode  of  ex- 
pression, than  as  imputative  of  intelligence.  Thus,  '■'•this  rational  cre- 
ative force^''  he  says,  "  is  exerted  in  every  animal  strictly  in  accordance 
with  what  the  nature  of  each  part  requires.'"  The  fact  is  truly  stated ; 
but  it  reposes  on  great  laws  of  organization,  not  upon  intelligence 
That  such  is  Miiller's  view  appears  from  another  expression,  that, 
"  the  formative  or  organizing  principle  is  a  creative  power,  modifying 
viatter  blindly  and  ujiconsciously."  The  radical  fault  of  this  philoso- 
pher consists,  like  that  of  Van  Helmont,  Stahl,  Hoffmann,  and  Para- 
celsus, in  referring  many  vital  results  of  organic  beings  equally  to  a 
"vital  creative  principle"  and  to  chemical  forces. — See  Muller's 
Physiology. 

10)1,  f  So  remarkably  different,  however,  are  all  the  results  of  life 
from  those  of  dead  matter,  that  some  of  the  shrewdest  physiologists, 
of  our  own  day,  can  scarcely  avoid  the  chimerical  theory  of  Van  Hel- 
mont.    Thus,  even  Marshall  Hall : 

"  The  principle  of  action  in  the  cerebral  system,"  he  says,  "  is  the 
ipvxq,  or  the  immortal  soul.  Upon  the  cei'ebrum  the  soul  sits  en- 
throned, receiving  the  embassadors,  as  it  were,  from  without,  along 
the  sentient  nerves;  deliberating  and  willing,  and  sending  forth  its 
emissaries  and  plenipotentiaries,  which  convey  its  sovereign  viandates, 
along  the  voluntary  nerves,  to  muscles  subdued  to  volition,"! — (Hall 

*  See  "  Examination  of  Reviews,"  p.  26-28  ;  also,  this  work,  §  189  h,  350^  h. 

t  I  have  somewhere  seen  it  suggested  that  the  doctrines  of  vitalism  may  be  applied  in 
support  of  animal  magnetism.  But,  while  vitalism  is  fundamentally  opposed,  even  to 
speculative  theoiy,  and  rests  alone  on  the  absolute  phenomena  of  organic  beings,  it  is  not 
less  true  that,  with  rare  exceptions,  the  medical  advocates  of  animal  magnetism  are,  as 
in  ancient  times,  among  the  physical  theorists  of  life  (^  844).  Dr.  Elliotson  is  of  that  de- 
nomination. (See  Med.  and,  Phys.  Comm.,  vol.  ii.,  p.  137,  138.)  And,  although  I  have,  in 
the  foregoing  work  (vol.  i.,  p.  632),  expressed  my  opinion  of  the  countenance  which  has  been 
given  to  this  imposture  by  distinguished  members  of  the  medical  profession,  I  will  add 
my  entire  concurrence  in  the  following  sentiments  by  Hannah  More.  In  a  letter  to  Hor- 
ace Walpole,  dated  1788,  she  remarks,  "  I  give  you  leave  to  be  as  severe  as  you  please 
on  tbe  demoniacal  inummery  which  has  been  acting  in  this  country ;  it  was,  as  usual  with 


78  INSTITUTES    OF    MEDICtNE. 

on  the  Nervous  System.)  Here  I  suppose  the  "  emissaries  and  pleni- 
potentiaries" to  be  nothing  more  than  the  nervous  power,  a  property 

prodigies,  the  operation  of  fraud  upon  folly.  In  vain  do  we  boast  of  the  enlightened  eigh- 
teenth ceutuiy,  and  conceitedly  talk  as  if  human  reason  had  not  a  manacle  left  about  her, 
but  that  philosophy  had  broken  down  all  the  strong-holds  of  prejudice,  ignorance,  and  su- 
perstition ;  and  yet,  at  this  very  time,  Mesmer  has  got  a  hundred  thousand  pounds  by 
animal  magnetism  in  Paris.  Mamaduc  is  getting  as  much  in  London.  There  is  a  fortune 
teller  in  Westminster  who  is  making  little  less.  The  divining  rod  is  still  considered  as 
oracular  in  many  places.  Devils  are  cast  out  by  seven  ministers.  Poor  human  reason, 
when  wilt  thou  come  to  years  of  discretion !"     (9  844.) 

I  may  also  add  the  foUowiug'exti'act  from  the  New  York  Journal  of  Medicine  for  March, 
1845: 

"New  York,  Feb.  14,  1845. 
"Mr.  Editor, 

"  Dear  Sir — In  a  letter  of  the  11th  inst,  addressed  to  myself,  you  desire  me  to  state 
what  I  witnessed  of  the  firmness  of  a  young  gentleman,  upon  whom  the  operation  of  ex- 
section  of  the  inferior  maxillary  bone  was  performed  by  Prof  Mott,  'and  the  reflections 
to  which  it  gave  rise,  as  bearing  on  the  subject  of  alleged  surgical  operations  without 
pain  in  the  mesmeric  state.' 

"The  case  to  which  you  refer  is  briefly  reported  in  the  January  number  of  the  New 
York  Journal  of  Medicine,  by  some  person,  who,  like  myself,  was  present  at  the  opera- 
tion. The  subject  is  there  stated  to  have  been  '  a  fine  intelligent  young  man,  whose  he- 
roic deportment  greatly  facilitated  the  operation.' 

"  Perhaps  it  is  enough  that  I  should  have  quoted  the  expressive  language  of  one,  who 
appears  to  have  looked  on  with  the  same  admiration  as  myself;  though  these  examples  of 
'  heroic  deportment'  are  common  enough  in  the  walks  of  surgery,  especially  among  females ; 
and  that,  too,  without  mesmeric  imposture.  The  same  eminent  surgeon,  who  operated  in 
the  case  which  is  the  subject  of  these  remarks,  wiU  tell  you  that  he  has  extirpated  many 
breasts,  rendered  highly  sensitive  by  carcinomatous  disease,  without  observing  any  evi- 
dence of  pain.  But  there  was  something  in  the  case  of  Mr.  Baker,  which  certainly  better 
deserved  the  encomium  of  '  heroic,'  than  any  thing  I  had  ever  before  seen,  or  heai'd  of,  or 
even  imagined  as  within  the  compass  of  human  fortitude. 

"  This  case,  therefore,  is  interesting  at  this  moment,  as  evincing  a  perfect  capability  of 
enduring  the  most  intense,  and  sudden,  and  prolonged  pain,  without  emotion,  and  as  form- 
ing a  test  by  which  '  the  subject  of  alleged  surgical  operations  without  pain  in  the  mes- 
meric state,'  will  receive  the  explanation  which  you  seek. 

"The  case  is  also  physiologically  interesting,  and  interprets  the  composure  of  those  or- 
ganic movements,  under  similar  conditions,  which  has  been  set  forth  in  behalf  of  animal 
magnetism. 

"To  appreciate  properly  the  'heroic  deportment'  of  young  Baker,  you  must  imagine 
yourself  to  have  been  a  spectator ;  foUow  the  able  surgeon  in  all  the  capital  steps,  and  in 
all  the  minor  details  of  the  operation,  and  watch  attentively  the  '  deportment'  of  the  sub- 
ject. He  was  laid  at  a  convenient  elevation  upon  a  table,  his  feet  crossed  upon  each 
other,  and  his  hands  lapped.  I  mention  this  position,  because  he  did  not  move  his  feet, 
nor  displace  his  hands  during  the  operation. 

"  Now  observe  the  operator ;  first,  making  a  long  and  deep  incision  among  the  muscles 
of  the  neck,  and  then  tearing  his  way  down  to  the  carotid  artery,  and  throwing  and  tying 
the  ligature.  It  was, in  itself,  one  of  the  most  capital  operations  in  surgery;  but,  owing 
to  the  dexterity  with  which  it  was  performed,  and  with  an  operation  stiU  before  us  far 
more  difficult,  and  tedious,  and  dangerous,  this  grand  step  toward  the  exsection  of  the  jaw 
lost  much  of  its  usual  interest  to  the  spectator.  But  it  was  not  the  less  painful  to  the 
sufferer ;  who,  however,  sustained  it  without  betraying  the  slightest  evidence  of  pain. 

"  Next  came  the  circular  incision,  reaching  all  the  way  from  the  joint  of  the  maxillary 
bone,  down  along  its  lower  edge,  up  to  the  middle  of  the  chin,  'riiis  was  done  by  one 
rapid,  immense  sweep  of  the  knife;  but  there  remained  the  same  imperturbable  compo- 
sure of  the  patient.  Not  a  sigh,  not  a  groan  escaped,  no  muscle  moved — the  very  eye  did 
not  wink.  And  then  followed,  as  you  may  well  suppose,  a  prolonged,  tedious,  painful  dis- 
section, in  which  it  became  necessary  to  exasperate  the  suffering  by  securing  many  bleed- 
ing vessels ;  till,  finally,  the  operator  was  ready  for  his  saw.  But  nothing  had  yet  hap- 
pened to  elicit  a  single  manifestation  that  the  patient  was  not  in  a  profound  slumber,  ex- 
cepting that  his  eyes  were  open,  and  that  he  occasionally  swallowed. 

"  But,  before  sawing  the  bone  at  the  middle  of  the  chin,  it  was  necessary  to  remove  one 
of  the  incisor  teeth,  and  this  was  so  firmly  rooted  that  a  straight  forceps  slipped  in  the 
hand  of  a  capable  assistant.  Another  puU,  however,  brought  with  it  the  tooth ;  but  in 
neither  attempt  was  there  any  more  indication  of  suffering  than  in  drawing  a  nail  from  a 
board. 

"  Then  came  the  process  of  sawing,  and  this  was  calculated  to  greatly  amioy  the  patient 
from  a  shght  accident  which  happened  to  the  saw,  and  which  prolonged  this  part  of  the 
operation.  Still,  however,  the  same  '  heroic  deportment'  distinguished  the  patient  for- 
bearance of  the  sufferer,  the  same  unexampled  complacency  continued  to  mark  every  lin- 
eament of  his  face,  his  very  eye  displaying  nothing  but  gentleness,  softness,  and  calm 
resignation. 


PHYSIOLOGY. VITAL    PROPERTIES.  7P 

of  the  vital  principle  of  animals,  and  whose  modus  operandi  in  devel- 
oping voluntary  motion  I  have  endeavored  to  expound  in  sections  233, 
245,  500,  d,  and  references  there. 

167,  g.  For  the  proof  of  the  existence  of  a  vital  principle,  and  of 
the  government  of  organic  beings  by  laws  peculiar  to  themselves,  as 
derived  exclusively  by  myself  from  their  composition,  see  that  divis- 
ion of  this  work,  and  my  Essays  on  the  Philosophy  of  Vitality  ;  and 
for  the  proof  which  I  have  offered  as  founded  on  the  phenomena  of 
life,  see  Essay  on  the  Vital  Powers,  in  Medical  and  Physiological 
Commentaries,  vol.  i.,  p.  1-119. — Also,  Rights  of  Authors,  p.  912. 

IGS.  It  is  practically  useless  to  investigate  the  nature  of  the  vital 
principle.  That  nature,  however,  may  be  as  well  inferred  through 
the  medium  of  its  phenomena,  as  the  nature  of  the  most  tangible  ob- 
jects. The  opinion  of  Miiller  commends  itself  to  every  right-thinking 
mind. 

"Whether  the  vital  principle,"  he  says,  "is  to  be  regarded  as  im- 
ponderahle  matter,  or  as  a  force  or  energy,  is  just  as  uncertain  as  the 
same  question  is  in  reference  to  several  important  phenomena  in 
physics.  Physiology,  in  this  case,  is  not  behind  the  other  natural  sci- 
ences ;  for  the  properties  of  the  vital  principle  are  as  well  known  in 
the  functions  of  the  nerves,  as  those  of  light,  caloric,  and  electricity 
in  physics."  "  But,  without,  in  the  remotest  degree,  wishing  to  com- 
pare the  vital  and  mental  principles  with  the  imponderable  agents, 
we  must  express  our  conviction  that  there  is  nothing  in  the  facts  of 
natural  science  which  argues  against  the  possibility  of  the  existence 
of  an  immaterial  principle  independent  of  matter,  though  its  powers  be 
manifested  in  organic  bodies — in  matter." — Mijller's  Physiology. 

"  The  bone  being'  separated  at  the  chin,  the  dissection  was  resumed  among  the  impor- 
tant parts,  and  though  conducted  with  all  possible  skill  and  rapidity,  it  was  necessarily 
tedious,  as  well  as  hopelessly  painful,  and,  therefore,  still  calculated  to  try  the  firmness  of 
the  stoutest  heart.  A  great  extent  of  all  kinds  of  tissues  was  divided,  and,  of  course,  no 
small  proportion  of  nerves.  Bleeding  vessels  continued  to  be  secured,  the  difficult  divis- 
ion of  the  articulating  ligaments  perfonned  witii  as  much  facility  as  its  difficulties  would 
admit ;  and  after  the  removal  of  the  jaw,  remaining  portions  of  diseased  muscle,  &.C.,  were 
cut  away,  and  which  tended  not  a  little  to  embarrass  that  '  heroic  deportment'  which  had 
marked  every  stage  of  this  great  and  triumphant  operation.  From  its  beginning  to  its 
ending,  which  occupied  one  hour  and  a  half  after  the  first  incision  till  the  final  extirpation 
of  all  the  diseased  mass,  the  suiferer  did  not  manifest  the  slightest  evidence  of  pain,  or  of 
impatience,  or  of  fatigue,  either  by  language,  gesture,  expression  of  countenance,  winking, 
groaning,  sighing,  or  any  other  imaginable  method  by  which  the  mesmerite  might  be  dis- 
posed to  evade  the  overwhelming  rebuke  which  the  recital  of  this  case  cannot  fail  to  in- 
flict on  his  love  of  the  marvelous,  or  his  love  of  mischief,  or  his  yet  more  culpable  designs 
on  human  credulity. 

"  I  have  said  that  there  was  something  physiologically  interesting  in  the  foregoing  case 
Deyond  its  simple  merit  of  an  'heroic  deportment,'  and  that  it  goes  to  the  very  depths  of 
mesmeric  assurance  and  duplicity.     It  was  this  : 

"  On  feeling  the  pulse  of  the  patient  twice  during  the  operation  (the  last  time  after  the 
lapse  of  an  hour),  I  found  it  calm,  undisturbed,  and  with  about  the  same  frequency  it  had 
before  the  operation  was  begun.  This  proves  to  us  what  I  have  before  expressed,  that  it 
is  not  pain,  but  the  consequent  mental  emotions  which  aifect  the  organs  of  circulation, 
whether  the  heart  or  blood-vessels. 

"Thus  ended  an  operation,  unequaled  in  ti^ie  annals  of  surgery;  alike  triumphant  to 
the  surgeon,  to  American  Genius,  to  the  admirable  subject,  to  the  cause  of  truth,  of  moral- 
ity, and  of  sound  religion. 

"  If  you  desire  it,  you  may  publish  the  foregoing  statement,  to  which  I  should  add  some 
comments  had  I  not  already  contributed  my  part,  in  a  medical  work,  toward  the  sup- 
pression of  one  of  the  greatest  nuisances  that  has  yet  infected  the  moral  and  reflecting 
part  of  the  community.  I  have,  however,  some  developments  in  reserve,  which  will  prob- 
ably see  the  light  when  the  parties  interested  may  be  beyond  the  reacli  of  greater  re- 
proof or  mortification. 

"  I  remain,  very  truly,  ycur  friend  and  obedient  servant, 

"  Martyn  Paisk." 


80  INSTITUTES    OF    MEDICINE. 

In  the  language  of  Liebig,  "  In  regard  to  the  nature  and  essence  of 
the  vital  force,  we  can  hardly  deceive  ourselves,  when  we  reflect^  that  2t 
behaves,  in  all  its  manifostations,  exactly  like  other  natural  forces ; 
that  it  is  devoid  of  consciousness^  or  of  volition,  and  is  subject  to  the  ac- 
tion of  a  blister"  (§  165,  a). 

169,  a.  We  know,  however,  but  little  of  the  nature  of  the  princi- 
ple of  life,  and  as  little  of  the  most  obvious  material  substances ; 
but,  while  this  proposition  is  sufficiently  plain,  it  is  extensively  ar- 
gued that  the  vital  principle,  or  organic  force,  has  no  existence,  be- 
cause it  is  not  obvious  to  the  senses.  Thus  neglecting  its  infinite 
phenomena  (our  only  knowledge  of  the  most  sensible  existences),  the 
age  has  run  into  a  materialism  that  takes  in  its  way  the  soul  itself. 

Our  great  interest  lies  in  the  phenomena  of  nature.  Through 
these  phenomena  their  causes  may  be  sought ;  their  nature  but  veiy 
impei-fectly.  We  can  only  describe  matter  by  its  manifestations; 
and  so  of  the  soul,  and  the  principle  of  life.  Of  the  nature  of  the 
soul,  however,  we  have,  as  it  respects  its  spirituality  and  some  other 
important  attributes,  a  special  Revelation, 

169,  b.  If  organized  beings  possessed  a  principle  of  life  that  could, 
like  light,  be  seen,  they  would  then  be  allowed  to  be  governed  by  this 
agent,  and  we  should  be  relieved  of  the  encumbrance  of  the  phys- 
ical and  chemical  hypotheses.  But,  though  no  such  principle  ad- 
dress itself  to  the  sight  like  electricity  or  light,  its  existence  is  far 
more  variously  attested  by  other  phenomena,  and  more  so  than  all 
the  other  powers  of  nature ;  and  these  phenomena  being  Avholly  dif- 
ferent fi'om  such  as  appear  in  the  inorganic  world,  it  is  frima  facie 
evident  that  powers  or  properties  which  are  predicated  of  them 
carry  on  the  processes  of  health  and  disease ;  while  the  scrutiny  of 
ages  has  never  produced  a  fact  in  opposition. 

169,  c.  Indeed,  with  so  much  light  upon  our  subject,  so  much  of 
fact  to  substantiate  our  conclusions,  it  would  seem  highly  probable 
that  all  the  facts  which  may  be  raised  in  opposition  have  no  j-elative 
bearing,  and  that  they  are  brought  forward  in  the  spirit  of  hypoth- 
esis. 

169,  d.  The  more  comprehensive  a  law  may  be,  the  more  readily 
is  it  known  and  determined,  and  the  less  likely  is  it  that  apparently 
conflicting  facts  will  arise.  Whenever  such  are  produced,  it  is  ow- 
ing to  a  pi'oper  want  of  investigation.  The  facts  are  examined  su- 
perficially ;  and  the  speculative  or  the  credulous  mind  seizes  upon 
some  prominent  characteristic,  and  pushes  its  opposition  to  nature 
under  the  spur  of  novelty,  or  the  delight  of  discovery,  or  the  goad  of 
ambition.  (See  Correlation  of  Forces,  p.  921,  §  1085.) 

Since,  also,  we  seek,  alone,  for  the  existence  and  the  nature  of 
causes  by  means  of  their  jjhenomena,  he  is  no  philosopher  who  refu- 
ses an  inquiry  into  causes  from  want  of  other  means  of  information. 
The  objection  has  never  been  raised  in  any  science  excepting  medi- 
cine ;  but  here  we  are  told  by  many  that  we  have  no  means  of 
reaching  even  the  existence  of  the  properties  of  life  as  contradistin- 
guished from  those  of  inorganic  matter.  It  is  this  blindness,  in  part, 
which  refuses  to  apply  to  the  science  of  life  the  universal  fact,  that  the 
phenomena  are  the  only  index  to  the  forces  which  govern  the  inor- 
ganic world,  that  has  embarrassed  the  progress  of  medicine,  and  en- 
cumbered it  with  a  spurious  philosophy. 


PHySIOLOGY. VITAL    PROPERTIES.  81 

1G9,  e.  Conscious,  then,  that  I  have  taken  my  stand  upon  ground 
which  true  philosophy  will  recognize  as  her  own,  I  shall  go  on  with 
an  investigation  of  the  properties  of  life,  as  the  source  of  all  vital 
phenomena,  of  all  morbid  conditions,  and  which  constitute  life  itself, 
and  lie  at  the  foundation  of  medicine.  I  shall  enter  far  more  exten 
sively  into  an  analysis  of  those  properties  than  any  other  writer,  shall 
set  forth  original  views  as  to  the  character  and  office  of  the  nervous 
power,  and  as  to  the  mode  in  which  this  power  participates  in  the 
operation  of  remedial  and  morbific  agents,  and  endeavor  to  show, 
also,  that,  in  proportion  as  philosophy  may  depart  from  the  deduc- 
tions which  are  founded  on  the  phenomena  of  living  beings,  so  must 
all  such  philosophy  be  fundamentally  false,  and  become  the  unavoid- 
able cause  of  practical  errors  ofthe  highest  moment  (Rights  &c.,  p.  912). 

169, /.  Nor  is  it  a  small  part  of  the  proof  that  vitalism  is  founded 
in  nature,  that  it  is  consistent  throughout';  seeking  no  multiplication 
of  causes,  but  serving  as  an  impregnable  and  universal  foundation  for 
every  fact  and  every  rational  principle  in  physiology,  pathology,  and 
therapeutics ;  and,  therefore,  uniting  all  the  principles  relative  to 
life,  health,  disease,  and  the  art  of  medicine,  into  one  consentane' 
ous,  harmonious  whole.  What  a  contrast  with  the  mechanical  and 
chemical  speculations,  or  those  commingled  with  vitalism !  What  a 
boundless  source  of  stupendous  philosophy  for  the  votaries  of  one  ; 
what  unmitigated  confusion,  and  corruption  of  knowledge,  and  mis- 
application of  mind,  for  the  disciples  of  the  other !  How  truly,  and 
with  what  sublimity  on  the  one  hand,  and  imbecility  on  the  other,  is 
here  exemplified  the  great  distinction  between  man  and  his  Creator, 
that  the  former  devises  in  parts  that  may  have  no  congruity,  while 
the  latter  perfects  the  whole  and  aZ^  together  (§  63,  &c.,  74,  80,  117, 
137,  143,  155,  156,  266,  323-326,  387,  399,  514  li,  524  d,  526  d, 
638)  ! 

170,  a.  The  vital  principle  is  a  whole,  in  respect  to  its  substantial 
nature,  and  is  common  to  vegetables  and  animals.  Organic  matter, 
or  an  organized  substratum,  is  necessary  to  its  existence ;  and,  since 
the  perpetuity  of  organic  matter  depends  upon  the  vital  principle,  it 
is  manifest  that  both  were  brought  into  being  without  the  agency  of 
each  other.  The  vital  properties  cannot  be  generated  by  matter, 
since  upon  them  the  existence  of  organization  depends,  nor  is  there 
a  single  phenomenon  that  indicates  their  presence  in  inorganic  sub- 
stances ;  nor  can  they  be  produced  by  the  forces  of  physics,  since 
they  are  perfectly  incapable  of  restoring  the  sti'ucture,  or  even  its 
elementary  composition,  after  the  organized  matter  is  decomposed, 
or,  of  reanimating  the  machine  before  decomposition  has  begun  ;  while, 
on  the  other  hand,  these  are  the  forces  which  lay  waste  the  structure, 
and  only  so,  after  the  signs  of  the  vital  properties  shall  have  totally 
disappeared  (§  1079  h,  1085).— Notes  Pp  p.  1143,  ftci  p-  1145._ 

This  unavoidable  deduction  goes  far  in  confirming  the  Mosaic  ac- 
count of  the  different  steps  observed  by  the  Almighty  in  the  creation 
of  living  beings ;  that  the  sensible  structure  was  first  produced,  and 
the  spiritual  and  vital  existences  superadded.*  The  rudiments  of 
that  organization  have  been  perpetuated  in  connection  with  the  prop- 
erties of  life  since  they  came  from  the  hands  of  the  Creator,  and  are 
the  present  source  of  all  animated  beings.     Any  doctrine  adverse  to 

"  See  Medical  and  Physiological  Commentaries,  vol.  i.,  p  86-92. 

F 


82  INSTITUTES    OF    MEDICINE. 

this  is  not  only  atheistical,  but  is  opposed  to  all  the  suggestions  of 
reason*  (  ^  74,  350|  k).  Nor  is  this  all.  The  varieties  in  the  differ- 
ent tissues  of  each  animal,  and  of  every  plant,  all  the  modifications 
of  the  vital  properties  in  each  species  of  animals  and  plants,  in  each 
tissue,  and  in  every  part,  as  already  set  forth  (§  133,  &c.),  and  to  be 
yet  expounded,  all  the  various  functions  that  correspond  to  the  mod- 
ified structure  and  vital  properties,  all  the  secretions,  even  to  the  od- 
or of  flowers,  &c.,  are  exactly  the  same  now  as  at  the  day  they  were 
called  into  being.  This  shows  us  that  the  properties  and  laws  by 
which  organic  beings  are  governed,  though  infinitely  varied,  are  as 
precise  as  the  principle  and  laws  of  gravitation,  as  the  conditions  of 
the  solar  beam  and  the  laws  which  they  obey. — Note  Pp  p.  1142. 

170,  h.  Again,  the  moment  inorganic  matter  is  brought  into  a  state 
to  receive  the  vital  principle,  however  low  in  degree  or  energy,  it 
must  be  exalted  to  an  organic  condition.  If  chyle,  blood,  semen, 
the  gastric  juice,  &c.,  possess  life,  so,  also,  must  they  possess  an  or- 
ganic state.  This,  indeed,  is  obvious  from  what  we  have  seen  of  thn 
manner  in  which  their  elements  are  united. 

170.  c.  The  living  principle  appears,  therefore,  to  be  neither  the 
result  of  organic  compounds,  as  supj^osed  by  Hunter  and  others, 
nor,  as  stated  by  Proiit,  Millengen,  and  others,  the  primary  cause  of 
organic  conditions.  Both  have  coexisted  since  they  were  the  prod- 
uct of  Creative  Power,  both  are  necessary  to  the  vivification  of  dead 
matter,  and  the  co-ojDeration  of  both  to  the  farther  development  of 
each, 

171.  The  vital  principle  appears  entire  in  parts  when  separated 
from  their  connections,  if  such  parts  be  constituted  with  the  requisite 
structure  for  independent  nutrition  (§  304).  Hence  the  development 
of  the  egg,  the  germination  of  seeds  and  flower-buds,  the  growth  of 
shoots,  and  the  multijjlication  of  polypi  from  portions  of  the  animal. 

Midler,  and  others,  suppose  the  vital  principle  to  be  divisible  in 
such  cases ;  but  this  construction  regards  the  principle  too  much  in 
the  light  of  ordinary  matter,  and  too  little  in  that  of  a  specific  sub- 
stance endowed  with  a  variety  of  properties.  These  properties,  so 
far  as  necessary  to  organic  life,  are  implanted  in  every  part,  and  each 
part  may  be  regarded  as  a  whole  as  it  respects  its  own  organic  con- 
dition. In  simple  beings,  therefore,  where  no  great  complexity  of 
organs  is  necessary  to  the  great  final  cause,  nutrition,  many  jDarts  of 
such  beings  may  be  capable  of  carrying  on  the  process  independent- 
ly of  the  rest  (§  299,  302,  304,  322).  It  is  probable,  therefore,  that 
the  vital  principle,  in  the  foregoing  cases,  is  no  more  "divided"  than 
the  soul  or  instinct  as  implanted  in  the  ovum, — Medical  and  Physio- 
logical Commentaries,  vol.  i.,  p.  85,  87. 

172.  The  principle  of  life,  or  life  itself,  may  be  summarily  defined 
as  a  cause,  consisting  of  certain  specific  properties,  appertaining  to 
organic  matter,  capable  of  being  acted  upon  by  external  and  internal 
physical  agents,  by  the  nervous  power,  and  by  mentalcauses,  and  of  thus 
being  brought  into  a  state  of  action  itself,  and  in  no  other  way.  Its 
action  is  exerted  upon  the  organism,  and  upon  certain  external  sub- 
stances, as  upon  food.  In  the  former  case  its  action  gives  rise  to  mo- 
tion, upon  which  all  the  functions  depend ;  in  the  latter  its  operation 

*  See  Med.  and  Phyaio.  Comm.,  vol.  ii.,  p.  123-140.    Also,  "Examination  ofKevieirs, 
p.  43;  and  "Notice,  nf  Reviews,"  p.  2,  (na.,  in  "Med.  and  Physiolog.  Comm.,"  vol  iii. 
-Also,  i,  1079  b,  1085. 


PHYSIOLOCy. VITAL    PROPERTIES.  83 

is  through  the  medium  of  the  gastric  juice  in  animals,  but  is  more 
obscure  in  vegetables.  The  principle  is  creative  so  far  as  it  combines 
the  elements  of  matter  in  peculiar  modes,  and  arranges  the  compound 
molecules  into  tissues  and  organs,  and  in  modes  identical  with  those 
which  came  originally  from  the  Creative  Energy  of  God,  Who  thus 
far  imparted  to  the  principle  of  life  a  formative  endowment.  The 
principle  is  capable  of  protecting  the  matter  which  it  endows  against 
the  decomposing  influences  of  all  the  physical  agents  by  which  it  is  nat- 
urally surrounded,  while  the  extinction  of  the  principle  exposes  the  or- 
ganic substance  to  an  intestine  chemical  dissolution,  and  to  the  decom- 
posing action  of  surrounding  agents,  which  proceeds  with  a  rapidity 
without  parallel  in  the  natural  state  of  the  inorganic  world.  The 
principle  is  also  susceptible  of  certain  limited  changes  from  the  in- 
fluence of  causes,  mental  and  physical,  which  constitute  the  essence 
of  disease ;  while  other  causes  are  capable  of  modifying  the  morbid 
changes  in  such  wise  that  the  principle  of  life  takes  on  a  restorative 
energy,  through  which  it  recovers  its  normal  condition.  The  prop- 
erties of  the  vital  principle  are  variously  and  naturally  modified  in 
different  j^arts,  and  undergo  natural  modifications  at  certain  stages  of 
life,  giving  rise  to  changes  of  organization,  &c.  (§  62,  64,  133,  &c.). 
These  natural  modifications  will  be  farther  explained  in  all  the  detail 
which  is  demanded  by  one  of  the  most  important  topics  in  physiolo- 
gy ;  and  I  now  proceed  to  the  various  specifications  relative  to  the 
principle  of  life. 

173.  It  is  the  special  province  of  the  vital  principle  in  plants  to 
combine  the  elements  of  matter  into  organic  compounds  ;  while  in  an> 
imals  it  can  only  appropriate  compounds  of  an  organic  nature.  This 
is  a  fundamental  distinction  between  the  two  departments  of  the  or- 
ganic kingdom ;  from  which  it  appears  that  plants  are  indispensable 
to  the  existence  of  animals  (^  1052). 

174.  The  vital  principle  is  subject  to  extinction,  and  this  consti- 
tutes death.  When  speaking  of  the  composition  of  organic  beings  1 
adverted  to  the  manner  in  which  they  resist  the  decomposing  eftects 
of  chemical  agents,  and  how  the  seed  and  egg  are  capable  of  being 
converted  into  complex  living  beings,  or  the  whole  animal  and  vege- 
table kingdom  of  being  resolved  into  their  ultimate  elements,  by  the 
action  of  heat,  air,  and  moisture.  The  same  structure  remains  in 
either  case  when  life  is  suddenly  destroyed,  and  the  exact  difference 
which  arises  in  the  two  cases,  from  the  influence  of  the  same  causes, 
can  be  owing  only  to  the  presence  of  peculiar  powers  in  one  case 
which  have  disappeai-ed  in  the  other.  The  cessation  of  the  phenom- 
ena of  life  is  the  consequence  of  death  ;  and,  there  is  nothing  to  die 
(certainly  not  the  forces  of  chemistry)  but  the  principle  of  life  upon 
which  the  phenomena  depended,  and  which  held  the  elements  of 
structure  in  vital  union  (§  584,  633). 

175.  a.  As  set  forth  in  the  Medical  and  Physiological  Commentaries, 
"  I  believe  the  vital  principle,  vital  power,  organic  force,  organic  power, 
are  one  substance,  whether  material  or  immaterial ;  and  they  refer, 
with  me,  to  a  universal  cause  of  animal  and  vegetable  life,  or,  rather, 
as  constituting  life  itself  I  believe,  also,  that  this  principle  has  vari- 
ous attributes,  common  or  generic,  and  partial  or  specific ;  or  perhaps 
I  should  call  the  former  distinct  pi'operties.  Thus,  of  the  generic,  we 
have   irritability,  mobility,  sensibility,  &c.,  and  the   modifications  of 


84  INSTITUTES    OF    MEDICINE. 

each  of  these  in  the  same  or  different  tissues  form  the  specific  or  pai- 
tial  variations.     These  properties  are  also  constantly  varied  in  dis- 
ease, and  these  variations  I  call  changes  in  kind.     The  partial  modifi 
cations  in  their  natural  state  I  designate  as  variations  'in  kind"  (§  133 
163,  171). 

l75,  h.  The  vital  principle  has  certain  analogies  with  the  mind  or 
soul,  and  with  the  instinct  of  animals  (§  241).  Each  is  inherent  in  or- 
ganic matter,  and  the  Generations  of  each  are  through  the  medium  of 
that  matter.  Each,  respectively,  is  one  substance,  and  each  possesses 
certain  distinct  attributes  or  properties.  Each  is  not  only  capable  of 
acting  by  means  of  organized  structure,  but  of  being  acted  upon,  and 
modified  in  its  nature,  and  only  so  in  conjunction  with  that  structure 
(§  189,  191,  234/  241,  5(56-568). 

Even  in  the  inorganic  world  we  meet  with  a  substance  which  is 
not  without  its  light  in  the  way  of  analogy.  This  substance  is  light 
itself.  It  is  apparently  one  homogeneous,  imponderable,  substance, 
yet  said  to  consist  of  distinct  component  parts,  each  of  which  is  endowed 
with  specific  attributes.  These  component  parts  would  thus  be  distinct 
entities,  which  I  do  not  recognize  in  relation  to  the  properties  of  the  vi- 
tal principle,  or  of  the  soul.  But  the  distinction  is  not  important  to 
my  present  purpose,  and  I  should  also  add  that  it  is  indifferent  wheth- 
er we  here  regard  the  corpuscular  or  the  more  probable  wave  theory 
of  light  (§  234  e),  as  the  individuality  operates  in  either  case. 

175,  hh.  It  has  been  well  said  by  Professor  Draper,  that 

"  Just  in  the  same  way  that  I  am  willing  to  admit  the  existence  of 
forty  different  simple  metals,  so,  upon  similar  evidence,  I  am  free  to 
admit  the  existence  of  fifty  different  imponderable  agents,  if  need  be. 
Is  there  any  thing  which  should  lead  us  to  suppose  that  the  imponder- 
ables are  constituted  by  Nature  on  a  plan  that  is  elaborately  simple, 
and  the  ponderables  on  one  that  is  elaborately  complex  %  That  the 
former  are  all  modifications  of  one  primordial  ether,  and  the  latter  in- 
trinsically different  bodies,  more  than  a  quarter  of  a  hundred  of  which 
iiave  been  discovered  during  the  present  century  1"  (^  1085). 

"  We  are  thus  forced  to  admit  that  rays  of  light,  rays  of  heat,  ti- 
thonic  rays,  phosphoric  rays,  and  probably  many  other  radiant  forms, 
have  an  independent  existence,  and  that  they  can  be  separated,  by 
proper  processes,  from  each  other." — Draper's  Treatise  on  the  For- 
ces wliich  produce  the  Organization  of  Plants,  p.  70,  71. 

Organic  life,  however,  needs  only  a  single  principle,  or  "  imponder- 
able," till  it  be  showTi  that  its  supposed  properties  are  individual  ex- 
istences (§  165,  h). 

175,  c.  I  have  presented  in  the  Commentaries,  in  the  Essays  "■on 
the  Vital  Powers,'''  and  '•  Spontaneous  Generation,"  and  my  "  Notice 
of  Reviews, '''  certain  facts  which  go  to  the  conclusion  that  the  mind 
or  soul  is  a  distinct  immaterial  substance,  and  that  the  instinctive 
principle  of  animals  is  equally  a  distinct  substance  from  the  brain.  I 
will  now  add  a  few  words,  physiologically,  in  respect  to  the  main  ar- 
gument of  the  materialists,  drawn  from  analogy,  that  the  mind,  like 
the  gastric  juice,  the  urine,  &:c.,  is  only  a  product  of  the  functions  of 
the  brain  (^  1076,  c). 

The  analogy  is  fictitious.  Both  the  mind  and  instinct  are  entirely 
wanting  in  every  known  attribute  of  the  product  of  other  organs,  and 
are  sui  gc7icris  in  all  their  characteristics.     This  is  sufficiently  obvi- 


PHYSIOLOGY. VITAL    PROPERTIES.     .  85 

ous.  But  there  are  other  considerations  which  establish  the  distinc- 
tion more  fully,  though  they  appear  not  to  have  engaged  the  attention 
of  physiologists.  What,  for  example,  is  the  efficient  cause  of  the  pro- 
duction of  bile,  urine,  &c.  1  Certainly  the  blood,  in  connection  with 
organic  structure  and  organic  actions,  and  while  these  actions  go  on, 
bile,  urine,  &c.,  are  uninteiTuptedly  secreted  ;  or,  if  aiTOSted,  it  is  from 
the  failure  of  the  organic  processes.  But,  it  is  just  otherwise  in  re- 
spect to  the  mind  and  the  instinctive  principle.  These  are  completely 
suspended  in  all  their  manifestations  during  sleep,  and  often  so  with 
great  instantaneousness.  And  yet  there  is  every  reason  to  believe 
that  the  organic  functions  of  the  brain  continue  to  move  on  as  per- 
fectly as  those  of  the  liver,  the  kidneys,  &c. ;  especially  when  it  is  con- 
sidered that  sleep  may  happen  in  almost  the  twinkling  of  an  eye. 
Indeed,  were  any  change  to  befall  the  brain,  it  should  be  more  or  less 
manifested  by  some  consequent  modification  of  all  the  organic  actions  ; 
particularly  as  those  of  animal  life  undergo  complete  suspension. 

Again,  other  peculiarities  which  contradistinguish  the  mind  and 
instinct  from  every  organic  product  are  the  quick  transitions  from 
sleeping  to  waking,  and  the  occurrence  of  the  change  without  any 
change  in  the  organic  functions  of  the  brain.  Take  in  connection  the 
act  of  sleeping  and  the  act  of  waking, — the  instant  suspension  and 
the  instant  reproduction  of  the  intellectual  operations,  and  in  all  their 
isolated  aspects,  and  the  most  obtuse  understanding  must  concede  not 
only  the  entire  want  of  analogy  with  any  other  phenomena  of  nature, 
but  that  there  must  be  a  unique  cause  for  such  perfectly  unique  effects. 

But,  again,  suppose  some  change  in  the  organic  condition  of  the 
brain  as  the  cause  of  sleep ;  what  is  it,  I  say,  that  so  instantly  rein- 
states its  functions  when  we  pass  from  the  sleeping  to  the  waking 
state  1  What  rouses  the  organ  to  its  wonted  secretion  of  mind  1  Are 
there  any  analogies  supplied  by  the  liver,  the  kidneys,  &c.  (§  241)1 
What  is  it,  I  say,  that  brings  the  great  nervous  centre  into  operation 
in  all  the  acts  of  volition,  in  all  the  acts  of  intellection  1  This  ques- 
tion must  be  answered  consistently,  or  in  some  conformity  with  the 
argument  drawn  from  analogy.  If  that  can  be  done,  then  it  must  be 
conceded  that  the  analogy  is  forcible,  and  that  the  argument  in  favor  of 
materialism  is  logically  taken.  So,  on  the  other  hand,  should  the  ar- 
gument fail  in  this  indispensable  requisite,  materialism  must  stand 
convicted  of  sophistry,  insincerity,  and  a  leaning  to  infidelity  (§  14,  c). 

The  premises  are  perfectly  simple.  They  are  also  sound  so  far  as 
it  respects  all  organic  actions  and  results.  The  blood,  as  with  all 
other  organs,  is  the  natural  stimulus  of  the  brain,  and  here  as  there 
all  the  organic  phenomena  are  distinctly  pronounced.  They  proceed, 
in  all  parts,  with  uniformity,  and  without  interruption.  Nothing  can 
suspend  them  or  modify  them  in  the  brain,  or  elsewhere,  during  their 
natural  condition.  So  far  the  analogy  is  complete.  Now,  as  it  can- 
not be  the  blood,  according  to  the  analogy,  which  rouses  the  brain  to 
action  in  willing,  reflecting,  &c.,  I  ask  the  materialist  the  nature  of  the 
stimulus  which  operates  upon  the  brain  in  eliciting  the  phenomena 
of  mind  ]  And  again,  I  say,  if  he  can  sustain  his  answer  by  analogy, 
such  is  the  consistency  of  Nature  in  organic  philosophy,  such  the  har- 
mony of  Design,  that  it  might  be  difficult  to  oppose  Revelation  itself 
to  what  is  so  fundamental  in  Nature.      {Continued  at  p.  882,  ^  1076). 

175,  d.  It  is  assumed  by  many  late  physiologists,  as  Drs.  Carpew 


86  INSTITUTES    OF    MEDICINE. 

ter,  Prichard,  &c.,  after  admitting  and  denying  the  existence  of  vital 
properties,  and  contending  for  their  existence  in  the  elements  of 
matter,  and  the  organizing  agency  of  the  forces  of  chemistry,  that, 
nevertheless,  all  the  results  of  organic  beings  ai-e  owing  to  the  im- 
mediate acts  of  the  Almighty  (§  64,  li).  This,  therefore,  as  with  the 
author  of  the  "Vestiges  of  Creation,"  is  only  a  circuitous  method 
of  confounding  nature  with  God  (§  350f  7^.-350^  I).  Let  us,  how- 
ever, suppose  that  there  is  a  Supreme  Being  in  their  opinion,  who  is 
the  Author  of  nature,  and  that  He  is  the  Power  who  presides  in  or- 
ganic beings,  and  regulates  all  their  processes,  and  we  shall  see  that 
the  doctrine  abounds  with  absurdities.  Its  advocates  generally  carry 
this  sophistry  so  far  as  to  affirm  that  the  particles  of  matter  are  con- 
stantly maintained  in  union  by  Almighty  Power,  that  chemical  affini- 
ties are  nothing  but  manifestations  of  that  Power,  that  gravitation  is 
only  a  constant  emanation  of  the  Deity,  that  digestion,  circulation, 
secretion,  excretion,  &c.,  are  only  immediate  acts  of  God.  It  is 
plain,  therefore,  that  they  can  allow  no  other  God  than  nature. 

But,  let  us  now  look  physiologically  at  this  pantheism.  Organic 
beings  are  made  up  of  matter,  which,  it  will  be  conceded,  is  distinct 
from  God,  if  we  allow  Jiis  existence  as  distinct  from  matter.  It  is 
therefore  perfectly  consistent  to  suppose  that  this  matter  is  endowed 
with  distinct  forces  for  its  own  government  (§  14,  c).  If  we  regard, 
next,  the  results  of  vital  stimuli,  we  have  a  palpable  proof  that  they 
elicit  actions  and  physical  results  through  principles  which  possess  the 
power  of  acting,  or  we  must  take  up  the  absurdity  of  supposing  that 
they  act  on  God  himself  The  same  may  be  affirmed  of  the  poisons, 
medicinal  agents,  &c.  But  this  will  not  hold  either  in  religion  or 
philosophy.  Nevertheless,  it  is  evident  that  some  active  agent  is  op- 
erated upon.  If  stimulants  are  applied  to  the  nose,  the  heart  may  be 
thrown,  on  the  instant,  into  increased  action.  Of  course,  it  cannot  be 
entertained  that  God  is  the  agent  acted  upon  in  such  a  case,  any  more 
than  when  prussic  acid  destroys  life  with  the  same  instantaneousness  ; 
and,  therefore,  He  cannot  be  assumed  as  the  cause  of  the  healthy  and 
natural  functions  (64  h,  241  d,  350f  g--350f  o,  376i,  733  d). 

In  my  "  Exam,  of  Reviews^''  (in  Comm.,  vol.  iii.)  I  have  shown 
that  the  doctrine  of  "  the  jnopertks  of  life,  in  tJie  elements  of  viatter"  is 
thoroughly  material  as  it  respects  the  soul  (§  14  c,  189  Z>,  350|  I,  m). 
176.  Besides  an  organized  substratum  and  a  principle  of  life,  there 
is  something  still  beyond  not  less  important  to  all  the  great  purposes 
of  life.  This  consists  of  the  actions  and  various  results  of  life.  If 
all  animated  beings  existed  in  the  state  of  the  seed  and  ovum,  the 
whole  universe  would  be  nearly  without  any  other  apparent  anima- 
tion than  what  is  elicited  by  the  forces  of  physics  and  chemistry. 
The  movements  of  the  heavenly  bodies  would  be  the  principal  de- 
monstrative source  of  power. 

Although,  therefore,  the  actions  and  phenomena  of  organic  beings, 
like  the  motions  of  the  heavenly  orbs,  are  merely  the  effects  of  a  pe- 
culiar power  which  we  call  life,  they  are,  nevertheless,  the  only  at- 
tendants of  life  that  interest  our  senses  beyond  the  physical  struc- 
ture. Hence,  it  is  not  remarkable,  considering  how  liable  the  senses 
are  to  take  the  lead  of  the  understanding,  that  even  the  soundest 
minds  have  supposed  that  life  consists  of  its  results  alone,  and  have 
overlooked  the  great  efficient  cause  or  power  upon  which  the  results 


PHYSIOLOGY. VITAL    PROPERTIES.  61 

depend  (§  234^,  247).  Had  they  considered  for  a  moment,  however, 
the  analogy  which  subsists  between  the  motions  of  organic  beings 
and  those  of  the  heavenly  orbs,  and  that  the  latter  depend  upon  a 
power  which  is  called  gravitation,  and  without  which  all  the  orbs 
would  suffer  the  stillness  of  death,  the  conclusion  would  have  been 
unavoidable  that  celestial  motion  is  merely  an  effect,  and,  therefore, 
that  all  organic  motions  and  their  results  depend  upon  moving  pow- 
ers. They  should  have  seen,  too,  that  when  a  drop  of  prussic  acid, 
or  of  the  spirituous  extract  of  nux  vomica,  is  apjslied  to  the  tongue, 
all  the  phenomena  of  life  are  instantly  extinguished,  that  nothing  can 
reproduce  them  although  the  organized  structure  remains  unimpair- 
ed, and  that  the  whole  being  is  immediately  resolved  into  its  ultimate 
elements  (§  1042). 

177.  The  properties  of  life  are  the  fundamental  cause  of  all  healthy 
and  morbid  phenomena.  They  are  liable  to  be  more  or  less  diverted 
from  their  natural  state  by  a  variety  of  causes,  and  these  new  condi- 
tions constitute  the  most  essential  part  of  disease.  This  instability 
of  the  properties  of  life  is  at  the  foundation  of  all  disease,  and  even 
of  therapeutics  (§  642,  b).  Other  causes,  acting  upon  these  morbid 
conditions,  alter  them  in  yet  other  ways,  and  contribute  to  their  res- 
toration to  the  natural  standard.  This  is  the  aim  of  all  our  remedies  ; 
and  the  recuperative  tendency  of  the  properties  of  life  [t7ie  vis  viedi- 
catrix  naturce),  when  they  are  driven  by  morbific  causos  from  their 
healthy  state,  enables  them  to  recover  spontaneously  from  the  artifi- 
cial conditions  which  are  substituted  by  remedial  agents  for  the  more 
intensely  morbid  (§  172,  851  a,  853,  854,  893,  900,  901,  905,  1059). 

178.  Notwithstanding  the  natural  instability  of  the  properties  of 
life,  they  have  a  definite  character  in  every  part  of  the  body,  accord- 
ing to  the  nature  of  each  part,  at  every  hour  of  existence  (§  153-156). 

179.  The  exact  nature  of  disease  depends  mostly  upon  the  forego- 
ing definite  conditions  (§  178),  and  upon  the  particular  virtues  of  the 
morlji^c  agents.  The  salutary  changes  produced  by  remedial  agents 
invo^^  the  same  principles.  But,  these  definite  changes,  and  the  ac- 
tion of  morbific  and  remedial  agents,  are  liable  to  contingent  influen- 
ces fi'om  habits,  &c. ;  as  set  forth  under  the  fifth  division  of  Physiol- 
ogy. Our  calculation  of  results  is  thus  embarrassed  according  to  the 
nature  and  extent  of  the  contingent  influences  (§  756,  V). 

180.  The  vital  properties  are  without  renovation,  or  mutation  in 
h-ealth,  except  as  they  are  liable  to  certain  natural  modifications  at 
different  periods  of  life,  or  during  gestation,  or  from  the  slow  opera- 
tion of  external  agents,  as  in  the  artificial  temperaments.  They  must 
remain  without  renewal,  to  be  forever  ready  for  the  work  of  nutri- 
tion, &c.  (§  237,  570-630). 

181.  The  permanency  of  the  vital  properties  enables  us  to  under- 
stand the  nature  of  predisposition  to  disease,  artificial  temperaments, 
and  hereditary  diseases,  which  many  refer  to  the  ever-changing  blood 
(§  238,  666). 

182.  a.  According  as  the  vital  properties  may  be  modified,  either 
in  the  foregoing  manner  (§  181),  or  as  in  disease  (§  177),  so  will  be 
the  condition  of  the  elementary  combinations,  and  other  physical 
products. 

182,  h.  Nevertheless,  the  properties  of  life  never  undergo  any  rad- 
ical change  till  they  shall  have  passed  the  limit  of  their  recuperative 


88  INSTITUTES    OF    MEDICINE. 

power  (§  177),  and  are  therefore  approaching  a  state  of  extinction. 
Hence,  essentially,  in  connection  with  the  nature  of  the  remote  causes, 
the  analogies  among  diseases  (§  670,  756). 

183.  In  their  highest  development,  the  properties  of  the  vital  prin- 
ciple are  six ;  namely,  irritability,  mobility,  vital  affinity,  vivijicaiion, 
sensibility,  and  the  nervous  power  (§  175).  They  are  called  vital  prop- 
erties, vital  powers,  and  vital  forces ;  but  are  clearly  attributes  of  a 
common  principle,  just  as  judgment,  perception,  the  will,  &c.,  are 
properties  of  the  soul.  They  will  be  examined  according  to  their 
nearest  relations  to  each  other  in  the  most  perfect  beings,  and  their 
practical  application. 

184,  a.  The  first  four  properties  (§  183)  are  common  to  plants  and 
animals,  and  reside  in  all  the  tissues.  Tlaey  may  be  properly  called 
organic  properties,  as  they  carry  on  the  organic  processes  (§  476-492, 
516  a).  The  last  two  are  peculiar  to  animals.  This  multiplication 
of  vital  properties  in  the  animal  kingdom  harmonizes  with  the  intro- 
duction of  tissues  and  organs  which  have  no  existence  in  plants  (§  201, 
222,232,  450,  &c.,  500). 

184,  b.  The  nervous  power  has  been  considered  a  principle  by 
itself,  and  often  regarded  by  eminent  physiologists  as  the  galvanic 
fluid,  generated  by  the  brain,  or  other  organs,  and  conducted  by  the 
nerves  {Med.  and  Phys.  Com?7i.,  vol.  i.,  p.  65-68,  107-119).  Its  phe- 
nomena, however,  declare  it  to  be  entirely  distinct  in  its  nature  from 
all  things  else  ;  while  its  analogies  to  the  other  properties  of  life  show 
it  to  be  an  element  of  the  vital  principle  (§  227-232).  If  it  be  difli- 
cult  for  the  limited  comprehension  of  man  to  surmise  how  this  prop- 
erty should  prove  an  agent  to  others  with  which  it  is  associated,  the 
difficulty  is  no  greater  than  the  admitted  fact  that  the  will  may  con- 
trol other  properties  of  the  mind,  and  the  passions.  Nevertheless,  it 
is  unimportant  in  a  practical  sense,  and  in  the  institution  of  principles, 
whether  the  nervous  power  be  considered  a  property  of  the  vital 
principle,  or  a  principle  by  itself  (§  175  bb,  186,  226,  1072  b). 

185.  Although  the  organic  properties  which  are  common  to  plants 
and  animals  ai'e  essentially  the  same,  they  possess  greater  modifica- 
tions throughout  than  will  have  been  seen  to  appertain  to  the  same 
properties  in  the  different  parts  of  animals.  But  all  the  variations  in 
the  two  organic  kingdoms  are  intimately  connected  by  close  analo- 
gies ;  just  as  they  are  in  the  different  animal  tissues  (§  133,  &c.). 
Much  of  the  difference  in  the  general  vital  constitution  of  the  two 
kingdoms  is  owing  to  the  presence  in  one,  and  the  absence  in  the  oth- 
er, of  the  nervous  system,  and  those  corresponding  properties  which 
play  so  important  a  part  in  the  animal  tribes  (§  733,^").  In  both  de- 
partments of  organic  nature,  however,  there  is,  essentially,  the  same 
principle  of  life,  its  great  organic  elements,  and  the  same  great  func- 
tions over  which  they  preside.  Here,  too,  in  the  vegetable  kingdom, 
in  the  modifications  of  structure  and  of  the  organic  properties  and 
functions,  and  of  the  laws  which  they  obey,  we  witness  the  greatest 
simplification  of  life.  The  vegetable  tribes,  being  also  exempt  from 
most  of  those  secondary  influences  which  so  constantly  embarrass  our 
inquiries  in  more  complex  organization,  especially  from  the  compli- 
cations that  arise  from  nen'ous  influence,  are  better  subjects  for  the 
experimental  researches  which  concern  the  philosophy  of  life ;  and 
tlie  facts,  therefore,  which  they  supply  may  be  canied  up,  for  the 


PHYSIOLOGY. VITAL    PROFERTIES.  89 

bame  general  pm'pose,  as  sound  analogies,  to  more  complex  beings 
(§  191  a,  409,  733,  853, 1052). 

186.  The  mental  property,  perception,  is  necessary  to  the  exercise 
of  specific  and  common  sensibility,  and  the  will  to  that  of  mobility  as 
modified  in  the  function  of  voluntary  motion  (§  194,  &c.,  226,  241 
243,  500  e).  Here  we  have  not  only  other  analogies  between  the  in- 
tellectual and  vital  principles,  but  each  is  brought  into  direct  action 
with  the  other  (§  175,  184  h). 

187.  The  vital  properties  co-operate  together  in  their  functions, 
more  or  less,  as  they  exist  in  any  given  being, 

187^.  The  conditions  now  mentioned  as  to  the  principle  of  life,  as 
well  as  all  those  to  be  hereafter  stated,  and  the  phenomena  of  which 
they  are  predicated,  form  other  groups  of  facts,  which,  individually 
and  collectively,  contradistinguish  the  principle  of  life  from  all  the 
forces  of  inorganic  nature  (^  1041). 

IRRITABILITY. 

188.  a.  Irritability  belongs  to  all  tissues,  and  is  the  property  upon 
which  all  vital  agents,  external  and  internal,  physical  and  mental,  nat- 
ural, morbific,  and  remedial,  produce  impressions  in  organic  life ;  ex- 
cept as  sensibility  is  concerned  in  reflex  nervous  actions  (§  201-203, 
220),  and  as  the  nerves,  from  being  incorporated  in  other  tissues,  take  a 
subordinate  part  in  organic  functions,  independently  of  reflex  action 
(§4G1,  492).  All  actions  or  motions,  in  animal  as  well  as  organic 
life,  ax-e  brought  about  by  impressions  on  irritability  (§  205,  233,  257, 
486,  500  d).  This  may  be  either  by  the  direct  action  of  the  agent,  or 
by  the  indirect  action  of  the  nervous  power  (§  222,  &c.). 

When  vital  agents  affect  the  organic  functions  in  a  direct  manner, 
it  is  by  direct  action  upon  the  irritability  of  the  parts  which  perform 
the  functions.  This  is  true,  in  part,  of  the  natural  excitants  of  organs  ; 
as  blood  acts  directly  upon  the  irritability  of  the  heart  and  blood-ves- 
sels, bile  upon  that  of  the  intestines,  food  upon  that  of  the  stomach, 
&c.  In  these  cases,  however,  influences  are  also  transmitted  through 
sympathetic  sensibility  to  the  nervous  centres,  and  thence  reflected 
upon  the  muscular  tissue  of  the  organs  (§  201,  514/).  So,  also,  re- 
medial agents  operate  upon  the  irritability  of  parts  to  which  they  are 
applied,  and  thus  aflfect  their  functions  in  a  direct  manner.  But  their 
influences  are  commonly  more  extensive,  and  then  they  call  into  ope- 
ration the  nervous  power  by  their  action  upon  sensibility  (§  201),  thus 
giving  rise  to  reflex  nervous  actions  (§  222,  &c.,  475i,  500). 

When  mental  emotions  affect  the  organic  functions  it  is  by  determ- 
ining the  nervous  power  upon  the  irritability  of  the  parts  (§  226,  227). 
And,  although  sensibility  receives  the  primary  impressions  in  the  func- 
tion of  sympathy,  the  resulting  influences  upon  organic  actions  are 
brought  about  by  a  determination  of  the  nervous  power  upon  the  irri- 
tability of  the  affected  organs  (§  201,  226,  227,  4751   6471,  1041). 

188,  h.  When  vital  agents  act  upon  specific  sensibility  the  results  of 
their  impressions  are  merely  their  propagation  to  the  nervous  centres, 
and  a  consequent  action  upon  those  parts  (§  194-204,  222-234). 

188,  c.  I  shall  endeavor  to  show  that  the  doctrine  is  entirely  unfound- 
ed which  supposes  that  vital  agents  produce  their  effects  in  organic 
life  by  direct  impressions  upon  the  nervous  system,  excepting  so  far 
as  explained  above  (§  188  a).    This  demonstration,  indeed,  was  made  in 


90  .NSTITUTES    OF    MEDICINE. 

the  Commentaries,  but  mainly  by  other  processes  than  will  be  present- 
ed  in  the  Institutes.  The  fact  alone,  however,  should  be  adequate, 
that  jjlants  have  no  nervous  system,  yet  carry  on  all  the  essential  or- 
ganic processes  that  exist  in  animals ;  while  they  are  alike  liable  to 
corresponding  results  from  the  operation  of  morbific  and  remedial 
agents. 

ISSj,  a.  Every  thing  which  is  capable  of  affecting  irritability,  and 
sensibility,  is  a  vital  agent.  These  agents  are  either  natural  to  the 
body,  as  blood,  heat,  bile,  &c.,  or  external,  as  food,  air,  heat,  light, 
electricity,  &c.  Irritability  is  perpetually  alive  to  the  stimulus  of 
blood  in  all  parts  of  the  sanguiferous  system,  as  it  is  to  that  of  the 
sap  wherever  it  circulates  (§  136).  This  shows  the  exquisite  suscep- 
tibility of  the  property. 

1881,  h.  Many  vital  agents,  those  just  mentioned,  are  indispensable 
to  the  maintenance  of  organic  processes,  either  in  animals  or  plants. 
Hence,  from  maintaining  the  organic  powers  in  constant  action,  they 
are  called  vital  stimuli.  Those  of  a  morbific  or  remedial  nature  are 
known  by  these  epithets,  though,  in  a  philosophical  sense,  they  are 
vital  agents.  They  are  distinguished  by  very  different  characteristics 
from  the  natural  agents  of  life  ;  even  all  those  which  are  stimulant  to 
the  organic  processes ;  for  they  not  only  excite  the  properties  of  life, 
but  are  capable,  also,  of  affecting  their  intrinsic  nature.  But,  there 
are  others,  whose  effect,  in  certain  degrees  of  intensity,  is  directly  the 
reverse  of  the  foregoing,  as  hydrocyanic  acid,  tobacco,  &c. ;  and  these, 
when  thus  operating,  are  vital  depressants  (§  441  d,  650,  743). 

188|,  c.  Some  of  the  vital  stimuli  which  are  natural  to  the  body, 
as  blood,  and  bile,  and  also  food,  subserve  other  purposes  than  that 
alone  of  rousing  the  action  of  organs.  They  are  also  acted  upon  and 
appropriated  to  the  uses  of  the  system.  This  is  more  extensively 
true  of  animals  than  of  plants.  In  the  latter  case  there  are  certain 
external  stimuli  which  are  indispensable  to  vegetation,  and  whose 
only  operation  is  that  of  excitants,  but  which  are  comparatively  un- 
important to  animals.  These  agents  are  particularly  light  and  heat, 
and  pei'haps  electricity.  The  heat  which  is  most  important  to  animals 
is  generated  by  the  living  organism. 

188^,  d.  An  important  error  has  prevailed  among  chemists,  from 
their  necessary  want  of  physiological  knowledge,  in  regarding  the 
imponderable  agents  as  the  causes  of  life,  and  not  as  mere  stimuli  to 
those  real  causes  which  are  implanted  in  the  organization  itself,  and 
by  which,  of  course,  all  the  actions  and  results  are  determined.  This 
vitiation  of  philosophy  has  beset,  especially,  the  functions  of  animals 
as  it  regards  their  assumed  dependence  on  electricity,  and  the  func- 
tions of  plants  in  their  obvious  dependence  upon  light.  The  fallacy 
of  the  former  hypothesis  is  shown  extensively  in  the  Medical  and 
Physiological  Commentaries  {Essay  on  the  Vital  Powers  and  its  Ap- 
pendix).  Of  the  latter  I  will  now  say,  that  in  all  the  relations  of  light 
to  plants  we  have  the  most  distinct  analogies  with  other  vital  stimuli 
to  guide  us  to  the  same  certain  conclusion,  that,  like  other  stimuli,  it 
does  but  rouse  the  properties  of  life  to  certain  special  modes  of  ac- 
tion, by  which  they  decompose  carbonic  acid  gas,  carry  on  the  work 
of  appropriation,  &c.  {Parallel  Columns,  nos.  64,  65,  66,  68,  74).* 

But,  thanks  to  my  colleague,  Professor  Draper,  whose  name  in 
early  life  glows  upon  the  sunbeam,  organic  science  is  supplied  with 
*  See  Correlation  of  Forces,  p.  921,  ^  1085. 


PHYSIOLOGY. V:TAL    rROPEETIES,  91 

an  adornment  which  vies  in  delicacy,  yet  sublimity,  witn  the  capa- 
bilities of  the  nervous  power  (§  222,  &c.,  234  e). 

The  professor  has  obligingly  furnished  me  with  the  following  state- 
ment of  the  pi'ogress,  and  nature,  of  the  discoveries  in  relation  to  the 
solar  beam.     Thus  : 

"  Until  the  time  of  Sir  Isaac  Newton,  it  was  universally  supposed 
that  light  was  a  simple  elementary  body,  and  therefore  incapable  of 
decomposition. 

"  The  great  optical  discovery  of  Newton  consisted  in  proving  that 
the  white  light  of  the  sun,  or  of  day,  is  in  reality  made  up  of  many 
colored  varieties.  He  fixed  the  number  at  seven :  red,  orange,  yel- 
low, green,  blue,  indigo,  violet.  He  indisputably  established  that 
that  which  we  commonly  call  ligJit  is  made  up  of,  and  therefore  con 
tains,  the  seven  prismatic  rays.  They  differ  not  only  by  impressing 
the  organ  of  vision  with  different  sensations,  but  also  in  intrinsic  brill- 
iancy or  illuminating  power.  It  is  to  be  remarked  that  of  these  the 
yellow  is  the  brightest. 

"  It  was  the  opinion  of  Newton,  and  his  followers,  that  when  light 
falls  upon  bodies  and  disappears,  it  is  converted  into  heat ;  or,  in  oth- 
er words,  that  heat  is  extinguished  light.  Sir  W.  Herschel,  the  as- 
tronomer, proved  the  separate  and  distinct  nature  of  these  j^rinciples. 
The  proof  chiefly  depends  on  the  fact  that  the  brightest  ray  is  not  the 
hottest,  and  that  in  the  sunbeams  there  exist  rays  in  abundance  which 
are  wholly  invisible,  but  which  can  rapidly  raise  a  thermometer. 
That  which  we  cannot  see  we  should  scarcely  call  light.  Moreover, 
a  vessel  of  hot  water  in  the  darkest  place  is  invisible ;  yet  common 
observation  shows  it  is  emitting  calorific  emanations.  The  independ- 
ence of  light  and  heat  may  therefore  be  considered  as  established. 

"  Some  of  the  alchemists  discovered  that  certain  of  the  white  salts 
of  silver  (the  chloride)  turned  black  under  the  influence  of  the  sun- 
shine. Toward  the  close  of  the  last  century  it  was  shown  that  the 
rays  which  produced  this  effect  were  invisible,  and  therefore  could 
not  be  regarded  as  rays  of  light.  At  a  later  period  I  showed  that  they 
could  not  disturb  a  thermometer,  or  communicate  to  our  organs  the 
impression  of  warmth,  and  therefore  must  be  distinct  from  heat. 
From  the  circumstance  that  they  are  always  accompanied  by  light,  I 
gave  them  the  provisional  name  of  Tithonic  rays,  from  the  fable  of 
Tithonus  and  Aurora. 

"  The  same  species  of  modification  which  light  exhibits  (as  colors) 
has  been  traced  by  Melloni  for  the  rays  of  heat,  and  by  me  for  the 
Tithonic  rays.  But,  as  both  these  classes  of  rays  are" invisible,  their 
coloration  must  be  necessarily  so  too,  and  is  known  to  us  only  by  in- 
direct facts.  We  speak  of  it,  therefore,  as  ideal  or  imaginary.  There 
are  seven  colors  for  heat  and  the  chemical  rays,  as  there  are  seven  for 

"  It  is  worth  remarking  how  complex  the  constitution  of  light  is 
now  understood  to  be,  when  contrasted  with  the  opinion  held  by  the 
predecessors  of  Newton  (§  183,  &c.). 

"  I  have  established,  as  respects  some  of  these  rays,  that  they  dis- 
charge extraordinary  functions.  It  is  the  yelloio  ray  of  light  which 
has  control  of  the  evolution  of  plants.  Under  its  influence  their  leaves 
effect  the  decomposition  of  carbonic  acid  gas  in  the  atmosphere,  set- 
ting free  its  oxygen  and  fixing  its  carbon.     This  wonderful  phenom- 


92  INSTITUTES   OF    MEDICINE. 

enon  is  unquestionably  the  first  step  in  the  production  of  organized 
matter,  such  as  starch,  woody  fibre,  &c.,  from  inorganic  gases.  Tho 
carbon  is  first  fixed  under  the  form  of  chlorophyll  in  the  leaf.  Chloro- 
phyll occurs  under  remarkable  circumstances  as  the  coloring  matter  of 
bile. 

"  Extended  investigations  have  shov^^n  that  each  particular  ray  of 
these  principles  exerts  specifi:  jDOvv^ers.  The  compounds  in  which 
silver  enters  are  afl'ected  by  those  of  a  violet  color;  chlorine  is  most 
acted  on  by  the  indigo;  and  carbon  by  the  yellow.  It  is  for  this  rea- 
son, as  I  have  shown,  that  to  the  animal  eye  the  yellow  ray  is  bright- 
est. If  nature  could  have  formed  a  retina  of  which  silver  was  the 
basis,  the  indigo  would  have  been  the  most  brilliant  ray.  All  our 
conceptions  of  beauty  in  colors  depend,  therefore,  on  the  physical  pe- 
culiarities of  the  carbon  atom.  And  it  is  a  beautiful  and  interesting 
fact,  that  the  ray  which  evokes  from  atmospheric  air  the  multitude  of 
forms  composing  the  vegetable  world  has  charge  of  the  process  of 
vision  in  all  animals  (p.  797,  798,  ^  1034). 

"  Dr.  Gardner  discovered  that  the  movements  of  plants  are  chiefly 
directed  by  the  indigo  rays  of  light.  They  grow  in  the  direction  in 
which  it  falls  upon  them ;  and  the  blue  color  of  the  sky  is  one  of  the 
causes  of  the  upright  growth  of  stems. 

"  Besides  the  three  classes  of  rays  which  I  have  mentioned,  there  is 
a  fourth,  of  which  much  less  is  known ;  the  phosphorogenic  rays. 
These  take  their  name  from  the  fact  that  when  they  fall  on  certain 
bodies,  such  as  the  diamond,  Canton's  phosphorus,  &;c.,  they  cause 
them  to  glow  with  a  pale  or  splendid  light.  The  extraordinaiy  pecu- 
liarity they  possess  is,  that  glass  is  opaque  to  them. 

"  The  advance  of  chemical  optics  has  sufficiently  proved  that  each 
of  the  constituent  rays  of  the  sunbeam,  or  of  light  derived  from  arti- 
ficial sources,  has  capabilities  of  its  own.  Thus,  each  of  the  seven 
rays  of  light  impresses  our  minds  with  special  sensations.  The  yel- 
low, moreover,  controls  the  growth  of  plants,  the  indigo  their  move- 
ments. Of  the  Tithonic  rays,  the  blue  is  the  one  concerned  in  Da- 
guerreotype portrait  taking,  and  the  red  can  bleach  paper  blacked 
with  oxide  of  silver.  The  same  peculiarities  will  undoubtedly  be 
discovered  as  respects  the  rays  of  heat." 

Professor  Draper's  analysis  of  the  sunbeam,  by  subjecting  plants  to 
the  various  elements  of  the  solar  spectrum,  demonstrates,  what  was 
still  conjectural,  the  individuality  of  its  component  parts,  and  estab- 
lishes their  rank  as  distinct  physical  and  vital  agents.  Analogy  justi- 
fied this  demonstration ;  and  had  the  professor  proceeded  upon  the 
basis  of  analogy,  and  applied  the  spectrum  to  the  philosophy  of  life, 
it  would  have  been  one  of  the  most  splendid  achievements  of  the  hu- 
man mind.  But,  like  Philip  and  Muller,  in  respect  to  the  nervous 
power,  he  lost  the  opportunity ;  but  in  losing  it,  he  reared  another 
beacon  upon  the  quicksands  of  chemistry  (§  476,  493,  514^  b). 

The  chemical  properties  of  the  solar  spectrum  having  been  an- 
nounced by  other  philosophers,  it  only  remained  to  infer  that,  like  all 
other  things,  the  integral  parts  of  the  spectrum  which  had  manifested 
peculiar  agencies  in  the  physical  world  would  probably,  if  each  were 
specifically  distinct,  exhibit  greater  diversities  in  organic  life  (§  52, 
136,  175  lb).  This  would  appear  to  settle  the  individuality  of  the  numerous 
rays.     The  results  of  sensation,  the  test  of  the  thermometer,  and  even 


PHYSIOLOGY. VITAL    PROPERTIES.  93 

of  chemistry,  with  their  united  force,  established  only  probabilities. 
Nature  may  have  supplied  the  unerring,  the  "  indisputable''  requisite, 
in  the  Vital  Principle.  And,  although  discovery  is  probably  only  be- 
gun, the  principles  of  individuality,  and  of  organic  relations,  are  as 
well  determined  by  the  properties  of  one  ray  as  by  those  of  a  dozen. 
That  others  than  such  as  are  known  belong  to  the  class  of  vital  agents, 
there  can  be  little  doubt.  The  physical  capabilities  of  other  rays  sup- 
ply a  sti'ong  analogy  for  this  conclusion.  Ikit  the  doctrine  of  individ- 
uality is  unimportant  to  our  purpose,  since,  if  the  homogeneous  nature 
of  light  and  the  elegant  wave  theory  become  established,  each  prismat- 
ic ray  will  be  as  much  distinguished  by  peculiar  properties  as  if  every 
ray  were  an  entity  (§  175  bh,  234  e). 

It  will  be  now  observed  that  every  tangible  substance  yields  an 
overwhelming  analogy  in  corroboration  of  the  doctrine  which  I  ad- 
vance as  to  the  vital  relations  of  the  solar  spectrum ;  while  the  coin- 
cidence in  the  specific  influences  of  its  component  parts  upon  organic 
life  with  every  other  distinct  agent,  equally  in  its  own  turn,  surrounds 
the  spectrum  with  a  vital  philosophy. 

Nor  is  this  alone  the  importance  to  organic  philosophy  of  the  rich 
discovery.  The  individual  parts  of  the  spectrum  not  only  affect  sen- 
sibility and  irritability  in  modes  peculiar  to  each,  but,  in  beautiful 
harmony  with  all  tangible  substances,  each  part,  respectively,  affect? 
certain  oi-gans  only,  according  to  their  special  modifications  of  irrita 
bility  or  sensibility,  and  according  to  its  own  peculiar  virtues  (§  133  b, 
136,  137  b,  150  a,  188  a,  190,  194,  199,  203).  Here,  also,  it  will  be 
seen,  is  another  analogical  proof  of  the  vital  nature  of  the  influences 
of  light  upon  organic  beings  (§  74  a,  303  e). 

Much,  also,  may  be  found  in  Professor  Draper's  own  conclusions 
to  show  the  vital  nature  of  the  agency  of  light.  Take,  for  example, 
the  statement  that  the  '■^indigo  ray  controls  the  movements  of  plants," 
and  that  "the  blue  color  of  the  sky  is  one  of  the  causes  of  the  upright 
growth  of  plants."  Now  what  intelligible  explanation  can  chemistry 
offer  of  those  phenomena  in  their  undoubted  relation  to  light  1  The 
unavoidable  answer  supplies  an  indisputable  analogy  for  the  vital  in- 
fluences of  the  yellow  ray,  &c.  As  to  the  decomposition  of  carbonic 
acid  gas,  it  is  the  only  phenomenon  in  organic  life,  and  I  may  add 
animal,  which  Liebig  abstracted,  unequivocally,  from  chemical  agen- 
cies (§  350,  nos.  66,  68). 

If  we  now  carry  the  foregoing  analogies  along  in  comparing  the 
effects  of  heat  and  electricity  with  those  of  light  upon  vegetable  or- 
ganization, we  shall  readily  see  that  a  common  philosophy  attends 
the  operation  of  the  whole,  and  that  light,  in  its  relation  to  vegetable 
life,  is  nothing  but  a  vital  stimulus,  adapted  to  the  peculiarly  modified 
vital  properties  of  the  leaf,  as  blood  is  to  the  sanguiferous  system, 
sap  to  the  circulatory  system  of  plants,  bile  to  the  intestine,  semen  to 
the  ovum,  pollen  to  the  germen,  &c.  (§  133,  &c.).  Consider,  too,  the 
analogy  which  is  supplied,  in  the  foregoing  aspect,  by  the  action  of 
light  upon  the  retina  (§  234,  e),  and  how  it  contributes  to  the  produc- 
tion of  various  hues  of  the  skin,  and  how,  on  the  other  hand,  the  skin 
becomes  blanched,  like  the  plant,  by  the  exclusion  of  light.  And  the 
analogy  may  be  extended  to  the  motions  produced  in  the  iris  by  the 
action  of  light  upon  the  "  carbon  atom"  of  the  retina  (§  514,  k). 
Nay,  more,  the  action  of  light,  as  I  have  shown,  by  its  absence,  at 


94  INSTITUTES    OF    MEDICINE. 

least,  reaches  far  beyond  the  peculiarly  modified  sensibility  of  the 
retina  (§  199) ;  since,  by  its  long  privation,  the  entire  organ  of  vision 
ceases  to  be  developed  (§  74).  Again,  by  what  chemical  philosophy 
shall  we  interpret  not  only  the  painful  effect  of  light  upon  an  inflamed 
eye,  but  its  aggravation  of  the  disease  1  And  here,  by-the-way,  its 
simultaneous  action  upon  the  sensibility  of  animal  life  and  the  irri- 
tability of  organic  life  concur  together  in  the  demonstration. 

And  now  to  continue  the  analogies  with  electricity  and  galvanism. 
Either  will  promote  the  growth  of  plants  which  no  degree  or  modifi- 
Ccltion  of  light  can  exert.  So  will  they,  also,  promote  nutrition  in 
muscles  that  are  wasted  in  paralysis ;  and  if  the  pneumogastric  nerve 
be  divided,  the  transmission  of  galvanism  through  the  inferior  portion 
will  rouse  the  stomach  to  the  production  of  the  true  gastric  juice  and 
partially  restore  digestion.  And  here  I  may  stop  to  say,  that  the  co- 
incidence in  the  effects  of  galvanism  upon  vegetable  and  animal  organ- 
ization is  one  of  the  many  facts  which  establish  the  general  identity 
of  the  properties  of  life  in  both  departments  of  the  animated  king- 
dom, while  it  proves  that  galvanism  and  the  nervous  power  are  per- 
fectly distinct,  though  each  be  a  vital  agent  (§  73  b,  74,  185,  226). 
Again,  also,  galvanism  is  a  remedial  agent,  affecting  morbid  functions 
after  the  manner  of  other  remedies,  which,  with  its  analogy  to  light  in 
promoting  the  growth  of  plants,  shows  farther  that  the  latter  is,  in  the 
same  sense,  only  a  peculiar  stimulus  to  organic  functions  (§  74,  303). 

What  is  said  by  Professor  Draper  in  the  foregoing  abstract  on  the 
subject  of  the  yellow  ray  in  its  connection  with  sensation  deserves  a 
critical  inquiry,  not  only  for  the  sake  of  the  facts,  but  as  contributing 
light  upon  organic  philosophy.  The  chemical  doctrine  of  vision  is 
so  clearly  fallacious,  that  any  specific  relations  which  may  be  shown 
between  particular  rays  of  light  and  the  sensibility  of  the  retina,  may 
advance  our  knowledge,  analogically,  of  the  connection  of  the  rays 
with  organic  functions,  through  irritability.  But  I  see  not  how  it  is 
shown  that  the  yellow  ray  "  has  charge  of  the  process  of  vision  in  all 
animals,"  since  "  each  of  the  seven  rays  of  light  impresses  our  minds 
with  special  sensations"  (p.  797-798,  I  1034). 

Moreover,  if  the  yellow  ray  give  rise  to  sensation  by  its  action  on 
the  carbon  atom,  or  by  any  chemical  influence,  then,  also,  do  each  of 
the  remaining  six,  and  each  one  in  modes  peculiar  to  itself,  and  in  all 
the  cases  upon  distinct  bases.  Nay,  more,  when  the  retina  feels  the 
united  rays,  each  of  the  seven  must  simultaneously  exert  their  specific 
chemical  actions.  Besides,  how  are  those  invisible  rays  employed 
which  operate  chemically  upon  inorganic  compounds  ?  'What  means 
the  important  distinction  between  the  visible  and  invisible  rajs  that 
the  former  act  upon  organic  beings,  the  latter  upon  inorganic  ? 

From  the  close  analogies  between  the  relation  of  physical  agents  to 
sensibility  in  animal  life  and  irritability  in  organic  life,  if  their  action 
in  the  former  case  be  not  chemical,  but  vital,  so  is  it  equally  in  the  lat- 
ter, and  vice  versa.    It  is  either  vital  throughout,  or  chemical  altogether. 

But,  organic  philosophy,  through  its  analogies,  should  be  able  to 
explain  what  chemistry  cannot  as  to  the  resulting  sensation  when  the 
united  rays  of  the  sunbeam  fall  upon  the  retina.  One  example  will 
do  it.  Thus,  every  distinct  agent  of  positive  virtues  produces  distinct 
impressions  in  organic  life.  But,  by  uniting  two  or  more  together, 
either  mechanically  or  chemically,  a  new  agent  is  created,  which  op- 


PHYSIOLOGY. VITAL    PROPERTIES.  96 

erates  either  in  an  individual  sense,  or  if  by  several  virtues,  as  an  en- 
tire vi^hole.  So,  in  i-espect  to  vision,  the  united  virtues  of  the  numer- 
ous rays  of  the  sunbeam  acting  upon  the  sensibility  of  the  retina  give 
rise  to  sensation  attended  by  a  white  light  (§  136,  188,  193,  199,  650, 
872  a,  1054).     In  organic  life  they  equally  act  separately  or  unitedly. 

The  intelligent  reader  may  now  test  the  foregoing  philosophy  by 
what  is  perpetually  observed  within  himself,  and  bring  to  its  illustration 
the  exact  analogies  which  I  have  indicated  as  being  supplied  by  the 
different  passions  of  the  mind  ;  how  anger  stimulates  the  whole  vascu- 
lar system, — how  fear  depresses  it, — how  shame  acts  upon  the  capilla- 
ries of  the  face  alone, — how  joy  acts  upon  the  heart  and  kindles  the 
eyes  in  its  own  peculiar  way,  or  its  antagonist,  grief,  seeks  the  lachry- 
mal gland,  or  expectation  of  food  the  parotids, — how  fear,  again, 
rouses  the  kidneys,  or  bathes  the  skin  with  perspiration, — how  love 
poises  its  aim  at  the  genital  organs  (§  227,  234  g^  509,  512,  &c.).  If, 
therefore,  light  do  not  affect  organic  actions,  and  influence  organic 
results  as  supposed  of  the  foregoing  mental  causes,  and  as  imputed,  also, 
to  all  vital  agents,  but,  on  the  contrary,  its  operations  upon  plants,  and 
therefore  upon  animals,  be  of  a  chemical  nature,  then,  by  the  clear- 
est analogy,  all  other  agents  of  life,  the  mind  and  its  passions,  every 
act  of  intellection,  every  voluntary  movement,  belong  equally  to  the 
same  category  (§  175  c,  349  e,  1072). 

189,  a.  where  physical  views  of  life  obtain,  their  advocates  sup- 
pose that  vital  agents  operate  directly  upon  the  structure.  This  is 
one  of  the  first  steps  in  materialism.  Many  of  the  chemical  school 
imagine,  as  Liebig  expresses  it,  that  "  every  motion,  every  manifesta- 
tion of  force,  is  the  result  of  a  transformation  of  the  structure,  or  of 
the  substance  of  parts  ;"  that  "  every  thought,  every  mental  affection, 
is  the  result  of  a  change  in  the  composition  of  the  substance  of  the 
brain."  And  so  of  every  pulsation  of  the  heart  (§  350).  Others, 
again,  who  belong  to  the  school  of  vitalism,  to  accommodate  their  lan- 
guage to  the  physical  conceptions  of  the  day,  speak  of  the  action  of 
vital  agents  "  upon  the  structure  through  the  medium  of  the  vital: 
properties."  This  difference  among  vitalists  is  only  verbal;  since,; 
by  admission,  the  structure  can  only  be  affected  "  through  the  medi- 
um of  its  vital  properties,"  upon  which,  therefore,  the  impression 
must  be  made.  Hence,  distinguished  vitalists.  Professor  Caldwell, 
for  example,  who  defend  the  semi-physical  mode  of  expression,  often 
fall  into  the  simple  realities  of  their  philosophy.  Thus  the  professor, 
m  his  "  Outlines  of  a  Course  of  Lecttcres,^'  observes  that  "  irritability 
and  sensibility  can  be  acted  on  by  stimulants  alone."  "  Purgative 
medicines  act  chiefly  on  our  irritability,"  &c.  (p.  185,  187).  And  so 
it  ever  happens  with  inquirers  after  truth.  They  cannot  adhere  even 
to  ambiguities  of  language  ;  and  others  who  see  the  truth,  but  build 
upon  hypotheses,  are  often  betrayed  into  fatal  contradictions  (§  64, 
236,  345-350,  350f  n,  699  c,  740,  819  b). 

189,  b.  But,  what  is  more  remarkable,  the  most  absolute  physical  phi- 
losophers of  life,  they  who  deride  the  existence  of  the  "  vital  proper- 
ties," and  speak  of  their  "  destruction"  as  an  absurdity,  not  only  fall  into 
the  language  of  the  vitalists,  but  unavoidably  contradict  their  wholo 
system  of  materialism,  whenever  they  approach  the  realities  of  life. 
This  is  true  even  of  Dr.  Carpenter,  who,  in  his  review  of  my  Com- 
mentaries, attempted  their  overthrow  by  satirizing  the  supposed  exist- 


96  INSTITUTES    OF    MEDICINE. 

ence  of  "  vital  properties,"  and  particularly  the  supposition  that  prop 
erties  could  be  "destroyed.'"     Thus,  then,  Dr,  Carpenter,  at  a  subse- 
quent time,  and  in  a  work  of  great  professional  popularity.     The  cap- 
itals and  italics  are  mine  : 

"  It  is  a  fact  of  some  importance,  in  relation  to  the  disputed  question 
of  the  connection  of  muscular  irritability  with  the  nervous  system, 
that  when,  by  the  application  of  narcotic  substances  to  the  nerves, 
their  vital  properties  are  destroyed,  the  irritability  of  the  muscle 
may  remain  for  some  time  longer;  and  the  latter  must,  therefore,  be 
independent  of  the  former.  Hence  we  should  conclude  that  contrac- 
tility [mobility,  of  these  Institutes,  §  205]  must  be  a  property  really 
inlierent  in  muscular  tissue,  which  may  be  called  into  action  by  va- 
rious stimuli  APPLIED  to  itself,  and  which  may  be  weakened  by  vari- 
ous depressing  agents  applied  to  itself  ;  and  that  the  nerves  have 
the  power  of  conveying  the  stimuli  which  call  the  property  into 
action,  but  have  little  or  no  other  influence  on  it." — Carpenter's 
Human  Physiology,  Sectio?i  376. — See,  also,  this  work,  §  175  d,  167  d, 
291,  350|  b  ;  and  Examination  ofRevieivs,  p.  8-12,  26-43. 

It  is  important  to  the  great  objects  of  medicine,  that  I  should  now 
say,  that  the  foregoing  is  only  an  example  of  numerous  palpable  con- 
tradictions of  the  physical  views  which  form  the  fundamental  philoso- 
phy of  life  in  the  foregoing  work,  and,  I  may  add,  of  most  others  which 
tire  devoted  to  the  propagation  of  medical  materialism.  It  will  be 
»een  that  enough  is  admitted  in  the  preceding  quotation  to  substantiate 
every  doctrine  advanced  in  these  Institutes.  There  are  the  vital  prop- 
erties, in  all  their  individuality,  called  into  action  by  stimuli,  and  "  act- 
ing" of  themselves  even  beyond  the  doctrine  of  vitalists,  or,  again, 
"  weakened  by  various  depressing  agents,"  and  liable  to  be  "  de- 
stroyed;" though  I  do  not  allow,  as  affirmed  in  the  quotation,  that 
"con/rac^z'toy"  is  the  property  acted  upon  (s^  206).  Finally,  we  have  ad- 
mitted, "  that  the  nerves  have  the  power  of  conveying  the  stimuli  which 
call  the proioerty  [contractility,  or  mobility^  into  action  ;'''  and  which  is 
all  that  is  necessary  to  the  whole  doctrine  which  I  have  propounded 
as  to  the  nervous  power  (§  222-233f ,  500,  &c.,  512,  &c.,  893-905). 

189,  c.  The  impressions  which  are  made  on  the  vital  properties  be 
come  the  causation  of  the  changes  which  may  ensue  in  the  actions,  or 
structure,  of  the  solids,  where  the  impression  is  made.  No  vital  agents 
elicit  actions,  or  a  single  phenomenon  of  life,  when  applied  to  an  in- 
organic compound,  not  even  from  an  organic  being  just  dead  from  in- 
stant destruction  by  hydrocyanic  acid,  or  by  a  pin  thrust  into  the  me- 
dulla oblongata.  On  the  contrary,  indeed,  all  the  agents  which  had 
before  contributed  to  the  maintenance  of  life,  now  caiTy  out  the  work 
of  destruction,  and  more  speedily  resolye  the  organic  fabric  into  its 
ultimate  elements  than  any  inorganic  compound  {k  62).  It  follows, 
therefore,  that  agents  do  not  elicit  the  actions  of  life  by  operating  upon 
the  organized  structure ;  but  upon  those  properties  which  hydrocy- 
anic acid,  &c.,  may  extinguish  in  an  instant  of  time  ;  nor  do  they  op- 
erate upon  the  functions,  since  those  are  merely  effects  (§  176).  And 
is  it  not  a  greater  paradox  that  hydrocyanic  acid,  or  aconite,  &c., 
should  destroy  life  in  a  second  of  time  by  its  action  upon  the  mere 
structure  than  upon  that  living  principle  which  imparts  to  the  organic 
kingdom  all  its  peculiar  characteristics'?  Or,  as  the  blood,  or  joy,  or 
fcnger,  rouses  the  heart,  or  as  fear  brings  on  perspiration,  micturition, 


PHYSIOLOGY. VITAL    PROPERTIBS.  9T 

<fec.,  or  as  the  want  of  air  throws  into  action  the  respiratory  muscles, 
or  as  odors,  light,  &c.,  produce  their  sensations  1 

By  facts  of  the  foregoing  nature,  and  by  all  those  considerations 
which  have  been  made  in  relation  to  the  differences  in  the  vital  con- 
stitution of  the  different  tissues,  and  of  different  parts  of  one  and  the 
same  continuous  tissue  (as  of  the  alimentary  and  pulmonary  mucous 
membrane,  §  133,  &c.),  it  becomes  perfectly  obvious  that  the  projDer- 
ties  of  life  are  something  j^er^e,  something  besides  organization  itself, 
or  organic  functions,  and  upon  which  the  agents  of  life  exert  their  im- 
mediate impressions  (^  1029,  1030,  1034,  1041). 

There  can,  therefore,  be  no  appreciation  of  the  laws  of  organic  be^ 
ings,  of  the  modus  opei'andi  of  natural,  morbific,  or  remedial  agents, 
of  healthy  or  morbid  processes,  of  voluntary  or  involuntary  muscular 
motion,  of  the  results  of  the  operation  of  the  nervous  power  and  sen- 
sibility, or  even  of  perception,  without  a  critical  reference  to  the  prop- 
erties of  life  as  the  efficient  causes,  and  as  receiving  the  impressions 
which  may  be  exerted  by  external  and  internal  agents  (§  872). 

190,  a.  Irritability,  and  other  vital  properties,  are  naturally  modi- 
fied, in  kind  and  degree,  in  the  different  tissues,  in  tissues  of  the  same 
order,  and  in  different  parts  of  one  and  the  same  continuous  tissue 
(§  133,  &c.,  199,  203,  227-232,  525-529). 

These  natural  modifications  are  shown  in  all  parts  by  the  peculiar 
action  of  the  natural  stimuli  of  life ;  as  blood  upon  the  heart  and 
blood-vessels,  food  on  the  stomach,  bile  on  the  intestines,  urine  on  the 
bladder,  the  will,  through  the  nervous  power,  upon  the  voluntary 
muscles  (§  215,  227,  486),  and  by  the  differences  that  arise  from  their 
action  on  parts  to  which  they  are  not  peculiar.  And  so  of  the  diversi- 
fied effects  of  external  agents  on  different  parts. 

190,  b.  There  are  remarkable  modifications  of  irritability  in  the  ova 
of  oviparous  and  viviparous  animals,  and  in  seeds.  Semen  is  the  only 
natural  stimulus  of  the  former,  in  their  absolute  state  of  ova ;  while 
in  the  ova  of  viviparous  animals,  the  actions,  after  being  roused  by 
the  stimulus  of  semen,  must  go  on  to  a  full  development  of  the  organ- 
ic being,  and  in  undisturbed  connection  with  the  parent ;  but,  in  th« 
oviparous,  when  the  ovum  has  acquired  a  certain  development,  the 
actions  cease  spontaneously,  the  properties  of  life  no  longer  obeying 
the  vital  stimuli  as  in  the  other  case.  These  properties  then  become 
dormant  (and  in  the  seed,  also),  and  nature,  having  fulfilled  her  final 
cause,  the  ovum  is  expelled  from  the  body,  and  the  seed  cast  off,  that 
they  may  be  subjected  to  new  agents.  Semen  will  not  now  act  upon 
the  egg,  but  heat  and  atmospheric  air  become  necessary  to  I'estore 
the  actions,  and  carry  out  the  process  originally  instituted  by  the  spe- 
cific stimulus  of  semen. 

There  are  certain  oviparous  animals  that  present  other  peculiarities^ 
and  other  changing  modifications,  of  irritability  in  respect  to  their  ova. 
At  certain  seasons  their  ova  undergo  a  partial  development  from  the 
influence  of  season,  and  from  the  stimuli  supplied  by  the  female  pa- 
rent. These  influences,  however,  finally  cease  to  operate,  and  the 
ovum  is  expelled  to  undergo  the  action  of  semen  in  the  external 
world.  This  action  again  modifies  irritability,  and  adapts  it  to  other 
vital  stimuli. 

Again,  it  may  be  affirmed  of  many  oviparous  animals,  e.g.  birds,  thai 
a  partial  development  of  the  ovum  takes  place,  though  imperfectly, 

G 


98  INSTITUTES    OF    MEDICINE. 

tlirougli  Stimuli  supplied  by  the  female  parent,  and  the  ovum  is  ulti- 
mately expelled  as  when  incipient  development  is  brought  about  by 
the  stimulus  of  semen,  but  that  these  ova  are  insusceptible  of  renewed 
actions,  either  from  the  stimulus  of  semen,  or  other  vital  agents  (§ 
71-73,  1051). 

191,  a.  The  variations  in  kind  and  degree  of  in-itability  (§  190) 
adapt  each  part  to  be  acted  upon  by  peculiar  natural  agents,  while 
the  same  agents  may  have  a  pernicious  effect  on  other  parts,  in  the 
great  plan  of  organic  life  (§  133,  &c.).  The  same  principle  governs 
the  operation  of  morbific,  and,  more  or  less,  of  remedial  agents,  and 
is  one  of  the  main  causes  of  disease,  and  of  the  determination  of  dis- 
ease upon  one  part  in  preference  to  another  (§  149-151).  The  prin- 
ciple is,  therefore,  very  comprehensive,  and  refers  as  well  to  the  kind, 
enei'gy,  and  degree  of  the  operating  causes  or  agents,  as  to  the  kind 
and  degree  of  irritability  (§  150).    And  so,  also,  of  sensibility  (§  194). 

The  principle  is  not  only  seen  in  all  parts  of  the  organic  being,  but 
eveiy  distinct  species  of  animal  and  plant  has,  in  a  collective  sense, 
its  own  special  modification  of  irritability,  through  v/hich  its  organic 
habits  as  to  food,  composition,  nutrition,  &c.,  are  specifically  regula- 
ted. It  is  this  which  renders  what  is  poisonous  to  one  animal  or 
plant  salubrious  or  inoffensive  to  another.  And  this  lets  us  into  a 
knowledge  of  the  reason  why  certain  atmospheric  influences  induce 
the  "milk-sickness"  in  the  hine  of  the  Western  States,  and  probably 
in  no  other  animal.  It  reveals  to  us  how  it  is  that  the  stately  plata- 
nus  occidentalis  and  the  common  ])each  tree  have  been  dying  out  over 
extensive  regions  of  country,  and  why  the  potato-crop  is  cut  off,  year 
after  year,  in  vast  regions  of  Europe  and  America,  while  every  otner 
tree  and  herb  escape  the  epidemics  (§  150).  These  very  facts  de- 
monstrate, also,  the  principle  as  to  the  natural  modifications  of  the 
properties  of  life,  and  establish,  alone,  the  fundamental  identity  of  the 
vital  properties  in  the  two  departments  of  the  organic  kingdom  (§  185). 

191,  h.  Again,  more  remarkable  modifications  of  irritability,  or 
changes  in  kind,  are  artificially  effected  by  morbific  and  remedial  in- 
fluences, external  and  internal,  physical  and  moral ;  and  these,  far 
more  than  a  mere  increase  and  depression  of  this  property,  constitute 
an  essential  part  of  disease.  These  affections  of  irritability  give  rise 
to  new  series  of  influences,  from  every  variety  of  agent,  and  often 
very  different  from  such  as  are  exerted  under  circumstances  of  health 
(§  542).  Hence  it  is  that  ordinary  food,  &c.,  becomes  morbific  in 
diseased  conditions,  remedial  agents  operative,  either  for  good  or  for 
evil,  when  otherwise  they  might  fail  of  any  effect  (§  226),  and,  upon 
this  mutability,  and  varying  susceptibility  of  the  property  now  under 
consideration,  is  greatly  founded  the  art  of  medicine.  It  is,  especial- 
ly, these  varying  conditions  of  irritability  which  demand  so  much 
critical  reference  to  the  exact  nature  of  remedial  agents,  their  doses, 
&c.  (§  857,  871,  878),  and  to  the  mutability  of  the  property  is  partic- 
ularly due  the  salubrious  influences  which  are  exerted  (§  901). 

191,  c.  And  here  we  have  striking  analogies  in  the  manner  in 
which  the  properties  of  the  mind  are  modified  in  their  character  and 
again  restored  to  their  integrity  when  the  organic  properties  of  the 
brain  become  affected  in  the  foregoing  manner  (§  175). 

191,  d.  Remote  analogies  probably  exist  even  in  the  inorganic 
kingdom ;  though  we  have  apparently  nothing  there  in  this  respect 


PHYSIOLOGY. VITAL    rROPERTIES.  99 

which  transcends  other  affinities  between  the  two  great  kingdoms  of 
nature.  We  do  not  find  that  dead  matter  is  endowed  with  proper- 
ties as  specifically  distinct  from  the  matter  itself  as  the  living  being  and 
the  properties  by  which  it  is  governed.  And,  so  far  as  this  analogy 
extends  to  dead  matter,  its  properties  do  not  appear  to  be  liable  to 
any  mutations  in  kind,  but  only  in  degree  ;  and  here  it  would  seem 
that  the  analogy  should  end,  since  we  do  not  find  that  instability  in 
the  mineral  world  which,  in  the  organic,  grows  out  of  the  mutability 
of  the  properties  of  life. 

What  I  have  thus  said  of  the  analogies  between  the  properties  of 
living  and  dead  matter  is  sustained  by  the  late  researches  of  chemists. 
Thus,  on  the  allotropism  of  simple  bodies,  it  is  said  by  Prof.  Draper, 
that,  "  to  a  certain  extent,  the  views  of  M.  Berzelius  coincide  with 
those  which  have  offered  themselves  to  me  from  the  study  of  the  prop- 
erties of  chloi'ine.  They  are  not,  however,  altogether  the  same.  M 
Berzelius  infers  that  elementary  bodies  can  assume,  under  varying  cir- 
cumstances, different  qualities.  The  idea  which  it  is  attempted  to 
communicate  in  this  memoir  is  simply  this, — that  a  given  substance, 
such  as  chlorine,  can  pass  from  a  state  of  high  activity,  in  which  it 
possesses  all  its  well-known  properties,  to  a  state  of  complete  inac- 
tivity, in  which  even  its  most  energetic  affinities  disappear.  And  that, 
hetween  these  extremes  there  are  innumerahle  intermediate  jwints.  Be- 
tween the  two  views  there  is,  therefore,  this  essential  difference :  From 
the  former,  it  does  not  appear  what  the  nature  of  the  neioly -assumed, 
froperties  may  he  ;  from  the  latter,  they  must  obviously  be  of  the  same 
character,  and  differ  only  in  intensity  or  degree,  diminishing  from  stage 
to  stage  until  complete  inactivity  results." — Draper,  on  Allotropism 
of  Chlorine  as  Connected  with  the  Theory  of  Substittitions.    1845. 

192.  Ii'ritability  stands  as  a  sentinel  at  all  the  openings  and  pores 
of  the  body,  and  between  the  capillary  and  extreme  vessels  of  the  ar- 
terial system  ;  admitting  and  excluding  according  to  its  natural  mod- 
ifications in  different  parts.  Thus,  all  but  chyme  is  excluded  from 
the  duodenum  by  the  pyloric  orifice  of  the  stomach,  and  all  but  atmo- 
spheric air  by  the  glottis.  The  globules  of  blood  are  vastly  smaller 
than  the  visible  capillaries  which  carry  only  white  blood,  from  which 
they  are  excluded  by  the  peculiar  irritability  of  these  vessels.*  When 
admitted,  as  in  inflammation,  it  arises  from  a  morbid  alteration  of  irri- 
tability. And  so  when  the  lacteals  absorb  deleterious  agents,  or  the 
pylorus  allows  the  escape  of  undigested  food.  There  is  no  analogy 
between  a  set  of  inert  tubes  and  the  living  ducts.  And  yet  are  we 
presented  with  tubular  instruments  of  glass,  &c.,  to  demonstrate  the 
laws  which  govern  the  circulation  of  the  blood  and  of  sap,  and  sponges 
and  lamp-wick  to  exemplify  the  process  of  absorption  as  carried  on 
by  the  lymphatics  and  lacteals  (§  289,  291). 

193.  Bichat  confounded  irritability  with  sensibility,  by  calling  the 
former  organic  sensibility,  and  the  latter  animal  sensibility.  He  made, 
also,  a  greater  mistake  in  supposing  that  irritability  and  sensibility  are 
only  different  degrees  of  one  property.  This  fact  deiives  its  impor- 
tance from  the  high  authoritij^of  the  French  philosopher,  and  the  er- 
rors into  which  he  has  thus  led  a  multitude  of  others. 

The  coincident  functions  between  plants  and  animals,  and  organic 
actions  being  carried  on  in  parts  of  animals  after  the  greatest  possibla 
destruction  of  the  nervous  communications,  evince  the  clearest  distinc- 
*  A  few  are  said  to  be  admitted,  but  are  visible  only  through  the  microscope. 


100  INSTITUTES    OF    MEDICINE. 

tion  between  irritability  and  sensibility,  however  close  their  analogies 
in  respect  to  the  operation  of  physical  agents.  Nor  can  the  nervous 
influence  act  as  a  stimulus  in  such  cases,  though  the  nerves  may  form 
a  channel  for  other  stimuli  (§  461,  476i  c,  489,  490). 

2.    SENSIBILITY. 

194.  Sensibility,  which  is  peculiar  to  the  vital  principle  of  animals, 
resides  exclusively  in  the  nervous  system.  That  which  gives  rise  to 
true  sensation  is  mainly  limited  to  the  cerebro- spinal  system  (§  184, 
523). 

195.  Through  sensibility  we  learn  the  existence  and  nature  of  ex- 
ternal objects.  These  objects  make  their  impressions  upon  this  prop- 
erty as  we  have  seen  of  other  agents  in  respect  to  irritability  (§  188, 
&c.). 

Another  important  function  is  also  performed  by  sensibility,  which 
consists  in  the  transmission  of  impressions  to  the  cerebro-spinal  axis, 
as  a  part  of  the  great  function  of  sympathy,  or  reflex  nervous  action. 

All  the  modifications  of  sensibility  are  designed  for  the  transmission 
of  impressions  from  the  circumference  to  the  nervous  centres  (§  450, 
451).     Tbe  sympathetic  nerve  contributes  centres  in  organic  life. 

196.  The  nerves  are  the  organs  of  sensibility,  and  the  brain  and 
spinal  cord  the  recipients  of  impressions  transmitted  by  this  property 
through  the  medium  of  the  nerves.  Perception  is  also  necessary  to 
the  recognized  modifications  of  sensation  ;  and,  therefore,  the  perfect 
exercise  of  the  power,  in  its  function  of  true  sensation,  requires  a 
healthy  state  of  the  foregoing  elements  (§  523,  no.  3). 

197.  Sensibility  is  said  to  be  of  two  kinds,  common  and  specific.  I 
shall  distinguish  it  into  a  third  kind,  which  may  be  calle^l  sympathetic 
sensibility  (^  1037,  h). 

198.  Common  sensibility  is  the  source  of  pain,  and  resides  in  all 
the  nerves.  It  is  generally  dormant  in  the  organs  of  organic  life,  but 
may  be  gi-eatly  roused  by  disease.  The  best  examples  of  this  latent 
state  occur  in  the  ligaments  and  bones.  Its  development  by  disease 
is  a  clear  illustration  of  the  light  which  is  reflected  upon  natural  phys- 
iological conditions  by  their  moAid  changes  (§  137,  d). 

199.  Specific  sensibility  is  peculiar  to  the  senses,  where  it  mani- 
fests very  striking  peculiarities.  Light,  alone,  will  affect  the  specific 
sensibility  of  the  retina,  the  intrinsic  virtues,  only,  of  various  substan 
ces  give  rise  to  tasting  and  smelling,  certain  mechanical  impressions 
to  hearing,  &c.  This  proves  a  difference,  or  modification,  of  specific 
sensibility  in  the  several  organs  of  sense,  by  which,  as  in  the  case  of 
irritability  (§  190,  191),  it  is  adapted,  in  various  parts,  to  the  action  of 
special  stimuli,  according  to  the  predetermined  uses  of  each  part. 

199|.  The  impressions  transmitted  by  common  and  specific  sensi- 
bility are  received  by  the  brain  alone,  or  its  equivalent.  The  spinal 
cord  is  only  a  medium  of  communication.  These,  also,  are  the  kinds 
of  sensibility  which  require  for  their  operation  the  exercise  of  per- 
ception (§  451,  523,  nos.  1,2);  and  it  is  these  upon  which  true  sen- 
sation depends.  Whenever  brought  into  operation,  the  mind  takes 
cognizance  of  the  transmitted  impressid'Jis  (p.  864,  note). 

200.  The  foregoing  (§  197-199)  are  coincident  with  what  we  have 
eeen  of  differences  in  irritability  (§  133,  &c.,  190,  191),  though  more 
strongly  pronounced,  and  are  clear  examples  of  what  is  meant  by 


PHYSIOLOGY. VITAL    PROPERTIES.  101 

natural  modifications  of  the  vital  properties ;  and  illustrate  those  mod- 
ifications which  constitute  the  essence  of  disease  (§  133,  &c.,  191). 

The  three  principal  kinds  of  sensibility,  and  the  several  modifica- 
tions of  the  specific  kind,  as  shown  by  the  special  causes  which,  re- 
spectively, give  rise  to  seeing,  tasting,  smelling,  &c.,  also  illustrate 
the  principle  which  governs  the  special  relations  of  different  agents, 
natural,  morbific,  and  remedial,  to  irritability  as  modified  in  difterent 
parts ;  and  this,  also,  reciprocally  illustrates  the  characteristics  of  sen- 
sibility. A  harmony  of  laws  prevails  universally  (§  133-138).  Like 
irritability,  sensibility  is  also  liable  to  artificial  modifications  from  the 
action  of  external  and  internal  causes ;  and,  as  will  be  seen,  the  ner- 
vous power  is  susceptible  of  even  more  remarkable  influences  (^  226- 
232,  725). 

201,  a.  The  last  section  leads  me  to  consider  the  third  kind  of  sen- 
sibility, or  what  I  have  denominated  sympathetic  sensibility  (§  197). 
Its  oflftce  will  explain  the  qualifying  term  sympathetic,  which  appears 
to  be  necessary  to  avoid  the  confusion  which  prevails  in  the  applica- 
tion of  the  general  term  to  the  distinct  offices  of  exciting  acts  of  in- 
tellection and  of  influencing  organic  motions,  and  of  producing  invol- 
untary motion  in  animal  life.  There  was  a  radical  objection  to  Bi- 
chat's  designation  of  irritability  as  organic  sensibility  (§  193)  ;  but  in 
the  present  term  there  seems  to  be  a  peculiar  advantage  (§  451,  d). 

"  Impressions,"  says  Miiller,  "  conveyed  by  the  sensitive  nerves  to 
the  central  organs  are  either  reflected  by  them  upon  the  origin  of  the 
motor  nerves,  without  giving  rise  to  true  sensations,  or  are  conducted 
to  the  sensorium,  the  seat  of  consciousness." 

When  light  produces  vision,  or  odors  give  rise  to  agreeable  sensa- 
tions, it  is  due  to  specific  sensibility.  The  mind  perceives,  and  the 
effect  goes  no  farther;  there  is  no  extension  of  the  impressions  be- 
yond the  sensitive  nerves.  Again,  the  light  or  mechanical  irritants 
are  productive  of  pain,  and  the  effect  is  limited  in  the  same  manner. 
But  here  there  is  no  specific  sensation.  It  is  the  same  in  all  the  or- 
gans of  sense.  This,  therefore,  is  due  to  common  sensibility.  At 
another  time,  however,  the  light  induces  a  paroxysm  of  sneezing,  or 
the  odor  syncope  or  disease.  Here  is  a  perfectly  new  train  of  re- 
sults, the  principal  of  which  are  in  parts  distant  from  the  direct  seat 
of  the  impressions.  The  primary  influeuces  have  been  propagated 
upon  various  organs  by  the  nervous  centres  through  the  system  of 
motor  nerves.  These  influences,  therefore,  have  called  into  action 
another  modification  of  sensibility,  and  that  is  the  sympathetic  (§  450, 
&c.,  464,  514  h-m,  902).— Note  Dp.  1114. 

201,  b.  This  variety  of  the  common  property,  like  specific  sensi- 
bility, belongs  to  certain  parts  only  of  the  nervous  system,  and  is  the 
medium  through  which  impressions  upon  all  parts  are  transmitted  to 
the  cerebro-spinal  axis,  in  the  function  of  sympathy.  Perception,  and 
true  sensation,  therefore,  which  is  rarely  an  attendant  phenomenon, 
are  not  necessary  to  the  office  of  this  modification  of  sensibility,  nor 
is  a  continuity  of  the  nerves  with  the  brain.  Reflected  motion  may 
be  as  readily  excited  through  the  spinal  cord  as  through  the  brain; 
"  and  we  are  in  possession,"  says  Miillei-,  "  of  no  facts  which  prove 
that  the  spinal  cord,  when,  separated  from  the  brain  and  medulla  ob- 
longata, can  be  the  seat  of  true  sensation.  The  reflected  motions  ex- 
cited by  the  irritation  of  the  surface  in  decapitated  frogs  are  no  proof 
of  this."     The  ganglia  of  the  sympathetic  nerve  are,  also,  centres. 


102  INSTITUTES    OF    MEDICINE. 

201,  c.  Sympathetic  sensibility  appertains  to  what  are  denominated 
the  sensitive  nerves,  and  the  sensitive  fibres  of  comj^ound  nerves, 
which  are  also,  in  part,  the  instruments  of  common  sensibility.  But, 
a  remarkable  anatomical  distinction,  and  which  goes  far  to  sustain 
the  variety  of  sensibility  which  is  here  indicated,  is  found  in  the  sen- 
sitive fibres  of  the  sympathetic  and  pneumogastric  nerves ;  which 
possess,  in  the  most  exalted  degree,  the  power  of  transmitting  organic 
impressions  to  the  nervous  centres,  but  which  are  nearly  destitute  of 
common  sensibility.  Indeed,  it  is  through  this  system  of  sensitive 
fibres  that  the  whole  organic  department  maintains  the  specific  rela- 
tions of  its  several  parts  (§  129,  523,  nos.  1,  2,  3,  6,  1037,  h). 

201,  d.  The  impressions  transmitted  through  sympathetic  sensibility 
may  be  received  either  by  the  brain,  spinal  cord,  or  certain  parts  of 
the  ganglionic  system  (§  520) ;  and  either  connectedly  or  independ- 
ently of  each  other.  When  thus  received  by  the  nervous  centres, 
they  give  rise  to  a  development  and  transmission  of  the  nei-vous  pow- 
er through  what  are  called  the  motor  nerves,  and  terminate  in  those 
influences  which  complete  the  function  of  sympathy,  by  giving  rise  to 
sensible  or  insensible  motions,  or  modifying  such  as  had  existed. 

202,  a.  The  manner  in  which  sympathies  are  brought  about  through 
the  medium,  in  part,  of  sensibility,  and  the  failure  of  impressions  upon 
common  and  specific  sensibility  to  generate  sympathy,  or  to  excite  the 
influence  of  the  motor  nerves,  and  the  absence  of  sensation  in  the 
former  case,  and  the  admissible  absence  of  the  brain,  as  well  as  other 
peculiarities,  prove,  abundantly,  the  existence  of  this  third  kind  of 
sensibility.  Besides,  also,  the  prominent  demonstrations  to  the  fore- 
going effect  which  occur  in  disease,  this  modification  of  sensibility  is 
in  universal  operation  in  healthy  states  of  the  body;  as  manifested  in 
resjjiration,  and  in  the  concerted  action  with  which  the  various  organs 
carry  on  their  respective  functions.  Through  this  modification  al) 
parts  transmit  to  the  cerebro-spinal  axis  special  influences  that  are 
relative  to  their  existing  conditions,  and  these  influences  are  propa- 
gated through  motor  nerves,  and  maintain  a  harmony  of  movements. 

These  reflex  nervous  actions  are,  therefore,  universal  and  perjoetual. 

The  special  function  of  this  kind  of  sensibility,  and  its  co-operation 
with  the  nervous  power  in  the  function  of  sympathy,  will  be  faither 
considered  along  with  that  function,  and  the  function  of  motion,  and 
again  under  the  laws  of  sympathy,  and  the  modus  operandi  of  reme- 
dial agents  (^  1037,  V). 

202,  h.  It  may  be  now  said,  however,  that  when  sympathetic  sen- 
sibility contributes  to  motion,  whether  in  organic  or  animal  life,  or 
whether  sensible  or  insensible,  it  is  through  impressions  received  and 
transmitted  by  this  property  to  the  cerebro-spinal  axis,  or  to  the 
centres  of  the  sympathetic  when  a  medium  of  reflex  action,  and  a 
consequent  development  of  the  nervous  power,  which  power  then  op- 
erates, through  motor  nerves,  upon  the  organic  irritability  of  parts 
which  are  brought  into  motion. 

203.  Like  specific  sensibility  (§  199),  and  the  organic  property,  ir- 
ritability (§  190-192),  sympathetic  sensibility  is  variously  modified  in 
different  parts,  by  which  it  is  adapted  to  the  reception  of  impressions 
from  agents  of  particular  virtues,  and  for  their  transmission  to  the 
nervous  centres,  and  for  the  ultimate  generation  of  true  sympathy; 
while  the  same  agents  fail  of  these  effects  in  other  parts  (§  133,  &c.). 


PHYSIOLOGY. VITAL    PROPERTIES.  103 

204.  Another  manifest  contradistinction  between  sympathetic,  and 
common  and  specific  sensibility,  is  seen  in  the  general  failure  of  im- 
pressions made  on  sympathetic  sensibility  to  act  upon  the  mind,  and 
therefore  in  the  ordinary-  absence  of  all  sensation.  If  sensation  be  an 
attendant  phenomenon,  it  then  arises  from  impressions  simultaneously 
made  upon  common  sensibility  (§  445,  464-467,  473,  no,  5,  474,  no.  4, 
523,  1037,  b). 

3.    MOBILITY. 

205,  a.  Mobility  is  the  property  by  which  all  motions  are  carried 
on  in  animals  and  plants.  It  is  peculiar  to  the  solids,  though  some 
late  physiologists  have  ascribed  it  to  the  globules  of  blood,  while  oth- 
ers have  mistaken  the  globules  for  entozoa  (§  233,  253,  &c.). 

205.  b.  Sensible  and  insensible  contractility,  as  employed  by  Bichat, 
and  muscular  power,  are  bad  substitutes  for  the  name  mobility.  They 
lead  to  erroneous  conclusions  ;  since  the  heart,  blood-vessels,  and  other 
muscular  organs  dilate  or  elongate,  as  well-  as  contract,  through  the 
same  vital  property;  and  motion  occurs  in  various  tissues. — [Med. 
and  Physiolog.  Conim.,  vol.  i.,  p.  150,  379-391.) 

The  terms  sensible  and  insensible  contractility  limit  the  law  of  mo- 
tion to  simple  contraction,  while  there  must  be  often  a  con-espond- 
ing  active  dilatation,  or  the  part  would  always  remain  in  a  state  of 
tonic  spasm.  Elasticity  will  never  explain  the  dilatation  of  the  heart, 
of  the  veins,  &c. — [Med.  and  Physiolog.  Conmi.,  vol.  ii.,  p.  147-156, 
175,  176,  399-402,  Mhere  this  is  fully  examined). 

206.  The  philosophical  Macbride  remarks  that,  "  as  irritability  ne- 
cessarily implies  mobility  of  the  animal  fibres,  this  does  not  require 
to  be  considered  a  distinct  property."  If,  then,  the  existence  of  mo- 
bility be  thus  implied,  it  is  a  distinct  property;  and  when  the  phenom- 
ena of  irritability  and  mobility  are  duly  considered,  it  will  be  seen 
that  they  should  be  regarded  in  a  separate  sense.  Imtability  is  cer- 
tainly necessary  to  the  exercise  of  mobility ;  but  the  former  may  be 
greatly  exalted  without  a  corresponding  increase  of  motion.  The 
distinctions  are  numerous  and  of  great  practical  importance  (^  500,  d). 

207.  The  existence  of  mobility  in  plants  is  abundantly  shown  by 
the  motion  of  their  fluids,  which  no  mechanical  principle  can  inter- 
pret, by  their  secretions,  and  by  other  results  analogous  to  those  which 
depend,  in  part,  on  this  property  in  animals.  It  is  also  manifested  by 
the  sensible  movements  of  the  leaves,  blossoms,  stamina,  &c. ;  and 
from  these  we  may  reason  analogically,  and  infer  insensible  motions 
of  the  sap-vessels,  the  secretory  apparatus,  &c.,  as  is  also  done  in  an- 
imals (^  1054). 

Mobility,  therefore,  gives  rise  to  sensible  and  insensible  motions. 
They  are  generally  sensible  in  animal  life,  and  of  either  kind  in  or- 
ganic (§  476-492,  516,  no.  2  ;  also,  Medical  and  Physiological  Com- 
mentaries, vol.  ii.,  p.  150,  379-391). 

208.  Mobility  is  brought  into  operation  through  impressions  made 
on  irritability,  whether  by  vital  stimuli  in  organic  life,  or  by  the  ner- 
vous power  in  either  organic  or  animal  life  (§  188).  The  philosophy 
of  this  will  be  considered  along  with  the  attributes  of  the  nervous 
power,  the  function  of  sympathy,  and  the  laws  of  sympathy. 

209.  If  sensation  apparently  give  rise  to  motion,  it  may  be  occa- 
sioned by  the  action  of  external  or  internal  causes  upon  sensibility; 


104  INSTITUTES    OF    MEDICINE. 

but  this  impression  is  imparted  to  in-itability  and  then  to  mobility, 
before  motion  can  follow  (§  195) ;  or,  from  the  intimate  associations 
and  analogies  between  irritability  and  sensibility,  the  two  properties 
may  be  simultaneously  affected  by  the  same  agents.  Where,  how- 
ever, sensation  is  accompanied  by  motion  as  an  apparent  effect  of  im- 
pressions upon  common  sensibility,  it  probably  arises  in  all  cases  from 
a  simultaneous  impression  upon  sympathetic  sensibility  (§  198,  201, 
202).     This  exact  analysis  is  indispensable  to  our  subject. 

210.  Irritability  may  be  increased  through  an  exalted  state  of  sym- 
pathetic sensibility,  and  organic  motions  may  be  thus  increased 
through  sensibility ;  which  is  nearly  the  same  as  the  foregoing  law 
(§209). 

211.  It  is  doubtful  whether  parts  may  be  irritated  without  exciting 
mobility  (§  202)  ;  but  it  is  otherwise  with  common  and  specific  sensi- 
bility, as  in  seeing,  tasting,  &c.,  and  in  pain. 

212.  Mobility,  like  irritability  and  sensibility,  may  be  in  a'passive 
or  dormant  state,  as  in  the  ovum  and  seed,  or  as  sensibility  exists  in 
the  organic  life  of  animals.  All  are  roused  by  appropriate  agents, 
and  could  not  be  roused  were  they  not  already  present.  Certain  an- 
imals, such  as  the  wheel,  and  the  sloth  animalcula,  may  have  all  appa- 
rent traces  of  life  extinguished,  maybe  completely  exsiccated,  and  be 
speedily  revived  by  heat  and  moisture.* 

The  first  impression  of  semen,  or  of  heat,  &c.,  upon  the  ovum,  or 
seed,  is  made  on  irritability,  through  which,  as  the  next  stejD  in  the 
process,  mobility  is  roused  into  action.  Then  follow  the  new  ele- 
mentary combinations. 

We  thus  learn,  in  part,  that  life  is  a  cause,  not  an  effect. — [Med. 
and  Physiolog.  Comm.,  vol.  i.,  p.  9,  et  seq.) 

213.  Sensible  mobility  is  especially  manifested  in  the  compound 
organs,  taken  as  a  whole  (§  205).  Insensible  mobility  occurs  in  the 
small  vessels  (§  207).  But,  the  palpable  evidences  of  a  special  law 
of  motion  in  the  small  vessels  are  apt  to  be  sacrificed  to  the  negative 
fact  that  the  motion  itself  is  not  of  a  visible  nature.  As  well  might 
we  deny  the  existence  of  microscopical  animals. 

214.  The  insensible  motions  in  organic  life  are  the  most  important 
that  occur,  especially  such  as  take  place  in  the  extreme  capillary  ves- 
sels ;  since  these  are  the  instruments  of  all  the  most  essential  actions 
and  phenomena  of  life,  and  of  disease. 

215.  Voluntary  motion  is  brought  into  exercise  by  the  will  and 
nervous  power,  as  will  be  set  forth  under  my  consideration  of  the  lat- 
ter property  and  the  function  of  motion  (§  222-233|,  500  d).  The 
essential  difference,  therefore,  between  the  motions  in  animal  and  or- 
ganic life  lies  in  the  nature  of  the  stimuli ;  voluntary  motion  requiring 
the  exercise  of  the  will,  while  the  organs  of  oi'ganic  life  rarely  obey 
the  stimulus  of  the  nervous  power  when  excited  by  the  will  (^^  500  e). 
It  is  probable,  also,  that  mobility  has  a  peculiar  modification  in  the 
muscular  tissue  of  animal  life. 

Notwithstanding  mobility,  in  animal  life,  is  always  subject  to  the 
nervous  power,  motion  is  here,  as  in  organic  life,  independent  of  the 
nervous  system,  excepting  as  supplying  a  stimulus  (H83,  486). 

*  Sec  Spallanzani's  Experiments  in  Opusculi  di  Fisca  Animale,  Opere,  t»vi,  p. 
*83-55e. 


PHYSIOLOGY. VITAL    PROPERTIES.  105 


4.    VITAL    AFFINITY. 

216.  It  has  been  seen  that  the  elements  of  organic  compounds  arc 
very  differently  combined  from  those  of  inorganic  (§  32,  &c.).  Hence 
has  arisen  the  term  vital  affinity,  as  denoting  a  property  peculiar  to 
plants  and  animals,  by  which  all  their  elements  are  united  and  main- 
tained in  combination.  When  death  takes  place,  chemical  affinities 
operate,  and  resolve  the  organic  into  inorganic  compounds,  or  into 
their  simple  elements  (§  174). 

217.  Vital  affinity  exists  in  modified  states  in  the  two  departments 
of  organic  nature  ;  since,  in  plants,  it  unites  the  simple  elements  into 
organic  compounds,  while  in  animals,  it  can  operate  only  upon  com- 
pounds of  this  complexity.  Vegetable  organization  is,  therefore, 
more  of  a  creative  nature  than  animal  (§  13). 

5.    VIVIFICATION. 

218.  By  vivijication,  in  conjunction  with  vital  affinity,  life  is  bestow- 
ed upon  dead  matter.  The  elements  of  matter  are,  essentially,  com- 
bined into  organic  compounds  by  vital  affinity  ;  but  there  is  a  pro- 
gressive vitalization  of  the  organic  compounds  till  they  become  united 
with  the  solids.  This  shows  that  vital  affinity  must  have  an  associate 
power  of  vivification. 

219.  Vivification  belongs,  particularly,  to  the  assimilating  organs, 
though  its  energy  must  be  great  in  the  gastric  juice.  It  has  natural 
modifications  in  all  parts,  and  presents  distinctions  between  plants 
and  animals. 

220.  a.  Vital  affinity  and  vivification,  like  the  other  properties  of  life, 
are  susceptible  of  morbid  changes.  This  gives  rise  to  changes  in  the 
general  vital  character,  and  in  the  composition,  of  the  solids  and  fluids. 

These  changes  in  composition  are  inferred  upon  principle,  as  well 
as  from  observation  (§  666,  Z»).  No  chemical  analysis  can  detect  them, 
unless  it  be  an  alkalescence  or  an  acidity  of  the  secreted  fluids,  or 
changes  in  the  urine ;  and  even  these  imperfect  results  are  often  sur- 
rounded by  objections  (§  5^  b,  53,  1029,  1030). 

220,  b.  Changes  in  some  of  the  secretions,  as  in  the  milk,  may  be 
brought  about  by  temporary  influences,  and  independently  of  disease, 
as  by  emotions  of  the  mind,  the  action  of  cathartics,  &c.  These  also 
affect  the  condition  of  organs  and  their  products  in  the  various  states 
of  disease;  and  upon  this  depends  the  art  of  medicine  (§  852,  &c.). 

220,  c,  The  alterations  which  take  place  in  the  solids  and  fluids  are 
always  the  same  in  any  given  condition  of  the  affected  properties  of 
life.  They  are,  therefore,  constantly  liable  to  variations  during  the 
progress  of  disease,  and  are  various  in  different  diseases,  and  accord- 
ing, also,  to  the  nature  of  remedial  influences,  and  of  those  other  causes 
by  which  they  are  affected  independently  of  disease  (§  672). 

221.  The  changes  which  arise  in  the  solids  and  fluids  from  morbid 
conditions  never  approximate  the  condition  of  dead  matter  {^  674). 

22 li.  Changes  in  organic  compounds  may  be  the  result  of  the  di- 
rect action  of  physical  agents,  but  are  generally  owing  to  alterative  in- 
fluences of  direct  or  reflex  nervous  action  leading  to  disease,  and  some- 
thing to  the  natural  law  that  the  nerves  impress  a  special  condition 
upon  animal  compounds,  both  solid  and  fluid  (§  69,  226,  399,  405, 
446  a,  455,  456  a,  461,  485,  4881  489,  512,  740,  952). 


106 


INSTITUTES    JF    MEDICINE. 


6.    THE    NERVOUS    POWER ITS    DIRECT    AND    REFLEX    ACTION. 

222,  a.  The  analysis  which  I  shall  make  of  sympathy  establishes  so 
clearly  its  functional  character,  that  I  shall  remove  it  from  among 
the  properties  peculiar  to  animals,  where  it  has  been  hitherto  placed. 
In  defining  this  function,  generally  regarded  as  a  property,  1  shall 
introduce  the  nervous  power,  upon  which,  in  connection  with  sensi- 
bility, the  function  depends  (§  201).     This  is  reflex  nervous  action. 

222.  b.  The  philosophy  of  the  operation  of  the  nervous  power  in 
producing  motion,  under  all  its  various  aspects,  as  manifested  in  its 
natural  regulation  of  organic  functions  (^  202),  or  by  its  ether  reflex 
actions  as  induced  by  morbific  and  remedial  agents,  or  by  the  influ- 
ences of  disease,  in  the  motions  which  are  generated  in  the  organs  of 
organic  life  by  the  passions  and  analogous  aftections  of  the  mind,  in 
the  movements  of  the  voluntary  muscles,  in  the  production  of  sudden 
death  from  all  causes,  as  well  as  the  solution  of  other  relative  prob- 
lems, and  the  physiological  interpretation  of  the  recognized  laws  of 
sympathy  and  their  general  introduction  into  pathology  and  thera- 
peutics, were  originally  attempted  by  myself  in  the  Medical  and 
Physiological  Commentaries,  and  subsequently,  and  more  extensively, 
in  my  Essay  on  the  Modus  Operandi  of  Remedial  Agents.*  Should 
the  exposition  there  and  now  set  forth  prove  to  be  well  founded,  it 
must  necessarily  result,  sooner  or  later,  in  the  overthrow  of  all  the 
mechanical  and  chemical  hypotheses  in  physiology,  consign  to  its 
well-merited  oblivion  the  humoral  pathology,  and  place  upon  its  true 
foundation  the  operation  of  remedial  agents. — See  Eights,  &c.,  p.  912. 

223.  The  nervous  power  appertains  to  the  vital  principle,  resides 
exclusively  in  the  nervous  systems,  and  is,  therefore,  peculiar  to  ani- 
mals (§  184,  h).  It  gives  rise,  however,  to  results  in  organic  as  well  as 
animal  life.  These  results,  also,  are  far  more  numerous  and  impor- 
tant in  the  organic  than  the  animal  mechanism,  while  sensibility  is  es- 
pecially designed  for  the  latter.  Unlike  sensibility,  also,  in  its  func- 
tion of  sensation,  perception  is  not  necessary  to  the  operations  of  the 
nervous  power,  nor  does  the  latter,  like  sensibility  in  its  office  of  pro- 
ducing sensation,  require  a  continuity  of  the  nerves  with  the  brain  for 
reflex  or  direct  action,  especially  in  organic  life  (§  209,  507). 

The  nervous  power  is  constantly,  though,  for  the  most  part,  in  in- 
sensible operation  throughout  the  organic  mechanism,  modifying  tho 
actions  and  animalizing  the  products  of  all  parts.  For  this  special 
reason  1  have  endeavored  to  show  that  the  nervous  power  is  super- 
added to  the  vital  principle  of  animals,  and  that  the  complexity  of  or- 
gans and  functions  which  it  is  designed  to  subserve,  and  the  absence 
of  its  phenomena  in  plants,  afford  a  substantial  proof  that  the  proper- 
ty belongs  to  animals  alone    (^  1041.) 

224.  The  nervous  power  is  exerted,  especially,  through  what  are 
denominated  the  motor  nerves  and  the  motor  fibres  of  compound 
nerves,  or  "  nerves  of  motion  ;"  these  nerves,  however,  being  mainly 
dependent  for  the  nervous  power  upon  the  brain  and  spinal  cord 
(§  201). 

Nevertheless,  there  is  reason  to  suppose  that  the  nervous  power  is 

implanted  in  the  motor  nerves,  as  well  as  in  the  brain  and  spinal  cord. 

The  phenomena  of  contiguous  sympathy,  as  when  inflammation  of 

the  liver,  the  lungs,  &c.,  is  relieved  by  blisters,  over  the  region  of  the 

*  Mkd.  and  Phys.  Com.\i.,  1840.— Ess.u',  cJc.,  1842. 


PHYSIOLOGY. VITAL    PROPERTIES.  107 

affected  organs,  cannot  be  traced  through  the  cerebro-spinal  system, 
excepting  in  its  connection  with  the  ganglionic,  which  supplies,  in  such 
cases,  the  immediate  centres  of  reflex  nervous  action  (§  893).  There 
exists  a  great  fundamental  distinction  between  the  cerebro-spinal  and 
ganglionic  systems,  the  former  of  which  is  allotted  especially  to  animal 
life,  the  latter  to  organic  (§  113);  and,  although  the  cerebro-spinal  be 
associated  in  function  with  the  ganglionic,  purely  cerebro-spinal  nerves 
exert  no  influences  upon  the  organic  functions,  not  even  the  pneumo- 
gastric  till  independent  life  begins,  while  the  ganglionic  supplies  the 
stimulus  to  organic  muscles,  combines  the  organic  viscera,  and  determ- 
ines exciting  and  modifying  effects  upon  all  their  actions,  by  which  the 
secretions  are  variously  increased  or  diminished,  and  the  organic  prod- 
ucts imbued  with  peculiarities  that  distinguish  them  from  the  or- 
ganic compounds  of  plants ;  and  what  is  of  vast  practical  importance, 
it  is  owing  to  those  physiological  differences  that  morbific  and  reme- 
dial agents  operate,  essentially,  through  the  sympathetic  system  (§  113, 
409  h,  422,  461-46U,  475i,  500  g,  524  a,  no.  7,  89U  g,  Ic,  893i). 

225.  Like  irritability,  sensibility,  and  the  other  properties  of  life,  the 
nervous  power  is  capable  of  being  acted  upon  by  external  and  internal 
causes,  both  mental  and  physical,  of  being  increased,  or  diminished,  or 
altered  in  kind,  according  to  the  nature  of  the  causes  (§  200,  203,  258). 

226.  The  nervous  power  possesses  the  remarkable  characteristic  of 
being  a  vital  agent  to  the  property  irritability  (§  184  I).  It  is  also  li- 
able to  artificial  modifications  from  the  operation  of  physical  and  mental 
causes  upon  the  nervous  system ;  and  its  influences  upon  irritability  will 
correspond  with  the  nature  of  its  modifications  ;  being  thus  rendered  a 
vital  stimulus,  or  a  vital  depressant,  or  a  vital  alterative  (§  150).  When, 
therefore,  this  power  operates  in  any  unusual  manner,  organic  and  an- 
imal motions,  whether  sensible  or  insensible,  will  be  variously  modified, 
or  produced,  by  calling  mobility  into  exercise,  according  to  the  nature 
of  the  influences  exerted  upon  the  power,  and  products  will  vary  ac- 
cordingly. This  grows  ovit  of  the  natural  ofl[ice  of  the  nervous  system 
of  exciting  and  modifying  organic  actions  and  their  results  (§  461). 

227.  The  nervous  power  is  brought  into  unusual  operation  very  va- 
riously, according  to  the  seat  and  nature  of  the  exciting  cause  (§  951). 

1st.  Its  operation  is  excited  in  a  direct  manner  by  irritants,  «&c.,  ap- 
plied to  the  brain,  to  the  spinal  cord,  and  to  the  motor  nerves.  It  is 
also  excited  directly  by  cerebral  or  spinal  disease,  by  the  passions,  men- 
tal emotions,  imagination,  intense  reflection,  and  by  the  yvi\\.  This  I 
call  direct  nervous  action  (§  222  a).  In  all  the  cases,  the  nervous  pow- 
er will  be  rendered  stimulant,  or  depressant,  or  alterative  to  the  or- 
ganic properties  and  functions ,  and  variously  energetic  according  to 
the  nature  of  the  operating  cause,  and  the  intensity  and  suddenness 
with  which  it  may  operate  (§  480,  743,  951).  In  blushing,  the  pow- 
er is  rendered  stimulant;  by  fear,  depressant;  by  grief,  anger,  hope, 
&c.,  alterative  (§  844).  These  effects  are  also  commonly  very  sud- 
den, especially  the  physiological.  Even  such  as  are  morbific  are  oft- 
en almost  instantaneous ;  and  this  rapidity  of  change  ceases  to  be  re- 
mai'kable  when  we  regard  their  near  coincidence  with  the  natural  re- 
sults, and  that  the  same  principle  is  involved  in  voluntary  motion. 

A  close  analogy  subsists  between  all  the  foregoing  direct  causes 
and  all  the  physical  agents  of  life,  whether  natural,  morbific,  or  reme- 
dial, as  the  latter  may  develop  the  nervous  power  through  sensitive 
nerves.     These  analogies  Avill  have  been  variously  illustrated.     They 


108  INSTITUTES    OP    MEDICINE. 

evince  tlie  simplicity  of  fundamental  principles  and  the  relationship 
and  perfect  harmony  which  prevail  among  the  whole,  even  those 
which  are  especially  relative  to  mind  and  instinct  as  superadded  to 
the  simple  condition  of  the  vegetable  kingdom  (§  323-325,  818^). 

2d.  The  reflex  action  of  the  nervous  power  is  excited  through  the 
medium  of  sympathetic  sensibility  (§  201-203).  This  complex  process 
results  in  the  true  function  of  sympathy.  Impressions  are  made  by 
physical  and  mental  causes,  by  disease,  &c.,  upon  the  foregoing  varie- 
ty of  sensibility,  which  I  call  sympathetic  from  the  office  of  the  sensi- 
tive conductors  in  this  function  of  reflex  nervous  action.  The  impres- 
sions are  then  communicated  to  the  cerebro-spinal  axis,  or  to  other 
central  parts  of  the  nervous  system,  and  there  bring  into  operation, 
and  variously  modify,  the  nervous  power  (§  224).  The  power,  thus 
developed,  thus  influenced,  or  so  modified  in  kind  that  it  partakes  of 
the  nature  of  the  transmitted  impressions,  which  are  more  or  less  co- 
incident with  the  virtues  of  the  remote  causes,  is  then  exerted,  through 
the  motor  system  of  nerves,  upon  the  organic  properties  of  distant 
parts,  or  of  the  nervous  system  itself  (§  208,  209,  462-469),  by  which 
those  properties,  and  their  resulting  functions  and  products,  are  vari- 
ously affected  according  to  the  foregoing  circumstances.  From  this 
fact  it  also  results,  that  the  modified  conditions  which  are  brought 
about  by  the  nervous  power,  when  the  preternatural  operation  of  this 
power  depends  upon  extei'nal  causes,  whether  morbific  or  remedial, 
are  more  or  less  analogous  to  those  changes  in  the  organic  conditions 
which  are  wrought  in  parts  by  the  direct  operation  of  the  same  causes 
(§  188,  657  b,  503-505,  8911  k  893  e,  902,  904  a,  951  c,  990^). 

228,  a.  It  thence  follows,  that  there  is  imparted  to  the  nervous 
power,  by  the  foregoing  means  (§  227),  more  or  less  of  the  charac- 
teristic virtues  of  the  remote  causes,  but  under  the  influence  of  its  own 
nature,  by  which  the  nervous  power  is  substituted  for  those  causes, 
and  thus  reaches,  with  its  acquired  attributes,  and  their  various  effects, 
every  pait  of  the  organization,  and,  often,  with  great  instantaneous- 
ness.  It  appears,  therefore,  that  this  constitution  of  the  nervous  pow- 
er is  wonderfully  suited  to  the  various  exigencies  of  life ;  while,  as 
will  be  seen  in  section  232,  it  grows  out  of  its  physiological  nature  as 
a  regulator  of  organic  actions  (§  1057,  1075,  481  d). 

228,  h.  It  is  also  an  important  law  that  the  nervous  power  is  vari- 
ously influenced  in  its  morbific  and  remedial  action  by  slight  vari- 
ations in  the  intensity  of  the  operating  causes,  whether  mental  or  phys- 
ical ;  though  a  determination  is  simultaneously  given  to  its  action  by 
the  numerous  other  conditions  already  mentioned,  and  which  may 
happen  to  be  present.  Thus,  an  impression  from  cold,  as  a  blast  of 
air,  or  a  drop  of  cold  water,  upon  the  skin  in  syncope,  will  rouse  the 
respiratory  organs.  Another  impression  from  the  same,  and  under 
other  circumstances,  will  excite  catarrh,  or  pneumonia,  or  articular 
rheumatism.  One  degree  of  impression  upon  the  stomach  by  tartar- 
ized  antimony  will  determine  the  nervous  power  upon  the  respiratory 
muscles  (as  will  cantharides  upon  the  bladder,  or  mercury  upon  the 
salivary  glands),  and  vomiting  is  the  consequence ;  while  it  simul- 
taneously reflects  the  same  power  upon  the  skin,  and  other  organs, 
and  of  which  perspiration,  &c.,  is  a  consequence.  In  smaller  doses, 
the  respiratory  movements  are  not  affected,  but  only  the  condition  of 
the  skin,  &c.,  and  in  lesser  degrees.     But,  these  examples  embrace 


PHYSIOLOGY. VITAL    PROPERTIES.  109 

only  certain  pails  of  the  influences  in  each  case ;  while  in  others  they 
are  far  more  complex,  one  sympathetic  result  becoming  the  cause  of 
others,  till,  through  a  single  impression  upon  the  skin,  vai'ious  circles 
of  morbific  or  remedial  reflex  nervous  actions  may  be  instituted. 

229.  When  disease  operates  in  the  foregoing  manner  in  exciting 
the  nervous  power,  and  determining  it  with  alterative  effects  upon  re- 
mote parts,  or  upon  the  nervous  system  itself,  it  often  imparts  to  it  a 
modification  by  which  a  similar  condition  of  disease  is  generated  in 
the  parts  vipon  which  the  power  is  thus  determined.  Hence  the  con- 
secutive inflammations  which  are  often  springing  up,  sympathetically, 
in  various  parts.  But,  this  depends,  more  or  less,  upon  the  nature  of 
the  organs  secondarily  affected,  upon  their  precise  condition  as  divert- 
ed more  or  less  from  their  healthy  states  by  other  causes,  upon  tem- 
perament, age,  sex,  &c.  When,  thei'efore,  the  nervous  power  is  de- 
veloped by  disease,  other  conditions  varying  more  or  less  from  the 
primary  affection  are  observed  among  the  common  effects.  For  the 
same  reasons,  also,  when  morbific  and  remedial  agents  operate  through 
the  medium  of  the  nervous  power,  the  results  may  be  very  various. 

230.  If  the  nervous  power  be  brought  into  preternatural  operation 
in  a  direct  manner  (§  227),  as  when  impressions  are  made  upon  the 
brain,  or  spinal  cord,  or  the  trunks  of  nei-ves,  or  by  cerebral  disease, 
or  when  the  mind  or  passions  develop  its  operation,  it  is  also  liable  to 
modifications,  and  corresponding  effects,  as  when  the  impressions  are 
communicated  through  the  medium  of  the  sensitive  conductors.  Thus 
alcohol,  applied  to  the  brain  or  spinal  cord,  increases  the  action  of  the 
heart  and  capillary  blood-vessels,  and  so  do  anger,  joy,  hope,  love, 
imagination.  But,  a  watery  infusion  of  opium  or  of  tobacco,  applied 
in  like  manner,  depressesthose  actions,  and  so  do  fear,  grief,  and  anx- 
iety. We  see,  also,  various  other  organic  functions  affected  in  a  cor- 
responding manner  (§  480-485,  489-492,  943,  945).  In  these  cases, 
the  nervous  power  is  often  determined,  with  more  or  less  effect,  di- 
rectly upon  the  organic  properties  of  the  brain,  and  may  extinguish 
them  instantly.  A  sudden  explosion  of  anger  may,  in  this  manner, 
induce  apoplexy,  while  in  other  cases  the  destructive  influence  of  the 
nervous  power  is  expended  mainly  upon  the  heart.  Inflammation  of 
the  brain  determines  the  nervous  power  directly  upon  the  cerebral 
vessels  which  carry  on  the  morbid  process,  and  thus  increases  its  force 
and  obstinacy.  So  with  many  morbific  and  remedial  agents  of  a 
physical  nature,  which,  when  applied  to  the  stomach,  excite  the  ner- 
vous power  indirectly,  or  through  the  medium  of  the  sensitive  fibres 
of  the  pneumogastric  and  sympathetic  nerves,  but  in  which  cases  the 
nervous  power  is  reflected  upon  the  organic  properties  of  the  brain, 
or  of  the  spinal  cord,  or  of  the  individual  nerves,  as  well  as  upon 
those  of  other  parts.  Such  is  the  case  with  all  the  narcotics,  strych- 
nine and  analogous  substances,  prussic  acid,  aconite,  &c.,  which  bear 
specific  relations  to'  the  nervous  system ;  either  exciting  or  removing 
morbid  states  of  the  brain  or  nerves  (§  487  g,  526  d). 

231.  It  is  not  alone  the  general  functions  of  tissues  and  of  com- 
pound organs  which  are  affected  by  the  nervous  power  in  the  fore- 
going manner  (§  227-230),  but  equally,  also,  those  of  the  intimate  or- 
ganization of  all  parts,  upon  which  nutrition,  vital  decomposition,  &c., 
depend.     It  always  acts  upon  minute  structure  {^  395,  1040). 

232.  The  modifications   of  the  nervous  power  now  described  (§ 


110  INSTITUTES    OF    MEDICINE. 

5J27-230)  are  analogous  to  those  which  we  have  seen  to  be  exerted 
upon  irritability  and  sensibility  (§  191,  200),  and  they  spring  from 
that  physiological  constitution  of  the  nervous  power  which  is  design- 
ed for  great  natural  purposes  in  the  animal  economy.  This  power  is 
manifestly  associated  with  the  vital  principle  of  animals  (§  184,  h)  as 
a  regulator  of  their  multifarious  parts,  by  which  the  whole  are  main- 
tained in  harmonious  action,  or  by  which  the  varying  changes  and 
failures  of  some  shall  institute  vital  changes  in  other  parts  that  shall 
contribute  to  the  restoration  of  the  former,  or  exempt  the  general  or- 
ganism from  the  evils  which  would  otherwise  arise  (§  455).  Volun- 
tary motion  (§  215,  486),  respiration,  a  permanent  contraction  of  the 
sphincters,  are  also  other  final  causes  of  the  institution  of  the  nei-vous 
power.  Tlie  power  is  in  perpetual  operation  in  every  part  of  the 
animal  organization,  though  more  obviously  pronounced  in  some  of 
its  results  than  in  others,  as  in  the  function  of  respiration,  the  perma- 
nent contraction  of  the  sphincters,  the  motions  of  the  iris,  &c.  It  is, 
however,  not  less  constantly  operative,  though  with  less  intensity,  in 
all  organic  processes,  bestowing  important  conditions  upon  all  pro- 
ducts of  an  organic  nature,  solid  or  fluid,  and  forever  stretches  its 
universal  sway,  as  a  harmonizing  power,  over  the  whole  organic 
mechanism.  This  power,  therefore,  is  rendered  exquisitely  suscepti- 
ble to  the  most  astonishing  variety  of  physical,  vital, and  mentalcauses  ; 
and,  that  it  may  feel  and  transmit  the  influences  of  the  vital  changes 
that  may  befall  one  part  or  another  to  other  parts,  for  the  maintenance 
of  the  gi'eat  balance  of  functions,  and  to  fulfill  the  ofiice  of  restoration 
as  well  as  of  conservation,  there  is  imparted  to  it,  as  to  the  other  prop- 
eities  of  life,  a  partial  mutability  in  its  nature,  confoiTnable  to  the  va- 
rious impressions  exerted  upon  it,  and  by  which  it  is  rendered  vari- 
ously and  usefully  alterative  to  morbid  conditions;  and  since,  also, 
such  alterative  effects  as  are  demanded  by  morbid  states  could  not  be 
exerted  by  a  natural  vital  agent  in  its  unmodified  condition.  Thus 
we  have,  in  the  obvious  constitution  of  the  nervous  power,  as  manifest 
in  its  common  functions,  a  principle  of  interpretation  for  all  the  vari- 
ety of  changes  that  are  not  less  obviously  exerted  upon  it  by  morbific 
and  remedial  agents  than  are  plain  its  reflex  and  direct  actions. 

233.  The  nervous  power  does  not  generate  motion  either  in  animal 
or  organic  life  (§  476-492,  516,  nos.  2,  7).  It  only  influences  the  or- 
ganic property  mobility,  upon  which  all  motion  depends,  through  the 
medium  of  irritability  (§  188,  205,  208,  209,  226).  Even  voluntary 
motion  is  entirely  independent  of  the  nervous  system,  excepting  as 
the  nervous  power  is  a  stimulus  to  in'itability.  In  the  production  of 
this  complex  function  several  elements  are  concerned  :  1st.  The  will, 
operating  as  a  stimulus  upon  the  brain,  develops  the  nervous  power; 
2d.  This  power  is  then  transmitted  to  the  voluntary  muscles,  where  it 
acts  as  a  stimulus  upon  irritability  (§  226) ;  3d.  Mobility  is  thus  called 
into  exercise,  the  immediate  result  of  which  is  voluntary  motion  (§ 
205,  206,  208,  209,  245,  256,  476  c,  486,  487,  492,  no.  7,  500  d). 
However  complex,  and  destitute  of  analogies  in  the  world  of  mere 
physics,  this  phenomenon  may  be,  I  have  no  doubt  that  the  solution 
which  I  have  offered  will  bj  received  by  every  philosophical  mind 
which  may  attentively  consider  the  nervous  power  in  its  connections 
with  the  motor  nerves,  and  the  experiments  of  Wilson  Philip  (§  464, 
&c.,  476,  &c.,  1041). 


PHYSIOLOGY. VITAL    PROPERTIES.  Ill 

Since,  also,  the  nervous  power  has  no  existence  in  plants,  their  ac- 
tions are  alone  influenced  by  the  physical  agents  of  life ;  and,  havin<» 
no  sympathetic  relation  of  parts,  the  diseases  of  one  part  are  felt  by 
other  parts  only  through  the  common  laws  of  nutrition,  wliile,  also, 
remedial  agents  are  curative  by  their  local  action  alone. 

2331^.  The  nervous  power,  in  a  manner  analogous  to  its  determ^ia- 
tion  upon  the  sphincter  of  the  bladder  after  the  evacuation  of  the 
urine,  may  be  propagated  upon  distant  parts,  with  morbific  or  curative 
effects,  long  after  the  removal  of  the  agent  by  which  it  was  originally 
■excited.  This  is  owing  to  the  continued  change,  or  impression,  wrought 
upon  the  part  to  which  the  agent  was  applied  (§  514  g,  516,  no.  6). 

233 J.  One  of  the  most  remarkable  laws  of  the  nervous  power  is 
that  of  its  determination  through  particular  nerves  upon  certain  parts, 
according  to  the  nature  of  the  exciting  cause,  whether  mental  or  phys- 
ical, whether  natural,  morbific,  or  remedial,  and  equally  so  in  animal 
and  organic  life ;  passing  over,  in  the  fulfillment  of  this  law,  various 
intermediate  nerves  of  more  direct  anatomical  connection.  This  is 
remarkably  exemplified  in  many  musical  performances  and  feats  of 
agility.  This  special  determination  of  the  nervous  power  is  most  in 
conformity  with  the  special  influences  that  may  bring  it  into  operation, 
in  healthy  conditions  of  the  body ;  but  in  diseased  states,  or  where  or- 
gans are  but  partially  diverted  from  their  natural  state,  a  direction  is 
more  or  less  given  to  the  determination  of  the  power  by  these  acquired 
susceptibilities  (§  500  j,  k,  871).  This  peculiar  attribute  of  the  ner- 
vous power  distinguishes  it  from  the  direct  action  of  remedial  and 
morbific  agents,  which,  if  taken  into  the  circulation  in  efficient  quan- 
tities, would  often  derange  the  universal  body.  But  the  same  physi- 
ological constitution  of  the  nervous  power  which  renders  it  obedient 
to  the  will  in  its  transmissions  to  particular  muscles,  or  to  the  passions 
in  its  effects  on  special  organs  in  organic  life,  renders  the  power,  when 
modified  by  remedial  or  morbific  agents,  and  according  to  its  pre- 
cise modification  and  susceptibility  of  parts,  equally  determinate  and 
circumscribed  in  its  operation  (§  150-152,  838,  814).  There  is  noth- 
ing in  Nature  more  wonderful  and  paradoxical  than  this  attribute  of 
the  nervous  power ;  and  while  the  facts  which  it  supplies  in  connec- 
tion with  the  operation  of  the  will  and  the  passions  bear  with  the 
strongest  analogical  force  upon  the  philosophy  which  respects  the  in- 
fluences of  morbific  and  remedial  agents  upon  all  paits  distant  from  the 
seat  of  their  application,  that  analogy  is  corroborated  by  the  limitation 
of  the  morbific  or  remedial  effects  to  certain  parts  of  the  organism. 

2334.  It  appears,  therefore,  that  the  nervous  influence,  rtjlex  or  di- 
rect, is  generally  the  immediate  remote  cause  of  all  changes  beyond  the 
seat  of  the  direct  action  of  other  causes  (§  644-647^,  889  A). 

GENERAL    REMARKS    UPON    THE    PHILOSOPHY    OF    LIFE. 

234,  a.  Notwithstanding  all  the  laws  of  sympathy,  that  are  neces- 
sary to  the  full  interpretation  of  the  remote  effects  of  morbific  and  re- 
medial agents,  are  as  well  established  as  any  laws  in  physics,  they 
have  not  been  applied  to  these  important  objects ;  but,  on  the  contra- 
ry, those  philosophers  who  have  contributed  most  to  their  critical  ex- 
position overlook  their  pathological  and  therapeutical  bearings,  and 
cling  to  the  doctrines  of  humoralism,  and  of  the  operation  of  remedial 
agents  by  absorption ;  nor  have  they  applied,  in  the  least,  the  nervous 


112  INSTITUTES    OF    MEDICINE. 

powei  ill  a  philosophical  manner  to  an  exploration  of  the  natural  phe- 
nomena of  sympathy.  The  oscillations  of  Newton,  the  contractions 
of  Darwin,  the  vibrations  of  Hartley,  the  secretions  of  Galen,  the  gal- 
vanism of  Galvani,  the  destructive  forces  of  the  chemist,  and  the  caloric 
and  the  magnetism  of  wilder  imaginations,  continue  to  be  adopted, 
an^  show  as  well  by  their  great  incongruity  as  by  their  failure,  that 
the  hypotheses  are  founded  on  imaginary  data,  and  that  each  has 
neglected  the  phenomena  of  life  (§  189  h,  785,  1085). 

234,  h.  I  say  nothing  of  those  who  still  refuse  their  assent  to  the 
well-ascertained  laws  of  sympathy,  as  manifested  in  the  natural  states 
of  the  body.  These  they  have  yet  to  study  and  to  learn ;  but  it  may 
be  well  objected  that  their  ignorance  shall  prove  an  obstacle  to  the 
progress  of  knowledge  (^  905f). 

He,  indeed,  must  have  been  a  vei-y  imperfect  spectator  of  human 
events,  who  anticipates  the  acquiescence  of  ignorance  or  prejudice,  or 
the  ready  concuiTence  of  inferior  minds,  in  the  intricate  problems 
which  relate  to  the  laws  of  the  vital  functions.  The  demonstrations 
of  Philip  have  become  obsolete  in  all  but  their  abstract  nature;  and 
the  discoveries  of  Prochasca,  Sir  Charles  Bell,  Miiller,  Hall,  Valentin, 
and  others,  in  the  functions  of  the  nerves,  are  either  unknown,  or  un- 
appreciated, by  all  but  the  erudite  student  or  such  as  aim  at  erudition ; 
and  the  very  anatomical  medium  of  reflex  actions,  through  which  the 
operations  of  the  nervous  power  and  the  phenomena  of  sympathy  ap- 
peal, as  it  were,  to  the  senses  as  well  as  to  the  understanding,  is  apt  to 
be  regai'ded  as  an  accidental  or  as  a  superfluous  appendage  of  the 
body,  or  thrown  in  to  embaiTass  inquiry  by  multiplying  the  complex 
ities  of  organic  beings  (^  1039). — Rights  of  Authors,  p.  912. 

Coming  to  the  ditferent  kinds  of  irritability  and  sensibility,  or  as 
these  are  modified  by  morbific  and  remedial  agents,  or  by  other  phys- 
ical causes,  as  well  as  the  analogous  modifications  of  the  nervous 
power,  and  its  remarkable  attributes  as  a  vital  agent,  its  direct  action 
as  such  when  developed  by  causes  acting  directly  upon  the  nervous 
system,  or  when  brought  into  opei'ation  indirectly  through  the  medi- 
um of  sympathetic  sensibility  (§  227),  and  other  analogous  facts  which 
are  equally  substantiated  by  an  endless  variety  of  phenomena,  they 
are  pronounced  by  a  no  small  number  of  the  profession,  even  by  wri- 
ters who  appear  in  the  character  of  expounders  of  medical  philosophy, 
as  metaphysical  speculations,  or  as  imaginary  hypotheses.  Even  life 
itself  is  regarded  as  a  subtlety  of  the  schools,  or  as  a  phantom  of  less 
reputable  claims.  "  For  my  part,"  says  Magendie,  "  I  declare  boldly 
that  I  look  upon  these  ideas  about  vitality,  and  the  rest  of  it,  as  noth- 
ing more  than  a  cloak  for  ignorance  and  laziness"*  (§  1034). 

234,  c.  If,  then,  you  object  to  the  existence  of  a  principle  of  life, 
why  not  to  the  existence  of  mind,  to  the  imponderables,  or  to  tangible 
matter  itself  (§  168,  169,  175  hb)  ]  Do  you  deny  its  several  well- 
attested  properties  ?  Then  why  not  deny  the  properties  of  the  mind  % 
Have  you  not,  for  the  aid  of  the  senses,  a  tangible  analogy  in  the  solar 
beam  (§  188^  d,  234  e)1  Do  you  cast  aside  all  the  phenomena  of 
irritability  and  sensibility,  and  maintain  that  the  action  of  internal  and 
external  causes,  the  mind  and  its  passions,  is  exerted  upon  the  struc- 
ture alone,  because  you  cannot  see  the  properties  (§  169,  189)  ]     Can 

*  See  Medical  and  Physiological  Commentaries,  vol.  i.,  p.  397,  511,  512,  514,  515,  as  to 
Magendie 


PHYSIOLOGY. VITAL    PROPERTIES.  113 

you  see  the  Maker  of  the  eye,  or  did  the  eye  make  itself  (§  74)  ?  Do 
the  muscles  move  without  a  moving  power  1  Are  you  not  amazed  at 
what  you  cannot  deny,  that  the  mutual  co-operation  of  the  mind  and 
the  'brain,  which  results  in  willing,  is  limited  in  its  action  upon  the 
body  to  exactly  those  parts  where  its  operation  can  be  alone  useful 
to  the  animal,  namely,  the  voluntary  muscles  ;  nay,  more,  that  the  will 
elects  of  these  muscles  such  only  as  are  precisely  necessary  to  its 
present  purpose,  and  bestows  every  imaginable  degree  of  force  with- 
in the  limit  of  its  power,  and  variously,  also,  on  the  several  muscles 
which  it  may  throw  into  simultaneous  action  (§  233f ,  349  e,  500  i)  % 
Is  there  nothing  as  improbable  in  all  this  as  in  the  propositions  of  the 
vitalist  ]  Consider  how,  on  the  other  hand,  those  other  acts  of  the 
mind,  called  the  passions,  so  near  akin  to  the  will,  judgment,  reflec- 
tion, are  clearly  ordained  to  operate  in  organic  life  for  the  moral  and 
physical  good  of  the  being  ;  or,  if  they  be  also  the  causes  of  pain  and 
disease,  the  analogy  of  Nature  shines  out  even  here  in  placing  them 
on  a  par  with  the  morbific  agents  of  the  external  world.  If  this  be 
so,  or  a  single  fact  conceded,  how  will  you  disregard  the  multitudi- 
nous phenomena  of  irritability  and  sensibility,  or  their  various  natu- 
ral and  artificial  modifications  (§  64, y)  %  Will  you  consider  an  ar- 
gumentum  ad  Tiominem  7  Do  you,  then,  deny  that  you  possess  judg- 
ment, reflection,  and  the  ability  to  discover  truth  ]  If  you  object  not 
to  this,  you  must  concede  the  philosophy  of  these  Institutes  as  to  the 
foregoing  properties  of  life,  and  by  the  same  demonstration  upon 
which  that  philosophy  rests  you  must  admit  the  imputed  attributes  of 
the  nervous  power,  which  are  far  more  clearly  and  variously  attested 
than  judgment,  reflection,  or  the  ability  to  discover  truth.  Look  at 
the  experiments  by  Wilson  Phihp,  Hall,  Miiller,  Bell  (§  464,  &c.,  476, 
&c.).  Look  at  the  nervous  system,  and  there  you  shall  absolutely  see. 
Or,  do  you  require  other  aid  for  your  sc?ises,  look,  again,  at  the  analo- 
gies which  are  supplied  by  the  solar  beam,  by  electricity,  by  galvan- 
ism, by  magnetism.  Consider  how  they  astonish  you  in  their  over- 
powering influences  upon  all  things  but  the  living  being.  And  yet 
you  can  not  see  how  these  destructive  effects  are  exerted.  You  give  up 
your  senses  when  the  needle  traverses  the  compass,  and  stand  in  mute 
astonishment,  gazing  at  the  north  for  some  sign  that  shall  help  the  un- 
derstanding as  to  the  nature  of  the  mysterious  agent.  But  you  see 
and  Jeel  nothing.  Nor  is  this  all ;  for  the  dismay  of  sense  becomes 
inexpressible,  when  imagination  surveys  the  interval  of  thousands  of 
miles,  through  which  the  unseen  force  exerts  its  mystic  sway.  And 
so  of  gravitation.  But  the  effects  are  strongly  pronounced  upon  the 
sense  of  vision,  and  their  frequent  repetition  begets  an  acknowledg- 
ment that  there  is  something  besides  the  tangible  and  visible  qualities 
of  matter  which,  operating  through  vast  distances,  maintains  the  nee- 
dle in  one  everlasting  direction,  and  the  heavenly  orbs  in  their  unde- 
viating  rounds.  And  here,  in  the  perpetual  operation  of  magnetism, 
there  is  something  to  aid  your  conception  of  an  equally  unintermit- 
ting  exercise  of  the  nervous  power  {^  1034). 

234,  d.  Do  you  object  to  what  I  have  propounded  as  to  the  artifi- 
cial and  temporary  modifications  of  the  nervous  power  (§  227-232)  ? 
Can  you  state  an  objection,  farther  than  that  which  has  been  just  con- 
sidered 1  Do  not  the  infinite  phenomena  of  sympathy  mutually  con- 
spire together,  without  a  contradictory  fact,  in  proving  the  occurrence 

H 


114  INSTITUTES    OF    MEDICINE. 

of  sucli  modifications ;  and  is  there  a  single  effect  of  morbific  and 
remedial  agents,  operating  through  the  nervous  systems,  which  cannot 
be  clearly,  perfectly,  explained  by  the  doctrines  which  I  have  pro- 
pounded in  relation  to  the  nervous  power  1  Can  a  like  afl[irmation  be 
made  of  any  other  thing  1  But,  you  cannot  see  the  modifications  of 
the  nei-vous  power.  Neither  can  you  see  the  modifications  of  the 
electric  fluid,  as  manifested  under  the  conditions  of  electricity  and 
galvanism  ;  but,  the  effects  of  the  latter  make  a  strong  impression 
upon  sense,  which  grows  into  the  belief  that  physical  causes  do,  in  re- 
ality, alter  the  conditions  of  electricity  and  turn  it  to  galvanism,  and 
those  effects  have  actually  engendered  the  expression  of  "modification 
of  electricity."  Here,  then,  is  something  for  the  senses,  to  aid  them 
in  their  sui-vey  of  the  less  tangible,  but  not  less  precise,  and  infinitely 
diversified,  phenomena,  that  mark  the  artificial  modifications  of  imta- 
bility,  sensibility,  and  the  nervous  power.  And,  should  you  require 
a  like  assistance  as  to  the  natural  modifications  of  irritability  and  sen- 
sibility, or  even  the  existence  of  the  different  properties  which  apper- 
tain to  the  vital  principle,  you  have  only  to  regard  the  solar  beam, 
and  the  solar  prism,  and  try  experiments  with  each  prismatic  color 
(§  188i,  d). 

234,  e.  Do  you  marvel  at  the  rapidity  with  which  the  nervous 
power  moves  in  its  operations  1  Consider,  then,  the  incomprehensi- 
ble velocity  of  light, — 200,000  miles  in  a  second  of  time  ;  or  the  more 
rapid  apparent  motion  of  the  electric  fluid.  Or,  take  the  more  prob- 
able doctrine  of  the  undulations  of  light,  and  this  will  be  yet  more  con^ 
formable  to  what  is  probably  true  of  the  nervous  power.  Of  the  un- 
dulations, then,  we  have  not  less  than  458,000,000,000,000,  for  the  red 
ray;  535,000,000,000,000,  for  the  yellow  ray ;  727,000,000,000,000, 
for  the  violet  ray,  in  a  second  of  time. — Note  Eee  p.  1150. 

I  say,  when  we  think  of  the  physical  effects  of  electricity,  galvan- 
ism, magnetism,  and  of  light,  and  more  especially  when  we  attempt  to 
think  of  the  inconceivable  rapidity  with  which  the  undulations  of  light 
are  propagated,  we  shall  have  no  difficulty  with  what  I  have  attrib- 
uted to  the  nervous  power  in  resolving  the  phenomena  of  sympathy, 
voluntary  motion,  &c.  ^  and  when,  also,  we  reffect  that  those  very  un- 
dulations, according  to  their  variety,  produce  on  the  retina  all  the  im- 
pressions that  are  requisite  for  every  phenomenon  of  vision,  and  that 
every  impression,  which  is  thus  produced,  must  be  transmitted  to  the 
brain,  before  the  sense  of  vision  can  be  excited  (§  188^  d,  500  k). 

If,  also,  the  retina  be  thus  sensitive  to  the  undulations  of  a  substance 
which  is  so  imponderable  that  it  is  doubted  by  many  whether  the  sub- 
stratum of  light  be  actually  material,  we  shall  have  no  difficulty,  I  say, 
by  the  aid  of  this  plain  analogy,  in  making  the  same  philocophical  use 
of  the  vastly  more  numerous  and  unique  facts  that  are  supplied  by  an- 
imal life,  or  in  apprehending  that  the  virtues  of  more  substantial 
agents,  whether  morbific  or  remedial,  may,  in  like  manner,  exert  pow- 
erful impressions  upon  the  properties  of  every  part,  both  nervous  and 
organic,  and  that  such  influences  may,  equally  with  the  impressions 
of  light,  be  transmitted  to  the  brain  and  spinal  cord,  and  establish  im- 
pressions upon  the  parts  in  conformity  with  the  virtues  of  each  agent 
(§  503). 

The  undulations  of  light  are  excited  by  the  various  objects  from 
which  they  proceed.    And  so  of  the  nervous  power.    It  is  not  w  tran' 


PHYSIOLOGY. VITAL    PROPERTIES.  115 

iitu,  a  movable  substance,  but,  like  the  principle  of  ligbt,  is  every- 
where diffused  through  its  appropriate  medium,'and,  like  that  princi- 
ple, is  brought  into  operation  by  exciting  causes.  Is  it  difficult,  how- 
ever, to  imagine  how  the  nervous  power  can  move  with  the  velocity 
of  light  in  parts  so  dense  as  the  nerves  ?  It  is  less  difficult  than  the 
comprehension  of  the  admitted  fact  that  light  traverses  the  diamond 
as  rapidly  as  it  does  ethereal  space  (§  175  b,  1SS|  d).  Do  you  still 
marvel  as  to  7iow  the  nervous  power  should  induce  or  subvert  diseases  1 
Were  you  not  equally  in  the  dark  as  to  the  modus  operandi  of  the  so- 
lar beam  in  its  various  agencies  upon  inorganic  compounds,  till  a  few 
obscure  phenomena  led  to  the  hypothesis  of  undulations  %  But,  what 
have  you  gained  by  the  undulations  %  Can  you  tell  us  how  these  in- 
conceivably small  motions  operate,  without  a  resort  to  absolute  as- 
sumptions ]  Are  you  any  more  convinced  than  before,  that  the  phe- 
nomena of  light  are  realities,  or  have  you  been  aided  a  whit,  by  these 
discoveries,  as  to  your  former  knowledge  of  the  laws  of  light  ]  You 
tell  us  that  not  only  the  well-known  colors  of  the  solar  spectrum 
possess,  individually,  specific  properties,  but  that  "  each  of  these  com- 
prises rays  differing  in  constitution,  and  differing  in  refrangibility, 
and  that,  doubtless,  to  each  one  specific  effects  are  due."*  You  show 
the  physiologist  a  few  positive  results,  and  he  believes  the  analysis, 
and  the  existence  of  the  several  rays ;  though  he  may  greatly  dis- 
credit your  philosophy  of  the  effects  as  manifested  in  a  department  of 
nature  which  you  study  only  under  influences  supplied  by  the  labora- 
tory (§  188^,  d).  But,  you  tell  him,  also,  that  the  solar  ray  embraces 
"  other  principles  which  are  invisible,"  and  you  call  upon  him  to  ad- 
rait  the  existence  of  these,  notwithstanding  he  cannot  see  them  (§ 
175,  bb).  The  physiologist,  however,  readily  admits  their  existence 
upon  the  strength  of  the  few  facts  which  imply  the  operation  of  an  in- 
visible agent ;  and  he  does  so  because  he  is  a  physiologist.  But,  ta- 
king your  own  rule  of  judgment  as  to  a  vital  principle  and  its  several 
properties,  you  were  doubtful  whether  he  might  demand  more  tangi- 
ble proof;  and,  accordingly,  you  prepare  him  for  an  admission  of 
your  premises  by  a  mode  of -reasoning  which  you  reject,  contemptu- 
ously, when  the  physiologist  sets  forth  his  endless  series  of  facts  which 
prove,  each  one,  the  existence  of  properties  peculiar  to  living  beings. 
You  prejudge  the  case,  as  it  were,  by  impugning  his  understanding, 
unless  the  induction  be  conceded.  You  tell  him,  that,  "just  in  the 
same  way  that  I  am  willing  to  admit  the  existence  of  forty  simple 
metals,  so,  upon  similar  evidence,  I  am  free  to  admit  the  existence  of 
fifty  different  imponderable  agents,  if  need  be"  (§  175  bh).  The  phys- 
iologist requires  you  to  admit  but  one,  and,  with  this  one  he  explains, 
with  perfect  consistency,  all  the  processes  of  living  beings,  all  the 
phenomena  in  physiology,  in  pathology,  and  therapeutics,  while  no  one 
of  them  can  be  interpi'eted  without  the  agency  of  such  a  principle. 

234, y]  But  again,  I  say,  what  have  we  gained  in  a  practical  sense, 
or  as  to  the  modus  operandi,  or  the  laws  of  light  and  heat,  or  of  the 
constituents  of  the  solar  ray,  by  the  discovery  of  the  undulations,  or 
by  any  supposed  decision  of  the  question  as  to  distinct  rays  or  modi- 
fications of  a  common  ray,  or  even  by  the  prismatic  colors  %  Nothing 
whatever ;  no  more  than  has  been  gained,  in  a  useful  sense,  by  mi- 
croscopic explorations  in  physiology,  but  with  the  greater  advantage 

*  Draper's  Treatise  on  The  Forces  which  produce  the  Organization  of  Plants,  p.  103. 


116  INSTITUTES    OF    MEDICINE. 

of  more  precision,  and  more  accomplishment  to  science,  and  without 
the  pernicious  hypotjjeses  of  the  latter.  And  can  the  same  affirma- 
tion be  made  of  our  knowledge  of  the  properties  of  the  vital  princi- 
ples, and  of  their  natural  modifications  in  different  parts,  and  those 
which  are  induced  by  morbific  and  remedial  agents  1  On  the  contrary, 
we  see  this  knowledge  every  where  converted  to  the  most  important 
uses  of  organic  beings,  not  only  in  a  direct  practical  sense,  but  in  un- 
folding the  great  laws  by  which  they  are  governed.  This  knowledge, 
indeed,  is  the  great  foundation  of  physiology  and  of  the  healing  art. 

Do  you  object  to  the  relation  which  sympathetic  sensibility  bears 
to  the  nervous  power  (§  201),  and  the  relation  of  the  nervous  power 
to  irritability  (§  226),  in  the  phenomena  of  motion?  Have  you  any 
better  data  for  your  conceptions  of  the  relation  of  the  magnetic  pole 
to  the  needle ;  and  to  explain  that  relation,  do  you  not  admit  a  pecu- 
liar imponderable,  invisible  agent,  which  acts  upon  the  properties  of 
the  needle  ?  Do  you  understand  any  better,  or  have  you  any  better 
facts  resj^ecting,  the  relation  of  physical  agents  to  the  mind,  in  the  phe- 
nomena of  sensation]  You  obtain  your  ideas  of  matter  through  the 
operation  of  physical  agents  upon  the  intellectual  part ;  and  how  will 
you  explain  the  access  of  those  physical  means  to  the  spiritual  sub- 
stance unless  you  also  admit  the  physiological  property,  sensibility  1 
What  intelligible  connection  is  there  between  the  properties  of  mind 
and  the  motions  of  the  brain  1  What  intelligible  connection  between 
the  stimulus  of  the  blood  and  the  motions  of  the  heart,  or  those  mo- 
tions which  attend  the  generation  of  bile  and  all  other  organic  products, 
unless  you  admit  a  principle  of  life  1  The  forces  of  life  are  concerned 
about  sensation  in  a  peculiar  manner,  and  there  would  be  a  violent 
interruption  of  the  law  of  analogy  were  there  not  something  interme- 
diate between  mind  and  matter,  a  bond  of  union,  as  it  were,  through 
which  impressions  upon  the  senses  should  reach  the  spiritual  existence. 
We  may  fancy  it  to  be  electricity,  or  the  chemical  forces ;  but,  this 
no  more  aids  our  comprehension,  through  the  known  phenomena  sup- 
plied by  these  causes,  as  to  the  communications  from  matter  to  the 
immaterial,  thinking  existence,  than  if  we  regard  the  nerves,  ^er  se, 
as  the  only  medium.  We  therefore  tui'n  our  reason  to  the  special 
phenomena,  and  find  a  property  in  universal  operation  throughout  the 
body,  as  the  medium  through  which  certain  kinds  of  impressions  from 
physical  agents  are  transmitted  to  the  mind.  But,  we  find,  also,  an- 
other analogous  series  of  phenomena  which  force  us  to  the  conclusion 
that  these  depend,  also,  upon  a  certain  modification  of  the  same  prop- 
erty as  that  through  which  impressions  are  made  upon  the  mind  by 
external  objects.  We  see,  also,  that  these  transmitted  impressions 
give  rise  to  another  endless  series  of  peculiar  results,  which  have  their 
point  of  departure  in  the  nervous  centres;  and  we  see,  too,  that  each 
one  corresponds  with,  and  confirms  the  others,  in  the  several  series 
respectively.  We  learn,  besides,  that  those  of  the  last  series  are  anal- 
ogous to  the  direct  effects  of  vital  agents,  healthy,  morbific,  and  re- 
medial, upon  the  organs  which  are  the  immediate  seat  of  their  opera- 
tion. Hence,  we  conclude,  inevitably,  that  there  exists  what  is  de- 
nominated the  nervous  power,  with  all  the  capabilities  which  I  have  as- 
cribed to  it,  and  that  it  is  brought  into  operation  through  the  same 
channel  of  sympathy  as  the  mind  when  sensible  objects  exert  their 
effects.     The  mind,  and  the  nervous  power,  are,  therefore,  so  far  on  a 


PHYSIOLOGY. VITAL   PROPERTIES.  117 

par.  Each  is  an  agent,  each  gives  rise  to  sensible  and  insensible  mo- 
tions, and  modifies  variously  the  ordinary  results  when  themselves 
are  affected  in  an  unusual  manner,  and  each  is  brought  into  opera- 
tion by  analogous  causes.  The  mind,  through  the  properties  of  life, 
forms  a  special  bond  of  union  between  itself  and  certain  paits  of  the 
organization  ;  the  nei'vous  power,  another  special  bond  between  the 
same  properties  of  the  vital  principle  and  other  parts  of  the  organi- 
zation, and  by  which,  and  by  the  peq^etual  operation  of  that  power, 
the  whole  organic  mechanism  of  animals  moves  on  in  a  well-balanced, 
concerted  action.  Thus  are  the  proj)erties  of  the  mind,  the  proper- 
ties of  the  vital  piinciple,  and  the  sensible  mechanism,  all  mutually 
related  to  each  other,  and  bound  together  by  laws  as  precise  as  those 
more  simple  ones  which  rule  in  the  inorganic  world. 

234,  g.  We  need  not,  therefore,  inquire  into  the  intrinsic  nature  of 
the  nervous  power,  or  of  the  organic  properties.  It  would  be  as  ab- 
surd as  to  interrogate  the  nature  of  gravitation,  or  of  any  other  prop- 
erty of  mere  matter,  or  even  matter  itself;  though  we  may  well  say 
what  the  nervous  and  organic  powers  are  not,  and  thus  save  much 
speculation  and  its  resulting  practice.  It  is  enough  that  we  know 
their  existence  and  the  laws  they  obey.  This  is  all  that  can  be  philo- 
sophically or  practically  useful.  With  these  we  are  about  as  well 
acquainted  as  we  are  with  the  laws  of  gravitation,  or  of  light.  An 
ignorance  of  the  nature  of  the  principles  or  causes  affects  in  no  respect 
our  study  of  their  laws,  of  their  modes  of  operating,  or  of  the  influ- 
ences to  which  they  may  be  liable.  Their  laws,  like  the  laws  of  gal- 
vanism, or  of  optics,  must  remain  the  same,  whatever  theory  may  be 
adopted  as  to  the  nature  of  the  causes. 

Inquiries,  therefore,  so  obviously  beyond  our  reach  as  the  absolute 
nature  of  the  vital  principle,  or  any  of  its  properties,  should  never 
raise  our  curiosity,  much  less  receive  our  attention.  Their  pursuit 
vitiates  the  judgment,  diverts  the  mind  from  practical  and  useful  in- 
quiries, and  renders  it  prone  to  speculation. 

But  again,  I  say,  we  know  enough  of  the  whole  of  this  subject  for 
the  purposes  of  philosophy,  and  for  the  good  of  mankind,  by  the  phe- 
nomena alone ;  and  since  the  phenomena  of  organic  beings  are  far 
more  diversified  than  those  which  relate  to  inorganic  matter,  so  also 
should  we  be  as  contented  with  the  former  as  with  the  latter,  and  ap- 
ply them  in  the  same  philosophical  and  practical  manner.  We  also 
know  enough  of  physics  to  marvel  at  nothing  in  organic  beings  which 
may  be  utterly  different  from  the  constitution,  the  phenomena,  and 
the  laws  of  inorganic  matter ;  and,  if  it  seem  mysterious  that  such  an 
agent  as  the  nervous  power  should  exist,  with  the  characteristics 
which  I  have  assigned,  it  will  become  less  wonderful  when  we  reflect 
upon  the  phenomena  of  the  immaterial  mind  in  its  connection  with 
organization,  as  in  muscular  motion,  blushing,  palpitation,  syncope, 
apoplexy,  &c.,  or  even  upon  the  velocity  of  light,  the  inconceivable 
rapidity  of  its  undulations,  its  laws,  its  effects,  &c. 

All  that  we  can  know  of  the  nature  of  any  substance,  material  or 
immaterial,  is  by  the  phenomena  it  manifests.  Where  these  are  the 
same,  or  closely  allied,  as  in  electricity  and  galvanism,  we  may  be 
sure  that  the  essential  causes  are  the  same.  But,  where  gi'eat  and 
striking  differences  exist,  and  more  especially  where  there  are  no 
analogies  in  the  phenomena,  as  between  the  nervous  power,  or  the 


118  INSTITUTES    OF    MEDICINE. 

organic  properties,  and  all  inorganic  agents,  substances,  or  causes,  we 
may  be  equally  certain  that  the  agents,  substances,  causes,  or  powers, 
are  as  different  from  each  other,  in  their  essence,  as  in  tljeir  phe- 
nomena (^  1085). 

It  follows,  therefore,  that  the  nervous  power,  and  the  organic  prop- 
erties, are,  respectively,  sui  generis  ;  having  no  analogies  in  the  inor- 
ganic world. 

The  phenomena  v/hich  different  agents,  powers,  or  causes,  manifest, 
are  so  vmlike  each  other,  that  different  modes  of  investigation  must  be 
pursued  to  arrive  at  a  knowledge  of  each ;  and  the  phenomena  will 
be  just  as  conclusive  of  the  nature  of  one  substance  or  power  as  of 
another.  A  stone,  for  instance,  affects  the  sight,  and  touch ;  it  ap- 
pears of  a  certain  size,  shape,  color,  &c.,  or  it  is  hard  or  soft ;  if  an- 
alyzed, it  is  found  to  be  composed  of  several  distinct  substances,  each 
of  which  manifest  other  phenomena;  and  this  is  all  we  know  of  the 
natui'e  of  a  stone.  And  so  of  magnetism,  galvanism,  light,  heat,  and 
whatever  else  appertains  to  the  inorganic  world.  We  examine  their 
manifestations,  and  compai'e  them  together,  and  distinguish  different 
things  from  each  other  by  the  manifestations  or  phenomena  of  each. 
But,  there  are  grouj^s  of  phenomena  which  have  certain  general  re- 
semblances, and  these  we  aiTange  into  genera  or  families,  as  the  sev- 
eral earths,  metals,  gases,  &c. ;  but  the  specific  distinctions  always 
remain,  so  that  by  the  phenomena  peculiar  to  each  species  we  can 
always  distinguish  one  from  another.  Just  so  it  is  in  respect  to  the 
physical  and  chemical  powers.  The  means  of  knowledge  are  of  the 
same  nature  in  all  the  cases,  and  the  proof  is  as  good  in  one  case  aa 
in  another. 

Coming  to  plants  and  animals,  a  general  survey  of  their  phenomena 
shows  us  that  they  have  no  other  analogies,  of  any  importance,  with 
the  inorganic  world,  than  in  the  elements  of  which  they  are  composed. 
These  are  derived  from  the  inorganic  kingdom ;  and  here  the  simili- 
tude ends.  If  we  investigate  the  phenomena  analytically,  they  come 
upon  us  in  a  profusion  wholly  surpassing  those  of  inorganic  beings, 
and  without  the  most  remote  resemblance.  Here,  therefore,  we  ap- 
ply the  same  rule  as  to  inorganic  beings,  and  we  learn  by  the  same 
process  of  observation  as  much  of  the  nature  and  powers  of  one  class 
of  beings  as  of  the  other,  and  the  proof  is  as  good  in  one  case  as 
in  the  other,  though  more  conclusive  in  respect  to  organic  beings,  in- 
asmuch as  their  phenomena  are  more  various.  By  the  same  rule,  also, 
we  attain  all  the  knowledge  we  possess  of  the  soul,  and,  beyond  that 
of  Revelation,  all  that  is  relative  to  a  Supreme  Being ;  and  we  distin- 
guish each  from  all  the  others,  or  bring  them  into  relationship,  in  the 
same  way. — See  Correlation  of  Forces,  §  1085. 

The  same  mode  of  reasoning  is,  of  course,  applicable  to  what  I 
have  said  of  the  modifications  of  the  nervous  power  (§  227-229),  and 
of  the  organic  properties  (§  133-156,  lSS-215). 

234,  7i.  We  are,  however,  so  much  the  creatures  of  sense,  that  the 
majority  will  probably  still  go  on  explaining  every  thing  appertaining 
to  life  by  some  tangible  or  visible  cause,  or  by  some  laws  with  which 
we  fancy  ourselves  to  be  better  acquainted.  I  have  already  cited  sev- 
eral examples  ;  and  if  we  take  up  any  writer,  indifferently,  it  is  more 
than  an  equal  chance  that  the  authorities  will  be  increased.  Thus, 
here   is   Sir  Gilbert  Blane's   excellent  work   on   "  Medical   Los;icy 


PHYSIOLOGY. VITAL    PROPERTIES.  119 

"  The  changes,"  he  says,  "  accomplished  by  the  actions  of  life  may  be 
conceived  to  be  effected  through  the  agency  of  some  imponderable 
fluid ;  such  as  electricity,  light,  or  magnetism.  We  may  conceive, 
for  instance,  that  each  gland  may  be  furnished  with  a  sort  of  voltaic 
apparatus  for  effecting  its  specific  change."  The  same  doctrine  has 
been  adopted  by  a  host  of  medical  philosophers  of  our  own  times. 
But,  did  any  of  tlae  foregoing  agents  ever  produce,  out  of  the  organic 
being,  a  single  one  of  the  phenomena  of  life  1  Did  they  ever  o-ive 
rise  to  one  of  those  phenomena  in  a  dead  subject,  although  the  organ- 
ized sti'ucture  remain  unimpaired ;  as  in  cases  of  instant  death  from 
hydrocyanic  acid,  nux  vomica,  or  from  a  needle  thrust  into  the  medul- 
la oblongata "?  Is  not  the  whole  hypothesis  contradicted  by  all  that  is 
known  of  the  effects  of  those  agents  1  It  is  the  merest  assumption  to 
sustain  an  unintelligible  and  absurd  hypothesis  to  affirm  that  struc- 
tural derangement  is  necessary  to  death.  If  galvanism,  the  chemical 
forces,  &c.,be  the  immediate  cause  of  the  deposition  which  constitutes 
the  interstitial  growth,  what  bestows  vitality  (or  life,  if  it  be  preferred) 
on  the  new-formed  matter "?  Or,  if  this  vitality  be  imparted  by  spe- 
cific powers  of  the  formative  instruments,  why  should  not  those  pow- 
ers be  adequate  to  the  entire  work  (§  64)  1  Why  so  great  a  violation 
of  the  most  common  rule  in  philosophy  as  to  introduce  other  forces, 
whose  great  office  is  to  pull  down,  and  whose  results  are  confusion  1 

234,  i.  The  whole  art  of  medicine  consists  in  producing  certain  im- 
pressions upon  properties  or  powers  that  are  wholly  unlike  those 
which  rule  in  the  inorganic  world.  It  will  not  answer  to  talk  of  mod- 
ifying the  operation  of  galvanism,  magnetism,  gravitation,  light,  chem- 
ical affinity,  &c.,  by  an  emetic  or  cathartic.  It  must,  however,  come 
to  this,  if  you  will  have  it  that  those  forces  preside  over  organized 
beings,  or  even  if  they  be  allowed  to  have  a  subordinate  agency  (§ 
175,  d,  360,  409  k,  446  a,  488^    493  cc,  500  n7i,  893  a,  893^). 

235.  Finally,  the  phenomena  of  life  are  as  easily  comprehended  as 
those  of  inorganic  matter,  and  denote  as  clearly,  and  even  more  so, 
the  nature  of  the  causes.  Who  will  demonstrate  the  nature  of  those 
physical  properties  by  which  foreign  agents  produce  their  impression 
on  the  properties  of  life  1  And  yet  so  accurate  is  our  discrimination 
among  them,  as  prompted  by  the  vital  signs  which  they  produce,  that 
it  is  one  of  the  most  important  objects  of  the  physician  to  select  from 
the  multitude  of  cathartics,  emetics,  &c.,  a  certain  species  whose 
properties  shall  correspond  with  the  modified  signs  of  the  properties 
of  life  ;  and,  it  is  no  unusual  phenomenon,  that,  of  the  whole  range 
before  him,  he  decides  with  accuracy  that  there  is  only  one  medicine 
which  is  well  suited  to  the  case.  And  his  conceptions  of  the  specific 
properties  of  the  agent,  and  of  those  of  the  organization,  even  in  the 
modified  state  of  the  latter,  are  so  comprehensive  that  he  may  foretell 
their  united  result.  He  knows  as  much  of  the  properties  of  life  as  of 
the  remedial  agent.  He  knows  them  far  better ;  and  that  he  admits 
their  existence  and  specific  nature  is  manifest  from  his  deliberate  ac- 
tion. Whoever  prescribes  for  disease  upon  any  other  ground  is  a 
mere  charlatan. 

Who,  again,  will  define  the  nature  of  cohesion,  gravitation,  chem- 
ical affinities,  &c.  ]  Like  the  properties  of  life  and  of  spirit,  and  their 
relations  to  matter,  their  existence  is  only  inferred  from  certain  uni- 
form phenomena,  and  from  such,  alone,  we  deduce  their  relations  to 


120  INSTITUTES    OF    MEDICINE. 

objects  of  more  sensible  demonstration ;  and  this  is  all  we  know  of 
the  sensible  objects  themselves.  We  reach  the  connection  between 
common  matter  and  its  properties,  between  the  vital  properties,  and 
organized  structure,  between  the  intellectual  and  moral  faculties  and 
the  nervous  system,  the  concurrence  between  them  in  the  production 
of  certain  effects,  and  the  differences  in  the  nature  of  the  several  prop- 
erties, by  a  common  process  of  observation.  There  are  mysteries  at- 
tending the  same  conditions  of  the  whole  which  must  be  left  to  the 
sole  comprehension  of  the  Author  Who  intended  the  whole  to  sub- 
serve the  purposes  in  which  we  are  alone  interested ;  Who  has  wise- 
ly secured  to  Himself  the  nature  and  control  of  primary  causes;  and 
Who  has  thereby  restricted  our  inquiries  to  the  only  useful  end  of 
knowledge,  the  existence  of  the  causes,  and  their  A^arious  phenomena 
and  laws.  These  may  be  so  employed  as  to  answer  the  wants,  the 
conveniences,  and  the  various  exigencies  of  intelligent  beings.  Those 
are  the  springs  of  action  which  it  might  be  unsafe  for  man  to  under- 
stand. 

236.  From  what  I  have  hitherto  said  on  the  subject  of  life  it  must 
evidently  be  regarded,  in  a  philosoj)hical  sense,  as  a  cause,  not  as  an 
effect.  The  functions  and  other  phenomena  are  the  effects.  This  con- 
struction, which  I  have  also  set  forth  in  my  Essay  on  the  "  Vital  Pow- 
ers" in  other  demonstrative  aspects,  is  indispensable  to  any  sound 
principles  in  medicine.  All  effects  have  their  causes ;  and  this  simple 
principle  obliges  us  to  look  for  a  cause  of  the  phenomena  of  life.  It 
is  with  the  conditions  of  that  cause,  ascertained  through  the  medium 
of  its  effects,  that  all  physiology  and  medicine  are  concerned. 

237.  The  powers  by  which  living  beings  are  governed,  cffi'c?7"*^;ar- 
tbus,  are  always  as  precise  in  their  operation,  and  bring  about  results 
as  precise,  as  gravitation  itself.  But  the  properties  of  life  are  con- 
stantly liable  to  variations,  and,  therefore,  there  will  be  correspond- 
ing variations  in  their  phenomena.  Gravitation,  and  other  physical 
forces,  on  the  other  hand,  are  immutable,  and  there  are,  therefore,  no 
variations  in  the  results  of  their  operation.  But  it  is  also  equally  true 
that  any  given  condition  of  the  properties  of  life,  connected  with  any 
given  influences,  is  equivalent  to  the  unvarying  state  of  the  physical 
forces.  That  particular  condition,  in  conjunction  with  the  supposed 
influences,  always  determines  the  same  results,  whether  in  health  or 
disease.  Every  power  in  nature,  when  operating  under  given  circum- 
stances, always  terminates  in  uniform  effects.  The  uncertainties, 
therefore,  to  which  the  science  of  medicine  is  liable,  or  any  other  which 
has  natui-e  for  its  foundation,  are  owing  to  our  inability  to  understand 
all  the  facts.  If  any  remedial  agent  produce  an  efl'ect  at  one  time 
which  it  does  not  at  another  it  is  because  the  properties  of  life  have 
been  differently  affected  in  the  different  cases  ;  and  there  may  have 
been,  also,  a  concurrence  of  many  other  different  influences.  Never- 
theless, in  each  case,  the  medicine  operates  according  to  established 
laws,  and  the  modifications  depend  upon  the  difference  of  circumstan- 
ces. Each  combination  of  circumstances,  however,  ahvays  gives  a 
uniform  determination  to  the  laws  which  govern  the  effects.  Where 
the  conditions  are  the  same,  the  remedy  in  a  certain  dose  will  always 
produce  the  same  results. 

Although  gravitation  is  immutable  in  its  nature,  we  yet  see  some- 
thing analogous  to  the  foregoing  influences  upon  the  properties  of 


PHYSIOLOGY. VITAL    PROPERTIES.  121 

life  in  the  manner  in  wliich  the  revolution  of  the  heavenly  bodies 
may  be  affected  by  their  interference,  in  relation  to  each  other,  with 
the  power  as  exercised  by  the  sun  ;  as  seen  in  the  erratic  movement 
of  comets.  In  either  case  the  incidental  influences  may  be  calculated, 
and  the  results  foretold, — conforming,  in  one  case,  to  the  laws  of  grav- 
itation, and  in  the  other  to  those  of  the  vital  force.  The  sameness  of 
the  physiological  conditions  enables  us  to  calculate  not  only  what  will 
happen  to-day,  but  through  all  future  time.  But,  the  vital  conditions 
are  subject  to  precise  modifications  at  the  several  great  eras  or  stages 
of  life ;  but,  being  marked  by  uniformity,  the  results  are  forever  the 
same,  at  each  era  respectively.  The  fundamental  changes  enable 
us,  also,  to  foresee  how  the  modified  properties  of  life  will  be  differ- 
ently affected  by  vital  stimuli,  the  new  sympathies  that  will  spring  up, 
the  different  relations  of  sensibility  to  the  faculties  of  the  mind,  the 
difference  in  the  acquisition  of  knowledge,  &c.,  at  the  several  eras. 
From  these  natural  and  uniform  modifications  of  the  vital  states,  we 
may  turn  to  those  of  a  fluctuating  and  accidental  nature,  which  grow 
out  of  the  influence  of  climate,  habits,  employments,  &c.,  and  which 
may  be  not  only  as  lasting  as  the  individual,  but  may  be  transmitted 
to  his  posterity.  As  at  the  different  eras  of  life,  we  here  find,  also, 
variable  influences  from  the  natural,  the  morbific,  and  the  remedial 
agents,  variable  sympathies,  &c.,  among  organs,  according  to  the  arti- 
ficially-modified condition  of  the  properties  of  life.  These  conditions, 
however,  are  rarely  exactly  the  same  in  any  two  individuals ;  but, 
they  are  strictly  analogous  in  principle  to  the  natural  ones  which  dis- 
tinguish the  several  stages  of  life,  and,  so  far  as  they  may  be  known 
in  any  given  case,  we  may  calculate,  with  great  approximation  to  the 
truth,  what  will  be  the  special  characteristic  phenomena  that  will 
mark  the  organic,  the  animal,  and  the  intellectual  existence  of  that  in- 
dividual (§  153-156,  535,  &c.,  574,  &c.). 

Thus  we  have  a  series  of  analogies,  in  respect  to  the  mutability  of 
the  properties  of  life,  and  corresponding  results,  which  bring  us  upon 
the  confines  of  disease  ;  which  consists,  also,  in  certain  modifications  of 
the  vital  properties,  but  more  profound,  more  various,  and  more  tran- 
sient (§  176-182).  Here  lie  the  difficulties  of  medicine  ;  difficulties 
attending  our  knowledge  of  the  modifying  causes,  the  influences  they 
produce,  the  complications  of  sympathy,  and  other  contingent  circum- 
stances. All  these  conditions  must  be  known  in  any  given  case,  to 
foresee,  with  certainty,  any  immediate  or  more  remote  result  either 
of  disease  or  of  the  action  of  any  medicine,  or  of  any  natural  vital 
agent.  But,  the  properties  of  life  being  never  very  greatly  varied 
from  their  natural  character,  we  may  come,  by  a  careful  observation 
of  their  varying  phenomena,  to  a  knowledge  of  their  conditions,  and 
to  foresee  the  results,  or  such  as  may  spring  from  the  operation  of 
medicine,  from  the  different  kinds  of  food,  &c.,  with  sufficient  accura- 
cy for  all  useful  purposes.  With  this  knowledge,  we  get  at  the  most 
important  laws  of  disease,  general  and  specific,  and  build  up  princi- 
ples which  are  more  valuable  in  practice  than  ages  of  disconnected 
experience  (§  149,  150). 

238.  I  have  said,  that  although  instability  is  a  prominent  character- 
istic of  the  properties  of  life,  and  lies  at  the  foundation  of  disease  and 
therapeutics,  these  properties  never  undergo  any  radical  change  till 
they  shall  have  lost  their  recuperative  tendency.     They  are  the  only 


122  INSTITUTES    OF    MEDICINE. 

attributes  of  organic  beings  that  do  not  undergo  absolute  change  and 
renewal.  These  properties  must  be  forever  present,  without  essential 
change  of  their  nature,  to  carry  on  the  work  of  decay  and  renewal, 
which  are  in  perpetual  progress  in  all  the  solids  and  fluids  over  which 
the  properties  preside. 

Hence  an  important  law,  that  all  hereditary  predispositions  to  dis 
ease,  and  all  impressions  from  morbific  agents,  which  do  not  produce 
their  manifest  effects  till  the  blood  shall  have  undergone  a  renewal 
(as  in  hydrophobia,  fevers,  &c.),  must  be  primarily  exerted  upon  the 
properties  of  life,  and  that  all  the  subsequent  changes  in  the  fluids 
and  solids  must  be  due  to  that  original  modification  of  the  vital  prop- 
erties. To  perpetuate  the  primary  influences  something  of  a  perma- 
nent nature  must  receive  the  impression.  Analogy,  alone,  would  as- 
sure us  that  this  must  be  also  equally  true  of  the  effects  of  all  mor- 
bific and  remedial  agents  (^  666). 

239.  There  is  nothing  more  important  to  be  known  and  appreci- 
ated than  the  endowment  of  the  properties  of  life  with  a  tendency  to 
return  from  diseased  to  their  natural  states.  This  is  the  vis  medica- 
trix  naturcB,  and  is  the  immediate  foundation  of  therapeutics.  This, 
and  this  alone,  has  given  rise  to  the  art  of  medicine ;  since,  by  no  ar- 
tificial means  can  the  diseased  properties  and  functions  of  life  be  con- 
verted into  their  healthy  state.  It  is  also  remarkable  that  the  most 
efficient  remedial  agents  institute  their  favorable  effects  by  establish- 
ing new  pathological  conditions  ;  which  farther  shows  that  it  is  nature 
alone  which  cures,  and  through  the  foregoing  principle.  That  prin- 
ciple consists  in  the  controlling  influence  of  physiological  laws,  and, 
without  it,  organic  nature  would  become  extinct  (^  853). 

240.  Connected  with  the  foregoing  law  is  another  not  less  funda- 
mental, and  which  shows  the  fallacy  of  reasoning  from  the  effects  of 
remedial  agents  upon  healthy  to  morbid  conditions.  It  is,  that  the 
susceptibility  of  all  parts  to  the  action  of  remedies,  physical  or  mental, 
is  very  different  in  disease  from  what  it  is  in  health,  and  the  nature 
and  the  results  of  the  influences  are  greatly  different  in  the  two  con- 
ditions. Take  many  of  the  most  powerful  agents,  arsenic,  tartarized 
antimony,  iodine,  &c.,  and  when  administered  in  certain  small  and 
repeated  alterative  doses  they  bring  about  the  cure  of  the  most  ob- 
stinate and  formidable  conditions  of  disease ;  while  the  same  doses 
may  not  manifest  any  action  upon  the  system,  or  on  any  part  of  it,  un- 
der circumstances  of  health.  This  manifestly  depends  upon  an  in- 
creased susceptibility  of  the  organic  properties,  in  their  diseased  con- 
ditions, to  the  action  of  foreign  agents,  and  upon  an  increased  dispo- 
sition to  undergo  changes.  And  here  we  have  opened  a  grand  dis- 
play of  infinite  Design,  Wisdom,  and  Goodness,  to  mitigate  the  pen- 
alties of  disease,  and  to  pi-eserve  the  human  race.  This  law,  which 
unfolds  a  principle  latent  in  health,  and  by  which  morbid  organic 
properties  acquire  susceptibilities  to  salutary  influences  from  agents 
which  in  health  would  either  produce  no  effects,  or  lead  to  untoward 
results,  and  its  ally,  the  great  recuperative  principle  (§  239),  impose 
the  highest  obligation  on  physicians  to  become  medical  philosophers. 

7.    THE    MIND    AND    ITS    PROPERTIES. 

241.  a.  Reason  and  instinct  belong  to  man;  instinct  alone  to  ani- 
mals.    INIind  is  commonly  regarded  as  synonymous  with  reason,  and 


PHYSIOLOGY. MENTAL    PROPERTIES.  123 

instinct  a  principle  by  itself.  The  latter  is  undoubtedly  true  of  ani- 
mals ;  but  I  would  consider  instinct,  in  relation  to  man,  as  a  property 
of  the  soul ;  while  in  animals  it  is  shorn  of  the  great  distinguishing 
attribute  of  man,  the  rational,  immortal  faculty.  Independently  of 
the  specific  facts  which  go  to  this  conclusion,  it  has  the  strong  ground 
of  analogy  in  the  more  complex  condition  of  the  principle  of  life  as  it 
exists  in  animals  than  in  plants  (§  184,  185). 

241,  h.  To  simplify  the  discussion  of  this  intricate  subject,  the  word 
mind,  with  the  foregoing  explanation,  and  mental  properties,  so  far  as 
perception,  the  will,  and  the  understanding,  are  concerned,  may  be 
applied  indiscriminately  to  man  and  animals.  Judgment  and  reflec- 
tion are  the  great  characteristics  of  reason ;  but,  contrary  to  the  usual 
representation,  the  understanding  belongs  as  well  to  the  instinct  of 
animals  as  to  the  human  mind.  Many,  again,  may  be  disposed  to 
consider  the  understanding  a  function,  rather  than  a  property ;  but 
this  construction  would  suppose  the  operation  of  judgment  and  reflec- 
tion, which  do  not  belong  to  animals.  The  term  is  also  employed  in 
other  acceptations  than  the  present. 

241,  c.  The  abstract  manner  in  which  metaphysicians  have  consid- 
ered all  the  operations  of  the  mind,  while  no  one  of  them  is  performed 
without  the  co-operation  of  the  brain,  or  a  principal  nervous  centime, 
and  originally  elicited  through  the  corporeal  senses,  proves  to  us  that 
physiologists  are  best  qualified  to  analyze  the  phenomena  of  the  soul 
and  of  instinct,  and  to  indicate  their  relations  to  the  body,  and  the 
laws  which  they  observe.  There  is  also  a  mysterious  afl^nity  between 
the  soul  of  man  and  the  instinct  of  animals,  of  which  metaphysicians 
take  but  little  or  no  cognizance.  This  alliance  is  shown  by  the  cor- 
responding manifestations  of  perception,  of  understanding,  and  of  the 
will  in  animals;  by  the  amazing  precision  with  which  their  habits  are 
regulated  ;  by  the  evidence  of  common  passions  ;  by  the  coincidence 
in  the  external  senses  of  man  and  animals,  through  which  they  alike 
acquire  a  knowledge  of  external  things  ;  by  the  parallel  in  the  ana- 
tomical structure  of  the  brain  of  man  and  of  animals  which  stand  high 
in  the  scale ;  and  by  other  analogies,  which  denote  an  affinity  between 
the  soul  and  instinct  So  great  and  various,  indeed,  are  the  evidences 
of  the  foregoing  nature,  that  the  special  attributes  of  instinct  are  as- 
sociated with  the  human  mind ;  thus  forming  a  connecting  link,  through 
the  moral  faculties,  between  rational  and  irrational  beings. 

Nevertheless,  the  phenomena  of  the  human  mind  are  infinitely  su- 
perior to  those  of  instinct,  while  the  operations  of  instinct  in  animals 
greatly  surpass  any  of  its  manifestations  in  man.  Many  special  pecu- 
liarities concur,  also,  in  demonstrating  an  absolute  distinction  between 
the  rational  mind  and  instinct.  The  latter,  for  instance,  always  moves, 
in  each  individual  species  of  animal,  in  a  particulai",  unvarying  path, 
but  differently  in  each  species  of  animal.*  It  never  diverges  to  im- 
prove its  original  endowments,  or  to  add  a  gain  which  it  did  not  pos- 
sess in  its  infant  condition.  It  is  then  nearly  as  perfect  in  its  opera- 
tions as  at  mature  age  ;  nor  does  one  generation  of  animals  gain  upon 
its  predecessors.  How  different  with  reason,  and  with  the  instinct 
of  man  !  He  passes  thi'ough  early  infancy  without  a  trace  of  the  for- 
mer,  and  with  only  that  helpless  development  of  the  latter  which  ena- 

*  Here  I  may  say  that  analogy  proves  that  there  is  hut  one  species  of  mankind,  since  the 
manifestations  of  reason  and  instinct  are  the  same  in  all. 


124  INSTITUTES    OF    MEDICINE. 

bles  him,  with  the  foreign  aid  of  reason,  to  imbibe  the  sustenance  re- 
quired by  organic  Hfe.  Unlike  the  instinct  of  animals,  however,  the 
corresponding  manifestations  become  greatly  multiplied  as  age  ad- 
vances ;  but  it  remains  always  far  more  circumscribed  and  imperfect, 
and  often  plunging  itself,  and  leading  reason,  into  violations  of  their 
natural  functions.  And  what  a  contrast  between  the  limitations  of  in- 
stinct and  the  progress  and  grasp  of  the  human  mind ;  the  latter  for- 
ever ranging  through  all  the  labyrinths  of  nature,  investigating  their 
phenomena,  developing  their  powers,  their  subsidiary  causes,  and  their 
laws,  turning  in  upon  itself  and  multiplying  its  knowledge,  and  en- 
larging its  powers  by  its  own  independent  efforts,  laying  up  the  gains 
of  the  past  as  a  fruitful  source  of  present  good  and  of  farther  acquisi- 
tions, distinguishing  good  from  evil,  from  which  results  the  sense  of 
moral  responsibility,  investigating  its  own  attributes,  and  attempting 
even  its  own  nature,  and  tracing  up  its  existence  to  a  Higher  Power, 
as  the  Author  of  the  Universe  which  was  made  for  the  contemplation 
and  the  enjoyment  of  mind  (§  175  c), 

241.  d.  It  is  not  an  object,  however,  of  the  Institutes  to  investigate 
the  philosophy  of  mind  beyond  those  physiological  considerations 
which  are  relative  to  the  properties  and  functions  of  life,  however 
it  may  have  been  important  to  their  interests  to  contradistinguish  the 
Maker  from  His  works  (§  14  c,  175,  350J  h-l).  Perception  and  the 
tvill  are  the  only  mental  properties  which  concur,  more  or  less,  in  the 
phenomena  of  animal  life. 

242.  Perception  is  always  necessary  to  true  sensation,  and  therefore 
to  the  exercise  of  all  the  senses.  The  mind,  or  instinct,  must  per- 
ceive an  impression  made  upon  sense,  and  consciousness  must  operate 
before  the  impression  can  be  realized.  The  phenomena  of  sympa- 
thy in  their  connection  with  sensibility,  in  the  ordinary  processes  of 
life,  are  not  relative  to  sensation,  but  depend  on  a  special  modification 
of  sensibility  and  on  the  neiTous  power. 

243.  The  toill,  another  property  of  the  'mind,  upon  which  volition 
depends,*exemplifie3  yet  farther  the  complexity  of  the  principles 
which  obtain  in  the  animal  kingdom ;  and  its  phenomena  admonish 
us  to  pause  over  that  materialism  which  sees  nothing  but  the  demon- 
strations of  physical  and  chemical  power  in  the  equally  unique  mani- 
festations of  irritability,  sensibility,  mobility,  the  nervous  power, — the 
entire  organic  force  (§  215). 

The  will  presides  in  animal  life.  It  governs  the  movements  not 
only  of  the  voluntary  muscles,  but  even  the  operations  of  the  other 
mental  faculties.  In  producing  muscular  motion,  the  operations  of 
judgment  and  perception  are  often  associated,  and  even  bring  the  will 
into  action.  All  muscular  movements  with  which  the  mind,  or  in- 
stinct, is  not  connected,  depend  upon  other  causes  than  the  will.  Vol- 
untary motion  is,  therefore,  as  dependent  on  the  will  as  true  sensation 
is  upon  perception  (^  1072,  b). 

The  will  has  very  little  operation  in  organic  life  (§  500,  e) ;  though 
the  passions  operate  with  power  upon  the  heart,  the  abdominal  viscera, 
&c.  This  peculiarity  is  founded  in  consummate  Design  ;  since  great- 
er latitude  to  the  will  would  be  incompatible  with  animal  existence ; 
while,  on  the  other  hand,  other  elements  of  the  mind  are  allowed,  for 
useful  pm-poses,  to  stretch  their  influences  to  the  deep  recesses  of  life. 

244.  The  will,  a  property  of  the  mind,  like  the  nervous  power  a 

*  Hy  some  the  will  is  considered  as  a  result  of  the  concurrent  action  of  the  mental 
faculties.    But  this  is  unimportant.     See  my  work  on  the  Sour,  and  Instinct,  1870. 


PHYSIOLOGY. FUNCTIONS.  125 

property  of  the  vital  principle,  is,  therefore,  a  vital  stimulus  to  the 
brain,  w^hose  chief  office  is  the  production  of  voluntary  motion,  by 
bringing  into  action  the  nei-vous  power. 

245.  When  the  will  gives  rise  to  voluntary  motion  the  philosophy 
is  the  same  as  when  motion  is  developed  in  the  organs  of  organic  life 
by  the  nervous  power  (§  205-215).  The  latter  may  take  place 
through  impressions  transmitted  to  the  nervous  centres  (§  227,  500), 
or  by  impressions  exerted  in  a  direct  manner  upon  these  centres  (§ 
227,  230,  477).  The  will  operates  in  the  direct  manner,  develops 
the  nervous  power,  and  transmits  it  to  the  irritability  of  the  voluntaiy 
muscles,  by  which  mobility  is  brought  into  operation  (§  233).  When 
the  passions  affect  the  movements  in  organic  life  it  is  exactly  in  the 
same  way  as  with  the  will  in  animal  life  (§  500  h,  1040,  1072  b). 

246.  Thus  it  appears  that  the  unity  in  the  great  plan  of  the  ner- 
vous power,  in  its  relations  to  both  organic  and  animal  life,  to  mind  as 
well  as  to  matter,  and  the  perfect  concurrence  of  all  the  facts,  and  the 
obvious  nature  of  the  whole,  which  declare  a  harmony  of  principles 
and  laws  throughout  all  the  immense  variety  relative  to  the  nervous 
power,  continue  to  unfold  a  grandeur  of  the  subject  which  invites  an 
unprejudiced  attention  to  the  expositions  I  have  made  of  this  brilliant 
institution  of  Nature  (§  1069-1082). 


FOURTH  DIVISION  OF  PHYSIOLOGY. 

FUNCTIONS. 

247.  Our  fourth  grand  division  of  Physiology  comprehends  the 
functions  of  organic  beings.  They  are  carried  on  by  the  properties 
of  life  in  their  connection  with  organized  structure  (§  170,  175,  177), 
and  of  which  the  functions  are  the  great  final  causes,  or  effects  (§  176). 
They  ai'e,  indeed,  the  only  useful  ends  of  life ;  since,  otherwise,  all 
organic  beings  would  exist  in  the  condition  of  the  seed  and  e^g  (§ 
235,  236).  The  terminating  series  of  the  capillary  vessels  are  the  im- 
mediate instniments  of  all  the  essential  processes  in  organic  life,  and 
therefore,  also,  of  all  diseases  (§  109,  410,  411,  668,  679). 

248.  The  functions  are  common  BTid  peculiar. 

249.  The  common  functions  belong  to  all  organic  beings.  They 
consist  of,  1st.  Motio7i ;  2d.  Absorption ;  3d.  Assimilation;  4th.  Dis- 
tribution ;  5th.  Appropriation,  or  nutrition  and  secretion  ;  6th.  Excre- 
tion ;  7th.  Calorification;  8th.  Generation.  The  first  seven  are  in- 
dispensable to  animals  and  plants.  The  eighth  appertains  only  to 
the  species,  and  has  no  essential  part  in  the  organic  economy  (§  97, 
118-123,  153-156,  237,  578). 

250.  The  peculiar  functions  belong  to  animals  only.     They  are, 

I.  Functions  of  relation  ;  comprehending,  1st.  Sensation ;  2d.  Sym- 
pathy, or  reflex  nervous  action. 

II.  Voluntary  motion,  and  functions  by  which  the  mind  and  instinct 
act  on  external  objects. 

III.  Other  mental  and  instinctive  functions. 


126  INSTITUTES    OF    MEDICINE. 


I.    COMMON,    OR    ORGANIC    FUNCTIONS. 

251.  Organs  which  perform  similar  functions  are  very  variable  in 
structure  in  different  orders  of  animals.  The  liver,  for  example,  "  is 
represented  in  one  case  by  simple  caeca,  or  blind  sacs ;  in  another  by 
tufts  of  cseca ;  in  a  third  by  bunches  of  cells  ;  in  a  fourth  by  a  spongy 
mass ;  in  a  fifth  by  branched  ducts  ending  in  feather-like  terminal 
twigs  ;"  and  so  on,  up  to  the  complication  of  the  most  perfect  animals. 
Nevertheless,  they  all  secrete  a  very  analogous  fluid.  And  so  of  oth- 
er organs  and  functions. 

A  due  regard  for  the  preceding  facts  must  unavoidably  reconcile 
every  mind  to  what  I  have  said  as  to  microscopical  explorations,  of  the 
minuteness  of  structure  (§  131,  304,  306,  409,  e). 

252.  Though  structure  be  very  various,  there  is  a  great  analogy 
in  the  vital  functions  and  their  immediate  products, — even  between 
plants  and  animals.  This  is  remarkably  true  of  every  individual  part 
in  the  different  races  of  animals,  whatever  its  simplicity  or  complexi- 
ty (§  251).  Hence,  it  becomes  more  and  more  manifest  that  the 
properties  of  life  have  a  greater  agency  in  the  formation  of  organic 
products  than  the  structure  itself  (§  67-69). 

1,    MOTION. 

253.  Motion  is  the  immediate  result  of  the  action  of  mobility  or 
contractility,  and  was  necessarily  explained  in  describing  that  prop- 
erty (§  205-215).  It  is  the  function  by  which  all  things  acquire  their 
movement  in  organic  beings. 

254.  Motion  may  be  remotely  mechanical,  as  the  movement  of  the 
blood,  ingesta,  &c. ;  but  the  power  and  the  actions  of  parts  which  gen- 
erate the  mechanical  movements  are  purely  vital. 

255.  Motion  belongs,  of  course,  to  every  tissue  in  which  its  mani- 
festations occur ;  and  it  is  therefore  an  error,  however  common,  to 
limit  this  function  to  the  muscular  tissue. 

256.  The  great  offices  of  motion  in  organic  life  are  to  supply  the 
system  with  useful  materials,  and  to  remove  such  as  are  useless. 

257.  In  animal  life  this  function  appears  under  the  aspect  of  loco- 
motion or  some  analogous  result,  and  I  have  associated  the  considera- 
tion of  this  modification  of  the  function  with  that  which  is  common  to 
the  organic  life  of  animals  and  plants,  on  account  of  their  common  na- 
ture. 

258.  Voluntary  motion  proceeds  from  the  action  of  the  will  upon 
the  great  nervous  centre,  by  which  the  nervous  power  is  developed 
and  transmitted  to  the  irritability  of  the  voluntary  muscles  (§  188,  208, 
233,  476  c).  Here  the  excitation  of  the  nervous  power  is  direct,  as 
in  the  experiments  by  Wilson  Philip  (§  486,  487).  If  the  motion  be 
involuntary,  as  in  the  ordinary  movements  of  respiration,  the  develop- 
ment of  the  nervous  power  is  indirect,  according  to  the  usual  process 
when  organic  actions  are  influenced  by  the  nervous  power  (§  222,  &c., 
500).  When  other  involuntary  motions  affect  the  muscles  of  animal 
life,  as  convulsions,  &c.,  the  development  of  the  nervous  power  may 
be  direct,  as  in  diseases,  and  concussions,  of  the  brain,  or  indirect,  as 
in  teething,  and  intestinal  irritation.  The  philosophy,  however,  re- 
specting the  production  of  motion  in  all  these  cases,  is  exactly  the 
same.     Whether   the  movements  be   voluntary   or  involuntary,  the 


PHYSIOLOGY. FUNCTIONS.  127 

movements  depend  upon  the  action  of  the  nervous  influence  upon  mo- 
bility through  the  property  irritability.  The  mind  does  not,  as  has 
been  supposed,  leave  the  brain  to  enter  the  muscles  in  voluntary  mo- 
tion. The  difficulties  of  explanation  are  not  only  multiplied  by  this 
supposition,  but  it  is  shown  to  be  erroneous  by  the  analogous  move- 
ments which  may  be  excited  through  the  spinal  cord,  or  through  the 
nerves,  after  the  soul  and  instinctive  principle  are  separated  from  the 
body  by  the  removal  of  the  head.  This  philosophy  is  also  coincident 
with  that  which  I  have  propounded  as  to  influences  of  the  nervous 
power  in  organic  life.     Each  illustrates  and  sustains  the  oth^r  (§  500). 

259.  It  is  now  important  to  repeat,  that  the  nervous  power  never 
generates  motion,  per  se  (§  222-232).  The  function  always  depends 
immediately  upon  the  organic  property  mobility/,  which  is  brought  into 
action  through  impressions  made  upon  irritability  (§  188).  The  ner- 
vous power  is  only  a  stimulus  to  irritability.  But,  it  is  much  more  im- 
portant to  motion  in  animal  than  organic  life ;  since  it  is  the  only  nat- 
ural stimulus  of  the  voluntary  muscles,  while  blood,  and  other  agents, 
operate  upon  the  tissues  with  which  they  are  in  contact  in  organic  life, 
and  thus  excite  reflex  nervous  actions,  and  render  them  tributary  as  an 
exciting  cause  of  muscular  motion  and  in  increasing  or  diminishing 
and  otherwise  affecting  the  secreted  products  (§  22-i,  226,  475-^,  893-i). 

260.  Very  important  laws  grow  out  of  the  foregoing  distinction  be- 
tween the  relation  of  the  nervous  power  to  the  function  of  motion  in 
animal  and  organic  life,  and  its  essential  independence  of  that  power 
in  either  life  (§  475^   476,  498,  500  m,  893^,  1042). 

261.  That  motion  does  not  depend  upon  the  nerves  is  showix  by 
the  sensible  and  insensible  motions  of  plants ;  by  that  of  their  leaves, 
stems,  stamens,  by  their  absorption,  nutrition,  secretion,  &c.  (§  455,  c). 
The  analogies  in  results  prove  this  independence  of  the  nerves,  and 
the  near  identity  of  the  function  in  plants  and  animals.  Indeed,  the 
chemists  will  have  it  that  all  the  essential  compounds  of  the  animal 
are  formed  by  vegetable  organization  (§  IS,  409).  Such  analogies  are 
always  sound,  being  based  on  great  fundamental  laws.  But  there  may 
be  great  variety  of  mechanism.  Where  nerves  exist,  and  in  connection 
with  centres  capable  of  generating  a  stimulus,  they  are  so  far  ti'ibutary 
to  muscular  and  other  motions,  and  voluntary  motion  is  wholly  depend- 
ent upon  that  stimulus,  as  also  natural  involuntary  muscular  motion. 

262.  "  The  heart  of  a  frog  continues  to  beat  with  its  ordinary  rhythm 
even  when  the  entire  base  of  the  organ,  when  the  ventricles,  as  far  as 
their  juncture  with  the  auricles,  are  cut  away"  (p.  346,  ^516  d,  no.  8). 

In  the  same  way,  "the  peristaltic  movements  of  the  intestinal  canal 
continue  not  only  when  the  intestine  is  removed  from  the  trunk  to- 
gether with  the  mesentery  and  ganglionic  plexus,  but  also  when  the 
intestine  itself  is  isolated  from  the  plexus  by  being  separated  from  the 
mesentery  at  the  line  of  its  insertion." — Muller's  Physiology. 

263.  Dr.  M.  Hall  tied  a  ligature  around  the  root  of  the  heart  and 
lungs,  and  then  separated  them  from  the  body.  "  The  action  of  the 
heart  was  still  such  as  to  carry  on,  in  a  slight  degree,  and  for  a  short 
period,  the  circulation  of  the  blood  through  the  pulmonary  artery,  and 
a  few  of  the  capillary  vessels."  He  adds  his  belief,  "  that  the  actual 
circulation  of  the  blood  has  not  been  before  seen  proceeding  entirely 
and  independently  of  the  sympathetic  system." — Hall. 

264.  Now,  in  the  last  two  of  the  foregoing  cases  there  may  have 


128  INSTITUTES    OF    MEDICINE. 

been  local  nervous  centres,  ganglia,  perhaps,  or  some  other  part  of  the 
sympathetic  nerve  to  supply  the  requisite  stimulus  through  reflex  ac- 
tions ;  the  air  and  the  injuries  operating  as  remote  exciting  causes  of 
the  nervous  influence  (§  475i).  But  in  the  case  of  the  mutilated  heart 
the  nature  of  the  injury  precludes  the  supposition  that  there  could  have 
been  any  radiating  focus  of  reflex  actions,  which  is  probably  equally 
true  of  the  case  in  §  498  e;  so  that  in  those  instances  the  air  and  the 
mechanical  irritation  Avere  alone  the  exciting  causes.  Note  A  p.  1111. 

265.  Motion,  therefore,  whether  voluntary  or  involuntary,  is  carried 
on  througji  properties  inherent  in  the  various  tissues,  and  the  nervous 
influence  is  only  a  remote  exciting  cause,  and  in  that  respect  on  com- 
mon ground  with  other  vital  agents,  while  also,  as  will  be  seen,  it  is  an 
indispensable  regulator  of  the  organic  mechanism  of  animals,  and  trib- 
utary to  the  perfection  of  their  oi'ganic  compounds  (§  222-233|,  500). 

266.  The  nervous  power,  in  developing  motion  in  either  organic  or 
animal  life,  as  a  stimulus  to  the  organic  properties,  does  not  follow 
the  nerves  according  to  their  regular  order  of  distribution  from  the 
nervous  centres.  On  the  contrary,  its  entire  want  of  uniformity  in 
that  respect — operating  simultaneously,  at  one  time,  through  a  nerve 
or  nerves  pi'oceeding  from  the  cranium  and  some  inferior  part  of  the 
spinal  canal,  while  it  passes  over  all  intermediate  nerves — or,  at  an- 
other time,  electing,  without  any  regularity  in  respect  to  order  of  ar- 
rangement, two  or  more  of  those  intermediate  spinal  nerves — thia 
entire  want  of  respect  to  anatomical  order  is  so  familiar  to  all  that  it 
has  not  appeared  as  one  of  the  most  difficult  and  sublime  problems  of 
nature.  This  very  extraordinary  attribute  of  the  nervous  power  is 
rendered  the  more  remarkable  by  our  knowledge  of  the  fact  that  ita 
operation  is  determined  through  particular  nerves  either  by  an  act  of 
the  Avill,  or,  in  oi'ganic  life,  by  particular  passions,  by  their  intensity 
of  operation,  and  by  the  special  nature  and  intensity  of  physical  agents 
which  may  transmit  their  influences  to  the  nervous  centres  through 
some  other  part ;  and,  in  the  cases  relative  to  organic  life,  according, 
also,  to  the  existing  susceptibility  of  the  various  parts  of  the  organism 
(§  137  cl,  143,  148-152,  233f,  500,  892i  v,  893,  905,  1059). 

267.  All  the  foregoing  are  established  facts,  of  perpetual  occurrence  ; 
and  they  should  be  taken  in  connection  with  the  doctrines  which  I  have 
advanced  as  to  artificial  modifications  of  the  nervous  power,  and  the 
modus  operandi  of  morbific  and  remedial  agents  (§  224-233|,  497-500, 
503,  506,  889  a,  89 U  /.-,  892  aa,  893-905). 

2.    ABSORPTION. 

268.  Absorption  is  performed,  in  animals,  by  the  lacteals  and  lym- 
phatics ;  those  vessels  being  very  similar  in  their  constitution  and 
function.  There  are  corresponding  means  for  the  office  of  absorption 
in  the  roots  and  leaves  of  plants. 

269.  Magendie,  and  others  who  have  copied  from  him,  have  fallen 
into  the  error  of  attributing  the  office  of  absorption  to  the  veins.  He 
was  led  into  the  mistake  by  an  ignorance  of  the  fact  that  the  lymphat- 
ics terminate  variously  in  small  veins.*  Fallacies  of  that  nature 
should  be  apparent  upc  n  principle  alone — at  least  to  such  as  recog- 
nize a  unity  of  design,  and  a  simplicity  in  the  great  institutions  of 
nature.     Every  system  of  vessels,  so  far  as  known,  has  but  one  func- 

*  Sec  Medical  and  Physiological  Commentaficf,  vol.  ii.,  p.  170,  note,  380,  394-39G. 


PHYSIOLOGT. FUNCTIONS.  129 

tion,  however  that  may  be  modified  in  diiFerent  partr,  as  seen  in  the 
lymphatics  and  lacteals,  in  the  terminal  series  of  the  capillary  arter- 
ips  in  all  parts,  &c.  The  distinction  depends  either  upon  structure 
connected  with  the  modifications  of  common  vital  properties,  and 
their  relative  adaptations  to  the  physical  properties  of  different  fluids, 
or,  structure  may  be  apparently  less  concerned  than  the  organic  prop- 
erties ;  which  is  one  of  the  most  universal  and  important  principles 
in  physiology  (§  133-150). 

270.  The  lacteals  perform  the  office  of  absorbing,  and  introducing 
into  the  organization  of  animals,  foreign  nutritive  matter. 

271.  The  lymphatics,  in  greater  part,  are  destined  for  the  vital  de- 
composition of  the  body,  and  for  the  removal  of  waste  parts,  which 
are  conveyed  by  the  lymphatics  into  the  torrent  of  blood  to  be  ulti- 
mately cast  out  of  the  system,  or  again  to  undergo,  in  part,  the  process 
of  sanguification.    May  absorb  from  surfaces,  but  not  nutritijje  matter. 

272.  By  these  vessels,  also,  the  solids  are  removed  in  the  ulcerative 
process  of  inflammation,  and  mortified  parts  are  detached  from  the 
sound,*  and  foreign  substances  which  are  introduced  into  the  body  are 
taken  up  and  removed. 

273.  Hence  it  is  obvious  that  the  lacteals  and  lymphatics  are  antag- 
onizing systems,  and  that  beings  so  endowed  are  the  constant  subjects 
of  waste  as  well  as  of  nutrition  ;  the  balance  being  maintained  through 
the  inlet  supplied  by  the  lacteals,  and  the  outlet  provided  by  the  lym- 
phatics (§  180-182,  286).  Notwithstanding,  therefore,  the  coincidence 
in  the  general  function  of  these  two  systems  of  vessels,  the  office  of  one 
is  creative,  that  of  the  other  destructive. 

During  the  period  of  growth  nutrition  overbalances  waste ;  but, 
when  growth  ceases,  nutrition  and  vital  decomposition  must  be  in 
equillbrio. 

274.  No  substances  but  such  as  exist  in  a  fluid  or  very  attenuated 
state  are  taken  up  by  the  lacteals  and  absorbents. 

275.  The  intestinal  villi  have  been  shown  by  Cruikshank,  Bleuland, 
and  others  to  possess  open  orifices,!  though  this  is  denied  by  the  mi- 
croscopists;  and  I  have  shown  that  the  modifying  influence  of  the 
ganglionic  nerves  upon  all  the  organic  functions  and  products  contra- 
dicts the  hypotheses  of  catalysis  and  endosmose  and  exosmose  (§  1089). 

276.  Different  substances  are  absorbed  with  various  degrees  of  ra- 
pidity, both  in  animals  and  plants.  This  depends  on  their  peculiar 
virtues,  and  on  the  manner,  therefore,  in  which  they  affect  irritability ; 
thus  showing  the  vital  nature  of  the  process  (§  149,  188,  &c.,  207). 
The  same  conclusion  is  also  inferable  from  experiments,  as  well  upon 
plants  as  animals. 

277.  a.  Again,  the  lacteals,  in  virtue  of  their  special  modifications 
of  irritability,  exclude  every  thing  but  chyle.  Bile  is  not  taken  up 
either  by  the  lacteals  or  lymphatics;  cathartics  pass  off;  emetics  are 
rejected.  The  principle  is  every  where;  is  shown  in  the  larynx, 
pylorus,  &c.,  in  the  sparseness  of  the  red  globules  in  the  lymph 
vessels,  though  their  diameters  be  many  times  larger  than  the  globules 
of  blood  (§  399).  The  principle  lies  in  the  virtues  of  the  agents  and 
the  special  modification  of  irritability  which  belongs  to  each  part  (§ 
135).     It  is  designed  for  the  conservation  of  every  part,  and  of  the 

*  See  Med.  and  Phvsiolog.  Coinm.,  vol.  ii.,  p.  168, 169,  171-173. 
t   Ibid.,  vol.  i.,  p.  683-690,  699-712. 
I 


130  INSTITUTES    OF    MEDICINE. 

whole.  Had  not  the  lacteals  and  lymphatics  been  endowed  in  this 
wonderful  manner,  or  were  absorption  a  mere  physical  process,  or  ca- 
pillary attraction,  or  endosmose,  all  foreign  substances  would  have  free 
access  to  the  internal  parts  of  the  organization,  and  organic  beings 
would  have  had  no  continued  existence.  They  would  have  perished 
as  soon  as  created.  Hence,  are  the  vital  properties  so  modified  in  all 
these  millions  of  inlets  into  the  labyrinth  of  organization  that  they 
shall  be  not  only  vigilant  sentinels,  but  recognize,  at  once,  every  one 
of  the  thousand  offenders  that  may  endeavor  to  steal  its  way  into  the 
sanctum  sanctorum  (§  192). 

277.  h.  Some  of  the  most  important  laws  in  medicine  are  founded  on 
the  special  modifications  of  irritability  in  different  parts  (§  149,  150); 
and  as  it  respects  the  lacteals  and  lymphatics,  the  principle  not  only 
contradicts  the  assumption  of  the  operation  of  medicines  by  absorption, 
but  confirjps,  in  a  beautiful  manner,  the  laws  of  sympathy. 

278.  It  is  only  when  the  lacteals  and  lymphatics  become  morbidly 
affected,  or  their  irritability  essentially  modified  by  the  morbific  action 
of  agents  offensive  to  the  organization,  that  those  agents  are  at  all  ad- 
mitted, and  then  only  very  sparingly.  The  principle  is  the  same  as 
when  undigested  food  escapes  the  pyloric  orifice  in  indigestion,  or 
the  red  globules  of  blood  gain  admittance  to  the  serous  vessels  in  in- 
flammation (§  14,  74,  117,  137, 143,  155,  156,  169  f,  266,  303^  a,  306, 
310,  313,  325,  387,  399,  409/,  422,  514  li,  524  d,  525,  526  d,  528  c, 
638,  649  d,  764  h,  811,  847  c,  848,  902/,  905). 

279.  If,  therefore,  foreign  agents  affectthe  absorbent  vessels  in  the 
foregoing  manner,  so  also  do  they  affect  the  condition  of  the  other  tissues 
of  the  part.  This  is  the  beginning  of  disease,  which  may  now  go  on 
accumulating  without  any  farther  agency  of  the  exciting  cause  ;  or, 
if  the  offending  cause  gain  admission  into  the  circulation,  it  may  con- 
tinue, per  se,  to  exasperate  disease.  But,  even  in  this  case  of  the  con- 
tinued operation  of  morbific  or  remedial  agents  after  their  absorption, 
I  have  shown  that  solidism  and  vitalism  can  alone  explain  their  effects 
(§  819,  &c.). 

280.  I  have  also  shown  that  when  morbific  or  remedial  agents  are 
taken  into  the  circulation  the  quantity  is  so  small,  their  dilution  by 
the  blood  and  other  fluids  so  great,  and  their  elimination  by  the  kid- 
neys so  rapid  (at  least  in  a  general  sense),  that  little  or  nothing  is 
likely  to  be  contributed  in  this  way  to  the  morbific  or  remedial  effects. 

The  rapidity  with  which  agents  that  are  not  morbific,  but  useless 
to  the  system,  are  elaborated  .by  the  kidneys,  is  a  proof,  upon  the  prin- 
ciple of  Design,  that  a  provision  exists  for  the  exclusion  of  deleterious 
agents  from  the  circulation.  But,  since  they  may,  under  special  cir- 
cumstances, pass  the  gi'eat  sentinel  (§  278),  the  kidneys  are  provided 
as  other  guards  to  the  general  organism,  to  expel  the  offenders  at  once. 
Just  so  with  the  lungs.  If  offensive  objects  pass  the  larynx,  all  the 
muscles  of  respiration,  through  a  beautiful  system  of  Design,  imme- 
diately set  at  work  to  get  rid  of  the  intruder.  The  intelligent  reader 
will  readily  carry  this  principle  to  more  recondite  processes,  as  the 
institution  of  abscesses,  and  the  curious  steps  that  attend  their  progress 
from  deep-seated  parts  toward  the  surface  (^  733). 

281.  It  may  be  also  added,  that  I  know  of  no  critical  attempt  having 
been  made  to  invalidate  the  facts  and  the  reasoning  set  forth  in  my 
Essay  on  the  Humoral  Pathrdogy,  which  has  for  its  object  the  ex- 


PHYSIOLOGY. FUNCTIONS.  131 

posure  of  that  pathology  and  the  defense  of  solidism  and  vitalism ; 
and,  although  that  work  has  been  now  six  years  before  the  public,  I 
know  not  that  I  have  omitted  the  investigation  of  one  essential  fact  or 
experiment  that  has  been  alleged  or  instituted  in  behalf  of  humoralism. 
If  such  omission  has  occurred,  let  it  be  shown.* 

282.  Many  distinguished  men  have  been  led  into  the  error  of  sup 
posing  that  noxious  substances  are  taken  readily  into  the  circulation 
because  the  skin  is  deeply  tinged  with  yellow,  in  jaundice  ;  or  because 
the  bones  become  red  when  madder  is  eaten ;  or  the  urine  is  colored 
by  rhubarb,  or  manifests  the  odor  of  tuipentine,  of  garlic,  &c.  But, 
let  it  be  considered,  that  the  inoffensive  coloring  matter  of  the  bile  is 
alone  absorbed,  as  is  also  that  of  madder  and  rhubarb,  &c. ;  while  the 
thousandth  part  of  a  grain  of  spirits  of  turpentine,  or  of  garlic,  is  enough 
to  impart  all  the  odor  to  the  urine  that  has  been  ever  observed  to  at- 
tend that  product. 

283.  If  remedial  and  morbific  agents  be  absorbed,  it  devolves  upon 
the  mechanical  philosophers  to  show  the  fact,  which  they  have  failed 
of  doing  in  regard  to  many  of  the  most  important  (§  826  c)  ;  but  should 
their  assumptions  become  realities,  I  shall  have  demonstrated  by  a  mul- 
titude of  analogies  where  absorption  is  out  of  the  question,  and  in  va- 
rious other  ways,  that  the  modus  ojjerajidi  of  the  whole  rests  upon  the 
philosophy  of  the  natural  physiological  laws  (§  1088-1089). 

284.  Although  a  very  limited  operation  of  morbific  and  remedial 
agents,  through  their  absorption  into  the  circulation,  be  not  incompat- 
ible with  solidism  and  vitalism  (§  277,  278,  283,  827/),  the  usual  in- 
terpretation of  their  effects,  according  to  the  doctrines  of  humoralism, 
would  compel  us  to  abandon  the  application  of  physiology  to  medicine, 
whether  pathologically  considered,  or  in  respect  to  the  operation  of 
curative  agents.  The  laws  of  disease  would  be  totally  unlike  the 
laws  of  health;  or,  rather,  disease  would  be  without  laws,  and  there 
would,  therefore,  be  no  general  principles  in  medicine.  Practice  would 
be  a  blind  empyricism.  Diseases  would  be  just  as  various  and  un- 
certain as  every  chemical  change  in  the  blood,  and  these  changes, 
upon  the  ground  of  humoralism,  would  have  no  resemblances  to  each 
other. 

285.  The  properties  of  life  lie  at  the  foundation  of  physiology. 
It  is  a  knowledge  of  their  character,  and  of  the  laws  which  they  obey, 
that  enables  us  to  conform  our  habits,  at  all  ages,  in  the  best  way  for 
the  maintenance  of  health.  But,  what  is  disease  1  It  is  a  deviation 
from  the  state  of  health ;  and,  therefore,  if  there  be  any  consistency 
in  nature,  disease  should  consist  primarily  and  essentially  in  modifi- 
cations of  those  vital  properties,  which,  in  a  different  state,  constitute 
the  important  conditions  of  health.  In  this  way,  therefore,  medicine 
takes  the  rank  of  an  intelligible  and  important  science.  Physiology 
is  the  ground-work  throughout.  Pathology  becomes  nothing  more 
than  physiology  modified.  And,  coming  to  therapeutics,  it  is  still 
physiology  applied  to  the  cure  of  diseases ;  or,  in  other  words,  the 

(application  of  such  agents  to  the  morbid  properties  of  life  as  shall  aid 
their  i-estoration  to  their  natural  physiological  state.  The  whole  is 
thus  bound  together.  No  new  elements  come  into  operation ;  but, 
throughout  the  whole  series  of  changes,  the  same  powers  are  in  action 
and  carry  on  all  the  processes.     Nor  are  there  any  new  laws  intro- 

'duced.       The   powers   and   actions  being  fundamentally   the   same, 

*In  Medical  and  Physiological  Comm.  vol.  i.  1840. — Now  25  years,  and  no  attempt  made. 
—1865. 


132  INSTITUTES    OF    MEDICINE. 

80  are  the  laws,  of  health  and  disease,  as  are  those,  also,  by  which 
diseased  are  converted  to  healthy  conditions.  But,  the  powers  or 
properties  of  life  being  modified  in  disease,  and  again  modified  in 
other  ways  by  the  action  of  remedial  agents,  so  are  the  laws,  mider 
which  all  these  results  happen,  varied  in  a  corresponding  manner. 
The  laws  are  only  the  conditions  under  which  effects  take  place  ;  and, 
as  those  effects  have  always  a  direct  reference  to  the  state  of  the  vital 
properties,  they  must  be  fundamentally  of  the  same  nature  under  all 
the  various  conditions  of  life,  since,  also,  the  vital  properties  never 
lose  their  fundatnental  character  (^  1,  639). 

286.  When,  therefore,  I  may  speak  of  the  laws  of  health  and  the  laws 
of  disease,  I  must  not  be  understood  as  meaning  something  entirely 
different  in  the  two  cases.  And  yet,  their  modifications  are  always 
precise,  and  the  results  of  each  are  always  determined  in  one  uniform 
manner.  This  is  necessarily  so,  because  the  changes  in  the  vital 
properties  are  always  precise,  and  according  to  the  nature  of  the  in- 
fluences by  which  the  changes  are  effected  (§  149,  150). 

287.  In  this  sense,  therefore  (§  286),  the  laws  may  be  assumed  to 
be,  in  each  individual  modification,  of  a  specific  nature. 

288.  Laws  may  be  said  to  be  general  and  specific;  which,  how- 
ever, is  only  another  mode  of  considering  the  foregoing  principle  (§ 
285).  Thus,  it  is  a  general  law  that  the  absorbents,  whether  in  health 
or  disease,  do  not  take  up  foreign  substances  of  a  deleterious  nature ; 
but,  it  is  a  specific  law,  that  when  the  irritability  of  the  lacteals  or 
lymphatics  is  modified  in  a  certain  way,  they  will  admit  a  small  pro- 
portion of  the  noxious  agent  by  which  the  alteration  is  produced  (§ 
277,  278). 

289.  Those  mechanical  physiologists  who  have  not,  or  will  not  have, 
just  conceptions  of  the  properties  and  actions  of  life,  refer  the  process 
of  absorption  to  capillaiy  attraction,  or  that  mechanical  principle  which 
determines  the  ascent  of  oil  in  the  wick  of  a  lamp  (§  277).  The 
chemists  belong  to  this  class  of  reasoners ;  even  such  of  them  as  allow 
the  existence  of  a  vital  principle.  Thus,  for  example,  Liebig  has  it, 
that, 

"  A  cotton  wick  inclosed  in  a  lamp,  which  contains  a  liquid  satura 
ted  with  carbonic  acid,  acts  exactly  in  the  same  manner  as  a  living 
plant  in  the  night.  Water  and  carbonic  acid  are  sucked  up  by  capil- 
lary attraction,  and  both  evaporate  from  the  exterior  part  of  the  wick." 
Again,  "  All  substances  in  solution  in  a  soil  are  absorbed  by  the 
roots  of  plants  exactly  as  a  sponge  imbibes  a  liquid,  and  all  it  con- 
tains, without  selection." — Liebig's  Organic  Chemistry  ap-plied  to 
Physiology  and  Agriculture. 

Now  all  this  might  be  very  good  philosophy  for  a  common  agricultu- 
rist; but  it  evinces  an  unaccountable  disregard  of  facts,  and  of  the  plain- 
est suggestions  of  nature.  And  yet  it  is  a  common  docti-ine  now-a- 
days  ;  a  part  of  the  "  new  experimental  philosophy."  In  the  first  place, 
however,  it  is  not  true  that  the  roots  of  plants  imbibe  their  nourish- 
ment "  without  selection."  When  plants  are  cultivated  in  glass  ves- 
sels containing  distilled  water,  their  roots  will  even  decompose  the 
glass,  and  select  its  silica,  or  alkali,  or  take  them  both,  and  assimilate 
them  to  themselves,  and  in  the  absence  of  any  known  chemical  affini- 
ties or  influences.  Absorption  is  nearly  as  exact  in  plants  as  in  ani- 
mals ;  and  so  is  appropriation.     Like  animals,  their  absorbent  system 


PHYSIOLOGY. FUNCTIONS.  133 

is  naturally  repulsive  of  every  thing  that  is  offensive  and  not  suitable  to 
their  economy.  If  poisons,  when  artificially  applied,  get  admission, 
it  is  by  inflicting  a  violence  on  the  radicles  of  plants  (§  278).  And 
what  is  thus  prompted  by  reason,  by  analogy,  by  common  expei'ience, 
is  fully  confirmed  by  the  chemists  themselves,  in  those  analyses  of  all 
parts  of  a  plant,  even  the  sap,  which  are  designed  as  standards  of  the 
composition  which  shall  serve  for  any  particular  part  of  any  given 
species  of  plant,  as  well  through  all  future  time  as  at  the  hour  when 
the  analyses  were  made  (^  1052,  1053,  1054). 

290.  The  simile  of  the  "  lamp-wick,"  and  of  the  "  sponge"  (§  289), 
show  us  how  far  astray  our  friends  are  from  the  path  of  truth.  It  is 
not  alone  the  complex  mechanism  of  the  root  which  the  absorbed  ma- 
terials traverse,  but  a  labyrinth  of  highly  organized  and  living  tubes, 
passing  through  the  whole  trunk  of  the  plant,  till  the  materials  finally 
reach  the  leaves.  In  those  respiratory  organs,  the  pabulum  vitce  is 
farther  subjected  to  the  action  of  another  complicated,  unique,  and 
living  system  of  vessels.  And  what  is  the  "wick  of  a  lamp?"  A 
mere  bundle  of  dead,  disorganized  fibres,  broken  upon  the  card,  and 
spun  upon  the  wheel  (§  3501-  n,  o,  826  c). 

291.  But,  the  foregoing  degrading  docti'ine  of  life  (§  289)  is  not  pe- 
culiar to  the  chemists.  Some  reputedly  profound  physiologists  apply 
it  not  only  to  plants,  but  to  animals,  and,  like  Liebig,  identify  the 
same  vital  and  physical  processes.  One  example,  in  a  distinguished 
quarter,  will  suffice.     Thus,  Dr.  Carpenter  : 

"  It  will  be  hereafter  shown  that  the  absorption  of  nutritious  fluid 
is  probably  due  to  the  physical  power  of  endosmose.  A  continued 
absorption  may  be  produced  by  a  physical  contrivance  wliich  imitates 
the  effects  of  vital  action  ;  [  !  ]  as  in  the  wick  of  a  lamp,  which  draws  up 
oil  to  supply  the  combustion  above,  but  will  cease  to  do  so  when  the  de- 
mand no  longer  exists'^  !  (§  64  g,  175  A). — Carpenter's  Comparative 
Physiology. 

The  work,  a  standard  one,  from  which  the  foregoing  is  quoted, 
abounds  with  analogous  doctrines.  They  are,  of  course,  fatal  to 
physiology  and  to  all  medical  science. 

292.  Immediately  after  the  quotation  from  Liebig,  in  the  preceding 
section,  that  author  proceeds  to  reprobate  physiologists  for  their  ex- 
clusion of  chemistry  from  organic  life,  and  charitably  regards  it  as  a 
prejudice  arising  from  our  ignorance  of  the  science  (§  350,  c).  This, 
however,  is  quite  an  untenable  position ;  for,  wherever  medicine  is 
cultivated  chemistry  is  justly  made  a  fundamental  part  of  education. 
It  is,  indeed,  the  knowledge  which  the  soundest  physiologists  possess 
of  chemical  science  that  enables  them  to  institute  the  necessary  con- 
trasts, and  which  convinces  them  that  chemistry,  in  its  proper  ac- 
ceptation, has  no  connection  with  the  processes  of  living  beings. 
This,  indeed,  I  have  abundantly  shown  to  be  the  real  opinion  of  the 
chemists  themselves  (§  350,  &c.).  Bold  in  assumption,  inapt  in  illus- 
tration, and,  at  last,  like  Liebig,  contradicting  the  whole  by  an  ac- 
knowledgment that  "  vitality,  in  its  peculiar  operations,  makes  use  of 
a  special  apparatus  for  each  function  of  an  organ,"  and  that  "m  the 
living  organism  we  are  acquainted  with  only  one.  cause  op  motion  ; 
artd  this  is  the  same  cause  tvhich  determines  the  growth  of  living  tis- 
sues, and  gives  them  the  power  of  resistance  to  external  agencies.  It  la 
VHE  vital  force." — LiEBiG  (§  350,  nos.  26,  27,  28,  71-77,  &c.). 


134  INSTITUTES   OF    MEDICINE. 

293.  Looking  at  other  facts  attending  the  process  of  absorption  in 
plants,  we  shall  find  them  all  concurring  with  what  I  have  already 
stated  as  to  the  dependence  of  this  function  upon  vital  actions ;  and, 
if  vital  here,  we  need  not  look  for  other  proof  of  a  similar  law  in  an- 
imals. Thus,  Van  Marum  demonstrated  that  absorbed  fluids  could 
rise  onlj''  eight  inches  by  capillary  attraction.  Hales,  Walker,  Mirbel, 
Chevreuil,  and  others,  have  shown  that  the  sap  moves  with  such  ve- 
locity and  force  in  plants,  that  it  must  be  propelled  by  vital  contrac- 
tions and  dilatations  of  the  vessels.  "We  have  examples  of  this  sur- 
prising rapidity  of  the  circulation  in  grape-vines.  Don  aiid  Bai'bieii 
affirm  that  they  saw  the  movements  of  the  vessels. 

Again,  the  motion  of  sap  is  increased  by  light,  heat,  and  other  stim- 
uli, which  have  no  effect  on  capillary  attraction.  And  this  is  the  opin- 
ion even  of  Liebig,  who  says  that  "  the  functions  of  plants  certainly 
proceed  with  greater  intensity  and  rapidity  in  sunshine,  than  in  the 
diffused  light  of  day ;  but  it  merely  accelerates  in  a  greater  degree 
THE  action  already  EXISTING;"  "an  action,"  he  says,  "which  de- 
pends on  the  vital  force  alone^ 

It  was  shown  by  La  Place,  that,  if  the  sap  rose  by  capillary  attrac- 
tion, it  should  not,  as  it  does,  flow  from  the  openings  made  in  the  ves- 
sels. But,  again,  the  sap  will  not  flow  from  the  openings,  if  the  plants 
be  poisoned  with  pmssic  acid.  The  effect  is  the  same  as  upon  the 
circulation  of  the  blood;  and  it  would  be  equally  absurd,  in  either 
case,  to  suppose  that  the  poison  acts  upon  any  physical  force.  As- 
tringents, and  various  other  substances,  apjalied  to  the  openings,  avert 
the  flow  of  sap,  which  can  only  be  done  through  the  foregoing  prin- 
ciples (§  278-284,  1054). 

294.  Here  is  another  fact,  and  which  appears  to  be  conclusive  of 
the  vital  nature  of  absorption,  and  of  the  discrimination  observed  by 
the  radicles  of  plants  (§  289,  291).  It  is,  that  the  sap  of  the  root  is 
unlike  any  thing  which  it  absorbs  from  the  earth.  All  the  substances 
are  decompounded  at  the  moment  of  entering  the  roots,  just  as  the 
carbonic  acid  is  by  the  leaves.  Their  elements  are  then  also  united 
according  to  the  modes  Avhich  prevail  in  organic  compounds  (§  38,  42). 

295.  Equally  unfounded  as  the  doctrine  of  capillary  attraction  are 
the  supposed  processes  of  endosmose  and  exosmose.  They  are  gen- 
erally predicated  of  experiments  upon  dead  matter,  and  are  then  car- 
ried, by  way  of  analogy,  to  the  living  organism,  and  in  defiance  of  all 
the  contradictory  phenomena  of  life.*  Having  entered  extensively 
into  a  refutation  of  the  hypothesis  of  endosmose  and  exosmose  in 
the  Medical  and  Physiological  Commentaries,  I  shall  not  now  resume 
the  subject  (^  1052,  1053,  1054). 

3.    ASSIMILATION. 

296.  By  the  function  of  assimilation  substances  taken  into  the 
body  are  converted  into  the  homogeneous  blood,  and  identified  in  com- 
position and  vital  properties  with  all  parts  of  the  body.  It  is  there- 
fore especially  concerned  in  the  process  of  growth,  and  in  supplying 
the  waste  which  is  constantly  in  progress.  It  is  the  function,  there- 
fore, by  which  the  properties  of  life  are  communicated  to  dead  matter. 

297.  All  dead  matter,  before  its  reception  into  the  body,  is  subject 
to  the  forces  of  chemistry.  The  operation  of  these  forces  is  arrest- 
ed in  tho  alimentary  canal  of  animals,  and  in  the  absorbing  vessels  of 
plants. 

*  Violence  is  inflicterl  in  the  experiments  upon  living  tissues. 


PHYSIOLOGy. FUNCTIONS.  135 

298.  The  nutriment  of  vegetables  consists  always  of  inorganic  sub 
stances,  or  is  reduced  to  the  condition  of  inorganic  matter  before  its 
appropriation.  The  food  ot  animals  is  always  organic.  The  former 
exists  in  an  elementary  or  in  a  state  of  binary  combination,  the  latter 
of  ternary,  quaternary,  &c.  It  is  the  work  of  vegetable  assimilation 
to  overthrow  the  chemical  combinations,  and  to  unite  the  elements 
in  those  very  different  modes  which  constitute  organic  compounds. 
This  is  the  most  remarkable  and  comprehensive  System  of  Design  of 
which  we  have  any  knowledge  (^  1052). — Notes  NR  pp.  1121, 1123. 

299.  Assimilation,  therefore,  devolves  especially  upon  the  proper- 
ties vivification  and  vital  affinity  (§  216,  218) ;  though  it  be  certainly 
true  that  all  the  organic  powers  and  functions  are  necessary  to  each 
other,  and  concur  together  in  producing  every  result.  But,  in  every 
result  thei'e  are  some  more  interested  than  others. 

300.  Animals,  being  incapable  of  organizing  inorganic  substances, 
are  dependent  upon  the  vegetable  kingdom  as  their  ultimate  source 
of  supply  (§  13,  14).  Such,  indeed,  is  the  final  cause  of  vegetable 
life.  But  the  food  of  animals  must  be  dead  before  it  can  begin  to  un- 
dergo the  action  of  the  vital  properties  in  another  being.  The  gas- 
tric juice,  for  instance,  has  no  effect  upon  any  living  substance. 

301.  No  organic  compound  ever  undergoes  chemical  decomposi- 
tion, or  any  approximation  toward  such  decomposition,  to  fit  it  for  the 
purposes  of  animal  life.  On  the  contrary,  every  such  tendency  places 
the  appropriate  nutriment  of  animals,  more  or  less,  beyond  their  as- 
similating endowments.  It  is  the  province  of  animal  life,  and  of  all 
its  provisions  for  assimilation,  not  to  carry  back  toward  their  inorganic 
condition  the  peculiar  compounds  generated  by  the  vegetable  king- 
dom for  the  foreordained  uses  of  the  animal,  but  to  carry  them  for- 
ward to  yet  higher  degrees  of  life  and  organization.  This  is  one  of 
the  most  fundamental  laws  of  nature,  and  is  conclusive  against  all  the 
chemical  speculations  with  which  physiology  has  been  so  unhappily 
visited  (§  356  b-376)*     The  argument  belongs  to  me  (§  1084). 

302.  a.  The  assimilating  organs  in  vegetables  are  more  simple  than 
in  animals,  and  the  complexity  increases  in  animals  according  to  their 
rank  in  the  scale  of  life.  It  would  appear,  therefore,  that  organiza- 
tion bears  a  ratio  more  or  less  proportionate  to  the  endowment  of  or- 
ganic compounds  with  the  properties  of  life  (§  301,  409). 

302,  b.  The  process  of  converting  inorganic  into  organic  compounds 
begins  in  two  orders  of  vessels,  one  of  which  are  the  radical  absorb- 
ents of  plants,  the  other  analogous  vessels  in  the  leaves. 

The  matter  absorbed  by  the  roots  ascends  through  the  stem  to  the 
leaves,  where,  by  the  operation  of  a  series  of  vessels,  variously  mod- 
ified in  different  species,  it  is  converted,  along  with  that  absorbed  by 
the  leaves,  into  a  juice,  which,  like  the  blood,  is  thus  fitted  for  the 
purposes  of  nutrition.  This  juice  then  descends  through  other  ves- 
sels, to  be  appropriated  to  all  parts,  and  to  form  the  source  of  all  the 
various  products  of  vegetable  organization. 

303,  a.  We  come,  therefore,  to  a  conclusion  as  remarkable  as  it  is 
comprehensive,  that  the  atmosphere  is  not  only  essential  to  plants  and 
animals  in  its  usual  acceptation,  but  that  it  supplies  the  gi'eat  means 
of  nutriment  to  both  organic  kingdoms :  directly  to  the  vegetable,  and 
indirectly  to  the  animal  department  (§  298-300).  Mineral  compounds 
appertaining  to  the  earth  must  yield  the  less  important  elements,  and 

*  Chemists  are  beginning  to  adopt  this  conclusion,  as  iJppears  in  Note  at  p.  196. — 1860. 


136  INSTITUTES    OF    MEDICINE. 

even  some  proportion  of  oxygen  through  the  decomposition  of  rocks 
and  metals  and  the  appropriate  combinations  that  may  ensue ;  but 
we  must  look  especially  to  the  atmosphere  and  what  it  contains  for 
the  four  great  elements  which  compose  organic  beings.  The  oxygen 
and  the  nitrogen  of  the  air,  the  oxygen  and  the  hydrogen  of  the  vapor 
which  the  air  contains,  and  the  carbon  of  the  carbonic  acid,  are  as 
much  at  this  day  the  gi'eat  source  of  nutriment  to  plants,  as  before  the 
"  mist"  went  up  from  the  seas,  or  animals  yielded  ammonia.  Oxygen 
and  nitrogen,  therefore,  as  it  respects  atmospheric  air,  are  appropri- 
ated by  plants  in  their  elementary  condition.  Upon  organic  com- 
pounds thus  formed  is  animal  existence,  in  the  main,  dependent. 
Ammonia  certainly  contributes  to  the  nourishment  of  plants.  But 
this  is  an  incidental  means,  at  least  if  there  be  any  truth  in  Moses. 
And  that  his  Record  is  true,  is  plain  enough  upon  the  principle  of 
Design ;  since  it  is  impossible  that  Providence  should  have  created 
the  animal  kingdom,  which  yields  the  ammonia,  before  he  brought 
forth  that  kingdom  upon  which  animals  depend  for  their  existence. 

303,  h.  As  it  respects  absorption,  the  leaves  and  the  roots  of  plants 
appear  to  have  a  common  office,  though  the  former  are  designed  es- 
pecially for  assimilation.  The  carbonic  acid,  and  the  oxygen  and  the 
nitrogen  of  the  air,  are  precipitated  along  with  the  vapor,  and  thus 
reach  the  organs  which  are  principally  devoted  to  absorption.  In  no 
other  way  can  we  primarily  reach  the  materials  of  all  organic  beings. 
Before  their  absorption  can  have  begun,  the  most  essential  elements 
must  have  been  embraced  originally  in  the  atmosphere,  and  in  the 
simple  conditions  which  I  have  stated.  Nor  is  it  a  difficult  process  to 
follow  out  that  circuit  of  causes  and  effects  in  which  revolves  the 
economy  of  nature  in  making  the  waste  of  organic  beings  during  their 
own  existence  a  subsidiary  supply  of  nourishment  to  themselves,  or  to 
others  of  their  own  day,  or  to  generations  in  the  womb  of  time ;  or, 
when  consigned  "  to  the  dust,"  how  their  elements,  from  one  genera- 
tion to  another,  form  an  endless  round  of  materials  for  reproduction 
and  growth,  either  in  the  form  of  gases  and  vapor  diffused  in  the  air 
or  as  imbo'dled  with  the  earth. 

303,  c.  Although  it  be  the  special  object  of  the  radical  fibres  to 
carry  on  the  function  of  absorption,  this  office  is  more  or  less  perform- 
ed by  the  leaves  of  plants,  but  in  various  degrees,  according  to  the 
nature  of  the  species.  In  arid  climates,  the  leaves  have  this  function 
strongly  pronounced ;  and  many  plants,  like  the  semper vir ens,  will 
grow  as  well  when  suspended  by  a  string,  as  when  connected  by  theic 
roots  with  the  soil. 

303,  d.  The  leaves  of  plants  absorb  carbonic  acid  mostly  during  the 
day,  decompound  it  through  a  vital  process,  and  otherwise  prepare  it  as 
an  important  source  of  nourishment.  Light  is  necessary  to  this  func- 
tion of  the  leaves,  and  without  it  the  plant  languishes  and  dies.  As 
an  attendant  result  oxygen  gas  is  evolved  into  the  atmosphere.  The 
process  is,  therefore,  suspended  during  the  absence  of  light,  and  some 
proportion  of  carbonic  acid  is  regenerated  and  escapes  along  with  the 
vapor  which  is  exhaled  by  the  leaves.  It  has  been  also  supposed  that 
more  or  less  oxygen  is  absorbed  at  night;  but  this  opinion  appears 
not  to  be  sustained  by  later  and  better  observations.  It  is  most  proba- 
ble, indeed,  that  the  temporary  absence  of  light  occasions  scarcely  more 
than  a  suspension  of  the  assimilating  process.     Light  acts  as  a  vital 


PHYSIOLOGY. FUNCTIONS.  137 

Stimulus  to  the  leaves,  by  which  their  organic  properties  are  lendereil 
capable  of  overthrowing  that  most  refractory  compound,  carbonic  acid 
(§  188|  d,  350,  nos.  64,  66,  68-76,) 

303,  e.  The  leaves  of  plants  being  the  great  organs  of  assimilation, 
and  light  the  vital  stimulus  by  which  the  function  is  maintained  (§ 
188J,  d),  it  appears  from  what  has  been  now  said  that  light  holds  the 
first  rank  among  the  requisites  of  life.  It  was  therefore  brought  into 
existence  before  the  creation  of  the  vefjetable  kingdom  :  and  being 
thus  indispensable  to  all  living  beings,  we  see  the  fallacy  of  a  common 
tenet  in  theoretical  geology,  that  the  most  thrifty  period  of  vegetation 
was  through  a  great  cycle  of  total  darkness,  and  an  atmosphere  of 
carbonic  acid  (§  74,  1079  b): 

303 J,  a.  One  of  the  most  interesting  facts  in  vegetable  physiology 
is  the  immediate  necessity  of  plants  to  animal  life  during  their  very 
growth;  their  final  cause,  in  this  respect,  being  the  abstraction  of  car- 
bonic acid  from  the  atmosphere,  and  the  renewal  of  its  oxygen.  Ani- 
mals, too,  as  we  have  seen,  incidentally  contribute  carbon  to  the  vege- 
table kingdom,  in  the  form  of  carbonic  acid,  and  nitrogen  in  the  form 
of  ammonia.  There  is  this  remarkable  subserviency  of  the  organic 
kingdoms  to  each  other,  though  there  be  not  a  reciprocal  dependence. 
Vegetables,  indeed,  preceded  animals,  and  are,  therefore,  essentially 
independent,  while  animals  derive  all  they  possess  from  vegetable 
creation  (§  303,  a).  Plants  are  the  producers,  animals  the  consumers. 
The  former  directly,  and  the  latter  indirectly,  live  upon  the  air  and 
what  it  contains.  The  plant  dies  and  becomes  food  for  the  animal ; 
but  it  seems  scarcely  less  important  in  its  living  state  to  the  exigen- 
cies of  animal  life.  And  so  the  animal,  living  and  dead,  yields  back 
its  all  to  the  atmosphere ;  and  thus  are  the  inorganic,  and  the  two  de- 
partments of  the  organic,  kingdoms  united  (§  1052,  1053). 

303i,  b.  But,  we  have  seen,  as  I  originally  indicated  in  the  Essay 
on  the  Philosophy  of  Vitality,  that  the  supply  of  ammonia  to  the  atmo- 
sphere is  only  a  contingent  result  of  the  creation  of  animals,  and  there 
fore  not  indispensable  to  vegetation  (§  156  b,  303  a).  Liebig,  how- 
ever, reverses  the  order  of  Creation,  and  afllirms  that 

"  We  have  not  the  slightest  reason  for  believing  that  the  nitrogen 
of  the  atmosphere  takes  part  in  the  process  of  assimilation  of  plants 
and  animals."  "  These  facts  are  not  sufficient  to  establish  the  opinion 
that  it  is  ammonia  which  affords  all  vegetables,  without  exception,  the 
nitrogen  which  enters  into  the  composition  of  their  constituent  sub- 
stances. Considerations  of  another  kind,  however,  give  to  this  opin- 
ion a  degree  of  certainty  which  completely  excludes  all  other  views  of 
the  matter.^' — Liebig's  Organic  Chemistry,  Sec,  p.  70,  71. 

303i,  c.  The  same  mistake  has  arisen  with  the  chemists  as  to  the 
recipi'ocal  dependence  of  animals  and  plants,  in  regard  to  the  excre- 
tion of  carbon  by  one  and  oxygen  by  the  other.  However  true  it  may 
be  that  animals  are  dependent  on  plants  for  oxygen  gas,  it  is  certainly 
an  assumption  that  the  vegetable  kingdom  is  alike  dependent  on  the 
animal  for  its  carbonaceous  element.  If  the  primary  creation  of  plants 
be  admitted,  that  is  sufficient;  and  to  those  who  reject  the  Mosaic 
Record,  and  the  concurring  testimony  of  geologists,  I  may  repeat 
the  admitted  faCt  that  vegetables  are  the  ultimate  source  of  supply 
to  all  animals.  The  former,  therefore,  are  essentially  independent, 
the  latter  dependent;    while  this  universal  fact  corroborates,  also, 


138  INSTITUTES    OF    MEDICINE. 

the  original  account  of  the  primary  creation  of  the  vegetable  kingdom 
(§  303}). 

As  to  the  relations  of  the  living  plant  to  organic  life,  it  is  computed 
by  Saussure,  and  allowed  by  others,  that  the  atmosphere  contains  about 
-_i__th  part  of  its  w^eight  of  carbonic  acid.  The  atmosphere  must 
be  also  losing,  through  the  processes  of  respiration,  combustion,  &c., 
a  proportion  of  its  oxygen.  It  is  estimated,  also,  that  the  present  num- 
ber of  human  beings  w^ould,  alone,  double  the  existing  quantity  of  car- 
bonic acid  in  the  air  in  1000  years ;  and,  in  303,000  years  would  ex- 
haust its  oxygen.  It  is  also  found  that  atmospheric  air  of  the  present 
day  does  not  contain  less  oxygen  than  that  which  is  found  in  jars 
buried  for  ISOO  years  in  the  ruins  of  Pompeii. 

From  all  this  it  is  inferable  that  there  is  a  universal  cause  in  oper- 
ation, by  which  the  carbonic  acid  of  the  air  is  consumed,  and  oxygen 
supplied;  and,  from  the  various  well-known,  and  indispensable  uses 
Df  the  vegetable  kingdom  to  the  animal,  which  declare  its  creation  for 
the  benefit  of  the  latter,  and,  therefore,  its  antecedent  or  simultaneous 
creation,  we  should  naturally  be  prompted,  by  analogy,  to  look  to  this 
subordinate  provision  as  the  universal  source  through  which  the  great 
purposes  of  respiration  are  maintained  unimpaired.  Chemistry  has 
here  elegantly  illustrated  this  great  element  in  the  final  causes  of  the 
vegetable  kingdom,  and  the  contingent  aid  which  it  derives  from  the 
animal ;  while  it  enlarges  our  view  of  the  vast  conceptions  of  Unity  of 
Design. 

303^.  It  is  also  worth  our  while  to  observe  of  these  important  laws, 
as  we  go  along,  how  they  are  perverted  by  the  ignorant  in  physiolo- 
gy, and  how  incapable  the  chemist  is  constantly  proving  himself  of 
"  pursuing  his  reasoning,"  as  said  of  him  by  Hunter,  "  even  beyond 
the  simple  experiment  itself." 

Vegetables,  as  we  have  seen,  are  composed  mainly  of  carbon,  oxy- 
gen, hydrogen,  and  nitrogen  (§  37,  303).  The  carbonic  acid  of  the 
air  (as  well  as  of  the  soil)  is  absorbed  by  plants,  and  appropriated 
to  their  nourishment  and  growth.  This  gaseous  substance,  therefore, 
is  decomposed  by  vegetable  organization,  the  carbon  vivified  and  ap- 
propriated, and  a  part  of  the  oxygen  thrown  off  to  replenish  the  at- 
mosphere. It  is  incorrectly  said,  however,  by  Liebig,  that  "  the  at- 
mosphere must  receive  by  this  process  a  volume  of  oxygen  for  every 
volume  of  carbonic  acid  which  has  been  decomposed."  It  may  be 
meant,  however,  that  an  equivalent  or  atom  of  oxygen  for  every  equiv- 
alent of  carbon  is  given  off  to  the  atmosphere ;  but  even  this  construc- 
tion is  invalidated  by  the  multiplicity  of  sources  from  which  plants  arc 
supplied  with  that  important  element.  But  enough  is  known  to  ren- 
der it  certain  that  a  large  proportion  of  the  oxygen  of  carbonic  acid  is 
retained  by  plants  and  combined  under  a  new  form  along  with  the  car- 
bon and  other  elements.  Liebig's  hypothesis  of  capillary  attraction 
led  him,  not  improbably,  to  overlook  the  fact  that  the  water  which 
is  absorbed  by  plants  is  actually  decompounded,  and  its  elements  com- 
bined with  others  according  to  the  laws  which  determine  organic  com- 
pounds. It  is  water,  indeed,  which  yields,  far  more  than  ammonia, 
the  hydrogen  which  abounds  in  plants  (§  303,  Z»).  Water,  therefore, 
being  composed  of  oxygen  and  hydrogen,  furaishes  a  source  of  the 
supply  of  that  oxygen  which  goes  to  the  increase  of  vegetables  ;  and, 
for  aught  that  can  be  said  to  the  contrary,  it  may  form  a  part  of  what 
is  evolved  into  the  air. 


PHYSIOLOGY. FUNCTIONS.  139 

"We  have  seen,  also,  that  plants  derive  a  part  of  their  oxygen  from 
mineral  compounds  appertaining  to  the  earth,  and  probably  by  means 
of  the  roots  from  the  atmospheric  air  which  is  held  in  solution  by  water, 
when  the  gas  may  be  thus  appropriated,  notwithstanding  its  elementary 
condition  in  the  latter  case.  Although,  doubtless,  more  or  less  carbonic 
acid  is  reproduced  in  the  leaves  and  escapes  at  night  along  with  the  va- 
por exhaled,  the  probabilities  arc  against  the  supposition  that  a  propor- 
tion is  also  then  generated  and  emitted  by  plants  in  a  manner  analogous 
to  the  respiration  of  animals,  and  having  for  its  object,  in  part,  the 
separation  of  carbon  from  some  of  the  vegetable  constituents. 

303f.  But  let  us  come  to  philosophy : — 

"  At  night,"  says  Liebig,  "  a  true  chemical  process  coxMMENCEs, 
in  consequence  of  the  action  of  the  oxygen  of  the  air  upon  the  sub- 
stances composing  the  leaves,  blossoms,  and  fruit.  This  process  is  not 
at  all  connected  with  the  life  of  the  vegetable  organism,  because  it 
goes  on  in  the  dead  plant  exactly  as  in  a  living  one"  ! 

Here,  in  the  first  place,  is  an  important  fallacy  in  the  premises  from 
which  the  induction  is  made ;  since  the  processes  have  not  the  least 
analogy  in  the  living  and  dead  plant.  In  the  former,  the  oxygen  is 
taken  into  the  organization,  and  goes  to  form  organic  compounds.  In 
the  dead  plant,  it  is  an  agent  of  chemical  decomposition,  by  which  the 
organic  compounds  are  destroyed,  and  the  structure  broken  up. 

Now  we  shall  always  find  that  authors  who  reason  in  the  foregoing 
manner  perpetually  contradict  themselves.  In  the  case  before  us,  a 
contradiction  necessarily  arises  from  the  fundamental  differences  be- 
tween the  processes  of  organic  and  inorganic  beings,  and  the  laws  by 
which  they  are  governed.  A  little  farther  on  from  the  quotation  I 
have  just  made,  Liebig  affirms  that  "  tlie  laws  of  life  cannot  he  investi- 
gated in  an  organized  being  which  is  diseased  or  dying"  Here,  then,  is 
a  contradictory  opinion,  which  inculcates  as  great  an  error  in  physi- 
ology as  that  of  identifying  the  effects  of  oxygen  on  "  living  beings" 
and  on  such  as  are  actually  dead.  Here  is  an  absolute  denial  of  any 
analogies  between  the  laws  which  govern  living  "  diseased  beings" 
and  the  "laws  of  life."  But,  this  declaration  of  the  chemist,  devoid 
of  truth  as  it  is,  is  universally  applicable  where  he  would  be  least 
disposed  to  see  it  operate.  Such  an  application,  too,  is  an  irresistible 
sequitur  ;  since,  if"  the  laws  of  life  cannot  he  investigated  i?i  an  organ- 
ized being  which  is  diseased  or  dying,"  it  certainly  follows  that  the 
laws  which  relate  to  dead,  or  inorganic  beings,  and  the  forces  upon 
which  those  laws  depend,  can  have  no  agency  in  living  beings. 

Such,  however,  is  the  material  which  is  now-a-days  denominated 
"  experimental  philosophy,"  and  "  the  progress  of  medical  science." 
And,  if  the  reader  will  now  turn  to  the  parallel  columns  (§  350),  he 
will  see  yet  other  contradictions  directly  relative  to  the  foregoing 
quotation  (^  1052,  1053). 

But,  it  may,  perhaps,  be  well  enough,  before  dismissing  this  sub- 
ject, to  say,  that,  although  "  the  laws  of  life  cannot  be  investigated  in 
an  organized  being  which  is  dying,"  the  laws  which  govern  diseased 
actions  and  their  results  are  only  slightly  modified  "  laws  of  life,"  and 
often  reflect  great  light  upon  their  strictly  healthy  condition.  We 
are,  or  should  be,  constantly  reasoning  in  this  manner  in  all  cases  of 
disease ;  and  it  is  only  by  comparisons  of  the  modifications,  which 
constitute  disease,  with  the  natural  conditions  of  life,  that  we  can  have 


140  INSTITUTES    OF    MEDICINE. 

any  just  knowledge  of  diseases.  In  proportion,  however,  as  the  indi- 
vidual approximates  a  state  of  death  all  this  reasoning  fails ;  and, 
when  actually  dead,  no  such  comparisons  can  be  instituted.  Here, 
then,  it  is  that  the  foregoing  admission  of  the  chemist  applies  with  all 
the  force  of  truth  (§  639  a). 

304.  The  greater  complexity  of  the  organs  of  assimilation  in  ani- 
mal life  gives  rise  to  a  variety  of  subordinate  functions  in  animals  not 
found  in  plants ;  such,  for  example,  as  digestion  by  the  gastric  juice, 
saliva,  bile,  &c. ;  then  a  farther  advancement  of  the  process  in  the 
lacteals,  in  the  blood-vessels,  in  the  lungs,  &c.  Some  of  these  subor- 
dinate functions,  however,  have  their  analogies  in  plants  ;  such  as  the 
action  of  the  sap-vessels  upon  the  circulating  fluid,  the  imbibition  and 
exhalation  of  gaseous  substances  by  the  leaves,  &c.  But,  in  all  the 
cases,  the  extreme  vessels  which  perform  the  office  of  nutrition  are  the 
main  instruments  of  organic  life.  All  the  functions  which  are  carried 
on  by  compound  structures  are  subsidiary  only  to  that  of  the  nutritive 
vessels  (§  171). 

305.  The  organs  of  assimilation  in  animals  are  more  or  less  com- 
plex according  to  the  nature  of  the  food.  Probably  every  animal 
has  a  stomach,  or  some  analogous  organ,  aiid  a  mouth,  and  anus, 
which  would  form,  as  supposed  by  Aristotle,  a  fundamental  distinc- 
tion between  plants  and  animals  (§  11).  The  analogies  which  are 
supplied  by  the  higher  orders  of  animals  would  prompt  this  conclu- 
sion in  respect  to  the  most  inferior,  or  some  equivalent  arrangement. 

306.  In  vertebrated  animals  the  stomach  is  generally  an  expand- 
ed portion  only  of  the  intestinal  canal.  In  fishes  the  intestine  is 
commonly  short ;  but  this  is  often  compensated  by  folds  in  the  mu- 
cous membrane.  In  birds  there  is  a  complexity  of  the  alimentary 
organs  which  does  not  exist  in  fishes,  amphibia,  or  reptiles.  In  mam- 
malia the  digestive  organization  is  still  different ;  and  here  it  is  more 
remarkably  various  according  to  the  nature  of  the  food,  and  as  the 
necessity  of  supplies  may  be  felt  at  short  or  at  longer  intervals.  The 
more,  also,  the  phenomena  of  animal  life  are  multiplied  the  greatei 
is  the  development  of  the  digestive  system  (§  107,  251,  353).  Its 
complex  nature  has  an  intimate  relation  to  the  qualities  of  the  food, 
and  these  relations  have  an  affinity  with  that-  principle  of  instinct 
which  directs  animals  in  the  selection  of  food.  The  more  dense  and 
tough  the  food,  and  the  more  removed  from  the  nature  of  the  body 
which  it  is  destined  to  nourish,  the  more  complex  are  the  organs  of 
digestion.  And  so,  on  the  contrary,  the  softer  the  food,  and  the  more 
it  is  like  the  animal  in  its  composition,  the  more  simple  are  the  assim- 
ilating organs.  Animals,  therefore,  which  live  on  hay  have  these  or- 
gans much  more  complex  than  such  as  are  nourished  by  animal  food  ; 
especially  that  part  of  the  organization  which  is  destined  to  make  the 
first  and  "freatest  chanofe. 

007.  The  principal  agent  in  the  assimilating  process,  in  animals,  is 
the  gastric  juice ;  a  vital  organic  fluid,  which  is  secreted  by  the  inter- 
nal coat  of  the  stomach  (§  135  a,  316,  419,  827  b).  This  secretion  is 
especially  promoted  by  the  stimulus  of  food,  which  is  dissolved  and 
altered  in  its  elementary  constitution  by  the  vital  influences  of  the 
juice.  This  is  the  first  and  greatest  step  in  the  process  of  assimilation. 
It  is  here  that  dead  matter  receives  its  first  impressions  from  the  prop- 
erties vivification  and  vital  affinity  (§  216,  218).     The  chemists  tell  us 


PHYSIOLOGY. FUNCTIONS.  141 

that  the  process  is  a  chemical  one ;  and  that,  notwithstanding  the  va- 
rious, and  unique,  and  astonishing  devices  of  nature  for  the  elaboration 
of  the  gastric  juice,  theywould  persuade  physiologists  into  the  belief 
that  many  different  processes  of  the  laboratory  vv^ill  generate  a  gastric 
juice  with  all  the  unique  properties  that  appertain  to  the  fluid  as  elab- 
orated from  the  blood  by  the  various  modifications  of  organization 
which  were  instituted  by  Almighty  Power  for  these  specific  objects. 
And  having  been  thus  regardless  of  the  most  sublime  and  profound 
institutions  of  that  Power,  they  proceed  to  assume  that  the  product  of 
these  artificial  compounds,  in  their  action  upon  food,  is  the  homoge- 
neous chyme  of  living  nature,  and  which  is  apparently  the  same  in  all 
animals,  whatever  the  kind  or  the  variety  of  food.  But  the  chemist 
is  met  at  the  very  threshold  by  the  fact,  that  there  is  nothing  in  or- 
ganic nature  itself  that  can  elaborate  that  fluid  from  the  blood  but  that 
particular  part  of  the  great  system  of  mucous  membranes  which  forms 
a  component  part  of  the  stomach  (§  135,  a). — Notes  N  R. 

308.  The  foregoing  relates  to  complex  animals ;  but  analogy,  as  well 
as  observation,  renders  it  evident  that  the  inferior  races  possess  an  or- 
ganization which  is  equivalent  to  the  stomach  (§  251). 

309.  In  most  animals  that  consume  food  of  a  solid  nature,  there  are 
preparatory  organs  which  assist  mechanically,  by  dividing  the  food. 
The  construction  of  these  organs  of  mastication,  both  as  to  their  osse- 
ous and  muscular  parts,  has  a  strict  reference  to  the  kind  of  food  upon 
which  the  animal  is  destined  to  subsist.  Animals  of  prey  are  furnish- 
ed with  organs  for  the  destruction  of  life  and  organization ;  since  no 
substance  which  possesses  life  can  undergo  digestion,  and  all  solids 
must  be  divided  to  admit  of  a  free  access  of  the  gastric  juice  and  saliva. 

310.  The  organs  of  mastication  are  more  various  than  any  other 
parts ;  yet  so  uniform  in  each  species,  so  allied  among  numerous  spe- 
cies, that  naturalists  have  taken  these  characters  not  only  as  signifi- 
,cant  of  the  species,  but  as  the  foundation  of  a  systematic  distribution 
of  the  species  into  genera,  and  of  genera  into  orders. 

311.  Where  the  usual  organs  of  mastication  are  deficient  in  ani- 
mals, the  species  is  often  supplied  with  means  in  the  stomach  itself 
for  reducing  the  aliment  to  a  soft  substance,  so  that  it  may  be  pene- 
trated by  the  gastric  juice.  The  stomach  of  the  armadillo,  which  sub- 
sists on  insects,  and  of  the  granivorous  birds,  is  endowed  with  a  pow- 
erful muscle  for  crushing,  or  grinding  the  food.  The  stomachs  of 
other  animals  are  armed  with  bony  or  horny  parts,  as  in  many  insects. 

312.  The  food  is  moved  about  in  the  stomach  by  the  muscular  ac- 
tion of  the  organ ;  but  so  peculiar  and  exquisite  is  the  modification 
of  irritability  of  the  pyloric  orifice,  the  food  is  not  permitted  to  pass 
this  outlet  till  it  is  converted  into  chyme  (§  278).  Much  of  the  aque- 
ous portion,  however,  is  early  and  rapidly  absoi'bed  by  the  stomach. 

313.  When,  however,  as  we  have  seen,  the  irritability  of  the  pylo- 
rus is  artificially  modified,  as  in  disease,  it  will  often  allow  undigested 
food  to  paSs,  more  or  less  readily,  into  the  duodenum  (§  278).  But  it 
is  more  remarkable  that  it  will  suffer  many  hard,  indigestible  sub- 
stances to  escape,  while  it  detains  such  as  are  most  congenial  to  its 
nature.  The  passage  of  indigestible  substances  is  effected  gradually 
by  repeatedly  presenting  thernselves  at  the  pylorus,  and  thus  so  habit- 
uating the  irritability  of  that  orifice  to  their  own  irritant  effects,  but 
not  to  those  of  digestible  food,  that  they  are  allowed  to  pass,  while 


142  INSTITUTES    OF    MEDICINE. 

the  latter  is  detained ;  the  stomach  thus  electing  what  is  most  conge- 
nial to  its  nature  and  to  the  wants  of  life  (§  188,  &c.,  539  a,  543,  551). 

314.  The  saliva,  bile,  and  pancreatic  juice  are  auxiliary  to  the  gas- 
tric juice,  though  how  far  is  considered  problematical.  The  liver  is 
found,  under  a  great  variety  of  forms,  in  all  animals  whose  structure 
can  be  made  the  subject  of  ocular  demonstration,  and  it  is  knov\Ti  to 
generate  bile  in  all  instances.  The  pancreas  and  salivary  glands  oc- 
cur in  all  the  mammifera,  birds,  and  reptiles,  and  in  many  fishes,  mol- 
lusca,  and  insects. 

From  the  general  occurrence,  therefore,  of  the  foregoing  organs,  it 
cannot  be  doubted,  independently  of  the  more  direct  facts,  that  the 
fluids  which  they  secrete  have  an  important  vital  agency  in  the  pro- 
cess of  assimilation. 

315.  Animals  which  nve  on  vegetables  have  larger  salivary  glands 
than  such  as  feed  on  animal  substances  ;  and,  since  vegetables  require 
greater  assimilating  means  than  animal  food,  it  is  a  just  inference 
from  final  causes  that  the  saliva  answers  a  far  more  important  object 
than,  as  is  commonly  imputed  to  it,  of  moistening  the  food  and  facili- 
tating its  passage  to  the  stomach.  On  the  other  hand,  however,  it  has 
been  with  still  less  reason  imagined  by  others  that  it  contributes  more 
than  the  gastric  juice  to  the  conversion  of  food  into  chyme.  But 
here,  as  on  all  speculative  questions,  some  distinguished  chemists  re- 
fer the  agency  of  the  saliva  in  the  process  of  digestion  to  the  atmo- 
spheric air  it  conveys  to  the  stomach,  while  others  of  equal  renown 
attribute  this  high  office  to  its  o^vn  specific  virtues. 

316.  The  bile  and  pancreatic  juice  mingle  with  the  chyme  in  the 
upper  part  of  the  duodenum,  where  it  is  probable  that  the  latter  fluid 
contributes  an  assimilating  influence  analogous  to  that  of  the  saliva ; 
while  the  disappearance  of  some  of  the  components  of  the  bile,  and 
other  relative  facts,  show  a  direct  connection  of  this  fluid  with  the 
px'ocess  of  assimilation.  The  bile  also  separates  the  excrementitious 
from  the  nutritious  part  of  the  chyme ;  the  former  portion  occupying 
the  centre  of  the  canal,  and  the  latter  the  parietes  (417,  h). 

Connected  with  these  important  uses  of  the  bile  is  its  well-known 
function  of  maintaining  peristaltic  action.  Such,  therefore,  being  its 
great  final  causes,  we  may  safely  reject  the  hypothesis  of  the  mechan- 
ical theorists,  that  the  liver,  like  the  lungs,  is  designed  to  depurate 
the  blood.  The  injury  consequent  on  the  failure  of  the  liver,  by  ex- 
periment or  otherwise,  to  perform  its  function,  no  more  proves  its 
supposed  depurating  office  than  a  like  contingency  befalling  the  stom- 
ach would  place  that  organ  in  the  same  category. — See  ^  1031-1033. 

317.  The  intestinal  tube,  like  the  roots  of  plants,  is  supplied  with 
absorbing  vessels,  which  are  called  lacteals  in  animals  of  complex  or- 
ganization. The  nutritive  part  of  the  chyme  is  taken  up  by  these 
vessels,  where  it  undergoes  a  farther  assimilation,  and  receives  the 
name  o?  chyle. 

Nothino-  is  absorbed  by  the  lacteals  which  is  offensive  to  their 
exquisitely  modified  irritability,  excepting  under  the  circumstances 
already  set  forth  (§  278). 

318.  In  the  higher  animals  the  chyle  is  transmitted  by  the  lacteals 
to  the  thoracic  duct,  and  by  this  vessel  to  the  left  subclavian  vein, 
where  it  mingles  with  the  general  mass  of  blood.  Thence  it  passes 
to  the  riffht  cavities  of  the  heart  to  be  sent  to  the  lungs,  where  it  re- 


PHYSIOLOGY. FUNCTIONS.  143 

ceives  another  important  impress  of  vivification,  parts,  for  the  first 
time,  with  a  portion  of  its  carbonaceous  matter,  and  undergoes  a  de- 
velopment of  its  coloring  principle.  From  the  lungs,  it  passes  with 
the  old  blood,  with  which  it  is  now  fully  incorporated,  to  the  left  cav- 
ities of  the  heart,  to  be  transmitted  to  all  parts  of  the  body  to  under- 
go the  last  act  of  assimilation. 

319.  Assimilation  advances  progressively  from  the  first  conversion 
of  food  into  chyme  till  the  nutritive  matter  becomes  vitally  united 
with  the  solid  parts.  At  each  step  of  the  process,  in  the  stomach,  in 
the  duodenum,  through  the  lacteals,  in  the  lungs,  and  at  its  final  des- 
tination, the  degree  and  kind  of  assimilation  is  forever  the  same,  at 
each  of  its  stages,  in  every  species  of  organic  beings  ;  thus  denoting 
specific  powers  and  laws  by  which  all  this  unvarying  exactness  is 
maintained  (§  42). 

Assimilation  is  more  simple  in  animals  low  in  the  scale  of  organi 
zation  ;  but  close  analogies  prevail  throughout. 

320.  The  chyle  is  found  to  exhibit  globules  under  the  microscope, 
of  which  some  are  reddish.  It  is  said,  also,  that  they  have  been  seen  in 
the  chyme  ;  but  Miiller  thinks  that  impossible,  as  the  lacteals,  accord- 
ing to  him,  have  no  open  orifices,  and,  therefore,  the  globules  could 
not  be  admitted  through  the  "  invisible  pores"  of  the  closed  lacteals. 
These  vessels,  however,  have  open  terminations  by  the  villi  of  the  in- 
testines (§  275,  1089). 

These  questions  as  to  the  existence  and  shape  of  the  globules  of 
blood,  chyle,  milk,  &c.,  are  of  very  little  practical  importance  and  are 
apt  to  lead  to  much  waste  of  time,  and  encumber  medicine  with  specu- 
lation and  false  doctrine ;  while  the  instrument,  through  the  aid  of 
which  the  imagination  is  thus  sent  upon  its  airy  flight,  is  also  the  im. 
bodyment  of  a  thousand  falsehoods  in  the  path  of  truth  (§  131,  251). 

321.  Since,  however,  no  one  doubts  that  the  nutritive  part  of  the 
chyme  undergoes  a  very  positive  change  in  the  lacteals  (§  320),  and  a 
higher  degi-ee  of  assimilation,  the  proof  is  the  same  here,  as  in  absorp- 
tion by  plants,  that  the  fluid  is  not  taken  up  and  carried  forward  by 
capillary  attraction  (§  289-291). 

322.  Looking  back  upon  the  variety  of  parts  which  are  concerned 
in  the  work  of  assimilation ;  their  exact  adaptation  to  each  other ; 
their  peculiarities  in  different  species  of  animals  according  to  the  na- 
ture of  their  food — varying,  indeed,  more  or  less  in  every  species,  yet 
always  alike  in  all  individuals  of  the  same  species ;  the  prevalence 
of  four  specific  digestive  fluids,  and  each  of  these  analogous  in  all  an- 
imals, notwithstanding  the  variety  in  the  structure  of  the  secreting  or- 
gans, yet  only  generated,  respectively,  by  one  special  part,  their  pro- 
duction in  unusual  quantities,  especially  of  the  gastric  juice,  to  meet 
the  exigencies  of  digestion ;  the  apparently  exact  similarity  in  the 
composition  of  the  chyme  of  all  animals,  whatever  the  nature  and  the 
variety  of  the  food  ;  it  appears  to  be  one  of  the  highest  absurdities  to 
suppose  that  all  this  complexity  of  paits,  all  this  magnificence  and 
variety  in  Design,  should  be  merely  intended  to  subserve  a  chemical 
reduction  of  food  in  the  stomach,  especially,  too,  as  all  that  is  known 
of  chemistry  is  in  conflict  with  every  part  of  this  stupendous  whole. 
And  when  we  pursue  the  other  steps  through  which  the  great  end  of 
liigestion  is  attained,  and  steadily  regard  each  individual  part  forever 
giving  rise  to  certain  unvarying  results,  each  part  in  its  anatomical 


144  INSTITUTES    OF    MEDICINE. 

and.  vital  relations  to  all  the  rest,  the  necessity  of  every  part  to  every 
step  in  the  process  of  assimilation,  the  necessity  of  the  whole  lo  every 
seci'eted  solid  and  fluid,  the  derivation  of  the  whole  unique  and  for- 
ever exact  variety  (millions  upon  millions,  §  41-46)  from  four  ele- 
ments mainly,  out  of  a  homogeneous  fluid  which  embraces  yet  fourteen 
other  elements,  the  necessary  co-operation  of  many  of  the  secreted 
fluids  toward  their  own  formation  individually,  and  toward  every  for- 
mation in  the  complex  animal — when,  I  say,  we  duly  consider  this 
labyrinth  of  complexities,  moving  on  in  one  unvarying  round  of  har- 
monious action  and  results,  moved  by  a  power  within  which  has  no 
known  analogy  in  the  world  where  chemical  results  obtain,  we  may 
reconcile  unbelief  in  all  this  Design  with  a  yet  higher  order  of  infi- 
delity, but  certainly  not  with  the  ordinary  promptings  of  reason,  oi 
with  the  plainest  rules  of  evidence  (§  638). 

But,  let  us  analyze,  in  another  section,  the  great  plan  of  nature  foi 
the  maintenance  of  organic  life  in  animals. 

323.  Let  us  analyze,  after  the  manner  of  Cuvier,  the  constitution 
of  animals  in  respect  to  the  subserviency  of  the  various  parts  of  the 
fabric  to  the  single  function  of  digestion,  and  according  to  the  nature 
of  each  species  of  animal ;  and  when  we  shall  have  reflected  upon 
the  principles  which  determine  the  coincidences,  and  see  that  no  one 
of  them  can  be  explained  by  any  of  the  forces  and  laws  of  the  inor- 
ganic world,  let  us  cast  from  us,  as  unworthy  a  thoughtful  mind,  the 
supposition  that  the  final  act,  or  that  of  digestion,  is  a  chemical  pro- 
cess ;  and  let  us  also  apply  the  same  induction  to  every  other  process 
of  living  beings. 

"  Every  organized  being,"  says  Cuvier,  "  forms  a  whole,  a  unique, 
and  pei-fect  system,  the  parts  of  which  mutually  correspond,  and  con 
cur  in  the  same  definite  action  by  a  reciprocal  reaction.  None  of 
those  parts  can  change  without  the  whole  changing;  and,  consequent- 
ly, each  of  them,  separately  considered,  points  out  and  marks  all  the 
others.  Thus,  if  the  intestines  of  an  animal  are  so  organized  as  only 
to  digest  flesh,  and  that  fresh,  it  follows  that  the  jaws  of  the  animal 
must  be  constructed  to  devour  prey,  its  claws  to  seize  and  tear  it,  its 
teeth  to  eat  and  divide  it,  the  whole  structure  of  the  organs  of  motion 
such  as  to  pursue  and  catch  it,  its  perceptive  organs  to  discern  it  at  a 
distance.  Nature  must  have  even  placed  in  its  brain  the  necessary 
instinct  to  know  how  to  conceal  itself  and  lay  snares  for  its  victims. 
That  the  jaw  may  be  enabled  to  seize,  it  must  have  a  certain-shaped 
prominence  for  the  articulation,  a  certain  relation  between  the  posi- 
tion of  the  resisting  power  and  that  of  the  strength  employed  with  the 
fulcrum ;  a  certain  volume  in  the  temporal  muscle,  requiring  an  equiv- 
alent extent  in  the  hollow  which  receives  it,  and  a  certain  convexity 
of  the  zygomatic  arch  under  which  it  passes.  This  zygomatic  arch 
must  also  possess  a  certain  strength  to  give  strength  to  the;  masseter 
muscle.  That  an  animal  may  catry  off"  its  prey,  a  certain  strength  is 
requisite  in  the  muscles  which  raise  the  head ;  whence  results  a  de- 
terminate formation  in  the  vertebrae  and  muscles  attached,  and  in  the 
occiput  where  the  muscles  are  inserted.  That  the  teeth  may  cut  the 
flesh,  they  must  be  sharp,  and  they  must  be  so  more  or  less  according 
as  they  will  have  more  or  less  exclusively  flesh  to  cut.  Their  roots 
should  be  more  or  less  solid,  as  they  have  more  and  larger  bones  to 
nreak.     All  these  circumstances  will,  in  like  manner,  influence  the  de- 


PHYSIOLOGY. FUNCTIONS.  145 

velopment  of  all  those  parts  whicli  serve  to  move  the  jaw.  That  the 
claws  may  seize  the  prey,  they  must  have  a  certain  mobility  in  the 
talons,  a  certain  strength  in  the  nails ;  whence  will  result  determinate 
formations  in  all  the  claws,  and  the  necessary  distribution  of  muscles 
and  tendons.  It  will  be  necessary  that  the  forearm  have  a  certain 
facility  in  turning,  whence,  again,  will  result  certain  determinate  for- 
mations of  the  bones  which  compose  it.  But,  the  bone  of  the  fore- 
arm, articulating  in  the  shoulder-joint,  cannot  change  its  sti-ucture 
without  this  also  changes." 

Again,  observe  what  may  be  infen-ed  from  some  other  given  part, 
as  from  the  shape  of  the  bones  :  "  The  formation  of  the  teeth  bespeaks 
that  of  the  jaw ;  that  of  the  scapula  that  of  the  claws  ;  just  as  the  equa- 
tion of  a  curve  involves  all  its  properties.  So  the  claw,  the  scapula, 
the  articulation  of  the  jaw,  the  thigh-bone,  and  all  the  other  bones 
separately  considered,  require  the  certain  tooth,  or  the  tooth  requires 
them,  reciprocally ;  and,  taking  any  one  of  them,  isolated  from  the  skel- 
eton of  an  unknown  animal,  he  who  possesses  a  knowledge  of  the  laws 
of  organic  economy,  could  expound  every  other  part  of  the  animal. 
Take  the  hoof,  for  example.  We  see,  very  plainly,  that  hoofed  ani- 
mals must  all  be  herbivorous,  since  they  have  no  means  of  seizing 
upon  prey.  We  see,  also,  that  having  no  other  use  for  their  fore- 
feet than  to  support  their  bodies,  they  have  no  occasion  for  a  power- 
fully-framed shoulder ;  whence  we  infer,  what  is  the  case,  the  absence 
of  the  clavicle  and  acromion,  and  the  straightnessof  the  scapula.  Not 
having  any  occasion  to  turn  their  fore-legs,  their  radius  will  be  solidly 
united  to  the  ulna,  or,  at  least,  articulated  by  a  hinge-joint,  and  not 
by  ball  and  socket,  with  the  humerus.  Their  herbivorous  diet  will 
require  teeth  with  a  broad  surface  to  crush  seeds  and  herbs.  This 
breadth  must  be  irregular,  and  for  this  reason  the  enamel  parts  must 
alternate  with  the  osseous  parts.  This  sort  of  surface  compelling  hor- 
izontal motion  for  grinding  the  food  to  pieces,  the  articulation  of  the 
jaw  cannot  form  a  hinge  so  close  as  in  carnivorous  animals.  It  must 
be  flattened,  and  correspond  with  the  facing  of  the  temporal  bones. 
The  temporal  cavity,  which  will  only  contain  a  very  small  muscle,  will 
be  small  and  shallow,"  &c.  (§  169,y"). 

324.  An  intestine,  claw,  tooth,  hoof,  or  other  bone,  therefore,  of  an 
unknown  animal  being  given,  we  may  construct  a  skeleton  that  shall 
be  nearly  true  to  nature  in  all  its  parts.  We  may  then  proceed  to 
cover  it  with  muscles ;  and,  lastly,  we  can  tell  from  that  tusk,  or  claw, 
or  hoof,  or  other  bone,  what  was  the  structure  of  the  digestive  appa- 
ratus, and  to  what  kind  of  food  the  gastric  juice  was  specifically  adapt- 
ed, and  what  were  the  peculiar  instinct  and  habits  of  the  animal, — so 
special  is  the  adaptation  of  all  other  parts  of  the  organization,  both  in 
animal  and  organic  life,  and  all  the  habits  and  instincts  of  animals,  to 
the  peculiarities  of  the  digestive  organs  in  every  species  (§  IS). 

325.  Now  the  whole  of  the  foregoing  mutual  concurrence  of  all 
parts  of  the  body,  the  adaptation  of  each  part  to  the  others  in  structure 
and  use,  being  directly  designed  to  subserve  the  purposes  of  diges- 
tion, and  since  it  cannot  be  seriously  entertained  that  any  physical  or 
chemical  force  is  concerned  in  such  a  labyrinth  of  harmonious  struc- 
ture and  actions,  and  so  distinguished  throughout  by  a  multitude  of 
the  most  consummate  Designs,  and  all  conspiring  to  one  common  end, 
it  is  manifestly  absurd  to  imagine  that  digestion,  thejinal  came  of  the 

K 


146  INSTITUTES    OF    MEDICINE. 

whole ,  is  carried  on  by  agencies  which  have  no  connection  with  the  va- 
rious subordinate  means  (§  14,  74,  80,  117,  129  i,  133-137,  143,  155, 
156,  169/  266,  3031  a,  306,  318,  336,  387,  399,  422,  514  h,  524  d, 
525,  526  d,  528  c,  638,  649  d,  733  b,  764  b,  811,  847  c,  848,  902/  905). 

326.  What  we  have  noAv  seen  of  fundamental  Design  in  the  con- 
struction and  subservience  of  all  parts  to  the  function  of  assimilation, 
and  of  the  exact  concurrence  of  the  whole  toward  the  incipient  step, 
may  well  prepare  the  mind  to  realize  the  same  Design  throughout  the 
whole  system  of  organic  processes,  the  same  exact  foundation  in  an- 
atomical structure,  and  in  vital  properties,  the  same  precise  and  ever- 
lasting laws  (§  169,/).  Do  we  look  again,  therefore,  at  the  stupen- 
dous fabric  upon  which,  and  its  special  vital  endowments,  the  laws  of 
sympathy  depend  1  Astonishment  abates,  and  unbelief  yields  as  well 
to  the  force  of  analogy  as  to  direct  demonstration. 

327.  The  philosophy  of  assimilation  applied  pathologically,  and  in 
conformity  with  the  doctrines  of  solidism,  is  the  following  :  The  func- 
tion of  assimilation,  being  performed  by  the  organic  properties  through 
their  media  of  action,  there  will  be  a  corresponding  change  in  the 
elementary  combination  of  the  new  compounds  which  are  added  to 
the  parts  affected,  and  the  same  morbid  condition  of  the  vital  proper- 
ties will  be  imparted  to  the  new  compounds. 

328.  If  the  stomach  be  diseased,  then  the  nature  of  the  gastric  juice 
will  be  altered  according  to  the  manner  in  which  the  properties  of  the 
stomach  may  be  affected.  If,  also,  we  allow,  in  this  case,  that  the 
chyme  will  have  a  corresponding  variation,  and  that  this  will  in  itself 
affect  the  whole  character  of  the  circulating  mass  of  blood,  so  that  the 
new  elementary  combinations,  those  of  the  solids  and  secreted  fluids, 
will  be  more  or  less  modified  in  all  parts,  we  shall  in  no  respect  com- 
promit  the  consistency  of  nature,  or  the  fundamental  principles  of 
physiology  (§  44,  52,  78,  153-155,  218-220).  However  such  admis- 
sion may  look  like  humoralism,  it  has  no  affinity  with  it.  The  whole 
process  resolves  itself  into  a  primary  disease  of  the  solids ;  and  the 
modified  condition  of  the  blood,  which  I  am  now  supposing,  does  not 
derange  the  vital  properties  and  actions  of  the  system  (§  156  b,  845, 
&c.).  But  when  chylification  is  affected  by  diseased  states  of  the 
stomach,  reflex  nervous  actions  are  then  so  exerted  by  that  organ  upon 
other  parts,  that  their  vital  states  do  actually  sustain  a  change,  and 
often  a  far  greater  one,  from  that  sympathetic  cause.  This  more  gen- 
eral modified  condition  of  the  solids  contributes  still  farther  to  modify 
the  new  combinations,  and  to  give  rise  to  what  are  called  vitiated  se- 
cretions. The  most  striking  examples  are  seen,  of  course,  when  di- 
gestion fails  altogether,  and  the  solids  become  universally  affected  by 
disease,  as  in  fever  (§  143  c,  148,  657  b,  776,  &c.). 

329.  If  the  heart  and  vascular  system  at  large  feel,  mainly,  the  in- 
fluence of  gastiic  or  some  other  local  disease,  the  blood  is  always  more 
or  less  affected  in  its  composition,  and  assimilation  is  otherwise  va- 
riously modified  in  all  other  parts,  not  only  in  consequence  of  the 
change  in  the  blood,  but  of  the  affection  of  all  the  organs  and  fluids 
which  are  concerned  in  assimilation.  Nothing  affects  the  composition 
of  the  blood  so  rapidly  as  disturbances  of  the  vital  conditions  of  the 
heart  and  blood-vessels ;  or,  perhaps,  I  should  rather  say  of  the  ex- 
treme capillary  blood-vessels.  Nothing  can  prove  more  distinctly  the 
truth  of  solidism  and  the  fallacies  of  humoralism;  especially  those 


PHYSIOLOGY. FUNCTIONS.  147 

more  instantaneous  changes  which  are  effected  in  the  entire  circula- 
ting mass  of  blood  by  abstracting  only  an  ounce  of  it  from  the  arm  (§ 
845,  &c.,  952). 

330.  Now,  suppose,  instead  of  treating  disease  upon  some  broad 
principles,  we  were  to  undertake  the  specific  object  of  theliumoralists 
in  any  of  the  foregoing  cases  (§  327-329)  ;  that  is  to  say,  the  resto- 
ration of  the  blood  in  its  composition  and  nature.  The  humoral  pa- 
thologist would  attempt  its  direct  medication,  in  the  vain  hope  that  his 
drugs  can  pi'oduce,  by  their  direct  action  upon  the  fluid,  that  natural 
combination  of  its  elements,  and  that  natural  state  of  its  vital  properties, 
for  doing  which  Nature  has  provided  the  whole  system  of  the  great 
vital  organs,  and  many  living  secretions  (§  845,  &c.).  Since,  there- 
fore, the  humoralist  has  not  a  physiological  principle  for  his  govern- 
ment, he  has  departed  wholly  from  nature.  The  duty  of  cure  thus 
devolves  upon  the  solidist,  who  proceeds  to  restore  assimilation  by  re- 
establishing the  natural  condition  of  the  various  tissues  and  organs 
whose  functions  had  become  dei'anged  and  had  been  the  cause  of  the 
altered  condition  of  the  blood ;  and  this  is  effected  according  to  the 
manner  set  forth  in  my  chapter  on  the  modus  operandi  of  remedial 
agents.  There,  too,  you  shall  find,  as  well  as  in  my  disquisitions 
upon  the  philosophy  of  solidism,  that  the  living  solids  are  the  only 
agents  which  can  possibly  effect  any  salutary  changes  in  the  pabulum 
vitce,  and,  therefore,  that  when  the  former  are  diseased  along  with  the 
latter,  they  must  take  the  initiating  step  both  in  the  morbid  and  healthy 
processes.  Just  in  proportion,  therefore,  as  the  solidist  improves  the 
condition  of  the  diseased  organs,  assimilation  will  approximate  its 
natural  state,  and  the  blood  be  regenerated  according  to  established 
physiological  laws. — Note  R  p.  1123. 

331.  The  condition,  therefore,  of  the  blood  and  of  the  products 
elaborated  from  it,  in  all  cases  of  disease,  should  be  regarded  only  as 
moi-e  or  less  significant  of  the  morbid  changes  which  may  affect  the 
solid  parts. 

332.  Having  now  gone  over  the  general  philosophy  relative  to  as- 
similation, I  shall  proceed  to  consider  its  principal  element,  or  what 
is  denominated 

THE    PHYSIOLOGY    OF    DIGESTION. 

In  my  investigation  of  this  subject  I  shall  enter  rather  extensively 
upon  the  ground  of  Organic  Chemistry,  in  all  its  applications  to  the 
science  of  medicine  ;  since  it  is  here,  especially,  as  said  in  the  Com- 
mentaries, that  chemistry  has  reared  its  batteries,  and  from  whence  it 
sends  forth  its  artillery  into  the. various  dominions  of  organic  life.  A 
contrast  will  be  instituted  under  the  general  designations  of  Physiol- 
ogy and  Organic  Chemistry,  in  their  relation  to  healthy  and  morbid 
processes. 

333.  The  doctrines  of  life,  as  hitherto  expounded,  should  be  appli- 
cable to  all  the  problems  in  organic  beings  which  may  seem  to  a  su- 
perficial observer  to  fall  under  the  laws  of  chemistry,  or  of  physics. 
Such  problems  are  especially  presented  by  digestion,  respiration,  and 
the  production  of  organic  heat ;  and  these  are  the  main  intrenchments 
af  chemistry.  If  the  philosophy,  therefore,  which  I  have  thus  far  pro- 
pounded lie  at  the  foundation  of  the  foregoing  results,  it  is  probable 
that  chemistry  must  be  abortive  in  facts,  and  wild  in  conclusions ;  and 


i48  INSTITUTES    OF    MEDICINE. 

the  more  so  as  it  advances  to  tlie  greater  obscurities  in  physiology^ 
pathology,  and  therapeutics.  Such  are  the  realities  ;  and  their  expo- 
sure is  the  overthrow  and  the  perpetual  doom  of  organic  chemistry. 

334.  Human  physiology  has  been  greatly  vitiated,  in  recent  times, 
by  experiments  upon  animals,  and  conducted  under  the  most  unnat- 
ural circumstances.  They  have  been  extensively  made,  in  a  physio- 
logical aspect,  without  any  view  to  the  differences  in  organization 
and  vital  constitution  between  animals  and  man,  and  often  with  a  ref- 
erence to  more  functions  than  belong  to  any  organic  being.  When 
prompted  by  pathological  and  therapeutical  considerations  the  ex- 
periments have  been  liable  not  only  to  the  foregoing  objections,  but 
to  the  greater  one  of  assuming  that  there  is  no  difference  in  the  sus- 
ceptibility of  organs  to  the  action  of  natural,  morbific,  and  remedial 
agents  in  the  varying  states  of  health  and  disease  (§  149,  150,  240). 
These  experimental  fallacies,  and  the  vast  errors  to  which  they  have 
led  and  are  still  leading,  I  have  considered  extensively  in  my  Essay 
on  the  Humoral  Pathology. — See  p.  839,  §  1058  b,  note. 

In  a  physiological  sense,  the  greatest  evil  attending  the  foregoing 
experiments  consists  in  neglecting  the  fact  that  the  constitution  of  man 
is  different  from  that  of  animals  when  applying  the  results  of  such 
otherwise  unnatural  experiments  to  explain  the  vital  laws  which  gov- 
ern the  functions  of  the  human  species. 

The  disparity  increases  between  the  natural  laws  and  results  of  the 
human  and  those  of  vegetable  organization,  and  others,  again,  of 
chemical  affinities,  just  in  the  ratio  of  the  difference  between  the  va- 
rieties of  organization  and  vital  constitution,  and  the  attributes  of  the 
inorganic  kingdom. 

335.  What,  then,  shall  be  said  of  those  experiments  which  are  con- 
ducted in  the  laboratory  of  the  chemist  to  determine  the  physiology 
of  the  highest  function  of  life,  but  in  which  organization  takes  no  part, 
and  the  whole  process  is  carried  on  by  artificial  "  mixtures'"  and 
chemical  reagents  1  This  is  now  the  almost  universal  philosophy,  and 
therefore  demands  an  investigation  which  shall  lead  either  to  its  con- 
firmation or  to  its  overthrow  (Rights  of  Authors,  p.  912). 

336.  It  is  in  the  stomach  that  vitality  is  exemplified  in  its  most  im- 
pressive and  astonishing  aspects,  and  where  unequivocal  demonstra- 
tions abound  that  fluids,  as  well  as  solids,  are  endowed  with  the  prin- 
ciple of  vital  operations,  "  a  principle  distinct  from  all  other  powers 
of  nature"  (§  64,  339).  It  is  here,  especially,  that  nature  has  illus- 
trated her  distinction  between  the  animate  and  inanimate  world,  and 
established  her  chain  of  connection.  It  is  here,  in  the  incipient  change 
of  dead  into  living  matter,  that  we  witness  a  full  display  of  those 
powers  which  operate  in  the  most  elaborate  organization,  and  an  equal 
exclusion  of  the  forces  which  appertain  to  dead  matter.  It  is  here 
the  line  of  separation  begins  abruptly  ;  but  where  analogies  are  pre- 
sented in  the  conversion  of  dead  into  living  matter,  through  new 
modes  of  combining  the  same  elements ;  and  admiration  increases, 
as  we  mount  along  the  entire  function  of  assimilation,  and  find,  at 
each  step  of  the  ascending  series,  that  the  whole  agency  is  committed 
to  forces  that  have  no  existence  in  the  inorganic  world  ;  that  the  whole 
is  the  harmonious  result  of  a  principle  which  may  form  an  interme- 
diate link  between  spirit  and  matter  ;  and  that  there  is  no  power  with- 
in our  control  by  which  we  can  determine  the  nature  of  the  changes. 


PHYSIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS.  149 

Casting  a  glance  at  the  vegetable  world,  we  find  the  connection  coti- 
tinued,  by  other  analogous  links,  with  elementary  matter  itself;  but 
hero,  as  in  the  higher  department  of  nature,  the  line  of  separation  is 
equally  defined,  however  low  in  the  scale  of  analogy  may  be  the  prop- 
erties of  life  which  have  their  beginning  in  vegetable  organization. 

It  is  here,  then,  at  the  threshold  of  life,  as  in  the  propagation  of  the 
species,  that  we  especially  witness  a  substitution  for  Creative  Power  ; 
and,  as  all  that  appertains  exclusively  to  the  organic  world  was  per- 
fectly distinct  in  its  Creation  from  the  inorganic,  so  are  the  substituted 
processes_  of  generation,  and  of  the  conversion  of  dead  into  living  mat- 
ter, equally  distinct  from  the  causes  and  results  of  inorganic  processes 
(§  32,  &c.,  63,  &c.). 

For  conducting  that  connected  series  of  changes  which  make  up 
the  process  of  assimilation  in  animals,  a  complex  apparatus  has  been 
provided,  whose  beginning  in  the  vegetable  kingdom,  and  whose  pro- 
gressive development  in  the  higher  kingdom,  have  been  contrived 
upon  consummate  principles  of  Design,  that  the  elements  of  matter 
shall  be  gradually  brought  into  those  perfectly  new  conditions,  both 
as  to  composition  and  properties,  which  contradistinguish  the  organic 
from  the  inorganic  kingdom,  and  thus  as  in  all  things  else  in  the  nat- 
ural world,  that  abrupt  transmutation  of  inorganic  into  organic  matter 
which  distinguished  the  Creative  Act  shall  be  avoided,  and  remain  a 
characteristic  of  Creative  Power  (§  14,  172,  325). 

337.  In  the  early  part  of  this  work,  I  set  forth  some  general  facts 
which  evince  an  incongruity  of  doctrines  that  clearly  divides  the  physi- 
ological world  into  three  schools  ;  one  of  them  (pure  chemistry)  mak- 
ing no  distinction  between  the  properties  and  laws  of  organic  and  in- 
organic beings  ;  a  second  (pure  vitalism)  contradistinguishing  the  two 
kingdoms  in  those  fundamental  conditions;  and  the  third  (chemico- 
vitalism)  blending  the  doctrines  of  chemistry  and  vitalism  (§  4^,  820  c). 
Each  of  these  denominations  has  interpreted  the  philosophy  of  di- 
gestion accordinty  to  the  g-eneral  doctrines  of  life  which  are  peculiar 
to  each. 

338.  Beginning  with  pure  chemistry,  we  find  the  great  leader  set- 
ting forth  the  process  of  digestion  in  the  following  language  in  his 
late  work  on  Animal  Chemistry  applied  to  Pathology  and  Therapeutics, 

"  Chymifxcation,"  he  says,  "  is  independent  of  the  vital  force. 
It  takes  place  in  virtue  of  a  purely  chemical  action, — exactly  sim- 
ilar to  those  processes  of  decomposition  and  transformation  which  are 
tnown  as  putrefaction,  fermentation,  or  decay"  (§  365). 

It  will  be  also  seen  from  the  foregoing  quotation,  that  the  chemist 
s  regardless  of  his  own  rules  of  philosophy,  and  of  the  fundamental 
principles  of  chemistry ;  since  he  identifies  the  organizing  act,  or  that 
which  combines  the  elements  of  matter  into  complex  organic  com- 
pounds, with  the  chemical  process  that  resolves  these  compounds  into 
their  ultimate  elements.  We  are  told,  indeed,  that  this  is  "  experi- 
mental philosophy,"  and  that,  therefore,  we  must  submit  to  it  (§  350). 

339.  a.  I  shall  now  set  forth  the  exact  doctrine  of  the  vitalists  rela- 
tive to  the  physiology  of  digestion,  in  the  language  of  the  same  dis- 
tinguished "  reformer"  whom  I  have  quoted  in  the  preceding  section. 
It  is  true,  the  doctrines  are  as  fundamentally  opposed  as  contradiction 
can  possibly  make  them.  But,  as  will  have  been  abundantly  seen, 
the  mo;t  remarkable  characteristic  of  the  writings  of  this  distinguishei? 


150  IXSTITUTES    OF    MEDICINE. 

man  are  their  palpable  contradictions.  Nor  can  there  be  any  proof 
so  conclusive  of  the  radical  distinction  between  the  philosophy  of  life 
and  the  philosophy  of  cliemistry,  about  which  "  the  reformer"  was 
simultaneously  concerned. 

But,  I  will  go  back  for  a  conflicting  doctrine  to  the  treatise  "on 
Organic  Chemistry  applied,  to  Physiology  "  published  a  year  or  two 
antecedently  to  his  work  "  on  Animal  Chemistry  ;^^  by  which  we  shall 
learn  the  extent  of  the  confusion  which  pei'vades  his  writings,  and  the 
tardiness  with  which  it  is  discerned  by  his  medical  disciples.  In  that 
work  he  says, 

"  The  equilibrium  in  the  chemical  attractions  of  the  constituents  of 
food  is  disturbed  by  the  vital  principle.  The  union  of  its  ele- 
ments, so  as  to  produce  new  combinations  and  forms,  indicates  the 
presence  of  a  peculiar  mode  of  attraction,  and  the  existence  of  k 
power  distinct  from  all  other  powers  of  nature,  namely,  the 
VITAL  principle."  "  If  the  food  possessed  life,  not  merely  the  chem- 
ical forces,  but  this  vitality  would  offer  resistance  to  the  vital  force 
of  the  organism  it  nourished." — Liebig. 

Such,  then,  is  exactly  the  doctrine  of  the  vitalist  and  solidist,  mis- 
taken by  the  chemist  for  his  own,  when  he  happened  to  be  reasoning 
according  to  the  promptings  of  organic  nature.  The  same  views  are 
presented  in  the  work  on  Ayiimal  Chemistry  (§  350). 

339,  h.  And  here,  perhaps,  it  may  be  worth  our  while  to  say  that 
the  resuscitated  chemical  doctrine  (§  338)  is  apparently  too  wide  a  de- 
parture from  fact  even  for  that  part  of  the  British  medical  profession 
who  have  received  most  of  the  sayings  of  Liebig  as  oracular  revela- 
tions ;  for  we  read  in  the  late  edition  of  the  "  Pharmacologia,'"  now 
devoted  to  the  authorized  philosophy  (§  349  (^,.676  h),  that, 

"  According  to  the  experiments  of  Spallanzani,  and  still  more  re- 
cently of  Dr.  Beaumont,  if,  after  putrefaction  has  actually  advanced,  a 
substance  in  such  a  condition  be  introduced  into  the  living  stomach, 
the  process  is  immediately  checked,  and  no  signs  of  putrefaction  are 
presented  by  the  digested  food,  although  were  the  same  substances 
left  at  the  temperature  of  99°  F.,  they  would  soon  evince  evidence  of 
its  progress.  It  is  therefore  clear  that  the  vital  powers  of  the  di- 
gestive organs  must,  in  such  cases,  reverse  or  suspend  the  ordinary 
chemical  affinities"  (§  676,  b). — P aris'sP har7?iacologia,  p.  148.  Lon- 
don, 1843.  And  such,  in  reality,  is  one  of  Liebig's  conflicting  state- 
ments. 

And  why  should  not  the  "  vital  powers  reverse  or  suspend  the  ordi- 
nary chemical  affinities"  in  all  other  cases  of  food,  whei-e  it  is  far  more 
obvious  that  such  resistance  does  happen  ;  and  why  may  we  not  con- 
clude that  the  law  in  relation  to  digestion  has  a  wide  foundation  in  liv- 
ing beings  1  Why  does  not  the  blood  putrefy  ]  Why  not  any  other 
animal  or  vegetable  fluid  ]  Why  not  any  living  animal  or  vegetable 
solid  ] 

340.  Let  us  now  hear  the  student  of  organic  nature  upon  the  phys- 
iology of  digestion.  What  says  John  Hunter,  of  whom  it  is  said  by 
one,  that  "he  stands  alone  in  our  profession;"  that,  "in  his  immense 
■career,  every  thing  bore  reference  to  one  great  idea, — the  discovery 
and  elucidation  of  ?iature' slaws  ;"  "who,"  says  another,  "  was  neither 
anatomist,  physiologist,  surgeon,  nor  naturalist,  alone,  but  the  most 
rema-.kable  combination  of  all  these  which  the  world  has  yet  seen;" 


PHYSIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS.  151 

for,  "  where,"  says  another,  "  in  the  calendar  of  time,  shall  we  look 
for  an  equal  in  the  compass,  the  variety,  and  the  depth  of  his  researches 
into  the  mysteries  of  animal  life,  or  for  consequences  such  as  those 
that  have  resulted  from  his  labors  to  universal  pathology ;"  while  an- 
other apostrophizes,  "  how  humble  do  any  of  the  men  of  the  present 
day  appear  when  placed  by  the  side  of  Hunter!"  "The  genius  of 
Hunter,"  says  another,  "long  ago  explained  the  objections  to  othei 
theories  of  digestion.  These  have  been  turned  into  ridicule  to  smooth 
the  way  for  hypotheses  that  have  no  better  foundation." 

Well  may  we  ask,  what  says  John  Hunter  on  the  physiology  of  di 
gestion  1 

"Digestion,"  he  says,  "is  an  assimilating  process.  It  is  a  species 
of  generation';  but  the  curious  circumstance  is  its  converting  both  veg- 
etable and  animal  matter  into  the  same  kind  of  substance  or  com- 
pound, which  no  chemical  process  can  effect.  Those  who  took  it  up 
dietnicalh/,  being  ignorant  of  the  principles  of  the  animal  ecoyiojny,  have 
erroneously  referred  the  operations  of  the  animal  machine  to  the  laws 
of  chemistry." 

341.  The  illustrious  George  Fordyce,  after  a  thorough  experiment 
h1  investigation  of  the  subject,  comes  to  the  conclusion  that, 

"  The  changes  which  take  place  in  the  substances  capable  of  giving 
nourishment,  and,  therefore,  of  being  converted  into  the  essential  parts 
of  the  chyle,  are  totally  different  from  those  changes  which  take 
place  any  where  but  in  the  stomach,  duodenum,  and  jejunum,  when 
alive.  Therefore,  no  experiment  made  any  where,  excepting  in  these 
INTESTINES  OF  THE  LIVING  ANIMAL,  can  in  the  Smallest  degree  influence 
the  doctrine  of  digestion."  "Food  placed  in  all  the  chemical  circum- 
stances that  can  be  conceived  similar  to  those  in  which  it  is  placed  in 
the  living  animal,  will  never  be  converted  into  chyme,  but  will  under- 
go other  changes  totally  different,"  He  finally  adds,  as  the  result  of 
his  own  experiments  out  of  the  stomach,  that,  "  tvhether  we  employ  the 
gastric  juice,  or  bile,  or  saliva,  in  no  case  has  chyle,  or  any  thing  like 
IT,  ever  been  produced."  The  reason  is,  that  the  gastric  juice,  like 
the  blood,  loses  its  vitality  as  soon  as  abstracted  from  the  stomach. 
Hunter  arrived  at  exactly  the  same  conclusion  from  his  obsei'vations 
(§  364).^    _  _  _  ...... 

342.  It  is  the  opinion  of  Tiedemann,  another  distinguished  inquirer 
into  the  nature  of  digestion  (§  340,  341),  that, 

"  All  the  phenomena  of  digestion  and  assimilation,  and  which  are 
only  observed  in  living  bodies,  appear  to  rest,  as  to  their  foundation. 
on  the  VITAL  property  which  organized  liquids  -possess  of  producing, 
under  certain  circumstances,  in  other  organic  matters,  similar  changes 
that  cause  these  bodies  to  acquire  the  properties  themselves  are  en- 
dowed withal."     Again : 

"  It  cannot  be  mistaken  that  digestion  is  an  operation  exclusively 
the  property  of  living  bodies,  and  is  in  no  ivay  to  be  compared  with  the 
changes  of  composition  which  general  physical  forces  and  the  play  of 
chemical  are  capable  of  producing  in  inorganic  matters.  It  must  be 
considered  as  a  vital  act,  as  an  effect  of  life." 

As  to  assimilation  by  vegetables,  Tiedemann  holds  the  same  doc- 
trine as  Hunter,  Fordyce,  and  all  other  physiologists  whose  opinions 
have  survived  the  day  on  which  they  were  promulgated.     Thus  : 

"On  the  subject  of  the  material  changes  which  vegetable  parts  un- 


152  INSTITUTES    OF    MEDICINE. 

tlergo  in  nutrition,  chemistry  has  hitherto  given  us  no  satisfactory  in- 
foiTnation,  simply  because,  being  effects  of  life,  such  changes  arc  beyond 
the  domain  of  chemical  science.  All  that  we  are  authorized  to  admit 
is,  that  the  changes  of  composition  that  occur  during  the  nutrition  of 
veo-etables  are  the  consequence  of  vital  manifestations  of  activity,  and 
not  the  effects  of  chemical  affinities,  such  as  are  observed  in  inorganic 
bodies." 

"All  the  attempts,"  he  goes  on,  "of  the  iatro-mechanicians  and  ia- 
tro-chemists  to  reach  this  point  (assimilation)  have  failed ;  and  it  is 
vfeW  ascertained  that  such  ideas  are  both  unsatisfactory  and  erroneous. 
We  are  therefore  under  the  necessity  of  regarding  them  as  effects, 
sui  generis,  as  vital  manifestations,  founded  on  a  pow^er  peculiar  to, 
and  inherent  in,  organic  bodies." — Tiedemann's  Physiology. 

343.  Turning  to  the  gieatest  of  French  physiologists,  we  hear  from 
him  the  same  general  protest  against  the  corruption  of  medicine  by 
ingrafting  upon  it  the  physical  sciences  (§  5^,  b). 

344.  In  considering  farther  the  physiology  of  digestion,  I  shall  in- 
troduce, in  the  first  place,  a  series  of  general  conclusions  which  have 
been  derived  from  chemistry,  both  as  to  digestion  and  other  organic 
processes,  and  when  in  this  respect  and  otherwise  prepared,  I  shall 
state  the  remaining  grounds  upon  which  I  rely  more  specifically  for 
establishing  the  vital  doctrine. 

345.  Let  us  hear,  then,  the  distinguished  chemist,  Dr.  Prout,  as  the 
representative  of  those  who  mingle  chemistry  with  vitalism. 

"  First,"  says  Dr.  Prout,  "  the  stomach  has  the  power  of  dissolving 
alimentary  substances,  or,  at  least,  of  bringing  them  to  a  semi-fluid 
state.     This  operation  seems  to  be  altogether  chemical. 

"  2d.  The  stomach  has,  within  certain  limits,  the  power  of  changing 
into  one  another  the  simple  alimentary  principles,"  and  "  this  part  of 
the  operation  of  the  stomach  appears,  like  the  reducing  process,  to  be 
chemical ;  but  not  so  easy  of  accomplishment.  It  may  be  termed  the 
converting  operation  of  the  stomach. 

"  3d.  The  stomach  must  have,  within  certain  limits,  the  power  of 
organizing  and  vitalizing  the  different  alimentaiy  substances."  "  It 
is  impossible  to  imagine  that  this  organizing  agency  of  the  stomach  can 
be  chemical.     Its  agency  is  vital,  and  its  nature  completely  unknown." 

346.  Such,  then,  is  the  doctrine  of  digestion  as  entertained  by  the 
chemico-vitalist  (§  345).  But,  from  what  we  shall  have  seen  of  the 
absolute  contradictions  which  abound  in  the  writings  of  those  who  at- 
tempt the  application  of  pure  chemistry  to  the  functions  and  results  of 
organic  life,  we  may  expect  that  the  chemico-vitalist  will  be  equally 
inconsistent  when  he  applies  himself,  at  one  time,  to  the  phenomena 
of  living  beings,  and,  at  another,  reasons  from  the  results  of  the  labor- 
atory to  those  phenomena.  Accordingly,  we  find  within  a  few  pages 
of  the  foregoing  doctrine  of  the  chemico-physiologist,  that  he  broadly 
affirms  that 

"  There  is  no  relation  whatever  between  the  mechanical  ar- 
rangements and  the  chemical  properties  to  which  they  administer." 
"  There  is  no  reason  why  the  chemical  changes  of  organization  should 
result  from  the  mechanical  arrangements  by  which  they  are  accom- 
plished ;  neither  is  there  the  slightest  reason,  why  the  mechanical 
arrangements  in  the  formation  of  organized  beings  should  lead  to  the 
chemical  changes  of  which  they  are  the  instruments"  ! 


PHYSIOLOGY. ORGANIC  CHEMISTRY — FUNCTIONS.      153 

Here,  then,' in  a  single  sentence,  are  not  only  the  strangest  contra- 
dictions, but  a  full  admission  that  there  is  not  the  "  slightest  reason" 
for  the  application  of  chemistry  to  any  piocess,  function,  or  result  of 
living  beings. 

347.  Nor  is  that  all.  For  the  chemico-vitalist,  the  same  eminent 
chemist  whom  I  have  just  quoted,  goes  on  to  say,  that  "  vs^ith  the  liv- 
ings the  animative  properties  of  organic  bodies,  chemistry  has  not  the 
smallest  alliance,  and  probably  will  never,  in  any  degree,  elucidate 
those  properties.  The  phenomena  of  life  are  not  even  remotely  anal- 
ogous to  any  thing  we  know  in  chemistry  as  exhibited  among  inorganic 
agents."  And,  as  if  to  complete  the  overthrow  of  the  chemical  part 
of  the  philosophy  of  digestion,  the  same  reasoner  observes  that,  "  the 
means  by  which  the  peculiarities  of  composition  and  structure  are 
produced,  which  is  so  remarkable  in  all  organic  substances,  like  the 
results  themselves,  are  quite  peculiar,  and  bear  little  or  no  resem- 
blance to  any  artificial  process  of  chemistry  f  that  "those  who  have 
attempted,  to  apply  chemistry  to  physiology  and  pathology  have  split 
on  a  fatal  rock  by  hastily  assuming  that  what  they  found,  by  experi- 
ment to  be  wanting,  or  otherwise  changed,  in  the  animal  economy, 
was  the  cause  of  particular  diseases,  and  that  such  diseases  were  to 
be  cured  by  supplying,  and  adjusting  artificially,  the  principle  in  error. 
But  the  scientific  physician  will  soon  discover  that  Nature  will  not  al- 
low him  to  officiate  as  her  journeyman,  even  in  the  most  trifling  de- 
gree."— Dr.  Prout's  Bridgewater  Treatise. 

348.  And,  to  the  same  effect  may  be  quoted  Dr.  Carpentei',  one  of 
the  foremost,  as  we  have  seen,  in  the  school  of  pure  chemistry  (§  64,^). 

"  The  agency  of  vitality,"  says  this  reasoner,  in  his  Comparative 
Physiology,  where  he  generally  ridicules  the  term  and  all  that  is  rela- 
tive to  it,  "  the  agency  of  vitality,  as  Dr.  Prout  justly  remarks,  does 
not  change  the  properties  of  the  elements,  but  simply  combines  the 
elements  in  modes  which  we  cannot  imitate"! 

So,  also.  Dr.  Roget,  alike  distinguished,  in  the  school  of  chemico- 
vitalism  (§  64,  f)  :  "  Vital  chemistry"  he  says, "  is  too  subtle  a 
vowEKfor  human  science  to  detect,  or  for  human  art  to  imitate." 

And.  thus  the  eminent  Wagner,  not  less  arrayed  on  the  side  of 
chemistry : 

"  The  existence  of  one  or  more  powers,  commonly  called  vital 
powers,  is  not,  however,  denied.  The  final  cause  of  the  secretion 
of  the  gastric  juice  lies  in  the  nature  of  the  animal  organism,  and 
is  unknown  to  us." — Wagner's  Physiology,  London,  1842,  p.  346. 
And  yet  this  distinguished  observer  is  one  of  the  manufacturers  of  gas- 
tric juice. 

349.  a.  Thus  might  I  go  on  with  one  after  another,  till  I  should 
have  exhausted  the  whole  that  have  attempted  to  confound  the  science 
of  life  with  the  science  of  chemistry,  and  prove  by  their  own  state- 
ments that  there  is  not  the  slightest  intelligible  connection  between 
them.  Indeed,  I  have  already,  in  the  Medical  and  Physiological 
Commentaries,  pointed  out  this  universal  admission  {^  626  h). 

The  ground  of  chemistry  being  thus  virtually  abandoned  to  the  vi- 
talist,  it  would  seem  superfluous  to  pursue  an  adversary  who  is  al- 
ways upon  the  retreat.  But,  as  he  flies,  he  is  forever  shooting  from 
behind,  and  his  Parthian  weapons  fall  thickly  and  heavily  upon  the 
vast  multitude.     He  must  therefore  be  subdued  into  a  practical  acqui- 


151  INSTITUTES    OF    MEDICINE. 

esceiice  \vith  those  consistent  piunciples  of  nature  which  exact  his  con 
sent,  but  not  his  comphance. 

349,  b.  Perhaps  no  author  has  supplied  so  many  examples  of  con- 
tradictions in  great  fundamental  principles,  and  in  so  small  a  compass, 
as  he  who  has  so  lately  taken  captive  the  physiological  world.  In  the 
Preface  to  the  Essays  "  On  the  Philosophy  of  Vitality  and  the  Modus 
Operandi  of  Remedial  Agents"  I  had  occasion  to  say  of  the  article  on 
"  Poisons,  Contagions,  and  Miasma,"  in  Liebig's  "  Organic  Chemistry 
applied  to  Agriculture  and  Physiology,''^  that  "  it  is  certainly  the  most 
stupendous  exhibition  of  perverted  facts,  of  combinations  of  conflict- 
ing doctrines,  and  of  the  rudest  system  of  pathology  and  therapeutics, 
that  can  be  found  in  the  records  of  dreamy  speculation." 

It  was  objected  by  the  editor  of  the  London  Lancet,  that  I  did  not 
prove  my  allegations  (§  5^,  a).  Nor  was  it  in  any  respect  the  object 
of  that  work  to  do  so.  I  was  satisfied  with  calling  attention  to  the 
facts,  and  with  what  I  had  already  published  in  the  Medical  and  Phys- 
iological Commentaries.  Since  that  day,  the  work  on  "  Ani7nal  Chem- 
istry'^ has  appeared  ;  and  it  is  now  my  purpose  to  sustain  the  allega- 
tions of  the  "  Preface,"  and  this  more  especially  from  the  objections 
alleged  by  Liebig  against  physiologists  (§  350,  mottoes,  a,  h,  c,  and  d). 

I  say,  therefore,  that  we  meet  on  the  same  page  a  purely  chemical 
and  a  purely  vital  philosophy  of  digestion ;  and  equally  so  of  other 
important  organic  processes.  That  each  is  laid  down  without  quali- 
fication, and  with  the  dictum  of  a  master,  who  is  conscious  that  the 
preponderance  he  gives  to  the  purely  chemical  philosophy  of  life  will 
establish  his  Empire  in  that  philosophy  with  an  age  more  prone  than 
ever  to  the  doctrines  of  materialism. 

349,  c.  Let  us,  therefore,  not  be  deceived;  for,  however  this  very 
extraordinary  and  successful  pretender  in  medicine  may  beguile  us 
with  words,  and  seem  to  persuade  rather  than  to  rule,  let  us  remem- 
ber that,  at  most,  he  does  but  invalidate  his  own  edicts  by  counter- 
mands, and  that  in  the  end  he  tells  us  that  these  apparently  adverse 
decrees  are,  in  their  absolute  import,  one  and  the  same  ;  that  they 
are  consistent  laws  delivered  from  the  laboratory,  though  apparently 
in  conflict  on  account  of  the  opposing  forces,  the  attraction  and  repul- 
sion, which  preside  in  the  chemistry  of  nature ;  that,  however,  in  re- 
ality, there  is  no  difference  whatever  in  the  seemingly  two  great  prin- 
ciples which  lie  at  the  foundation,  which  are  one  and  identical,  since 
"  the  mysterious  vital  principle  can  he  replaced  hy  the  chemical  forces  f^ 
and  since,  also,  "  the  vital  force  unites  in  its  manifestations  all  the  pe- 
culiarities of  the  chemical  forces,  and  of  the  no  less  wonderful  cause 
which  toe  regard  as  the  ultimate  origin  of  electrical  phenomena.''  And 
again,  "  in  the  processes  of  7iutrition  and  reproduction,  the  ultimate  cause 
of  the  different  conditions  of  the  vital  force  are  chemical  forces'"  (§  64,  e). 
— Liebig's  Organic  Chemistry  ;  and  Animal  Chemistry. 

349,  d.  It  is  painful  to  speak  thus  of  one  so  highly  endowed,  so 
devoted  in  mind,  so  accomplished  in  chemistry ;  but  science  and  hu- 
manity demand  the  sacrifice.  But,  again,  I  wish  to  be  understood, 
that  neither  here,  nor  in  any  other  case,  is  it  the  individual  of  whom 
I  speak,  but  of  his  doctrines  alone  (§  1  Zi,  4  h).  Nor  yet  would  the 
doctrines  of  an  individual  become  the  subject  of  extended  remark, 
did  they  not  represent  the  existing  state  of  the  three  high  branches 
of  medicine.     The  gigantic  physical  school  had  too  much  of  the  Pro- 


PH\SIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS.  155 

teaxi  character,  too  little  unity  of  purpose,  and  demanded  greater  sta;- 
bility.  The  learned  men  of  a  great  Nation,  The  British  Associa- 
tionfor  the  Advancement  of  Science,  united  in  the  object,  and  be- 
stowed the  honor  of  achieving  the  enterprise  upon  a  foreign  Chemist. 
The  note  of  proscription  has  been  sounded  in  high  quarters,  in  due 
conform'ity  (§  51  a,  350^  ]ck),  and  medical  philosophy  has  nothing  to 
hope  even  from  a  spirit  of  toleration.  The  subject,  therefore,  must 
be  brought  to  the  test  of  observation  and  reason,  and  he  who  arraigns 
the  authorized  doctrines  will  cheerfully  abide  an  unsuccessful  issue 
(§  1  b,  676  b,  709,  note).  I  shall  therefore  dwell  upon  the  conclusions 
of  those  who  have  engendered  the  corruptions,  and  shall  array  them 
in  all  the  force  demanded  by  the  magnitude  of  my  subject,  that  we 
may  the  better  realize  the  shallowness  of  that  pretended  philosophy 
which  has  so  lately  swept,  like  a  hurricane,  over  the  intellectual  world, 
that  we  may  see,  in  the  system  of  contradictions,  the  equal  fallacy  of 
that  school  who  endeavor,  with  great  sincerity,  to  mingle  the  conflict- 
ing principles,  and  that  we  may  the  better  cultivate  and  enjoy  the 
simple  and  consistent  philosophy  which  nature  teaches.  Nor  will  1 
yet  leave  this  general  reference  to  that  stupendous  system  of  assump- 
tion and  contradiction  which  was  so  lately  hailed  by  physiologists  as 
the  harbinger  of  a  total  revolution  in  medical  science,  ay,  in  the  very 
practice  of  medicine,  without  showing  you  the  depth  of  the  material- 
ism in  whicli  it  was  founded.  I  say  nothing  now  of  the  avowed 
infidelity  to  which  it  has  led.  Examples  of  that  disregard  of  instinct- 
ive faith  I  have  already  placed  in  their  proper  connection  with  my 
subject.*  But,  I  will  merely  present,  in  relief,  from  Liebig's  revolu- 
tionary work,  a  doctrine  of  the  chemical  school,  from  which,  if  I  mis- 
take not  the  ambition  of  intellectual  and  immortal  beings,  the  very 
impulse  of  nature  will  turn  the  most  indifferent  with  a  loathing  aver- 
sion. We  shall  see  from  it,  also,  how  entirely  degraded  to  the  rank 
of  the  merest  matter  is  every  thing  relating  to  organic  life  ;  even  man 
himself.  Thus,  then,  "  the  Reformer,"  in  behalf  of  the  school  of 
chemistry : 

349,  e.  "  Physiology  has  sufficiently  decisive  grounds  for  the  opin- 
ion that  every  ^notion,  every  manifestation  of  force,  is  the  result  of  a 
transformation  of  the  structure  or  of  its  substance  ;  that  every  concep- 
tion, every  mental  affection,  is  followed  by  changes  in  the  chemical 
nature  of  the  secreted  fluids ;  that  every  thought,  every  sensation,  is 
accompanied  by  a  change  in  the  composition  of  the  substance  of 
the  brain."  "  Every  manifestation  of  force  is  the  result  of  a  trans- 
formation of  the  structure  or  of  its  substance^ — See  p.  158,  no.  b\. 

And  now  may  it  not  be  reasonably  asked,  what  is  the  cause  of  those 
ciiemical  changes  in  the  cerebral  substance  which  give  rise  to  "  every 
conception,  every  mental  affection,  every  thought,  and  every  sensa- 
tion" (§  175  c,  500  n,  1054,  1076  a)  those  ''manifestations  of  force"  ? 

Many  organic  chemists,  however,  are  disposed  to  admit  a  spiritual 
part,  and  they  should  therefore  recollect  that  the  existence  of  a  prin- 
ciple of  life  is  not  less  substantiated  by  facts  than  the  existence  of  the 
soul,  which  they  are  so  ready  to  concede  when  inviting  our  attention 
to  the  physical  doctrines  of  life. 

350.  I  have  just  said  that  I  would  present  such  an  aiTay  of  contra- 

*  See  Medical  and  Physiological  Commentaries,  vol.  ii.,  p.  122-140.  Also,  the  Essay 
on  the  Vital  Poioers,  in  vol.  i.    Also  Tacitus'  Dialogue  Concerning  Oratory, 


156  INSTITUTES    OF    MEDICINE. 

dictoiy  opinions  on  the  physiology  of  digestion,  and  the  general  phi- 
losophy of  life  and  disease,  from  the  two  brief  National  Essays  by 
Liebig  (§  349,  b),  as  should  induce  physiologists  to  retrace  their  steps, 
and  thus  make  some  atonement  to  the  science  which  was  surrendered 
with  an  acclamation  that  had  been  worthy  the  original  institution  of 
medicine. 

In  the  first  place,  however,  with  a  view  to  the  cause  which  I  advo- 
cate, and  in  justice,  also,  to  able  and  independent  philosophers,  I  shall 
quote  the  foUowdng  remarks  from  a  letter  addressed  to  myself  by  a 
distinguished  writer,  of  Manchester  (England)  : 

"Manchester,  May  5,  184G. 

"  Dear  Sir, 
'■'■  I  made  your  famplilet  (a  Lecture  on  Digestion)  tlie  sxihject  of  a 
Paper  xoMcli  I  read  before  the  Manchester  Literary  and  Philo- 
sophical Society,  and  which  provoked  a  discussion  two  nights.  The 
result  was  almost  unanimously  infovor  of  your  views  in  reference  to  the 
Philosophy  of  Digestion.     lam,  &c., 

"  Charles  Clay,  M.D," 

I  shall  now  exhibit,  in  parallel  columns,  the  new  philosophy  which 
forms  the  present  science  of  medicine,  preceded  by  some  appropriate 
mottoes. 

a.  "  Animal  and  vegetable  physiologists  institute  experiments  without  being  ac- 
quainted with  the  circumstances  necessary  to  the  continuance  of  life — with  the  qualities 
and  proper  nourishment  of  the  animal  or  plant  on  which  they  operate — or  with  the  nature 
and  chemical  constitution  of  its  organs.  These  experiments  are  considered  by  them  as 
convincing  proofs,  while  they  are  fitted  only  to  awaken  pity"  (no.  50). 

b.  "  All  discoveries  in  physics  and  in  chemistry,  all  explanations  of  chemists  [ !  ] 
must  remain  without  fruit  and  useless,  because  even  to  the  great  leaders  in  physi- 
ology, carbonic  acid,  ammonia,  acids,  and  bases,  are  sounds  without  meaning,  words 
without  sense,  terms  of  an  unknown  language,  which  awaken  no  thoughts,  and  no  asso- 
ciations. They  treat  these  sciences  like  the  vulgar,  who  despise  a  foreign  literature  ia 
exact  proportion  to  their  ignorance  of  it." — Liebig's  Organic  Chemistry  applied  to  Phys- 
iology, &.C.     [See  no.  2.]— ((J  1034). 

c.  "  None  of  them  (the  most  distinguished  physiologists)  had  a  clear  conception  of  the 
process  of  development  and  nutrition,  or  of  the  true  cause  of  death.  They  professed  to 
explain  the  most  obscure  psychological  phenomena,  and  yet  they  were  unable  to  say  what 
fever  is,  and  in  what  way  quinine  acts  in  curing  it"  (no.  2,  42).  The  oft-reiterated  conclu- 
sion folbws,  that  it  is  reserved  for  chemistry  to  resolve  these  problems. 

d.  "  Thus  medicine,  after  the  fashion  of  the  Aristotelian  philosophy,  has  formed  certain 
conceptions  in  regard  to  nutrition  and  sanguification.  Articles  of  diet  have  been  di- 
vided into  nutritious  and  non-nutritious  ;  but  these  theories  [ !  ]  being  founded  on 
observations  destitute  of  the  conditions  most  essential  to  the  drawing  of  just  conclusions, 
could  not  be  received  as  expressions  of  the  truth.  How  clear  are  now  to  us  the  relations 
of  the  different  articles  of  food  to  the  objects  which  they  sei-ve  in  the  body,  since  organic 
chemistry  has  applied  to  the  investigation  her  quantative  method  of  research"  !  (§  18,  409.) 

e.  "The  limited  acquaintance  of  physiologists  with  the  methods  of  research  employed  in 
chemistiy  will  continue  to  be  the  chief  impediment  to  the  progress  of  physiology,  as 
well  as  a  reproach  which  that  science  cannot  escape." — Liebig's  Animal  Chemistry. 

f.  "  Wliat  has  the  soul,  what  have  consciousness  and  intellect  to  do  with  the  develop- 
ment of  the  human  foetus,  or  the  foetus  in  a  fowl's  egg  ?  Not  more,  surely,  than  with  the 
development  of  the  seeds  of  a  plant.  Let  us  first  endeavor  to  refer  to  their  ultimate  causes 
those  phenomena  of  life  which  are  not  psychological ;  and  let  vs  beware  of  drawing  con- 
clusions before  we  have  a  ground-ivoi-k.  We  know  exactly  the  mechanism  of  the  eye ;  but 
neither  anatomy  nor  chemistry  will  ever  explain  how  the  rays  of  light  act  on  conscious- 
ness, so  as  to  produce  vision.  Natural  science  has  fixed  limits  which  cannot  be  passed, 
and  it  must  always  be  borne  in  mind  that,  with  aU  oiu-  discoveries,  we  shall  never  know 
what  Ught,  electricity,  and  magnetism  are  in  their  essence,  because,  even  of  those  things 
which  are  material,  the  human  intellect  has  only  conceptions.  We  can  ascertain,  how- 
ever, the  laws  which  regulate  their  motion  and  rest,  because  these  are  manifested  in  phe 
nomena.  In  like  manner,  the  laws  of  vitality,  and  of  all  that  disturbs,  pro 
MOTES,  OR  alters  VITALITY,  may  certainly  be  discovered,  although  we  shall  never  learn 
what  life  is"  {^  1G8).  —  Liebig's  Animal  Cliemistry. 


,  PHYSIOLOGY. — ORGANIC   CHEMISTRY — FUNCTIONS.  157 

g.  "For  years  past  a  tribunal  has  been  established  at  Giessen,  before  which  Liebig 
is  at  the  same  time  accuser,  witness,  public  prosecutor,  advocate,  and  judge." — Mcl- 
dek's  Reply  to  Liehig.     Translation,  London,  1846. 

h.  "  Chemists  and  natural  philosophers,  accustomed  to  study  the  phenomena  over  which 
the  phj'sical  forces  preside,  have  carried  their  spirit  of  calculation  into  the  theories  of  the 
vital  laws." — Bichat's  General  Anatomy,  vol.  ii.,  p.  54. 

i.  "  Let  a  man  be  given  up  to  the  contemplation  of  one  sort  of  knowledge,  and  that  wiU 
become  every  thing-.  The  mind  will  take  such  a  tincture  from  a  familiarity  with  that  ob- 
ject, that  eveiy  thing  else,  how  remote  soever,  will  be  brought  under  the  same  view.  A 
metaphysician  will  bring  ploughing  and  gardening  immediately  to  abstract  notions  ;  the 
history  of  natm-e  will  signify  nothing  to  him.  A  chemist,  on  the  contrary,  shall  reduce 
divinity  to  the  maxims  of  his  laboratory,  explain  morality  by  sal,  sulphur,  and  mercury 
and  allegorize  the  Scripture  itself,  and  the  sacred  mysteries  thereof,  into  the  philosopher's 
stone." — Locke,  on  the  Human  Understanding. 

k.  "Mr.  Locke,  I  think,  mentions  an  eminent  musician,  who  believed  that  God  created 
the  world  in  six  days,  and  rested  on  the  seventh,  because  there  are  but  seven  notes  in 
music.  I  myself  knew  one  of  that  profession  who  thought  there  were  only  three  parts  in 
harmony,  to  wit,  base,  tenor,  and  treble,  because  there  are  but  three  persons  in  the  Trin- 
ity."— H,EiD,  0)1  the  Powers  of  the  Human  Mind,  vol.  ii..  Essay  6,  c.  viii. 

I.  "  When  education  takes  in  error  as  a  part  of  its  system,  there  is  no  doubt  that  it  will 
operate  with  abundant  energy,  and  to  an  extent  indefinite"  (^  433). — Burke. 

CHEMICAL    DOCTRINES.  VITAL    DOCTRINES. 

1.  "  My  OBJECT  has  been,  in  the  47.  "A  rational  physiology 
present  work,  to  direct  attention  to  cannot  be  founded  on  mere  re- 
the  points  of  intersection  of  cJiem-  actions,  and  the  living  body  cannot 
istry  with  physiology.,  and  to  point  be  viewed  as  a  chemical  labor- 
out  those  parts  in  which  the  sci-  atory." 

ences  become,  as  it  were,  mixed       "  The    study    of    the    uses    of 

up  together.     It  contains  a  collec-  the  functions  of  different  organs, 

lion  of  problems,  such  as  chemis-  and  of  their  mutual  connection 

try  at  present  requires  to  be  re-  in  the  animal  body,  was  formerly 

solved,  and  a  number  of  conclu-  the  chief  object  in  physiological 

sions  drawn  according  to  the  rules  researches ;  but  lately  this  study 

of  that  science.     These  questions  has  fallen  into  the  back-ground." 

and  problems    will  be   resolved;  — Liebig's  Animal   Chemistry. — 

and  Ave  cannot  doubt  that  we  shall  (See  motto  c.) 
have  in  that  case  a  new  physiol-        48.  "  With  all  its  discover- 

OGY  AND  A  RATIONAL  PATHOLOGY."  lES,  Modem    Chemistry  has  per- 

— Liebig's  Animal  Chemistry.  formed  but  slender  services  to 

2.  "  In  earlier  times,  the  attempt  physiology  and  pathology." — Lie- 
has  been  made,  and  often  with  big,  ibid. 

GREAT  success,  to  apply  to  the  ob-  49.  "  Physiology  still  endeavors 

jects  of  the  medical  art  the  views  to  apply  chemical  experiments  to 

derived    from     an     acquaintance  the  removal  of  diseased  conditions; 

with   chemical   observations.     In-  but,  with  all  these  countless  ex 

deed,  the   great  physicians,  who  periments,  we  are  not  one  step 

lived  toward  the  end  of  the  17th  nearer  to  the  causes  and  essence  of 

century,  were  the   founders    of  diseased — Liebig,  ihid. 

CHEMISTRY,  AND   IN   THOSE  DAYS  50.  "  Mechanical    philosophers 

THE     ONLY     PHILOSOPHERS     AC-  and    CHEMISTS  justly    ascribe   to 

QUAiNTED    WITH     IT." — Liebig's  THEIR   methods    of  research   the 

Animal  Chemistry .     (See  mottoes  greater  part  of  the  success  which 

i,  e.)  has  attended  their  labors." — Lie- 
big's Animal  Chemistry  (a). 

3.  "\xi\hQ  animal  hody  we,  r&c-  51.  "In  the  animal  ovum,  as 
ognize  as  the  ultimate  cause  of  all  well  as  in  the  seed  of  a  plant, 


158  INSTITUTES    OP   MEDICINE. 


CHEMICAL    DOCTRINES.  VITAL    DOCTRINES, 

force  only  one  cause,  the  chemical  we  recognize  a  certain  remark- 
action  which  the  elements  of  the  ABLE  force,  the  SOURCE  OP 
food  and  the  oxygen  of  the  air  growth,  or  increase  in  the  mass, 
mutually  exercise  on  each  other,  and  of  reproduction,  or  of  supply 
The  only  known  ultimate  cause  of  of  the  matter  consumed  ;  a  force 
vital  force,  either  in  animals  or  in  in  a  state  of  rest.  By  the  ac- 
plants,  is  a  chemical  process.  If  tion  of  external  influences,  by  im- 
THis  be  prevented,  the  phenom-  pregnation,  by  the  presence  of  air 
ENA  OF  life  do  NOT  MANIFEST  and  moisture,  the  condition  of 
themselves.  If  the  chemical  ac-  static  equilibrium  of  this  force 
tion  be  impeded,  the  vital  phenom-  is  disturbed.  Entering  into  a 
ena  must  take  new  for  7ns.'"  "  All  state  of  motion  or  activity,  it 
VITAL  activity  ARISES  from  the  exJiihits  itself  in  the  production 
mutual  action  of  the  oxygen  of  the  of  a  series  of  forms,  which,  al- 
atmosphere  and  the  elements  of  the  though  occasionally  bounded  by 
food," — Liebig's  Animal  Chemis-  right  lines,  are  yet  widely  distinct 
try,  from  geometrical  forms,  such   as 

4.  "  The  LIFE  of  animals  exhib-  we  observe  in  crystalized  miner- 
its  itself  in  the  continual  absorp-  als.  This  force  is  called  the  vi 
tion  of  the  oxygen  of  the  air,  and  tal  force,  vis  vitce,  or  vitality." 
its  combination  with  certain  parts  "The  increase  of  mass  is  effect- 
of  the  animal  body." — Liebig's  ed  in  living  parts  by  the  vital 
Animal  Chemistry.  force." — Liebig's  Animal  Chem- 

5.  "  Physiology  has  sufficiently  istry.  (See  my  Essays  on  Vitali- 
decisive  grounds  for  the  opinion,  ty,  &c.,  p.  13-18.) 

that  every  motion,  every  mani-       51|,  "  The  oxygen  of  the  at- 

FESTATioN  OF  FORCE,  IS  THE  RE-  mosphere  is  the  proper,  active,  ex- 

SULT   OF   A   TRANSFORMATION   OF  tcrnal  causc  of  the  WASTE  of  mat- 

THE   STRUCTURE   OR  OF   ITS   SUB-  tcr  in  the  animal  body.     It  acts 

STANCE  ;  that  every  conception,  ev-  like  a  force  which  tends  to  disturb 

ery  mental  affection,  is  followed  by  and  destroy  the  manifestations  of 

changes   in    the    chemical  nature  the  vital  force  at  every  moment, 

of  the   secreted  fluids;  that  every  But  its  effect  as  a  chemical  agent 

thought,  every  sensation,  is  accom-  (in  producing  waste),  the  disturb- 

panied  by  a  change  in  the  composi-  ance  proceeding  from  it,  is  held 

i/(??«  of  the  substance  of  the  brain"!  in    equilibrium    by    the    vital 

— Liebig's  Animal  Chemistry  (no.  force." — Liebig's  Animal  Chem- 

41,18-J).  istry. 

5i,  That   our  Author's    intent        52.  "  The  vital  force  is  manifest- 

cannot  be  doubtful   appears  from  ed  in  the  form  of  resistakce,  in- 

his   unequivocal   statement  that —  asmuch  as  by  its  presence  in  the 

"  The  higher  phenomena  of  men-  living  tissues  their  elements  acquire 

tai  existence  cannot,  in  the  pres-  the  poicer  of  ivithstanding  the  dis- 

ent  state  of  science,  be  referred  to  turhance  and  change  in  their  form 

their  proximate,  and  still  less  to  and  composition  which   external 

their  ultimate  causes.     \()f  course,  agencies  tend  to  produce :  a  pow- 

therefore,  not  to  a  Soul']  .  We  only  er    which,    as     CHEJncAL     COM- 

know  of  them  that  they  exist."  pounds,  they  do  not  possess." 

Again — "The  efforts  of  philoso-  — Ja^jsig's,  Animal  Chemistry. 
phers,  constantly  made   to   pene-       53.  "  The  vital  principle  must 

trate  the  relations  of  the  soul  to  be  a  motive  poaver,  capable  of 


PHYSIOLOGY. 


-ORGANIC    CHEMISTRY- FUNCTIONS. 


159 


CHEMICAL   DOCTRINES. 

animal  life,  have  all  along  retard- 
ed the  progress  of  physiology.  In 
this  attempt  men  have  left  the 
province  of  philosophical  research 
for  that  of  fancy"  (p.  182-183, 
§  350|  gg,  p.  924-925,  §  1085).— 
Liebig's  Animal  Chemistry. 


6.  "  In  the  processes  of  nutri- 
tion and  REPRODUCTION,  we  per- 
ceive the  passage  of  matter  from 
the  state  of  motion  to  that  of  rest 
(static  equilibrium).  Under  the  in- 
fluence of  the  nervous  system,  this 
matter  enters  again  into  a  state  of 
motion.  The  ultimate  causes  of 
these  different  conditions  of  the  vi- 
tal force  are  chemical  forces." 

7.  "  The  cause  of  the  state  of 
motion  is  to  be  found  in  a  series 
of  changes  which  the  food  under- 
goes in  the  organism,  and  these 
are  the  results  of  processes  of 
DECOMPOSITION,  to  which  either 
the  food  itself,  or  the  structures 
formed  from  it,  or  parts  of  organs, 
are  subjected"  (^  1054). 

8.  "  The  change  of  matter,  the 
manifestation  of  mechanical  force, 
and  the  absorption  of  oxygen,  are, 
in  the  animal  body,  so  closely  con- 
nected with  each  other,  that  we 
may  consider  the  amount  of  mo- 
tion and  the  quantity  of  living 

TISSUE  TRANSFORMED,  AS  PROPOR- 
TIONAL TO  THE  QUANTITY  OF  OX- 
YGEN inspired  and  consumed  in  a 
given  time  by  the  animal." — Lie- 
big's Animal  Chemistry  (no.  3,  4). 

9.  "  If  we  employ  these  well- 
known  facts  as  means  to  assist  us 
in  investigating  the  ultimate  cause 
of  the  mechanical  effects  in  the  an- 
imal organism,  observation  teaches 
us  that  the  motion  of  the  blood 

AND   of    the    other    ANIMAL    FLU- 


VITAL   DOCTRINES. 
BIPARTING    5I0TI0X    TO    ATOMS    AT 

REST,  and  of  opposing  resistance 
TO  OTHER  forces  producing  mo- 
tion, such  as  THE  CHEMICAL  FORCE, 

heat  and  electricity." — Liebig's 
Lectures  for  1844. 

"Every  thing  in  the  organism 
goes    on    under    the    influence    of 

the    VITAL    FORCE,   AN   IMMATERIAL 

agent,  which  the  chemist  cannot 
employ  at  will." — Liebig's  Ani- 
mal Chemistry. 

54.  "  There  is  nothing  to  pre- 
vent us  from  considering  the  vital 
FORCE  as  a  PECULIAR  property, 
which  is  possessed  by  certain  ma- 
terial bodies,  and  becomes  sensi- 
ble when  their  elementary  parti- 
cles are  combined  in  a  certain  ar- 
rangement or  form.  This  suppo- 
sition takes  from  the  vital  j^henom- 
ena  nothing  of  their  wonderful  pe- 
culiarity. It  may,  therefore,  be 
considered  as  a  resting  point 
from  which  an  investigation  into 
these  phenomena,  and  the  laws 
which  regulate  them,  may  be  com 
menced ;  exactly  as  we  considei 
the  properties  and  laws  of  light 
to  be  dependent  oh  a  certain  lu- 
miniferous  matter  or  ether,  which 
has  no  farther  connection  with  the 
laws  ascertained  by  investigation." 
— Liebig's  Animal  Chemistry. 

55.  "  Every  thing  in  the  ani- 
mal organism,  to  which  the  name 
of  motion  can  be  applied,  pro- 
ceeds from  the  nervous  appara- 
tus." "  In  animals  we  recognize 
in  the  nervous  apparatus  a  source 

OF   POWER   capable    OF    RENEWING 

ITSELF  at  every  moment  of  theii 
existence."  —  Liebig's  Animal 
Chemistry. 

5^.  "  We  may  communicate 
motion  to  a  body  at  rest  by  means 
of  a  numher  of  forces,  very  differ- 
ent in  their  manifestations.  Thus, 
a  time-piece  may  be  set  in  motion 
by  a  falling  weight  {^gravitation'), 
or  by  a  bent   spring  {elasticity\ 


160  INSTITUTES    OF   MEDICINE. 


CHEMICAL    DOCTRINES.  VITAL    DOCTRINES, 

IDS  ])roceeds  fi'om  distinct  organs,  Every  kind  of  motion  may  be  pro- 

which,  as  in  the  case  of  the  heart  duced  by  the  electric  or  magnetic 

and  intestines,  do  not  generate  force,  as  well  as  by  chemical  at 

THE    MOVING    POWER    IN     THEM-  tractioTfi  /  whilc  wc  cannot  say,  as 

SELVES,  BUT  RECEIVE  IT  FROM  oTH-  long  as  we  Only  consider  the  man- 

ER  QUARTERS." — Liebig's  Animal  ifestation  of  these  forces  in  the  phe- 

Chemistry  (no.  3,  4),  nomenon  or  result  produced,  which 

10.  "  Now,  since  the  phenome-  of  these  various  causes  of  change 
na  of  RioTioN  in  the  animal  body  of  place  has  set  the  objects  in  mo- 

ARE    dependent    ON    THE    CHANGE  tion.       In    THE    ANIMAL    ORGANISM 

OF   MATTER,  the  increase   of  the  we  are  acquainted  with  only  one 
change  of  matter  in  any  part  is  fol-  cause  of  motion,  and  this  is  the. 
lowed  by  an  increase  of  all  the  same  cause  which  determines  the 
motions.     Consequently,if,  in  con-  growth  of  living  tissues  and  gives 
sequence  of  a   diseased   trans-  \X\qxq.  the  j)ower  of  resistance  Xo  Qy.- 
FORMATiON   OF  LIVING   TISSUES,  a  tcrnal  agencies.     It  is  the  vital 
greater  amount  offeree  be  gener-  force." — Liebig,  ihid. 
ated  than  is  required  for  the  pro-        57.  "  In  order  to  attain  a  clear 
duction  of  the  normal  motions,  it  conception  of  these  manifestations 
is  seen  in  the  acceleration  of  of  the  vital  force,  so  different 
ALL  OR  some  of  THE  INVOLUNTARY  in  form,  we  must  bear  in  mind, 
motions,  as  well  as  in  a  higher  that  every  known  force  is  recog- 
TEMPERATURE    OF    THE    DISEASED  nizcd  by  two  conditious  of  activi- 
PART." — Liebig's  Animal  Chem-  ty,"  &c. — Liebig's  Animal  Chem- 
istry.    \Such,  with  §  350|-,  i,  and  istry. 
no.  11,  M  the  chemical  substitute  for 
the  medical  aphorism,  "  uhi  irrita- 
tio  ihi  ajjluxus.^'     It  will  be  also 
scenfrovi  the  foregoing  nos.  7,  8,  9, 
that  Liebig  considers  the  circula- 
tion of  the  blood  due  to  the  agen- 
cies of  oxygen,  and  not  at  all  to  the 
action  of  the  heart. \ 

11.  "  The  power  to  effectTRANS-  58.  •'  Our  notion  of  life  involves 
FORMATIONS  docs  not  belong  to  the  something  more  than  mere  repro 
vital  principle.  Each  transforma-  duction,  namely,  the  idea  of  an  ao 
tion  is  owing  to  a  distui'bance  in  tive  power  exercised  by  virtue  of 
the  attraction  of  the  elements  of  a  a  definite  form,  and  production 
compound,  and  is,  consequently,  a  and  generation  in  a  definite  form. 
PURELY  CHEMICAL  PROCESS."  —  The  productiou  of  organs,  and 
Liebig's  Organic  Chemistry  ap-  their  power  not  only  to  produce 
flied  to  Physiology,  &c.  their  component  parts  from  the 

12.  "The  combinations  of  the  food  presented  to  them,  but  to  gen- 
chemist'  relate  to  the  change  of  erate  themselves  in  their  orig- 
maiter,  forward  and  backward,  to  inalform  and  loith  all  their  prop- 
the  conversion  OF  FOOD  into  the  crtics,  are  characters  belonging 
VARIOUS  TISSUES  and  secretions,  exclusively  to  organic  life,  and 
and  to  their  metamorphosis  into  constitute  a  form  of  reproduction 
lifeless  compounds ;  his  investiga-  independent  op  chemical  pow- 
TioNs  ought  to  tell  us  what  has  ers.    The  chemical  forces  are  sub- 


VHYSIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS. 


161 


CHEMICAL    DOCTRINES. 


VITAL    DOCTRINES. 


TAKEN  PLACE  AND  WHAT  CAN  TAKE  ject  TO  THE  INVISIBLE  CAUSE  BY 
PLACE     IN    THE    BODY." LiEBIG's     WHICH    THIS    FORM    IS    PRODUCED. 

Animal  Gliemistry.  Of  the  existence  of  this  cause 

13.  "  How  beautifully  and  admi-  itself  we  are  made  aware  only 
rably  SIMPLE,  with  the  aid  of  these  hy  the  phenomena  which  it  pro 
discoveries  {chemical),  appears  the  duces.  Its  laws  must  be  inves- 
process  of  nutrition  in  animals,  tigated_;M*i  as  we  investigate  those 
the  formation  of  their  organs,"  of  the  other  powers  which  effect 
&c.  motion  and  changes  in  matter." — 

14.  "Inthehandsofthephysiolo-  Liebig's  Organic  Chemistry  ap- 
gist,  ORGANIC  CHEMISTRY  must  be-  plied  to  Physiology,  &c. 

come  an  intellectual  instrument,  by  59.  "It  is  not  the  true  chemist 
means  of  which  he  will  be  enabled  who  has  endeavored  to  apply  to 
to  trace  the  CAUSES  of  phenomena  the  animal  organism  his  notions 
invisible  to  the  bodily  sight." —  derived  from  purely  chemical  pro- 
Liebig's  Animal  Chemistry.  cesses.     He  has  not  had  the  re- 

14i.  "  Since,  in  different  indi-  motest  intention  of  undertaking 
viduals,  according  to  the  amount  the  explanation  of  any  really  vital 
of  force  consumed  in  producing  phenomenon  upon  chemical  prin- 
voluntary  mechanical  effects,  une-  ciples.  The  only  part  which 
qual  quantities  of  living  tissues  are  chemistry  now,  or  for  the  future, 
wasted,  there  must  occur  in  every  can  take  in  the  explanation  of  the 
individual,  unless  the  phenomena  vital  processes,  is  limited  to  a  more 
of  motion  are  to  cease  entirely,  a  precise  designation  of  the  phenom- 
condition  in  which  all  voluntary  ena,  and  to  the  task  of  control- 
motions  are  completely  checked ;  ling  the  correctness  of  inferen- 
in  which,  therefore,  these  occasion  ces,  and  insuring  the  accuracy  of 
no  waste.  This  condition  is  caUed  all  observations  by  number  and 
sleep." — Ibid.  weight.     Although  the  chemist  is 

able  to  analyze  organic  bodies,  and 
tell  us  their  ultimate  elements,  he 
does  not  claim  the  power  of  syn- 
thesis, or  of  producing  them  again 
by  the  union  of  these  elements"  ! ! ! 
— Liebig's  Lectures  for  1844  (§ 
350|-350|).— See  no.  39. 

15.  "  The  self-regulating  steam-  60.  "  In  what  form  or  in  what 
engines  furnish  no  unapt  image  manner  the  vital  force  pro- 
ofwhat  occurs  in  the  a^imaZJofZy."  duces  mechanical  effects  in 
"  The  body,  in  regard  to  the  pro-  the  animal  body  is  altogether 
duction  of  heat  and  force,  acts  unknown,  and  is  as  little  to 
just  like  one  of  these  machines." —  be  ascertained  by  experiment 
Liebig's  Animal  Chemistry.  as  the  connection  op  chemical 

16.  "  The  vital  force  unites  in  action  with  thf  phenomena  of 
its  manifestations  all  the  peculi-  motion,  which  we  can  produce 
ARiTiES  OF  CHEMICAL  FORCES,  and  with  the  galvanic  battery.  We 
of  the  not  less  wonderful  cause  know  not  how  a  certain  invisible 
which  we  regard  as  the  ultimate  something,  heat,  gives  to  certain 
origin  of  electrical  phenomena."  bodies  the  power  of  exerting  an 
— Liebig's  Animal  Chemistry.  enormous  pressure  on  surround- 

17.  "The    mysterious    vital   ing  objects.     "We  know  not  even 

L 


162 


INSTITUTES    DF    MEDICINE. 


CHEMICAL    DOCTRINES. 

rRiNCiPLE  can  be  replaced  by  the 
CHEMICAL  FORCES." — LiEBio's  Or- 
ganic Chemistry  applied  to  Phys- 
iology, &c, 

17-|.  "The   animal    body   is   a 
heated   mass,    Avhich    bears   the 

SAME  RELATION  TO  SURROUNDING 
OBJECTS    AS     ANY     OTHER    HEATED 

MASS.  It  receives  heat  when  the 
surrounding  objects  are  hotter,  it 
loses  heat  when  they  are  colder 
than  itself."  —  Liebig's  Animal 
Chemistry.  (See  §  3o0f,  440  c, 
1044  a,  b,  1046-1050.) 


17f .  "  The  high  temperature  of 
the  animal  body  is  uniforonly  and 
under  all  circumstances  the  result 
of  the  combination  of  a  combusti- 
ble substance  with  oxygen." 

"  The  CARBON  of  the  food,  which 
is  converted  into  carbonic  acid 
within  the  body,  must  give  out  ex- 
actly as  much  heat  as  if  it  had  been 
directly  burned  in  the  air,  or  in 
oxygen  gas.  The  only  difference 
is,  that  the  amount  of  heat  pro- 
duced is  diffused  over  unequal 
times." 

"  By  the  combination  of  oxygen 
with  the  constituents  of  the  met- 
amorphosed tissues,  the  tempera- 
ture necessary  to  the  manifes- 
tations OP  vitality  is  produced 
in  the  carnivora." — Liebig's  A7ii- 
mal  Chemistry  (§  440,  nos.  17  and 
18). 

18.  "  The  nerves  which  accom- 
plish the  voluntaiy  and  involunta- 
ry MOTIONS  in  the  body  (no.  7-9) 
are,  according  to  the  preceding 
exposition,  not  the  producers, 
but  ONLY  the  conductors  of  the 
vital  force  (§  59).     They  permit 


VITAL    DOCTRINES. 

HOW  this  something  itself  is  pro* 
duced  when  we  burn  wood  oi 
coals. 

"  So  it  is  with  the  vital  force 
and  with  the  phenomena  exhibit- 
ed by  living  bodies.  The  cause 
of  these  phenomena  is  not  chem- 
ical force ;  it  is  not  electricity, 
nor  magnetism.  It  is  a  peculiar 
FORCE,  because  it  exhibits  mani- 
festations which  are  formed  by  NO 

OTHER  KNOWN  FORCE."' 

61.  "In  regard  to  the  nature 
AND  essence  of  the  vital  force,  we 
can  hardly  deceive  ourselves,  when 
we  reflect,  that  it  behaves,  in  all 
its  manifestations,  exactly  like 
other  natural  forces ;  that  it  is 
devoid  of  consciousness  or  of  vo- 
lition, and  is  subject  to  the  action  of 
a  blister."  —  Liebig's  Animal 
Chemistry. 

^\\.  "  Certain  other  constitu- 
ents of  the  blood  may  give  rise  to 
the  formation  of  carbonic  acid  in 
THE  lungs.  But,  all  this  has  no 
connection  with  that  vital  pro- 
cess BY  WHICH  THE  HEAT  neCCSSa- 

ry  for  the  support  of  life  is  gen- 
erated in  every  part  of  the  body." 
— Liebig's  Animal  Chemistry. 

Glf.  Nevertheless  —  "In  the  animal 
organism  two  processes  of  oxydation  are 
going  on  ;  one  in  the  kings  [the  union 
of  oxygen  with  an  '  organic  compound  of 
iron'],  the  other  in  the  capillaries  [the 
union  of  the  absorbed  oxygen  with  car- 
bon, &c.].  By  means  of  the  fokjiee,  in 
spite  of  the  degree  of  cooling,  and  of  the 
increased  evaporation  which  takes  place 
there,  the  constant  temperature  of  the 
LtrxGS  is  kept  up,  while  the  heat  of  the 
KEST  OF  THE  BODY  Is  Supplied  by  the 
latter"  ! — Liebig's  Animal  Chemistry. 


62.  "  In  the  present  state  of  our 
knowledge,  no  one,  probably,  will 

IMAGINE  that  ELECTRICITY  is  tO  be 

considered  as  the  cause  of  the 
phenomena  of  motion  in  the 
body."  "  Every  thing  in  the  ani- 
mal oro-anism  to  which  the  name 


PHYSIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS. 


163 


CHEMICAL    DOCTRINES. 

the  current  to  traverse  them,  and 
present,  as  conductors, of  elec- 
tricity, ALL  THE  phenomena 
WHICH  THEY  EXHIBIT  AS  CONDUCT- 
ORS  OF    THE   VITAL   FORCe"  ! LlE- 

big's  Animal  Chemistry.  [Com- 
pare with  no.  55.] 

18j.    "  If    CHEMICAL    ACTION    be 

excluded  as  a  condition  of  nervous 
agency,  it  means  notiiing  else  than 
to  derive  the  presence  of  motion, 

the  MANIFESTATION  OF  FORCE,  FROM 

NOTHING.  But  no  force,  no  pow- 
er, CAN  COME  FROM  NOTHING"!  — 
Liebig's  Animal  Chemistry  (no.  5). 

19.  "  By  means  of  the  nerves, 
ALL  PARTS  of  the  body  receive  the 
moving  force  which  is  indispen- 
sable to  their  functions,  to  change 
of  place,  to  the  production  of  me- 
chanical effects.  Where  nerves  are 
not  found,  motion  does  not  occur. 
[In  plants,  for  example  1]  The 
excess  of  force  genei"ated  in  one 
place  is  conducted  to  other  parts 
by  the  nerves.  The  force  which 
one  organ  cannot  produce  in  itself 
is  conveyed  to  it  from  other  quar- 
ters, [  !  ]  and  the  vital  force  which 
is  wanting  to  it,  in  order  to  furnish 
resistance  to  external  causes  of 
disturbance,  it  receives  in  the  form 
of  excess  from  another  organ,  an 
excess  which  that  organ  cannot 
consume  in  itself"! — Liebig's  An- 
imal Chemistry  (§  422,  423,  733  e). 

20.  "  The  phenomena  of  motion 
IN  VEGETABLES,  the  circulation  of 
the  sap,  for  example,  observed  in 
many  of  the  characeas,  and  the 
closing  of  flowers  and  leaves,  de- 
pend on  PHYSICAL  and  mechanical 
causes.     Heat  and  light  are  the 

remote  causes  of  MOTION  in  VEG- 
ETABLES ;  but  in  animals  we  rec- 
ognize in  the  nervous  apparatus  A 
SOURCE  OF  POWER,  Capable  of  re- 
newing itself  at  every  moment  of 
their  existence," — Liebig's  Ani- 
mal Chemistry. 

21.  "  While    the   assimilation 


VITAL    doctrines. 

of  MOTION  can  be  applied  proceeds 
from  the  nervous  apparatus.  In 
animals  we  recognize  in  the  ner- 
vous apparatus  a  source  of  pow- 
er, CAPABLE   OF    RENEWING  ITSELF 

at  every  moment  of  their  exist- 
ence."— Liebig's  Animal  Chem- 
istry (no.  55). 

62i.  "But  all  this  (formation 
of  carbonic  acid)  has  no  connection 
with  that  VITAL  process  by  which 
the  heat  necessary  for  the  support 
of  life  is  generated  in  every  part 
of  the  body."  —  Liebig's  Animal 
Chemistry. 

63.  "  Pathology  informs  us  that 
the  true  vegetable  life  is  in  no  way 
dependent  on  this  apparatus 
(the  cerebro-spinal) ;  that  the  pro- 
cess of  nutrition  proceeds  in  those 
parts  of  the  body  where  theNERVES 
of  sensation  and  voluntary  motion 
are  paralyzed,  exactly  in  the  same 
way  as  in  other  parts  where  these 
nerves  are  in  the  normal  condi- 
tion ;  and,  on  the  other  hand,  that 
the  most  energetic  volition  is  inca- 
pable of  exerting  any  influence  on 
the  contractions  of  the  heart,  on 
the  motion  of  the  intestines,  or  on 
the  processes  of  secretion." — Lie- 
big's Ani?nal  Chemistry. 


64.  "  Although  plants  require 
light,  and,  indeed,  sun  light,  it  is 
not  necessary  that  the  direct  rays 
of  the  sun  reach  them.  Their 
FUNCTIONS  certainly  proceed  with 
greater  intensity  and  rapidity  in 
sunshine,  than  in  the  diffused  light 
of  day;  but  it  merely  accelerates 
in  a  greater  degree  the  action 
already  existing."  —  Liebig's 
Organic  Cheinistry  applied  tf 
Physiology,  &c. 

0,5.  "  The  vital  principle  is 
only  known  to  us  through  the  pe- 
culiar form  of  its  instruments  , 


164  INSTITUTES    OF    MEDICINE. 


CHEMICAL  DOCTRINES.  VITAL  DOCTRINES. 

of  food  in  VEGETABLES,  and  the    that   is,    through    the    organs    in 

WHOLE  PROCESS   OF   THEIR  FORMA-     WHICH  IT  RESIDES.       Hcnce,  what- 

TioN,  are  dependent  on  certain  ever  kind  of  energy  a  substance 

EXTERNAL  INFLUENCES  wMc7i  fTo-  may  possess,  if  it  is   amorphous 

duce  motion,  the  development  of  the  and    destitute    of    organs    from 

ANIMAL   organism  is,  to  a  certain  which   the   impulse,    motion,   or 

extent,  independent  of  those  exter-  change,    proceeds,   it   does    not 

nal  influences,  just  because  the  live.      Its    energy    depends,   in 

animal  body  can  produce  within  this  case,  on  a  chemical  action, 

itself  that   source   of  motion  Light,  heat,  electricity,  or  other 

which  is  indispensable  to  the  influences  [justly  considered  here 

VITAL    process." — Liebig's   Ani-  by  Lieblg  as  vital  stimuli  and  not 

vial  Chemistry.  forces^  may  increase,  diminish,  or 

22.  "  Neither  the  emission  of  arrest  this  action  ;  but  they  are 
carbonic  acid  nor  the  absorption  not  its  efficient  cause."  "  The 
of  oxygen  (by  plants)  has  any  con-  vital  principle  opposes  to  the 
nection  with  the  process  of  assim-  continual  action  of  the  atmosphere, 
ilation  ;  nor  have  they  the  slight-  moisture,  and  temperature,  upon 
est  relation  to  each  other.  The  the  organism,  a  resistance  which 
one  is  purely  a  mechanical,  the  is,  in  a  certain  degree,  invincible. 
other  a  purely  chemical  process.  It  is  by  the  constant  neutralization 
A  COTTON  WICK,  inclosed  in  a  and  renewal  of  these  extei'nal  in- 
lamp,  w^hich  contains  a  liquid  sat-  fluences  that  life  and  motion  are. 
urated  with  carbonic  acid,  acts  ex-  maintained."  —  Liebig's  Organic 
actly  in  the  same  manner  as  a  liv-  Chemistry  applied  to  Physiology, 
ing  plant  in  the  night." — Liebig's  &c.  (§  188J,  d). 

Organic     Chemistry     applied     to  66.  "  An   abnormal  productioi' 

Physiology,  Sec.  of  certain  component  parts  of  plants 

23.  "  At  night,  a  true  chemical  presupposes  a  power  and  capabil- 
process  commences,  in  conse-  ity  of  assimilation,  to  which  the 
quence  of  the  action  of  the  oxygen  most  powerful  chemical  action 
of  the  air  upon  the  substances  cannot  be  compared.  The  best 
composing  the  leaves,  blossoms,  idea  of  it  may  be  formed,  by  con- 
and  fruit.  This  process  is  not  at  sidering  that  it  sui-passes  in  power 
all  connected  with  the  life  of  the  the  stronge st  galvanic  battery,  with 
vegetable  organism,  because  it  which  v,-e  are  not  able  to  separate 
goes  on  in  the  dead  plant  exact-  the  oxygen  from  carbonic  acid,  as 
LV  as  in  a  living  one"  !  is  done  by  the  leaves  of  plants,''^ 

Nevertheless,  "  and  without  the  direct  solar  rays." 

231.  "  What  value  can  be  at-  67.  "  All  that  we  can  do  is  to 
tached  to  experiments,  in  which  supply  those  substances  which  are 
all  those  matters  which  a  plant  adapted  for  assimilation  by  the 
REQUIRES  in  the  process  of  assim-  power  already  present  in  the  or- 
ilation,  besides  its  mere  nutri-  gans  of  the  plant." — Liebig's  Or- 
ment,  have  been  excluded  with  ganic  Chemistry  applied  to  Phys- 
the    greatest    care  %     Can   the   iology,  &c. 

laws  of  life  be  investigated  in  68.  "  The  living  part  of  a  plant 
an  organized  being  which  is  dls-  acquires  the  whole  force  and  di- 
eased  or  dying  ?" — Liebig's  Or-  rectlon  of  its  vital  energy  from 
ganic  Chemistry  applied,  &c. — Or,  the  absence  of  all  conductors  of 
can  those  laws  be  investigated  in  force.     By  this  7neans  the  leaf  it 


PHYSIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS. 


165 


CHEMICAL  DOCTRINES. 

"  a  cotton  wick,  inclosed  in  a 
lamp  ]" 

And  so  of  animals. 

24.  "  The  peiTneability  to  gases 
is  a  mechanical  property,  common 
to  ALL  ANIMAL  tissues ;  and  is 
found  in  the  same  degree  in  the 
LIVING  as  in  the  dead  tissue"  ! — 
Liebig's  Animal  Chemistry  (§ 
350J,  n,  and  Medical  and,  Phys- 
iological Commentaries,  vol.  i.,  p. 
565,  569,  notes,  683-690). 

24^.  "  The  surface  of  the  body 
is  the  membrane  from  which  evap- 
oration goes  constantly  forward. 
In  consequence  of  this  evapo- 
eation  all  the  fluids   of  the 

BODY,  IN  obedience  TO  ATMOS- 
PHERIC PRESSURE,  EXPERIENCE  MO- 
TION in  the  direction  toward  the 
evaporating  surface.  This  is  ob- 
viously the  CHIEF  CAUSE  of  the 
passage  of  the  nutritious  fluids 
through  the  walls  of  the  blood-ves- 
sels [strained  of],  and  the  cause 

OF   THEIR    DISTRIBUTION    THROUGH 

THE  BODY.  We  know  NOAV  what 
important  function  the  skin  fulfills 
through  evaporation"  !  — Liebig's 
Researches  on  the  Chemist)^  of  Food, 
«fec.,  American  Journal  of  Science 
and  Arts,  May,  1848,  p.  415.  — 
See  contradiction  in  nos.  5,  6,  7,  8, 
9,  10,  69-75.     Also  §  350i  n. 

25.  "Analogy,  that  fertile  source 
of  error,  has  unfortunately  led  to 
the  very  unapt  comparison  of  the 
VITAL  functions  of  plants  with 
those  of  animals." — Liebig's  Or- 
ganic Chemistry  applied  to  Physi- 
ology, &c. 

26.  "  All  substances  in  solu- 
tion IN  a  soil  ARE  ABSORBED  BY 
THE  ROOTS  OF  PLANTS,  EXACTLY  AS 
A  SPONGE  IMBIBES  A  LIQUID,  AND 
ALL  THAT  IT  CONTAINS,  WITHOUT 
SELECTION,"  and  "  THEIR  ASSIMI- 
LATION is  a  PURELY  CHEMICAL  PRO- 
CESS."—IbID.  (no.  22,  §  289-291). 

Nevertheless, 


VITAL  DOCTRINES. 

enabled  to  overcome  the  strongest 
chemical  attractions,  to  decompose 
CARBONIC  acid,  and  to  assimilate 
the  ELEMENTS  of  its  nourishment." 
— Liebig's  Animal  Chemistry. 

69.  "  In  vegetable  physiology, 
a  leaf  is  regarded  in  every  case 
merely  as  a  leaf,  notwithstanding 
that  leaves  generating  oil  of  tur- 
pentine or  oil  of  lemons,  must  pos- 
sess a  different  nature  from  those 
in  which  oxalic  acid  is  formed. 
Vitality,  in  its  peculiar  operations, 
MAKES  use  of  a  SPECIAL  apparatus 
for  each  function  of  an  organ.  Veg- 
etable physiologists,  in  the  study 
of  their  science,  have  not  directed 
their  attention  to  that  part  of  it 
(the  laws  of  vitality)  which  is  most 
ivorthy  of  investigation." — Liebig's 
Organic  Chemistry  applied  to  Phys- 
iology, &c. 

70.  "In  the  living  plant,  the  in- 
tensity of  the  VITAL  force  far  ex- 
ceeds that  of  the  chejhcal  action 
of  oxygen.  "We  know,  Avith  the 
UTMOST  certainty,  that,  by  the  in- 
fluence of  the  VITAL  FORCE,  OXY- 
GEN is  separated  from  elements  to 
which  it  has  the  strongest  affinity  ; 
and  that  it  is  given  out  in  the  gas- 
eous form,  without  exerting  the 
slightest  action  on  the  juices  of  the 
plant."  —  Liebig's  Animal  Chem- 
istry. 

71.  "  The  ANIMAL  ORGANISM  I; 
A  higher  KIND  OF  VEGETABLE." 

"  Assimilation,  or  the  process 
of  FORMATION  and  GROWTH,  goes 
on  in  the  same  way  in  animals 
and  in  vegetables.  In  both  the 
SAME  cause  determines  the  in- 
crease of  mass.  This  constitutes 
the  TRUE  vegetative  life." — Lie 
big's  Animal  Chemistry. 

72.  "  The  CONSTITUENTS  of  veg 

etable  and  animal  substances  are 
formed  under  the  guidance  and 
power  of  the  vital  principle, 
which  determines  the  direction  of 
their  molecular  attraction  "     "  In 


166  INSTITUTES    OF    MEDICINE. 


CHEMICAL  DOCTRINES.  VITAL  DOCTRINES. 

26^.  "  When  roots  find  their  the  formation  of  vegetable  and  an- 
MORE  appropriate  BASE  in  suffi-  imal  substances,  the  vital  prin- 
cient  quantity,  they  will  take  up  ciple  opposes,  as  a  force  of  re- 
less  OF  ANOTHER." —  And,  again  sistance,  the  action  of  the  other 
{in  opposition  to  the  simile  of  the  forces,"  &c. — Liebig's  Lectures 
"  sponge,'"  and  "  la?np-wick")  :  for  1844. — See  p.  31,  >^  59. 
"  It  is  thought  very  remarkable,  73.  "  The  force  which  gives  to 
that  those  plants  of  the  grass  the  germ,  the  leaf,  and  the  radi- 
tribe,  the  seeds  of  which  furnish  cal  fibres  of  the  vegetable  the 
food  for  man,  follow  Mm  like  the  same  wonderful  properties  (di- 
domestic  animals.  But  sali?ie  plants  gestion,  circulation,  and  secretion), 
seek  the  sea-shore  ov  sali?ie  springs,  is  the  same  as  that  residing  in 
and  the  Chcenopodium  the  dung-  the  secreting  membranes  and 
hill  from  similar  causes.  Saline  glands  of  animals,  and  which  en- 
plants  require  common  salt,  and  ables  every  animal  organ  to  per- 
plants  which  grow  on  dung-hills,  form  its  own  proper  functions." — 
only,  need  ammonia  and  nitrates,  Liebig's  Animal  Chemistry. 
and  they  are  attracted  whither  74.  "In  the  animal  organism  the 
these  can  be  found,  just  as  the  vital  force  exhibits  itself  as 
dung-fly  is  to  animal  excrements."  in  the  plant,  in  the  form  of 
"  The  roots  of  plants  are  con-  growth,  and  as  the  means  of  re- 
stantly  engaged  in  collecting  from  sistance  to  external  agencies." 
the  rain  those  alkalies  which  form-  — Ibid. 

ed  part  of  the  sea-water,  and  also  75.  "  If  we  assume  that  all  the 

those  of  the  water  of  springs  which  phenomena  exhibited  by  the  oi"- 

penetrates  the  soil."  ganism  of  plants  and  animals  are 

27.  "Each  new  radical  fihril  to  be  ascribed  to  A  peculiar  cause, 
which  a  plant  acquires  may  be  re-  different  in  its  manifestations  from 
garded  as  constituting,  at  the  same  all  other  causes  which  produce 
time,  A  mouth,  a  lung,  and  a  motion  or  change  of  condition  ; 
stomach.  The  roots  perform  the  if,  therefore,  we  regard  the  vital 
functions  of  the  leaves  from  the  force  as  an  independent  force 
first  moment  of  their  formation  ;  (no.  3),  then,  in  the  phenomena 
they  EXTRACT  from  the  soil  their  of  organic  life,  as  in  all  other  phe- 
proper  nutriment,  namely,  the  CAR-  nomena  ascribed  to  the  action  of 
BONic  ACID  generated  by  the  hu-  forces,  we  have  the  statics,  that  is, 
mus." — Liebig's  Organic  Chem-  the  state  of  equilibrium  determ- 
istry  applied  to  Physiology.  ined  by  a  resistance,  and  the  dy- 

28.  ["  Nature  speaks  to  us  in  a  namics  of  the  vital  force"  ! — 
peculiar  language,  in  the  language  Ibid. 

of  phenomena.    She  answers,  at  all  76.    "  Vegetables    produce    in 

times,  the  questions  which  are  put  to  their  organism  the  blood  op  all 

her;  and  such  questions  are  exper-  animals." — Liebig,  ?'&?(?. 

iments.     An  experiment  is  the  eX'  To  occupy  space,  nos.  26^  and 

pression  of  a  thought.    We  are  near-  27  are  contrasted  with  nos.  25  and 

er  the  truth,  when  the  phenom-  26  in  the  same  column.     And  so 

enon,  elicited  by  the  experiment,  with  5^,  23^.    But  here  is  more  in 

corresponds    to   the  thought  ;  the  more  appropriate  place,  upon 

while  the  opposite  result  shows  this  fundamental  point.     Thus  : 

that  tlte  questiomvas  f\IjSTS.i.y  ST  A-  77.   "When    it    is    considered, 

ted,  and  that  the  conception  teas  that  sea-water  contains  less  thar 


PHYSIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS. 


167 


CHEMICAL    DOCTRINES. 

ERRONEOUS."  —  Liebig's    Organic 

Chemistry,  &c.  (^  1052,  1054). 

[I  pause  in  my  quotations  for  the  pur- 
pose of  indicating  the  important  bearing  of 
the  '■'■chemistry  of  plaints"  upon  the  chem- 
ical philosophy  of  digestion  in  animals  as 
carried  on  b}'  the  gastric  juice.  Now,  if 
in  the  latter  case  the  agencies  be  of  a  chem- 
ical nature,  there  should  be  some  analogy 
between  the  supposed  chemical  transform- 
ation of  organic  compounds  by  the  gastric 
juice  and  the  transformation  of  inorganic 
substances  into  organic  compounds  as  ef- 
fected by  plants,  especially  considering 
that  "vegetables  produce  in  their  organ- 
ism the  blood  of  all  animals"  (no.  76). 
Chemistrj'  is  prodigal  of  experiments,  and 
of  supposititious  agents  from  pepsin  to 
chlorine,  in  resolving  digestion  by  ani- 
mals, but  vouchsafes  scarcel}-  a  word  in 
behalf  of  tliat  ^'creative  function"  by  which 
"  the  blood  of  all  animals"  is  generated  by 
plants  out  of  the  elements  of  matter.  Will 
Chemistry  explain  (§  301,  360)  ?  ] 


29.  "  The  most  decisive  exper- 
iments of  physiologists  have  shown 
that  the  process  of  chymification 
is  independent  of  the  vital  force ; 
that  it  takes  place  in  virtue  of  a 

PURELY  CHEMICAL  action,  EXACTLY 

SIMILAR  to  those  processes  of  de- 
composition or  transformation 
which  are  known  as  putrefac- 
tion, fermentation,  or  decay." 
— Liebig's  Animal  Chemistry. 

"  Those  remarkable  phenom- 
ena, fermentation,  putrefac- 
tion, and  DECAY,  are  the  pro- 
cesses of  Decomposition,  and 
their  ultimate  results  are  to  re- 
convert the  elements  of  organic 
bodies  into  that  state  in  which  they 
exist  before  they  participate  in  the 
processes  of  life." — Liebig's  Lec- 
tures for  1844. 

30.  "  The  second  part  of  the 
work  will  treat  of  the  chemical 
processes  which  effect  the  com- 
plete DESTRUCTION  of  plants  and 
animals  after  death,  such  as  the 
peculiar  modes  of  decomposition 
usually  described  d,s  fir  mentation, 
-putrefoction.   and   decay y — Lie- 


vital  doctrines. 

To 00 00 o'  ^^  ^^^  own  weight  of  io- 
dine, and  that  all  combinations  of 
iodine  with  the  metallic  bases  of 
alkalies  are  highly  soluble  in  wa- 
ter, so7nc  2>rovisio7i  Tnust  necessarily 
be  supposed  to  exist  in  the  organ- 
ization of  sea-weed  and  the  dif- 
ferent kinds  offeree  by  which  they 
are  enabled,  during  their  life, 
TO  EXTRACT  IODINE  in  the  form  of 
a  soluble  salt  from  sea-water,  and 

to  ASSIMILATE  IT  IN  SUCH  A  MAN- 
NER that  it  is  not  again  restored  to 
the  surrounding  mediuhi.  These 
plants  are  collectors  of  iodine, 
JUST  as  land  plants  are  of  al 
KALiES  ;  and  they  yield  us  this  el- 
ement IN  quantities  such  as  we 
could  not  otherwise  obtain  from 
the  water  without  the  evaporation 
of  WHOLE  SEAS."  —  Liebig's  Or- 
ganic Chemistry  applied  to  Physi- 
ology, &c. — (^  1054). 

78,  "  The  equilibrium  ixi  the 
chemical  attractions  of  the  constit- 
uents of  food  is  disturbed  by  the 
VITAL  PRINCIPLE  ;"  and  "  the  un- 
ion of  its  ELEMENTS,  SO  as  to  pro- 
duce neiv  combinations  ^.ndi  forms 
indicates  a  peculiar  mode  of  at- 
traction, and  the    existence   of  A 

POWER   DISTINCT  FROM  ALL   OTHER 

POWERS  OF  NATURE,  namely,  the 
VITAL  PRINCIPLE."  —  Liebig's  Or- 
ganic Chemistry  applied  to  Physi- 
ology, &c. 

79.  "  The  VITAL  force  causes  a 
DECOMPOSITION  oi  the  constituents 
of  food,  and  destroys  the  force  of 
attraction  which  is  continually  ex- 
erted between  their  molecules.  It 
altei's  the  direction  of  the  chemi- 
cal FORCES  in  such  wise,  that  the 
ELEMENTS  of  the  Constituents  of 
the  food  arrange  themselves  in  an- 
other form,  and  combine  to  pro- 
duce new  compounds.  It  forces 
the  new  compounds  to  assume  forms 
altogether  different  from  those 
which  are  the  result  of  the  attrac- 
tion of  cohesion  when  acting  free* 


168  INSTITUTES    OF    MEDICINE. 


CHEMICAL    DOCTRINES.  VITAL    DOCTRINES. 

big's   Organic  Chemistry  aj^plicd  ly,  that  is,  without  resistance.''—- 

to  Tliysiology,  &c.  Liebig's  Animal  Chemistry. 

31.  "  In  the  SAME  WAY  as  Mus-  80.  "It  is  well  known  that 
CULAR  fibre,  when  separated  from  in  many  graminivorous  animals, 
the  body,  communicates  the  state  where  the  digestive  organs  have 
of  decomposition  existing  in  its  been  overloaded  with  fresh  juicy 
elements  to  the  peroxide  of  hydro-  vegetables,  these  substances  un- 
gen,  so  a  certain  product,  arising  dergo  in  the  stomach  the  same 
by  means  of  the  vital  process,  and  decomposition  as  they  would  at 
hy  consequence  of  the  transposition  the  same  temperature  out  of  the 
of  the  elements  of  parts  of  the  stom-  body.  They  pass  into  ferment  a- 
ach  and  of  the  other  digestive  or-  tion  and  putrefaction,  whereby 
gans  [  !  ]  while  its  own  metamor-  so  great  a  quantity  of  carbonic 
pilosis  is  accomplished  in  the  stom-  acid  gas  and  of  inflammable  gas 
ach,  ACTS  ON  the  food.  The  in-  is  generated,  that  these  organs 
soluble  matters  are  digested"  ! —  are  enormously  distended,  and 
Liebig's  Animal  Chemistry.  sometimes   even  to  bursting." — 

32.  "  Is  it  truly  vitality,  which  Liebig's  Animal  Chemistry. 
generates  sugar  in  the  germ  for  81.  "  The  vital  force  appears 
the  nutrition  of  young  plants,  or  as  a  moving  force  or  cause  of  mo- 
which  gives  to  the  stomach  the  tion,  when  it  overcomes  the  chem- 
power  to  dissolve  and  to  prepare  ical  forces,  cohesion  and  affini- 
for  assimilation  all  the  matter  in-  ty,  which  act  between  the  con- 
troduced  into  it  ?  A  decoction  stituents  of  food,  and  when  it 
OF  MALT  possesses  as  little  power  changes  the  position  or  place  in 
to  reproduce  itself,  as  the  stomach  which  their  elements  occur.  The 
of  a  DEAD  CALF.  Both  are,  un-  vital  force  is  manifested  as  A 
questionably,  destitute  of  life.  But,  cause  of  motion  in  overcoming 
when  starch  is  introduced  into  a  the  chemical  attraction  of  the 
decoction  of  malt,  it  changes,  first  constituents  of  food,  and  is,  far- 
into  a  gummy  matter,  and  lastly  ther,  the  cause  which  compels 
into  sugar.  Hard-boiled  albumen,  them  to  combine  in  a  new  arrange- 
and  muscular  fibre,  can  be  dis-  ment,  and  to  assume  new  forms.' 
solved  in  a  decoction  of  a  calf's  — Liebig's  Animal  Chemistry. 
stomach,  to  which  a  few  drops  of  82.  "  It  will  be  shown  in  the 
muriatic  acid  have  been  added,  second  part  of  this  woi'k,  that  all 
precisely  as  in  the  stomach  it-  plants  and  vegetable  structures 
*eZ/l" — Liebig's  Organic  Chemis-  undergo  two  processes  of  decom- 
try.,  &c.  (no.  11).  position   after   death.     One   of 

33.  "  All  substances  which  can  these  is  named  fermentation,  the 
an-est  the  phenomena  oi  fermen-  other  decay  or  putrefaction." — 
tation  and  putrefaction  in  liquids,  Liebig's  Organic  Chemistry  ap- 
also  arrest  digestion  when  taken  j'^^^^^  to  Physiology,  &c.,  (§  349, 
into  the  stomach"  ! — Liebig's  An-  c,  e). 

imal  Chemistry . 

34.  "  In  the  natural  state  of  the  83.  "  The  individual  organs 
digestive  process,  the  food  only  such  as  the  stomach.,  cause  all  the 
undergoes  %  change  in  its  state  of  organic  substances  conveyed  tc 
cohesion,  becoming  fluid  without  them,  which  are  capable  of  trans- 
any  other  change  of  properties." —  formation,  to  assume  new  forms. 
Liebig's  Animal  Chemistry.  The    stomach   compels   the    ele- 


PHYSIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS 


169 


CHEMICAL    DOCTRINES. 

35.  Although  "the  process  of 

CHYMIFICATION  IS  INDEPENDENT  of 

the  vital  force,  and  takes  place  in 
virtue  of  a  purely  chemical  action, 
EXACTLY  similar  to  those  processes 
of  decomposition  which  are  known 

as    PUTREFACTION,    FERMENTATION, 

or  DECAY  ;"  nevertheless,  "  Inor- 
ganic compounds  differ  from  or- 
ganic in  as  great  a  degree  as  in 
their  simplicity  of  constitution  " — 
Liebig's  Animal  Chemistry,  and 
Organic  Chemistry. 


36.  "  The  power  of  elements  to 
unite  together,  and  to  form  pecu- 
liar compounds  which  are  genera- 
ted in  animals  and  vegetables,  is 
chemical  affinity."  —  Liebig's 
Organic  Chemistry  applied  to 
Vhysiology^  &c. 


37.  "  We  should  not  permit  our- 
selves to  be  withheld,  by  the  idea 
of  a  VITAL  principle,  from  consid- 
ering in  a  chemical  point  of  view, 
the  process  of  transformation  of 
the  food,  and  its  assimilation  by 
the  VARIOUS  organs.  This  is  the 
more  necessary,  as  the  views  hith- 
erto held  have  produced  no  re- 
sults, and  are  quite  incapable  of 
useful  application." — Liebig's  Or- 
ganic Chemistry  applied,  &c. 

38.  "  We  know  that  an  organ- 
ized body  cannot  generate  sub- 
stances, but  only  change  the  mode 
of  their  combinations,  and  that  its 
sustenance  and  reproduction 
depend  upon  the  chemical  trans- 
formation of  the  matters  which  are 
employed  as  its  nutriment,  and 
which  contain  its  own  constituent 


VITAL    DOCTRINES. 

MENTS  of  these  substances  to  unite 
into  a  COMPOUND  j?^^e<i  for  the  for- 
mation of  the  blood." — Liebig's 
Organic  Chemistry,  &c. 

84.  "  The  FIRST  substance  ca- 
pable of  affording  nutriment  to  an- 
imals is  the  LAST  product  of  the 
CREATIVE  ENERGY  of  Vegetables." 
— Liebig's  Animal  Chemistry. 

85.  "  The  special  characters  of 
food,  that  is,  of  substances  fitted  for 
assimilation,  are  absence  op  ac- 
tive chemical  PROPERTIES,  and 
the  capability  of  yielding  to  trans- 
formations." —  Liebig's  Organic 
Chemistry  applied  to  Physiology 
&c. 

86.  "  Ml  experience  proves  that 
there  is  in  the  organism  only  one 
source  of  physical  power ;  and 
this  source  is  the  conversion  of  liv- 
ing parts  into  lifeless,  amorphous 
COMPOUNDS."  —  Liebig's  Animal 
Chemistry. 

86j.  "  It  is  only  with  the  com- 
mencement oi chemical  action  that 
the  separation  of  a  part  of  an  or- 
gan in  the  form  of  lifeless  com- 
pounds begins."  —  Liebig's  Ani- 
mal Chemistry, 

87.  "  When  a  chemical  com 
pound  of  simple  constitution  is  in- 
troduced   into    the    stomach,   its 

CHEMICAL  ACTION  is,  of  COUrSC,  OP- 
VoSED    BY    THE    VITAL    PRINCIPLE 

The  results  produced  depend  upon 
the  strength  of  their  respective  ac- 
tions. Either  an  equilibrium  of 
BOTH  POWERS  is  attained,  a  change 
being  effected  without  the  destruc- 
tion of  the  vital  principle  ;  in  which 
case  a  medicinal  effect  is  occa- 
sioned. Or,  the  acting  body  yields 

TO  THE  SUPERIOR  FORCE  OF  VITAL- 
ITY, that  is,   IT    IS    DIGESTED.      Or 

lastly,  the  chemical  action  ob- 
tains the  ascendency  and  ^TS  as 
A  POISON."  —  Liebig's  Organic 
Chemistry  applied  to  Physiology 
&c. 

87|.  "  The  VITAL  POWER  in  veg 


f70  INSTITUTES    OF    MEDICINE. 


CHEMICAL    DOCTRINES.  VITAL    DOCTRINES. 

elements.     Whatever  we  regard   etables  accomplishes  the   trans 
as  the  cause  of  these  transforma-   formation  of  mineral  substances 
dons,  the  act  of  transformation  is   into  an  organism   endowed  with 
a  purely  CHEMICAL  PROCESS.     It  life."  —  Liebig's    Animal    Chcni- 
will  be  shown,  when  considering  istry. 

the  processes  oi  fermentation  and  S7|.  "  The  cause  of  waste  of 
vutref action,  that  any  disturbance  matter  is  the  chemical  action  of 
of  the  mutual  attraction  subsist-  oxygen.  This  waste  of  matter  oc- 
ing  between  the  elements  of  a  curs  in  consequence  of  the  absorp- 
body  gives  rise  to  a  transforma-  tion  of  oxygen  into  the  substances 
tion." — Liebig's  Organic  Chem-  of  living  parts.  This  absorption 
rstry,  &c.  of  oxygen  occurs  only  when   the 

resistance  which  the  vital  force  oj 
living  parts  opposes  to  the  chem- 
ical action  of  the  oxygen  is  weak- 
er than  that  chemical  action." — 
Liebig's  Animal  Chemistry  (nos.  3, 
4,  7,  8,  11,  86i). 

39.  "  By  CHEMICAL  AGENCY  we  88.  "  The  constituents  of  veg- 
can  produce  the  constituents  of  etable  and  animal  substances 
muscular  fibre,  skin,  and  hair"  !  having  been  formed  under  the 
"  We  are  able  to  form,  in  our  la-  guidance  and  power  of  the  vital 
boratories,  formic  acid  and  urea,  principle,  it  is  this  principle  which 
&c.,  all  products,  it  is  said,  of  the  determines  the  direction  of  their 
VITAL  principle.  We  see,  there-  molecular  attraction."  "  The  vi- 
fore,  that  this  mysterious  vital  tal  principle  alone  is  capable  of 
PRINCIPLE  can  be  REPLACED  BY  restoring  the  original  order  and 
the  CHEMICAL  FORCEs"  ! ! — LiE-  manner  of  the  molecular  arrange- 
big's  Organic  Chemistry  (no.  16,  ment  in  the  smallest  particles  of 
51,  59,  ^  53).  albumen." — Liebig's  Lectures  for 

1844  (§  48-50). 

"  We   cannot    expect  from  oi- 

ganic    chemistry    the    synthetic 

proof  of  the  accuracy  of  the  views 

*  entertained,  because  every  thing 

in  the    organism  goes   on  under 

THE  INFLUENCE  of  the  VITAL  FORCE, 
AN  IMMATERIAL  AGENT  [!]  which  the 

chemist  cannot  employ  at  will." 
— Liebig's  Animal  Chemistry. 

40.  "  The  INFLUENCE  of  poisons  89.  "From  the  theory  of  dis- 
and  of  remedial  agents  on  the  liv-  ease  developed  in  the  preceding 
ing  animal  body  evidently  shows  pages,  it  follows,  obviously,  that  a 
that  the  chemical  decompositions  diseased  condition  once  establish- 
and  combinations  in  the  body,  ed,  in  any  part  of  the  body,  can- 
which  manifest  themselves  in  not  be  made  to  disappear  by  the 
THE  phenomena  OF  VITALITY,  may  chemical  action  of  a  remedy." — 
be  increased  in  intensity  by  chem-   Liebig's  Animal  Chemistry. 

iCAL  FORCES  of  an  analogous  char-  90.  "  The  vital  force  is  sub- 
acter,  and  retarded  or  put  an  end  ject  to  the  action  of  a  blister." 
TO  by  THOSE  of  opposite  character:    — Ihid. 


PHYSIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS. 


17J 


CUEMICAL    DOCTRINES. 

and  that  we  are  enabled  to  exer- 
cise an  influence  on  every  part  of 
an  organ  by  means  of  substances 
possessing  a  well-defined  chem- 
ical ACTION." — Liebig's  Animal 
Chemistry  (mottoes  a-e). 

41.  "  It  is  singular  that  we  find 
medicinal  agencies  all  depend- 
ent on  certain  matters,  which 
differ  in  composition  [moral  emo- 
tions, heat,  cold,  change  of  air,  ex- 
ercise .?] ;  and  if,  by  the  introduc- 
tion of  a  substance,  certain  abnor- 
mal conditions  are  rendered  nor- 
mal, it  will  he  impossible  to  reject 
the  opinion,  that  this  "phenomenon 
depends  on  a  change  in  the  com- 
position of  the  constituents  of  the 
diseased  organism  [no.  5],  a  change 
in   which  the   elements   of  the 

REMEDY  take  A  SHARE  SIMILAR  TO 
THAT  which  THE  VEGETABLE  ELE- 
MENTS OF  FOOD  have  taken  in  the 
formation  oi  fat,  of  m,emhranes,  of 
the  saliva,  of  the  seminal  fluid,  &c. 
[!]  Their  carbon,  hydrogen,  or  ni- 
trogen, or  whatever  else  belongs 
to  their  composition,  are  derived 
from  the  vegetable  organism  ;  and, 
after  all,  the  action  and  effects  of 
quinine,  morphia,  and  the  vegeta- 
ble poisons  in  general,  are  no 
hypotheses'''  !  —  Liebig's  Animal 
Chemistry  (§  18,  and  motto  d). 

42.  "  With  respect  to  the  ACTION 
of  quinine,  or  the  alkaloids  of  opi- 
um, &c.,  physiologists  and  pathol- 
ogists entertain  no  doubt  that  it  is 
exeited  chiefly  on  the  brain  and 
nerves.  If  we  reflect  that  this  ac- 
tion is  exerted  by  substances  which 
are  material,  tangible,  and  ponder- 
able ;  that  they  disappear  in  the 
organism ;  that  a  double  dose  acts 
more  powerfully  than  a  single  one ; 
that,  after  a  time,  a  fresh  dose 
must  be  given  if  we  wish  to  pro- 
duce the  action  a  second  time ;  all 
these  coiisiderations,  viewed  chevi' 
ically,  [!]  permit  only  one  form 
of  explanation ;    the    supposition, 


VITAL    doctrines. 

91.  "  The  VITAL  FORCE  in  a  liv- 
ing animal  tissue  appears  as  a 
CAUSE  of  growth  in  the  mass,  and 
of  RESISTANCE  to  those  external 
agencies  which  tend  to  alter  the 
form,  structui'e,  and  composition 
of  the  substance  of  the  tissue  in 
which  the  vital  energy  resides."" — 
Liebig's  Animal  Chemistry . 

92.  "The  slightest  action  of  a 
chemical  agent  upon  the  blood  ex- 
ercises an  INJURIOUS  influence. 
Even  the  momentary  contact  with 
the  air  in  the  lungs,  although  ef- 
fected through  the  medium  of  cells 
and  membmnes,  alters  the  color 
and  other  qualities  of  the  blood." 
— Liebig's  Organic  Chemistry  ap- 
plied to  Physiology,  &c. 

93.  "  Every  substance  may  be 
considered  as  nutriment,  which 
loses  its  former  propefties  when 
acted  on  by  the  vital  principle, 
and  does  not  exercise  a  chemical 
action  upon  the  living  organ.  An- 
other CLASS  of  bodies  change  the 
direction,  the  strength,  and  inten- 
sity of  the  resisting  vital  principle 
and  THUS  exert  a  modifying  influ- 
ence upon  the  functions  of  its  or- 
gans. These  are  medicaments. 
A  THIRD  class  of  compounds  are 
called  POISONS,  when  they  possess 
the  property  of  uniting  with  or- 
gans or  with  their  component 
parts,  and  when  their  power  of  ef- 
fecting this  is  stronger  than  the  re- 
sistance offered  hy  the  vital  princi- 
ple.^'— Liebig's  Organic  Chemis- 
try, &c. 

93^.  "  Death  is  the  condition 
in  which  all  resistance  on  the  part 
of  the  vital  force  entirely  ceases. 
So  long  as  this  condition  is  not 
established  the  living  tissues  con- 
tinue to  offer  resistance." — Lie- 
big's Animal  Chemisti-y. 


172 


INSTITUTES    OF    MEDICINE. 


CHEMICAI.  DOCTRINES. 


VITAL  DOCTRINES. 


namely,  that  these  compounds,  by  [The  n£xt  folloicing  (94)  is  con- 
means  of  their  elements,  take  a  firmed  by  other  observations,  shoioing 
share  in  the  formation  of  neiv  or  that  Alcohol,  Opium,  and  Tobacco 
the  TRANSFORMATION  OF  EXISTING  are  not  absorbed,  but  act  through  the 
BRAIN  AND  NERVOUS  MATTER"  ! ! —  nci-voiis  System,  p.  301-310,  §  481- 
Liebig's  Animal  Chemistry.  484.     Alcohol  is  digested.] 

43.  "  Owing  to  its  volatility  and  94.  "  According  to  all  the  ohser- 
tlie  ease  with  which  its  vapor  per-  vations  hitherto  made,  neither  the 
meates  animal  tissues,  alcohol  expired  air,  nor  the  perspiration, 
CAN  SPREAD  THROUGHOUT  THE  nor  the  urine,  contains  any  trace 
BODY  IN  ALL  DIRECTIONS"  ! — LiE-  OF  ALCOHOL,  after  indulgence  in 
big's  Aniinal  Chemistry  (§  350^,  spirituous  liquors." — Liebig's  An- 
n). — Notes  JST  R  pp.  1121,  1123.  imal  Chemistry* 

44.  "  It  is  impossible  to  mistake  95.  "  The  vivifying  agency  of 
the  modus  operandi  of  putrefied  the  blood  must  ever  continue  to 
sausages,  or  mu,scle,  mane,  cheese,  be  the  most  important  condition 
cerebral  substance,  and  other  mat-  in  the  restoration  of  a  disturbed 
ters,  in  a  state  of  putrefaction.'''  equilibrium,  and  the  blood  must, 
"  It  is  obvious  that  they  communi-  therefore,  be  considered  and  con- 
CATE  THEIR  OWN  STATE  OF  PUTRE-  stantly  kept  in  view,  as  the  ulti- 

FACTION     TO     THE     SOUND     BLOOD,  mate    and    MOST   POWERFUL    CAUSE 

from  which  they  were  produced,  of  lasting  vital  resistance,  as 

exactly  in  the  same  manner  as  glu-  well  in  the  diseasrd  as  in  the  un- 

ten  in  a  state  of  decay  or  putrefac-  affected   parts   of  the  body." — 

tion  causes  a  similar  transforma-  Liebig's  AniTual  Chemistry, 

tion  in  a  solution  of  sugar'''  !  Nevertheless, 

45.  "  The  mode  op  action  of  "  No  other  component  part  of 
a  morbid  virus  exhibits  such  a  the  organism  can  be  compared  to 
strong  similarity  to  the  action  the  blood,  in  respect  of  the  fee- 
OF  yeast  upon  liquids  containing  ble  resistance  which  it  offers  to 
sugar  and  gluten,  that  the  two  exterior  influences."  "Thechem- 
processes  have  been  long  since  ical  force  and  the  vital  principle 
compared  to  one  another,  although  hold  each  other  in  such  perfect 
merely  for  the  purpose  of  illusira-  equilibrium,  that  every  disturb- 
tion.  [They  have  often  been  rep-  ance,  however  trifling,  or  from 
resented  as  identical.]^  But,  when  whatever  cause  it  may  proceed, 
the  phenomena  attending  the  ac-  effects  a  change  in  the  blood." 
tion  of  each  respectively  are  con-  — Liebig's  Organic  Chemistry  ap- 
sidered  more  closely,  it  will  in  re-  plied,  &c. 

ality  be  seen  that  their  influence  But,  again,  nevertheless,. 

depends  upon  the  same  cause."  "  It  is  obvious,  moreover,  that 

"  Ordinary  yeast,  and  the  viriis  of  in  all  diseases  where  the  forma- 

human  small-pox,  effect  a  violent  tion  of  contagious  matter  and  of 

tumultuous  transformation,  the  for-  exanthemata  is  accompanied  by  fe- 

mer  in  vegetable  juices,  the  latter  ver,Two  diseased  conditions  .smMZ- 

in  the  blood"  !    "The  action  of  the  tancously  exist,  and  two  process- 

virus  of  cow-pox  is   analogous  to  es  are  simultaneously  completed ; 

that  of  low  yeast  [  .'  ]     It  commu-  and  that  the  blood,  as  it  were,  by 

nicates  its  own  state  of  decomposi-  reaction,  that  is,  fever,  becomes 

tion  to  A  matter  in  the  blood,  and  A  means  of  cure." — Liebig's  An' 

from  a  second  matter  is  itself  re-  imal  Chemistry. 

*  This  is  contradicted  hy  French  chemists,  who  deny,  also,  that  alcohol  is  "  burned  " 
but  assert  that  it  exists  in  the  body  in  a  free  state. — 18G1. 


PHYSIOLOGY. ORGANIC  CHEMISTRY FUNCTIONS. 


173 


VITAL    DOCTRINES. 

96.  "It  is  only  by  a  just  appli- 
cation of  its  principle  that  any 
theory  can  produce  really  bene- 
ficial results." — Liebig's  Animal 
Chemistry. 

97.  "  We  can  have  no  very  high 
idea  of  experiments  made  by  gen- 
tlemen [chemists,  vsrith  reference  to 
digestion)  who,  for  w^ant  of  ana- 
tomical knowledge,  have  not  been 
able  to  pursue  their  reasoning 
even  beyond  the  simple  experi- 
ment itself"  —  John  Hunter's 
Observations  on  Digestion. 

98.  "  Whenever  the  chemist  for- 
sakes his  laboratory  for  the  bedside, 
he  forfeits  all  his  claims  to  our  re- 
spect, and  his  title  to  our  confidence. 
It  is  amusing  to  see  the  ridiculous 
errors  into  which  the  chemist  falls 
when  he  turns  physician." — Paris' 
Pharmacologia.  London,  6th  ed., 
1825. 


CHEMICAL    DOCTRINES. 

generated"  !  "  The  susceptibility 
of  infection  by  the  virus  of  human 
small-pox  MUST  cease  after  vacci- 
nation, FOR  THE  SUBSTANCE  tO  the 

presence  of  which  this  suscepti- 
bility is  owing  HAS  been  removed 
from  the  body  by  a  peculiar  pro- 
cess of  decomposition  artificially 
excited"  !  "  Cold  meat  is  always 
in  a  state  of  decomposition.  It  is 
possible  that  this  state  may  be 
communicated  to  the  system  of 
a  feeble  individual,  and  may  be 
one  of  the  sources  of  consump- 
tion" ! !  (§  821) — Liebig's  Organ- 
ic Chemistry  applied  to  Physiology, 
&c. 

"  From  the  unequal  degree  of  the 
conducting  power  in  the  nerves,  we 
must  deduce  those  conditions  which 
are  termed  paralysis,  syncope,  and 
spasm" ! — Liebig's  Animal  Chem- 
istry. 

46.  "  In  all  chronic  diseases, 
death  is  produced  by  the  same 

CAUSE,  namely,  the  CHEMICAL 
action  of  the  ATMOSPHERE." 

"  The  TRUE  CAUSE  of  death  IS 
THE  RESPIRATORY  PROCESS,  [  !  ]  that 

is,  the  chemical  action  of  the  at- 
mosphere." —  Liebig's  Animal 
Chemistry  (§  674-67G). 

* ^  The  quotations  from  "  Liebig's  Organic  Chemistry  applied  to  Physiology"  are  do- 
rived  from  Mr.  Playfair's  edition,  London,  1840 ;  those  from  "  Liebig's  Animal  Chemis- 
try" are  taken  from  Professor  Gregory's  edition,  reprinted  New  York,  1842.  The  italics 
and  capitals  are  mine. 

350i.  To  carry  out  the  full  object  of  the  foregoing  section,  I  shall 
devote  another  to  a  farther  exhibition  of  the  pathological  and  thera- 
peutical doctrines  which  have  been  deduced  by  the  author  of  the  "  new 
era  in  medicine"  from  his  chemical  and  physiological  elements,  as 
their  resulting  compounds.  This  more  extended  display  of  theoret- 
ical and  practical  doctrines,  as  they  came  to  us  from  the  laboratory, 
will  reflect  a  broad  light  upon  the  chemical  hypotheses  of  digestion, 
nutrition,  &c.,  as  set  forth  in  the  preceding  section,  and  show  us,  also, 
the  extent  of  the  probabilities  which  relate  to  the  analysis  of  food 
and  of  the  conclusions  which  are  predicated  of  that  analysis  (§  18, 409, 
676  b),  and,  in  brief,  enable  us  to  comprehend  the  nature  and  amount 
of  the  service  which  organic  chemistry  has  rendered  to  the  science  of 
medicine  (§  5,  5^  a,  376-t,  1029,  1030,  1034). 

This  otherwise  isolated  subject  will  be  farther  interesting,  as  I  shall 
embrace  in  the  quotations  the  whole  science  of  medicine  as  founded 


174  INSTITUTES    OF    MEDICINE. 

on  chemistry  and  physics,  and  thus  place  in  contrast  the  systems  of  the 
two  rival  schools,  and  enable  the  reader  to  adjust  their  relative  mer- 
its. To  do  this  work  of  consigning  chemistry  to  its  legitimate  pur- 
suits the  more  effectually,  I  shall  also  expose,  in  an  appropriate  place, 
the  chemical  doctrine  of  animal  heat  in  the  language  of  him  who  is 
supposed  to  have  settled  the  philosophy  of  that  subject  (§  433-450, 
676,  1043-1050). 

And  before  proceeding  to  a  farther  exposition  of  the  vital  and 
chemical  dcrctrines  of  digestion,  I  shall,  in  consideration  of  the  gen- 
eral surrender  of  this  subject  to  the  laboratory  of  the  chemist,  exhibit 
the  corroborating  testimony  of  the  distinguished  Mulder  that  physiol- 
ogy and  medicine  have  nothing  to  hope  from  obsei-vations  conducted 
out  of  the  living  body  (§  350,  nos.  48,49,  also  Lehmann,  ^1029, 1030). 

By  the  method  now  contemplated  obstacles  may  be  removed,  and 
the  reader  better  disposed  to  consider  maturely  the  grounds  upon 
which  I  have  placed  the  vital  docti-ine  of  digestion,  and  come  the  more 
willingly  to  the  conclusion  that  none  are  so  imperfectly  qualified  to 
interpret  the  properties  and  laws  of  organic  beings  as  they  who  can 
reason  alone  from  the  slender  and  deceptive  analogies  supplied  by  in- 
organic nature,  and  artificial  expedients. 

It  is  certainly  remarkable  that  this  systematic  exposure  should  be 
necessary  at  the  middle  of  the  nineteenth  century,  when  arts  and  all 
other  sciences,  though  more  so  the  arts,  are  making  a  steady,  some- 
times an  astonishing  progress. 

I  may  be  mistaken  in  the  importance  which  I  have  attributed  to  the 
innovations  which  have  been  made  by  organic  chemistry  upon  medi- 
cal philosophy.  I  know  that  I  am  but  feebly  sustained  by  others  in 
my  conclusions ;  though  now  and  then  a  blaze  of  mind  assures  me 
that  deep  volcanic  action  is  in  smothered  progress  (§  376|). 

350|,  a.  We  have,  then,  from  the  authorized  works  of  Liebig  (§ 
349,  d),  in  the  first  place,  the  following  inductions,  in  the  order  of 
their  occurrence,  of 

Tatliological  Principles,  or  *'  Theory  of  Disease'^  (350,  no.  59). 

"  Every  substance  or  matter,  every  chemical  or  mechanical  agency, 
which  changes  or  disturbs  the  restoration  of  the  equilibrium  between 
the  manifestations  of  the  causes  of  waste  and  supply,  in  such  a  way 
as  to  add  its  action  to  the  causes  of  waste,  is  called  a  cause  of  dis- 
ease. Disease  occurs  when  the  sum  of  the  vital  force,  which  tends 
to  neuti'alize  all  causes  of  disturbance,  in  other  words,  when  the  re- 
sistance offered  by  the  vital  force,  is  weaker  than  the  acting  cause  of 
disturbance ;" — with  the  reservation,  nevertheless,  that  '■'the  cause  of 
disturbance,  or  chemical  force  and  the  vital  force,  are  one  and  identical." 

350^,  b.  "  Death  is  the  condition  in  which  all  resistance  on  the  part 
of  the  vital  force  entirely  ceases.  So  long  as  this  condition  is  not  es- 
tablished, the  living  tissues  continue  to  offer  resistance." 

350^,  c.  "  To  the  obsers'-er,  the  action  of  a  cause  of  disease  exhibits 
itself  in  the  disturbance  of  the  proportion  between  waste  and  supply 
which  is  proper  to  each  period  of  life.  In  medicine,  every  abnormal 
condition  of  supply  or  of  waste,  in  all  parts,  or  in  a  single  part  of  the 
body,  is  called  disease." 

35O2,  d.  "  It  is  evident  that  one  and  the  same  cause  of  disease  will 
produce  in  the  organism  very  different  effects,  according  to  the  period 


PHYSIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS.  175 

of  life.  A  cause  of  disease  which  strengthens  the  causes  of  supply, 
either  directly  or  indirectly,  by  weakening  the  action  of  the  causes  of 
waste,  destroys,  in  the  child  and  in  the  adult,  the  relative  normal  state 
of  health  ;  while  in  old  age  it  merely  brings  the  waste  and  supply  into 
equilibrium. 

35O2,  e.  "  A  child,  lightly  clothed,  can  bear  cooling  by  a  low  exter- 
nal temperature  without  injury  to  health.  [ !  ]  The  force  available  for 
mechanical  purposes  and  the  temperature  of  its  body  increase  with  the 
change  of  matter  which  follows  the  cooling ;  while  a  high  tempera- 
ture, which  impedes  the  change  Of  matter,  is  followed  by  disease." 

3501,  y!  "  A  deficiency  of  resistance,  in  a  living  part,  to  the  causes 
of  waste,  is,  obviously,  a  deficiency  of  resistance  to  the  action  of  the 
oxygen  of  the  atmosphere. 

350i,  g.  "  When,  from  any  cause  whatever,  this  resistance  dimin- 
ishes in  a  living  part,  the  change  of  matter  increases  in  an  equal  de- 
gree. 

350i,  h.  "  Now,  since  the  phenomena  of  motion  in  the  animal 
body  are  dependent  on  the  change  of  matter,  the  increase  of  the 
change  of  matter  in  any  part  is  followed  by  an  increase  of  all  motions. 
According  to  the  conducting  power  of  the  nerves,  the  available  force 
is  carried  away  by  the  nerves  of  involuntary  motion  alone,  or  by  all 
the  nerves  together.  [ !  ] 

3504^,  ^.  "Consequently,  if,  in  consequence  of  a  diseased  transforma- 
tion of  living  tissues,  a  greater  amount  of  force  be  generated  than  is 
required  for  the  production  of  the  normal  motions,  it  is  seen  in  an  ac- 
celeration of  all  or  some  of  the  involuntary  motions,  as  well  as  in  a 
higher  temperature  of  the  diseased  part.  This  condition  is  called 
Jever. 

350^,  j.  "When  a  great  excess  of  force  is  produced  by  change  of 
matter,  the  force,  since  it  can  only  be  consumed  by  motion,  extends 
itself  to  the  apparatus  of  voluntary  motion.  This  state  is  called  a 
febrile  paroxysm. 

350^,  Ti.  "  In  consequence  of  the  acceleration  of  the  circulation  in 
the  state  of  fever,  a  greater  amount  of  arterial  blood,  and,  consequent- 
ly, of  oxygen,  is  conveyed  to  the  diseased  part,  as  well  as  to  all  other 
parts ;  and,  if  the  active  force  in  the  healthy  parts  continue  uniform, 
the  whole  action  of  the  excess  of  oxygen  must  be  exerted  on  the  dis- 
eased part  alone  (§  350,  no.  10). 

350i,  I.  "According  as  a  single  organ,  or  a  system  of  organs,  is  af- 
fected, the  change  of  matter  extends  to  one  part  alone,  or  to  the  whole 
affected  system. 

350i,  m.  "  Should  there  be  formed,  in  the  diseased  parts,  in  conse- 
quence of  the  change  of  matter,  from  the  elements  of  the  blood  or  of 
the  tissue,  new  products,  which  the  neighboring  parts  cannot  employ 
for  their  own  vital  functions  ;  should  the  surrounding  parts,  moreover, 
be  unable  to  convey  these  products  to  other  parts,  where  they  may  un- 
dergo transformation,  then  these  new  products  will  suffer,  at  the  place 
where  they  have  been  formed,  a  process  of  decomposition  analogous  to 
fermentation  or  putrefaction^'  ! 

350|-,  n.  "  If  we  consider  the  fatal  accidents  which  so  frequently 
occur  in  wine  countries  from  the  drinking  of  what  is  called  feather 
white  wine,  we  can  no  longer  doubt  that  gases  of  everv  ^stm^wheth. 
er  soluble  or  insoluble  in  water,  possess  the  property  of  permeating  am- 


176  INSTITUTES   OF    MEDICINE. 

mal  tissues,  as  water  penetrates  unsized  paper  [ !  ]  (§  350,  no.  24).  This 
poisonous  wine  is  wine  still  in  a  state  of  fermentation,  which  is  in- 
creased by  tlie  heat  of  the  stomach.  The  carbonic  acid  which  is  dis- 
engaged penetrates  through  the  parietes  of  the  stomach,  [!!J  through 
the  diaphragm,  [ ! ! !  ]  and  through  all  the  intervening  membranes,  [ ! ! ! !  J 
into  the  air-cells  of  the  lungs,  [!!!!!]  out  of  which  it  displaces  the  at- 
mospherical air.  [!!!!!!]  The  patient  dies  with  all  the  symptoms  of 
asphyxia  caused  by  an  irrespirable  gas,  [ !  ]  and  the  surest  proof  of  the 
presence  of  carbonic  acid  in  the  lungs  is  the  fact,  that  the  inhalation 
of  ammonia,  which  combines  with  it,  is  recognized  as  the  best  antidote 
against  this  kind  of  poisoning"  ! — (^  1055). 

"  No  doubt  a  part  of  these  gases  may  enter  the  venous  circula- 
tion through  the  absorbent  and  lymphatic  vessels,  and  thus  reach  the 
lungs,  where  they  are  exhaled;  [!]  but  the  presence  of  membranes 
offers  not  the  slightest  obstacle  to  their  passing  directly  into  the 
cavity  of  the  chest"  !  (§  349  d,  447  h,  827  h). 

3501,  o.  "  It  is  known  that  in  cases  of  wounds  oftlie  lungs  a  pecu 
liar  condition  is  produced,  in  which,  by  the  act  of  inspiration,  not  only 
oxygen  but  atmospherical  air,  with  its  whole  amount  of  nitrogen,  pen- 
etrates into  the  cells  of  the  lungs.  This  air  is  canied  by  the  circula- 
tion [ !  ]  to  every  part  of  the  body,  [ ! !  ]  so  that  every  part  is  inflated  or 
puffed  up  with  the  air,  as  with  water  in  dropsy.  [ !  ]  This  state  ceases, 
without  pain,  as  soon  as  the  entrance  of  the  air  through  the  wound  is 
stopped." 

3501,  p,  •'  The  frightful  effects  of  prussic   acid,  which,  when  in 
spired,  puis  a  stop  to  all  the  phenomena  of  motion  in  a  few  seconds, 
are  explaini^d  in  a  natural  manner  by  the  well-known  action  of  this 
compound  on  those  of  iron,  when  alkalies  are  present"  ! !  (^  494  dd, 
827  d,  904  h). — Liebig's  Animal  Chemistry. 

350 1^,  q.  The  foregoing  doctrines,  with  the  humoral  philosophy  as 
quoted  in  §  350,  nos.  40-45,  make  up  the  whole  science  of  pathology 
as  delivered  to  us  from  the  laboratory ;  and  such,  too,  are  the  doc- 
trines which  are  hailed  as  the  foundation  of  "  a  new  and  the  greatest 
era  of  medicine."  There  can  be  no  doubt,  however,  that  deliberate 
investigation  will  satisfy  every  mind  that  they  are  unintelligible,  im- 
practicable, absurd  ;  and,  consequently,  that  the  whole  pretended  sys- 
tem of  physiology  from  which  they  are  deduced,  is  equally  unworthy 
the  dignity  of  reason. 

350|,  a.  T  shall  now  employ  the  same  authorized  chemist  (§  349,  d) 
to  give  the  last  blow  to  his  baseless  fabric,  and  to  scatter  its  fragments 
beyond  the  reach  of  idolatry  itself  This  will  be  done  by  setting 
forth,  in  the  language  of  the  author,  his  deductions  from  the  physio- 
logical and  pathological  doctrines  of  the  laboratory,  as  to 

The  Chemical  Treatment  of  Disease  (§  350,  no.  59). 

"  The  accelerated  change  of  matter,  and  the  elevated  temperature 
in  diseased  parts,  show  that  the  resistance  offered  by  the  vital  force  to 
the  action  of  oxygen  is  feebler  than  in  the  healthy  state.  But  this  re- 
sistance only  ceases  entirely  when  death  takes  place  (nos.  1,  46). 
By  the  artificial  diminution  of  resistance  in  another  part  (as  by  blis- 
ters, sinapisms,  or  setons),  the  resistance  in  the  diseased  organ  is  not, 
indeed,  directly  strengthened ;  but  the  chemical  action,  the  cause  of 
the  charge  of  matter,  is  diminished  in  the  diseased  part,  being  direct- 


PHYSIOLOGY. — ORGANIC  CHEMISTRY FUNCTIONS.      177 

ed  to  another  part,  where  the  physician  has  succeeded  in  producing  a 
still  more  feeble  resistance  to  the  change  of  matter,  to  the  action  op 

OXYGEN. 

350|,  h.  "A  complete  cure  of  the  original  disease  occurs,  when  ex- 
ternal action  and  resistance,  in  the  diseased  part,  are  brought  into  equi- 
librium. Health,  and  the  restoration  of  the  diseased  tissue  to  its  orig- 
inal condition,  follow,  when  we  are  able  so  far  to  weaken  the  disturb- 
ing action  of  oxygen,  by  any  means,  that  it  becomes  inferior  to  the  re- 
sistance offered  by  the  vital  force,  which,  although  enfeebled,  has  never 
ceased  to  act ;  for  this  proportion  between  these  causes  of  change  is 
the  uniform  and  necessary  condition  of  increase  of  mass  in  the  living 
organism." 

350|,  c.  "  In  cases  of  a  different  kind,  where  artificial  external  dis- 
turbance produces  no  effect,  the  physician  adopts  other  indirect 
methods  to  exalt  the  resistance  offered  by  the  vital  force.  He  dimin- 
ishes, by  blood-letting,  the  number  of  the  carriers  of  oxygen  (the  glob- 
ules), and,  by  this  means,  the  conditions  of  change  of  matter ;  he  ex- 
cludes from  the  food  all  such  matters  as  are  capable  of  conversion  into 
blood,  &c. 

350^,  d.  "  If  he  succeed,  by  these  means,  in  diminishing  the  action 
of  oxygen  in  the  blood  on  the  diseased  part,  so  far  that  the  vital  force 
of  the  latter,  its  resistance,  in  the  smallest  degree,  overcomes  the  chem- 
ical action  ;  and  if  he  accomplish  this  without  arresting  the  functions 
of  other  oi'gans,  then  restoration  to  health  is  certain.  [ !  ] 

350|,  e.  "  Practical  medicine,  in  many  diseases,  makes  use  of  cold 
in  a  highly  rational  manner,  as  a  means  of  exalting  and  accelerating, 
in  an  unwonted  degree,  the  changes  of  matter.  This  occurs  espe- 
cially in  certain  morbid  conditions,  in  the  substance  of  the  centre  of  the 
apparatus  of  motion ;  when  a  glowing  heat  and  a  rapid  current  of 
blood  toward  the  head  point  out  an  abnormal  metamorphosis  of  the 
BRAIN  [ !  ]  (350,  motto  i,  nos.  3,  5).  When  this  condition  continues 
beyond  a  certain  time,  experience  teaches  that  all  motions  in  the 
body  cease.  [ !  ]  If  the  change  of  matter  be  chiefly  confined  to  the 
brain,  then  the  change  of  matter,  the  generation  of  force,  diminishes 
in  all  other  parts.  [  !  ]  The  metamorphosis  which  decides  the  issue  of 
the  disease  is  limited  to  a  short  period.  We  must  not  forget  that  the 
ice  melts  and  absorbs  heat  from  the  diseased  part;  that  if  the  ice  be 
removed  before  the  completion  of  the  metamorphosis,  the  temperature 
again  rises ;  that  far  more  heat  is  removed  from  the  head  than  if  we 
were  to  surround  the  head  xoith  a  bad  conductor  of  heat.  There  has 
obviously  been  liberated,  in  an  equal  time,  a  far  larger  amount  of 
heat  than  in  the  state  of  health.  [That  is  to  say,  such  is  the  pathol- 
ogy of  cerebral  inflammation,  such  the  remedy,  and  such  its  modus 
operandi.] 

350|,yi  "  The  self-regulating  steam-engines,  in  which,  to  produce 
a  uniform  motion,  the  human  intellect  has  shown  the  most  admirable 
acuteness  and  sagacity,  furnish  no  unapt  image  of  what  occurs  in  the 
animal  body. 

"  Every  one  knows,  that  in  the  tube  which  conveys  the  steam  to  the 
cylinder  where  the  piston-rod  is  to  be  raised,  a  stop-cock  of  peculiar 
construction  is  placed,  through  which  all  the  steam  must  pass.  By  an 
arrangement  connected  with  the  regulating  wheel,  this  stop-cock  opens 
when  the  wheel  moves  slower,  and  closes  more  or  less  completely 

M 


178  INSTITUTES    OF    MEDICINE. 

when  the  wheel  moves  faster  than  is  required  for  a  uniform  motion 
When  it  opens,  more  steam  is  admitted  (more  force),  and  the  motion 
of  the  machine  is  accelerated.  When  it  shuts,  the  steam  is  more  or 
less  cut  off,  the  force  acting  on  the  piston-rod  diminishes,  the  tension 
of  the  steam  increases,  and  this  tension  is  accumulated  for  subsequent 
use.  The  tension  of  the  vapor,  or  the  force,  so  to  speak,  is  pro- 
duced BY  CHANGE  OF  MATTER,  hij  the  comhustion  of  coals  in  the  firC' 
place.  The  force  increases  (the  amount  of  steam  generated  and  its 
tension  increase)  with  the  temperature  in  the  fire-place,  which  de- 
pends on  the  supply  of  coals  and  of  air  (§  433,  &c.).  There  are  in 
these  engines  other  arrangements,  all  intended  for  regulation.  When 
the  tension  of  steam  in  the  boiler  rises  beyond  a  certain  point,  the 
passages  for  admission  of  air  close  themselves ;  the  combustion  is  re- 
tarded, the  supply  of  force  (steam)  is  diminished.  When  the  engine 
goes  slower,  more  steam  is  admitted  to  the  cylinder,  its  tension  di- 
minishes, the  air-passages  are  opened,  and  the  cause  of  disengage- 
ment of  heat,  or  production  of  force,  increases.  Another  arrange- 
ment supplies  the  fire-place  incessantly  with  coals  in  proportion  as 
they  are  wanted. 

"  If  we  now  lower  the  temperature  at  any  part  of  the  boiler,  the 
tension  within  is  diminished.  This  is  immediately  seen  in  the  regu- 
lators of  force,  which  act  precisely  as  if  we  had  removed  from  the 
boiler  a  certain  quantity  of  steam,  or  force.  The  regulator  and  the 
air-passages  open,  and  the  machine  supplies  itself  with  more  coals. 

"  The  hody,  in  regard  to  the  production  of  heat  and  force,  acts  just 
like  one  of  these  machines.  With  the  lowering  of  the  external  tem- 
perature, the  respirations  become  deeper  and  more  frequent ;  oxygen 
is  supplied  in  greater  quantity  and  of  greater  density,  the  change  of 
matter  is  increased,  and  more  food  must  be  supplied,  if  the  tempera- 
ture of  the  body  is  to  remain  unchanged," — X^ikbig^  s  Animal  Chemistry. 

Here  ends  the  science  of  therapeutics,  as  founded  upon  the  prece- 
ding doctrines  in  physiology  and  pathology ;  and  as  the  whole  system 
is  comprehended  within  the  limits  of  the  last  three  pages,  the  reader 
will  readily  contrast  its  brevity  with  the  labors  of  the  past,  and  will 
not  fail  to  discover  in  this  time-saving,  thought-saving  attainment  of 
medicine,  as  well  as  in  the  impenetrability  of  the  system  itself,  and 
the  unequaled  confidence  with  which  it  is  set  forth,  the  main  causes 
of  its  success. 

I  shall  now  proceed,  as  proposed  in  §  350i,  to  demonstrate  by  the 
farther  showing  of  chemistry  itself,  that  physiology  and  medicine 
have  little  to  hope  from  the  laboratory  of  the  chemist. 

350j,  a.  Of  the  school  of  pure  chemistry,  and  of  an  authority  ap- 
proaching to  Liebig,  is  the  distinguished  Professor  Mulder;  less  in- 
consistent than  Liebig,  but  compelled  to  admjt  the  existence  of  pecu- 
liar forces  in  living  beings,  yet  positively  denying  them.  He  advo- 
cates, after  the  manner  of  Prichard,  Carpenter,  Fletcher,  &c.,  the 
existence  of  all  the  properties  of  living  beings  in  the  elements  of  mat- 
ter, which  conducts  him,  like  others,  to  the  belief  in  Equivocal  Gen- 
eration ;  adopts  the  Catalytic  theory  of  Berzelius,  in  which  he  differs 
fundamentally  from  Liebig  (§  409,_;) ;  reasons,  after  the  usual  manner 
of  the  physical  philosophers  of  life,  from  the  results  of  inorganic  pro- 
cesses, and  overlooks  entirely,  except  by  admission  of  their  existence, 
all  the  unique  phenomena  of  living  beings,  and,  perhaps,  more  thah 


PIlYStOLOGY. ORGANIC    CHEMISTRY FUNCTIONS.  179 

any  author  of  merit,  is  guided  in  his  conclusions  as  to  the  processes 
and  results  of  organic  beings  by  the  fallacious  analogies  which  are 
studiously  sought  in  the  inorganic  world.  The  whole  system  of  vital 
philosophy,  as  taught  by  this  distinguished  Professor  of  Chemistry, 
may  be  so  briefly  set  forth  in  extracts  from  his  work  on  "  The  Chem- 
istry of  Vegetable  and  Animal  Physiology,"  and  they  convey  so  forci- 
bly the  conjectural  nature  and  worthlessness  of  chemical  physiology, 
that  the  selection  will  contribute  its  important  part  toward  the  final 
expulsion  of  chemistry  from  the  rich  and  fascinating  domain  of  or- 
ganic nature.  The  quotations  will  be  made  in  the  order  of  their  oc- 
currence in  the  work  ;  and  we  learn  from  the  first  the  author's  opinion 
ol force,  which  corresponds  with  my  own  as  employed  in  the  Covi- 
mentaries,  and  as  defended  in  my  Examination  of  Reviews.     Thus  : 

350|,  b.  "  It  is  a  matter  of  indifference  whether  we  conceive  that 
the  forces  slumber  in  two  substances,  and  are  brought  into  operation 
by  contact ;  or  that  these  forces  were  present  in  the  two  bodies  in  an 
active  state,  previoiis  to  the  contact,  but  produced  the  phenomena  of 
combination  only  during  the  contact.  The  mode  of  considering  this 
point  is  almost  a  matter  of  indifference  ;  but  we  must  always  bear  in 
mind  that  it  is  ^,  power,  b.  force  which  is  exexted  by  the  one,  and  which 
acts  upon  the  other." — Mulder. 

350^,  c.  The  next  quotation  is  preliminary  to  the  total  denial  of  the 
Principle  of  Life,  and  of  all  the  properties  in  living  beings  excepting 
such  as  are  active  or  "  slumbering"  in  the  elements  of  matter.  Here, 
too,  appears  the  fallacy  of  analogies  derived  from  the  laboratory  of 
the  chemist.     Thus : 

"  Adhering  to  what  we  observe  and  know  with  certainty,  we  calcu- 
late that  every  elementary  body  is  endowed  with  a  great  many  specific 
properties,  which,  to  a  large  extent,  are  dependent  on  the  same  prin- 
ciple that  causes  their  combination,  and  thus  on  the  proportion  and 
character  of  the  chemical  tendency.  If  we  adopt  this  idea,  we  have 
the  advantage  of  seeing  somewhat  of  vitality  iiv  dead  matter.  [ !  ] 
It  is  an  idea  derived  from  the  endless  series  of  phenomena  which 
are  observed  in  the  laboratory,  in  daily  occurrences,  and  in  nature 
at  large"  (§  115,  d). — Mulder. — (§  1034,  Lehmann). 

3503,  d.  After  the  usual  disquisition  upon  the  "  catalytic  action"  of 
platinum  and  other  inorganic  substances,  we  come  next  to  the  same 
application  o?  catalysis,  in  connection  with  the  ordinary  laws  of  chem- 
ical affinity,  to  the  interpretation  of  organic  processes  and  results,  as 
I  have  examined  in  the  "  Commentaries'^  (vol.  i.,  p.  55-78).  It  com- 
prehends Miilder's  whole  theory  of  life,  and  is  a  good  specimen  of  the 
author's  analogical  i-easoning.     Thus  : 

"  Platinum  possesses  chemical  tendency  in  a  high  degree ;  but  it  is 
of  such  a  kind,  that  it  does  not  react  upon  the  platinum.  Hence  it 
may  be  inferred,  that  we  have  good  reason  for  distinguishing  by  a  pe- 
culiar name  such  actions  as  proceed  from  certain  substances  without 
reacting  upon  themselves;  and  we  have  to  acknowledge  that  to  the 
introduction,  by  Berzelius,  of  the  peculiar  term  catalysis,  we  are  in- 
debted for  a  more  correct  idea  of  the  nature  of  ordinary  chemical 
action. 

"  What  is  called  the  nascent  state  of  substances  is  that  condition  of 
the  elements  in  which  they  exhibit  both  analytic  and  catalytic  phenom- 
ena; in  which,  being  free  and  unconstrained,  not  rendered  powerless 


180  INSTITUTES    OF    MEDICINE. 

either  by  being  agglomerated  into  masses,  or  by  combination  into  c  5m 
pounds,  they  show  themselves  in  their  proper  cliemical  condition] 
that  is,  an  active  one,  in  which  they  can  operate  upon  others,  excite 
a  slumbering  energy,  and  cause  combinations  and  decompositions,  in 
which  they  themselves  may  either  participate  or  not.  This  nascent 
state  is  the  real  chemical  state  of  bodies.  In  that  state  both  the  ele- 
ments and  compounds  exhibit  themselves  in  their  true  character.  In 
the  organic  kingdom  the  greater  number  of  substances  are  actually  in 
that  condition ;  and  to  this  nascent  state  we  ought  to  ascribe  the  nu- 
merous peculiar  phenomena  apparent  in  organic  substances"  (§  409). — 
Mulder. — (^  1034,  Lehmann). 

350f ,  e.  The  next  quotation  sets  forth  the  whole  practical  applica- 
tion of  the  foregoing  doctrines,  and  is  a  fine  example  of  the  chemical 
reduction  of  organic  nature  to  the  condition  of  dead  matter,  and  one 
of  the  best  summary  exhibitions  of  chemistry  in  all  its  pretended  re- 
lations to  living  beings.     It  begins  with  the  caption 

"  Disturhance  of  Chemical  Equilibrium." 

"  It  is  a  property  of  the  chemical  forces,  when  active  in  any  substance, 
to  excite  analogous  forces  in  others.  We  notice  this  especially  iis 
organic  nature,  and  it  is  nowhere  more  strikingly  illustrated  than 
in  the  nutrition  of  animals.  Blood,  a  homogeneous  fluid,  circulates 
through  very  different  parts  of  the  body  (§  42).  In  the  muscles  it 
sustains  muscles,  in  the  liver  it  supplies  the  component  parts  of  the 
liver,  and  from  it  the  gall  is  there  secreted  ;  in  the  kidneys  it  maintains 
their  various  parts,  and  secretes  the  urine,  &c.  None  of  these  secre- 
tions appear  in  the  hlood  with  their  peculiar  qualities  ;  of  some  of  them 
not  even  a  trace  is  found.  But  the  four  organic  elements  of  the  whole 
are  to  be  found  in  protein  and  its  combinations,  in  the  coloring  mat- 
ter of  the  blood,  &c.  The  elements  of  protein  might,  no  doubt,  be 
transposed  in  the  liver,  &c.,  by  means  of  catalysis,  and  so  the  compo- 
nent parts  of  the  liver  and  gall  be  produced  from  it.  It  would  only 
be  necessary,  then,  that  the  constituent  parts  of  the  liver  should  be 
put  into  contact  with  the  component  parts  of  the  blood,  and  the  forces 
of  affinity  resident  in  the  substance  of  the  liver  would  not  require  to 
influence  those  in  the  protein,  or  to  produce  any  chemical  alteration 
in  its  component  parts. 

"  Other  causes,  however,  ought  undoubtedly  to  be  considered. 
For  instance,  a  change  of  its  component  parts  takes  place  in  the  liver 
itself,  and,  from  the  first,  chemical  forces  actively  operate  therein. 
For  the  continual  change  of  its  component  parts  is  a  chief  character- 
istic of  every  living  organic  substance.  These  forces  may  disturb  the 
chemical  equilibrium  of  other  substances,  and  cause  the  formation  of 
new  products.  If  the  constituents  of  the  blood — the  combinations  of 
protein,  the  coloring  matter,  &c. — enter  the  liver  when  it  is  in  a  state 
of  action,  and  are  there  put  in  contact  with  the  gall  during  its  secre- 
tion, and  with  the  substance  of  the  liver  itself,  which  is  in  a  state  of 
continual  alteration,  then  the  result  will  be,  that  this  change  of  their 
component  parts  having  taken  place,  the  action  will  be  transferred  to 
the  elements  of  the  blood,  and  will  maintain  the  secretion.  If,  on  the 
other  hand,  the  constituents  of  the  blood  are  in  a  state  of  continual 
change,  then  the  circle  of  action  in  which  they  are  involved  will  ex- 
tend'to  the  mass  of  the  liver  j  and  so  with  every  organ  (§  18). 


PHYSIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS.  181 

"  We  have,  however,  no  more  knowledge  of  the  manner  in  which 
this  secretion  originally  commences — whether  it  proceeds  from  the 
blood  or  from  the  secreting  organ,  [ !  ]  or  whether  each  of  these  con- 
tributes its  part — than  with  the  manner  in  which  the  first  germ  of  the 
whole  organ,  the  liver,  is  produced,  or  in  which  the  germ  of  the  ani- 
mal is  converted  into  an  animal.  But  the  continuance  of  the  action — 
the  duration  of  secretion — entirely  corresponds  with  some  other  phe- 
nomena, which  we  may  observe  separately,  and  which  therefore  throw 
light  upon  these  animal  actions.  This  is  the  case  especially  withyer- 
mcntation,  from  which  Liebig  has  drawn  many  illustrations,  for  the 
purpose  of  clearly  exhibiting  his  ideas ;  and  with  the  same  view  we 
shall  also  avail  ourselves  of  this  process. 

"  Yeast  changes  sugar  into  carbonic  acid  and  alcohol,  and  is  at  the 
same  time  changed  itself  The  latter  change  causes  the  former,  and 
is  only  transferred  to  the  sugar.  If  we  substitute  hloodfor  yeast,  and 
the  liver  for  sugar,  we  may  form  an  idea,  more  or  less  distinct,  of  the 
secretion  of  the  gall.  [ !  ]  The  component  parts  of  the  blood  are  con- 
tinually undergoing  change.  This  constant  change  of  the  component 
parts  in  organic  bodies  is  a  chief  cause  of  the  continuation  of  their  ex- 
istence. The  liver  without  intermission  assumes  new  parts  and  loses 
others.  This  process  we  call  nutrition.  At  the  same  time  that  the 
parts  of  the  blood  in  the  substance  of  the  liver  ai'e  thus  undergoing 
change,  chemical  forces  are  excited ;  these  forces  are  ti'ansferred  to 
the  elements  of  the  blood,  and  so  are  enabled  to  produce  from  them 
the  gall.  This  takes  place  the  more  easily,  as  the  blood  itself  is  also 
in  a  state  of  continual  alteration,  and  thus  readily  yields  to  the  impulse 
which,  in  some  way  or  other,  is  communicated  to  it.  As  the  impulse 
varies,  so  does  the  effect.  Hence  that  great  diversity  in  the  secre- 
tion of  very  dissimilar  substances,  which  are  in  a  state  of  alteration, 
from  the  same  fluid — that  is,  the  blood,  which  is  itself  at  the  same 
time  in  a  state  of  decomposition." — Mijlder. 

350|,y^  In  our  next  quotation  we  have  an  assumption  founded  on 
a  begging  of  the  very  question  at  issue ;  that  is  to  say,  whether  there 
be  or  not  a  radical  difference  in  the  original  constitution  of  organic 
and  inorsfanic  nature.  The  author  having:  assumed  that  there  is  no 
difference,  proceeds,  by  the  force  of  surmised  analogies  drawn  from 
the  probable  constitution  of  inorganic  matter,  to  repeat  the  assump- 
tion already  stated  that  there  are  no  other  properties  in  living  beings 
than  such  as  exist  in  the  elements  of  matter.     Thus  : 

"  The  idea  o?  communication  of  forces  is  unsound;  it  is  only  what  is 
substantial  that  we  can  communicate.  Forces  may  be  excited,  they 
cannot  be  communicated.  Hence  it  results  that  every  transformation 
in  plants  is  effected  by  the  molecular  forces  of  carbon,  hydrogen,  ox- 
ygen, and  nitrogen, — the  elements  of  carbonic  acid,  water,  and  am- 
monia,— the  forces  being  excited  in  these  elements  by  the  plants  them- 
selves." "  Any  one  who  imagines  that  there  is  any  thing  else  in  ac- 
tion than  a  molecular  force,  than  a  chemical  force,  sees  more  than  ex- 
ists. Thej^rce*  excited  in  the  elements  vary  with  the  influence  which 
certain  agents — temperature,  moisture,  light,  &c. — exert.  By  the  aid 
of  crucibles  and  retorts,  therefore,  compounds  can  be  formed  which 
differ  from  those  produced  by  the  organs  of  plants ;  while,  from  car- 
bonic acid  and  water,  plants  can  produce  cellulose  and  oxygen,  a  result 
which  CANNOT  YET  be  imitated  by  art."     "  To  expres-s  our  idea  in  a 


182  INSTITUTES    OF    MEDICINE. 

few  words  : — The  elements  of  the  organic  kingdom,  carbon,  hydiii 
gen,  oxygen,  and  nitrogen,  are  susceptible  of  endless  modifications 
For  that  reason  they  can  form,  with  minute  changes,  a  great  diversity 
of  products  (^  41)  ;  and  by  the  operation  of  the  same  friviary  forces, 
they  stand  toward  each  other  in  entirely  different  relations  from  those 
assumed  by  all  the  other  elements  ;  so  that  they  can  produce  a  vecu- 
liar  scries  of  bodies,  which  are  called  organic  substances"  /*  "  Organic 
substances,  whether  called  germs  or  food,  possess  properties  of  a  pe- 
culiar KIND,  EXISTING  IN  THE  FOUR  ELEMENTS  of  wliich  they  are  all 
constituted"  ! — Mulder. 

350f ,  g.  The  difficulty,  therefore,  with  the  chemists  appears  to  lie 
in  their  habits  of  reasoning  exclusively  from  what  they  obsei-ve  of  in- 
organic compounds  and  their  elements,  and  an  indisposition  to  admit 
that  the  Almighty  superadded  to  organic  beings  a  principle  of  life, 
while  they  allow  the  special  creation  of  mind  in  animals.  Nor  does 
their  philosophy  permit  them  to  imagine  that  the  former  may  be  as 
capable  of  governing  all  the  processes  of  organic,  as  the  latter  is  of 
animal  life,  and  that  the  principle  of  life  may  be  supposed,  with  as 
much  reason  as  the  principle  of  intelligence,  to  be  imparted  by  the 
exact  organization  pei-petuated  from  the  Almighty  Hand  to  new  ac 
cessions  to  that  organization  ;  v/hile  the  phenomena  of  life  are  far 
more  multifarious  and  conclusive  of  the  existence  of  a  special  princi- 
ple than  such  as  oblige  the  chemist  to  yield  his  assent  to  a  mental 
principle  distinct  from  the  matter  with  which  it  is  associated.  Why, 
then,  does  not  the  chemist  equally  maintain  the  existence  of  mind,  as 
of  the  properties  of  life,  in  the  elements  of  matter,  and  that  its  devel- 
opment is  alike  owing  to  a  difference  of  circumstances  ?  Does  he 
fear  that  this  stretch  of  materialism,  this  act  of  philosophical  consist- 
ency, or  his  neglect  to  abjure  the  obvious  inference,  may  impair  our 
confidence  in  the  apparently  though  not  really  less  objectionable 
scheme  of  reducing  oi'ganic  life  to  the  virtual  condition  of  the  simple 
elements  of  matter,  and  thus  fail  of  inculcating  the  most  dangerous 
atheism  by  attributing  creative  power  to  those  elements  (§  14,  c)? 

350|-,  gg.  But  let  us  hear  the  chemist  upon  this  interesting  point. 
And  Liebig,  first ;  who,  also,  shall  show  that  no  injustice  is  done  by 
the  preceding  remarks.     Thus : 

"The  higher  phenomena  of  " Physiology  has  sufficiently  rfe- 
mental  existence  cannot,  in  the  cisive  grounds  for  the  opinion  that 
present  state  of  science,  be  referred  every  thought,  every  sensation,  is 
to  their  proximate,  and  still  less  to  accompanied  by  a  change  in  the 
their  ultimate  causes.  We  only  composition  of  the  sicbstatice  of  the 
knoio  of  them  that  they  exist,  brain;  that  every  motion,  every 
We  ascribe  them  to  an  immaterial  manifestation  of  force,  is  the  ee- 
agency,  and  that,  in  so  far  as  its  sult  of  a  transformation  of  the 
manifestations  are  connected  with  structure  or  of  its  substance." — lb. 
matter,  an  agency  entirely  distinct  "Thought,  sensation,"  &c.,  are 
from  the  vital  force,  with  which  "  7nanifcstations  of  force,"  and  are, 
it  has  nothing  in  common." — Lie-  therefore,  "  the  result  of,"  &c. 
big's  Animal  Chemistry.  See  Parallels,  p.  158,  no.  51.) 

And  now  the  other  able  and  distinguished  chief: 

*  Seo  my  "  Notice  of  Reviews  "  ut  cit.,  and  my  ^^Examination  cfHeviezcs"  p.  43,  44, 
in  "Commentaries,"  vol.  iii. 


PHYSIOLOGY ORGANIC    CHEMISTRY FUNCTIONS.  183 

''  I  will  not  venture  to  raise  the  veil,  by  which  the  action  op  the 
NERVES,  or  the  higher  functions  op  the  MIND,  have  hitherto  been 
shrouded  from  observation.  As  man  has  an  immaterial  and  immor- 
tal part,  which  is  identical  with  his  real  being,  and  of  which  alone  lie 
will  consist,  when  the  material  frame  by  which  he  is  bound  to  the 
earth,  shall  be  dissolved ;  and,  as  the  inferior  animals  possess,  in  com- 
mon with  man,  certain  powers  of  perception,  associated  with  certain 
appropriate  organs,  whose  functions  have  no  connection  with  con- 
sciousness ;  so  do  animals  and  plants  perform  in  common  a  great  many 
operations  which  are  distinct  from  both  of  those  now  mentioned,  or 
which,  at  least,  have  their  origin  in  distinct  causes. 

"  It  is  only  the  latter  class  of  which  I  speak,  and  to  which  I  apjDly 
the  general  term  of  organic  life.  To  that  subject  I  shall  restrict  my 
remarks." — Mulder,  ut  cit. 

Now,  I  say,  1st.  Why  not  "raise  the  veil  from  the  action  of  the 
nerves'^  in  a  professed,  work  on  physiology,  and  a  work,  too,  which 
would  revolutionize  the  science  %  Have  you  no  phenomena  to  guide 
you  in  "  raising  the  veil  V  Do  you  fear  their  contact  with  the  phe- 
nomena of  the  laboratory  \  Is  it  right  to  make  this  declaration,  and 
then  to  refer  a  vast  series  of  phenomena  exclusively  to  "  organic  life," 
which  could  have  had  no  existence  without  the  "  action  of  the  nerves" 
(see  §  350,  no.  181)  ?  I  deny,  too,  2d,  that  "  the  higher  functions  of 
the  mind  have  hitherto  been  shrouded  from  observation ;"  and  I  am 
supported  by  all  who  truly  believe  in  the  independent  existence  of 
mind,,  in  the  affirmation  that  its  "  functions"  are  characterized  by  an 
infinitely  greater  variety  of  unique  phenomena  than  are  the  processes 
of  inorganic  nature.  There  is  no  "  veil  to  be  raised"  in  this  or  the 
other  case.  It  is,  indeed,  by  the  i-ecognition  of  these  phenomena  that 
our  author  feels  obliged  to  admit  the  existence  of  "  an  immaterial 
part,"  however  inconsistent  the  simultaneous  declaration  that  "  the 
functions  of  the  mind  have  hitherto  been  shrouded  from  observation." 
And,  I  am  alike  sustained,  also,  and  by  every  dictate  of  philosophy, 
in  the  conclusion  that,  if  the  phenomena  of  mind  are  decisive  of  the 
existence  of  "  an  immaterial  part,"  so  are  the  far  more  varied,  and 
numerous,  and.  equally  unique  phenomena  of  organic  processes,  con- 
clusive of  the  existence  of  some  not  less  peculiar  force,  power,  or 
"  immaterial"  or  material  "  part,"  upon  which  they  depend.  In  any 
event,  however,  the  physiologist  has  a  right  to  insist  that  the  chemist 
shall  not  reject  all  considerations  relative  to  the  "  action  of  the  nerves,^' 
when  he  invades  organic  nature  with  retorts,  crucibles,  acids,  &c. 

"  Analogy  is,"  undoubtedly,  as  Bacon  says,  "  the  basis  of  all  the 
sciences."  Nature,  throughout,  is  bound  together  by  analogies.  The 
principle  reaches  from  the  Creator  to  the  mind  of  man,  to  his  "  im- 
material and  immortal  part."  And.  so  it  does  from  the  force  and 
the  properties  of  life  to  those  of  dead  matter.  Here  is  the  delusion 
of  the  chemist.  But,  there  is  even  a  wider  difference  between  the 
formative  principle  of  life  and  destructive  chemical  affinity,  than  there 
is  between  the  Creative  Spirit  of  God  and  the  created,  dependent 
spirit  of  man  (^  1076). 

350f,  h.  The  grand  characteristic  of  organic  life  is  the  principle  of 
life.,  capable  of  imparting  that  principle  to  matter  which  is  destitute 
of  it,  and  which  it  retains  only  while  in  its  proper  connection  with  the 
being  by  which  it  was  so  endowed.     The  doctrine  which  refers  the 


184  INSTITUTES    OF   MEDICINE. 

properties  of  life  to  the  elements  of  matter  is  atheistical  in  its  applica- 
tion (§  14  c,  74,  175) ;  and  the  recognition,  simultaneously,  of  a  "  Cre- 
ative Power,"  is  but  another  conventional  word  for  nature,  or  design- 
ed to  protect  the  doctrine  against  the  fatal  imputation  of  irreligion  (§ 
64,  7i).  That  imputation,  however,  is  indelibly  stamped  by  nature 
herself.  The  mode  of  defense  is  well  shown  in  the  late  highly  laud- 
ed and  popular  work  on  the  "  Vestiges  of  the  Natural  History 
OF  Creation,"  in  which  the  author  considers  La  Place's  infidelity  as 
to  the  modus  operandi  of  matter  in  forming  the  Universe,  and  the  doc- 
trine of  spontaneous  generation  in  its  most  ample  extent.  The  au- 
thor's defense  of  Mr.  Crosse's  creation  of  animals  out  of  silex  is  a  good 
example  of  the  specious  reasoning  by  which  so  many  are  cheated  into 
projects  which  contemplate  the  worst  results  to  philosophy  and  relig- 
ion.*    Thus : 

350|,  i.  "  The  supposition  of  impiety  arises  from  an  entire  miscon- 
ception of  what  is  implied  by  an  aboriginal  creation  of  insects.  The 
experimentalist  could  never  be  considered  as  the  author  of  the  exist- 
ence of  these  creatures  except  by  the  most  unreasoning  ignorance. 
The  utmost  that  can  be  claimed  for,  or  imputed  to  him,  is,  that  he  ar- 
ranged the  natural  conditions  under  which  the  true  creative  energy, 
that  of  the  Divine  Author  of  all  things,  was  pleased  to  work  in  this 
instance.  On  the  hypothesis  here  brought  forward,  the  Acarus  Cros- 
sii  [ !  ]  was  a  type  of  being  ordained  from  the  beginning,  and  destin- 
ed to  be  realized  under  certain  physical  conditions.  When  a  human 
HAND  brought  these  conditions  into  the  proper  arrangement,  it  did  an 
act  akin  to  hundreds  of  familiar  ones  which  we  execute  every  day, 
and  which  are  followed  by  natural  results,  but  it  did  nothing  more." 
The  defense  of  La  Place's  system  proceeds  upon  the  same  specious 
assumption  (p.  910-911,  §  1083,  p.  921-928,  ^  1085). 

Now  the  foregoing  doctrine  transcends  not  only  the  usual  geologi- 
cal hypothesis  of  a  successive  creation  of  animals,  but  that,  also,  of 
spontaneous  generation ;  both  of  which  are,  of  course,  anti-Mosaic, 
and  regardless  of  the  established  order  of  creation  (§  303  a,  303i). 
But  here  we  have  an  exemplification  of  a  strictly  atheistical  expedi- 
ent, in  the  attempt  to  assign  the  existence  even  of  organic  beings  to 
the  merest  chance,  under  the  pretext  of  ascribing  to  that  chance  the 
intrinsic  attributes  of  a  Creative  Power,  and  the  imposing  title  of 
"  the  Divine  Author  of  all  things"  !  It  is  the  same  with  each  and  all 
who  allow  a  God,  a  Creator,  &c.,  yet  reject  entirely  His  Revelation 
as  to  creation,  supported  as  it  is  by  the  most  consummate  and  endless 
systems  of  Deai'^n.  It  is  the  old  expedient  of  the  wolf  in  the  disguise 
of  the  sheep  (§  14  c,  64  A,  74,  733  d). 

350|,  k.  Nevertheless,  the  foregoing  work  is  powerfully  sustained 
by  able  articles  in  the  British  and  Foreign  Medical  Review  for 
January,  1845,  consisting  of  twenty-six  pages  of  eulogistic  remarks; 
and  in  the  Medico-Chirurgical  Review  for  the  same  month,  often 
pages  not  less  congratulatory.  The  work  was  published  late  in  1844, 
and,  although  not  at  all  relevant  to  medicine,  it  was  taken  up  with 
avidity  by  the  two  leading  medical  journals  of  Europe,  and  an  effort 

*  See  Medical  and  Physiological  Commentaries,  vol.  i.,  p.  707  ;  vol.  ii.,  p.  96.  In  vol.  i.. 
Grass  is  a  typographical  error  for  Crosse.  It  is  also  possible  that  the  "  created  animals,' 
instead  of  being  "  ciystalized  spiculse,"  were  real  animals  evolved  by  the  action  of  galvan 
sim  from  ova  contained  in  the  water  (see  §  74,  188^  d). 


PHYSIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS.  185 

made  to  prepossess  the  medical  profession  before  the  work  itself 
should  fall  under  their  observation ;  observing  in  this  respect  the  sys- 
tem which  was  almost  universally  pursued  by  the  periodical  press 
even  in  anticipation  of  Liebig's  work  on  Animal  Cliemistrrj. 

In  my  Essay  on  Spontaneous  Generation,  embraced  in  the  Medical 
arid  Physiological  Commentaries,  I  have  had  occasion  to  refer  to  the 
charge  of  infidelity  which  is  often  laid  against  the  Medical  Profession. 
I  have  there,  too,  defended  that  Profession  against  so  great  an  injus- 
tice, and  have  held  responsible  the  proper  Sources  that  have  given 
rise  to  this  imputation.  I  have  also  shown  that  that  imputation  is 
greatly  due  to  the  cultivation  of  the  chemical  and  physical  hypotheses 
of  life,  to  which  the  foregoing  Reviews  have  been  laboriously  devoted. 
In  conclusion  of  the  whole  matter  I  have  said  that, 

"  The  steps  are  gradual  from  the  incipient  errors  in  natural  philos- 
ophy to  a  disbelief  in  the  Mosaic  Record  of  Creation.  When  we 
have  ultimately  reached  the  brink  of  the  precipice,  there  is  but  one 
dreadful  plunge,  and  we  are  then  in  the  vortex  of  atheism.  We  may 
begin,  as  I  have  said,  by  a  simple  denial  of  the  living  powers  of  or- 
ganized beings,  when  it  will  become,  at  last,  an  easy  argument  upon 
this,  and  analogous  premises,  that  the  Almighty  had  but  very  little,  if 
any  agency,  in  the  most  sublime  part  of  existences." 

"  Let  philosophy  interrogate  nature  to  its  fullest  satiety,  under  the 
direction  of  its  Heaven-born  principles ;  but  let  it  be  consistent,  and 
maintain  its  dignity.  And  should  it  sometimes,  as  it  must  in  its  wide 
range  of  nature,  come  in  contact  with  miracle,  that  is  its  limit,  con- 
tented that  it  begins  at  the  confines  of  Creation  ;  yet  still  may  it 
stretch  into  the  regions  of  Eternity,  past  and  to  come ;  but  now  it  is 
employed  in  its  nobler  work  of  sacrificing  its  relations  to  second 
causes,  and  in  establishing  relations  with  the  First  Cause  of  All." 
— Medical  and  Physiological  Commentaries,  vol.  ii.,  p.  140. 

3503,  hJc.  It  is  now  my  purpose  to  quote  the  foregoing  Reviews  m 
connection  with  the  "  Vestiges  of  Creation,"  partly  for  the  object  just 
assigned,  and  in  part  to  supply  other  examples  in  justification  of  what 
I  have  said  in  behalf  of  the  Profession,  and  of  the  tendency  of  the 
chemical  and  physical  hypotheses  of  life  and  disease  to  lay  the  foun- 
dation of  a  grosser  materialism,  and  of  infidelity  in  Religion  (§  175). 
It  seems  peculiarly  appropriate  that  Reviewers,  who  wield  an  exten- 
sive and  powerful  sway,  and  whose  occupation  it  is  to  defame  what- 
ever molests  that  dominion,  should  be  used  for  the  contemplated  pur- 
pose, and  this,  more  especially,  as  both  Reviewers  offer  defiance  to  the 
"  Saints,"  and  the  "timid  religionists."  The  Reviews  are  conducted 
with  great  diligence  and  research.  Their  influence  is  coextensive 
with  medicine.  That  influence  must  be  sapped  by  a  display  of  its 
tendencies.  There  can  be  no  difficulty  with  a  defense  of  the  right. 
The  inculpated  are  able,  their  means  ample,  their  coadjutors  numer- 
ous and  powerful,  the  public  generous,  and,  as  I  said  on  a  like  occa- 
sion in  the  Commentaries,  "  I  am  single-handed,  and  have  nothing  but 
facts  for  my  weapons"  (vol.  i.,  p.  391). — Note  W  p.  1127. 

Infidelity  is  certainly  a  term  which  should  be  well  sustained  in  its 
application ;  better,  at  least,  than  when  applied  to  myself  by  the  first 
of  the  following  journals  (see  Examination  of  Reviews,  p.  84-88). 
As  it  respects  the  Reviewers,  the  imputation  appears  to  be  invited 
and  expected,  as  an  obvious  consequence  of  the  doctrines  advanced; 


186  INSTITUTES    OF    MEDICINE. 

and,  although  I  do  not  belong  to  the  denomination  of  "  Saints,"  or  of 
the  "  timid  religionists,"  it  is  not  less  my  duty  as  a  man,  and  as  an  ex- 
pounder of  the  Institutes  of  Nature,  to  bring  those  institutions  to  op- 
erate vipon  infidelity.  There  can  be  no  place  more  appropriate  for 
looking  "  through  Nature  up  to  Nature's  God,"  than  in  the  general 
survey  of  organic  beings.  If  ordained  in  their  organization  and  their 
laws  by  a  higher  Power,  that  organization  and  those  laws  may  well 
be  urged  in  proof  of  their  Origin.  Then,  too,  shall  the  minister  of 
health  realize  the  importance  of  the  Institutes  of  Medicine,  and  the 
spirit  of  the  HipjDocratic  maxim,  that  "  a  philosophical  physician  is  like 
a  god." 

I  shall  quote  a  passage  of  general  import  from  each  of  the  forego- 
ing Reviewers,  that  no  doubt  may  linger  upon  the  mind  of  any  reader 
as  to  the  justice  of  the  criticism  which  I  have  now  exercised  in  behalf  of 
religion,  of  morality,  of  the  dignity  of  medicine.     The  empliasis  is  mine. 

And  first  the  elder  brother  ;  beginning  thus  : 

"  This  is  a  remarkable  volume,  small  in  compass,  but  embracing  a 
wide  range  of  inquiry  from  worlds  beyond  the  visible  starry  firma- 
ment, to  the  minutest  structures  of  man  and  animals.  No  name  is  pre- 
fixed,— perhaps  in  order  to  avoid  the  snarls  of  the  naiTOw-minded. 
and  bigoted  saints  of  the  present  day,"  &c. 

The  middle  thus : 

"  For  how  many  millions  and  millions  of  years  this  production  and 
reproduction  of  animals  went  on  before  man  made  his  appearance 
on  the  scene,  no  human  being  will  ever  know.  [ !  ]  In  all  probability, 
countless  ages  must  have  elapsed,  before  this  master-piece  of  creation 
appeared.  Our  author's  speculations  on  the  liow,  the  why,  the  when, 
and  the  icherefore  this  great  event  occuiTed,  will  not  give  satisfaction 
to  the  present  race  of  mankind.  [ !  ]  His  hypothesis  is  three  or  four 
centuries  in  advance  of  the  times,  and  will  be  stigmatized  by  the 
modern  saints  as  do^vnright  atheism,"  &c. 

And  the  end,  thus  : 

"  We  have  dedicated  a  space  to  this  remarkable  work  that  may  in- 
duce many  of  our  readers  to  peruse  the  original.  The  author  is  de- 
cidedly a  man  of  great  information  and  reflection.  He  will  have  a 
host  of  saints  in  array  against  him,  and  many  will  join  in  the  cry, 
from  hypocrisy  and  self-interest.  As  we  said  before,  his  doctrines 
have  come  out  a  century  before  their  time." — Medico-Chirurgical 
Review,  p.  147,  153,  157.     London,  Jan.,  1846. 

Next,  Di",  Forbes,  in  the  BritisJi  and  Foreign  Medical  Review. 

"  This  is  a  very  heautifil  and  a  very  interesting  book.  Its  theme  is 
one  of  the  grandest  that  can  occupy  human  thought, — no  less  than 
the  Creation  of  the  Universe."  "We  are  also  influenced  by  the 
abstract  desire  to  place  before  our  readers  matter  for  their  contem- 
plation, which  cannot  fail  at  once  to  elevate,  to  gratify,  and  to  enrich 
the  mind.  It  has  always  been  one  of  the  boasts  of  our  noble  profes- 
sion that  it  touches  and  blends  with  eveiy  science ;  and  we  should  be 
sorry  that  our  humble  efforts  should  at  any  time  be  wanting  to  stimu- 
late its  professors  to  exertions  that  might  still  justify  the  boast"! 

Of  La  Place's  nebular  hypothesis,  he  says  : 

"  So  far  from  admitting  the  atheistical  tendency  which  timid  relig- 
ionists have  attributed  to  the  nebular  hypothesis,  we  consider  it  the 
grandest  contribution  which  Science  lias  yet  made  to  Religion,^*  &c. 


PHYSIOLOGY,— ^ORGANIC    CHEMISTRY FUNCTIONS.  187 

The  reader,  therefore,  will  have  no  difficulty  in  undei'standing  the 
■'conventional"  nature  of  certain  phrases  in  the  following  remarks  by 
Dr.  Forbes.     (See  Ji.) 

"  That  the  Creator  formed  man  out  of  the  dust  of  the  earth,  we  have 
scriptural  authority  for  believing,  and  we  must  confess  our  oivn  predi- 
lection for  the  idea,  [  !  ]  that,  at  a  period  however  remotely  antece- 
dent, the  Creator  endowed  certain  forms  of  inorganic  matter  with  the 

PROPERTIES   REQUISITE  TO   ENABLE   THEM  TO  COMBINE,  AT  THE   FITTING 

SEASON,  INTO  THE  HUMAN  ORGANISM,  [ !  !]  ovor  that  which  would  lead 
us  to  regard  the  great-grand-father  of  our  common  progenitor  as  a 
chimpanzee  or  an  orang-outang." — British  and  Foreign  Medical 
Review,  p.  155,  158,  180.     London,  January,  1846.     (See  I.) 

The  author  of  the  Vestiges  of  the  Natural  History  of  Creation  is 
thus  quoted  by  Dr.  Forbes  : 

"  We  have  seen  powerful  evidence  that  the  construction  of  this 
globe  and  its  associates,  and,  inferentially,  that  of  all  the  other  globes 
of  space,  was  the  result,  not  of  any  immediate  or  personal  exertion 
of  the  Deity,  but  of  natural  laws  which  are  expressions  of  His  will. 
What  is  to  hinder  our  supposing  that  the  organic  creation  is  also  a 
result  of  NATURAL  LAWS  whicli  are,  in  like  manner,  an  expression  of 
His  will  ■?" — Natural  History  of  Creation. 

Upon  the  foregoing  extract,  which  is  a  part  of  a  more  extended 
one  of  the  same  nature.  Dr.  Forbes  remarks,  that, 

"  The  complete  accordance  of  these  views  with  those  some  time 
ago  propounded  by  ourselves  (vol.  v.,  p.  342),  must  be  evident,  we 
think,  to  our  readers.  To  the  objection  which  some  timid  religion- 
ists may  urge  against  them,  that  they  are  inconsistent  with  the  INIo- 
saic  record,  we  simjily  reply  with  our  author,  that  we  do  not  think  it 
right  to  adduce  that  record  either  in  support  of,  or  in  objection  to, 
any  scientific  hypothesis,  based  upon  the  phenomena  of  nature,"  &c.! 
— British  and  Foreign  Medical  Review,  p.  167. — Note  Pp  p.  1142. 
Dr.  Forbes  assumes,  of  course,  that  all  the  misapprehensions  and 
perversions  of  "  the  phenomena  of  nature"  are  paramount  to  any  thing 
declared  in  the  Mosaic  Record  (§  b\,  74,  733  d,  1079  h,  1085). 

The  most  superficial  reader  cannot  fail  of  discerning  in  the  fore- 
going principles,  as  in  many  other  analogous  instances,  the  motives 
which  have  induced  those  foremost  medical  Reviews  to  lend  their 
powerful  aid  in  propagating  the  materialism  of  Carpenter,  the  absurd- 
ities of  Liebig,  the  humoralism  of  Andral,  and  the  putrid  anatomy  of 
Louis,  and  of  their  respective  schools  ;  and  why,  on  the  other  hand, 
they  have  been  equally  regardless  of  truth  in  their  vocation  as  critics 
on  the  labors,  the  researches,  and  the  statements  of  others. — NoteW 
350|,  I.  I  have  ah'eady  shown  in  this  and  other  works  how  conve- 
nient a  matter  it  is  for  "the  properties  of  life  in  the  elements  of  mat- 
ter" to  bring:  these  elements  into  an  orsranic  state.  And  since  I  am 
now  on  the  subject  of  the  first  and  gi'eatest  step  in  the  process  oi  vivi- 
fication,  it  may  be  useful,  as  it  is  appropriate,  to  show  how  the  advo- 
cates of  "  the  properties  of  life  in  the  elements  of  matter,"  and  the 
propagators  of  spontaneous  generation,  and  eminent  geologists  who 
promulgate  a  successive  creation  of  animals  according  to  their  scale 
in  organic  nature  and  in  conformity  with  the  development  of  new 
physical  agencies,  ay,  and  certain  eminent  vitalists  whose  otherwise 
Bound  philosophy  should  have  enlightened  them  sip  to  the  Great  First 


188  INSTITUTES    OF    MEDICINE. 

Cause — in  view  of  all  these  things,  I  say,  it  may  be  conducive  ta 
sound  physiology  to  show  how  the  foregoing  schemers  of  "  creation" 
airive,  in  part,  at  least,  at  the  conversion  of  oi'ganic  matter  into  the 
complex  fabric,  after  that  matter  shall  have  been  duly  compounded 
by  "  the  properties  of  life  which  reside  in  the  elements."  For  this 
purpose  I  will  take  the  statement  of  the  distinguished  vitalist  Tiede- 
mann.     Thus, 

"  The  most  probable  hypothesis  is,  that  the  substance  of  organic  bod- 
ies existed  primitively  in  water,  as  matter  of  a  particular  kind,  and 
that  it  was  there  endowed  with  the  plastic  faculty;  that  is  to  say,  with 
the  power  of  acquiring,  by  degrees,  different  simple  forms  of  living 
bodies,  with  the  concurrence  of  the  general  influences  of  light,  heat, 
and  perhaps  also  of  electricity,  &c.,  and  of  then  passing  from  the  sim- 
ple forms  to  other  more  complicated  ;  varying  in  proportion  to  the 
modification  occurring  in  the  external  influences,  until  the  point  when 
each  species  acquired  duration  by  the  production  and  manifestation 
of  activity  of  the  genital  organs"  ! — Tiedemann's  Physiology  of  Man. 

That  is  the  doctrine,  candidly  avowed  by  those  to  whom  genius  and 
the  conviction  of  a  right  discernment  of  the  ways  of  nature  impart  a 
fearless  independence,  however  it  may  be  disguised  by  others  under 
the  "  conventional  term"  o?  creation.  But,  Tiedemann  is  a  philosoph- 
ical vitalist,  and  did  not  confound  the  principle  of  life  with  the  forces  of 
inorganic  matter,  nor,  like  Carpenter,  Fletcher,  Prichard,  Roberton, 
Forbes,  &c.,  place  the  properties  of  that  principle  in  the  elements  of 
matter.  He  started  with  matter  in  more  or  less  of  an  organic  state, 
and  leaves  it  problematical  how  its  elements  became  united  into  that 
peculiar  vital  compound.  He  did  not  even  imply  that  the  elements 
being  so  endowed  could  organize  themselves,  for  he  adds  to  the  fore- 
going statement,  that, 

"  Although  we  cannot  here  answer  the  question,  whence  came  the 
water  and  the  organic  matter  which  it  contained,  yet  this  hypotliesis 
is  the  one  which  accords  best  with  the  facts  with  which  geology  has 
lately  been  enriched.'^  And  again,  "  If  it  be  asked,  whence  oiganic 
matters  proceed,  how  they  are  produced,  together  with  the  power  of 
formation  inherent  in  them,  we  are  necessitated  candidly  to  confess 
our  ignorance  on  the  subject,  inasmuch  as  the^r*;;  origin  of  organic 
matters  and  living  bodies  is  altogether  beyond  the  range  of  experi- 
ment."— Tiedemann's  Physiology  of  Man,  p.  14,  193. 

It  will  be  thus  seen  that  even  Tiedemann's  doctrine  enjoys  "  a  loop- 
hole" which  cannot  be  allowed  to  those  who  place  "  the  properties  of 
life  in  the  elements  of  matter,"  or  who  endeavor,  or  propose,  to  ere 
ate  organic  compounds  in  the  laboratory  of  the  chemist ;  since,  in  re- 
spect to  the  latter,  were  the  production  of  organic  compotinds  within 
*'  the  range  of  experiment,"  the  accidental  nature  of  the  origin  of 
such  compounds,  and,  therefore,  the  incipient  being  of  man,  would 
be  established  by  the  laboratory.  And  now  I  ask,  does  not  the  or- 
ganic chemist  attempt  or  profess  to  create  organic  compounds  ?  So 
says  Liebig,  §  350,  no.  39,  and  so  say  most  other  distinguished,  chem- 
ists. Liebig  and  his  disciples  create  the  compounds  ;  Crosse  and  his 
followers  create  the  animal.  Others  do  but  make  the  attempt ;  and 
this  is  a  very  numerous  class  who  thus  enter  into  competition  with  the 
Original  Author  of  organic  compounds.  What,  therefore,  is  the 
difference  in  principle  between  him  who  pretends  to  have  succeeded 


PHYSLOLOGi. ORGANIC    CHEMISTRY FUNCTIONS  189 

m  this  work  of  creation,  and  the  other  who  has  attempted  the  work, 
but  without  success  1 

From  the  physiologist  who  advocates  the  existence  of  "  the  proper- 
ties of  life  in  the  elements  of  matter,"  we  hear  that, 

"  There  is  no  reasonable  ground  for  doubt  that  if  the  elements 
could  be  brought  together  in  their  requisite  states  and  proportions  iy 
the  liand  of  man,  the  result  (artificial  organic  compound)  would  be  the 
same  as  the  natural  compound."  Again,  "  that  the  germs  (of  parasitic 
plants  and  animals  in  the  interior  of  others)  have  been  conveyed^ow 
without  into  the  situations  where  they  are  developed,  must  be  held  as 
a  very  forced,  supposition^'' ! — Carpenter's  Principles  of  General  and 
Comparative  Physiology,  p.  146,  395  ;  also,  this  work,  ^  14  c,  175  c, 
d,  189  h. — See  doctrine  of  "Developmenf'p.  922,  andNoTEPpp.1142. 

350|,  m.  Mulder  has  the  manliness  to  carry  out  the  obvious  ten- 
dency of  his  doctrines,  which  may  be  expressed  in  a  brief  quotation. 
Thus, 

"Upon  the  principles  which  have  been  stated,  no  room  is  left  for 
the  dispute  as  to  equivocal  generation  and  epigenesis."  Nevertheless, 
it  is  allowed  by  Mulder  that  cellular  structure  "  cannot  yet  be  imitated 
by  art."  But,  waving  this  conceded  difficulty,  if  the  physiological  ar- 
guments which  I  have  advanced  in  section  14  c,  as  to  a  real  Creator, 
can  be  invalidated,  I  shall  concede  that  a  ground  has  been  obtained 
for  the  doctrine  of  spontaneous  generation  (^  1051,  p.  922,  ^  1085). 

350^,  n.  As  I  shall  soon  dismiss  this  author,  it  may  be  useful,  in 
consideration  of  his  exalted  woi'th  as  a  chemist,  and  his  authority 
among  physiologists,  to  show  that  even  one  who  endeavors  to  hold  a 
consistent  philosophy  on  the  subject  of  chemical  physiology,  yet  sees 
in  organic  beings  so  much  to  contradict  his  chemical  doctrines,  that  he 
evinces  the  usual  inconsistency  of  those  who  have  endeavored  to  con- 
found the  science  of  life  with  that  of  chemistry  (§  4^,  d).  For  this 
pm-pose  I  shall  select  two  passages  only,  and  place  them  in  parallel 
columns,  after  the  manner  adopted  in  relation  to  Liebig  in  section 
350.  I  shall  elect,  also,  for  the  negative  side,  a  passage  which  will 
show,  what  cannot  be  too  often  repeated,  that  the  chemists  are  absolute- 
ly regardless  of  their  own  fundamental  doctrine,  of  "  ascending  from 
phenomena  to  their  causes,"  by  rejecting  all  the  unique  phenomena 
of  life  as  indicative  of  any  peculiar  force  or  laws.  The  afirmative 
?ide,  however,  is  all  that  the  vitalist  desires  (§  189). 

Denial  of  the  Vital  Principle  and    Recognition  of  the  Vital  Principle 
Vital  Properties.  and  Vital  Properties. 

*'  Wherever  forces  are  found  in        "  The  question  is,  whether,  du- 

organic  nature,  there  are  substan-  ring  decomposition,  the   organic 

ces  which  are  all  supplied  with  forces    grow    weaker    of    them- 

molecular  CHEMICAL  forces.  Even  selves,  permitting  the  elements  to 

those     singular     structures,     the  obey  their  primary  tendency, — or 

nerves,   consist  of  the  same  ele-  whether    causes    must    exist    by 

ments  as  the  ordinary  substances  which  these  organic  forces  are 

of   the    organic   kingdom.     It   is  made    weaker  1     Neither   is   im- 

thus  undeniable,  that  the  molecu-  probable.      Every    thing     which 

LAR  forces  act  a  chief  part  in  the  ceases  to  be  subject  to  the  vital 

organism,  so  far  as   a  change  of  principle,  becomes  incapable  of 

substances   takes    place   therein ;  being    stimulated    by   tlie    vital 


190 


INSTITUTES    OP    MEDICINE. 


and  that  no  general,  no  vital 
FORCE,  should  be  assumed  as  the 
source  of  those  molecular  forces. 
Such  a  vital  force  is  irreconcilable 
with  the  true  principles  of  science, 
which  require  that  nothing  should 
be  assumed  as  existing,  but  that 
every  thing  should  be  sought  for 
in  nature ;  which  teach  us  to  as- 
cend only  from  an  unprejudiced 
consideration  of  the  phenomena  to 
their  causes,  and  to  assign  those 
causes  only  as  we  deduce  them 
from  the  observed  phenomena." 
— Mulder's  Chemistry  of  Vege- 
table and  Animal  Physiology,  p. 
68.     1845. 


forces  ; — it  is  placed  in  other 
circumstances ;  and  as  the  prod- 
ucts OP  the  vital  functions 
are  different  from  the  prod- 
ucts OP  inorganic  nature,  in 
consequence  of  the  very  differ- 
ence of  the  circumstances  in 
which  the  elements  are  placed,  so 
the  products  of  substances,  de- 
prived of  vital  influence,  must 
also  greatly  vary  with  circum- 
stances. Hence  it  may  happen, 
that  THE  forces  present  in  organ- 
ic substances,  when  deprived  of 
the  VITAL  influence,  may  disap- 
pear of  themselves.  The  impres- 
sion they  had  at  first  received  is 
changed,  modified,  obliterated 
and  therefore  the  effects  can  no 
longer  be  the  same.  A  substance 
persists  in  the  state  into  which  it 
yvQ.s  first  put,  according  to  the  law 
of  INERTIA ;  but  the  maxim,  suh- 
lata  causa  tollitur  effectus,  is  of 
EQUAL  VALUE." — Mulder's  Chem- 
istry of  Vegetahle  and  Animal  Phys- 
iology, p.  54  (§  59). 

I  shall  conclude  with  an  extract  from  Mulder,  in  which  it  will  bt 
seen  that  he  has  adopted  the  method  set  forth  by  myself  in  my  Essay 
on  the  Philosophy  of  Vitality'^  (1842),  of  investigating  the  subject  in 
the  development  of  the  germ.  It  may  be  useful  to  place  in  contrast 
the  purely  chemical  and  the  purely  vital  interpretations  of  that  devel- 
opment (§  65).  I  may  also  premise  that  it  should  be  observed  that 
the  chemist  keeps  out  of  view  all  the  remarkable  circumstances  at- 
tending the  development  of  the  egg  which  I  have  set  forth  as  irrecon- 
cilable with  chemical  phenomena,  and  limits  himself  to  statements 
founded  on  a  supposed  analogy  with  the  simple  results  of  chemical 
affinity  as  observed  in  inorganic  nature.     Thus  : 

"  If  we  review  the  phenomena  of  life,  caused  by  change  of  materi 
als,  we  must  go  back  to  the  original  formation  of  organs — to  the 
growth  of  an  individual  from  a  germ."  After  illustrating  the  devel- 
ment  of  the  germ  by  "  an  example  from  the  inorganic  kingdom"  (the 
formation  of  prisms  from  a  solution  of  the  sulphate  of  soda!),  this 
distinguished  chemist  proceeds  to  say,  that 

"  Undoubtedly  the  differences  which  exist  between  the  particles  of. 
the  same  organic  substances  are  not  chemical,  in  the  ordinary  gross 
signification,  but  are  of  the  nature  of  those  which  are  connected  with 
polymorphism.  The  chemist  gives  us  but  a  rude  result — the  compo- 
sition in  a  hundred  parts,  fi-equently  not  affording  us  any  insight  into 
either  the  real  characters  of  substances,  or  into  their  real  differences. 
Whenever  such  dissimilar  particles  come  together,  a  compound  must 
be  produced,  possessing  peculiar  forces,  which,  though  dependent  upon 


PHYSIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS.  191 

the  molecular  forces  of  the  elements,  are  yet  not  determined  by  these 
alone.  The  new  arrangement  causes  a  modification  of  those  primary 
forces.  Whenever  it  takes  place,  they  appear  modified,  and  therefore 
indicate  their  presence  by  producing  new  effects.  In  sulphate  of  soda, 
the  whole  collected  forces  of  its  constituent  molecules — those  of  sul- 
phur, sodium,  and  oxygen — are  still  existent;  and  upon  these  alone 
depend  its  qualities,  composition,  and  crystaline  form.  Sulphate  of 
soda  cannot  possess  other  qualities — cannot  become  other  in  property 
— than  what  results  from  its  elements,  and  exclusively  originates  in 
these. 

"  Thus,  then,  we  suppose  that  the  molecules  of  the  substances  in 
the  embryo  are  arranged,  in  the  first  place,  simply,  and  afterward  more 
complexly.  Not  a  trace  of  any  organ  is  as  yet  perceptible,  however ; 
nor  of  any  force,  therefore,  by  which  these  organs  will  be  governed. 
By  the  new  arrangement  of  the  particles,  the  molecular  forces  are 
modified  anew,  and  this  process  is  continuous.  Although  the  primary 
forces,  once  united  with  the  materials,  remain  the  source  of  every  ac- 
tion, of  every  manifestation  of  phenomena,  of  every  chemical  and  or- 
ganic, that  is,  physical,  combination  ;  they  must,  nevertheless,  produce 
different  effects,  as  the  combinations  become  more  complex.  Each 
existing  particle  is  the  germ  of  a  subsequent  one,  which  is  more  com- 
plex; and,  while  the  temperature  necessary  for  hatching  keeps  the 
primary  forces  always  excited,  there  is  originated  in  the  new  arrange- 
ment of  the  particles,  and  also  in  the  forces  proceeding  from  the 
groups  recently  formed,  a  modification  of  these  primary  forces,  which 
is  constantly  on  the  increase. 

"  The  whole  material  of  the  embryo  in  the  egg  is  gradually  brought 
in  this  manner  within  the  circle  of  action.  Then  the  circle  is  still 
more  extended,  and  in  its  action  are  comprehended  the  elements  of 
the  yolk,  and  also  of  the  albumen.  These  are  erroneously  called  the 
food  of  the  newly-formed  chicken,  or  its  rudiments.  In  these  ele- 
ments there  are  forces  also  conjoined  with  the  materials — chemical 
forces,  analogous  to  those  which  exist  in  the  embryo,  and  contributing 
to  the  production  of  the  whole.  These  forces  differ  from  those  found 
in  the  embryo,  not  in  nature,  .but  only  in  direction,  or  in  the  mode  of 
manifestation." — Mulder,  ut  cit,  p.  71-73. 

351.  Having  in  the  preceding  sections,  as  well  as  at  other  times, 
summoned,  in  behalf  of  truth,  and  of  the  noblest  institutions  of  na- 
ture, an  adverse  party,  and  having  shown,  not  only  by  the  nature  of 
the  pursuits  which  engage  the  whole  practical  attention  of  the  leaders 
of  that  party,  but  by  an  open  cross-examination  of  the  acknowledged 
chiefs,  that  the  entire  field  of  physiology  and  medicine  remains,  as 
ever,  in  sole  possession  of  those  who  are  employed  in  its  cultivation, 
and  that,  by  no  possible  accident,  fraud,  or  conspiracy,  can  it  be  trans- 
formed or  transferred  into  the  laboratory  of  the  chemist,  I  shall  pro- 
ceed to  a  more  critical  examination  of  the  philosophy  of  digestion, 
both  in  its  vital,  and  its  supposed  chemical  attributes. 

352.  All  other  processes  of  living  beings,  whether  animal  or  vege- 
table, and  especially  the  whole  work  of  assimilation  after  the  entrance 
of  the  food  within  the  lacteals,  being  exclusively  vital,  it  follows,  as  a 
great  analogy  of  nature,  that  the  first  step  in  the  process  of  assimila- 
tion is  equally  due  to  vital  influences  (§  323-326). 

353.  Since  every  species  of  complex  animals  has  some  peculiarity  of 


192  INSTITUTES    OF    MEDICINE. 

organization,  not  only  of  the  alimentary  canal,  but  of  the  liver,  sali- 
vary glands,  pancreas,  teath,  jaw,  skeleton,  muscles,  and  also  of  in- 
stinct, corresponding  with  a  certain  modification  of  the  vital  endow- 
ments of  the  gastric  juice  in  each  species  of  animal,  which  shall  be 
exactly,  and  forever,  and  undeviatingly  suited  to  the  digestion  of  those 
kinds  of  food  which  were  ordained  by  the  Creator  for  the  sustenance 
of  each  when  He  thus  wonderfully  instituted  this  almost  endless  sys- 
tem of  exact  Designs ;  each  individual  part  having  its  specific  final 
cause,  each  final  cause  modified  in  every  species  and  with  correspond- 
ing peculiarities  of  organization,  and  all  concurring  to  one  great  final 
cause  of  subserving  those  exigencies  of  life  which  are  fulfilled  by  the 
gastric  juice,  and  whose  modifications  in  diflferent  species  of  animals 
harmonize  with  the  special  attributes  of  all  the  concuixing  causes,  and 
so  suited  by  Infinite  Wisdom  to  the  nature  of  the  food  of  every  ani- 
mal, that  its  incipient  change  shall  be  one  of  assimilation  to  the  nature 
of  the  being,  yet  nearly  coincident  in  all  animals  from  the  general  co- 
incidence in  all  organic  compounds ;  I  say,  in  all  this  labyrinth  of  De- 
signs, so  exactly  modified  in  every  species,  yet  correspondent  in  all, 
and  each  and  all,  in  their  individuality,  their  variety,  their  modifica- 
tions, and  their  unity  of  purpose,  having  a  specific  reference  to  the 
alimentary  inaterial  of  each  species  of  animal,  we  see  in  perpetual 
progress  what  is  equivalent  to  a  never-ending  voice  from  Heaven, 
proclaiming  that  the  organic  stomach  has  no  parallel  in  its  capabilities 
and  results  in  the  inorganic  world,  or  in  the  laboratory  of  the  chemist. 
But  this  is  not  all ;  nor  will  I  fail  to  convert  the  stupendous  whole,  as 
I  advance  with  the  details  of  assimilation,  to  the  fundamental  philoso- 
phy of  organic  life. 

354.  The  constituent  elements  of  the  food  having  been  subjected  to 
special  transformations,  and  imbued  with  the  first  gradations  of  life,  by 
the  vital  action  of  the  salivary  and  gastric  juice,  and  perhaps,  also,  by 
contact  with  the  stomach,  is  thus  converted,  in  all  animals,  into  appa- 
rently one  and  the  same  homogeneous  product.  It  is  then  submitted 
to  the  farther  organizing  effects  of  the  bile  and  pancreatic  juice,  pass- 
ed through  the  wonderfully  vivifying  lacteals,  carried  forward  and 
subjected  to  the  whole  animating  influence  of  the  pulmonary  system, 
perfected  in  its  exalted  endowments  by  the  whole  labyrinth  of  the 
circulatory  organs,  and,  lastly,  though  not  least,  the  various  com- 
pounds are  determined,  each  and  all,  from  that  one  homogeneous 
fluid,  and  in  one  everlastingly  exact  manner,  and  according  to  the 
nature  of  each  part,  by  other  complex  living  systems,  and  thus  per- 
petuated forever  in  all  their  exact  varieties, — but  /iow,  no  imagina- 
tion can  form  the  most  remote  conception,  but  through  the  instrumen- 
tality of  those  specific  properties  of  life  which  were  the  only  power 
concerned  from  the  beginning  to  the  ending  of  the  astonishing  series 
of  unvarying  changes  (§  42) ;  and,  however  it  be  that  each  ultimate 
product  is  destined  for  the  immediate  uses  of  the  individual,  it  is  un- 
deniable that  the  great  final  cause  of  every  step  in  the  assimilating  pro- 
cess, till  it  results  in  the  formation  of  blood,  is  the  reproduction  of  gastric 
juice  for  the  maintenance  of  an  unceasing  supply  to  the  exigencies  of 
organic  life,  and  the  perpetuation  of  the  species  (§  41,  323-326). 

355.  The  gastric  juice  being  designed  to  prepare  the  material  for 
•  the  formation  of  blood  has  its  powers  so  constituted  as  to  be  merely 

an  agent.     The  blood,  being  the  pahuhim  vitce  fully  prepared  for  the 


PHYSIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS.  193 

regeneration  of  the  gastric  juice,  as  well  as  of  other  organic  compounds 
(§  354),  is  mostly  a  substance  acted  upon  by  the  living  solids,  or  by 
the  ovum-cell,  just  as  the  food  had  been  by  the  gastric  juice,  w^hile  it 
serves,  also,  as  a  stimulus  to  the  vascular  parts,  and  is  highly  endovr- 
ed  w^ith  the  properties  of  life  to  facilitate  its  conversion  into  living 
solids  or  fluids,  and  to  make  its  presence  in  the  blood-vessels  compat- 
ible with  their  life. — Note  R  p.  1123. 

356,  a.  While  we  are  thus  employed  in  describing  the  various  de- 
tails of  assimilation,  attention  is  unavoidably  aiTested  by  the  magnifi- 
cence of  its  unique  philosophy,  and  by  the  ultimate  aim  of  every  de- 
tail of  all  the  immense  variety  (§  353-355),  even  excretion  itself  (§ 
412,  &;c.),  at  the  production  of  gastric  juice  !  And  as  we  penetrate 
the  more  latent,  but  yet  more  impressive  physiological  laws  to  which 
that  juice  is  obedient,  we  rise  in  admiration  of  the  pi'eliminary  means 
of  their  fulfillment;  and  now  again  addressing  myself  to  the  chemist, 
I  ask  him  as  a  philosopher,  as  one  who  would  protect  the  consistency  of 
his  own  science,  what  can  be  more  emphaticallysignificantof  the  abstrac- 
tion of  difjestion  from  chemical  ao^encies  than  the  fact  that  the  nervous 
power  so  modifies  the  vital  constitution  of  the  gastric  juice  that  it  faihi 
of  its  usual  function  when  a  division  is  made  of  the  pneumogastric 
nerve  ?  Imagination  can  suiTnise  no  connection  between  the  nervous 
power  and  the  processes  of  chemistry.  And  yet  do  the  writings  of 
Liebig,  and  of  other  organic  chemists,  abound  with  assumptions  that 
the  supposed  afiinities  of  chemistry,  as  operative  in  animals,  are  sub- 
ject to  the  nervous  power !  though  it  is  conceded  that  the  nearly  co- 
incident processes  and  results  in  plants  sustain  no  such  nervous  influ- 
ences (§  500,  nn).  "  Tlie  anivial  organism,^'  says  Liebig,  truly,  "  is  a 
higher  kind  of  vegetable.'"  To  suppose  that  such  powers  operate  in 
harmony  together,  and  that  the  mind  or  its  passions  are  capable  of  in- 
fluencing, extensively,  the  operation  of  chemical  forces,  in  constantly 
modifying  the  various  secreted  products,  both  as  to  quality  and  quan- 
tity, is  a  positive  violation  of  the  most  obvious  and  universal  rules  in 
natural  philosophy  (§  455  a,  461,  478  h,  4881,  493  ^c,  893  a,  c,  8931). 

356,  b.  It  is  evident  that  a  great  difficulty  exists  with  many,  who 
admit  a  principle  of  life  in  relation  to  the  solids,  in  imagining  a  fluid 
to  be  equally  endowed,  and  alike  capable  through  that  principle  of 
acting  upon  organic  matter.  But  we  must  take  the  facts  as  we  find 
them,  nor  allow  inorganic  nature  the  slightest  interference.  If  analo- 
gies must  be  had,  let  us  seek  them  in  the  organic  being,  and  we  shall 
be  certain  of  success.  In  the  instance  before  us  we  have  the  admit- 
ted vitality  of  the  blood  ;  but,  unlike  the  gastric  juice,  it  produces  no 
changes  in  matter.  We  have,  however,  the  simple  ovum,  "  tohose  vital 
properties,'"  in  the  language  of  Dr.  Carpenter,  "  confer  upon  it  the 
■means  of  itself  assimilating,  and  thereby  organizing  and  endowing  ivitJi 
vitality  the  materials  supplied  by  the  inorganic  world"  (§  64,  g').  Here, 
then,  the  analogy  is  remarkably  forcible,  and  the  more  so,  as  the  fact 
is  conceded  by  the  strictly  chemical  school  of  digestion.  So,  of  the 
Bemen,  in  another  aspect  of  the  active  condition  of  the  principle  of  life 
in  an  organic  fluid ;  this  substance,  through  that  principle,  being  ca- 
pable of  modifying  the  organic  constitution  of  the  ovum  in  such  wise, 
that  the  offspring  shall  inherit  the  intellectual,  vital,  and  physical  pe- 
culiarities of  the  male  parent,  with  six  fingers  instead  of  five  (§  72,  73). 

357.  One  of  the  most  important  arguments  in  favor  of  vital  diges- 


194  INSTITUTES    OF    MEDICINE. 

tion  consists  in  the  remarkable  endowments  of  the  stomach,  as  mani- 
fested by  its  vital  signs,  and  by  the  sympathies  which  prevail  between 
this  organ  and  all  other  parts.  The  final  cause  of  this  peculiar  con- 
stitution of  the  stomach,  this  lavish  supply  of  the  properties  of  life,  this 
subservience  of  other  organs  to  its  dominion,  must  be  sought  in  its 
adaptation  to  the  generation  of  a  fluid  that  may  bestow  the  first  and 
most  difficult  act  of  vitalization  upon  dead  matter  (§  356,  a).  There 
would  also  have  been  something  harsh  and  abrupt  in  nature  to  have 
admitted  into  the  recesses  of  her  living  organization  mere  dead  mat- 
ter. It  is  opposed  to  all  analogy,  and  is,  therefore,  opposed  to  all 
reason.  But,  that  a  fluid  should  perform  this  astonishing  office,  this 
first  and  great  step  in  the  ascending  series,  it  must  possess  in  a  high 
degree  the  principle  of  life.  Mysterious  as  it  may  be  represented,  we 
must  all  of  us  come  at  last  to  the  admission  of  the  existence  of  a  vital 
principle  ;  yet  far  less  mysterious,  and  far  less  difficult  of  comprehen- 
sion than  the  human  soul.  It  is  fair,  then,  to  conclude  that  an  organ 
destined  for  such  a  high  function  should  possess  that  principle,  in 
common  with  all  other  parts,  as  the  means  on  which  its  function  de- 
pends ;  and  the  best  evidences  in  favor  of  this  analogical  inference  are 
to  be  seen  in  its  diversified  manifestations  of  life. 

358.  We  have  seen,  also,  that  it  is  conceded  by  philosophers  who 
defend,  in  cxtenso,  the  chemical  hypothesis  of  life,  that  there  may  be 
something  appertaining  to  the  stomach  totally  distinct  from  the  chem- 
ical powers,  and  which  is  capable  of  imbuing  the  chyme  with  vitality 
and  an  organic  condition  ;  and  it  is,  therefore,  quite  a  philosophical 
conclusion  that  this  vital  something  has  an  important  agency  in  pre- 
paring the  material  for  the  admitted  exercise  upon  it  of  the  vivifying 
or  organizing  power.  Nor  can  there  be  any  valid  objection  to  the 
supposition  that  this  vitalizing  power,  which  so  far  transcends  the 
chemical  forces  in  the  organizing  effect  it  is  allowed  to  exert,  may  be 
fully  adequate  to  any  transmutations  the  food  may  undergo ;  and  this 
inference  is  the  more  corroborated  by  the  consideration  that  matter 
already  in  an  organic  state  must  be  better  fitted  for  the  process  of 
vivification  than  it  can  possibly  be  after  its  elements  are  broken  up 
and  recombined  by  forces  with  which  those  of  life  are  in  absolute  op- 
position. Besides,  the  vitality  of  the  gastric  juice,  or  the  vital  influ- 
ence of  the  stomach  itself,  being  fully  admitted,  and  even  capable  of 
organizing  the  food  anew,  should  sufficiently  protect  the  alimentary 
matter  against  any  chemical  agencies  which  have  been  supposed  to 
operate.  That  this  counteracting  power,  indeed,  prevails  to  the  full 
extent  which  I  have  alleged,  appears  to  be  rendered  certain  by  the 
ordinary  absence  of  any  of  those  chemical  changes  which  take  place 
where  numerous  substances  are  mixed  together  out  of  the  stomach — 
substances  which  often  possess  strong  chemical  affinities  for  each 
other,  and  v/hose  operation  within  the  stomach  would  be  promoted  by 
its  high  temperature.  On  the  contrary,  whatever  the  variety,  it  is 
uniformly  resolved  into  one  and  the  same  homogeneous  substance,  ut- 
terly unlike  the  results  of  chemical  reactions  of  one  kind  of  food  upon 
other  kinds ;  and  what  is  also  as  conclusive  as  it  is  astonishing,  the 
chyle  is  apparently  the  same  substance  in  all  animals.  Chemistry 
must  here  be  consistent  with  itself,  and  not  renounce,  for  the  sake  of 
hypothesis,  those  precise  laws  by  which,  in  its  legitimate  pursuit,  it 
lays  open,  with  astonishing  exactness,  what  had  appeared  the  arcan? 


I'HYSIOLOGY. ORGANIC    CHEMISTRY FUNCTIONS.  195 

of  nature.  Here,  too,  upon  the  chemico-physiological  hypothesis,  is 
presented  an  instance  in  which  it  is  necessarily  assumed  that  the 
properties  of  life  and  the  forces  of  chemistry  act  together  in  concert 
in  converting  dead  into  living  matter — one  destroying,  and  at  the 
same  moment  the  other  vitalizing !  while  the  assumption  is  contra- 
dicted by  all  that  is  known  of  the  relation  of  these  forces  to  each 
other  (§  301,  338,  360,  436). 

Nor  may  we  lose  sight  of  the  demand  of  philosophy  not  to  multiply 
causes  where  one  is  perfectly  adequate ;  and  especially  where  it  is 
admitted  that  all  the  others  are  of  themselves  wholly  inadequate. 

359.  The  last  remark  may  be  also  equally  applied  to  a  common  as- 
sumption which  is  set  forth  in  the  following  apparently  plausible  man- 
ner :  "  The  vitalists,"  says  one  of  their  opponents,  "are  loath  to  admit 
the  operation  of  chemical  agents  at  all,  and  would  seem  to  consider  it 
derogatory  to  suppose  that  any  changes,  save  the  subtle  ones  effected 
by  the  powers  of  life,  are  worked  upon  the  aliment."  "  The  vital 
principle,^'  he  says,  "  whatever  it  may  be,  incessantly  makes  use  of 
chemical  and  mechanical  agents  for  its  purposes ;  and  it  is  no  more 
degrading  to  it  to  employ  an  acid  liquid,  and  a  triturating  process,  in 
order  to  digest  the  aliment,  than  it  was  to  have  recourse  to  bony  lev- 
ers, cartilaginous  pulleys,  and  tendonous  ropes." 

Here,  in  the  first  place,  will  be  observed  an  entire  begging  of  the 
question  as  to  digestion  by  an  acid,  since  that  has  never  been  shown, 
and  is  the  main  point  at  issue.  It  is  a  perfectly  unfounded  and  ex- 
torted inference  from  the  factitious  analogy  supposed  to  be  seen  in 
the  admitted  mechanical  movement  of  the  food  in  the  stomach,  bony 
levers,  cartilaginous  pulleys,  &c.  But  the  pi'etended  analogy,  I  say, 
is  utterly  inapplicable,  were  it  admissible  to  reason  from  better  prem- 
ises of  this  nature  to  the  existence  of  important  facts  which  have  no 
other  foundation.  The  bony  levers,  muscles,  tendons,  heart,  and  large 
blood-vessels,  are  mere  instruments  acted  upon  by  the  vital  princij)le, 
and  have  no  part  in  the  vital  results,  except  as  they  are  the  passive 
instruments  of  the  properties  of  life.  The  same  distinction  exists  be- 
tween the  process  of  digestion,  and  the  mechanical  movement  of  the 
food  in  the  stomach,  or  the  "  trituration"  of  the  food,  as  it  is  errone- 
ously called  by  the  writer  just  quoted  ;  since  food  is  not  triturated  by 
the  stomach  excepting  where  that  organ  is  designed  to  supply  the 
place  of  teeth.  There  exists,  I  say,  a  total  want  of  analogy  between 
that  mechanical  movement  of  the  food  and  the  assumed  action  of  an 
acid  ;  since,  in  the  latter  case,  a  radical  change  is  supposed  to  be 
wrought  in  the  alimentary  mass,  while  np  such  change  is  wrought  by 
the  mere  movement,  or  even  by  the  trituration  or  grinding  of  food  in 
the  stomach.  The  contractions  of  the  stomach,  which  are  purely  of  a 
vital  nature,  facilitate  the  process  of  digestion;  but  they  do  no  more 
than  to  expose  the  food  freely  to  the  action  of  the  gastric  juice,  by 
which,  alone,  the  conversion  into  chyme  is  performed.  The  contrac- 
tions, or  "  trituration,"  ar6  exactly  on  a  par,  as  auxiliaries  to  diges- 
tion, with  the  teeth,  or  with  the  knife,  which  divide  the  food.  The 
acid  alone  applies  to  the  supposed  chemical  process  of  chymification. 
This  is  the  only  agent,  involving  the  only  force  distinct  from  the  vital 
principle  that  is  supposed  to  operate,  and  to  take  part  with  the  prop- 
erties of  life  in  the  functions  which  belong  to  these  properties.  Nor 
•3  this  all.     Those  chemical  forces,  or  an  equivalent  agent,  are  sup- 


19G  INSTITUTES    OF    MEDICINE. 

posed  to  a},  pertain  to  the  gastric  juice  (a  product  of  the  most  highly 
endowed  oigan  in  the  animal  system) ;  and  through  that  product,  and 
by  that  product,  to  operate  independently  of  the  vital  properties,  or, 
under  their  control.  But,  here  it  may  be  again  affirmed  that  through- 
out nature  there  is  not  an  analogical  fact  to  warrant  the  conclusion ; 
and  with  equal  truth  it  may  be  said  that  there  is  nothing  to  aid  our 
conception  of  the  co-operation  of  the  chemical  and  vital  forces,  while 
all  that  is  known  of  their  relations  to  each  other  proclaims  their  ab- 
solute independence. — Med.  Chirurg.  Rev.  Lend.  vol.  29,  p.  107. 

360.  But,  again,  it  is  the  admitted  final  cause  of  the  gastric  juice  to 
bestow  life  upon  dead  matter,  while  it  is  incontrovertible  that  inorgan- 
ic matter  is  insusceptible  of  any  such  influence  from  gastric  action. 
Every  fact  proclaims  that  nature  has  provided  the  vegetable  kingdom 
for  the  purpose,  especially,  of  determining  organic  combinations  out 
of  inorganic  substances  for  the  sustenance  of  animal  life.  In  the  lan- 
guage of  Liebig,  "  The  first  substance  capable  of  affording  nutriment 
to  animals  is  the  last  product  of  the  creative  energy" — ay,  "  the 
CREATIVE  ENERGY,"  he  says,  "  of  vegetables." — (Animal  Chemistry.) 
It  is  manifest,  therefore,  that  it  would  be  an  absurdity  on  the  part  of 
nature  to  have  ordained  that  chemical  agencies  should  operate  even 
at  the  very  threshold  of  life,  at  the  very  fountain  for  which  she  had 
provided  elaborate  means  to  subvert  the  combinations  of  chemistry, 
and  to  bring  them  into  those  entirely  new  arrangements  that  approx- 
imate the  changes  they  are  destined  to  undergo  in  the  animal  stom- 
ach. And  far  less  probable  is  it,  that  this  fundamental  principle 
should  be  lost  as  we  ascend  from  vegetable  to  animal  organization ; 
since  every  chemical  result  within  the  stomach  would  tend  to  reduce 
the  aliment  to  the  state  of  that  inorganic  matter  whose  complete  re- 
duction into  organic  compounds  was  effected  by  the  vegetable  king- 
dom for  the  uses  of  the  animal.  Such  chemical  results,  therefore, 
would  counteract  the  great  final  cause  of  nature,  in  either  organic 
kingdom;  and,  in  the  animal,  would  render  the  means  of  sustenance 
more  and  more  indigestible,  and  progressively  liable  to  the  condition 
of  inorganic  matter  (§  33S).*  This  is  fully  allowed  by  the  chief  of  the 
school  of  pure  chemistry,  as  shown  in  the  foregoing  parallel  quota- 
tions. Take  another  summary  statement,  than  which  nothing  can  be 
more  contradictory  of  the  chemical  rationale.  "While  no  part  of  an 
organized  being,"  says  Liebig,  "  can  serve  as  food  to  vegetables,  un- 
til, by  the  process  of  putrefaction  and  decay,  it  has  assumed  the  form 
of  inorganic  matter,  the  animal  organism  requires,  for  its  support  and 
development,  highly-organized  atoms.  The  food  of  all  animals,  in  all 
circumstances,  consists  of  parts  of  organisms." — {Ani7)ial  Chemistry.) 
Chemical  philosophy  should  consider  that  nutriment  of  an  animal  na- 
ture requires  but  little  more  than  the  solvent  process,  and  the  bestow- 
ment  of  vital  properties  ;  while,  in  accordance  with  its  crude  hypothe- 
ses, animal  compounds  must  be,  more  than  vegetable,  subject  to  dis- 
organizing agencies,  and  thus  more  completely  removed  from  their 
original  and  near  approximation  to  those  of  the  living  animal  ('^  18  a). 
oGl.  But  again  I  say,  if  the  vital  principle  be  "capable  of  making 
use  of  chemical  agents,"  no  reason  can  be  assigned  why  it  may  not 
be  equal  to  the  whole  work  of  digestion,  and  of  every  other  process 

*  This  argument  is  adopted  b}'  a  writer  (a  distinguished  chemist!)  in  the  Amer. 
Jourti.  of  Science  and  Arts,  May,  1859,  wlio  verbally  agrees  with  me  that — "  The  forces 
of  life  and  inorganic  nature  act  in  opposite  directions,  the  former  vpivard,  the  latter 
do2i-mvard."—SiQe  §  301,  and  p.  911,  §  1083.    Also,  p.  236,  ^  436.— (1860). 


PHYSIOLOGY. ORGANIC  CHEMISTRY FUNCTIONS,  19'' 

of  living  beings.  The  simple  construction  may  be  comprehended, 
wbile  the  other  is  utterly  unintelligible.  The  former  alone  is  agree- 
able to  the  rules  of  philosophy,  and  abolishes  the  inextricable  confu- 
sion which  attends  the  chemical  hypothesis.  What,  indeed,  can  be 
meant,  by  the  vital  properties  making  use  of  chemical  forces  1  Can 
there  be  a  more  glaring  absurdity  %  more  absolute  nonsense  1  How 
are  those  chemical  forces  brought  into  use,  how  held  in  subjection, 
how  forever  maintained  in  one  exact  operation  in  each  particular  or- 
ganic process,  of  which  there  are  multitudes,  distinct  from  each  other, 
going  on  in  the  same  individual  ]  How  do  they  elaborate  from  one 
common,  homogeneous  fluid,  either  the  blood,  or  the  sap,  all  the  va- 
rious, unique,  unchanging,  secreted  products  of  the  whole  organic  be- 
ing 1  Products,  forever  the  same  in  every  part,  yet  differing  from 
each  other  according  to  the  nature  of  the  parti  Did  you  ever  hear 
or  dream  of  any  thing  analogous  to  this  in  that  inorganic  world  where 
chemistry  holds  its  empire  ]  When  do  those  chemical  forces  begin 
to  operate,  in  the  living  body,  what  part  do  they  perform,  and  what  is 
the  allotment  of  the  properties  of  life  1  Is  there  any  known  concert 
of  action  between  the  two  species  of  forces "?  On  the  contrary,  is  it 
not  every  where  demonstrated  that  the  properties  of  life  are  in  direcl 
opposition  to  the  forces  of  chemistry  1 

Whatever  be  the  construction,  by  uniting  the  two  forces  (as  is  done 
by  the  only  chemical  school  that  is  entitled  to  a  respectful  notice),  we 
convert  what  is  a  simple  problem,  like  all  other  processes  of  nature, 
into  the  greatest  paradox  that  has  been  yet  devised  by  the  ingenuity 
of  man.  It  is  in  vain  to  say  that  some  one  or  two  of  the  products  of 
organization,  such  as  carbonic  acid,  and  urea,  are  such  as  result  from 
chemical  affinities,  since  these  are  excrementitious ;  while  chemistry 
assures  us  that  all  organic  compounds  are  utterly  different  in  their  el- 
ementary combinations  from  any  compound  of  a  chemical  nature. 

Thus  might  I  go  on  to  argue  this  subject  upon  general  principles 
alone ;  while  at  every  step  of  the  argument  we  should  see  the  whole 
chemical  hypothesis  of  life  taking  its  proper  rank  as  a  dream  of  the 
imagination,  or  as  a  project  of  ambitious  minds. 

362.  Digestion  having  been  assumed  to  be  more  or  less,  or  alto 
gether,  a  chemical  affair,  it  rationally  followed  that  it  might  be  imita- 
ted by  art.  Accordingly,  when  this  ambitious  science  had  succeeded 
in  turning  the  whole  inorganic  world  into  the  laboratory,  it  set  itself 
at  the  manufacture  of  organic  compounds,  and  even  at  the  entire  ani- 
mal. It  did  not,  like  Alexander,  sit  down  and  weep  because  it  had 
no  more  worlds  to  conquer;  but,  like  Shakspeare,  having  "exhaust- 
ed worlds,  it  then  imagined  new."  Even  eminent  physiologists,  who 
should  look  with  jealousy  upon  any  invasions  upon  the  laws  of  nature, 
especially  upon  such  as  it  is  their  peculiar  province  to  illustrate,  be- 
gan the  manufacture  of  gastric  juice  by  fire  and  acids,  and  metallic 
salts.  We  are  thus  presented  by  these  philosophers  with  artificial 
compounds,  of  a  most  incongruous  nature,  and  we  are  told  that  each 
one  is  the  gasti-ic  juice ;  that  each  is  capable  of  the  same  precise 
results  as  that  universal  product  of  animals,  apparently  the  same  in 
all,  and  elaborated  from  the  blood  by  an  organ  of  the  highest  vital 
endowments,  and  to  which  there  is  nothing  analogous  in  all  the  other 
products  of  living  beings,  each  product  being,  also,  equally  unique, 
and  all  derived  from  one  common  source  (§  135  a,  314,  419,  827  Z*). 


198  INSTITUTES    OF    MEDICINE. 

363.  A  diversity  of  opinions  exists  as  to  the  real  nature  i^f  the 
chemical  agent  supposed  to  be  employed  by  nature  in  the  process  of 
digestion.  Free  muriatic  acid  having  been  found,  or  supposed  to  ex- 
ist, in  the  stomach,  it  has  been  concluded  by  many  that  this  must  be 
the  gi-eat  agent;  while  Dr.  Prout,  and  others,  affirm  that  "free  mu- 
riatic acid  more  or  less  retards  the  process  of  reduction."  Dr.  R. 
Thompson,  however,  states  that,  by  digesting  muscular  fibre  in  dilute 
muriatic  acid,  he  produced  a  substance  "exactly  resembling  chyme." 
This  experiment  was  pretty  widely  repeated,  and  many  were  equally 
successful  with  "  dilute  muriatic  acid"  as  was  Dr.  Thompson.  Oth- 
ers, on  the  contrary,  declared  their  failure,  and  others,  like  Dr.  Prout, 
maintained  that  this  acid  retarded  digestion.  Eberle  had  already  ad- 
vanced the  hypothesis  that  mucous  membranes,  no  matter  whether  of 
the  stomach  or  the  bladder,  dissolved  either  in  muriatic  or  acetic  acid, 
Avould  form  the  true  gastric  juice,  and  perform  its  wonderful  opera- 
tions. There  is  now  a  general  bias  in  favor  of  one  of  these  com- 
pounds, though  other  preparations  are  supposed  by  many  to  form  very 
good  gastric  juice.  Again,  it  is  said  that  the  "digestive  mixture,"  as 
it  has  been  well  denominated  by  the  manufacturers,  "  retains  its  sol- 
vent properties  for  months,"  while  the  gastric  juice  loses  its  solvent 
power  soon  after  its  abstraction  from  the  stomach  (§  341).  And  what 
equally  establishes  a  total  difference  between  the  "  mixture"  and  the 
gastric  juice  is  the  no  small  circumstance  that  the  chemist  may  torture 
and  extinguish  the  artificial  "digestive  principle"  in  a  variety  of  ways, 
and  then  transmute  it  back  in  all  its  vigor.  Thus,  according  to  Schwann 
and  Miiller,  the  artificial  "digestive  principle"  maybe  neutralized  by 
an  alkali,  and  afterward  "  precipitated  from  its  neutral  solution  by 
acetate  of  lead,  and  obtained  again  in  an  active  state  from  that  precip- 
itate by  means  of  hydro-sulphuric  acid."  This  precipitate,  we  are 
told,  when  thus  treated,  and  thus  compounded  of  principles  radically 
different  from  the  original  mixture,  is  essentially  the  same  as  the 
gastric  juice,  and  that  the  results  of  such  artificial  preparations  must 
be  taken  as  the  test  of  the  physiology  of  natural  digestion  ;  that,  aban- 
doning nature,  we  must  look  to  the  resources  of  the  laboratory"  for 
any  satisfactory  account  of  her  vital  processes.  Nor  do  I  at  all  exag- 
gerate ;  for  it  is  distinctly  avowed  that  we  knew  nothing  of  digestion 
till  the  invention  of  the  artificial  mixtures.  Thus,  it  is  said  of  Schwann 
by  one  so  able  and  distinguished  as  Miiller,  that  he  (Schwann)  "hav- 
ing discovered  that  the  infusion  of  dry  mucous  membrane  with  dilute 
acid,  even  after  it  is  filtered,  still  retains  its  digestive  power,  the  di- 
gestive principle,  therefore,  is  clearly  in  solution,  and  the  theory  of  di- 
gestion hy  contact  falls  to  the  ground."  Here,  a  most  important  phys- 
iological induction  is  wholly  founded  upon  a  process  which  has  not 
the  most  remote  connection  with  organized  matter. 

364.  I  have  said  that  the  experimenters  took  the  hint  of  manufac- 
turing gastric  juice  from  the  occasional  discovery  of  an  acid  in  the 
stomach.  But,  this  is  undoubtedly  a  rare  phenomenon  in  a  healthy 
stomach,  and  where  the  food  has  been  at  all  appropriate  in  quality 
and  quantity.  The  chemical  hypothesis,  as  I  have  said,  was  long  ago 
in  vogue,  and  was  put  at  rest  by  demonstrative  proof.  Distinguished 
observers,  Hunter,  Haller,  Willis,  Spallanzani,  Fordyce,  and  more 
recently  Dumas,  Schultz,  and  others,  insist  that  the  reputed  acid  is 
the  result   of  a  true   chemical  decomposition   of  vegetable   matter 


PHYSIOLOGY. ORGA.M   C    CHEMISTRY FUNCTIONS.  19ft 

Spallanzani,  whose  experiments  were  almost  endless,  Scopoli,  Chev- 
reuil,  and  others,  rarely  succeeded  in  finding  it  at  all,  and  in  some  an- 
imals never.  Spallanzani,  indeed,  affirms  that  the  gastric  juice  is 
neither  acid  nor  alkaline  in  its  natural  state. 

As  far  back  as  Haller's  day,  when  this  subject  was  agitated,  it  is 
said  by  this  illustrious  and  accurate  observer,  that,  "  although  there 
may  be  some  rare  signs  of  an  acid  in  the  stomach,  it  does  not,  there- 
fore, become  "us  to  suppose  that  food  is  animalized  by  a  chemical 
process ;  much  less  to  compare  this  process  with  the  action  of  an 
acid."  And,  anticipating  the  modern  experiments  with  the  "  diges- 
tive mixture,"  he  declares  of  analogous  proceedings  at  his  own  era, 
"  frustra  etiam  quisquam,  imitatus  liquores  acres  chemicos,  liquoi'em 
corrodentem  invenerit,  qui  carnem  in  pultem  resolvat."  And  there 
can  be  no  doubt  that  Hunter's  prophecy  holds  good  to  this  day,  that, 

"  If  ever  any  matter  is  formed  in  any  of  the  juices  secreted  in  any 
part  of  a  vegetable  or  animal  body  similar  to  what  arises  from  fer- 
mentation, we  may  depend  on  it,  it  arose  from  that  process ;  but  we 
may  also  depend  on  it,  that  there  is  a  defect  of  the  living  principle  in 
these  cases." 

These  are  not  the  mere  speculations  of  genius,  but  the  facts  and 
the  conclusions  of  genius  after  a  long,  and  wide,  and  experimental 
survey  of  nature.  And  are  these  observations,  nay,  our  own  experi- 
ence, our  own  senses,  to  be  set  aside  to  accommodate  an  hypothesis 
of  "life  which  identifies  dead,  even  inorganic,  with  living  beings  1 

364^.  But  perhaps  even  a  greater  violence,  than  the  foregoing 
manufacture  of  gastric  juice,  has  been  recently  done  to  physiology, 
in  the  alleged  conversion,  by  chemical  manipulations,  of  the  secreted 
products  of  organs,  totally  unlike,  into  each  other.  It  should  be  con- 
ceded, however,  that  this  has  been  generally,  sanctioned  by  the  jour- 
nals of  the  day.  Thus,  in  the  London  Lancet  for  July,  1845,  is  a 
quotation  from  the  report  of  MM.  Villefranche  and  Barreswill  to  the 
French  Academy  on  the  "  Che??iical  Phenomena  of  Digestion,"  from 
which  the  conclusion  is  deduced  that 

"  Thus,  it  appears  easy  to  transform  the  gastric  juice,  the  pancreatic 
fluid,  and  the  saliva,  into  each  other,  and  to  make  an  artificial 

GASTRIC    JUICE    FROM    THE    PANCREATIC    FLUID,   and  vicC  VCrSO"  ! 

It  appears,  also,  from  these  late  experiments,  that  the  digestive 
principle  depends  on  an  organic  matter,  that  "  the  said  matter  may  be 
destroyed  by  an  elevated  temperature,"  and  that  "  its  digestive  pow- 
ers vary,  according  as  it  is  associated  with  a  fluid  having  an  acid  or 
an  alkaline  reaction." 

It  would  seem,  therefore,  not  improbable  that  a  new  hypothesis 
will  soon  be  in  vogue,  and  that  the  acid  principle  will  be  abandoned 
to  satisfy  the  claims  of  new  aspirants. 

365.  The  assumed  identity  of  the  artificial  products  with  the  chyme 
of  the  human  and  other  stomachs  has  never  been  shown  in  the  slight- 
est degree  ;  and  that  it  is  the  merest  assumption  is  not  only  proved 
by  what  I  have  already  set  forth,  but  is  fully  admitted  by  those  who 
advocate  the  chemical  doctrine.  The  conclusion  rests  upon  the  mere 
appearance  which  the  artificial  substance  offers  to  the  eye.  Thus,  it 
is  lately  said  by  Dr.  Davy,  that 

"  It  is  impossible  to  witness  the  change  which  takes  place  in  mus- 
cular fibre,  in  consequence  of  putrefaction  giving  rise  to  a  fluid  very 


200 


INSTITUTES    OP    MEDICINE. 


like  cliyme  in  appearance,  without  asking,  may  not  putrefaction  bo 
concerned  in  digestion  itself,  according  to  the  earliest  theoretical  no- 
tions on  the  subject,"  and  as  now  maintained  by  Liebig,  and  his  fol- 
lowers (§  350)  ]  Farther  on,  however,  in  the  same  work,  he  says, 
"  twenty  different  semi-fluids  might  be  mentioned,  to  which,  as  far  as 
ihe  eye  can  judge,  this  puti-id  matter  bears  as  close  a  resemblance  as 
to  chyme''  (§  341). 

366.  "  Dr.  Beaumont  [of  St.  Martin  celebrity]  has  instituted  several 
experiments  with  a  view  to  determine  the  power  of  acids  in  dissolv- 
ing articles  of  food ;  and  the  results  which  he  obtained,  although  they 
varied  somewhat  according  to  the  substances  employed  in  the  exper- 
iments, have  nevertheless  led  him  to  the  conclusion  that  no  other  fluid 
produces  the  same  effect  on  food  which  the  gastric  juice  does,  and  that 
IT  is  the  only  solvent  of  aliment'''  (§  341,  373). — Muller's  Physiology, 
p.  589.     London,  1839. 

So  far  Dr.  Beaumont's  accuracy  may  be  readily  admitted.  But,  as 
his  observations  upon  the  natural  process  of  digestion,  as  carried  on 
in  St.  Martin's  stomach,  have  become  incoi-porated  in  most  of  the 
subsequent  works  on  physiology,  and  even  in  systematic  works  on 
diet,  where  they  generally  serve  as  a  foundation  for  some  of  the  most 
important  conclusions  in  the  science  of  life,  and  have  been  seized 
upon  with  avidity  by  the  supporters  of  the  physical  and  chemical 
doctrines,  and  without  any  reference  to  their  credibility,  or  to  the  un- 
natural condition  of  that  celebrated  stomach,  it  may  be  well  to  show, 
by  their  conflict  with  universal  expei'ience,  that  those  observations 
are  not  only  worthless,  but  pregnant  with  the  greatest  practical  er- 
rors. For  this  purpose,  it  is  only  necessary  to  present  a  brief  abstract 
from  the  tabular  view  supplied  by  the  author  of  the  average  time  oc- 
cupied by  different  alimentary  substances  in  undergoing  digestion. 
Thus : 


ARTICLES  OF  DIET. 


Pigs'  feet,  soused 

Tripe,  do 

Salmon  trout,  fresh     . 
Apples,  sweet    .... 
Cabbage,  with  vinegar 
Hash,  meat  and  vegetables 

Goose 

Cake,  sponge      .... 

Pig 

Pork,  fat  and  lean,  recently  salted 

Pork  steak 

Sausage,  fresh    .... 
Dumpling,  apple 
Green  com  and  beans 
Bread,  wheat,  fresh    . 

Do.     Indian  com 
Eggs,  fresh  .... 

Oysters,  fresh     .... 
Beef,  fresh,  lean,  rare 
Mutton,  fresh      .... 
Fowls,  domestic 
Potatoes,  Irish    .... 


Mean  Time  of  Chymijia.ition. 


Preparation. 

h.n,. 

boiled. 

1  00 

do. 

1  00 

do. 

1  30 

raw. 

1  30 

raw. 

2  00 

warmed. 

2  30 

roasted. 

2  30 

baked. 

2  30 

roasted. 

2  30 

raw  or  stewed. 

3  00 

broiled. 

3  15 

do. 

3  20 

boiled. 

3  00 

do. 

3  45 

baked. 

3  30 

do. 

3  15 

boiled. 

3  30 

stewed 

3  30 

roaste'' 

3  00 

do. 

3  15 

do.  and  boiled. 

4  00 

boiled. 

3  30 

Here,  then,  we  have  pigs'  feet  nearly  four  times  as  easy  of  diges 
lion  as  baked  bread,  or  roasted  mutton,  or  beef,  or  domestic  fowls, 
or  eggs,  or  oysters ;  raw  cabbage  nearly  twice  as  easy  of  digestion ; 
I'oasted  pig  and  goose  a  third  or  more  eas?ier,  &:c.     And  these  aro 


rtlYSlOLOGY. ORGANIC    CHEMISTRY FUNCTIONS.  201 

common  examples  of  what  is  known,  in  medicine,  as  "  the  experi- 
mental philosophy  of  the  nineteenth  century,"  and  "  the  march  of  med- 
ical science"  over  all  former  and  more  rational  experience  {§  IS). 

367.  The  experiments  with  pepsin,  or  the  artificial  mixtures,  have 
been  limited  to  substances  already  animalized,  in  their  simple  condi- 
tions, and  in  minute  proportions.  Hay,  nuts,  onions,  and  even  arrow- 
root, would  be  appalling  to  pepsin ;  and  the  quantities  of  the  gor- 
mand,  or  the  variety  of  the  epicure,  would  soon  show  the  nature,  of 
this  branch  of  "  experimental  philosophy." 

368.  A  chemical  dilemma  pi-esents  itself  The  supposed  chemical 
agent  in  digestion  should  be  the  same  in  all  animals,  to  explain,  in  the 
least,  the  identity  of  the  resulting  products, — and  so  it  is  admitted  by 
the  advocates  of  one  "  mixture,"  or  of  another,  respectively.  But 
this,  on  the  other  hand,  is  clearly  contradicted  by  the  variety  of  the 
"  mixtures,"  and  by  the  vast  variety  of  alimentary  substances,  con- 
sumed by  different  species  of  animals ;  while,  indeed,  if  the  least  re- 
gard were  paid  to  the  laws  of  chemical  affinity,  it  should  be  obvious 
that  there  would  be  no  small  variety  of  chemical  influences  in  the 
stomach  of  omnivorous  man. 

369.  Nevertheless,  if  the  "  digestive  mixture"  be  made  from  the  mu- 
cous tissue  of  the  stomach  of  a  strictly  graminivorous  animal,  or  even 
from  its  bladder,  it  will  "  digest"  meat  and  other  substances  which 
form  the  peculiar  food  of  carnivorous  animals,  but  will  refuse  to  di- 
gest most  of  the  substances  common  to  the  animal  fi'om  whose  stomach 
the  "  digestive  mixture"  is  pi'epared.  This,  therefore,  is  contrary  to 
nature. 

370.  Digestion  is  well  performed  and  often  promoted  when  alkalies 
are  taken  into  the  stomach  in  sufficient  quantities  to  hold  the  reputed 
amount  of  acid  in  a  neutral  state. 

371.  On  the  contrary,  digestion  is  always  impaired  by  the  introduc- 
tion of  acids  into  the  stomach  while  the  process  is  going  on. 

372.  Did  the  supposed  acid  exist  in  the  gastric  juice,  it  would  ren 
der  the  medicinal  doses  of  the  nitrate  of  silver,  or  the  acetate  of  lead, 
perfectly  inert.     This  principle  is  also  of  obvious  application  to  many 
other  substances.  "  Indeed,  it  would  be  a  perpetual  "  incompatible" 
with  many  remedial  agents. 

373.  If  digestion  depend  on  the  supposed  chemical  agencies,  the 
stomach  should  always  undergo  more  or  less  of  that  change  after 
death ;  especially  violent  death.  It  is  the  rarest  phenomenon,  however, 
in  man  or  animals,  to  witness  the  slightest  change  in  that  organ  that 
can  be  referable  to  the  gastric  juice  (§  366). 

374.  It  is  fundamental  in  nature  that  an  organ  which  is  designed 
for  the  production  of  an  organic  fluid  does  not  also  generate  an  inor- 
ganic substance,  especially  a  simple  element  like  chlorine,  for  the  pur- 
pose of  bestowing  organization  and  life. 

375.  Again,  since  it  is  the  raucous  tissue  of  the  stomach  alone 
which,  in  all  animals,  secretes  a  juice  capable  of  producing  chyme; 
and  as  no  other  part  of  any  organized  being  can  generate  a  substance 
of  similar  power,  how  arrogant,  therefore,  the  supposition  that  art  can 
manufacture  a  fluid  of  the  same  virtues  (§  323-325) ! 

376.  As  new  aspirants  enter  the  field,  novelties,  of  course,  will 
spring  up.  They  serve,  however,  to  show  us  the  importance  of  re- 
garding with  suspicion  whatever  ^nav  conflict  with  the  long-estab)ish- 


202  INSTITUTES    OF    MEDICINE. 

ed  conclusions  which  have  been  drawn  from  an  observation  of  the 
most  common  phenomena  of  living  beings.  This  leads  me  to  advert 
to  the  experimental  researches  of  Dr.  Schultz,  the  eminent  Berlin 
professor,  which,  whatever  be  their  foundation,  effectually  destroy  our 
confidence  in  all  those  "  digestive  mixtures"  which  have  figured,  of 
late  years,  so  conspicuously  in  nearly  all  the  systematic  works  or; 
physiology. 

In  the  first  place,  Professor  Schultz  infers  that  neither  the  stomach 
nor  the  gastric  juice  have  much  agency  in  digestion,  but  that  this 
great  office  is  mostly  performed  by  the  saliva.  This  distinguished 
observer  also  finds  that, 

1st.  "  The  secretions  of  the  stomach  are  always  alkaline  excepting 
during  the  process  of  digestion." 

2d.  "  No  food  undergoes  digestion  without  saliva." 

3d.  "  The  chyme  is  not  produced  by  chemical  action,  but  is  an  or- 
ganic compound  formed  by  a  vital  transformation  of  the  food." 

4th.  "  There  is  no  such  product  as  the  supposed  acid  gastric  juice; 
only  a  sour  chyme"  (§  364,  Hunter). 

5th.  "  The  acid  found  in  the  stomach  is  the  result  of  a  chemical  de- 
composition of  the  food"  (§  364). — Schultz,  de  Aliment.  Concoctione 
Also,  the  Rejuvenescence  of  Man,  &c,     1842. 

Again,  still  more  recently,  M.  Blondlot,  under  the  guidance  of  "  ex- 
perimental philosophy,"*  afl&rms  that  the  saliva  is  of  the  nature  of  mu- 
cus, little  else  than  the  waste  of  organs  {as  Liehig  regards  tlie  gastric 
juice,  §  350),  contributing  nothing  to  digestion,  and  only  useful  as  a 
shield  to  the  mucous  surface  (Blondlot,  Traite  de  Analitiqtce  de  la 
Digestion,  p.  124,  126). 

3761-.  It  appears,  therefore,  that  all  the  prevailing  physical  views 
of  digestion,  the  chemical  doctrines  of  secreted  products,  the  healthy 
and  morbid  processes  of  living  beings,  the  modus  operandi  of  morbific 
and  remedial  agents,  which  completely  shuts  out  the  magnificent  laws 
of  sympathy,  and  the  whole  bathos  of  the  humoral  pathology,  have 
been,  in  recent  times,  the  work  of  the  laboratory.  Physiologists  and 
therapeutists,  the  British  especially,  appear  to  have  forgotten  that  it  is 
their  business  to  explore  the  facts  and  the  laws  of  Organic  nature,  and 
to  have  turned  the  whole  matter  over  to  the  chemist  (§  349,  d).  They 
have  surrendered  this  high  calling  to  the  laboratory,  and  have  bowed 
in  submission  to  whatever  its  acids  and  crucibles  have  pretended  to 
reveal  as  to  the  processes  and  laws  of  living  beings.  A  vast  number 
have  thus  discarded  their  lofty  pursuits,  and  have  substituted  for  them 
a  most  unnatural  dependence  upon  the  laboratory  of  the  chemist. 

The  chemist  has  seized  the  opportunity  with  avidity ;  since  his  em- 
ployment with  inorganic  nature  is  mostly  analytical,  mostly  exhausted, 
while  that  which  relates  to  living  beings  supplies  an  unbounded  field 
for  the  institution  of  great  principles  and  laws,  whether  true  or  false, 
and  for  the  highest  renown  in  philosophy.  It  is  not  remarkable, 
therefore,  considering  the  prizes  are  few,  the  competitors  many,  that 
the  "  race  is  to  the  swift,  and  the  battle  to  the  strong,"  that  the  ambi- 
tious chemist  should  abandon  the  mere  work  of  analysis,  and  push  his 
inquiries  into  that  magnificent  department  of  nature  where  the  richest 
laurels  may  be  gathered.  Inorganic  chemistry  supplies  no  such  op- 
jwrtunities.  Its  work  is  analytical,  and  its  principles  few  and  simple  ; 
*  An  artificial  fistulous  opening  in  a  dog's  stomach  (§  366). 


PHYSIOLOGY. OKGANIC    CHEMISTRY FUNCTIONS.  203 

md  this,  alone,  is  ilie  legitimate  object  of  organic  chemistry.  That  ob- 
ject has  been  lately  well  expressed  by  Mr.  Hoblyn,  in  his  Manual  of 
Chemistry.     Thus : 

"  The  peculiar  principles  which  exist  in  all  organized  beings  are 
distinct  from  those  which  operate  on  inorganic  matters,  and  may  be 
denominated  organic  agents.  Their  mode  of  operation  is  mysterious. 
The  object  of  organic  chemistry  is  to  investigate  the  chemical  history  of 
the  products  which  occur  in  the  vegetable  and  animal  kingdoms,  and 
which  are  hence  called  organic  substances." 

I  therefore  say,  let  us  look  well  to  the  doings  of  the  chemist.  Let 
us  properly  regard  his  tampering  with  so  profound  a  subject  as  phys- 
iology, whether  in  its  natural  or  morbid  aspects.  Let  us  scrutinize 
his  facts  when  he  assails  the  experience  of  all  the  renowned  in  medi- 
cal science  through  all  past  time,  and  declares  that  experience  worth- 
less (§  350,  mottoes').  Let  us  not,  however,  indignantly  retaliate  upon 
him  his  attempts  to  overthrow  the  great  fabric  of  medicine,  or  his  ef- 
forts to  undervalue  the  labors  and  the  doctrines  of  men  wlio  have 
toiled  in  the  field  of  organic  nature,  and  have  immolated  themselves 
in  the  chambers  of  the  sick.  Let  us  rather  kindly  advise  the  chemist 
to  cultivate  modesty,  and  tell  him,  frankly,  that,  to  comprehend  the 
laws  and  the  processes  of  living  beings,  they  must  be  perpetually  the 
objects  of  profound  study,  both  in  the  natural  state  of  the  being  and 
in  all  the  variations  to  which  he  is  liable  from  the  influences  of  mor- 
bific and  remedial  agents.  Let  us  tell  him  that  he  has  acted  wisely 
in  refraining  from  all  such  observations,  and  in  making  the  laboratory 
the  exclusive  theatre  of  his  experimental  inquiries.  Either  science, 
analytical,  and  limited  in  principles  and  laws,  as  chemistry  may  be,  is 
enough  for  the  compass  of  an  individual ;  and  medicine  transcends 
the  powers  of  the  most  gigantic  mind.  The  physician,  therefore,  if  he 
aim  at  the  highest  practical  usefulness,  or  at  the  science  of  medicine, 
will  find  only  the  leisure  to  acquire  the  outlines  of  chemistry,  and  it 
is  equally  certain  that  the  chemist  who  aspires  at  a  profound  knowl- 
edge of  that  department  must  spend  his  clays  and  his  nights  within 
the  precincts  of  his  workshop, — Notes  Ddd,  Ggg,  p.  1149, 1151. 

And  now  let  us  remember,  that  there  is  not  one  name  in  all  the 
annals  of  medicine  which  rests  for  its  distinction  on  the  physical 
and  chemical  doctrines  of  life.  On  the  contrary,  in  every  instance 
where  attempts  have  been  made  to  carry  the  science  of  chemistry  into 
physiology,  in  all,  and  every  such  instance,  the  individuals  who  have 
been  so  employed  have  sunk  rapidly  into  oblivion ;  unless  here  and 
there  a  name,  like  Fourcroy's  and  Liebig's,  which  is  rescued  by  lofty 
genius,  and  by  purely  chemical  labors  in  the  inorganic  kingdom. 

376|,  a.  Finally,  I  will  not  forego  this  opportunity  of  bringing  to 
the  support  of  opinions  which  I  have  hitherto  advanced  the  following 
extract  from  Judge  Story's  late  address  before  the  Alumni  of  Har- 
vard University.  It  will  be  seen  that  the  views  of  this  distinguished 
man  are  entirely  coincident  with  those  which  I  had  expressed  in  a 
former  work.  (See  Medical  and  Physiological  Commentaries,  vol.  i., 
p.  331-333,  310,  307,  308,  327,  385-400 ;  vol.  ii.,  p.  666-677,  801- 
815,  12,  13,  203,  644,  &c.) 

"  I  have  said,"  says  this  eminent  jurist,  "  that  the  tendency  in  our 
day  is  to  ultraism  of  all  sorts.  I  am  aware  that  this  suggestion  may 
appear  to  some  minds  of  an  easy  good-nature,  or  indolent  confidence. 


204  INSTITUTES    OF    MEDICINE. 

to  be  over-wrought,  or  too  highly  colored.  But  unless  we  choose 
voluntai-ily  to  blind  ourselves  to  what  is  passing  before  our  eyes  in 
the  daily  intercourse  of  life,  it  seems  to  me  impossible  not  to  feel  that 
there  is  much  which  demands  severe  scrutiny,  if  not  serious  alarm. 
I  meddle  not  here  with  the  bold,  and  yet  familiar  speculations  upon 
government  and  polity,  upon  the  fundamental  changes,  and  even  abo- 
lition of  constitutions,  or  upon  the  fluctuating  innovations  of  ordinary 
legislation.  These  might,  of  themselves,  furnish  out  exciting  themes 
for  public  discussion,  if  this  were  a  fit  occasion  to  introduce  them.  I 
speak  rather  of  the  interests  of  letters — of  the  common  cause  of  learn- 
ing— of  the  deep  and  abiding  principles  of  philosophy.  Is  it  not  pain- 
fully true  that  the  spirit  of  the  age  has  broken  loose  from  the  strong 
ties  which  have  hitherto  bound  society  together  by  the  mutual  cohe- 
sions and  attractions  of  habits,  manners,  institutions,  morals,  and  liter- 
ature 1  It  seems  to  me,  that  what  is  old  is  no  longer  a  matter  of 
reverence  or  affection.  What  is  established,  is  not  on  that  account 
esteemed  positively  correct,  or  even  salutary  or  useful.  What  have 
hitherto  been  deemed  fundamental  truths  in  the  wide  range  of  human 
experience  and  moral  reasoning,  are  no  longer  admitted  as  axioms^ 
or  even  as  starting-points,  but  at  most  are  propounded  only  as  prob- 
lems, worthy  of  solution.  They  are  questioned  and  scrutinized,  and 
required  to  be  submitted  to  jealous  proofs.  They  have  not  even  con- 
ceded to  them  the  ordinary  prerogative  of  being  presumed  to  be  true 
until  the  contrary  is  clearly  shown.  In  short,  there  seems  to  me,  at 
least,  to  be  abroad  a  general  skepticism — a  restless  spirit  of  innova- 
tion and  change — a  fretful  desire  to  provoke  discussions  of  all  sorts, 
under  the  pretext  of  free  inquiry,  or  of  comprehensive  liberalism. 
And  this  movement  is  to  be  found  not  merely  among  illiterate  and 
vain  pretenders,  but  among  minds  of  the  highest  order,  which  are  ca- 
pable of  giving  fearful  impulses  to  public  opinion.  We  seem  to  be 
borne  on  the  tide  of  experiment  with  a  rash  and  impetuous  speed, 
confident  that  there  is  no  risk  in  our  course,  and  heedless  that  it  may 
make  shipwreck  of  our  best  hopes,  and  spread  desolation  and  ruin  on 
every  side,  as  well  on  its  ebb  as  its  flow.  The  main  ground,  there- 
fore, for  apprehension,  is  not  from  undue  reverence  for  antiquity,  so 
much  as  it  is  from  dreamy  expectations  of  unbounded  future  intellect- 
ual progress ;  and,  above  all,  from  our  gross  over- valuation  and  in- 
ordinate exaggeration  of  the  peculiar  advantages  and  excellences  of 
our  own  age  over  all  others.  This  last  is,  so  to  say,  our  besetting  sin  ; 
and  we  worship  the  idol,  carved  by  the  cunning  of  our  own  hands, 
with  a  fond  and  parental  devotion.  There  are  many  even  among  the 
educated  classes,  and  far  more  among  the  uneducated,  who  imagine 
that  we  see  now,  as  men  never  saw  before,  in  extent,  as  well  as  in 
clearness  of  vision ;  that  we  reason,  as  men  never  reasoned  before ; 
that  we  have  reached  depths  and  made  discoveries,  not  merely  in  ab- 
stract and  physical  science,  but  in  the  ascertainment  of  the  moral  and 
intellectual  powers  of  man,  and  the  true  structure  and  interests  of  gov- 
ernment and  society,  which  throw  into  comparative  insignificance  the 
attainments  of  past  ages.  We  seem  to  ourselves  to  be  emerging,  as 
it  were,  from  the  darkness  of  by-gone  centuries,  whose  glow-worm 
lights  '  show  the  matin  to  be  near,  and  'gin  to  pale  their  ineffectual 
fires,'  before  our  advancing  radiance.  We  are  almost  ready  to  per- 
suade ourselves  that  their  experience  is  of  little  value  to  us ;  ihat  the 


PHYSIOLOGY. ORGANIC  CHEMISTRY FUNCTIONS.      205 

change  of  circumstances  is  so  great,  that  what  was  wisdom  once  is 
no  longer  such ;  that  it  served  well  enough  for  the  day,  but  that  it 
ought  not  now  to  be  an  object  of  desire,  or  even  of  commendation. 

"  Nay,  the  comparison  is  sometimes  eagerly  pressed  of  our  achieve- 
ments in  literature  with  those  of  former  ages.  Our  histories  are  said 
to  be  more  philosophical,  more  searching,  more  exact,  more  elaborate 
than  theirs.  Our  poetry  is  said  to  surpass  theirs  in  brilliancy,  imag- 
inativeness, tenderness,  elegance,  and  variety,  and  not  to  be  behind 
theirs  even  in  sublimity,  or  terrific  grandeur.  It  is  more  thoughtful, 
more  natural,  more  suggestive,  more  concentrative,  and  more  thrill- 
ing than  theirs.  Our  philosophy  is  not,  like  theirs,  harsh  or  crabbed, 
or  irregular;  but  wrought  out  in  harmonious  and  well-defined  pro- 
portions. Our  metaphysical  systems  and  mental  speculations  are  (as 
we  flatter  ourselves)  to  endure  forever,  not  merely  as  monuments  of 
our  faith,  but  of  truth  ;  while  the  old  systems  must  fall  into  ruins,  or 
merely  furnish  materials  to  reconstruct  the  new — as  the  temples  of 
the  gods  of  ancient  Rome  sei've  but  to  trick  out  or  ornament  the  mod- 
ern churches  of  the  Eternal  City.  Ay,  and  it  may  be  so.  But  who 
will  pause  and  gaze  on  the  latter,  when  his  eyes  can  fasten  on  the  gi- 
gantic forms  of  the  Coliseum,  or  the  Pantheon,  or  the  Column  of  Tra- 
jan, or  the  Arch  of  Constantino  1 

"  May  I  not  stop  for  a  moment,  and  ask  if  there  is  not  much  delu- 
sion and  error  in  this  notion  of  our  superiority  over  former  ages  ;  and 
if  there  be,  whether  it  may  not  be  fatal  to  our  just  progress  in  litera- 
ture, as  well  as  to  the  permanent  interests  of  society  ?  I  would  not 
ask  those  who  entertain  such  opinions  to  accompany  me  back  to  the 
days  of  Aristotle  and  Cicero,  whose  works  on  the  subject  of  govern- 
ment and  politics  alone  have  scarcely  received  any  essential  addition 
in  principles  or  practical  wisdom,  down  to  this  very  hour.  Who,  of 
all  the  great  names  of  the  past,  have  possessed  so  profound  an  influ- 
ence and  so  wide  an  authority  for  so  long  a  period  1  Jf  time  be  the 
arbiter  of  poetical  excellence,  whose  fame  is  so  secure  as  that  of  Ho- 
mer and  Virgil  1  Whose  histories  may  hope  to  outlive  those  of  Thu- 
cydides  and  Tacitus  1  But  I  would  limit  myself  to  a  far  naiTower 
space,  to  the  period  of  the  two  centuries  which  have  elapsed  since 
our  ancestors  emigrated  to  America.  Survey  the  generations  which 
have  passed  away,  and  let  us  ask  ourselves  what  have  been  their  lit- 
erary labors  and  scientific  attainments  1  What  the  productions  of 
their  genius  and  learning  1  What  the  amount  which  they  have  con- 
tributed to  meliorate  the  condition  of  mankind — to  lay  deep  and  broad 
the  foundations  of  Theology,  and  Jurisprudence,  and  Medicine — to 
establish  and  illustrate  the  principles  of  free  goveraments  and  inter- 
national law — and  to  instruct  as  well  as  amuse  the  leisure,  and  to  re- 
fine the  taste  of  social  life  1  Unless  I  greatly  mistake,  a  calm  survey 
of  this  whole  matter  would  convince  every  well-balanced  mind,  that 
if  we  may  claim  something  for  ourselves,  we  must  yield  much  to  the 
scholars  of  those  days.  We  shall  find  that  much  of  our  own  fruits 
have  been  grafted  on  the  ancient  stocks.  That  much  of  what  we  now 
admire  is  not  destined  for  immortality.  That  much  which  we  deem 
new  is  hut  an  ill-disguised  plunder  from  the  old  repositories.  And  that 
much  which  we  vaunt  to  he  true  consists  of  old  fallacies,  often  refuted 
and  forgotten,  or  of  unripe  theories,  which  must  perish  by  the  way- 
side, or  be  choked  by  other  weeds  of  a  kindred  gi'owth. 


206  INSTITUTES    OF    MEDICINE. 

"  The  truth  is,  that  no  single  generation  of  men  can  accoviplish  muck 
of  itself  or  for  itsef  which  does  not  essentially  rest  upon  what  has  been 
done  before.  Whatever  may  be  the  extent  oi'  variety  of  labors  and 
attainments,  much  of  them  will  fail  to  reach  posterity,  and  much  which 
reaches  them  will  be  felt,  not  as  a  distinct  formation,  but  only  as  com- 
ponent ingredients  of  the  general  mass  of  knowledge.  Many  of  the 
immortals  of  one  age  cease  to  be  such  in  the  next  which  succeeds  it ; 
and,  at  best,  after  a  fitful  season  of  renown,  they  quietly  pass  away, 
and  sleep  well  in  the  common  cemetery  of  the  departed.  What  is 
present  is  apt  to  be  dazzling  and  imposing,  and  to  assume  a  vast  im- 
portance over  the  distant  and  the  obscure.  The  mind  in  its  perspect- 
ive becomes  affected  by  the  like  laws  as  those  of  the  natural  vision. 
The  shrub  in  the  foreground  overtops  the  oak,  that  has  numbered  its 
centuries.  The  hill  under  our  eye  looms  higher  than  the  snowy  Alps, 
which  skirt  the  edge  of  the  hoinzon. 

"  But  let  us  subject  this  matter  to  a  little  closer  scrutiny,  and  see  if 
the  annals  of  the  last  two  centuries  alone  do  not  sufficiently  admonish 
us  of  the  mutability  of  human  fame,  as  well  as  that  of  human  pursuits. 
What  a  vast  amount  of  intellectual  power  has  been  expended  during 
that  period,  which  is  now  dimly  seen,  or  entirely  forgotten !  The 
very  names  of  many  authors  have  perished,  and  the  titles  of  their 
works  are  to  be  gathered  only  from  the  dusty  pages  of  some  obscure 
catalogue.  What  reason  can  we  have  to  suppose  that  much  of  our 
own  labors  will  not  share  a  kindred  fate  %  But,  turning  to  another 
and  brighter  part  of  the  picture,  where  the  mellowing  hand  of  time 
has  touched  with  its  finest  tints  the  varying  figui'es.  Who  are  there 
to  be  seen  but  Shakspeare,  and  Milton,  and  Bacon,  and  Locke,  and 
Newton,  and  Cudworth,  and  Taylor,  and  Barrow,  not  to  speak  of  a 
host  of  others,  whose  works  ought  to  be  profoundly  studied,  and 
should  illustrate  every  library.  I  put  it  to  ourselves  to  say,  who  are 
the  men  of  this  generation  to  be  brought  into  comparison  with  these.,  in 
the  extent  and  variety  of  their  labors,  the  powers  of  their  genius,  or  the 
depth  of  their  researches  1  Who  of  ourselves  can  hope  to  exercise  an 
influence  over  the  human  mind  as  wide-spread  as  theirs  ]  Who  can 
hope  to  do  more  for  science,  for  philosophy,  for  literature,  for  theolo- 
gy, than  they  %  I  put  the  argument  to  our  modesty,  whether  we  can 
dispense  with  the  products  of  their  genius,  and  wisdom,  and  learning; 
or  may  cast  aside  their  works,  as  mere  play-things  for  idlers,  or  curi- 
osities for  collectors  of  the  antique  % 

"  I  have  but  glanced  at  this  subject.  It  would  occupy  a  large  dis- 
course to  unfold  it  in  its  various  bearings  and  consequences.  But  the 
strong  tendency  of  our  times  to  disregard  the  lessons  and  the  author- 
ity of  the  past  must  have  any  thing  but  a  salutary  effect  upon  all  the 
complicated  interests  of  literary  as  well  as  social  life.  It  not  only 
loosens  and  disjoints  those  institutions,  which  seem  indispensable  to 
our  common  happiness  and  security,  but  it  puts  afloat  all  those  prin- 
ciples, which  constitute,  as  it  were,  the  very  axioms  of  all  sound  phi- 
losophy and  literature.  In  no  country  on  earth  is  the  danger  of  such 
a  tendency  so  pregnant  with  fearful  results,  as  in  our  own  ;  for  it 
nurses  a  spirit  of  innovation,  and  experiment,  and  oscillation,  which 
leaves  no  resting-place  for  sober  meditation  or  permanent  progress. 
It  was  the  striking  remark  of  an  acute  obsei-ver  of  the  human  mind, 
that  '  he  who  sets  out  with  doubting,  will  find  life  finished,  before  he 


PHYSIOLOGY. FUNCTIONS.  207 

becomes  master  of  the  rudiments ;'  and  that  he  who  begins  by  pre- 
suming on  his  own  sense  has  ended  his  studies  as  soon  as  he  has 
commenced  them." — Judge  Story's  Address,  &c.* 

376|,  h.  In  parting,  for  the  present,  with  organic  chemistry  . 
would  again  pay  my  humble  tribute,  to  a  science  of  exalted  worth,  in 
its  vocation  of  laying  open  the  constitution  and  laws  of  inorganic  na- 
ture, and  in  applying  its  results  to  many  of  the  most  useful  purposes 
of  life.  The  physiologist  venerates  the  science,  does  homage  to  its 
cultivators,  would  do  battle  for  its  cause.  In  protecting  the  great  In- 
stitution which  it  is  his  province  to  illustrate,  in  preserving  unsullied 
the  stupendous  philosophy  of  Medicine,  he  makes  no  enci'oachment 
on  a  sister  science  ;  but,  ever  obedient  to  the  voice  of  Nature,  he  wor- 
ships in  all  her  temples  (i^  1034). 

4.    DISTRIBUTION. 

377.  The  fourth  function  common  to  animals  and  plants  is  distribu- 
tion or  circulation.  In  the  former,  after  the  food  has  become  so  far 
assimilated  as  to  receive  the  final  act  of  appropriation,  or,  in  other 
words,  after  it  is  formed  into  blood,  it  must  be  distributed  to  all  parts 
of  the  body,  for  their  growth,  nutrition,  &c.  This  office  is  performed 
by  the  heart  and  blood-vessels  in  all  perfect  and  superior  animals, 
and  by  the  blood-vessels  alone  in  the  inferior  tribes,  and  whenever 
the  heart  is  wanting.  In  the  last  instance  the  means  are  very  similar 
to  those  which  carry  on  the  circulation  in  plants. 

378.  The  mechanism  of  circulation  is  shown  by  the  function.  In 
the  perfect  animals  the  blood  is  expelled  by  the  left  venti'icle  of  the 
heait  into  the  aorta,  and  thence  distributed  to  all  parts  of  the  body ; 
where  it  is  applied  to  nutrition  and  secretion,  and  undergoes  depura- 
tion by  the  excretory  organs.  Such  as  is  not  thus  appropriated  is 
sent  forward  to  the  communicating  veins,  by  which  it  is  conveyed  to 
the  right  auricle,  and  from  thence  to  the  right  ventricle,  to  be  distrib- 
uted to  the  lungs  through  the  pulmonary  artery,  and  returned,  again, 
to  the  left  ventricle  through  the  pulmonary  veins  and  left  auricle.  In 
the  lungs,  the  venous  blood  is  converted  to  arterial,  and  perfected  foi 
the  various  exigencies  of  organic  life,  by  the  joint  agency  of  the  pul- 
monary mucous  tissue  and  atmospheric  air  (§  419,  827  b). 

379.  A  remarkable  exception  occurs  to  the  foregoing  general  plan 
of  the  circulation  in  the  transmission  of  venous  blood  from  the  ab- 
dominal viscera  to  the  liver,  through  the  vena  portae.  It  is  also 
anomalous,  that  this  blood  is  appropriated,  in  part,  to  the  formation 
of  an  organic  fluid,  the  bile,  while  the  residue  is  transmitted  to  the 
vena  cava  through  the  hepatic  veins ;  these  veins  being  also  the  asso- 
ciate medium  for  the  return  of  blood  from  the  hepatic  artery  (i^lOSl). 

380.  There  are  three  principal  distinctions  between  the  blood  senl 
out  by  the  left  ventricle  and  that  which  is  returned  to  the  right :  1st. 
The  color  of  venous  blood  is  a  modena  red  ;  that  of  arterial  a  bright 
scarlet.  2d.  Venous  blood  is  more  highly  charged  with  carbonaceous 
matter  than  the  arterial.  3d.  Venous  blood  will  not  support  the  life 
of  organs. 

381.  The  blood  supplies  all  parts  with  their  means  of  nutrition,  se- 
cretion, &c.,  and  is,  itself,  the  stimulus  by  which  its  own  circulatory 
organs  are  excited  to  motion,  and  by  which  the  formative  and  secre- 
tory vessels  are  maintained  in  their  action.     The  pahtdum  vitce  is, 

*  See  a  remai-kable  parallel  to  the  foregoint;  in  Tacitus'  Dialogue  concerning  Ora- 
tory.    The  coincidences  should  admonish  us  tlie  more. 


208  INSTITUTES    Cf    MEDICINE. 

therefore,  remarkably  distinguished  from  all  other  substances  in  na- 
ture, in  being  equally  the  stimulus  of  the  whole  circulatory  system, 
and  the  substance  acted  upon  and  appropriated  according  to  the  na- 
ture of  every  part  in  which  it  may  circulate  (§  136). 

It  is  the  same  with  the  sap  of  plants  as  with  the  blood ;  both  being 
alike  the  pabvlum  vitce.  Each  is  every  where  converted  into  the 
solid  organs  to  which  it  is  distributed,  and  into  fluids  and  other  prod- 
ucts which  have  their  special  allotment  in  organic  life ;  and  nothing 
is  formed  which  is  not  derived  immediately  from  the  blood  or  sap  (§ 
41-44,  847  c,  1053). 

OF    THE    POWERS    WHICH    CIRCULATE    THE    BLOOD.* 

382.  Much  of  the  philosophy  of  medicine  is  involved  in  a  right  es- 
timate of  the  powers  which  carry  on  the  circulation  of  the  blood. 
But,  having  set  forth  this  subject  extensively  in  the  Medical  and 
Physiological  Commentaries,  I  shall  now  limit  my  remarks  to  a  state- 
ment of  the  most  prominent  facts  (§  407,  a). 

383,  a.  A  great  error  has  prevailed  of  ascribing  the  circulation  of 
the  blood  to  the  propelling  power  of  the  heart  alone.  Another,  less 
common,  imputes  venous  circulation  to  the  action  of  the  capillary  ar- 
teries ;  while  a  still  greater  regards  it  as  a  hydrostatic  phenomenon 
dependent  on  the  arterial  column  of  blood.  Another,  subversive  of 
all  principles  in  medicine,  refers  the  circulation  in  the  capillary  ves- 
sels— those  instruments  of  all  the  essential  organic  processes — to  cap- 
illary attraction.  Another  supposes  that  the  blood  is  moved  in  viitue 
of  its  own  inherent  power.  Another,  that  the  globular  portion  is 
composed  of  animalcula,  which  traverse  the  circulatory  system  by 
their  locomotive  endowment.  But,  the  most  obnoxious  to  objection 
is  the  latest  speculation  which  flows  from  the  universal  doctrine  of 
Liebig,  that 

"  All  vital  activity  arises  from  the  mutual  action  of  the  oxygen  of 
the  atmosphere  and  the  elements  of  the  food  ;"  that  "  the  life  of  ani- 
mals exhibits  itself  in  the  continual  absorption  of  the  oxygen  of  the 
air,  and  its  combination  with  ceitain  component  parts  of  the  animal 
body ;"  and  that  "  the  cause  of  the  state  of  motion  is  to  be  found  in 
a  series  of  changes  which  the  food  undergoes  in  the  organism ;  those 
changes  being  the  results  of  processes  of  decomposition,  to  which  the 
food  itself,  or  the  structures  formed  from  it,  or  parts  of  organs,  are 
subjected."     (See  §  350,  nos.  9,  10,^  1054). 

This  last  hypothesis  imputes  the  circulation  entirely  to  the  chemical 
action  of  oxygen  gas  upon  the  tissues  and  upon  the  blood  itself;  re- 
jects, altogether,  the  propelling  and  suction  power  of  the  heart,  over- 
looks the  respiratory  movements,  the  peristaltic  action  of  the  intesti- 
nal canal,  the  permanent  contraction  of  the  sphincters,  the  motions  of 
the  iris,  denies  all  vascular  action,  even  in  the  face  of  such  phenome- 
na as  blushing,  and  all  other  sympathetic  movements,  nor  recognizes 
a  local  morbid  physiological  determination  of  blood,  or  a  morbid  pro- 
cess, or  a  physiological  influence  of  therapeutical  agents,  but  con- 
strues all  these  unique  results  upon  the  same  chemical  phenomenon. 

383,  h.  A  modification,  however,  of  this  doctrine  concedes  an  in- 
strumentality of  the  heart  in  circulating  the  blood.  The  heart  still 
acts  in  virtue  of  the  combustive  process ;  and  so  far  the  doctrine  is 

*  The  term  powers,  as  here  employed,  comprehends  the  instruments  of  circtdation. 


PHYSIOLOGY. FUNCTIONS.  209 

consistent.  But  it  is  fundamentally  contradicted  by  the  incongruity 
of  the  two  great  sources  of  power  at  the  apex  and  at  the  circumfer- 
ence of  the  circulation,  when  contrasted  with  the  exact  balance  which 
prevails  between  the  moving  power  of  the  heart  and  the  circulation 
of  the  blood  in  the  capillary  system.  Nor  is  there  to  be  found  in  na- 
ture two  such  distinct  sources  of  power  for  the  accomplishment  of  a 
specific  effect  as  that  which  imputes  the  circulation  of  the  blood  to 
an  associate  mechanical  impulse  by  the  heart  and  a  chemical  process 
in  the  capillary  blood-vessels  (§  129). 

384.  There  are  numerous  elements  concerned  in  the  circulation  of 
the  blood,  each  one  of  which  I  have  endeavored  to  substantiate  in  a 
former  work.* — See  also  p.  934,  ^  1090. 

1st.  The  heart  possesses,  through  its  vital  properties,  an  active 
power  of  dilating  and  contracting  (§  498,  e,  1090), 

2d.  The  arteries  possess  a  similar  power,  though  in  a  far  inferior 
degree.  This  has  been  determined  by  the  application  of  irritants. — 
{Medical  and  Physiological  Comm.,  vol.  ii.,  p.  147-152,  375-403.) 

3d.  The  capillary  arteries,  or  the  reservoirs  of  blood  to  the  ex- 
treme vessels,  have  the  same  power,  which  is  much  more  actively  ex- 
ercised than  in  the  larger  arteries.  The  capillaries  are  consequently 
brought  into  greater  action  when  stimulated  by  physical  agents,  as  in 
inflammatory  diseases,  or  by  the  nervous  power,  as  in  blushing  (§ 
480,  1039),  or  as  it  lights  up  inflammation  (§  647^,  746  c,  973-974). 

4th.  The  extreme  vessels,  or  terminating  series  of  the  arterial  sys- 
tem, have,  also,  a  like  power  of  contracting  and  dilating  actively,  and 
in  a  still  greater  degree  than  the  capillary  arteries  (§  136,  750). 

5th.  The  extreme  capillary  veins  have,  also,  a  special  action  of  the 
foregoing  nature,  which  aids  in  transmitting  the  blood  from  the  arte- 
rial system  to  the  next  larger  series  of  veins. 

6th.  The  larger  veins  possess  the  power  of  dilating  and  contracting 
actively,  according  to  the  varying  quantities  of  blood  transmitted  from 
the  arterial  system.  Their  constant  conatus  to  contract  on  their  con- 
tents assists  in  the  transmission  of  the  blood. 

7th.  All  the  cavities  of  the  heart  operate  upon  the  principle  of  an 
exhausting  pump,  during  their  dilatation. — Note  Bb  p.  1131. 

385.  All  the  foregoing  powers  (§  384)  concur  together,  according 
to  a  consummate  Design,  in  circulating  the  blood.  All  are  important 
elements ;  no  one  adequate  in  itself,  while  each  should  be  studied  by 
itself,  as  well  as  in  connection  with  the  whole  (§  74,  80,  117,  137,  143, 
155,  156,  169/,  266,  3031  a,  306,  310,  311,  387,  399,  409/  422, 
514  h,  524  d,  525,  526  d,  528,  638,  733  h,  750,  764  h,  811,  847  c, 
848,  902/  905,  1054).     The  Exp.  &c.  are  in  the  Commentaries.* 

386.  The  contraction  and  dilatation  of  the  heart  and  arteries  are, 
respectively,  nearly  synchronous.  Although  there  be  a  perfect  consent 
of  action  between  the  capillaries,  the  extreme  vessels,  and  the  heart, 
those  vessels  are  not  associated  with  the  movements  of  the  heart, 
nor  with  each  other,  in  the  same  way  as  the  actions  of  the  heart  and 
arteries ;  and  they  are  modified,  also,  according  to  the  special  func- 
tions they  perform  in  different  parts  (133  h,  135  a,  136).  The  case 
of  blushing  shows  us  the  law  in  regard  to  the  capillaries  (§  476,  &c.). 

387.  The  final  cause  of  motion  in  the  veins  is  chiefly  that  of  sub- 

*  Medical  and  Physiological  Commentaries,  vol.  ii.,  p.  375-426,  147-152,  and  the  Essay 
on  the  Theoiies  of  Inflammation,  ibid. 


210  INSTITUTES    OP    MEDICINE. 

serving  the  arterial  system ;  and  here  the  consent  of  action  between 
the  veins  and  arteries  is  still  more  illustrative  of  the  profound  nature 
of  the  principles  and  laws  which  govern  the  functions  of  organic  life. 
It  has  been,  indeed,  the  universal  doctrine  that  the  capacity  of  the 
veins  is  determined  in  a  mechanical  manner  by  the  volume  of  blood 
transmitted  from  the  arteries  ;  but  I  have  endeavored  to  show  that  the 
supposed  physical  distension  and  elastic  contraction  of  the  veins  are 
without  foundation,  and  would  form  a  most  serious  obstacle  to  the  cir- 
culation of  the  blood.  On  the  contrary,  it  appears  that  those  actions 
are  not  only  of  a  vital  nature,  but  that  they  are  a  perpetual  illustra- 
tion of  sympathy,  depending  upon  sympathetic  relations  of  the  veins 
to  the  communicating  series  of  arterial  capillaries. 

This  peculiar  constitution  of  the  veins  explains  the  reason  why  they 
collapse  when  divided  ;  since  their  sympathetic  relation  to  the  arteries 
is  thus  extinguished.  The  veins,  indeed,  appear  to  be  not  less  sus- 
ceptible of  action  from  the  stimulus  of  sympathy  with  the  capillary 
artei'ies  than  the  iris  with  the  retina  (§  514,  k),  whose  phenomena  so 
clearly  demonstrate  the  operation  of  that  principle  in  developing  sen- 
sible motions ;  but  compounded  as  to  veins  of  continuous  and  remote.* 

The  dilatations  and  contractions  of  the  veins  are,  therefore,  very 
greatly  effected  by  reflex  nervous  influences  exerted  upon  them  by  the 
varying  states  of  the  capillary  arteries,  as  well  as  by  the  quantities  of 
blood  they  are  employed  in  transmitting  to  the  veins.  These  influ- 
ences appear  to  be  originally  felt  by  the  capillary  series  of  veins, 
where  the  organic  properties  are  most  strongly  pronounced,  and 
thence  propagated  by  continuous  sympathy  to  the  larger  series  (§  498, 
and  Co7n7n.,  vol.  ii.,  p.  520,  521,  &c.),  when  reflex  actions  ensue.* 

Did  not  a  consent  of  action  with  the  arteries  (depending  on  the 
princijjle  of  sympathy,  §  452,  495,  &c.,  498)  exist  in  the  veins,  the  vi- 
tal contractility,  and  the  elastic  property  of  the  coats,  must  be  me- 
chanically overcome  by  the  increased  quantity  of  blood  transmitted  to 
them.  The  blood  must  be  forcibly  injected  into  the  capillary  veins 
by  the  vis  a  tergo,  and  in  numerous  parts  of  difficult  penetration 
by  the  finest  injections  of  art.  This  is  utterly  repugnant  to  that  Uni- 
ty of  Design  which  prevails  in  all  parts  of  the  organized  being,  and 
would  be  leaving  an  important  function  to  a  fortuitous  and  inadequate 
pi-ovision.  Nor  can  it  be  consistently  supposed  that  the  phenomena 
which  appertain  to  one  class  of  vessels  are  of  a  vital  nature,  and 
those  of  the  other,  resulting  in  an  anatomically  associated  series, 
mechanical. 

The  veins  possess,  also,  longitudinal  fibres,  by  which  they  are  fit- 
ted for  rapid  and  uniform  motion  over  an  extensive  tract ;  and  this 
action  implies  a  predominance  of  continuous  sympathy  (§  498).  It  is 
also  proved  that  the  veins,  like  the  heart  and  arteries,  dilate  actively 
on  the  application  of  certain  stimuli  to  their  external  surface. — 
{Med.  and  Physiolog.  Comm.,  vol.  ii.,  p.  147-152,  375-401.) 

388.  Venous  circulation  is  determined  principally  by  the  suction 
or  derivative  power  of  the  right  cavities  of  the  heart,  but  is  aided  by 
the  contractile  power  of  the  large  veins,  by  the  more  specific  action 
of  the  capillary  veins,  and  by  the  propelling  power  of  the  communi- 
cating series  of  arterial  capillaries.  The  contraction  of  the  left  ven- 
tricle of  the  heart,  and  that  of  the  large  arteries,  have  little  or  no 
agency  in  venous  cii'culation.     Their  force  is  probably  exhausted,  or 

■*  Continuous  sympathy  is  continuous  in fluerice  of  these  Institutes  (sec.  129  c,  f,  498  a) 


PHYSIOLOGY. FUNCTIONS.  211 

nearly  so,  when  the  blood  has  reached  the  terminal  series  of  the  arte- 
rial system. 

The  blood  is  returned  from  the  lungs  to  the  left  cavities  of  the  heart 
by  the  powers  just  stated. 

It  is  not  alone  the  dilatation  of  the  auricles  which  constitutes  the 
derivative  power,  as  had  been  supposed  till  1  investigated  this  subject; 
but  equally,  also,  that  of  the  ventricles  [^  1090). 

389.  In  the  Medical  and  Physiological  Commentaries,  I  have  ex- 
amined every  objection  which  has  been  alleged  against  the  imputed 
dependence  of  venous  circulation  upon  the  dilatation  of  the  cavities  of 
the  heart,  and  atmospheric  pressure.  One  objection  had  been  stated 
with  greater  force  and  apparent  plausibility  than  the  rest,  by  Di"s. 
Philip,  Arnott,  and  other  eminent  men  ;  namely,  that  the  pai'ietes  of 
the  veins  should  collapse  upon  the  supposed  doctrine  of  suction.  To 
this  objection  I  have  replied,  that  the  injecting  power  of  the  commu- 
nicating arterial  capillaries  maintains  the  veins  in  a  state  of  fullness. 
The  perfectly  harmonious  relation  among  the  powers  which  circulate 
the  blood  establishes  a  correspondence  between  the  movements  in 
the  venous  and  arterial  systems,  by  which  nature  has  duly  provided 
against  so  great  an  evil  as  apprehended. 

390,  a.  The  suction  power  of  the  heart,  as  I  have  endeavored  to 
show  in  the  "Commentaries,"  is  indispensable  to  the  portal  circula- 
tion, and  to  that,  also,  of  the  lymphatics,  lacteals,  thoracic  duct,  and 
umbilical  vein ;  though,  doubtless,  the  independent  action  of  these 
vessels  contributes  to  the  motion  of  their  contents. 

390,  h.  In  the  foregoing  work  I  have  considered  the  objection  rela- 
tive to  the  occasional  jet  of  blood  from  a  vein  wounded  in  venesec- 
tion in  certain  conditions  of  disease ;  and  I  purpose  now,  from  its 
ambiguous  relation  to  my  subject,  adverting  to  the  causes  of  the  in- 
termitting pulse  that  so  often  attends  congested  states  of  the  liver. 
This  phenomenon  has  been  long  observed ;  but  no  substantial  cause 
has  been  assigned.  It  is  due,  I  apprehend,  to  two  influences,  one  of 
which  is  sympathetic,  the  other  more  or  less  mechanical. 

The  sympathetic  is  readily  appreciated ;  the  mechanical,  and  most 
important,  requires  explanation.  In  my  Essay  on  Inflammation,  and 
in  the  present  work,  I  have  endeavored  to  show  that  the  current  of 
blood  is  accelerated  in  the  vessels  immediately  concerned  in  that 
morbid  process,  notwithstanding  the  enlarged  diameters  of  the  vessels 
(§  711,  &c.).  But  not  so  in  venous  congestion,  unless  the  propelling, 
and  therefore,  also,  the  suction  power  of  the  heart,  be  considerably 
increased.  It  often  happens,  however,  that  the  force  of  the  heart, 
in  venous  congestions  of  the  liver,  is  even  reduced  below  its  ordinary 
standard,  however  there  may  be  an  attendant  hardness  of  the  pulse 
(§  688).  Now,  therefore,  since  the  veins  undergo  an  enlargement  in 
their  congested  states,  and  since,  also,  the  volume  of  blood  which  is 
transmitted  to  the  heart  through  the  portal  system  is  very  large,  if  it 
enter  that  organ  in  an  unusual  manner,  it  is  highly  probable  that  it 
would  embarrass  its  action.  Such  would  be  the  effect  of  a  sluggish 
or  irregular  ingress,  especially,  as  will  be  seen,  if  not  correspondent 
with  the  egress  of  blood. 

But,  it  not  unfrequently  happens  that  the  pulse  becomes  intermit- 
tent, for  the  first  time,  after  the  hepatic  affection  has  sensibly  yielded. 
This  occurs,  however,  mostly,  if  not   altogether,   in   rather  intense 


212  INSTITUTES    OF    MEDICINE. 

fonns  t  £  venous  congestion,  and  wlicrc  the  force  of  the  heart,  and 
therefore  its  suction  power,  are  manifestly  increased,  so  much  so, 
indeed,  that  practitioners,  cautious  of  blood-letting,  will  venture  upon 
the  remedy.  An  incomplete  subsidence  of  the  disease,  and  the 
means  of  treatment,  reduce  the  action  of  the  heart ;  and  the  suction 
power  being  thus  lessened,  while  the  veins  remain  yet  enlarged,  the 
blood  moves  with  a  tardy  pace  in  the  portal  veins,  and  disturbs  the 
rhythmic  action  of  the  heart. 

There  is  also  another,  and  important  element  of  this  mechanical 
cause,  which  consists  in  an  interrupted  balance  between  the  blood 
which  enters  the  heart  and  that  which  is  projected  from  it ;  its  en- 
trance being  rendered  slow  by  the  state  of  the  portal  veins,  while  its 
projection  is  unembarrassed.  If  the  pulse  be  merely  intermittent, 
and  only  so  after  several  beats,  excitement  from  exercise,  but  not 
from  the  mind,  will  often  restore,  for  a  sliort  time,  the  harmony  of 
both  ventricles.  Mental  excitement,  on  the  contrary,  through  nervous 
influence,  is  apt  to  increase  the  intermission,  and  often  adds  an  irreg- 
ularity (§  227,  509,  &c.).  But,  unlike  the  simply  intermitting,  an  ir- 
regular pulse  is  commonly  increased  in  its  irregularity  by  violent 
exercise,  as  well  as  by  excitements  of  mind.  The  intermitting  pulse, 
on  the  contrary,  is  often  most  strongly  pronounced  in  the  horizontal 
posture.      Pvcflcx  nervous  influences  enact  a  part  in  this  phenomenon. 

The  nature  of  the  sympathetic  cause  will  be  readily  appreciated 
by  the  accurate  observer,  when  he  considers  how  often  intermis- 
sions or  irregularities  of  the  pulse  are  increased  by  a  full,  and  some- 
times a  scanty  meal  (§  512),  through  reflex  nervous  actions. 

Cerebral  inflammation  often  gives  rise  to  an  irregular  action  of  the 
heart ;  but  here  the  cause  is  determined  by  the  nervous  power  alone 
(§  226,  &c.).  In  the  case  of  the  brain,  also,  the  pulse  is  apt  to  be 
more  irregular  than  intermittent ;  while  in  that  of  the  liver  it  may 
be  both  (§  G87,  &c.). 

391.  The  valves  of  the  veins  have  been  universally  supposed  to  con- 
tribute essentially  to  venous  circulation,  by  supporting  the  column 
of  blood.  This,  however,  I  have  endeavored  to  show,  is  a  mistaken 
opinion  ;*  for  they  are  always  open  when  the  current  of  blood  is  pass- 
ing. Like  the  valves  of  the  heart  their  great  final  cause  is  to  prevent 
the  reflux  of  blood  when  pressure  operates,  and  to  contribute  to  the 
like  design  of  the  frequent  inosculation  of  the  veins.  The  supposed 
co-operation  of  the  voluntary  muscles  in  venous  circulation  is  also 
merely  accidental. 

392,  a.  It  appears,  therefore,  that  the  whole  theory  of  the  circula- 
tion is  strictly  relative  to  the  properties  of  life.  The  pressure  of  the 
atmosphere,  by  which  the  blood  is  forced  along  the  returning  vessels, 
is  entirely  incidental ;  and,  although  the  transit  of  blood  from  one 
part  to  another  is  merely  mechanical,  its  motion  originates  entirely  ir. 
vital  agencies.  The  facts,  of  which  the  foregoing  conclusions  are 
predicated,  arc  very  numerous,  and  contribute  to  some  of  the  most 
important  pathological  and  therapeutical  principles.  It  may  bo  use- 
ful to  consider  yet  farther  some  of  the  most  indisputable,  and  to  re- 
gard them,  at  the  same  time,  in  their  connection  with  the  laws  of 
which  they  are  the  foundation. 

392,  h.  Although  the  vascular  system  contributes  an  important  part 

*  Medical  and  Physiological  Commentaries,  vol.  ii.,  p.  412,  426. 


PHYSIOLOGY. FUNCTIONS.  213 

toward  the  common  circulation,  the  heart  possesses  within  itself  a 
general  control  over  this  gi-eat  function  of  life.  Had  it  been  other- 
wise, "  a  thousand  causes  might  intervene,  over  which  the  organ,  so 
limited  in  influence,  could  have  no  control,  to  retard  or  divert  the 
course  of  the  blood  ;  and  which,  by  occasioning  one  short  delay,  might 
pi-event  its  return  forever."  It  is,  therefore,  not  only  the  great  mo- 
tive source,  through  its  contractile  power,  in  the  universal  act  of  dis- 
tribution, but,  to  effect  a  return  of  the  venous  blood,  "  it  is  made  the 
centre  of  atmospheric  pressure  and  gravity,  and  designates  the  stage 
in  the  circulation  in  which  a  deficiency  of  supply  would  be  the  last  in 
being  felt.  Hence  it  appears  that  the  functions  of  the  heart  are  per- 
formed, and  life  preserved,  notwithstanding  long  and  copious  dis- 
charges of  blood,  which,  upon  any  other  hypothesis,  must  have  been 
fatal.  For,  according  to  these  hypotheses,  the  heart,  or  at  least  the 
auricles,  are  placed  at  the  end  of  projection.  They  mark  the  highest 
advance  of  the  tide,  and  would  first  be  abandoned  by  the  retii'ing 
fluid.  They  would  be  drained  by  every  profuse  hemorrhage,  and  the 
heart  would  expend  its  energy  in  fruitless  efforts  to  circulate  a  fluid 
that  came  not  within  its  reach."  Upon  any  other  theory,  how  could 
what  Armstrong  calls  "  the  beautiful  balance  between  the  right  and 
left  sides  of  the  heart"  be  preserved]  How,  otherwise,  would  the 
circulation  be  restored  in  syncope  ]  In  respect,  also,  to  the  absorbent 
power,  it  is  farther  well  said  by  Carson,  that,  "  though  we  are  not  ac- 
quainted with  any  data  from  which  the  power  of  the  heart  can  be  cal- 
culated, there  must  exist,  nevertheless,  certain  limits,  within  which  it 
must  reasonably  be  supposed  to  be  confined.  If  we  consider  that  the 
quantity  of  blood  in  circulation  is  neai-ly  one  fifth  of  the  weight  of  the 
whole  body ;  that  this  gieat  mass  is  spread  over  an  immense  surface ; 
that  it  is  therefore  subjected  to  great  resistance  from  friction,  espe 
cially  in  the  small  vessels  where  each  globule  is  to  be  rolled  over  a 
fixed  surface ;  that  the  currents,  in  consequence  of  anastomosing 
branches,  arc  perpetually  flowing  in  opposite  directions,  and  that  at- 
traction must  powerfully  prevail  between  the  blood  and  small  vessels; 
when  wc  consider  the  mass  moved,  the  motion  with  which  it  is  moved, 
and  the  resistance  opposed,  it  is  impossible  to  imagine  that  this  labor 
could  have  been  performed  by  the  propelling  power  of  the  ventricle  ;" 
besides  the  obvious  objections  of  the  liability  of  the  curvature  of  the 
aorta  and  the  capillary  arteries  to  be  ruptured,  and  the  exigencies  of 
the  portal,  placental,  and  lymphatic  circulation  (§  390). 

Again,  "the  two  trunks  of  the  ascending  and  descending  cava  meet 
at  the  heart  in  such  a  manner  as  to  form  a  straight  line.  The  streams 
of  blood  which  are  conveyed  by  these  vessels  to  the  heart  are  placed 
at  that  point  in  direct  opposition.  Upon  the  supposition  that  the  blood 
is  returned  to  the  heart  by  a  vis  a  tergo,  this  position  of  the  vessels  is 
the  most  unfavorable  that  can  be  conceived  for  the  ofHce  that  is  as- 
signed to  them.  The  momentum  of  blood  in  one  vessel  would  be  de- 
stroyed by  that  of  the  other ;  or,  if  the  current  in  the  descending  was 
stronger  than  that  in  the  ascending  cava,  the  blood  in  the  weaker 
stream  would  be  prevented  from  ever  reaching  the  heart." 

392,  c.  In  the  Medical  and  Physiological  Commentaries,  especially 
in  the  Essays  on  Inflammation,  and  the  Powers  which  Circulate  the 
Blood,  I  have  exhibited  a  great  amount  of  proof  establishing  the 
vital  actions  of  the  capillary  blood-vessels,  and  showing  that  the  mo 


214  INSTITUTES   OF    MEDICINE. 

mentum  of  the  blood,  as  derived  from  the  left  cardiac  ventricle,  is 
nearly  lost  in  the  capillaries.  The  opinion  of  Hunter,  Bichat,  Philip, 
and  other  distinguished  observers,  to  the  same  effect,  being  founded 
upon  the  most  ample  investigations,  vs^ould  seem  to  leave  no  doubt 
upon  a  question  of  such  fundamental  importance  in  the  philosophy 
of  organic  life.  "  Have  they,"  says  Wilson  Philip,  "  who  maintain 
that  the  circulation  is  supported  by  the  muscular  power  of  the  heart 
alone,  made  even  the  rudest  calculation  of  the  degree  of  resistance 
to  be  overcome  in  driving  the  blood  through  two  capillary  systems  at 
such  a  rate,  that,  in  a  given  time,  the  same  quantity  shall  be  delivered 
by  the  veins,  which  is  thrown  into  the  arteries  ?  Have  they  made 
any  estimate  of  the  strengtli  necessary  in  the  different  sets  of  vessels, 
and  particularly  in  the  larger  arteries,  to  sustain  a  power  capable  of 
overcoming  this  resistance  1  Let  them  give  what  imaginable  power 
they  will,  they  cannot  make  this  power  greater  than  the  coats  of  the 
vessels  will  bear  without  rupture"  (^  1054, 1056). 

So  completely  arrested,  indeed,  is  the  momentum  of  blood  when 
it  reaches  the  arterial  capillaries,  so  manifest  are  the  vital  actions  of 
these  vessels,  and  so  unaccountably  did  Philip  and  Bichat  overlook 
the  suction  power  of  the  heart,  that  they  ascribed  the  circulation  in 
the  veins  entirely  to  the  propelling  action  of  the  capillary  arteries. 
Owing  to  this  limited  view,  Bichat  was  led  to  observe,  that,  "  not- 
withstanding all  that  has  been  written  as  to  the  cause  of  venous  cir- 
culation, there  is  an  obscurity  in  it,  in  which  there  are  but  few  rays 
of  light."  The  circulation  of  the  liver  embaiTassed  him  especially; 
since  any  general  hypothesis  which  should  fail  here  must  be  wholly 
abandoned  (^  390).  He  considered  it,  however,  "  incontestibly 
proved,  that  when  the  blood  has  arrived  in  the  general  capillary  sys- 
tem, it  is  absolutely  beyond  the  influence  of  the  heart,  and  that  the 
left  ventricle  has  no  influence  in  the  venous  system." 

392,  d.  The  demonstrations  of  a  direct  nature,  to  show  the  inde- 
pendent action  of  the  blood-vessels  (the  veins  as  well  as  arteries), 
are  too  numerous  and  various  for  concentrated  observation.  They 
are  scattered  throughout  this  work,  and  many  of  importance  occur 
only  in  the  Medical  and  Physiological  Commentaries  (vol.  ii.,  p.  147- 
152,  375-401).  The  original  suggestions  of  many  belong  to  myself, 
ds,  also,  their  general  application  to  the  subjects  before  me.  It  has 
been  one  of  my  special  objects  to  demonstrate  an  active  dilatation  of 
all  the  blood-vessels,  as  well  as  their  active  contraction.  The  latter, 
indeed,  proves  that  the  dilatation  is  active  and  vital.  The  greater 
principle  lies  in  the  necessity  of  a  counteracting  power ;  since  active 
contraction  alternating  with  dilatation  necessarily  implies  correspond- 
ing principles  of  motion,  or  there  would  be  a  permanent  state  of 
contraction  or  tonic  spasm.  The  sanguiferous  system,  therefore, 
would  be  devoid  of  function,  and  nothing  but  "  stagnation"  would 
be  the  great  law  of  organic  nature  (§  748,  1039,  1090). 

393.  The  doctrine  of  venous  circulation,  as  I  have  expounded  it 
here,  and  proved  it  extensively  in  the  '*  Commentaries,"  is  replete 
with  the  most  important  physiological,  pathological,  and  therapeutical 
conclusions.  It  strikes  a  fatal  blow  at  the  whole  mechanical  hypoth- 
esis and  the  stimulant  treatment  of  venous  congestion  (§  788-793), 
as  shown  in  my  Essay  on  that  affection.  It  determines  all  the  great 
fundamental  points  which  have  been  in  dispute  respecting  the  circu- 


PHYSIOLOGY. FUNCTIONS.  215 

lation  of  the  blood.  It  proves  that  the  propelling  force  of  the  left 
ventricle  of  the  heart  is  lost,  or  nearly  so,  in  the  extreme  capillary- 
arteries.  It  proves,  what  is  of  greater  importance  than  all  things 
else  in  the  Institutes  of  medicine,  that  the  extreme  vessels  possess  an 
independent  vital  action  ;  since  otherwise  the  blood  could  never  be 
carried  forward  in  the  veins  by  the  power  of  suction  (§  389).  But 
that  would  not  be  the  greatest  oversight  in  the  plan  of  organic  na- 
ture (^  1039,1040). 

394.  The  highest  practical,  as  well  as  philosophical,  conclusions 
are  involved  in  a  correct  estimate  of  the  powers  which  determine  the 
circulation  of  the  blood  (§  393).  But  there  are  no  errors  so  prolific 
of  evil,  and  so  derogatory  to  medical  philosophy,  as  that  which  as- 
sumes a  passive  state  of  the  terminal  series  of  the  arteries,  or  that 
circulation  is  carried  on  in  that  series  by  capillary  attraction,  or  by 
their  oxydation  (§  383). 

Were  either  of  these  hypotheses  true,  there  could  be  none  of  the 
organic  products,  as  derived  from  the  blood,  no  secretion,  no  nutri- 
tion— not  a  principle  in  physiology,  pathology,  or  therapeutics ;  for 
all  the  essential  organic  functions,  and  all  the  processes  of  disease, 
are  carried  on  by  the  terminal  series  of  the  arteries  (§  481  g,  483,  &c.). 

Consider  the  phenomena  of  sympathy  ;  contemplate  the  experi- 
ments of  Philip  to  determine  the  laws  of  the  vital  functions ;  study 
the  laws  of  the  nei"vous  power  in  their  relation  to  organic  functions ; 
observe  how  instantly  mental  emotions  will  variously  affect  the  action 
of  the  heart,  or  bring  a  suffusion  of  blood  to  the  pallid  face,  or  how 
stimuli  applied  to  the  brain  will  as  instantly  produce  corresponding 
results  (§  481-485);  and  you  will  concede  that  these  results  of  the 
operation  of  the  nervous  power  demonstrate  the  independent  vital  ac- 
jdoxL  of  the  capillary  vessels,  and  overtui'n  the  physical  and  chemical 
hypotheses  of  life. 

395.  The  foregoing  influence  of  the  cerebro-spinal  and  ganglionic 
systems  upon  the  capillaries  and  extreme  vessels  is  of  the  highest  im- 
portance in  pathology,  and  in  the  philosophy  and  treatment  of  dis- 
ease. These  vessels  are  not  only  the  instruments  of  disease,  but  they 
sustain  all  the  morbific  influences  which  result  in  sympathetic  dis- 
eases, and  upon  these  vessels  all  remedial  agents  exert  their  curative 
effects,  whether  by  their  direct  action,  or  through  the  instrumentality 
of  the  nervous  power  (§  222-233|,  456  a,  1039,  Note  Bb  p.  1131). 

396.  Nor  is  it  alone  an  active  condition  by  which  the  terminal  se- 
ries of  arteries  is  remarkably  distinguished.  Our  various  facts  estab- 
lish the  no  less  important  principles,  that  the  several  orders  of  term- 
inal vessels  have  their  vital  properties  and  actions  strongly  pronoun- 
ced, and  that  these  properties  and  actions  are  peculiarly  modified  in 
their  natural  state,  both  in  a  general  sense,  and  in  different  parts,  and 
that  they  are  liable  to  various  other  peculiar  modifications  from  the 
operation  of  morbific  and  therapeutical  agents.  Hence,  all  our  cura- 
tive means  must  have  a  steady  and  direct  reference  to  the  existing 
condition  of  these  extreme  capillary  vessels  (§  149,  150,  &c.). 

397.  Of  the  extreme  vessels  physiologists  have  supposed,  with  great 
reason,  that  thei'e  are  at  least  three  series  ;  one  being  destined  for  nu- 
trition, another  for  the  secretion  and  excretion  of  the  fluids,  and  an- 
other series  coinciding  with  the  veins. 

Without  being  disposed  to  submit  this  question,  in  the  least,  to  the 


816  INSTITUTES    OF    MEDICINE. 

microscope  (§  131),  there  might  be  allowed,  according  to  Wagner, 
what  has  probably  been  hypothetically  suggested  by  the  well-known 
simplicity  of  nature,  that  there  is  "  but  one  kind  of  termination  in  ref- 
erence to  an  artery — a  passage  into  a  vein  through  a  capillary  vessel, 
and  an  intermediate  net-work."  In  this  case,  however,  there  must 
either  exist  lateral  projections  from  the  terminal  capillary,  or  there 
must  radiate  from  the  "  intermediate  net-work"  vessels  whose  office  is 
to  distribute  the  blood  from  which  are  eliminated  the  materials  for 
nutrition,  &c. 

398.  The  extreme  vessels  which  are  destined  for  nutrition,  secre- 
tion, and  excretion,  elect  from  the  blood,  contained  in  their  reservoirs 
the  capillary  arteries,  the  precise  elements  that  are  necessary  to  the 
formation  of  each  peculiar  compound  throughout  the  body,  and  in 
such  uniform  proportions  and  modes  of  combination  as  shall  forever, 
and  without  deviation,  render  them  exactly  conformable  to  the  nature 
of  every  part,  as  ordained  at  the  Creation  (§  41-44).  This  is  done 
in  virtue  of  the  peculiarly  modified  states  of  irritability  and  other 
properties  of  life,  according  to  the  exact  office  of  every  part.  Yet 
are  these  the  vessels  which  are  said  to  be  under  the  sole  government 
of  physical  and  chemical  laws  (§  383),  and  whose  morbid  state  in  in- 
flammation is  constituted  by  a  mechanical  relaxation  of  their  parietes, 
and  a  stagnation  and  coagulation  of  their  contents  (§  711,  &c.)  ! 

399.  In  their  natural  state,  the  foregoing  vessels  admit  but  very  few 
of  the  red  globules  of  blood,  in  virtue  of  their  peculiarly  modified  ir- 
ritability; and  this,  therefore,  where  the  calibre  surpasses  the  diam- 
eters of  the  red  globules.  There  is  no  mechanical  "straining  off  oi 
the  finer  from  the  coarser  parts  of  the  blood"  by  an  inadequate  capa- 
city of  those  vessels  which  convey  only  white  blood  (§  493,  d).  The 
separation  is  effected  in  a  homogeneous  substance,  and  by  causea 
which  are  very  foreign  to  "strainers"  and  "sieves"  (§  129,  135-138, 
266,  750).  The  same  principle  interprets  the  admission  of  the  red 
globules  into  those  serous  vessels,  in  inflammation.  In-itability  is  there 
morbidly  affected,  and  the  usual  process  of  vital  decomposition  of  the 
blood  is,  of  course,  aiTested  (§  327-329).  The  entire  blood  then  finds 
its  way  into  the  lymph  vessels,  as  they  are  called  ;  and  the  organic 
law  by  which  that  result  is  determined  (§  192,  278)  is  beautifully  illus- 
trated by  two  experiments ;  one  by  Buniva,  the  other  by  Procter 
The  experiments  also  confirm  the  doctrines  which  I  have  taught  as  to 
the  character  of  the  nei-vous  power,  and  its  agency  in  organic  actions, 
while  both  observers  pursuing  different  routes,  and  attaining  a  com- 
mon end  through  opposite  effects,  but  by  common  principles  relative 
to  the  nervous  power,  illustrate  and  confirm  the  experiments  of  each 
(§  222-233|,  476,  &c.,  500). 

Buniva  had  great  difficulty  in  effecting  an  injection  of  an  artery  of 
a  living  dog,  till  he  divided  the  spinal  cord,  when,  by  thus  withdraw- 
ing the  stimulus  of  the  nervous  power,  the  capillaries  lost  their  pecu- 
liar susceptibility,  and  the  contents  of  the  syringe  passed  freely  on. — 
Buniva  (^  1039,  1056). 

In  Procter's  experiment,  "  a  horse  was  killed  by  dividing  the  me- 
dulla, the  bowels  turned  aside,  and  the  branch  of  the  sympathetic 
nerve,  which  joins  the  ischiadic,  laid  bare ;  also,  one  of  the  arteries 
of  the  leg.  A  wire  applied  to  the  positive  pole  of  a  galvanic  bat- 
tery, defended  with  sponge,  was  applied  to  the  nerve,  and  the  nega 


PHYSIOLOGY. FUNCTIONS.  217 

tive  wire  to  the  artery.  The  positive  wire  was  then  drawn  slowly 
along  the  plates  of  a  fifty-plate  battery  and  the  effect  was  certainly 
not  only  to  reproduce  the  pulsation  in  the  artery,  but  also  clearly  to 
excite  circulation  in  the  more  minute  vessels."  A  by-stander  ex 
claimed,  "  See  how  that  pipe  beats  when  they  put  on  those  wires !' 
— Procter,  on  the  Sympathetic  Nerve.     1844. 

To  the  foregoing  may  be  added  the  experiment  by  Dr.  Hall  (§  263) 
which,  it  will  have  been  observed,  is  insuperably  opposed  to  his  con 
elusions  as  to  the  agency  of  the  nervous  system  in  producing  organic 
actions,  and  as  examined  in  my  Essays  on  "  Vitality,"  &c.  (p.  42 
note).  See,  also,  Experiments  by  Kriemer,  §  485,  and  Philip,  §  483 
and  Dr.  Parry's  case,  §  487,  gg. — Note  Q,  p.  1122. 

5.    APPROPRIATION,    OR   NUTRITION    AND    SECRETION. 

400.  Appropriation,  like  assimilation,  is  a  comprehensive,  though 
less  complex,  function.  It  embraces  what  are  commonly  designated 
as  two  functions,  namely,  nutrition  and  secretion. 

401,  a.  A  common  fluid  being  formed,  and  distributed  to  the  sever- 
al parts  of  the  animal  and  vegetable,  is  then  appropriated  to  their 
several  uses. 

401.  b.  Animals  are  distinguished  by  an  unceasing  change  of  the 
materials  of  which  they  are  composed.  The  actions  of  life  disturb 
the  composition  of  parts,  which,  being  thus  unsuited  for  the  purposes 
of  organization,  and  reduced  to  a  fluid  state,  are  returned  to  the 
general  circulating  mass  of  blood,  where  they  either  again  undergo 
assimilation,  or  are  eliminated  and  cast  off"  by  the  excretory  organs. 
To  supply  this  waste  is,  in  part,  the  office  of  appropriation,  which 
furnishes  new  molecules  from  the  blood,  in  exact  conformity  with  the 
process  of  disintegration  after  growth  is  completed,  but  occuiTing  in 
excess  while  nutrition  is  engaged  in  rearing  up  the  fabric  to  a  state 
of  maturity.  Appropriation  is  also  the  function  through  which  those 
secreted  fluids,  which  act  as  auxiliaries  in  the  processes  of  life,  are 
renewed  in  their  original  character. 

402.  Appropriation,  therefore,  whether  it  ref^r  to  the  increase  and 
renewal  of  the  solid  parts,  or  to  the  production  of  useful  fluids,  being 
equally  a  process  of  secretion,  every  organic  product,  vegetable  or 
animal,  is  the  result  of  secretion.  But  appropriation,  as  applied  to 
the  useful  fluids  that  are  formed  from  the  blood  or  sap,  is  more  com- 
monly known  as  an  act  of  secretion ;  and  though  the  next  function 
which  will  be  considered,  namely,  excretion,  is  very  analogous,  yet  the 
final  causes  of  secretion  and  excretion  being  entirely  different,  it  is 
proper  that  they  should  be  arranged  as  distinct  processes. 

Since,  however,  nutrition,  secretion,  and  excretion  are  very  analo- 
gous processes,  secretion  is  a  good  generic  term  for  the  whole.  Each 
process  consists  of  certain  acts  by  which  new  formations  are  gener- 
ated from  the  blood.  All  parts  are  first  eliminated  in  a  fluid  state. 
Such  as  are  destined  for  nutrition  assume  the  condition  of  the  solids 
which  they  supply  as  soon  as  eliminated :  such  as  subserve  the  uses 
of  fluids  remain  permanently  fluid.  It  is  evident,  therefore,  that  ap- 
propriation, in  a  philosophical  sense,  is  the  highest  act  of  assimila- 
tion, but  may  be  very  propei'ly  regarded  as  a  function  by  itself 

403.  Every  part  of  the  body  possesses  a  secreting  apparatus,  since 
every  part  appropriates  the  blood  to  itself  (§  398). 


218 


INSTITUTES    OF    MEDICINE. 


404.  The  organs  which  generate  the  permanent  fluid  products  are 
very  various,  and  more  complex  than  such  as  carry  on  nutrition.  The 
former  are  either  glands  or  simple  membranes,  acting  in  their  com- 
pound condition  (§  92).  The  immediate  instruments  consist  of  a  sim 
pie  series  of  extreme  vessels  which  pervade  every  part,  and  which 
are  every  where  so  constituted,  anatomically  and  vitally,  that  they 
elaborate  from  the  common  nutritive  fluid  such  compounds  as  are  ex- 
actly conformable  to  the  nature  of  each  part  respectively  (§  41-44, 
133,  &c.,  135  I,  188,  &c.,  205,  &c.,  233,  397,  398). 

405.  The  variety  of  secreted  products,  solid  and  fluid,  is  greatei, 
and  the  quantity  more  abundant  in  animals  than  in  plants,  and  in  pro- 
portion, also,  to  the  complexity  of  organization. 

406.  The  following  products  of  secretion  which  remain  more  oi 
less  fluid  occur  in  the  animal  kingdom.  The  first  six  are  common  to 
most  animals : 

1.  Gastric  juice. 

2.  Saliva. 

3.  Pancreatic  juice. 

4.  Bile. 


Concerned  in  digestion. 
C  Of  the 


5.  Serous  fluids. 


{ 


6.  Mucous  fluids. 


7.  Tears. 


serous  tissues, 
cellular  tissue, 
articular  tissues, 
chambers  of  the  eye. 
capsule  of  the  lens, 
labyrinth  of  the  ear. 
^  Of  the  mucous  tissue  of  the  mouth. 

"  "         nose. 

"  "         pharynx. 

"  "         larynx  and 

trachea. 

"  "        lungs. 

'•  "         stomach. 

"  "        intestines, 

urinary  and  genital  organs, 
skin  of  aquatic  animals. 


I 


C  Suet,  and  fat  of  cellular  tissue. 

Marrow  of  bones. 

Liquids  in  the  cryptee  of  the  skin. 

Cerumen  of  the  ear. 

Fatty  fluid  of  prepuce. 
I   Many  other  oily  products. 
^  Ink  of  the  sepia. 
J  Liquids  of  insects, 
j  Virus  of  serpents,  &c. 
[^  Galvanism  of  torpedo,  &c. 
Humors  of  the  spider,  and  of  other  insects,  from  which  their 
webs,  cocoons,  &c.,  are  formed. 

Germinal  fluid. 

Semen. 

Product  of  vesiculae  seminales. 

Liquor  of  Cowper's  glands. 

Liquids  in  the  foetal  membranes. 

The  milk  of  mamraifera. 


8.  Fatty  or  oily  liquids.     < 


9.  Fluids  of  defense. 


10. 


11.  Fluids  necessary  to  the 
preservation  of  the 
species. 


IHYSIOLOGY. FUNCTIONS.  219 

The  foregoing  fluids  are  variable  according  to  the  nature  of  the  an- 
imal, but  always  the  same  in  each  species,  and  analogous,  respective- 
ly, in  all  (§  53,  &c.,  83). 

407,  a.  In  considering  the  mechanism  and  the  function  of  appro- 
priation, it  devolves  upon  the  Institutes  of  Medicine,  as  in  all  other 
anatomical  and  physiological  inquiries,  to  apply  the  whole  to  the  elu- 
cidation of  the  laws  upon  which  the  mechanism  is  founded,  and  un- 
der which  the  phenomena  take  place.  It  will  still  be  my  pui-pose, 
therefore,  to  interrogate  the  whole  in  their  various  relations,  and  to 
illustrate  the  philosophy  of  the  whole  by  contrasting  the  defects  of 
spurious  systems. 

407,  h.  The  exact  anatomical  condition  of  the  instruments  of  nu- 
trition and  secretion,  as  well  as  the  functions  themselves,  can  never 
be  brought  within  the  cognizance  of  sense  ;  nor  would  it  be  of  any 
practical  use  to  know  them  beyond  what  is  revealed  by  the  vital  and 
physical  results  (§  S3,  131).  By  these  facts  we  are  enabled  to  insti- 
tute many  of  the  most  important  conclusions  in  physiology.  By 
them,  especially,  we  demonstrate  the  errors  of  the  physical  and 
chemical  doctrines  of  capillary  circulation,  and  of  the  chemical  and 
mechanical  hypotheses  relative  to  secretion.  By  them,  we  show  that 
all  the  products  from  the  blood,  as  well  as  effusions  of  blood  in  the 
ordinary  forms  of  capillai-y  hemorrhage,  find  their  way  out  of  the 
vessels  through  some  vital  act,  and  that  the  physical  doctrines  of  per- 
colation, and  endosmose  and  exosmose,  have  no  foundation  in  or- 
ganic nature  (§  131,  275). 

407,  c.  It  has  been  also  seen  by  demonstrations  in  respect  to  the 
development  of  the  ovum,  that  appropriation  is  conducted  by  the 
same  powers  throughout  the  life  of  the  being  that  were  brought  into 
action  by  the  stimulus  of  semen  ;  and  it  may  be  now  added  that  the 
coincidence  is  beautifully  enforced  by  a  progressive  and  uninterrupt- 
ed march  of  that  primary  development,  which  was  instituted  in  the 
ovum,  after  the  beginning  of  independent  life  (§  63-81,  153-159). 

408,  The  mechanical  doctrine  of  filtration,  which  supposes  the  in- 
calculable variety  of  secreted  products  to  exist  already  formed  in 
the  blood  (§  41),  still  disfigures  the  physiology  of  the  schools,  and 
forms  a  prominent  characteristic  in  the  prevailing  pathology  of  in- 
flammation. To  the  whole  of  this  subject,  as  well  as  to  the  chemical 
hypotheses,  I  have  given  an  extensive  investigation  in  my  Essays  on 
the  Humoral  Pathology,  on  the  Vital  Powers,  on  the  Theories  of  In- 
flammation, on  Endosmose  and  Exosrnose,  and  on  Diabetes,  as  em- 
braced in  the  Medical  and  Physiological  Commentaries.  Many  re- 
markable assumptions,  intended  to  sustain  the  physical  rationale  of 
vital  processes,  are  there  examined  and  refuted.  But,  the  explosion 
of  one  error,  it  has  been  said,  often  prepares  the  way  for  another ;  as 
exemplified  in  the  following  quotation,  relative  to  the  hypothesis  of 
endosmose  and  exosmose  : 

"  This  permeability  to  gases,"  says  Liebig,  "  is  a  mechanical  prop- 
erty, common  to  all  animal  tissues ;  and  it  is  found,  in  the  same  degrea 
in  the  living  as  in  the  dead  tissue." — Liebig's  Ani?nal  Chemistry.— 
See,  also,  §  350,  1031  h. 

409,  a.  When  considering  the  subject  of  proteine  in  a  former  sec- 
tion (§  IS),  I  reserved  for  this  place  all  that  was  not  immediately  rel- 
ative to  elementary  composition.    What  was  there  set  forth  should  be 


220  INSTITUTES    OF    MEDICINE. 

applied  in  connection  with  what  I  shall  now  advance  in  continuation 
of  the  subject. 

409,  h.  We  have  seen  that,  in  opposition  to  the  received  doctrines 
as  quoted  from  Liebig  in  section  18,  there  is  nothing  in  the  secreted 
products  of  animals,  solid  or  fluid,  that  subsist  on  vegetable  substan- 
ces similar  to  the  food,  except  in  elementary  composition,  nor  in  the 
blood  itself;  while  it  is  also  affirmed  by  Liebig,  that  "  analogy,  that 
fertile  source  of  error ^  lias  urfortunately  led  to  the  very  unapt  com- 
parison of  the  vital  functions  of  plants  with  those  of  animals  ^  But 
the  reader,  who  may  have  attended  to  the  parallel  columns,  and  the 
sections  on  the  chemical  hypotheses  of  disease  and  therapeutics,  will 
be  neither  surprised  at  the  inconsistencies  now  and  formerly  indicated 
as  to  the  prerogative  of  the  vegetable  kingdom  in  doing  the  whole 
work  of  assimilation,  and  even  trespassing  upon  that  of  appropriation^ 
in  behalf  of  the  animal  tribes,  nor  unprepared  for  a  farther  explosion 
of  the  doctrine  by  its  principal  author.  Let  us,  therefore,  hear  the 
chemist  yet  farther  in  his  contradiction  of  the  great  fundamental  doc- 
trine (§  IS).     Thus : 

"We  must  not  forget,"  says  Liebig,  "that,  in  Avhatever  light  we 
may  view  the  vital  operations,  the  production  of  nervous  matter  from 
the  blood  presupposes  a  change  in  the  composition  and  qualities  of 
the  constituents  of  blood.  That  such  change  occurs  is  as  certain  as 
that  the  existence  of  the  nervous  matter  cannot  be  denied.  In  this 
sense,  we  must  assume  that  from  a  compound  oi proteine  may  be  form- 
ed ^  first,  second,  third,  ^c,  product^  before  a  certain  number  of  its 
elements  can  become  constituents  of  the  nervous  matter." 

Again,  having  in  view  another  special  point,  we  are  told  that 

"  This  much,  at  least,  is  undeniable,  that  the  herbs  and  roots  con- 
sumed by  the  cow  contain  no  butter ;  that  in  hay,  or  the  other  fodder 
of  oxen,  no  beef  suet  exists ;  that  no  hog's  lard  can  be  found  in  the 
potato  refuse  given  to  swine ;  and  that  the  food  of  geese  or  fowls 
contains  no  goose  fat  or  capon  fat;" — "  that  as  yet  no  trace  of  starch 
or  sugar  has  been  detected  in  arterial  blood,  not  even  in  animals 
which  had  been  fed  exclusively  with  those  substances." — (See  Comm., 
vol.  i.,  p.  674-682.) 

And  what  gives  special  plausibility  to  these  speculations  is  the  con- 
troversy which  has  taken  place  between  "  the  Reformer"  on  one 
side,  and  Dumas  and  other  French  chemists,  on  the  other,  respecting 
the  origin  oi  fat ;  the  former  maintaining  that  it  results  from  trans- 
formations of  sugar,  starch,  and  other  "  vegetable  proximates,"  while 
the  latter  contend  that  not  only  this,  but  agree  with  Liebig  that  all 
the  other  unique  products  of  herbivorous  animals  are  formed  without 
the  aid  of  their  complex  assimilating  organs, — that  they  are  merely 
applied  as  generated  by  the  plant.  In  this  latter  doctrine  is  also  seen 
a  striking  display  of  the  human  mind  to  run  into  simple  views  of  na- 
ture ;  overlooking  all  the  complicated  facts  and  the  whole  labyrinth  of 
animal  organization,  and  making  the  ultimate  sustenance  of  animal 
life  but  one  remove  from  the  constituents  of  the  atmosphei'e  (§  SOS^^, 
304,  305,  322). 

And  again,  when  chemical  demonstrations  cannot  be  resisted, 

"  We  must  admit,"  says  Liebig,  "  as  the  7nost  important  result  of 
the  study  of  the  composition  of  gelatinous  tissue,  and  as  a  point  unde- 
niahly  established,  that,  although  formed  from  compounds  of  pioteine 


PHYSIOLOGY. FUNCTIONS.  22  J 

it  no  longer  belongs  to  the  series  of  the  compounds  of  proteine.  No 
substance  analogous  to  the  tissues  yielding  gelatin  is  found  in  vege- 
tables." 

Nay,  not  even  in  the  blood  itself;  though, 

"  It  is  conceivable  that  membranes  and  tissues  vi^hich  yield  gelatin 
are  formed  from  albumen  by  the  addition  of  oxygen,  of  the  elements 
of  watei',  and  those  of  ammonia,  accompanied  by  a  separation'of  sul- 
phur and  phosphorus.  At  all  events,  their  composition  is  entirely 
DIFFERENT  from  that  of  the  chief  constituents  of  the  blood"  "  But 
there  is  no  doubt  that  these  tissues  are  formed  from  the  constituents 
of  the  blood"  !   Q,.  E.  D. — Liebig's  Animal  Chemistry. 

It  will  be  thus  seen  that  the  chemist  is  finally  coerced  to  the  admis- 
sion that  many  of  the  most  important  organic  compounds  depend 
altogether  upon  the  specific  action  of  organs  by  which  they  are  elab- 
orated from  the  blood,  and  that  he  is  even  embarrassed  with  a  "  doubt" 
whether  "  these  tissues  are  formed  from  the  constituents  of  the  blood.'* 
The  admission  is  comprehensive.  It  betrays  the  factitious  nature  of  the 
whole  physical  rationale.  It  proclaims  that  eveiy  secreted  product  is 
different  from  the  common  source  of  supply,  and  different  in  every 
part  of  the  animal.  Chyme  differs  from  chyle,  and  blood  from  either. 
Each  differs  in  every  species  of  animal,  from  man  down  to  the  white- 
blooded  tribes ;  yet  each,  wherever  existing,  is  forever  the  same  in 
the  same  species.  And  so  with  plants,  even  with  such  as  seek  for 
ammonia  and  nitrates  upon  the  dung-hill,  or  others  that  gather  iodine 
from  the  deep  (§  289,  350,  nos.  26^,  77).  Each  product,  therefore,  is 
generated  in  its  unique  characteristics  by  agents  and  processes  which 
are  designed  specifically  for  the  formation  of  each.  Nor  would  this 
be  doubtful  to  any  observer  who  may  pass  along  the  various  grada- 
tions of  the  assimilating  organs  from  their  simple  condition  in  plants 
to  that  complexity  which  demanded  the  superaddition  of  the  nervous 
systems  (§  336,  356  a,  461,  478  5, 488^,  493  cc,  500  nn,  893  a,  c,  893^). 

If  we  take,  now,  the  premises  on  which  the  chemist  proceeds  to 
the  exact  conclusions  which  he  sets  forth  in  his  formulae  of  organic 
compounds,  those  who  have  been  inattentive  to  his  method  will  be 
surprised  at  its  destitution  of  all  but  vague  conjecture,  where  organic 
compounds  are  concerned  ;  and,  for  the  unique  nature  of  these  com- 
pounds the  reader  must  turn  to  what  I  have  said  on  the  subject  of 
Composition.     The  following  is  the  great  starting  point : 

"  The  organs  are  formed  from  the  blood,  and  contain  the  elements 
of  the  blood.  They  become  transformed  into  new  compounds  with 
the  addition  only  of  oxygen  and  water.  Hence  the  relative  propor- 
tion of  carbon  and  nitrogen  must  be  the  same  as  in  the  blood. 

"  If,  then,  we  subtract  from  the  composition  of  blood  the  elements 
of  the  urine,  then  the  remainder,  deducting  the  oxygen  and  water 
which  have  been  added,  must  give  the  composition  of  the  bile. 

"  Or,  if  from  the  elements  of  the  blood  we  subtract  the  elements  of 
the  bile,  the  remainder  must  give  the  composition  of  urate  of  ammo- 
nia, or  of  urea  and  carbonic  acid"  !  Q,.  E.  D. — Liebig's  Animal  Chem- 
istry. — See  Lehmann's  opinion  p.  780,  ^  1029,  1031  b. 

Such,  once  more,  is  the  basis  of  oiganic  chemistry,  with  all  the  ap- 
parent precision  of  mathematics  in  its  extraction  of  a  cube  root ;  yet 
never  the  same  in  its  analysis  of  the  elementary  composition  of  the 
blood,  avowing  the  homogeneous  nature  of  that  compound  of  17  or 


222  INSTITUTES    OF    MEDICINE. 

18  elements,  and,  finally,  in  the  very  midst  of  its  mathematical  accu- 
racy, allowing  that  there  is  no  one  organic  compound  elaborated  from 
the  blood  by  the  living  similar  to  the  results  of  artificial  processes. 
This  I  have  already  abundantly  shown,  even  in  the  present  section, 
and  in  another  relative  to  it  (§  18).  The  same  evidence  abounds  in 
the  parallel  quotations  (§  350),  and  a  glance  at  the  "  Animal  Chem- 
istry,''' or  the  "  Organic"  would  supply  other  facts  for  my  present 
purpose.  Thus,  in  the  following  sentences  enough  is  conceded  to 
substantiate  my  position ;  and  it  is  worth  the  specific  remark  that 
**  we  know  with  certainty"  that  albumen  and  fibrin  have  not  the  same 
composition. 

"  We  must  be  careful  not  to  deceive  ourselves  in  our  expectations 
of  what  chemical  analysis  can  do.  We  know,  with  certainty,  that  the 
numbers  representing  the  relative  proportions  of  the  organic  elements 
are  the  same  in  albumen  and  fibrin,  and  hence  we  conclude  that  they 
have  the  same  composition." 

"  If  we  reflect,  that  from  the  albumen  and  fibrin  of  the  body  all 
the  other  tissues  are  derived,  it  is  perfectly  clear  that  this  can  only 
occur  in  two  ways.  Either  certain  elements  have  been  added  to,  or 
removed  from,  their  constituent  parts,"  and  so  on. — Liebig's  Animal 
Chemistry. — Note  N  p.  1121. 

409,  c.  If  the  viper  be  fed  exclusively  with  any  one  substance,  its 
peculiar  poison  will  be  generated  ;  and  so  of  the  characteristic  prod- 
ucts of  the  civet,  the  cuttlefish,  the  skunk,  the  beaver,  &c. ;  each, 
also,  being  always  generated  by  one  particular  part.  Here,  then,  are 
tests  for  an  important  and  compi'ehensive  philosophy.  From  these 
we  may  descend  along  a  scale,  where  we  shall  find  in  some  of  the  se- 
creted products  of  every  animal  and  plant  certain  prominent  charac- 
teristics which  declare  that  not  only  these,  but  the  less  striking,  also, 
are  as  much  dependent  on  special  organization,  and  special  powers 
and  actions,  as  the  poison  of  the  viper,  or  the  fcetor  of  the  skunk,  or 
the  civet,  or  the  beaver,  or  the  ink  of  the  cuttlefish,  &c.  AVill  any 
thing  in  nature,  excepting  the  mucous  tissue  of  the  stomach,  produce  a 
substance  at  all  analogous  to  the  gastric  juice  ]  Is  there  any  thing 
analogous  to  semen  in  the  blood  %  Can  it  be  genera*:ed  by  any  thing 
but  the  testis  (§  83,  b)%  Can  it  be  surmised  that  it  is  at  all  the  prod- 
uct of  forces  which  govern  the  inanimate  world  %  Consider  the  na- 
ture of  granulations,  so  obvious  to  the  eye,  and  yet  so  analogous  to 
the  products  of  nutrition.  From  whatever  parts  of  the  body  they 
spring  up,  they  have  all,  originally,  the  same  appearance.  The  same 
in  bone  as  in  muscle.  But,  so  various  are  the  modifications  of  their 
vital  constitution,  that  they  ultimately  elaborate  substances  exactly 
conformable  to  the  nature  of  the  tissues,  respectively,  by  which  the 
granulations  were  generated.  We  know  that  there  must  be  specific 
powers  to  effect  these  results,  and  that  in  each  tissue,  and  in  the  gran- 
ulations thereof,  the  powers  ai'e  modified ;  and  we  know,  also,  that 
the  results  defy  all  explanation  by  any  chemical  or  mechanical  laws. 

409,  d.  Carry  the  same  principle  to  morbid  conditions.  Is  not  the 
virus  of  hydrophobia  generated  exclusively  by  the  salivary  glands, 
and  by  those  glands  in  a  particular  state  of  disease,  and  probably,  also, 
by  the  canine  and  feline  tribes  alone  %  Does  not  every  morbid  prod- 
uct require  a  specific  mode  of  disease  ]  Is  not  this  distinctly  exem- 
plified in  scarlatina,  measles,  small-pox ;  and,  therefore,  equally  true 


PHYSIOLOGY. FUNCTIONS.  223 

in  less  striking  cases  1  Equally  as  true  of  common  pus  as  of  the  pus 
of  variola  1  And  here  I  would  refer  to  what  I  have  said,  in  my  Es- 
say on  Inflammation,  of  the  nature  and  formation  of  pus;*  how  its 
formation  is  indiscriminately  imputed  by  the  same  philosophers  to  a 
spontaneous  alteration  of  blood  in  the  large  vessels,  to  chemical  ac- 
tions in  the  small,  and  to  the  decomposition  of  dead  animal  matter; 
how  its  analysis  has  led  different  chemists  to  opposite  conclusions 
both  as  to  its  nature  and  formation ;  and  how  it  is  affirmed  by  the 
chemist  to  be  unchangeably  the  same,  whether  the  product  of  an  ab- 
scess, of  a  chancre,  or  of  the  variolous  pustule.  The  confusion  in 
these  respects  is  very  remarkable,  showing  the  perfect  inadequacy  of 
the  principles  by  which  the  explanation  is  attempted ;  while  they, 
who  believe  that  animated  nature  operates  by  other  forces,  see  noth- 
ing but  admirable  simplicity,  and  a  fountain  of  the  highest  practical 
advantages  to  mankind  (^  653). 

409,  e.  Again,  do  we  not  find  remarkable  relations  between  the 
structure  of  secreting  organs  and  the  matter  secreted  (§  346)  ]  Where 
organization  is  most  complex,  the  secretions  are  most  compounded, 
and,  as  the  structure  becomes  more  and  more  simple,  so  also  do  the 
corresponding  secretions.  And  yet,  in  the  most  simple  membranes, 
apparently  of  the  same  organization,  the  products,  according  to  Cu- 
vier  and  others,  are  almost  as  various  as  the  different  species  of  ani- 
mals, consisting  of  fluids  in  some,  and  of  air  in  others  ;  yet  always  the 
same  in  each  species.  On  the  other  hand,  what  complexity  of  organ- 
ization in  the  liver  of  the  higher  animals ;  yet  all  is  precise,  harmoni- 
ous, and  adapted  to  specific  ends.  Those  ends,  and  that  complexity, 
are  fatal  to  all  the  chemical  and  physical  views  of  the  functions  of 
assimilation  and  appropriation.  And  yet  is  the  secretion  of  bile, 
which,  according  to  the  chemists,  is  composed  of  forty  different  com- 
pounds, and  these  made  up  of  four  or  five  elements,  compared  to 
what  is  supposed  to  be  a  chemical  evolution  of  carbon  from  the 
blood;  and  the  liver  is  also  said,  by. distinguished  physiologists,  to  be 
merely  a  "  strainer  of  bile."  We  are  told  that  "  physiologists  have 
been  induced  to  suppose  that  the  structure  of  the  kidney  is  such  that 
it  allows  the  urea  to  percolate  through  the  fine  vessels  emptying  into 
its  pelvis,  like  the  mechanical  operation  of  sifting  ox  filtering,  but  de- 
nies a  passage  to  the  other  constituents  of  the  arterial  blood."  But 
how  "  deny"  them  ;  why  do  they  never  escape  ;  why  do  not  the  con- 
stituents of  the  bile  come  this  way,  and  vice  versa  ?  Is  it  more  diffi- 
cult for  one  substance  to  "  sift  and  filter"  its  "  passage"  through  one 
set  of  vessel's  than  the  other  %  The  iatro-mechanical,  it  is  true,  are 
Comparatively  few  with  the  iatro-chemical  philosophers.  The  latter 
have  also  greater  zeal.  They  are  more  recently  in  a  field  full  of  se- 
ductive novelties,  and  other  allurements,  while  pure  chemistry  can 
offer  nothing  but  the  details  of  analysis  (^  1032). 

409,  y!  All  the  secreted  fluids  not  only  have  an  apparatus  peculiar 
to  each,  whose  complexity  \eorresponds  remarkably  with  the  com- 
pound nature  of  their  products,  but  they  are  all  destined  for  import- 
ant specific  ends  in  the  economy  of  living  bodies ;  a  final  purpose  of 
which  chemistry  and  physics  are  wholly  incapable.  One  would  be 
perfectly  unsuited  to  the  office  of  another,  and  would  be  even  destruc- 
tive of  life,  in  most  of  the  cases,  should  one  product  interchange  with 
*  In  Medical  and.  Physiological  Commentaries,  vol.  ii.,  p.  181-204. 


224  INSTITUTES    OF    MEDICINE. 

another  (§  129,  135-137).  The  saliva,  gastric  and  pancreatic  juices, 
are  designed  for  digestion;  the  blood  being  thus  an  almost  direct 
cause  of  its  own  reproduction  (§  323-325,  356  a).  The  bile  sub- 
serves three  specific  purposes,  w^hich,  when  regarded  in  their  connec 
tion,  supply  one  of  the  most  remarkable  instances  of  Design.  This 
fluid  participates  directly  in  the  assimilation  of  food,  is  the  important 
cause  of  peristaltic  motion,  and  performs,  lastly,  that  inferior  office, 
which  is  often  regarded  as  its  only  one,  of  contributing  with  the  lungs, 
kidneys,  and  skin,  as  an  emulgent  of  the  blood,  though  in  a  different 
aspect  from  the  organs  of  excretion  (§  415,  423).  The  products  of  the 
serous  membranes  are  designed,  for  the  most  part,  to  facilitate  organic 
and  voluntary  movements ;  mucus  serves,  like  the  cuticle,  to  protect 
its  organ  against  offending  causes,  &c. ;  the  "  humors"  of  the  eye,  and 
of  the  internal  ear,  are  media  of  communication  between  external  ob- 
iects  and  the  nei'ves  of  sensation  ;  and  they  are  wonderfully  adapted  to 
the  laws  which  they  are  intended  to  subserve.  The  semen,  milk,  fat, 
animal  heat,  &c.,  are  other  remarkable  examples  of  final  causes  which 
secretion  is  intended  to  fulfill.  To  these  might  be  added  many  others, 
less  important,  but  not  less  to  our  purpose ;  as  the  poison  of  snakes  and 
of  insects,  the  galvanism  of  aquatic  animals,  the  ink  of  the  sepia,  the  flu- 
id from  which  the  spider  builds  his  house,  and  with  which  we  cure  in- 
termittent fever,  &c.  And,  when  we  regard,  in  connection,  the  bile, 
the  gastric  juice,  semen,  milk,  &c. — all  derived  from  the  homogeneous 
blood, — and  consider  the  uniformity  of  their  respective  composition 
in  health,  their  changes  according  to  the  alterations  of  the  vital  prop- 
erties in  disease,  and  these  changes  corresponding  with  certain  modi- 
fications of  the  vital  phenomena,  are  we  not  moved  with  astonish- 
ment at  the  total  difference  in  their  nature  ]  Is  there  any  relief  for 
our  astonishment  but  in  a  firm  reliance  upon  powers  that  are  equally 
unique  in  their  operation  ]  Would  not  amazement  otherwise  increase, 
till  it  should  prove  that  the  human  mind  does  not  rightly  interpret  the 
laws  of  nature,  and  is  unjust  to  its  own  endowments  1 

409,  g.  If  we  now  survey  the  vegetable  kingdom,  we  shall  find  all 
things  constituted  upon  the  same  plan.  The  poppy,  digitalis,  croton, 
spurge, — every  thing  growing  side  by  side  in  the  same  earth,  the  same 
air,  and  watered  with  the  same  fluid,  have,  each  one,  its  unique  and 
unvarying  sap  and  secreted  products  ;  an  infinite  variety  of  precise 
combinations  derived  from  about  four  simple  elements  (§  41,  42). 
Again,  also,  not  only  different  species  of  plants  when  flourishing  in  the 
same  soil  yield  different  products  throughout,  but  the  same  species 
have  produced,  from  the  day  of  their  creation,  the  same  identical 
products,  in  all  their  parts,  in  every  variety  of  soil  and  climate.  And 
so  of  all  animals,  whatever  the  variety  of  food.  In  the  vegetable 
kingdom,  we  are  also  amazed  at  the  systematic  Design  manifested  in 
the  coincidences  between  the  various  elementary  combinations  and 
their  virtues  as  vital  stimuli,  or  as  morbific  or  remedial  agents,  which 
obtain  among  numerous  species  of  many  genera  of  plants,  and  which 
are  maintained  in  all  the  varieties  of  soil  to  which  the  plants  may  be 
subjected.  But,  while  these  analogies  prevail  among  the  medicinal 
properties  of  certain  extensive  groups  of  plants,  the  products  of  each 
species,  and  of  the  several  parts  of  the  same  species,  have  certain  pe- 
culiarities, and  these,  too,  will  depend,  in  many  plants,  upon  the  stage 
of  their  advancement  toward  the  flowering  season,  while  they  are  not 
influenced  by  soil,  climate,  &c.  (§  52,  155). 


PHYSIOLOGY. FUNCTIONS.  225 

409,  h.  Apply  what  has  now  been  said  of  the  products  from  the  sap 
of  plants  to  the  formation  of  blood  alone,  which  is  composed  of  about 
the  same  elements,  and  we  see  how  vain  the  attempts  to  explain  by 
chemical  laws  even  the  formation  of  chyle ;  its  conversion  even  from 
a  white  to  a  deep  red  color,  and  yet  that  color  changing  to  white  again 
under  the  influence  of  slight  disease ;  and,  finally,  the  vitality  with 
which  the  blood  is  endowed.  And,  notwithstanding  the  complexity 
of  the  human  body,  its  endless  variety  of  food,  and  its  artificial  com- 
binations and  changes,  has  not  the  chemist  given  us  a  standard  of  the 
composition  of  the  chyle,  the  blood,  the  gastric  juice,  bile,  saliva,  milk, 
&c.,  by  which  their  morbid  changes  are  to  be  tested  in  all  countries, 
at  all  seasons,  at  all  ages  of  man  and  of  the  world  %  Has  he  not  told 
us  that  all  this  is  so  uniform  in  the  natural  state  of  the  animal,  so  unlike 
the  results  of  chemical  agencies,  that  when  changes  arise  they  are  in- 
dicative of  changes  in  health?  And  does  he  not  oifer  to  show,  that 
this  alteration  of  the  blood  and  secretions  is  so  uniform  under  the  same 
circumstances  of  disordered  health,  that  you  may  tell  by  it  the  nature 
of  disease  and  the  appropriate  remedy  (§  5,  b\  a)  1  Is  not  this  the 
basis  of  practical  humoralism  1  I  grant  the  fact  as  to  the  relation  of 
specific  changes  in  the  secretions,  the  blood,  also,  and  specific  modifi- 
cations of  action.  But  is  not  all  this  in  absolute  opposition  to  what- 
ever is  known  of  the  capricious  operation  of  chemical  forces  1  And 
what  shadow  of  proof  is  there,  that  these  vital  powers,  which  the  chem- 
ist now  and  then  invokes  to  his  aid,  are  not  entirely  adequate  to  the 
physiological  results  that  are  ascribed  to  the  forces  of  chemistry  1 

409,  Ml.  As  to  the  hypothesis  which  supposes  that  galvanism  is 
identical  with  the  nervous  influence,  and  the  eflicient  power  in  the 
formation  of  animal  products,  it  is  fully  contradicted  by  the  many  anal- 
ogous compounds  generated  by  plants.  This  subject  will  have  been  va- 
riously considered  in  other  places  (§  70-80,  409  k,  493  cc,  893  a,  &c.). 
409,  i.  And  now,  turning  again  to  the  mere  physical  theorist,  if 
there  be  any  who  cannot  appreciate  the  objections  which  I  have  set 
forth  to  their  peculiar  views  of  secretion,  let  them  appeal  to  their  or- 
dinary habits  of  observation,  and  look  at  the  condition  of  the  blood 
as  reputedly  laden  with  the  various  compounds  which  are  supposed 
to  be  strained  ofl"  from  the  great  vital  fluid.  What  an  unphilosophical 
mixture  !  All  the  forty  ingredients  of  the  bile  into  which  that  homo- 
geneous substance  is  separated  by  the  various  manipulations  of  the 
chemist, — all  the  variety  into  which  the  urine  is  resolved  by  the  same 
ingenious  devices, — mucus,  saliva,  gastric  juice,  albumen,  gelatin,  ce- 
rebral substance,  fat,  tears,  sweat,  milk,  semen,  the  germinal  fluid, 
&c., — nay,  more,  all  the  peculiar  compounds  which  go  to  the  forma- 
tion of  the  different  parts  of  the  body ;  and  each  one,  and  no  other, 
strained  off"  by  that  part  alone  which  has  been  forever  engaged  in  the 
individual  office  of  eliminating  one  exact  compound,  or  one  special 
variety  of  compounds.  Nor  is  this  the  end  of  the  absurdities ;  for 
the  same  physical  doctrine  supposes  that  this  principle  is  coextensive 
with  the  vegetable  kingdom,  and  that  every  species  of  plant  and  ani- 
mal embraces  in  its  circulating  fluid  special  varieties,  which,  in  the 
aggregate,  make  up  the  many  millions  of  specific  and  unvarying  com- 
pounds of  which  the  organic  kingdoms  are  composed  (§  41).  Nor  is 
it  a  small  part  of  the  difficulties  which  surround  tho  mechanical  and 
cliemical  hypotheses  of  secretion,  that  all  these  millions  of  compounds 

P 


226  INSTITUTES    OF    MEDICINE. 

are  liable  to  exact  variations,  according  to  morbid  changes  in  the 
parts  by  which  they  are  elaborated. 

409,  j.  Is  the  chemical  hypothesis  of  catalysis  better  calculated 
than  the  mechanical  to  resolve  the  great  problem  which  concerns  the 
formation  of  the  millions  of  unique  products  from  one  common  fluid, 
and  in  conformity  with  the  facts  which  have  been  hitherto  stated  1 
This  doctrine  is,  doubtless,  the  most  ingenious  of  any  which  has  been 
advanced  by  chemistry ;  but  it  has  little  to  sustain  it  even  of  the  spe- 
cious analogies  supplied  by  inorganic  processes.  Indeed,  so  little  is 
catalysis  sujjported  by  the  phenomena  of  inorganic  nature,  that  its 
existence  is  denied  by  many  able  chemists.     Thus : 

"  Liebig,"  says  Mulder,  "has  been  led  to  reject  catalysis  entirely, 
and  to  give  a  totally  different  explanation  of  facts.  He  has  assumed, 
that  chemical  forces  are  in  action  in  those  substances  which,  accord- 
ing to  the  supposition  of  Berzelius,  are  capable  of  exciting  action, 
though  without  taking  part  in  that  action  ;  and  he  thinks  that  by  such 
chemical  action,  another  may  be  excited  in  other  substances.  .  He 
adopts  the  principle,  indicated  by  La  Place  and  Berthollet,  that  a 
molecule,  being  put  in  motion,  can  communicate  its  motion  to  others, 
if  in  contact  with  them.  He  apjilies  this  principle  to  yeast  especial- 
ly," &c. — Mulder's  Chemistry  of  Vegetable  and  Aimnal  Physiology. 

In  section  350|,  d,  is  a  brief  statement  of  the  catalytic  theory  as 
advocated  by  Mulder;  and  in  the  Medical  and  Physiological  Com- 
mentaries (vol.  i.,  p.  55-78)  I  have  considered  specifically  the  obsta- 
cles to  its  application  to  organic  processes,  while  it  must  encounter, 
also,  all  that  I  have  here  alleged  against  the  mechanical  and  other 
physical  doctrines.  Nor  is  it  the  least  objection  to  the  whole  chem- 
ical system  of  organic  life,  that  the  two  principal  leaders  in  organic 
chemistry  "give  a  totally  different  explanation  offacts^''  that  make  up 
the  essential  attributes  of  living  beings.  Mulder  affirms  that  Liebig's 
theory,  is  an  "assumption,"  while  Liebig  "  rejects  entirehf  the  cata- 
lytic theory  of  Mulder.  The  medical  reader  will  easily  appreciate 
the  worth  of  Liebig's  "  assumption,"  by  referring  to  its  attempted 
"explanation  of  facts"  as  revealed  by  disease.  (See  §  350,  nos.  40, 
41,  42,  44,  45,  3501,  and  Leiimann  on  Chemical  Equations,  §  1029). 

409,  k.  In  respect  to  the  supposed  agency  of  galvanism  in  the  for- 
mation of  animal  compounds  through  the  medium  of  the  nervous  sj^stem, 
the  doctrine  is  consistently  applied  to  the  modifications  which  arise 
from  morbid  processes  ;  but  we  have  just  seen  (§  409  hh)  that  the  fun- 
damental hypothesis  is  contradicted  by  the  close  analogy  betAveen  the 
products  of  plants  and  animals,  and  by  the  absence  of  the  nervous  sys- 
tem in  the  former,  and  therefore,  a  fortiori,  galvanism  has  no  connec- 
tion with  morbid  products.  Galvanism  is  also  alike  a  stimulus  to  the 
secretory  functions  of  plants  and  animals,  which  farther  establishes  its 
distinction  from  the  nervous  power  (§  113,  224,  226,  356  a,  399,  446  a, 
461,  475-^,  493  cc,  500  nn,  512,  893  a,  c,  893i,  902).— Note  Y. 

410.  We  may  therefore  Avell  conclude  that  there  is  nothing  so  im- 
portant in  the  whole  compass  of  physiology,  and  in  the  philosophy 
and  practice  of  medicine,  as  a  proper  understanding  of  the  vital  con- 
stitution, in  their  properties  and  functions,  of  those  extreme  vessels 
by  which  nutrition  and  secretion  are  performed.  Those  are  also  the 
instruments  of  all  morbid  processes,  and  those  by  which  all  morbid 
products  are  elaborated  from  the  blood.  And  since  all  healthy  prod- 
ucts ai'e  clearly  tlie  result  of  processes  to  which  there  is  nothing  anal- 


PHYSIOLOGY. FUNCTIONS.  221 

ogous  in  the  world  of  dead  matter,  how  obviously  must  all  the  prod- 
ucts of  disease,  all  those  of  inflammatory  conditions,  which  vary  but 
little  from  the  natural  standard,  be  owing  to  the  same  vital  processes 
of  those  formative  and  secretory  vessels  somewhat  diverted  from  their 
natural  states,  and  in  which  deviations  disease  must  be  allowed  to  con- 
sist (§  750,  1039,  1040,  1056J. 

411.  Finally,  the  function  of  appropriation  is  that  which  evinces, 
more  than  any  other,  the  existence  of  a  vital  principle.  This  princi- 
ple, being  admitted  as  the  basis  of  that  function,  must  be  carried  to  ev- 
ery other  process  of  living  beings.  It  is  by  appropriation  that  the  new 
elementary  combinations,  in  their  endless  variety,  are  formed  from 
the  blood  or  sap.  By  nutrition,  which  begins  at  the  earliest  develop- 
ment of  the  embryo  in  the  aspect  of  growth,  under  the  government  of 
a  peculiar  power,  as  admitted  by  all,  the  organic  being  is  carried  for- 
ward to  full  maturity,  and  maintained  while  life  continues.  At  every 
stage  of  his  existence,  it  is  the  same  process  as  that  which  was  start- 
ed by  the  impression  of  the  semen  upon  the  germ  ;  and,  since  no  new 
results  are  brought  forth,  no  new  powers  can  be  called  into  opera- 
tion. The  living  semen  is  the  first  stimulus  of  the  organic  properties 
of  the  embryo,  and  in  this  respect  it  is  analogous  to  those  vital  stimuli 
which  forever  after  maintain  the  same  powers  in  action,  and  by  which 
the  same  nutrition,  or  the  same  elementary  combinations,  are  effected 
at  every  subsequent  stage  of  existence.  By  nutrition,  through  the 
operation  of  these  vital  properties,  and  according  to  specific  plans  in- 
stituted by  the  Creator,  and  to  be  forever  perpetuated  by  the  substi- 
tuted energy  of  the  vital  principle,  all  those  forms  of  organic  beings, 
which  pass  by  almost  insensible  gradations  from  the  mushroom  up  to 
the  gigantic  tree,  and  from  the  microscopic  animalcule  to  the  majesty 
of  man,  are  maintained  in  all  their  exact  peculiarities,  in  all  their  anal- 
ogies to  each  other,  in  all  their  vital  and  moral  attributes.  It  is  by 
nutrition,  that  is  to  say,  by  the  specific  modes  in  which  some  three  or 
four  principal  elements  are  united  together,  and  joined  to  pre-existing 
parts  of  the  same  nature  (§  41,  42),  that  each  animal  or  plant,  accord- 
ing to  its  species,  acquires  and  maintains  a  specific  configuration  and 
organization,  exhibiting  vital  results  that  are  peculiar  to  each,  pro- 
ducing specific  germs  that  are  developed  in  exact  conformity  with  the 
nature  of  the  parent,  and  each  pursuing  forever  a  certain  path  which 
was  marked  out  for  itself  alone  by  the  Hand  which  gave  it  existence. 
Such,  and  far  more,  is  the  wonderful  power,  a  power  substituted  for 
the  Creator  Himself,  which  directs  capillary  circulation,  and  governs 
the  process  of  nutrition  in  the  development  of  the  embryo,  in  the  ma- 
turity of  the  being,  and  in  the  perpetuation  of  the  species. 

Briefly,  then,  the  whole  essential  philosophy  of  organic  life,  all  that 
is  important,  or  useful,  or  dignified  in  medicine,  is  directly  relative  to 
the  vital  constitution,  and  the  vital  actions  of  the  formative  and  secre- 
tory vessels.  Here  is  the  labyrinth  of  life,  here  of  disease,  here  the  ul- 
timate aim  of  medical  philosophy  (^  1040). — Note  I  p.  1118. 

6.    EXCRETION. 

412.  Excretion  is  the  sixth  grand  function  common  to  animals  and 
vegetables.  It  is  analogous  to  secretion,  and  is  performed  by  analo- 
gous organization  ;  though  the  differences  in  these  respects  are  prob- 
ably greater  than  betweea  nutrition  and  secretion,  in  their  ordinary- 
acceptation  f§  402   404). 


228  INSTITUTES    OF    MEDICINE. 

413.  By  excretion  useless  matter  is  elaborated  from  the  blood  and 
ejected  from  the  body.  The  results  of  this  function,  therefore,  are 
entirely  different  from  those  of  secretion,  which  are  destined  for  use- 
ful purposes  in  the  animal  economy. 

414.  The  terminal  series  of  the  arterial  system,  as  with  appropri 
ation,  are  the  immediate  instruments  *of  the  function  of  excretion. 
But,  like  secretion,  a  compounded  organization  is  necessary  to  excre- 
tion. In  this  respect  there  appears  to  be  about  the  same  anatomical 
variety  allotted  to  secretion  and  excretion  (§  404).  The  same  tissue, 
indeed,  and  even  the  same  part,  may  perform  both  functions ;  as  in 
the  lungs,  and  in  the  uterus  (§  135). 

Notwithstanding,  however,  these  coincidences,  the  final  causes  of 
excretion  and  secretion  are  so  very  different  (§  413),  the  processes 
which  give  rise  to  such  opposite  results  should  be  regarded  as  differ- 
ent functions. 

415.  The  difference  between  secretion  and  excretion,  ^s  denoted 
by  their  respective  uses,  is  confirmed  by  the  elementary  constitution 
of  the  products  of  these  functions  ;  those  of  secretion  being  organic, 
those  of  excretion  inorganic.  There  is  also  reason  to  believe  that 
special  elementary  changes  take  place  in  the  urine  soon  after  its  elim- 
ination from  the  blood.*  Urea  may  be  also  artificially  produced ; 
and  such  is  not  improbably  the  fact  when  chemically  obtained  from 
blood,  or  even  from  the  urine  (§  53,  h,  1032  a,  Lehmann). 

416.  The  principal  excreted  substances  are,  1st.  Carbon  ;  2d.  Sweat ; 
3d.  Urine.  The  lungs,  skin,  and  kidneys,  are  the  organs  by  which 
they  are  elaborated.  The  lungs  and  skin  exercise  their  function, 
principally,  after  nutrition  and  secretion  have  been  performed,  and 
are,  therefore,  mainly  concerned  in  excreting  the  waste  parts  of  the 
body ;  though  this  devolves  also  upon  the  kidneys,  especially  in  dis- 
ease. 

417.  a.  No  one  of  the  foregoing  products  is  of  an  organic  nature  ;  and 
the  supposed  triumph  of  the  chemist  in  manufacturing  urea  is  no  more 
a  proof  of  the  dependence  of  organic  compounds  on  chemical  process- 
es than  any  other  transformation.t  The  sweat  and  the  urine  be- 
ing liable  to  transformations  as  soon  as  elaborated  (§  415),  and  more 
especially  as  every  chemical  agent  by  which  their  analysis  is  attempt- 
ed necessarily  changes  their  composition,  their  actual  condition  at  the 
moment  of  their  production  can  never  be  known.  Such,  also,  is  true 
of  the  analysis  of  every  organic  compound.  The  very  analysis  sup- 
poses the  generation  of  compounds  or  of  elements  in  artificial  modes  ; 
but  the  original  compound  being  the  product  of  the  organic  powers, 
the  transformation  of  its  elements,  whether  spontaneous  or  effected  by 
the  chemist,  and  through  certain  agencies,  occurs  in  certain  determi- 
nate modes,  and  according  to  the  influences  which  had  been  impressed 
by  the  organs  of  life  (§  54,  a).  Besides,  it  is  now  fully  admitted  that 
many  very  uniform  and  remarkable  formations  out  of  organic  com- 
pounds, and  themselves,  too,  allied  to  organic  substances,  have  no  such 
natural  existence  ;  as  hydrocyanic  acid,  narcotin,  &c.  (§  42,  409). 
Even  Mao'endie  threw  in  the  way  of  proximate  analyses  the  conclu- 
sive fact  that,  "  during  the  short  transit  from  the  vascular  tubes  to 
your  receiver,  the  component  elements  of  the  blood  are  found  to  effect 
a  new  arrangement"  (^  1032  h,  c). 

*  See  Medical  and  Physiological  Commentaries,  vol.  i.,  p.  526,  585,  602,  675-679. 
t  Lehmann  says  tbat— "  We  can  liardly  any  longer  enumerate  urea  among  true  organic  sub- 
etances." — IbSO. 


PHYSIOLOGY. FUNCTIONS.  229 

417,  b.  When,  therefore,  I  may  speak  of  changes  in  the  "  compo- 
nent parts"  of  organic  compounds,  I  refer  either  to  such  as  may  be 
wrought  by  organic  processes,  or  by  influences  exerted  by  leSs  ob- 
vious causes,  as  in  the  case  of  the  bile  (§  316),  or  to  those  chemical 
transformations  of  a  specific  nature  which  depend  upon  chemical 
agencies  (a). 

418,  Carbon  is  the  greatest  excrement  of  animals,  and  is  evolved 
from  plants.  In  the  former  it  is  effected  by  the  mucous  tissue  of  the 
lungs,  and  often  by  the  skin  (§  135);  in  the  latter  by  the  leaves  (§  303 1). 

419,  a.  The  excretion  of  carbon  by  the  lungs  is  construed  by  the 
chemists  according  to  their  rules  of  interpreting  other  organic  actions. 
But,  as  I  have  endeavored,  in  the  "  Commentaries,"  to  establish  the 
vital  character  of  this  phenomenon,  I  shall  only  now  advert  to  its  phi- 
losophy, and  in  connection  with  that  which  respects  the  production 
of  animal  and  vegetable  heat  (§  433,  &c.).  They  are  thus  associated 
by  myself  out  of  regard  to  the  confusion  which  has  befallen  them  in 
the  hands  of  the  chemist.  But,  appealing  to  him  who  sees  in  organic 
nature  its  plainest  contradistinctions  from  inorganic,  I  would,  in  this 
place,  submit  to  his  understanding  whether  it  be  not  probable  that 
the  same  philosophy  attends  the  elaboration  of  carbon  by  the  lungs 
and  by  the  skin,  and  whether  that  function  of  the  skin  in  many  animals 
be  not  as  much  an  organic  process  as  the  associate  secretion  of  sweat  ? 

419,  b.  But,  if  the  foregoing  analogies  be  not  sufficiently  conclusive, 
consider,  next,  the  elaboration  of  that  excrementitious  matter,  the 
urine ;  which  all  but  the  purely  physical  philosopher  recognize  as  a 
vital  process.  And,  again,  shall  it  be  admitted  that,  while  nature  has 
constituted  the  pulmonary  mucous  tissue,  like  that  of  the  stomach, 
intestine,  bladder,  &c.,  upon  her  universal  plan  of  organization,  and 
endowed  it  with  the  vital  function  of  generating  mucus,  she  has  depart- 
ed from  it  in  an  isolated  part  of  one  and  the  same  continuous  tissue  to 
introduce,  along  with  the  vital,  a  chemical  function  1  It  is  the  same 
argument  as  derived  from  the  production  of  sweat,  in  its  connection 
with  carbonaceous  matter;  and  here  the  analogy  brings  into  co- 
operation every  product  of  the  living  being,  and  establishes  the  whole 
upon  common  principles  (§  447|^  c,  1032  b). 

419,  c.  There  remains,  however,  a  demonstration  from  analogy 
which  is  perfectly  irresistible.  We  have  already  seen  how  differently 
modified  in  their  vital  character  are  not  only  different  tissues,  and  tis- 
sues of  the  same  apparent  organization,  but  even  different  parts  of 
one  and  the  same  continuous  tissue.  We  have  seen  this  exemplified 
in  a  variety  of  aspects,  and  especially  by  the  specific  nature  of  the 
product  of  certain  parts.  We  have  seen,  for  example,  that  there  is 
nothing  in  nature  but  that  part  of  the  gastro-intestinal  mucous  tissue 
which  lines  the  stomach  that  will  generate  gastric  juice,  while,  also,  it 
produces  mucus  (§  133-136).  Now,  carry  this  to  another  part  of  the 
same  continuous  tissue  which  lines  the  air-cells,  and  the  inference  is 
plain  that  if  the  gastric  juice  be  elaborated  by  a  vital  process,  so  also 
is  the  carbonaceous  matter.  Nor  can  any  objection  be  urged  that 
other  parts  of  the  mucous  system  do  not  contribute  to  the  function  of 
decarbonization  upon  the  ground  that  they  are  less  delicate,  and 
therefore  less  permeable  to  the  air,  than  the  mucous  portion  of  the 
lungs,  since,  in  some  animals,  that  dense  organ,  the  skin,  performs  the 
Bame  office.     Nor  is  there  a  better  chance  for  the  application  of  en 


23t)  INSTITUTES    OF    MEDICINE. 

dosmose    and    exosmose,    since  atmospheric  air  is  often  in  contact 
with  the  mucous  tissue  of  the  stomach  (^  4475-  c). 

420.  Perspiration  or  sweat,  which  is  sensible  and  insensible,  beino 
elaborated  by  an  organ  of  highly  complex  organization,  is  clearly  a 
product  of  organic  actions ;  and  since  the  skin  of  some  inferior  ani- 
mals, like  the  mucous  tissue  of  the  lungs,  eliminates  both  mucus  and 
carbon,  this  coincidence  of  function  in  two  very  complex  organs  may 
be  considered  worthy  of  some  regard  in  forming  the  logical  induction 
to  which  the  facts  in  the  preceding  section  may  seem  entitled. 

421.  The  excretion  of  urine  is  the  next  great  source  of  depuration 
to  the  blood.  Like  the  other  products  of  excretion,  it  contributes  to 
the  process  of  assimilation  by  its  depurating  effects  (^  416).  It  is  as- 
tonishing, too,  with  what  rapidity  many  substances  appear  in  the  urine 
after  their  admission  into  the  stomach  ;  often  not  more  than  five  or  ten 
minutes  intervening.  This  lapidity  of  excretion  is  particularly  true 
of  all  matter  which  is  offensive  to  the  organization. 

422.  a.  There  is  a  remarkable  sympathy  subsisting  between  the 
kidneys  and  skin,  by  which,  as  it  were,  they  interchange  functions 
with  each  other.  We  are  all  familiar  with  the  fact  that  the  urine  is 
most  abundant  in  cold  weather,  and  the  perspirable  matter  most  de- 
ficient, and  vice  versa  ;  and,  as  a  general  principle,  when  one  excre- 
tion abounds,  the  other  is  lessened.  This  is  true  in  disease  as  in 
health  (§  129,  1032  a).     It  depends  upon  reflex  nervous  actions. 

422,  h.  For  the  fulfillment  of  their  final  cause  the  kidneys  possess 
an  exquisite  susceptibility  to  the  influence  of  the  nervous  power 
(§  188,  &c.,  226,  528).  Hence  arises  the  rapid  and  profuse  excre- 
tion of  urine  when  fear  and  certain  other  emotions  of  the  mind  are 
in  operation.  The  same  affii'mation,  too,  may  be  made  of  the  skin, 
though  perhaps  less  extensively.  This,  too,  is  the  reason  why  fear 
so  readily  induces  copious  sweats.  In  either  case,  the  phenomena 
are  owing  to  the  direct  development  and  determination  of  the  nervous 
power  upon  the  organs,  respectively.  These  phenomena,  too,  prove 
the  great  susceptibility  of  the  skin  and  kidneys  to  the  influence  of  the 
nervous  power,  and  are  a  key  to  the  whole  philosophy  of  the  inter- 
changes of  action  between  the  skin  and  kidneys  (§  129,  230,  638^). 

But  there  are,  also,  as  may  be  inferred  from  the  facts  just  stated, 
great  sympathetic  relations  between  the  skin  and  kidneys  and  many 
other  organs,  though  these  relations  are  much  more  manifested  by  ef- 
fects which  arise  sympathetically  in  the  excretory  organs  than  by  the 
influences  of  these  organs  upon  other  parts.  This  is  mostly  seen  in 
disease,  and  during  the  operation  of  remedial  agents  applied  to  the 
stomach.  So  great,  indeed,  is  the  susceptibility  of  the  skin  and  the 
kidneys,  in  their  excretory  function,  to  remedial  agents,  that  a  large 
variety  have  received  the  denomination  of  sudorifics,  and  another 
class,  diuretics.  But,  owing  to  the  special  vital  constitution  of  the 
skin  and  kidneys,  by  which  they  are  rendered  sensitive  in  their  ex- 
cretory function  to  a  thousand  slight  influences,  it  is  obvious  that  the 
foregoing  denominations  of  remedies  convey  hypotheses  that  are  un- 
founded, and  of  injurious  tendencies.  There  are  no  better  sudorifics 
than  fear  and  hot  water ;  no  better  diuretic  than  impending  danger 
(§  246,  500,  892|,  1040);  all  through  rf/Vec^  or  rr^ea;  nervous  influence. 

422,  c.  In  respect  to  the  foregoing  principle  as  shown  by  diseased 
?.onditioT!s  the  facts  are  not  less  familiar.     In  such  cases,  an  organ 


PHYSIOLOGY. FUNCTIONS.  231 

which  is  naturally  designed  for  secretion  may  sometimes,  by  a  nioi-bid 
increase  of  its  products,  take  on  the  relative  function  of  excretion, 
and  thus,  both  by  morbific  reflex  nervous  actions,  and  by  copious 
elaborations  from  the  blood,  diminish  or  suspend  the  excretion  of 
urine.  In  the  cholera  asphyxia  this  excretion  would  fail  entirely, 
even  when  the  profuse  intestinal  discharges  were  unattended  by  the 
usual  perspiration.  But,  in  the  case  of  the  intestinal  affection,  much 
was  due  to  the  morbific,  vital  influences;  since  we  often  see  the  urine 
increased  by  the  active  operation  of  cathartics,*  Scarcely  a  morbid 
state  disturbs  the  organs  of  digestion  without  diminishing  or  increas- 
ing the  effete  pi'oducts  of  the  kidneys  and  skin,  especially  of  the  for- 
mer organ.  The  kidneys,  however,  being  designed  for  the  mere  pur- 
pose of  depuration,  do  not  hold  a  corresponding  sway  over  the  great 
organs  of  life,  but  mainly  so  as  it  respects  their  dependence  upon 
those  organs  (§  129) ;  while  a  greater  reciprocity  of  sympathy  be- 
tween the  skin  and  the  essential  viscera  of  life,  and  a  predominant 
sympathy  between  the  skin  and  kidneys  as  organs  of  excretion, 
evince  the  wonderful  nature  of  Design  in  its  provisions  and  limita- 
tions, according  to  the  final  causes  which  directed  the  plan  of  organic 
life  (§  325).— illustrated  by  heart  in  §  500  m,  687^-688,  694f ,  826  cc. 

423.  How  vain  the  attempt  to  refer  any  of  the  foregoing  processes 
and  results  to  any  of  the  forces  or  laws  which  rule  in  the  inorganic 
world !  The  entire  rationale  rests  upon  the  peculiar  operations  of 
the  nervous  power,  and  its  laws  of  reflex  action  (§  222,  &c.,  446,  &c., 
455  c,  500).  A  balance  of  actions  and  products  is  thus  perpetually 
maintained,  though,  of  course,  with  less  uniformity  and  exactness  in 
sickness  than  in  health.  But  nature,  ever  provident,  has  so  constitu- 
ted the  properties  of  life,  that  when  one  organ,  whether  excretory  or 
secretory,  becomes  morbidly  suspended  in  its  function,  the  evil  will 
be  felt  by  other  organs,  hy  reflected  nervous  action;  and  they  will 
thus  take  on,  as  it  were,  the  work  of  that  suspended  organ.  If  the 
excretion  of  urine  be  wholly  arrested,  not  only  the  skin,  but  many 
other  parts,  may  join  in  the  concerted  action  of  relief.  But,  no  other 
part  will  ever  excrete  urine,  no  more  than  the  skin  will  secrete  se- 
men.t  The  absurdity  of  this  prevailing  doctrine  is  shown,  at  once, 
by  the  fact  that  urine  would  excoriate  the  eliminating  vessels  of  every 
part  excepting  those  of  the  kidney  (§  83  b,  133,  &c.). 

Organs  of  pure  secretion,  however,  may  take  on,  in  consequence 

.  of  the  foregoing  condition,  the  office  of  excretion  ;  that  is  to  say,  they 

will  elaborate,  along  with  their  natural  fluids,  the   excrementitious 

matters,  In  certain  ^j/ec^Z/ar  combinations,  which,  in  the  healthy  state 

of  the  kidneys,  would  appear  in  the  form  of  urine  (§  417). 

424.  The  philosophy  of  all  that  I  have  now  said  in  respect  to  the 
interchange  of  offices  among  the  organs  of  secretion  and  excretion, 
and  of  the  dependence  of  the  several  products  upon  special  condi- 
tions of  anatomical  structure  and  modifications  of  the  organic  proper- 
ties, is  the  same  that  is  concerned  in  the  process  of  lactation  after 
parturition,  however  different  the  remote  and  final  causes.  The  mam- 
mary glands  sympathize  with  the  new  change  in  the  uterine  system, 
and  produce  a  fluid  which  is  totally  different  from  the  blood,  although, 
like  all   other  products,  it  is  derived  from  that  fluid.     And,  there 

*  See  my  work  on  the  Cholera  Asphyxia  of  New  York,  1832. 

t  See  Medical  and  Physiological  Commentaries,  vol.  i.,  p.  526,  598,  603,  608..  680. 


232  INSTITUTES    OF    MEDICINE. 

would  be  just  as  much  wisdom  in  supposing  that  the  reflex  nervou;? 
action  of  the  womb  upon  the  mammary  glands,  at  this  critical  junc- 
ture, is  a  chemical  phenomenon,  as  there  is  in  refen-ing  the  elabora- 
tion of  milk  to  the  capricious  forces  of  chemistry,  while  its  reputed 
filtration  from  the  blood,  by  others,  is  equally  refuted  by  the  sympa- 
thetic nature  of  lactation  in  every  species  of  mammifera  (^  1031,  b). 

425.  The  excretion  of  urine,  more  than  the  products  of  any  other 
part,  may  be  affected  by  the  absorption  of  unnatural  agents  into  the 
circulation.  This  is  because  many  agents  which  will  excite  the  ac- 
tion of  the  kidneys  are  not  offensive  to  the  lacteals  nor  to  the  system 
at  large,  and  are  therefore  freely  absorbed.  Such  are  many  saline 
and  alkaline  substances,  and  others,  again,  which  are  natural  to  the 
body,  as  aqueous  fluids,  &c.  Those  being  either  unnatural  or  re- 
dundant rouse  the  action  of  the  kidneys,  as  the  proper  organs  for 
their  elaboration.  The  quantity  of  urine  is  thus  increased  ;  and, 
while  the  kidneys  are  thus  stimulated  they  may  be  rendered  the 
means  of  excreting  other  matters,  though  in  a  very  different  condition 
from  their  existence  in  the  blood  (§  408). 

426.  In  morbid  states  of  all  the  principal  organs  the  urine  is  remark- 
ably liable  to  change.  This  arises  from  various  causes.  If  the  stom- 
ach be  the  primary  seat  of  disease,  or,  if  its  condition  be  disturbed 
by  reflected  nervous  influences  of  other  diseased  organs,  as  is  almost 
constantly  the  case,  digestion  is  imperfectly  performed,  and  the  chyle, 
in  consequence,  becomes  more  or  less  unfitted  for  the  purposes  of 
nutrition  and  secretion.  The  kidneys,  therefore,  carry  off  more  than 
their  wonted  quantity  of  excrementitious  matter,  while  this  matter  ap- 
pears under  conditions  more  or  less  varied  from  the  natural  product 
(§  425).  The  whole  office  of  appropriatipn  is,  also,  more  or  less  im- 
paired, which  farther  modifies  the  condition  of  the  blood  and  the  for- 
mative action  of  the  kidneys  ;  though  a  part  of  the  office  of  excretion, 
under  these  circumstances,  devolves  upon  the  skin  and  lungs  (§  416). 
A  third  great  cause  of  the  variableness  of  the  urine  consists  in  un- 
usual vital  decomposition  or  wasting  of  the  body,  or  of  some  of  its 
parts,  when  it  devolves  upon  the  kidneys  to  co-operate,  beyond  their 
natural  habit,  with  the  lungs  and  skin,  in  removing  the  redundancy 
of  waste  materials.  A  fourth  cause  of  the  urinary  changes,  and  an 
important  one,  lies  in  actual  morbid  states  of  the  kidneys  themselves. 
The  kidneys,  however,  are  not  often  the  seat  of  morbid  affections  be- 
yond those  of  a  simple  functional  and  transient  nature,  as  induced  by 
reflex  nervous  actions  excited  by  the  diseases  of  other  parts ;  but  to 
which  influences  the  kidneys  are  extremely  liable,  and,  therefore,  to 
consequent  modifications  of  the  urinary  product. 

427.  Briefly,  then,  every  alteration  of  the  natural  action  of  the  kid- 
neys, whether  primary  or  sympathetic,  and  every  defect  in  assimila- 
tion and  appropriation,  is  attended  by  some  change  in  the  urine  ;  while 
an  endless  variety  is  imparted  to  it  by  the  qualities  and  quantities  of 
the  ingesta.  From  this  circumstance,  which  should  have  prompted 
other  conclusions,  has  arisen  the  belief  that  the  state  of  the  urine 
supplies  some  of  the  most  important  signs  of  pathological  conditions, 
not  only  of  the  kidneys  themselves,  but  of  remote  organs  with  which 
they  may  sympathize.  From  Hippocrates  to  our  day,  elaborate  dis- 
quisitions have  appeared  concerning  the  changes  of  the  urine  as  indic- 
ative of  particular  forms  of  disease,  of  their  special  seats,  of  the  dif- 


PHYSIOLOGY. FUNCTIONS.  233 

ferent  stages  of  their  rise  and  decline,  and  of  their  degrees  of  se- 
verity and  danger.  The  humoralists  were  apt  to  regard  the  unusual 
conditions  of  this  product,  and  other  "  vitiated  secretions,"  as  the 
disease  itself;  and  in  this  respect  they  are  imitated  by  the  humoral- 
ists of  the  nineteenth  century.  Chemistry  has  been  also  brought  to 
bear  upon  the  fluctuating  states  of  the  urine,  and  has  increased  the 
factitious  importance  of  a  symptom  which  is  often  as  likely  to  denote 
some  alimentary  substance,  or  divers  forms  of  disease,  or  imperfect 
digestion,  or  some  remedial  agent,  as  the  source  from  which  it  ema- 
nates. 

But,  coming  to  the  bed-side  we  find  that  all  these  critical  obser- 
vations are  relics  of  the  speculative  ages  of  humoralism.  Here,  we 
find  that  all  that  is  practically  useful  in  relation  to  the  urine  is  gener- 
ally best  ascertained  by  mere  inspection ;  and  upon  this  subject,  we 
have  all,  and  more  than  is  desirable,  from  Hippocrates  himself.  Those 
philosophers,  however,  who  are  employed  in  interrogating  disease  by 
chemical  analyses  are  not  often  or  long  in  the  chambers  of  the  sick. 
They  carry  on  the  investigation  of  morbid  processes  in  the  laboratory 
of  the  chemist,  and  then  and  there  fabricate  the  appropriate  reagents 
(§  5j,  a).  He  who  studies  organic  nature  according  to  the  method 
of  solidism  and  vitalism  has  neither  the  leisure  for  those  most  difii- 
cult,  unattainable,  and  laboi-ious  analyses,  nor  would  they  have  any 
influence  upon  his  judgment  as  to  the  pathology  or  treatment  of  dis- 
ease, in  the  midst  of  such  a  multitudinous  variety  as  is  presented  by 
the  vital  phenomena  of  disease.  Of  one  thing,  also,  we  may  rest  as- 
sured, that  nature  has  supplied  all  those  ready  means  for  interpreting 
disease  that  may  be  necessary  for  immediate  action  ;  nor  can  we  often 
delay  the  treatment  of  acute  disease  for  consultations  with  the  labora- 
tory. In  respect  to  the  blood,  were  it  even  practicable  to  learn  from 
analysis  its  variable  conditions  in  disease,  it  would  reflect  no  light  upon 
morbid  states  of  the  organs,  since  the  qualities  of  that  fluid  vary  with 
every  varying  change  in  the  vital  conditions  of  the  solids,  and  there- 
fore, too,  would  fail  to  indicate,  in  the  least,  the  appropriate  remedies. 
This  is  also  true,  in  a  general  sense,  of  the  urine  and  all  other  excre- 
tions, and  secretions.  The  ready  sight,  their  sensible  properties,  the 
vital  phenomena,  physical  signs,  experience,  and  general  principles, 
must  be  our  guide.  These  may  be  sometimes  facilitated  by  extraor- 
dinary modes  of  observation,  but  which  are  always  within  the  reach 
and  clear  understanding  of  every  practitioner;  such  as  the  usual 
mode  of  examining  the  blood  in  inflammatory  diseases,  evapoi'ating 
the  urine  in  diabetes,  &c.  On  the  contrary,  were  the  humoral  doc- 
trines correct  the  teaching  and  the  practice  of  medicine  should  be  re- 
stricted to  chemists  alone ;  since  there  is  no  branch  of  inquiry  so  dif- 
ficult as  organic  analyses,  while  their  uncertainty  would  soon  imply 
that  the  vis  7nedicatrix  natures  is  the  only  ordination  of  nature  for  the 
maladies  of  the  human  race  (§  691,  1033  b). 

428.  The  menstrual  fluid  is  another  and  a  fourth  product  of  excre- 
tion ;  and,  from  its  close  resemblance  to  the  blood,  in  the  human  spe- 
cies, it  is  one  of  the  proofs  that  capillary  hemorrhage  is  generally  the 
result  of  a  secretory  process.  In  the  higher  orders  of  animals,  even  a 
clearer  index  of  its  origin  is  supplied  by  the  intermixture  of  blood 
with  the  periodic  secretion  of  mucus,  which,  in  lower  orders,  occurs 
without  blood.     The  menses,  however,  is  a  product  sui  generis,  and  is 


234  INSTITUTES    OF    MEDICINE. 

specifically  determined  by  the  nature  of  the  part  (§  135).  Unlike 
the  other  products  of  excretion,  it  is  not  essential  as  an  evacuation, 
though  important  to  the  function  of  generation.  It  is  therefore  pe- 
culiar, also,  in  exerting  imjjortant  vital  influences  upon  the  genera- 
tive system. 

429.  At  certain  periods  of  the  year  the  female  genitals  of  all  ani- 
mals undergo  changes,  by  which  they  are  developed  or  prepared  for 
generation  ;  as,  for  instance,  the  ovaria  of  birds  become  enlarged,  the 
vagina  of  rabbits  and  of  other  animals  is  tumefied  with  blood,  increas- 
ed in  its  vascular  action,  and  pours  out  an  unusual  mucous  or  bloody 
fluid.  It  is  only  at  these  periods  that  they  are  susceptible  of  impreg- 
nation. 

430.  But  woman  is  capable  of  impregnation  at  all  times;  and  that 
this  may  happen,  her  organs  must  be  often  developed  and  prepared 
for  the  purpose. 

The  jjhilosophy  of  the  whole  of  this  preparation,  however  various 
in  different  species,  and  at  whatever  intervals  of  time,  is  the  same  in 
all.  The  several  conditions  depend  upon  changes  in  the  vital  states 
of  the  generative  organs,  by  which  the  sexual  desire  is  excited,  and 
the  germ  rendei'ed  susceptible  to  the  stimulus  of  the  semen.  This  is 
the  end  and  the  aim  of  the  whole. 

431.  It  follows,  therefore,  that  the  periodical  excretion  of  the  men- 
strual fluid  is  only  essential  to  the  office  of  generation,  and  not  to  the 
whole  system,  excepting  so  far  as  this  excretion  is  a  healthy  function  ; 
and  the  suspension  of  any  function  being  a  morbid  condition,  the 
whole  system  may  sympathize  with  the  uterus  when  the  menstrual 
discharge  is  suspended. 

432.  Hence  it  follows,  as  a  practical  result,  that  all  our  prescrip- 
tions for  suspended  menstruation  must  proceed  upon  the  principle 
that  this  excretion  is  a  vital,  and  not  a  mechanical  result ;  and  that  its 
suppression  is  owing  to  some  morbid  state  of  the  uterus,  either  direct, 
or  sympathetic. 

7.    CALORIFICATION. 

433.  Calorification  is  the  function  by  which  plants  and  animals  gen- 
erate the  heat  which  is  peculiar  to  themselves.  Chemistry,  however, 
has  enjoyed  a  more  undisturbed  exposition  of  the  nature  of  this  func- 
tion than  even  that  of  digestion  ;  nearly  all  but  the  most  eminent 
physiologists,  such  as  Hunter  and  Bichat,  having  acquiesced  in  the 
speculations  and  assumptions  of  chemists  as  setting  forth  the  true  phi- 
losophy of  animal,  or,  rather,  organic  heat  (§  333). 

It  is  obvious,  therefore,  that  few  things  in  medical  philosophy  have 
greater  demands  upon  the  physiologist  than  a  right  interpretation  of 
this  great  and  wonderful  function  of  organic  life,  that  its  philosophy 
may  be  carried  to  the  illustration  of  other  organic  processes,  that  all 
may  be  seen  as  a  system  of  consistent  Designs,  and  that  no  foot-hold, 
in  the  way  of  analogy,  shall  remain  to  him  who  would  substitute  arti- 
ficial devices  for  the  institutions  and  laws  of  Nature.  The  times  have, 
and  always  have  had,  a  demand  upon  the  physiologist  for  a  critical 
exposure  of  this  extensive  vitiation  of  medical  philosophy.  They  urge 
it  upon  him  now  mote  than  at  former  periods.  Nothing  has  been 
hitherto  done  but  to  express  opinions  ;  and  we  now  witness,  as  a  con- 
sequence, an  almost  universal  substitution  of  the  chemical  and  phys- 


PHYSIOLOGY. FUNCTIONS.  235 

ical  theories  ol  life,  disease,  and  therapeutics,  for  the  promptings  of 
the  most  obvious  phenomena  of  Nature.  Mankind,  in  masses,  in  the 
aspect  of  Nations,  are  carried  away  by  the  simplicity  of  the  chemical 
dogmas,  and  by  the  confidence  with  which  they  ai'e  uttered.  They 
have  become  incorporated  in  most  of  our  works  on  Physiology,  Med- 
icine, Hygiene.  Nor  is  this  at  all  limited  to  the  Medical  Profession. 
It  is  coextensive  with  society.  It  is  ingrafted  upon  popular  works; 
carried  into  our  colleges,  academies,  and  even  public  schools.  It  has 
become  a  part  of  the  general  plan  of  elementary  education  ;  and  it  is 
now  most  extensively  an  object,  through  voluminous  publications,  to 
induce  the  whole  race  of  mankind  to  regulate  their  food  by  chemical 
analysis.  Banners,  I  had  almost  said,  are  every  where  paraded,  beai'- 
ing  the  inscription  from  Liebig's  Animal  Chemistry,  that 

"  To  DETERMINE  WHAT  SUBSTANCES  ARE  CAPABLE  OF  AFFORDING 
NOURISHMENT,  IT  IS  ONLY  NECESSARY  TO  ASCERTAIN  THE  COMPOSITION 
OF  THE  FOOD,  AND  TO  COMPARE  IT  WITH  THE  INGREDIENTS  OF  THE 
BLOOD." 

434.  At  the  very  outset  of  our  inquiry,  we  discern  the  speculative 
nature  of  the  chemical  philosophy  from  the  vast  difference  in  the  sev- 
eral hypotheses  which  have  been  advanced  with  equal  confidence, 
and  which,  for  awhile,  have  been  received  with  almost  universal  fa- 
vor. The  theory  of  Crawford,  which  is  relative  exclusively  to  the 
lungs,  and  to  the  difference  in  the  capacity  for  heat  of  venous  and  ar- 
terial blood,  will  not  soon  lose  its  fascinating  simplicity  nor  the  plau- 
sibility of  its  pretensions.  Its  elegance  will  stand  forever  in  forcible 
contrast  with  that  deformity  which  is  the  idol  of  the  present  day. 
Genius  and  taste  will  never  cease  to  do  their  mournful  homage  to 
one,  while  they  turn  from  the  other  as  from  the  distortions  of  a  Pagan 
deity. 

A  third  hypothesis  may  be  stated  as  contributing  to  the  improba- 
bilities of  the  whole,  and  which  has  not  yet  been  fully  supplanted  by 
the  greater  novelty.  This  is  that  which  ascribes  the  evolution  of  or- 
ganic heat  to  the  passage  of  the  common  nutritive  fluid  to  a  solid  state. 
It  has,  even  more  than  Crawford's,  the  merit  of  philosophical  simpli- 
city, and  of  an  apparent  foundation  in  nature,  but  far  less  of  the  spice 
of  genius. 

435,  a.  The  first  two  of  the  foregoing  hypotheses  have,  as  one  of 
their  indispensable  elements,  the  imion  of  the  oxygen  of  the  air 
with  the  carbon  of  the  blood,  or  with  that  of  the  body ;  though,  aa 
E  have  endeavored  to  show  in  the  Medical  and  Physiological  Com- 
mentaries, neither  that  act  in  respiration,  nor  the  excretion  of  carbon, 
has  any  greater  connection  with  the  production  of  animal  heat  than  it 
has  with  that  of  the  gastric  juice,  or  any  other  result  of  organic  func- 
tions. The  whole  of  that  subject  ig  investigated  so  extensively  in  the 
work  just  mentioned,  and,  I  may  say,  the  speculations  and  assump- 
tions which  have  been  subsequently  put  forth  by  Liebig  and  his  school 
are,  also,  so  fully  considered  in  the  same  work,  either  as  already  ex- 
tant, or  as  hkely  to  ensue,  that  I  shall  now  limit  myself  to  a  statement 
of  the  latest  and  most  approved  positions  of  chemistry,  and  to  such 
remarks  and  prominent  facts  as  may  be  necessary  to  complete  the  in- 
tegrity of  those  fundamental  principles  which  are  the  main  objects  of 
this  work,  and  to  show  that  nature  operates  in  her  several  depart- 
ments, respectively,  by  general  and  not  by  partial  laws,  and  that  a 


236  INSTITUTES    OF    MEDICINE. 

Stable  and  perfect  foundation  may  be  thus  laid,  as  it  exists  in  nature 
for  the  great  superstructure  of  pathology  and  therapeutics  (§  2,  892) 
435,  h.  The  arguments  and  the  facts  which  I  have  employed  in  the 
foregoing  Essay  on  Animal  Heat  must  have  been  oftener  approved  than 
avowed,  since  they  have  been  freely  adopted  by  some  subsequent 
writers  without  indicating  the  source  from  whence  they  were  derived 
(§  906,^). — See  Rights  of  Authors  p.  919,  no.  23. 

435,  c.  I  may  be  also  permitted  to  make  the  following  extract  fiom 
the  Preface  to  the  third  volume  of  the  Medical  and  Physiological 
Commentaries,  published  four  years  subsequently  to  the  first  two  vol- 
umes.    Thus : 

"  In  respect  to  chemistry,  the  author  may  safely  affirm  that  not  a 
fact  has  been  subsequently  disclosed  that  reflects  the  smallest  light 
upon  physiology  or  pathology.  The  whole  of  that  ground,  wherever 
chemistry  has  obtruded  itself  upon  the  science  of  life  and  disease,  is 
so  amply  explained  in  the  former  volumes  of  these  Commentaries, 
that  not  a  substantial  fact,  nor  a  vague  conclusion,  has  been  put  forth 
by  the  school  of  Liebig,  which  is  not  there  examined,  anticipated,  and 
answered,  as  something  which  had  already  an  existence,  or  was  like- 
ly to  emerge  from  the  speculative  philosophy  of  the  laboratory  then 
in  almost  universal  vogue"  (§  1  Z>,  3501,  820  c).* 

436,  What,  therefore,  I  may  now  say  in  refutation  of  this  or  of 
other  chemical  doctrines  of  organic  processes  and  results,  will  con- 
sist, in  part,  of  a  summary  view  of  some  of  the  facts  and  arguments 
which  are  arrayed  in  copious  detail  in  the  Medical  and  Physiological 
Commentaries.  And,  truth  being  my  only  object,  I  shall  begin  the 
subject  under  consideration  with  a  statement  of  the  opinions  of  some 
of  the  most  accurate  and  distinguished  observers,  which  correspond 
with  my  own.  But  to  show,  however,  that  nothing  but  opinions  have 
been  expressed  even  by  those  who  have  comprehended  the  subject,  I 
shall  quote  from  each  author  all  that  I  have  any  knowledge  of  his  hav- 
ing said  upon  the  question  at  issue,  with  the  exception  of  the  little 
which  occurs  along  with  Hunter's  observations  upon  the  temperature 
of  trees.  I  will  add,  also,  in  proof  of  the  necessity  of  these  inquiries, 
that  no  preceding  attempt  had  been  made  to  show  the  errors  of  the 
chemical  doctrines  of  digestion,  and  that  I  have  incorporated  in  my 
prefatory  remarks  to  that  investigation  all  that  I  could  learn  from  the 
distinguished  authors  whom  I  have  there  summoned  in  behalf  of 
philosophy. — See  Rights  of  Authors  p.  919,  no.  22, 

437,  a.  Let  us,  then,  hear  the  great  French  physiologist.  "  The 
extrication  of  caloric,"  says  Bichat,  "  is  a  phenomenon  exactly  analo- 
gous to  those  of  which  the  general  capillary  system  is  the  seat." — 
"  The  disengagement  of  caloric  is  always  subordinate  to  the  state  of  the 
vital  forces^ — "  The  state  of  respiration  has  no  influence  upon  the 
actual  heat  of  the  body." — "  When  we  place  on  one  side  all  the  phe- 
nomena of  animal  heat,  and  on  the  other  the  chemical  hypothesis,  it 

*  That  this  opmion  is  not  peculiar  to  myself  appears  from  critical  notices  of  the  Com- 
mentaries.  Thus,  for  example,  it  is  said  by  the  distinguished  author  of  the  "  Climate  of 
the  United  States  and  its  Endemic  Injluences,"  that, 

"  It  will  be  seen  that  Dr.  Paine,  in  fact,  anticipates  the  whole  chemical  theory  of  Lie- 
big,  as  set  forth  in  his  'Animal  Cliemistry.'  This  he  does  not  only  in  his  Essay  on  Vi- 
tality, in  which  he  controverts  some  of  the  German  professor's  opinions,  advanced  in  the 
'  Orf;anic  Chemistry  applied  to  Agriculture  and  Physiology!  but  likewise  in  his  Medi- 
cal and  Physiological  Commentaries,  published  before  the  appearance  of  either  of  Lie 
big's  works." 


PHYSIOLOGY. FUNCTIONS.  237 

appears  to  me  so  inadequate  to  the  explanation  that  I  think  every  me- 
thodical mind  can  refute  it  without  my  assistance^' — Bichat's  General 
Anatomy  applied  to  Physiology  and  Medicine. 

437,  b.  John  Hunter,  like  Bichat,  placed  the  elaboration  of  organic 
heat  upon  the  same  vital  grounds  ;  regarding  it  as  a  secreted  product. 
"  It  is  most  probable,"  he  says,  "  that  the  power  of  generating  heat 
in  animals  arises  from  a  principle  so  connected  with  life,  that  it  can, 
and  does,  act  independently  of  circulation,  &c.,  and  is  that  power 
which  preserves  and  regulates  the  internal  machine." — Hunter's 
Observations  on  Certain  Parts  of  the  Animal  Economy. 

437,  c.  And  thus  Wilson  Philip :  "  Among  the  secretions  I  havo 
ranked  the  evolution  of  caloric,  although  not  taking  place  on  any  par- 
ticular surface,  because  it  appeared  to  be  performed  by  the  same 
power  acting  on  the  same  fluid ;  and  because,  like  secreted  fluids,  it 
fails  when  any  considerable  part  of  the  influence  of  the  brain  or  spi- 
nal cord  is  withdrawn." — Philip's  Experimental  Inquiry  into  the 
haws  of  the  Vital  Functions  (§  446,  b). 

437,  d.  And  thus  the  philosophical  Moore  :  "  We  must  allow  the 
bodies  of  living  animals  and  vegetables  to  form  an  original  source  of 
heat,  as  much  beyond  our  power  of  explaining  as  the  source  of  the 
sun's  heat." — INIoore's  Medical  Sketches. 

437,  e.  And  Miiller  thus  :  "  From  the  expex'iments  of  Dulong  and 
Despretz,  it  results  that,  even  if  the  chemical  theory  of  respiration  be 
adopted,  there  must  be  still  some  other  source  of  animal  heat.''  "A  gen- 
eral source  of  animal  heat  is  undoubtedly  to  be  found  in  the  organic 
processes,  in  which,  by  the  organizing  forces  on  the  organic  matter, 
heat  is  generated  not  in  one,  but  in  every  organ  of  the  body."  Again, 
"  Since  all  organic  processes  are  chiefly  dependent  on  the  influence 
exerted  by  the  nerves  on  the  organic  mattter  of  the  body,  it  cajinot 
appear  wonderful  if  the  reciprocal  action  between  the  organs  and  the 
nerves  is  a  main  source  of  animal  heat." — Muller's  Physiology. 

437, y.  Tiedemann  has  the  same  view  of  the  subject.  "  The  only 
point,"  he  says,  *'  that  can  be  regarded  as  placed  beyond  doubt  is,  that 
the  evolution  of  heat  is  a  vital  act  which  depends  immediately  on  the 
process  of  nutrition,  the  conditional  and  preservative  cause  of  life. 
The  intensity  of  the  evolution  of  heat,  and  the  property  of  maintaining 
itself  at  a  certain  temperatui'e  proper  to  each  species,  are,  in  animals, 
in  direct  ratio  with  the  composition  of  their  organization,  and  with 
the  sum  and  intensity  of  their  manifestations  of  activity." — Tiede- 
mann's  Physiology. 

437,  g.  Finally,  it  is  even  said  by  the  distinguished  chemical  phys- 
iologist, Dr.  Carpenter,  that,  "  It  is  evident  that  the  chemical  doc- 
trine in  its  present  form  is  insufficient  to  explain  the  phenomena  of 
animal  calorification." — Carpenter's  Human  Physiology,  p.  611. 
Jjondon,  1842. 

438,  a.  The  very  able  Dr.  Edwards,  in  his  work  on  the  Influence 
jf  Physical  Agents  on  Life,  maintains  that  "  respiration  and  animal 
heat  stand  related  as  cause  and  effect.'"  This  doctrine  is  maintained 
by  Edwards  with  great  ability  ;  far  more  so  than  by  all  other  authors 
whom  I  have  consulted.  I  thought  it,  therefore,  important  to  dispose 
of  his  facts  and  arguments,  in  my  former  work,  as  far  as  their  plausi- 
bility and  my  own  advantage  of  the  right  position  would  admit. 
There  is  much  said,  in  the  Gomnventaries,  in  refutation  of  that  doc* 


238  INSTITUTES    OF    MEDICINE. 

trine,  which  is  at  the  foundation  of  Liebig's  (§  440),  and  to  which 
no  farther  reference  will  be  made  in  this  work  (^  1044). 

438,  h.  Coming  to  the  heterogeneous  assumptions  which  distinguish 
the  school  of  Liebig,  there  was  no  difficulty  in  anticipating  the  nature 
of  such  as  might  be  relative  to  former  theories.  I  had  set  forth  the 
various  doctrines  in  their  ample  dimensions,  and  brought  them  to  the 
test  of  facts  and  philosophy.  The  combustion  theory  was  then  in 
vogue,  and  nearly  in  the  terms  as  expounded  by  Liebig.  In  descant- 
ing upon  its  peculiarities  I  took  for  my  guide  the  most  recent  and  ap- 
proved phraseology,  which,  it  will  be  seen,  is  coincident  with  the  sup- 
posed novelty;  and,  although  it  had  numerous  and  ai'dent  admirers, 
it  passed  into  such  oblivion,  in  the  brief  space  of  two  years,  that  when 
Liebig  promulgated  the  same  hypothesis,  and  in  the  same  language, 
it  was  hailed  as  one  of  the  most  brilliant  achievements  of  that  distin- 
guished man  (§  349,  d).  The  doctrine  which  had  been  thus  nearly 
expressed  by  Billing,  in  his  "  Principles  of  Medicine,"  was  taken  for 
my  text,  and  is  now  presented  again,  in  its  original  typography.  Thus  : 

"  We  have  in  the  lungs  a  charcoal  fire  constantly  burning,  and 
in  the  other  parts  a  wood  fire,  the  one  producing  carbonic  acid  gas, 
the  other  carbon  ;  the  food  supplying,  through  the  circulation,  the  veg- 
etable or  animal yi;c^,  from  which  the  charcoal  is  prepared  that  is  burn- 
ed in  the  lungs.  It  is  thus  that  animal  heat  is  kept  uj)." — Billing, 
1838  (§  447^  a,  no.  4,  1044). 

438,  c.  Somewhat  pi-ior  to  Billing's  day,  Roget  had  embellished  his 
"  Bridgewater  Treatise  on  Animal  and  Vegetable  Physiology,"  by 
the  following  graphic  desci'iption  of  the  apparatus,  and  the  office 
which  each  part  fulfills  in  the  generation  of  animal  heat.     Thus  : 

"  The  food  supplies  \\\q  fuel,  which  is  prepared  for  use  by  the  di- 
gestive organs.,  and  conveyed  by  the  pulmonary  arteries  to  the  place 
where  it  is  to  undergo  comhustion.  The  diaphragm  is  the  bellows 
which  feeds  the  furnace  with  air ;  and  the  trachea  is  the  chimney 
through  which  the  carbonic  acid,  which  is  the  product  of  combustion, 
escapes." — Roget  (§  350f ,y). 

438,  d.  Now,  the  only  fundamental  difference  between  the  forego- 
ing and  Liebig's  hypothesis  is  this :  The  former  supposes  the  com- 
bustion to  take  place  in  the  lungs,  the  latter  in  every  other  part  ex- 
cepting the  lungs,  where,  as  will  be  seen,  a  special  provision  is  made 
for  the  temperature  of  those  organs  (§  447^,/"). 

That  no  imaginary  obstacle  may  lie  in  the  way  of  the  vital  theory, 
and  that  truth  may  have  the  advantage  of  rival  doctrines  by  their  close 
apposition,  and  that  knowledge  may  not  be  limited  to  the  facts  and 
deductions  of  unadulterated  science,  it  remains  to  show,  by  a  series  of 
quotations  from  Liebig's  Animal  Chemistry,  that  the  doctrine  of  the 
dependence  of  organic  heat  upon  the  chemical  process  of  combustion 
has  gained  nothing  from  the  Laboratory  at  Geissen  ;  while  the  atten- 
tive reader  will  find  in  the  extracts  themselves  the  most  ample  proof 
of  its  untenable  nature.  This,  indeed,  may  have  been  well  anticipa- 
ted from  what  I  have  shown  of  this  philosopher's  regard  for  facts  and 
consistency  in  section  350.  Indeed,  the  same  incongruities,  the  same 
contradictions,  and  worse  assumptions,  go  to  form  the  whole  fabric  of 
Liebig's  disquisitions  upon  animal  heat,  as  I  have  shown  to  make  up 
his  jumble  respecting  digestion,  and  other  great  functions,  as  well  as 
properties  of  living  beings  (^  1044). 


PHYSIOLOGY. FUNCTIONS.  239 

1  shall  endeavor  to  execute  my  task  with  the  same  efficiency  as 
was  attempted  in  relation  to  the  chemical  views  of  digestion  (§  350), 
in  the  earnest  hope  that  the  chemist  may  discern  the  error  of  his 
ways,  and  leave  to  the  student  of  Organic  Nature  those  difficult  prob- 
lems which  concern  the  highest  welfare  of  man,  and  whose  consist- 
ency, in  their  philosophical  bearing,  cannot  be  disturbed  without  laying 
in  ruins  every  principle  in  physiology,  and  carrying  death  into  the 
chambers  of  the  sick  (§  4  a,  5,  5^  a,  3761,  376f  b,  819,  &c.) 

440,  a.  Let  us  begin,  then,  with  a  statement  of  the  doctrine  as  sum- 
marily delivered  by  Liebig  in  his  work  on  Animal  Chemistnj,  and 
we  shall  see  from  the  first  proposition  that  it  is  essentially  the  old 
speculation  (§  438,  h),  alike  based  upon  artificial  expedients,  and  upon 
the  assumption  that  the  living  organism  is  a  mere  chemical  apparatus, 
destitute  of  all  properties  and  laws  that  are  not  common  to  dead 
matter. 

1.  "  It  is  evident  that  the  supply  of  heat  lost  by  cooling  is  effected  by 
the  mutual  action  of  the  elements  of  the  food  and  the  inspired  oxygen, 
which  combine  together.  The  animal  body  acts,  in  this  respect,  as  a 
furnace  which  we  supply  icith  fuel."  "  In  order  to  keep  up  in  the 
furnace  a  constant  temperature,  we  7nust  vary  the  supply  of  fuel  accord- 
ing to  the  external  temperature,  that  is,  according  to  the  sujfply  of  oxy- 
gen.^'— Ani?}ial  Chemistry. 

It  will  be  seen,  from  the  close  of  the  foregoing  quotation,  tliat  a 
capital  error  is  made  in  assuming  a  law  that  the  quantity  of  food  is 
regulated  by  the  temperature  of  the  air  (§  440  cc,  no.  12).  That 
assumption  is  carried  out  in  opposition  to  all  well-known  facts  ;  while 
it  is  also  assumed  as  a  law,  that  animal  heat,  whatever  its  uniformity 
in  the  warm-blooded  animal,  or  its  instability  in  the  cold-blooded,  de- 
pends upon  the  relative  law  of  the  temperature  of  the  air  and  the 
quantity  of  food  consumed,  although  this  law  is  virtually  contradicted 
by  various  other  requisites  for  the  promotion  and  maintenance  of  ani- 
mal heat.  But  let  us  have  another  unqualified  proposition  which  de- 
fines the  law  in  relation  to  the  dependence  of  animal  heat  upon  exter- 
nal temperatui'e  and  the  food  consumed.     Thus  : 

2.  "  In  different  climates,  the  quantity  of  oxygen  introduced  into  the 
system  by  respiration  varies  according  to  the  temperature  of  the  ex- 
ternal air.  The  quantity  of  inspired  oxygen  increases  with  the  loss 
of  heat  by  external  cooling,  and  the  quantity  of  carbon  or  hydrogen 
necessary  to  combine  with  this  oxygen  must  be  increased  in  the  same 
ratio." — Animal  Chemistry. 

Now  compare  the  following,  3,  4,  and  5,  with  the  preceding  1  and 
2,  and  observe  the  conflict  between  them,  and  the  contingencies  upon 
which  the  great  law  is  made  to  depend  that  determines  a  uniform 
temperature.     Thus  : 

3.  "  The  quantity  of  oxygen  consumed  varies  according  to  the  tem- 
perature and  density  of  the  air,  according  to  the  degree  of  motion, 
labor,  or  exercise,  to  the  amount  and  quality  of  the  food,  to  the  com- 
parative warmth  of  the  clothing,  and  also  according  to  the  time  within 
which  the  food  is  taken"  !  A  proposition  mostly  relative  to  man,  and 
unfounded  as  to  him  (§  440,  c). 

4.  "  The  quantity  of  food  is  regulated  by  the  number  of  respirations, 
by  the  temperature  of  the  air,  and  by  the  amount  of  heat  given  off  to 
ihe  surrounding  medium"  !    (§  447,  c). 


240  INSTITUTES   OF    MEDICINE. 

5.  '*  The  inutual  action  between  the  elements  of  the  food  and  the  oxy- 
gen  conveyed  by  the  circulation  of  the  blood  to  every  part  of  the  body  is 
THE  SOURCE  OF  ANIMAL  HEAT."  "  For  a  given  amount  of  oxygen  the 
heat  produced  is,  in  all  cases,  exactly  the  same  J' — Liebig's  Animal 
Chemistry  (§  447,  c,  1048). 

6.  "  There  is  not  the  smallest  support  to  the  opinion  that  there  ex- 
ists, in  the  animal  body,  any  other  unknown  source  of  heat,  besides 
the  mutual  chemical  action  between  the  elements  of  the  food  and  the 
oxygen  of  the  air." — Animal  Chemistry. 

No  farther  comment  is  necessary  to  indicate  the  complexities  and 
contradictions  involved  in  the  foregoing  quotations  ;  such  as  "  the  quan- 
tity of  oxygen  consumed  depends  on  the  amount  and  quality  of  the 
food,"  while  "  the  quantity  of  food  is  regulated  by  the  number  of  res- 
pirations," that  is,  by  "  the  quantity  of  oxygen  consumed,"  &c. 

If,  also,  we  now  add  to  the  foregoing,  1,  2,  3,  4,  5,  6,  other  contin- 
gencies upon  which  it  is  assumed  that  animal  heat  depends,  we  shall 
have  such  a  variety  of  accidental  circumstances  to  interpret  the  uni- 
form temperature  of  each  individual  of  every  species  of  animal,  and 
that,  too,  according  to  the  constitutional  peculiarities  of  each  species, 
that  the  nature  of  the  chemical  rationale  will  be  sufficiently  obvious. 
Thus : 

7.  "  Where  the  food  contains  meat,  fat,  and  wine,  by  reason  of  the 
hydrogen  in  those  kinds  of  food  which  is  oxydized,  and  which,  in  being 
converted  into  water,  it  evolves  much  more  heat  for  equal  weights." 

8.  "  The  cooling  of  the  body,  by  whatever  cause  it  maybe  produced, 
increases  the  amount  of  food  necessary.  The  mere  exposure  to  the 
cold  air,  &c.,  increases  the  loss  of  heat,  and  compels  us  to  eat  more 
than  usual.  [  !  ]  The  same  is  true  of  those  who  are  accustomed  to 
drink  large  quantities  of  cold  water.  It  increases  the  appetite,  [  !  ]  and 
persons  of  a  weak  constitution  find  it  necessary,  by  continued  exer- 
cise, to  supply  to  the  system  the  oxygen  required  to  restore  the  heat 
abstracted  by  the  cold  water"  ! — Animal  Chemistry . 

440,  b.  Here  I  pause  for  a  moment  to  advert  to  the  ground  of  the 
assumptions  in  the  quotations  7  and  8.  The  reason  is  one  which  goes 
conclusively  to  the  vital  theory  of  animal  heat.  When  wine,  for  ex- 
ample, is  taken  into  the  stomach,  an  evolution  of  heat  ensues  as  soon 
as  the  stimulant  is  swallowed,  in  virtue  of  its  stimulant  effect  on  that 
organ.  In  the  same  way  meat  stimulates  more  than  vegetables,  and 
will  light  up  a  glow  upon  a  cold  surface  before  its  digestion  has  be- 
gun (§  512,  Z»).  In  respect  to  the  superiority  of  cold  water  in  pro- 
voking hunger,  there  is  no  other  way  of  explaining  the  philosophy 
against  the  fact  than  by  supposing  "  the  Reformer"  was  pledged  to 
the  popular  cause  of  temperance.  But  since  wine,  brandy,  &c.,  far 
more  than  cold  water,  "  increase  the  appetite"  and  "  compel  us  to  eat 
more  than  usual,"  and  since  these  fluids  are  said  to  yield  a  far  greater 
amount  of  "fuel"  to  the  system  than  the  food  itself  (whose  main  ob-- 
ject  is  also  supposed  to  supj^ly  the  means  of  combustion),  it  should 
follow,  upon  our  author's  premises,  that  less  food  would  be  necessary 
to  the  pui-poses  of  life  in  proportion  to  the  quantity  of  alcohol  con- 
sumed, and  therefore  that  wine  should,  in  reality,  diminish  the  appe- 
tite and  "  compel  us  to  eat  less  than  us/aal"  (nos.  4,  7  ;  §  441,  e). 

It  may  be  worth  observing,  also,  in  respect  to  the  "  cold  water," 
that  the   assumption   is  foundec    upon   several  important  mistakes ; 


PHYSIOLOGY. FUNCTIONS.  241 

namely,  1st,  That  the  appetite  is  virtually  regulated  by  the  condition 
of  the  calorific  process ;  2d.  That  "  the  animal  body  bears  the  same 
relation  to  surrounding  objects  (in  respect  to  an  interchange  of  calor- 
ic), as  any  other  heated  mass"  (no.  14)  ;  and,  3d.  That  drinkino' 
cold  water  diminishes  the  temperature  of  the  body  (§  442,  b,  c,  d,  e). 
And  the  most  strenuous  and  extensive  efforts  have  been  made  to  choke 
down  these  absurdities  under  the  penalty  of  being  lampooned  as  an 
enemy  to  "  experimental  philosophy"  (§  5|,  a).  I  have  no  doubt, 
however,  that  they  will  forcibly  remind  the  reader  of  the  parallel  quo- 
tations, and  of  the  pathological  and  therapeutical  principles  which 
emanate  from  them  in  the  two  subsequent  sections. 

440,  bb.  As  to  the  "fat"  (no.  7),  the  chemist  assumed  that  to  be  an 
important  source  of  animal  heat  because  it  is  one  of  the  best  sub- 
stances for  combustion  "  in  the  air  or  in  oxygen  gas"  (no.  10) ;  and 
this  hypothesis  conducts  him  to  the  ludicrous  mistake  of  I'egarding  it 
equally,  and  in  the  same  aspect,  as  a  source  of  animal  heat,  whether 
It  be  taken  as  an  article  of  food  and  converted  into  chyme,  or  consist 
of  food  which  has  been  converted  into  the  fat  that  makes  up  a  part  of 
the  consumer.  The  uniform  temperature,  therefore,  among  a  variety 
of  other  things,  will  depend  not  only  on  the  amount  of  fat  eaten,  but 
on  the  amount  formed  out  of  the  blood.  This  leads  our  author  to 
say  that, 

9.  "  If  we  were  to  go  naked,  like  certain  savage  tribes,  or  if  in 
hunting  or  fishing  we  were  exposed  to  the  same  degree  of  cold  as  the 
Samoyedes,  we  should  be  able  with  ease  to  consume  ten  pounds  of 
flesh,  [ !  ]  and  perhaps  a  dozen  of  tallow  candles  into  the  bargain,  daily, 
as  warmly-clad  travelers  have  related  with  astonishment  of  these 
people.  [ !  ]  We  should  then,  also,  be  able  to  take  the  same  quantity  of 
brandy  or  train  oil  without  bad  effects,  because  the  carbon  and  hydro- 
gen of  these  substances  would  only  suffice  to  keep  up  the  equilibrium 
between  the  external  temperature  and  that  of  our  bodies." — Animal 
Chemistry  {^  1050).     And  yet  Alcohol  is  not  absorbed  §  350,  no.  94, 

And  that,  too,  in  a  critical  work  on  science  which  professes  a  rigor- 
ous adherence  to  facts,  as  the  only  apology  for  a  contemptuous  deris- 
ion of  long-established  doctrines,  and  as  the  only  basis  for  the  attempt- 
ed substitutes.  But  let  us  now  turn  from  "  fat"  as  a  combustible 
substance,  via  the  digestive  apparatus,  to  "  fat"  as  appertaining  to 
the  organized  tissues  (§  1048,  1049). — Note  N  p.  1121. 

10.  "  The  formation  oi  fat  depends  on  a  deficiency  of  oxygen. 
But,  in  this  process,  in  the  formation  of  fat  itself,  there  is  opened  up 
a  neio  source  of  animal  heat.  The  oxygen  set  free  in  the  formation 
of  fat  is  given  out  in  combination  with  carbon  or  hydrogen,  and  there 
must  have  been  generated  by  the  formation  of  carbonic  acid  or  water 
as  much  heat  as  if  an  equal  weight  of  carbon  or  hydrogen  had  been 
burned  in  air  or  in  oxygen  gas." — Liebig's  Organic  Chemistry ,  &c. 

Introductory  to  the  foregoing  quotation,  we  are  told,  that, 
"  The  production  of  fat  is  always  a  consequence  of  a  deficient  sup- 
ply of  oxygen,  for  oxygen  is  absolutely  indispensable  for  the  dissipa 
tion  of  excess  of  carbon  in  the  food." 

And  then  we  are  refeiTed,  in  illustration,  to  the  "  lean,  muscular, 
einewy  limbs  that  are  exhibited  with  pride  by  the  Bedouin  and  Arab  of 
(he  desert"  (c).  But  what  says  the  variety  in  respect  to  fat,  and  oxygen! 
-nd  heat,  that  prevails  among  the  tenants  of  the  ocean,  who  have  but  ono 

Q 


242  INSTITUTES    OF    MEDICINE. 

common  supply  of  food  1  Contrast,  for  example,  the  blubber  of  the 
whale,  who  breathes  with  lungs,  with  many  a  lean,  voracious,  cold- 
blooded animal  that  respires  with  gills.  The  hypothesis,  therefore, 
falls  (no.  Ill,  and  §  443,4).  Or,  if  it  survive  such  difficulties,  take, 
then,  tlie  following  statement,  designed  as  an  important  basis  for  the 
combustion  theory,  and  which  should  have  had  a  place  among  our  au- 
thor's pathological  doctrines  (§  350i).  But  our  present  interest  liea 
in  the  fact  that  it  appears,  after  all,  that  it  is  not  "  true  without  excep- 
tion," that  "  the  production  of  fat  is  always  in  consequence  of  a  defi- 
cient supply  of  oxygen."     Thus  : 

"  Exercise  and  labor  cause  a  diminution  in  the  quantity  of  the  men- 
strual discharge ;  and  when  it  is  suppressed  in  consequence  of  dis- 
ease, the  vegetative  life  is  manifested  in  a  morbid  productio?i  of  Jut"  / 

H^re  is  another  "  most  trustworthy  observation,"  and  "  perfectly 
conclusive"  as  to  our  author's  doctrine.     Thus  : 

"  The  quantities  of  oxygen  which  a  whale  and  a  carrier's  horse  can 
inspire  in  a  given  time  are  very  unequal.  The  temperature,  as  well 
as  the  quantity  of  oxygen,  is  much  greater  in  the  horse." — Liebig's 
Animal  Chemistry,  &c. 

Now  the  temperature  of  the  whale  in  the  frozen  seas  is  more  than 
100°  Fh.,  nor  can  the  "  carrier"  bring  up  that  of  his  horse  to  a  higher 
degree,  with  the  aid  of  a  tropical  sun.  It  is  evident  that  our  author 
has  regarded  the  whale  as  a  cold-blooded  fish. 

440,  c.  I  shall  not  now  stop  to  inquire  farther  into  the  factitious  na- 
ture of  the  foregoing  doctrine,  but  go  on  with  other  extracts  in  which 
the  author  endeavors  to  sustain  his  great  law  of  animal  heat  (5.  6), 
and  expound  by  other  contingencies  that  exact  temperature  which 
distinguishes  every  warm-blooded  individual  of  every  species  of  ani- 
mal, and  according  to  the  nature  of  the  species,  and  with  scarce  a  va- 
riation, at  all  seasons,  in  all  climates,  at  all  ages,  with  all  kinds  and 
quantities  of  food,  from  him  who  "devours  10  lbs.  of  flesh  and  a  dozen 
tallow  candles  into  the  bargain,  daily,  and  the  same  quantity  of  brandy 
and  train  oil  without  bad  effects"  (no.  9),  to  him  who,  like  "  old  Cor- 
naro,"  lives  on  "half  an  egg  a  day;"  and  whether  clad  in  the  flannels 
and  woolen  broadcloths  that  are  preferred  as  matters  of  comfort  by 
many  inhabitants  of  tropical  climates,  or  absolutely  naked,  with  Fah- 
renheit at  40°  and  lower,  like  the  Petcherai  Indians  (442,  h) ;  or,  wheth- 
er sleepirig  or  waking,  sitting  or  standing,  running  or  walking,  in  an 
ice-house  or  in  an  oven,  in  all  past  time,  now,  and  forever ;  whatever 
statements  our  "  Reformer"  may  make  to  the  contrary  notwithstand- 
ing. It  will  appear,  therefoi'e,  that  the  following  affirmations  should 
be  carefully  considered,  before  they  are  admitted  as  appendages  to 
the  general  law ;  namely, 

11.  "Our  clothing  is  merely  an  equivalent  for  a  certain  amount  of 
food.  [  !  J  The  more  warmly  we  are  clothed  the  less  urgent  becomes 
the  appetite  for  food,  [ !  ]  because  the  loss  of  heat  by  cooling,  and  con- 
sequently the  amount  of  heat  to  be  supplied  by  the  food,  is  diminish- 
ed" (no.  9,  and  12,  and  §  442  a,c,  1047,  1048,  1049). 

Here  our  author  predicates  two  important  errors  of  the  hypothesis 
which  they  are  intended  to  sustain ;  the  assumptions  and  the  hypoth- 
.esis  being  mutually  designed  to  support  each  other. 

11-|.  But  again;  having  seen  that  (in  the  language  of  Mr.  Ancell, 
•'the  Rf former's"  interpreter)  "the  deposition  of  fat  is  supposed  to 


PHYSIOLOGY. FUNCTIONS.  243 

act  as  a  substitute  for  free  respiration  in  the  production  of  heat"  (no. 
10),  we  shall  not  be  surprised  to  learn  that  "  its  absorption  answers 
as  a  substitute  for  food  in  the  production  of  animal  heat."  So  it  is  ex- 
tensively affirmed  in  the  work  on  Animal  Chemistry. 

Why,  then,  is  the  temperature  of  a  very  fat  ox  and  a  very  lean  one, 
or  of  a  very  fat  man  and  a  very  lean  one,  exactly  the  same  in  each 
Bpecies,  respectively  1  Why  does  the  fat  man  sustain  a  much  less 
exaltation  of  heat  than  the  lean  one  when  emaciation  is  in  rapid 
progress  in  febrile  diseases  1  Why  those  daily  periodical  evolutions 
of  heat  (100°  to  110°  Fh.)  in  the  emaciated  subject  of  phthisis,  sub- 
sisting on  barley-water ;  and  respiring  with  lungs  unfitted  for  half 
their  usual  functions  ?  And  this  leads  me  to  state  the  chemical  phi- 
losophy of  mania  and  delirium,  which  flows  immediately  from  the 
subject  before  us ;  and  by  which  we  learn,  also,  what  is  more  im- 
portant, the  extent  of  our  author's  theory  of  combustion.     Thus  : 

"  In  the  progress  of  starvation  it  is  not  only  the  fat  which  disap- 
pears, but  also,  by  degrees,  all  such  of  the  solids  as  are  capable  of  be- 
ing dissolved.  In  the  wasted  body  of  those  who  have  suffered  starva- 
tion the  muscles  are  shrunk  and  unnaturally  soft,  and  have  lost  their 
contractility.  All  those  parts  of  the  body  which  were  capable  of  en- 
tering into  a  state  of  motion  have  served  to  protect  the  remainder  ot 
the  frame  from  the  destructive  influence  of  the  atmosphere.  [ !  ]  To- 
ward the  end,  the  particles  of  the  brain  begin  to  undergo  the  process 
of  oxydation,  and  delirium.,  mania,  and  death,  close  the  scene." 

This  construction  of  the  cause  of  delirium  and  mania  is  conformable 
to  the  author's  hypothesis  of  thought,  mental  emotions,  &c.  (§  349,  e) ; 
but  that  the  phenomena  are  due  to  totally  different  influences  "  in  the 
progress  of  starvation  "  is  shown  by  the  uniform  preservation  of  the 
intellectual  powers  in  the  most  emaciated  subjects  of  phthisis  pulmo- 
nalis  (§  441,  c). — See  Index  II,  Article  Hunger. 

440,  CO.  But,  we  are  only  beginning  with  the  contingencies  which 
contribute  to  the  fundamental  principle  of  animal  heat,  and  which  are 
designed  to  interpret  its  remarkable  uniformity,  yet  variety,  in  differ- 
ent species  of  the  warm-blooded  tribes,  and  its  variableness  in  the  cold- 
blooded, and  to  bring  the  general  doctrine  into  correspondence  with 
a  great  law  of  caloric  which  prevails  in  the  inorganic  world  ^§  440  e, 
no.  14). 

12.  "  In  cold  and  temperate  climates,  the  air  which  incessantly 
strives  to  consume  the  body  [  !  ]  urges  man  to  laborious  efforts  in  or- 
der to  furnish  the  means  of  resistance  to  its  action,  while,  in  hot 
climates,  the  necessity  of  labor  to  provide  food  is  far  less  urgent" 
(§  445,  b). — Afii?nal  Chemistry. 

In  the  first  place,  all  animals  are  overlooked  in  the  foregoing  state- 
ment, and  our  philosopher  is  actually  regarding  man  as  the  only  liv- 
ing creature  who  has  a  temperature  above  the  surrounding  atmo- 
sphere J  for  it  surely  will  not  be  said  of  animals  that  they  must  work 
harder  for  a  supply  of  food  in  temperate  than  in  warmer  climates. 
Nor  will  the  reader  fail  to  observe  that  much  of  the  statements  and 
reasoning,  throughout,  is  predicated  specifically  of  man,  and  of  man, 
too,  in  a  state  of  health. 

As  to  the  necessity  of  more  "  laborious  efforts  to  provide  food"  in 
cold  than  in  hot  climates,  a  very  different  philosophy  lies  at  its  bottom 
than  assigned  by  Liebig,  which  consists  in  the  greater  necessity  of 


244  INSTITUTES    OF    MEDICINE. 

labor  to  cultivate  the  earth  and  raise  the  means  of  supply  in  the  foi.' 
mer  than  the  latter  sections  of  the  globe.  It  is  evident,  also,  thai 
"  the  Refoi-mer"  had  not  only  man  exclusively  in  view,  but  in  that 
part  of  the  contrast  which  relates  to  "  hot  climates,"  he  was  thinking 
alone  of  the  indolent  and  luxurious  master,  without  reference  to  the 
slave,  who  toils  the  day  long  under  a  torrid  sun  for  his  own  scanty 
subsistence  and  his  master's  too. — Note  Oo  p.  1141. 

But  again,  although  man  be  compelled  to  work  in  cold  climates 
"to  provide  food"  to  keep  up  his  temperature,  while  this  "necessity 
for  labor  is  far  less  urgent  in  hot  climates,"  the  cold-blooded  finny 
tribe,  and  the  warm-blooded  whale,  and  beasts  of  prey  are  quite  on 
an  equality,  in  that  respect,  in  all  regions  of  the  earth. 

440,  d.  But,  we  are  yet  far  from  the  end  of  the  "  contingent  influ- 
ences" which  modify  the  exact  law  of  animal  heat  (nos.  5,  6),  and 
which  go  to  the  preservation  of  its  exact  uniformity.  One  of  our  au- 
thor's hypotheses,  which  will  be  soon  stated  (no.  14),  betrays  him  into 
a  mistake,  which  has  been  often  made  and  as  often  exposed.     Thus : 

13.  "  The  contraction  of  muscles  produces  heat;  but  the  force  ne- 
cessary for  the  contraction  has  manifested  itself  through  the  organs 
of  motion,  in  which  it  has  been  excited  by  chemical  changes.  The 
ultimate  cause  of  the  heat  produced  is,  therefore,  to  be  found  in  these 
chemical  changes." — Animal  Chemistry. 

Now,  setting  aside  the  sophistry  of  this  reasoning  in  a  ciicle,  we 
have  the  simple  proposition  that  "  tlie  contraction  of  musclti  'produces 
heat  s^'  and  evidently  because  "  a  piece  of  caoutchouc,  when  rapidly 
drawn  out,  forcibly  contracts  again,  with  disengagement  of  heat." 
And  to  this  conclusion  the  "  Reformer"  was  impelled  by  his  funda- 
mental doctrine  that  the  living  and  the  dead  are  undistinguishably 
governed  by  the  same  properties  and  laws,  as  implied  by  no.  14,  and 
as  extensively  set  forth  in  §  350.  This  assumption  as  to  the  effects 
of  muscular  motion  I  have  sufficiently  noticed  in  my  former  Essay  on 
Animal  Heat ;  but  it  may  be  now  said  that  it  is  disproved  by  the  uni- 
formity of  animal  heat  in  all  warm-blooded  vertebrata,  under  all  cir- 
cumstances of  rest  and  exercise.  When  the  latter  is  sufficient  to  give 
an  impulse  to  the  general  circulatory  and  other  organs,  an  increased 
evolution  of  animal  heat  is  liable  to  happen,  like  an  increased  flow  of 
saliva,  sweat,  or  any  other  secreted  product ;  but  it  does  not  happen 
with  any  certainty,  and  is  never  due  to  the  physical  causes  assigned  ; 
neither  the  mechanical  one  of  "muscular  contraction,"  nor  the  "chem- 
ical changes." 

440,  e.  I  come  now  to  one  of  our  philosopher's  parallelisms  of  or- 
ganic and  inorganic  beings  in  respect  to  their  great  laws  and  functions, 
and  which  necessarily  flows  from  the  grand  physical  hypothesis  that 
the  living  body  is  a  mere  chemical  apparatus.     Thus : 

14.  "  The  animal  body  is  a  heated  mass,  which  bears  the  same 

RELATION    TO     SURROUNDING    OBJECTS    AS    ANY    OTHER    HEATED     MASS. 

It  receives  heat  when  the  suiTounding  objects  are  hotter,'  it  loses 
heat  when  they  are  colder  than  itself;" — Animal  Chemistry.  (See 
§  350|,  e,  1044  a,  b). 

Thus  we  have  throughout  a  consecutive  series  of  mistakes  and  blun- 
ders, emanating  from  a  false  position  in  respect  to  the  fundamental 
constitution  of  living  beings ;  while  this  perversion  of  nature  is  the 
monomania  of  materialism.  But  there  remains  much  of  the  like  na- 
ture yet  in  prospect. 


PHYSIOLOGY. FUNCTIONS.  245 

From  the  last  proposition,  and  from  the  common  level  in  which  liv- 
ing and  dead  objects  are  regarded,  and  in  his  unacquaintance  vi^ith 
physiological  facts,  the  chemist  has  been  betrayed  into  the  supposition 
that  all  the  contingent  circumstances  which  I  have  now  stated  (nos. 
,1-14)  contribute,  along  with  the  fundamental  law,  5  and  6,  to  the  pro- 
duction and  maintenance  of  that  uniform  temperature  by  which  every 
warm-blooded  vertebrata  is  distinguished,  while  every  other  product 
of  the  tissues  is  forever  variable  in  quantity,  and  which  are  to  explain 
lequally,  also,  the  vicissitudes  of  the  cold-blooded  race,  and  all  the 
diversities  of  temperature  which  spring  from  disease. 
1  The  plainest  facts  in  "  experimental  philosophy"  contradict  the  as- 
sumption, and  place  the  generation  of  animal  heat  upon  its  own  inde- 
pendent ground.  If  we  enter  an  apartment  heated  to  260°  F.,  the 
temperature  of  the  body  remains  unaffected  ;  and  equally  so  in  a  bath 
of  water,  where  all  evaporation  is  prevented.  If  we  pass  the  day  in 
an  ice-house,  or  dwell  in  an  atmosphere  at  50°  below  the  zero  of 
Fahrenheit,  it  is  all  the  same  (§  442,  c,  d).  If  water,  at  zero,  be 
dashed  on  the  body,  a  glowing  heat  is  instantly  lighted  up  on  the  sur- 
face ;  and  so  it  is  upon  the  cold  and  shriveled  skin  of  the  starving 
man  as  soon  as  food  shall  have  entered  his  stomach.  A  flash  of  indig- 
nation, or  an  impulse  of  shame,  will,  on  the  instant,  set  the  whole  face 
in  a  state  of  "  combustion ;"  the  face  being  then  said,  by  common 
consent,  to  "burn"  (§  441,  c).* 

With  the  last  proposition  (14)  goes  another  which  has  the  concur- 
rence of  all ;  namely, 

15.  "  The  heat  given  off  to  the  surrounding  medium  is  restored 
within  the  body  with  gi-eat  rapidity." — "  All  living  creatures,  whose 
existence  depends  on  the  absorption  of  oxygen,  possess  within  them- 
selves a  source  of  heat  independent  of  surrounding  objects." 

16.  And  (for  the  third  time,  5  and  6),  "  This  disengagement  of 
heat  is,  uniformly  and  under  all  circumstances,  the  result  of  the  com- 
bination of  a  combustible  substance  with  oxygen." — Animal  Chem- 
istry. 

Such  a  chemical  machine,  with  an  internal  source  of  heat,  and  con- 
stantly liable  to  elevations  and  depressions  of  temperature  from  "sur- 
rounding objects  like  any  other  heated  mass,"  could  possess  no  sta- 
bility of  temperature, — none  comparable  with  the  inanimate  objects 
by  which  its  own  internal  source  of  heat  is  said  to' be  influenced  ;  and 
when  we  superadd  the  various  other  contingencies,  the  varying  quan 
tities  and  qualities  of  food,  variableness  of  respiration,  the  oxygen 
respired,  clothing,  climate,  season,  weather,  rest  or  exercise,  age,  fat, 
candles,  train  oil,  and  rum,  which  are  said  to  have  important  influen- 
ces on  animal  heat  (nos.  1-14),  and  then  caiTy  out  the  assumed  rela- 
tion of  the  living  body  to  "  surrounding  objects,"  and  thus  identify  it 
with  a  "  heated  mass"  of  iron,  a  thousand  other  modifying  contin- 
gencies present  themselves,  which,  in  connection  with  the  "  internal 
independent  source  of  heat,"  should  render  the  temperature  of  the 
living  warm-blooded  vertebrata  variable  at  every  moment,  while  that 
of  the  cold-blooded  animal  should  be  distinguished  by  the  greater  uni- 
formity. 

It  need  scarcely  be  added,  that  the  warm-blooded  vertebrata  are 
remarkably  exempt  from  the  law  which  chemistry,  to  be  consistent, 
imputes  to  them  as  conductors  of  caloric  (no.  14).     And  herein,  as 

*  How  absurd  does  the  doctrine  of  combustion  appear  in  the  presence  of  those  Metv- 
tal  Emotions  which  instantly  light  up  a  glow  on  the  surface  of  the  body  ! 


246  INSTITUTES    OF    MEDICINE. 

every  where  else,  chemistry  betrays  the  fallacy  of  its  fundamental  as- 
sumption (nos.  5,  6,  16).  The  warm-blooded  vertebrata  are  espe- 
cially contradistinguished  from  "  other  heated  masses,  in  their  relation 
to  surrounding  objects,"  by  their  resistance  of  heat  from  external  ob- 
jects (§  441  c,  442  c) ;  and  this  contradistinction  is  not  only  shown  by 
universal  experience,  but  forcibly  so  by  the  comparative  relation 
which  cold-blooded  animals  and  "  other  heated  masses  bear  to  sur- 
rounding objects."  These  animals  depend  mostly  for  their  tempera- 
ture upon  that  of  the  surrounding  medium,  and  consequently  sustain 
much  of  the  relation  of  "  other  heated  masses."  Still,  they  possess 
not  only  a  feeble  power  of  generating  heat,  but,  what  is  more  to  my 
purpose,  they  have  a  corresponding  power  of  resisting  its  ingress  from 
surrounding  objects,  since  it  was  ascertained  by  Crawford  that  "« 
living  frog  acquires  heat  more  slowly  than  a  dead  oneT — London 
'Philosoph.  Trans.,  1781,  p.  485. 

It  is  also  worthy  of  remark,  that  the  chemist  has  mistaken  the  rise 
of  animal  heat,  when  occasioned  by  the  heat  of  a  fire,  for  that  inter- 
change of  caloric  which  takes  place  between  inanimate  substances  of 
different  temperatures.  The  phenomenon  is  peculiarly  a  fact  for  the 
vitalist,  since,  in  the  former  case  the  rise  of  heat  is  due  to  the  action 
of  caloric  as  a  stimulant  to  the  organic  functions  (§  1881). 

On  the  other  hand,  when  the  temperature  falls  from  the  direct  ac- 
tion of  cold  upon  the  living  body,  it  is  from  the  abduction  of  heat  from 
the  superficial  capillaries  alone,  by  which  the  calorific  function  is  ar- 
rested not  only  in  the  skin,but  may  be,  by  reflex  nervous  action, through- 
out the  body.  And  what  also  forcibly  shows  the  vital  nature  of  this 
phenomenon  is  the  frequent  and  speedy  exaltation  of  the  cutaneous 
heat  after  its  sudden  reduction  by  the  application  of  cold  water  (i^  1044). 

440, yi  In  the  midst  of  so  much  error  and  confusion,  it  is  no  diffi- 
cult matter,  as  already  seen  (§  350),  to  paralyze  an  author  by  an  ex- 
posure of  palpable  contradictions  in  fundamental  doctrines.  As  an 
example  of  this  nature  in  relation  to  the  present  subject  I  shall  place 
in  opposition  the  following  statements  : 

Affirmative.  'Negative. 

17.  "  In  whatever  way  carbon  IS.  "  Carbon  never  combines 
may  combine  with  oxygen,  the  act  at  common  temperatures  with  ox- 
of  combination  cannot  take  place  ygen,  so  as  to  form  carbonic  acid." 
without  the  disengagement  of  heat.  "There  is  no  example  oI  car- 
It  is  a  matter  of  indifference  wheth-  hon  combining  directly  with  oxygen 
er  the  combination  take  place  at  a  at  common  temperatures ;  but  nu- 
HiGH  or  at  a  low  TEMPERATURE  ;  merous  facts  show  that  hydrogen, 
the  amount  of  heat  liberated  is  a  in  certain  states  of  condensation, 
constant  quantity."  possesses  that  property.     Lamp- 

"  In  the  foregoing  pages,  it  has  black  which  has  been  heated  to  red- 
been  assumed  that  it  is  especially  ness  may  be  kept  in  contact  with 
CARBON  and  hydrogen  which,  by  oxygen  gas,  without  forming  car- 
combining  with  oxygen,  serve  to  bonic  acid.  The  spontaneous  in- 
produce  animal  heat."  flammability  of  the  charcoal  used 

"  The  carbon  of  the  food,  which  in  the  fabrication  of  gunpowder 
is  converted  into  carbonic  acid  has  been  correctly  ascribed  to  the 
within  the  body,  must  give  out  ex-  hydrogen  which  it  contains  in  con- 
Bctlv   as  much   heat  as  if  it  had   siderable  quantity ;  for  during  its 


PHYSIOLOGY. FUNCTIONS.  247 

been  directly  bunied  in  the  air  or  reduction  to  powder,  no  trace  of 

in  oxygen  gas."  carbonic  acid  can  be  detected  in 

"  The  13-9  oz.  of  carbon  which  the  air  surrounding  it.     It  is  not 

are  daily  converted  into  carbonic  ioxmedi.  walW  the  tenijoerature  of  the 

acid    in    the    body    of  an    adult,  mass   has    reached    the   red   heat. 

evolve   197477   degi'ees    of  heat,  The  heat  which  produces  the  in- 

which  is  sufficient  to  raise  the  tem-  flammation  is  therefore  7iot  caused 

perature  of  370  lbs.  of  water  to  hy  the  oxydation  of  the  carbon.'^ — 

98*3'^,  the  temperature  of  the  hu-  Liebig's    Organic    Chemistry   ap- 

man   body."  —  Liebig's    Animal  plied  to  physiology ,  &c.,  p.  263, 

Chemistry.,  1842.    [See,  also,  nos.  311. 
o,  6,  16.]' 

440,  g.  These  contradictory  doctrines  were  put  forth  in  different 
works,  but  almost  simultaneously,  and  each  was  designed  to  sustain 
important  hypotheses  that  regarded,  respectively,  the  negative  and 
the  affinnative  statement.  But,  even  in  the  work  on  Animal  Chem- 
istry., a  subject  collateral  to  the  general  hypothesis  of  animal  heat 
leads  the  author  to  a  partial  contradiction  of  his  all-pervading  idea  of 
the  ready  combustion  of  carbon  at  temperatures  as  low,  at  least,  as 
those  of  cold-blooded  animals ;  since,  upon  that  collateral  subject,  he 
says,  ""at  the  temperature  of  the  (warm-blooded)  body,  the  affinity  of 
hydrogen  for  oxygen  far  surpasses  that  of  carbon  for  the  same  ele- 
ment."    (See  §  441,  e.) 

440,  h.  I  shall  not  undertake  to  decide  whether  oxygen  unites  sin- 
gly with  carbon  or  hydrogen,  in  the  living  body,  or  along  witii  other 
elements  from  which  the  carbon  is  ultimately  excreted,  nor  is  it  the 
province  of  these  Institutes  to  inquire  into  a  truth  which  belongs  to 
the  laboratory.  In  my  former  Essay  on  Animal  Heat,  I  have  exam- 
ined this  subject  in  its  physiological  aspect  adversely  to  the  chemical 
doctrine,  and  in  confonnity  with  the  great  law  which  excludes  the 
formation  of  all  inorganic  compounds  within  the  living  organism,  as 
set  forth  by  chemistry  (§  38,  39,  419). 

440,  i.  Of  the  remaining  subsidiary  causes,  that  relative  to  the  bile 
should  not  be  neglected.  It  is  thus  summarily  expressed  by  Liebig's 
interpreter,  Mr.  Ancell : 

19.  "  These  facts,  and  the  reasoning  founded  upon  them,  have  led 
Liebig  to  the  conclusion  that  the  function  of  the  bile  is  to  support 
respiration  and  produce  animal  heat,  by  presenting  carbon  and  hy- 
drogen in  a  very  soluble  form  to  the  oxygen  of  aiterial  blood." — Mr. 
Ancell,  iii  London  Lancet,  1843. 

The  reader  will,  therefore,  the  more  readily  comprehend  the  doc- 
trine of  "  the  Reformer"  as  stated  in  the  following  language.     Thus  : 

"  In  the  carnivora  the  bile  contains  the  carbon  of  the  metamorphos- 
ed tissues.  This  carbon  disappears  in  the  animal  body,  and  the  bile 
likewise  disappears  in  the  vital  process.  Its  carbon  and  hydrogen  are 
given  out  through  the  skin  and  lungs  as  carbonic  acid  and  water ;  and 
hence  it  is  obvious  that  the  elements  of  the  bile  serve  for  respiration 
and  for  the  production  of  animal  heat." — Animal  Chemistry. 

That  may  answer  for  the  "carnivora  ;"  while  the  graminivora  de- 
pend more  upon  their  "fat,"  and  other  tribes  upon  their  special  al- 
lotments. 

Having  already  adverted  to  the  true  uses  of  the  bile  (§  314-316, 


248  INSTITUTES    OF    MEDICINE. 

409y),  I  shall  proceed  to  say,  without  stopping  to  inquire  how  the 
foreo'oino'  "  facts"  were  ascertained,  that  this  part  of  the  doctrine  will 
hardly  abide  the  test  of  morbid  conditions.  It  often  happens,  for  in- 
stance, when  the  production  of  bile  is  nearly  or  wholly  arrested,  that 
the  temperature  of  the  body  is  exalted  above  its  natural  standard, 
while  at  other  times,  when  the  bile  is  redundant,  the  temperature 
sinks  below  its  equilibrium.  This,  too,  is  familiar  to  physicians  as 
occurring  in  the  progress  of  the  same  disease ;  and  I  have  thus  intro- 
duced this  subject  more  for  its  bearing  upon  physiology  and  disease, 
than  on  account  of  its  perversion  by  the  chemist  (^  1031  b). 

441,  a.  Having  now  set  forth  the  principal  doctrine,  and  the  most 
important  contingencies  which  are  brought  to  its  support,  I  shall  pro- 
ceed to  make  some  farther  comments  both  upon  the  doctrine  and  its 
auxiliaries,  and  present  a  variety  of  facts  in  confirmation  of  the  phys- 
iological theory  of  animal  heat. 

441,  5.  In  the  first  place,  it  is  worthy  of  farther  remark  in  regard 
to  a  principal  element  of  the  main  hypothesis,  that  scarcely  any  two 
individuals,  of  whatever  species,  consume  the  same  quantities  of  food 
in  a  o-iven  time,  while  society  abounds  with  habitual  examples,  where, 
under  the  same  circumstances  of  age,  health,  sex,  climate,  tempera- 
ture, employment,  &c.,  there  is  every  gradation  in  quantity  from  a 
daily  consumption  of  many  pounds  to  a  few  ounces,  or  with  slight  va- 
riations as  to  quantity  in  many  individuals.  Without,  however,  now 
revertino-  to  the  preceding  relative  statements  of  our  author,  let  us 
adduce  another  for  the  sake  of  its  logic  and  precision.     Thus  : 

"  The  consumption  of  oxygen  in  equal  times  may  be  expressed  by 
the  number  of  respirations.  It  is  clear  that  in  the  same  individual  the 
quantity  of  nourishment  required  must  vary  with  the  force  and  num- 
ber of  the  respirations." — Ani??ial  Chemistry. 

Immediately  after  this  quotation,  which  has  for  its  object  an  adjust- 
ment of  "  the  quantity  of  nourishment  required"  for  the  assumed 
amount  of  carbonic  acid  generated  in  the  body,  we  are  told  that, 

"  A  child,  in  whom  the  organs  of  respiration  are  naturally  very  ac- 
tive, requires  food  oftener  than  an  adult." 

Thus,  therefore,  according  to  this  statement  (which  has  the  merit 
of  being  true,  not  only  as  it  respects  a  "  child,"  but  all  young  animals), 
the  author  has  presented  a  fact  subversive  of  his  hypothesis  relative 
to  the  source  of  animal  heat ;  since,  if  a  "  child"  and  all  young  ani- 
mals consume  more  food  and  oxygen  in  the  ratio  of  their  size  than 
men  and  adult  animals,  the  power  of  evolving  heat  should  be  gi-eater 
in  the  young  than  in  the  adult.  But  the  experiments  of  Edwards,  and 
others,  have  demonstrated  that  young  warm-blooded  animals  may  be 
cooled  do^vn  rapidly  to  near  the  temperature  of  the  surrounding  ail', 
which  is  impracticable  with  adults.  But  Edwards  adds  the  fact, 
which  farther  confirms  the  vital  doctrine  of  the  generation  of  animal 
heat,  that  "  the  rajnd  2>rogress  which  they  make  in  acquiring  the  power 
of  producing  heat  is  wonderful."  The  same  facts  are  applicable  to  a 
"  child,"  though  probably  less  so  than  to  unfledged  birds,  puppies,  &c. 
(§  153-155,  442  a,  445  /).  I  may  finally  add,  that  the  whole  of  this 
subject  is  extensively  considered  in  my  former  Essay  on  Animal  Heat. 

441,  c.  Nor  can  I  neglect  refemng  the  reader  to  the  facts  which 
I  have  arrayed  in  the  Commentaries  upon  the  subject  of  food,  with  a 
view  as  well  to  the  humoral  pathology  as  to  the  chemical  doctrine  of 


PHYSIOLOGY. FUNCTIONS.  I|  249 

animal  heat, — how  the  northern  savages,  as  known  by  obseiTation, 
and  from  the  necessity  of  the  case,  consume  much  less  food  than  the 
civilized  man  of  the  temperate  and  even  equatorial  climates;  the  for- 
mer, also,  often  breaking  his  fast  only  at  distant  intervals.  There,* 
too,  may  be  found  a  multitude  of  corresponding  facts  in  relation  to  the 
endurance  of  Fasting  without  any  sensible  influence  on  the  human 
system, — a  general  survey,  also,  of  the  habits  of  animals  in  relation  to 
temperature,  and  which,  like  many  of  my  arguments  and  other  facts, 
have  been  advantageously  employed  by  subsequent  writers  to  accom- 
plish what  I  had  already  done.  I  have  urged  the  fact,  in  respect  to 
animals,  that  they  enjoy,  ex  necessitate  rei,  but  a  scanty  supply  of  food 
in  the  arctic  regions,  and  that,  when  gorged  with  the  same  sustenance 
on  their  removal  to  warmer  climates,  they  still  maintain  nearly  their 
original  constitutional  temperature ;  and  there  may  be  found  a  series 
of  facts  as  to  the  relative  temperature  of  the  warm-blooded  and  the 
cold-blooded  tenants  of  the  deep,  which,  side  by  side  in  the  arctic  seas, 
subsist  on  food  of  the  same  quality ;  the  whale,  with  a  temperature  ot 
102°  F.,  and  the  far  more  voracious  shark,  whose  heat  is  down  to  a 
lower  standard.  There  it  is  urged,  that  when  the  emaciated  hiberna- 
ting animal  is  roused  by  pricking,  &c.,  ay,  even  by  exposure  to  a  still 
lower  temperature,  25°  F.,  his  heat  suddenly  rises  from  39°  to  97°  F. ; 
besides  a  multitude  of  similar  proofs  which  should  be  examined  in 
connection  with  what  I  have  said  extensively  on  the  influence  of  th-e 
nervous  system  upon  the  generation  of  organic  heat  in  the  wann-blood- 
ed  vertebrata  (^  1047,  1050). 

How  poorly  accords  our  author's  assumption  as  to  the  gi'eater  vo- 
racity of  polar  animals  with  the  well-known  facts  relative  to  the  hy- 
enas, tigers,  lions,  crocodiles,  vultures,  cormorants,  &c.,  that  range  in 
temperate  and  equatorial  quarters  !  And  what  answer  will  chemisti-y 
make  to  the  poor  ability  of  all  tropical  animals  to  bear  even  the  au- 
tumnal cold  of  the  temperate  zones,  whatever  the  quantity  of  food"? 

But  the  facts  are  "  the  things,"  and  let  us,  therefore,  have  them 
(§  5i,  a).  They  will  show  how  far  "  the  animal  body  bears  the  same 
I'elation  to  surrounding  objects  as  any  other  heated  mass"  (§  440  c, 
no.  14),  and  how  far  a  large  supply  of  food  is  necessary  to  the  same 
animal  temperature  ih  frozen  regions  as  appertains  to  the  inhabitants 
of  warmer  climates. 

In  the  Commentaries,  then,  I  have  called  to  witness,  against  the 
assumptions  which  I  am  again  employed  in  refuting,  the  half-staired 
bears,  and  foxes,  and  reindeers,  and  hares,  and  even  small  birds,  sub- 
sisting on  a  scanty  amount  of  half-frozen  food,  and  respiring  and  sur- 
rounded by  an  atmosphere  at  30°  to  50°  below  the  zero  of  Fahrenheit ; 
yet  maintaining  about  the  same  temperature  as  when  transported  to 
a  southern  climate.  I  have  said  that  "  in  15  out  of  16  foxes,  the  tem- 
perature was  100°  to  1063°,  in  the  other  98°  ;  the  thermometer  rang- 
ing below  zero  from  3°  to  32°  Fh,  Capt.  Lyon  found  that  the  tetro 
albus  maintained  its  temperature  at  50°  below  zero.  It  was,  also, 
equally  so  with  the  smallest  birds"  (§  442  b,  446  d,  1046-1050). 

After  what  has  been  stated,  however,  of"  tallow  candles,"  "labori- 
ous eflbrts,"  "  heated  masses,"  "  clothing,"  &c.  (§  440,  nos.  9,  11,  12), 
the  reader  will  not  be  surprised  at  our  author's  statement  that,  "  every 

*  Medical  and  Physiological  Commentaries,  vol  i.,  p.  691-695.  Also,  the  Essaj'  on  An- 
Vmal  Heat,  in  vol.  ii.— 1840. 


250  p  INSTITUTES    OF    MEDICINE. 

owe  knows  that  the  animals  of  prey  in  the  arctic  regions  far  excvad  in. 
voracity  those  of  the  torrid  zone."  And  yet  "  every  one  knows"  that 
the  consumption  of  food  is  universally  gi'eatest  where  it  is  most  abun- 
dant, and  therefore  least  where  it  is  assumed  to  be  most  abundant. 

And  what  will  the  disciples  of  chemistry  say  to  the  fact  that  the 
low-born  of  the  North  of  Europe,  the  exiles  of  Siberia,  &c.,  often  get 
little  more  than  bread  made  from  the  wood  of  trees,  and  a  wardrobe 
equally  expressive  of  their  destitution  of  the  "  comforts  of  life"  (§  442 
h,  and  Cojnmcntaries,  vol.  i.,  p.  691-698)  ]  What  is  the  contrast  in 
temperature  between  the  well-fed  loungers  of  Europe  and  the  half- 
starved  laborers  of  the  same  countries '?  AVhat,  again,  between  the 
slave  and  his  master  %  One,  too,  feasting  on  animal  food  and  othei 
highly  "  combustible  matter,"  in  the  shape  of  brandy,  porter,  wine, 
&c.,  while  the  other  gets  nothing  but  potatoes,  yams,  or  bread,  at 
best,  and  limpid  water  (nos.  7,  8)  ?  Their  temperature  is  alike.  The 
only  contrast  in  the  case  is  between  truth  and  error.  Is  the  balance, 
then,  to  be  found  in  the  difference  of  clothing  (no.  11)1  Exactly 
otherwise ;  for  the  man  of  ease  is  incased  with  flannels  and  broad- 
cloths, and  lives  in  heated  apartments  (no.  14),  while  he  of  the  shovel 
or  the  hod  is  no  less  contented  and  comfortable  in  rags,  and  whether 
he  repose  upon  a  bed  of  straw  or  a  bank  of  snow.  And  here  I  may 
add,  what  is  equally  fatal  to  the  chemical  hypothesis,  that  this  house- 
less sans  culottes  will  maintain  his  warmth  better  with  water  than  with 
rum,  and  that,  the  more  he  consumes  of  the  "  combustible  substance," 
the  greater  will  be  his  danger  from  frost  (nos.  7,  9,  Note  Oo  p.  1141). 

It  is  also  manifest  that  the  ever-varying  quantities  and  qualities  of 
food  employed  by  man  in  temperate  and  torrid  zones,  while  his 
heat  is  always  nearly  the  same, 'shows,  with  my  other  facts,  that  it  is 
less  dependent  on  food  than  are  other  products  of  organization.  More 
especially  is  this  demonstrated  in  many  acute  diseases,  where  the 
temperature  of  the  body,  or  of  particular  parts  only,  is  often  greatly 
exalted,  and  where,  too,  the  patient  is  wholly  deprived  of  food,  and 
emaciation  so  far  advanced  that  not  only  the  "fat,"  but  the  veiy  "  tis- 
sues" are  nearly  "  consumed." 

Without  inquiring  into  the  hypothesis  that  meat  is  more  combustible, 
and  yields  a  greater  quantity  of  heat  than  vegetable  matter,  it  is  im- 
portant to  place  their  relations  to  the  calorific  function  in  the  proper 
physiological  aspect. 

There  is  no  doubt  that  the  generation  of  heat  is  more  promoted  by 
animal  than  by  vegetable  food,  until  the  system  is  accommodated  to 
the  latter  by  its  habitual  use  ;  and  even  then  the  preponderance  will 
be  in  favor  of  the  former  in  high  northern  latitudes.  The  princi- 
ple to  which  I  now  advert  depends  upon  the  law  of  vital  habit  and 
that  which  relates  to  the  virtues  of  different  natural  stimuli,  and  is  as 
foreio-n  from  chemistry  as  any  two  subjects  can  be  from  each  other 
(§  136,  150-152,  188f,  442,  512  Z>,  535-568). 

The  whole  philosophy,  then,  which  concerns  the  greater  tendency 
of  animal  than  of  vegetable  food  to  promote  the  generation  of  heat, 
consists  in  the  fact  that  animal  is  a  greater  stimulus  than  vegetable 
matter  to  the  organic  functions  (§  188^,  512  h).  The  fact  is  demon- 
strable, as  I  have  said,  while  the  food  lies  yet  undigested  upon  the 
stomach  of  the  famished  wayfarer;  and  eveiy  one  knows  that  his 
warmth  will  be  thus  instantly  increased  to  a  greater  degree  by  cold 


PHYSIOLOGY. FUNCTIONS.  251 

meat  than  by  cold  potatoes  (§  512,  h).  And  so  is  it,  to  a  greater  ex- 
tent, with  the  alcoholic  liquors  which  the  chemist  assumes  are  burned 
in  the  recesses  of  the  organization  (nos.  7,  9).*  The  principle  which 
concerns  the  whole  is  exactly  the  same  as  when  warm  water  lights 
up  a  glow  upon  the  surface,  or  determines  perspiration,  or  an  act  of 
vomiting.  Here,  too,  in  all  this  development  of  heat,  as  in  the  other 
results,  is  involved  a  magnificent  agency  of  the  nervous  system,  but 
which  to  the  chemist  is  impenetrable  darkness  (§  350,  no.  97,  500  wn, 
512  b). — See  a  curious  coiitradiction  about  alcohol,  p.  172,  nos.  43,  94. 
Those  that  have  but  imperfect  views  in  physiology  may  compre- 
hend the  merits  of  this  subject  by  considering  the  relative  effects  of 
animal  and  vegetable  food  in  fevers  and  inflammations.  An  ounce  of 
the  mildest  broth  may  raise  the  temperature  many  degrees,  while  a 
liberal  supply  of  appropriate  vegetable  food  would  have  no  such  in- 
fluence ;  though  a  great  exaltation  of  temperature  would  ensue  upon 
solid  vegetable  food  that  should  not  undergo  digestion.  The  reason 
of  all  this  gives  the  right  interpretation  to  the  relative  effects  of  ani- 
mal and  vegetable  food  in  the  generation  of  heat  in  ox-dinary  states  of 
the  system,  or  till  habit  may  interpose  its  influence.  Irritability  be- 
ing in  an  exalted  state  in  febrile  affections  is  more  than  usually  sus- 
ceptible of  the  stimulus  of  animal  food,  and  hence  the  increase  of  vas- 
cular action  and  the  greater  evolution  of  heat,  both  from  the  direct  ef- 
fect of  the  food  and  the  exciting  reflex  nervous  actions  it  occasions. 

Where  vegetable  food  remains  undigested,  in  the  foregoing  case,  it 
becomes  a  morbid  irritant  to  the  stomach,  and  the  cause  of  reflex 
nervous  influences  that  augment  the  fever  or  the  inflammation,  and  thus 
engenders  a  rise  of  temperature  (§  137  d,  150-152,  222,  &c.,  512,  &c.). 
The  same  philosophy  is  applicable  to  differences  in  climate.  Little 
vegetable  food  is  consumed  in  the  arctic  regions,  and,  as  little  animal 
food  should  be  eaten  by  man  in  the  equatorial.  Nature  has  ordained 
this  allotment  to  men  and  animals,  by  a  scanty  vegetation  at  the  north, 
while  she  appears  to  have  limited  her  provision  of  animal  food  in 
tropical  climates  to  the  wants  of  the  carnivorous  race.  To  the  north 
she  has  given  beasts  and  birds,  but  with  a  stinted  hand,  and  has  been 
scarcely  more  liberal  of  the  tenants  of  the  deep.  To  the  tropics  a 
profusion  of  esculent  roots,  fruits,  &c. ;  and  has  displayed  a  munifi- 
cence in  animal  and  vegetable  creation  throughout  the  vast  temperate 
regions.  This  ordination  of  nature  is  particularly  suited  to  the  exi- 
gencies of  the  human  constitution.  Animal  food  is  especially  stimu- 
lating to  all  the  functions  of  man,  and  therefore  to  that  which  gen- 
erates heat.  Irritability  is  greater,  more  susceptible  to  the  action  of 
stimuli,  in  equatorial  than  in  other  climates.  The  tropical  heat  is  its 
measure  of  endurance ;  and  when  the  stimulus  of  animal  food  is  su- 
peradded, the  tropical  man  is  extremely  pi-one  to  fever,  and  dies 
early.  If  wine,  brandy,  &c.,  be  added  also,  so  much  the  worse ;  but 
not  because  it  is  "burned"  in  the  body  (§  188,  &c.,  615,  &c.,  618). 
Our  author's  philosophy,  however,  is  too  much  of  a  curiosity  to  be 
neglected,  and  should  have  gone  along  with  the  pathological  induc- 
tions (§  350i).     Thus: 

"  The  Englishman  in  Jamaica  sees  with  regret  the  disappearance 
of  his  appetite,  previously  a  source  of  frequently-recurring  enjoy- 
ment; and  he  succeeds,  by  the  use  of  Cayenne  pepper  and  the  most 
powerful  stimulants,  in  enabling  himself  to  take  as  much  food  as  he 
*  Alcohol  appears  to  be  in  certain  degrees  digested,  and  in  that  state  of  transform' 
ation  it  undergoes  absorption. — JSote  N  p.  ]]21. 


252  INSTITUTES    OF    MEDICINE. 

was  accustomed  to  eat  at  home.  But  the  whole  of  the  carbon  thus 
introduced  into  the  system  is  not  consumed.  The  temperature  oi 
the  air  is  too  high,  and  the  oppressiv,e  heat  does  not  allow  him  to 
increase  the  number  of  respirations  by  active  exercise,  and  thus  to 
proportion  the  waste  to  the  amount  of  food  taken.  Disease  of  some 
kind,  THEREFORE,  cnsues" — Animal  Chemistry. 

Again,  also,  for  a  like  physiological  reason  that  animal  food  is  too 
stimulating  for  man  in  tropical  climates,  vegetable  is  not  sufficiently 
so  for  the  obtuse  irritability  of  the  northern  man  (§  191,  585,  &c.) ; 
and  it  is  therefore  true  in  this  acceptation  that  the  arctic  man  would 
be  more  likely  to  freeze  upon  vegetable  than  animal  food,  despite  of 
the  superabundance  of  carbon  in  the  former  (§  447,  h).  But,  as  I 
have  said,  and  shown,  he  may,  by  the  mere  force  of  habit,  come  to 
endure  the  cold  nearly  as  well  upon  vegetable  as  on  animal  diet 
1§  442  h,  535,  1048). 

I  will  also  say,  that  it  is  a  vulgar  prejudice  that  "  train  oil  and  tal- 
.ow  candles"  are  appropriate  food  for  man  in  any  climate  (§  440  h, 
no.  9).  The  arctic,  like  every  other  man,  would  soon  perish  upon 
these  indigestible  substances.  They  would  yield  him  neither  flesh 
nor  "fuel."  And,  having  thus  come  again  upon  the  philosophy  of 
"  fat"  as  a  source  of  heat  when  taken  into  the  stomach  (§  440,  hh),  the 
chemist  is  evidently  embarrassed  by  the  contrast  which  is  presented 
by  certain  graminivorous  and  carnivorous  animals  (§  440,  ?')  ;  and  so 
he  clears  the  way  by  the  following  assumptions,  which  have  only  ref- 
erence, also,  to  a  limited  number  of  two  genera  of  animals  (§  440,  cc). 
The  conclusion  of  the  extract  is  a  good  specimen  of  our  author's  mode 
of  disposing  of  former  observation,  and  a  profitable  commentary  upon 
what  is  requisite  in  "  experimental  philosophy"  (§  350,  mottoes  a-e, 
and  no.  28).     Thus  : 

"  We  know,  in  fact,  that  the  graminivora  expire  a  volume  of  car- 
bonic acid  equal  to  that  of  the  oxygen  inspired,  while  the  carnivora, 
the  only  class  of  animals  whose  food  contains  fat,  inspire  more  oxy- 
gen than  is  equal  in  volume  to  the  carbonic  acid  expired.  Exact  ex- 
periments have  shown,  that  in  many  cases  only  half  the  volume  of  ox- 
ygen is  expired  in  the  form  of  carbonic  acid  [3501  n,  440y)  nos.  17 
and  IS,  447iy].  These  observations  cannot  be  gainsayed,  and  are 
far  more  convincing  than  those  arbitrary  and  artificially  produced 
phenomena,  sometimes  called  experiments  [by  the  "  digestive  mix- 
ture," retoits,  acids,  lamp- wick,  &c.  %\ ;  experiments  which,  made,  as 
too  often  they  are,  without  regard  to  the  necessary  and  natural  con- 
ditions, possess  no  value,  and  may  be  entirely  dispensed  with ;  espe- 
cially, when,  as  in  the  present  case,  Nature  affords  tlie  opportunity  for 
observation,  and  when  we  make  a  rational  use  of  that  opportunity." 

It  remains  only  to  say  of  the  foregoing,  that  the  chemist  was  not 
duly  mindful  of  the  fact  that  all  the  principal  tenants  of  the  deep, 
warm-blooded  and  cold-blooded,  are  alike  carnivorous;  and  that  the 
exalted  temperature  of  the  blubber-whale,  the  porpoise,  &c.,  breath- 
ing, also,  with  lungs,  and  in  their  comparison  with  the  low  tempera- 
ture of  their  associates  that  respire  with  gills,  contrasts  forcibly  with 
those  carnivorous  animals  whose  respiration  of  oxygen  is  said  to  pre- 
vent an  accumulation  of  fat.  Such,  I  mean,  is  the  fundamental  doc- 
trine of  "fat"  (§  440  hh,  no.  10).  But  since  animal  food,  especially 
fat,  contains  m(^re  of  the  "fuel"  than  vegetable  food,  how  does  it  hap- 


PHYSIOLOGY. FUNCTIONS.  253 

pen,  acceding  to  the  foregoing  statement  as  to  the  relative  propor- 
tions of  oxygen  consumed  and  carbonic  acid  expired  by  the  graminiv- 
orous and  the  carnivorous  animal,  respectively,  that  the  former  should 
surpass  the  latter  in  the' formation  of  fat] 

Wherever,  therefore,  we  look  at  the  "  facts"  of  the  organic  chem- 
ist, we  find  ourselves  not  only  in  the  midst  of  contradictions,  but  em 
ployed  in  refuting  assumptions  that  are  opposed  by  universal  experi- 
ence (§  5i).  That  experience  I  had  employed  in  the  Commentaries 
for  the  very  purposes  to  which  its  adverse  assumptions  are  now  con- 
secrated by  the  disciples  of  the  "  improved  philosophy"  (§  349  d,  3501). 

441,  d.  In  the  case  of  the  hibernating  animals  (§  441,  c),  the  ex 
cessive  cold,  and  mechanical  in-itation,  in  rousing  the  calorific  func- 
tion, operate  as  a  stimulus  to  the  nervous  system,  and  thus  restore  the 
organic  functions,  and  the  natural  temperature  as  a  consequence, 
along  with  the  other  organic  products ;  though  the  heat  more  per- 
fectly than  any  other.  In  a  less  degree,  cold  is  a  sedative  to  the  hi- 
bernating animals  (§  188j,  743). .  This,  also,  is  an  example  illustra- 
tive of  the  opposite  influences  of  vital  agents,  according  to  their  in- 
tensity of  action,  and  the  circumstances  under  which  they  are  applied, 
and  of  the  wonderful  adaptation  of  the  natural  agents  of  life  to  the  pe- 
culiarities of  jaarticular  species  of  organic  beings  (§  191,  446  cZ,  500  6). 

The  impression  of  cold,  or  mechanical  imtation,  in  the  foregoing 
case,  is  transmitted  from  the  skin  to  the  cerebro-spinal  axis,  where 
the  nervous  power  is  developed  and  radiated  abroad  upon  the  or- 
ganic properties  of  the  entire  body,  by  which  they  are  brought  into 
operation  (§  222-233,  500,  512,  &c.,  638,  1044,  h\ 

Respiration  and  other  organic  functions  nearly  cease  during  the 
state  of  torpor ;  but  the  restoration  of  heat  is  far  more  than  com- 
mensurate with  the  progressive  return  of  respiration.  Of  all  the 
products,  an  evolution  of  heat  takes  the  lead,  as  indispensable  to  the 
other  important  results.  This  appeal's  to  have  been  seen  by  Liebig. 
Nor  is  there  any  principle  in  physiology,  nor  any  facts,  which  will 
at  all  explain  the  operation  of  cold  in  diminishing  respiration,  or  cir- 
culation, till  it  has  first  reduced  the  temperature  of  the  surface.  And, 
were  the  chemical  hypothesis  true,  the  hibernating,  and  the  young  of 
other  warm-blooded  animals,  should  not  sustain  the  remarkable  re- 
duction of  heat  which  is  produced  by  an  atmospheric  temperature  of 
45^  F.,  since  more  oxygen  is  then  consumed  than  at  higher  tempera- 
tures. There  can  be  no  such  positive  exceptions  to  a  fundamental 
law.  If  peculiarity  of  constitution  be  assigned  as  the  cause,  then  is 
the  chemical  hypothesis  abandoned,  and  the  vital  theory  admitted. 

It  is  therefore  apparent,  that  the  reduction  of  temperature  depends 
essentially  on  other  causes  than  diminished  respiration.  The  con- 
verse of  this  must  be  equally  true ;  and  when  heat,  therefore,  is  re- 
stored, the  first  step  in  the  process  is  an  increased  action  of  the  cap- 
illary blood-vessels,  through  the  stimulus  of  the  nervous  power  (§ 
222,  &c.),  by  which  an  evolution  of  heat  is  immediately  started ;  and 
then  begins  an  increase  of  the  respiratory  movements.  "  Wo  can  al- 
ways hasten  respiration,"  says  Bichat,  truly,  "  by  making  an  animal 
suffer;  but  an  acceleration  of  the  pulse  is  always  prior  to  that  of  res- 
piration, which  appears  to  be  determined  by  it." — (See  §  484,  Exp.  C.) 

441,  e.  That  is  a  test.  If  the  heat  rises  without  oxygen,  it  certain- 
ly does  not,  in  such  a  case,  depend  upon  combustion.     The  "earners" 


254  INSTITUTES    OF    MEDICINE. 

must  be  regularly  supplied  (§  447^,  a).  I  have  said  that  Liebig  ap- 
pears to  have  been  sensible  that  internal  heat  is  important  to  the  or- 
ganic processes,  though  vastly  more  so  in  the  w^arm-blooded  than  the 
cold-blooded  race,  and  his  statement  upon  this  subject  is  one  of  his 
numerous  contradictions  of  the  hypothesis  which  he  assumes.    Thus  : 

"  It  is  obvious  that  the  cause  of  the  generation  of  force  is 
diminished,  because,  with  the  abstraction  of  heat,  the  intensity  of  tJie 
vital  force  diminishes.  It  is  also  obvious,  that  the  momentum  of  force 
in  a  living  part  depends  on  its  proper  temperature."  "  The  increase 
of  mass  is  effected  in  living  parts  by  the  vital  force.  The  manifesta- 
tion of  this  power  is  dependent  on  heat ;  that  is,  on  a  certain  temper- 
ature peculiar  to  each  specific  organism."  "  The  abstraction  of  heat 
must  be  viewed  as  quite  equivalent  to  a  diminution  of  vital  energy." 
— Liebig's  Animal  Chemistry . 

Now,  according  to  this  reasoner,  "in  the  animal  body  we  recognize 
as  the  ultimate  cause  of  all  force  only  one  cause,  the  chemical  action 
which  the  elements  of  the  food  and  the  oxygen  of  the  air  mutually  ex- 
ercise on  each  other." 

We  are  also  told  that  "  the  mutual  action  between  the  elements  of 
the  food  and  the  oxygen  conveyed  by  the  circulation  of  the  blood  to 
every  part  of  the  body  is  the  source  of  animal  heatJ'' — Liebig's  Ani- 
mal Chemistry. 

But,  we  have  just  seen  that  the  same  reasoner  affirms  that  these 
very  movements  are  "dependent  on  heat"  (§  350,  no.  17|,  &c.). 
The  cause  depends  upon  the  effect,  and  the  effect  depends  upon  the 
cause  (§  440, y).  And  how  could  it  be  otherwise  Avith  an  hypothesis 
BO  estranged  from  nature  ]  Indeed,  our  author  not  unfrequently  quits, 
entirely,  the  chemical  ground  of  animal  heat,  as  we  have  seen  of 
many  other  assumptions  (§  350),  and  gives  way  to  the  simple  dictates 
of  nature.     For  example, 

"  Certain  other  constituents  of  the  blood  may  give  rise  to  the  for- 
mation of  CARBONIC  acid  in  the  lungs.  But,  all  this  has  no  connec- 
tion with  that  VITAL  process  by  which  the  heat  necessary  for  the 
support  of  life  is  generated  in  every  part  of  the  body." — Liebig's 
Animal  Chemistry. 

And  yet  it  is  both  a  doctrine  of  this  philosopher  in  physiology  and 
medicine,  that  the  evolution  of  animal  heat  is  a  purely  chemical  pro- 
cess, and  that  carbonic  acid  cannot  be  formed  in  the  body  without  the 
disengagement  of  heat  (§  350,  no.  17^  ;  §  440,  no.  17).  Taking,  also, 
in  connection  the  two  parts  of  the  foregoing  quotation,  we  have  one 
of  those  palpable  contradictions  of  a  fundamental  assumption  which 
are  the  never-failing  characteristic  of  false  doctrines.  There  is  the 
double  affirmation  that  carbonic  acid  resulting  from  any  other  source 
than  a  vital  process  is  not  a  cause  of  animal  heat,  and  that  animal 
heat  is  alone  generated  by  a  vital  process.  (See,  particularly,  §  440, 
nos.  6  and  16.)  Or,  allowing  what  the  language  does  not  admit,  the 
dependence  of  animal  heat  upon  carbonic  acid  "  generated  in  every 
part  of  the  body,"  we  should  then  have  the  curious  phenomenon  in 
chemistry  of  the  production  in  the  animal  body  of  carbonic  acid  by  a 
chemical  process  and  by  a  vital  process,  while  that  of  the  former,  the 
very  gist  of  the  doctrine,  does  not,  as  avowed,  contribute  to  animal 
heat  (§  1044). 

441, y;  Again,  it  is  reiterated,  that  "  the  mutual  action  between  the 


PHYSIOLOGY. FUNCTIONS.  255 

elements  of  the  food  and  the  oxygen  conveyed  by  tlie  circulation  oftht 
blood  to  every  part  of  the  body  is  the  source  of  animal  heat"  (^  350, 
no.  3). 

Now,  frogs  have  a  feeble  power  of  generating  heat,  as  have  "  all 
living  creatures  whose  existence  depends  on  the  absorption  of  oxy- 
gen" (§  443,  c).  But,  these  animals  contradict  our  author's  hypothesia 
as  to  the  "  carriers  of  oxygen,"  not  only  in  its  relation  to  animal  heat, 
but  other  importanc  matters,  such  as  the  production  oi force,  oi  motion, 
&c.  (see'§  350,  nos.  3,  4,  8).  Spallanzani,  for  instance,  deprived  a 
number  of  frogs  and  toads  of  the  heart,  large  blood-vessels,  &c., 
and  buried  them  in  the  snow,  along  with  others  which  retained  their 
circulation  and  vivacity.  The  whole  soon  became  completely  torpid, 
and  "  appeared  as  if  frozen."  In  a  few  hours  they  were  all  removed 
to  a  warm  situation,  where  all  of  them  began  to  leap  and  make  theii 
escape  ;  the  reanimation  being  apparently  as  perfect  in  those  which 
had  been  deprived  of  blood  as  in  those  which  had  not.  When  ex- 
posed to  greater  degrees  of  cold  they  perished  in  equal  times  (§  441^ 
d,  443  b,  494). 

How  simple  an  experiment,  therefore,  may  overthrow  the  most  pop 
ular  hypothesis  in  philosophy.  It  cannot  be  true  of  frogs  that  will 
leap  and  jump  without  blood,  as  well  as  frogs  with  blood,  after  being 
"  apparently  frozen,"  that  their  independent  source  of  heat  is  owing 
to  "  the  oxygen  conveyed  by  the  circulation  of  the  blood,"  any  more 
than  their  "  amount  of  motion  is  proportional  to  the  quantity  of  oxygen 
inspired  and  consumed  in  a  given  time  by  the  animal"  (§  350,  no.  8). 
And  then,  too,  according  to  our  author, 

"  Since  physiology  has  proved  that  the  globules  of  blood  take  no 
share  in  the  process  oi  nutrition,  it  cannot  be  doubted  that  they  play  a 
part  in  the  process  of  respiration."  Especially  in  white-blooded  ani 
mals. — Liebig's  Animal  Chemistry. 

From  all  which  it  is  more  and  more  apparent,  that  "  the  Reformer" 
was  employed  about  a  plan  of  human  chemistry  rather  than  of  animal 
chemistry  (§  440,  c). 

The  foregoing  subject  is  farther  continued  in  §  443-445. 

44I2-,  a.  What  has  been  said  in  the  preceding  section  of  the  hiber- 
nating and  cold-blooded  animals  is  true,  in  principle,  of  all  other  an- 
imals who  suffer  only  a  partial  reduction  of  temperature.  The  differ- 
ences do  not  arise  from  different  fundamental  laws,  but  from  different 
modifications  of  the  properties  of  life  in  different  species  of  animals, 
and  at  different  ages  of  the  same  individual  (§  155,  185,  191).  There 
are  many  animals  that  approximate  the  hibernating  in  their  feeble 
power  of  maintaining  heat ;  and  others,  again,  which  sustain  interme- 
diate relations  to  the  more  perfect  of  the  warm-blooded  vertebrate. 
*'  The  high  temperature,"  says  Edwards,  in  his  Influence  of  Physical 
Agents  on  Life,  "  which  seems  to  characterize  the  mammalia  and 
birds,  does  not  belong  to  them  exclusively,  since  examples  of  it  are 
found  among  insects ;  and,  on  the  other  hand,  among  the  mammalia 
themselves  (as  the  hibernating),  which,  at  certain  periods,  present  the 
principal  phenomena  of  the  cold-blooded  vertebrata  ;  and,  lastly,  a 
great  number  of  non-hibernating  mammalia  and  birds,  in  the  early 
periods  of  their  life,  show,  as  far  as  the  phenomena  of  heat  are  con- 
cerned, a  strong  resemblance  to  the  cold-blooded  animals." 

It  may  be  thence  inferred,  that  what  is  so  remarkably  conspicuous 


256  INSTITUTES    OF    MEDICINE. 

in  the  torpid  hibernating  animals  is  only  the  result  of  a  law  that  pre^ 
vails  throughout  the  animal  kingdom.  This  law  extends  equally  to 
the  vegetable  kingdom,  which  possesses  a  far  greater  power  of  gen- 
erating heat  than  frogs  and  other  cold-blooded  animals.  The  trees 
and  shrubs  which  belong  to  northern  climates  have,  also,  exactly  the 
peculiarity  of  the  hibernating  animals,  while  those  of  tropical  regions 
maintain  a  greater  uniformity  of  temperature,  and  are  destroyed  by  a 
degree  of  cold  in  which  some  northern  herbaceous  plants  spring  into 
active  life,  and  pierce  their  way  through  snow  and  ice, 

441^,  h.  And  this  leads  me  to  say,  that,  through  the  same  law,  the 
warm-blooded  vertebrata  have  their  standard  of  heat  modified  by  cli- 
mate ;  and  even  man  himself  sustains  variations  of  l'^  to  2°  F.  And, 
as  I  have  said  in  my  former  Essay  on  Animal  Heat,  it  is  important  to 
remark,  as  showing  the  entire  independence  of  this  phenomenon  of 
respiration,  this  change  does  not  take  place  till  such  as  remove  from 
one  climate  to  another  shall  have  been  for  some  time  subjected  to  the 
new  condition  of  vital  stimuli.  It  is  the  result  of  acclimation,  and, 
trivial  as  it  may  seem,  it  is  full  of  the  most  insti'uctive  illustration  to 
a  reflecting  mind.  The  phenomenon,  I  say,  is  owing  to  permanent 
modifications  of  the  vital  constitution,  and  is  of  the  same  nature  as  the 
change  of  temperament  which  the  melancholic  undergoes  on  passing 
from  the  temperate  to  the  equatorial  regions  (§  602),  and  about  which 
the  law  of  vital  habit  is  interested  (§  561,  585,  602,  603,  1047). 

4411,  c.  It  is  equally  a  fatal  circumstance  to  the  chemical  hypothe- 
sis, that  the  standard  of  heat  is  lowest  in  cold,  and  highest  in  hot  cli- 
mates, whatever  the  amount  of  clothing,  &c.,  since  more  oxygen  is 
respired  in  the  former,  and,  according  to  our  author,  a  far  greater 
quantity  of  "  fuel"  is  consumed  both  by  the  mouth  and  by  oxygen  gas 
(§  440,  nos.  8,  9,  &c.).  It  is  not  difficult,  therefore,  to  understand  the 
bearinor  of  the  followingf  statement: 

"  The  most  trustworthy  observations  prove  that  in  all  climates,  in 
the  temperate  zones  as  well  as  at  the  equator  or  the  poles,  the  tem- 
perature of  the  body  in  man,  and  in  what  are  commonly  called  warm- 
blooded ammaAs,  is  invariabli/  tJie  same." — Liebig's  Ani?nal  Cheynistnj. 

And  why,  again,  is  the  temperature  of  man  higher  in  tropical  than 
in  temperate  climates  1  The  reply  is  another  proof  of  the  tampering 
of  chemistry  with  a  subject  utterly  beyond  its  reach;  since  the  heat 
of  the  tropics  operates  gradually  as  a  vital  stimulus  to  the  calorific 
function,  and  thus  slowly  establishes  that  condition  by  which  an  ex- 
alted temperature  is  determined  throughout  the  universal  body  (§  350, 
no.  65,  441  c,  445  e). 

44 li,  d.  Nor  may  I  neglect  the  striking  characteristic  of  the  Ggg, 
which  possesses  the  power  of  resisting  cold  "  in  a  degree  equal  to 
that  of  many  of  the  inferior  animals."  This  is  one  of  the  facts  which 
led  Mr.  Hunter  to  believe  that  the  vital  properties  are  capable  of 
generating  heat  independently  even  of  circulation  (§  441, y),  while  its 
greater  evolution  is  seen  to  be  the  result  of  those  properties  in  active 
operation  through  the  mature  organization  (§  65).  The  former  con- 
dition, associated,  also,  with  the  power  of  resisting  the  causes  of  putre- 
faction, is  a  beautiful  illustration  of  the  nature  of  life,  that  it  is  an  ac- 
tive, not  a  passive  state,  that  it  consists  essentially  of  power,  and  that 
its  laws  are  specific.  But,  how  will  the  combustion  hypothesis  dis- 
}X)se  of  the  internal  source  of  heat  in  the  eg^l 


PHYSIOLOGY. FUNCTIONS.  257 

442,  a.  In  respect  to  the  affirmation  that  "clothing  is  merely  an 
equivalent  for  a  certain  amount  of  food"  (§  440,  no.  11),  I  have  addu- 
ced, in  my  former  Essay,  many  facts  to  prove  that  our  clothing  is 
greatly  a  matter  of  habit,  and  this  is  shown  by  the  facts  which  will  be 
soon  presented.  It  is,  indeed,  a  forcible  illustration  of  the  nature  of 
the  properties  of  life,  of  the  dependence  of  animal  heat  upon  vital  ac- 
tion, and  of  its  obedience  to  the  law  of  vital  habit,  and  to  the  consti- 
tutional law  by  which  all  results  shall  be  so  regulated  as  to  maintain 
the  integi'ity  of  organic  processes,  and,  therefore,  a  unifoi-m  tempera- 
ture of  non-hihemating  warm-blooded  vertebrata ;  while,  as  I  have 
endeavored  to  show  in  the  same  work,  the  modifications  of  these  pro- 
cesses in  hibernating  and  cold-blooded  animals,  as  well  as  in  the  veg- 
etable kingdom,  are  not  only  perfectly  consistent  with  what  is  observ- 
ed of  the  non-hibernating  warm-blooded  vertebrata,  but  go  to  con- 
firm the  whole  philosophy  which  is  founded  upon  the  phenomena  of 
these  animals. 

There,  too,  I  have  shown  by  an  examination  of  facts,  that  the  rapid 
change  in  the  power  of  elaborating  heat  in  early  life  depends  on  the 
same  common  principle  which  determines  the  changes  in  all  other 
functions  and  results,  that  they  are  all  on  a  par  in  principle,  and  that 
the  rapid  increase  of  the  resistance  of  cold  in  the  young  of  the  warm- 
blooded vertebrata  proves  the  vital  character  of  the  calorific  function 
(§  153-159,  441  5,  1047,  1048). 

442,  h.  In  illustration  of  the  law  of  vital  habit  as  it  respects  the 
power  enjoyed  by  man  of  resisting  cold  (§  441,  c),  and  in  farther  dis- 
proof of  the  assumption  that  a  living  animal  is  "like  any  other  heated 
mass  in  relation  to  the  temperature  of  surrounding  objects,"  I  shall 
quote  from  the  Commentaries  one  of  the  facts  which  are  there  present- 
ed for  the  purpose  which  is  now  in  view.     Thus  : 

"  Mackenzie  says,  that  some  of  the  northern  savages  follow  the 
chase  in  the  coldest  weather  with  only  a  slight  covering.  Lewis  and 
Clark  state,  that  two  Indians  slept  upon  the  snow  during  the  night 
in  a  light  dress,  when  the  thermometer  was  40  degrees  below  the 
zero  of  Fahrenheit.  The  man  was  uninjured ;  the  boy  had  his  feet 
frozen.  Now  it  is  evident  that  no  civilized  man  could  sustain  such  an 
exposure.  The  phenomenon  is  owing  to  the  poicer  of  habit  in  rela- 
tion to  the  forces  of  life,  and  is  utterly  insusceptible  of  explanation  on 
any  other  principle." — Comvientarics. — See  §  1047,  1048. 

On  the  other  hand,  an  individual  froze  to  death  in  the  woods  of 
Peacham,  Vermont,  on  the  night  of  the  7th  of  June,  1817;  notwith- 
standing, also,  he  was  full,  to  intoxication,  of  the  most  combustible 
substance  (§  440,  no.  9). 

But,  again,  we  are  informed  by  Captain  Wilkes,  that,  when  the 
thermometer  was  at  40°  F.,  "  the  Petcherai  Indians  were  entirely 
naked,  with  the  exception  of  a  small  piece  of  seal-skin,  only  sufficient 
to  cover  one  shoulder,  and  which  is  generally  worn  on  the  side  from 
which  the  wind  blows,  affording  them  little  shelter  against  its  pierc- 
ing influence." 

Again,  says  Captain  Wilkes,  "On  the  11th  of  March,  three  bark 
canoes  arrived,  containing  four  men,  four  women,  and  a  girl  about 
sixteen  years  of  age,  four  little  boys,  w\^  four  infants,  one  of  the  latter 
about  a  week  old,  and  quite  naked.     The  thermometer  was  at  46*^ 

R 


258  INSTITUTES    OF    MEDICINE. 

Fh." — Wilkes's  Narrative  of  the  United  States  Exploring  Expedi' 
tion,  vol.  i.,  p.  121,  124.     1845. 

The  foregoing,  in  relation  to  the  infants,  should  be  considered  m 
connection  with  what  has  been  ascertained  by  Dr.  Edwards  as  to  tho 
comparative  inability  of  infants  to  bear  a  cold  atmosphere,  when  un- 
accustomed, and  with  what  is  known  of  hereditary  constitution  (§ 
447  h,  540,  561.  See,  also,  Medical  aiid  Physiological  Commenta 
rics,  vol.  ii.,  p.  27,  52,  56,  69-74). 

"  The  power  of  the  Russian  Zincali  of  resisting  cold,"  says  Barrow, 
"  is  truly  wonderful,  as  it  is  not  uncommon  to  find  them  encamped  in 
the  midst  of  snow,  in  slight  canvas  tents,  when  the  temperature  is  30^ 
or  40^  below  the  zero  of  Fahi'enheit." — Barrow's  Zincali  of  Spain. 

No  two  individuals  under  apparently  eqvial  circumstances,  of  the 
same  health,  age,  sex,  and  with  the  same  quantities  and  qualities  of 
food,  clothing,  &c.,  are  alike  in  the  power  of  resisting  cold.  Place 
them  in  a  temperature  at  zero  of  Fahrenheit,  and  one  will  perish 
while  the  other  will  not  suffer.  One  shall  enjoy  a  glow  of  warmth 
from  athletic  exercise,  while  the  other  shall  perish  with  the  same 
counteracting  means.  It  is  a  common  event  to  witness  the  blasters, 
in  the  vicinity  of  New  York,  at  work  in  winter  with  heavy  drills  in 
their  naked  hands,  while  others,  unaccustomed,  would  be  frost-bitten 
at  the  same  temperature.  The  difference  is  manifestly  owing  in  part 
to  a  difference  in  constitution,  but  especially  to  the  influence  of  habit, 
which  engenders  the  power  of  enduring  intense  degrees  of  cold,  and 
which  no  chemical  principles  can  possibly  expound  (§  535-568,1047). 

442,  c.  The  foregoing  facts  show  us,  also,  how  it  has  happened  that 
animals  have  spread  abroad  from  the  spot  where  they  were  created, 
and  become  specifically  adapted  to  different  climates.  The  element 
of  their  adaptation  was  implanted  in  their  vital  constitution  at  the 
time  of  their  creation,  and  relates  to  almost  all  physical  agents.  And 
so  with  vegetables,  which  may  be  gradually  transplanted  from  the 
equator  to  high  northern  latitudes,  where  they  also  undergo  changes 
of  organization  (§  155,  535,  538,  &;c.).  Thus  do  we  also  again  bring 
the  philosophy  of  physiology  to  the  overthrow  of  that  infidelity  which 
departs  from  the  Mosaic  account  of  organic  Creation  (§  74,  350|,  h-n). 

442,  d.  Again,  do  the  beasts  or  the  birds  of  the  polar  clime  change 
their  fur  or  their  plumage  when  transported  to  a  temperate  region  1 
What,  for  example,  answers  the  white  bear,  with  which  we  are  all 
familiar  1  And  yet  their  temperature  sustains  but  a  slight  change, 
though  a  change  subversive  of  the  combustion  theory  (§  441  c,  441-2). 
Here,  too,  in  truth,  they  consume  a  far  greater  quantity  of  food  ;  and, 
if  the  chemist's  hypothesis  as  to  an  interchange  of  caloric  with  the  at- 
mospheric air  be  adopted  (§  440,  no.  14),  these  transj^lanted  creatures 
should  sustain  a  very  exalted  rise  of  temperature.  But,  upon  the 
physiological  action  of  external  heat,  as  a  vital  stimulus,  the  high  tem- 
perature of  a  warm  climate  would  much  more  than  compensate  for 
any  supposed  deficiency  of  oxygen  (§  440  e,  441^-  c,  1047). 

"  And  then,  on  the  other  hand,"  turning  again  to  man,  and  as  1 
have  said  in  the  Commentaries,  "  are  the  experiments  of  individuals 
subjecting  themselves  to  an  excessively  high  temperature  without  sus- 
taining any  sensible  variation  of  heat.  This  was  fully  demonstrated 
by  Blagden,  Banks,  Fordyce,  Solander,  G.  Home,  Dundas,  Dr.  North, 
Phipps,  Seaforth.  and  Dobson,  who  exposed  themselves  to260^  F."* 

*  CI.  Bernard's  late  Experiments  of  this  nature  upon  animals  do  not  affect  these  facts  or  the  plii- 
osphy.     They  were  like  those  of  graduated  poisons. — 18G0. 


PHYSIOLOGY. FUNCTIONS.  259 

442,  e.  We  see,  then,  in  the  various  demonstrations,  which  have 
now  been  made,  of  the  power  of  all  warm-blooded,  non-hibernatin"- 
vertebrata  to  maintain  a  uniform  degree  of  heat  under  the  greatest 
vicissitudes  of  atmospheric  temperature  that  are  compatible  with  life, 
a  proof  of  a  most  astonishing  law  of  the  living  body,  in  perfect  con- 
flict with  the  laws  of  caloric  as  they  exist  in  the  inorganic  world. 
"  AVe  know  it"  as  exactly  as  we  comprehend  the  nature  and  opera- 
tion of  the  most  precise  law  in  physics.  It  is,  in  itself,  demonstrative 
of  the  government  of  living  beings  by  specific  forces.  It  establishes 
a  positive  distinction  between  these  forces  and  the  organized  structure. 
If  I  am  not  right  in  this  construction,  I  say,  once  more,  let  the  ground 
of  objection  be  shown.  I  mean  not  the  usual  denial,  or  by  renewed 
misrepresentations  of  my  statements.  The  objections  must  be  found- 
ed upon  a  broad  and  ptilosophical  survey  of  all  the  phenomena  of 
heat  that  relate  to  living  objects  as  they  may  be  modified  by  natural 
causes,  or  by  morbid  states  of  the  system  ;  and  the  ground  must  cover 
the  general  physiological  condition  of  organized  beings.  How  wide 
fi'om  all  this  are  the  assumptions,  and  those  mostly  relative  to  man 
(§  440,  c),  that  have  been  lately  consecrated  as  the  true  "  experimen- 
tal philosophy"  of  animal  heat''(§  349  d,  1047)  ! 

443,  a.  As  my  former  Essay  embraces  an  extensive  range  of  inquiry 
into  the  facts  and  philosophy  attending  the  calorific  function  in  the 
cold-blooded  race,  I  shall  now  add  only  a  few  remarks  to  what  I  have 
already  stated  upon  this  subject,  and  as  suggested  by  the  present  stage 
of  my  inquiry  (§  44iy,  441^  a). 

443,  b.  Frogs  and  other  cold-blooded  animals  are  supplied  with 
capacious  lungs ;  and,  however  it  may  be  argued  that  their  consump- 
tion of  oxygen  is  less  than  that  of  warm-blooded  animals,  they  have, 
nevertheless,  the  same  respiration,  nutrition,  vital  decomposition,  and 
the  same  "  charcoal  fire,"  in  the  ratio  of  the  food  consumed,  and  yet 
is  their  tempei-ature  principally  regulated  by  that  of  the  suiTOunding 
medium.  They  also  emit  a  large  amount  of  carbonic  acid,  which 
proves  a  free  consumption  of  oxygen  and  a  liberal  supply  of  food.  All 
this  is  as  essential  to  frogs  as  to  man  ;  and  they  equally  perish 
when  deprived  of  atmospheric  air,  and  so  of  all  the  cold-blooded  finny 
tribe  (§  350,  no.  17-|,  and  §  440,  no.  10).  And  what  will  chemistry 
answer  to  the  exalted  temperature  which  attends  the  inflammations 
of  the  cold-blooded  vertebrata  ? 

Chemistry  must  here  be  consistent,  and  in  being  so  it  necessarily 
abandons  the  hypothesis  that  the  evolution  of  heat,  in  warm-blooded 
animals,  depends  on  the  union  of  oxygen  with  the  carbon  and  hydro- 
gen of  the  body,  and  that  it  occui's  in  the  ratio  of  that  combination. 
"7;i  the  animal  bod?/,"  says  Liebig,  "  the  food  is  the  fuel ;  with  a  prop- 
er supply  of  oxyqen  toe  obtain  the  heat  given  out  during  its  combus- 
tionr     (Also,  §  440,  nos.  5,  6,  17.) 

443,  c.  The  difference  in  the  law  regulating  temperature  is  owing 
to  a  difference  in  vital  constitution,  of  which  the  chemist  takes  no  ac- 
count (§  440,  no.  12).  But,  there  are  also  many  other  peculiarities 
in  the  vital  phenomena  of  cold  and  warm-blooded  animals  which  are 
due  to  the  same  condition  of  constitution,  and  by  which  their  relative 
power  of  generating  heat  is  shown  to  depend  on  a  common  cause, 
and  which  is  common  to  all  the  phenomena.  It  is  this  which  ren- 
ders cold-blooded  animals  greatly  subject  to  the  temperature  of  the 


2tJ0  INSTITUTES    OF    MEDICINE. 

RurrouTJtling  medium,  but  whicli  also  enables  them  to  resist  its  influ- 
ence by  some  2  or  3  degrees  at  all  seasons  of  the  year. 

443,  d.  If"  the  chemist  resort  to  difference  of  constitution  in  explain- 
ing the  foregoing  phenomena,  as  is  generally  done,  he  resorts  to  the 
properties  and  functions  of  life,  and  abandons  his  own  ground.  In 
one  case  he  says,  it  is  because  they  are  cold-blooded,  and  in  the  other, 
because  they  are  warm-blooded,  and  so  on.  Such,  indeed,  is  the  fact. 
But,  is  it  not  because  the  organization  and  vital  endowments  are 
not  adapted  to  the  same  generation  of  heat  in  one  case  as  prevails  in 
the  other ;  and  this,  too,  when  the  organization  may  be  in  a  high  de- 
gi'ee  simple  (§  409,  e)  ? 

444,  Let  us,  therefore,  settle  this  question  by  reference  to  an  animal 
without  lungs,  or  gills,  and  in  which,  also,  the  temperature  is  clearly 
influenced  by  causes  which  can  alone  operate  as  vital  stimuli.  The 
temperature,  for  example,  of  a  hive  of  bees  is  at  about  90°  F.,  when 
the  air  is  at  40°,  and  upward  of  70°  in  winter.  Their  power  of  gen- 
erating heat  is  also  increased  during  the  breeding  season.  This  phe- 
nomenon corresponds  with  the  observations  that  I  have  made  upon 
vegetables ;  having  found  the  temperature  highest  when  the  leaves 
and  blossoms  are  putting  forth. — [Medical  and  Physiological  Commen- 
taries, vol.  ii.,  p.  75-78.) 

445,  a.  Still  more  conclusively,  than  the  obvious  dependence  of  or- 
ganic heat  in  the  cold-blooded  vertebrata,  insects,  &c.,  upon  vital 
principles,  do  the  phenomena  of  vegetable  heat  evince  the  same  great 
law  of  organic  nature.  This  subject  has  been  ably  explored  by  John 
Hunter,  and,  as  I  have  intimated  in  the  foregoing  section,  has  re- 
ceived a  careful  attention  from  myself.  Senebier,  also,  saw  the  ther- 
mometer rise  from  79°  to  143°  F.,  when  placed  in  the  midst  of  a 
dozen  spathes  of  the  arum  cordifolium,  at  the  time  of  opening  their 
sheaths.     And  so  Huber,  and  others. 

445,  b.  That  fact,  and  the  ability  of  plants  to  generate  a  tempera- 
ture often  far  above  the  earth  or  the  surrounding  atmosphere,  are  so 
apparent  that  they  are  universally  admitted  ;  but  obtain  from  the 
chemist  no  farther  notice.  Indeed,  the  following  is  all  that  we  have 
from  Liebig  on  the  subject  of  vegetable  heat.     Thus  : 

"  All  living  creatures,  whose  existence  depends  on  the  absorption 
of  oxygen,  possess  within  themselves  a  source  of  heat  independent  of 
surrounding  objects.  This  truth  applies  to  all  animals,  and  extends, 
besides,  to  the  germination  of  seeds,  to  the  flowering  of  plants,  and  to  the 
maturation  of  fruits." — Animal  Chemistry. 

And  yet  is  the  "  combustive  process"  always  in  progress,  more  or 
less,  in  all  parts  of  vegetable  organization.  The  question,  therefore, 
arises  as  to  the  motive  for  not  only  concealing  an  important  fact,  but 
in  thus  implying,  by  circumstantial  statements,  that  no  other  parts  of 
vegetables  "possess  within  themselves  a  source  of  independent  heat." 
The  very  fact  that  such  a  source  belongs  to  seeds  in  their  germinating 
state,  &c.,  is  sufficiently  conclusive  that  it  extends  to  every  part  of  the 
plant,  and  "  the  Reformer"  could  not  have  been  ignorant  that  the  very 
*igg  resists  a  temperature  below  the  freezing  point  in  virtue  of  its  in- 
ternal source  of  independent  heat. 

But,  all  this  is  fatal  to  our  author's  hypothesis.  Eggs  do  not  con- 
sume oxygen,  have  no  "  caniers  of  oxygen,"  and  trees,  it  is  said,  do 
not  "  burn"  like  the  animal  body  (§  302,  303|).     Consequently,  the 


PHYSIOLOGY. FUNCTIONS.  261 

chemist,  to  carry  out  his  hypothesis  of  animal  heat,  must  maintain  the 
anomaly  that  seeds,  flowers,  and  fruits,  during  their  development,  are 
the  only  parts  of  the  vegetable  vv^orld.  that  possess  "  an  independent, 
source  of  heat."  The  secret  of  all  this  w^ill  be  farther  seen  in  the  fol- 
lowing passage : 

'14:5,  d.  "  The  distinguishing  character  of  vegetable  life  is  a  contin- 
ued passage  of  matter  from  the  state  of  motion  to  that  of  static  equilib-' 
rium.  A  plant  produces  within  itself  no  cause  of  motion''''  (see  §  350, 
nos.  7,  8,  10,  and  §  440,  nos.  5,  6,  8,  9,  12,  &c.).  "  In  a  word,  no 
waste  occurs  in  vegetables.  [  %  ]  Waste,  in  the  animal  body,  is  a 
change  in  the  state  or  in  the  composition  of  some  of  its  parts,  and 
consequently  is  the  result  of  chemical  action."  —  Liebig's  Animal 
Chemistry. 

And,  again  :  "  Analogy,  that  fertile  source  of  error,  has  unfortu- 
nately led  to  the  very  unapt  comparison  of  the  vital  functions  of  plants 
with  those  of  animals." — Liebig's  Organic  Chemistry,  &c. 

445,  e.  Thus  is  the  problem  solved.  There  is  either  no  heat  gen- 
erated by  plants,  or,  otherwise,  the  chemical  doctrine  of  animal  heat 
is  radically  false.  To  show  how  this  may  be  I  shall  now  introduce 
an  abstract  of  some  observations  made  by  myself  on  the  temperature 
of  trees.  It  is  unnecessary  to  state  the  mode  in  which  the  observa- 
tions were  conducted,  or  the  precautions  adopted,  as  they  are  record- 
ed in  the  Commentaries. 

On  the  9th  of  April,  1839,  in  a  neighboring  forest,  the  following  re- 
sults were  obtained : 

Range  of  the  thermometer  in  the  shade  during  the  observations, 
which  lasted  six  hours,  from  38°  to  52°  F.  Near  freezing  at  sunrise. 
A  dead  upright  tree  was  selected  as  a  standard  of  comparison. 
Its  diameter  was  12  inches.  The  temperature  of  this  tree,  at  the  close 
of  my  observations,  was  45°  at  the  centre  and  in  all  other  parts  (§ 
440,  nos.  14,  15,  and  16). 


Juglans  squamosa, 

diameter  10  inches. 

48° 

Buds  slightly  enlargin 

Do.            do. 

6 

49^'' 

do. 

Fagus  sylvatica. 

"         ]0-      " 

40° 

Buds  swelling. 

Cluercus  tinctoria. 

7 

49° 

No  buddinsr. 

Castanea  Americana, 

TO 

50 

do. 

Betula  nigra, 

4 

51° 

Flowering. 

Salix  Babylonica, 

18 

53 

Buds  unfolded. 

Do.            do. 

18 

53° 

do. 

Pinus  Canadensis, 

18 

54° 

Platanus  occidentalis, 

18        " 

50° 

No  budding 

Do.                do. 

6 

54° 

do. 

Do.                do. 

4 

55° 

do. 

Juniperus  Virginiana, 

4        <i 

55° 

Robina  pseudacacia, 

3 

62° 

do. 

Populus  IsBvigata, 

4        « 

62° 

In  bloom. 

Do.            do. 

"           4 

64° 

do. 

Do.            do. 

3 

63° 

do. 

Do.           do. 

3 

65° 

do. 

Do.            do. 

"           2        " 

67° 

io. 

Do.            do. 

T)  _1' • .^1     .i    • 

68° 

do. 

were  correct,  I  should  find  an  elevation  of  vegetable  heat  as  the 
warmth  of  the  season  increased,  and  the  energy  of  vegetable  life  be- 
came more  exalted,  on  the  l&th  of  the  same  April  I  made  another 
visit  (§  4411,  c). 

Range  of  the  thermometer  in  the  shade   during  the  observations, 
which  lasted  five  hours,  from  40°  to  65°. 


2(i2  INSTITUTES    OF    MEDICINE. 

Temperature  of  two  dead,  dry,  upright  birch  trees,  one  eight 
inches  in  diameter,  the  other  six  inches,  at  end  of  observation  60°  in 
all  their  parts.  Temperature  of  the  earth  six  inches  below  surface 
47°  in  shade,  at  close  of  observation.     Probably  50°  at  two  feet. 


Be  tula  nigra, 

diameter  15  inches, 

54° 

Buds  swellinj^. 

Platauas  occideutalis, 

6 

59° 

do. 

Quercus  wens, 

8 

62° 

do. 

Do.          do. 

2i      " 

73° 

Buds  much  more  advanced 

Do.        tiuctoria, 

18 

65° 

Buds  swelling. 

Do.            do. 

6 

66° 

do. 

Juuiperus  Virginiana, 

5 

64° 

Do.                do. 

"           2        " 

79° 

Acer  rubram, 

13       '• 

65° 

In  bloom. 

Castanea  Americana, 

4 

66° 

Buds  swelling. 

Comus  Florida, 

"           2        " 

68° 

5  Flower-buds  advancing;  liu 
I     leaves. 

Fa^s  sylvatica. 

12 

68° 

Buds  opening. 

Ju<?lans  alba 

4 

75° 

Buds  swelling. 

Do.       do. 

1 

83° 

Buds  larger. 

Do.       do. 

5     " 

82° 

Buds  opening. 

445, y!  It  is  abundantly  manifest  from  the  foregoing  observations 
that  vegetables  possess  a  vital  power  of  generating  heat,  according  to 
the  activity  of  their  organic  forces ;  and  I  carry  the  analogy  to  the 
animal  kingdom.  The  temperature  was  not  influenced  by  that  of 
the  earth,  as  seen  by  the  pi-eceding  statement.  The  heat  of  the  lat- 
ter, however,  was  not  ascertained  at  the  first  observation.  It  appears, 
also,  that  the  power  of  generating  heat  is  greater  in  proportion  to  the 
youth  of  trees.  This  remarkable  fact  is  not  only  especially  indicative 
of  the  vital  agencies  in  the  generation  of  vegetable  heat,  but  is  worthy 
of  notice  on  account  of  its  opposition  to  what  obtains  in  the  animal 
kingdom  in  respect  to  age.  It  corresponds,  also,  with  observations 
upon  herbaceous  plants.  The  difference  depends  upon  the  relative 
difference  in  organization  and  vital  properties  at  the  corresponding 
pei-iods  of  life.  — Comvi.     Also,  §  153-155,  441  i-i^  1054. 

445,  g.  It  is  a  fundamental  principle,  therefore,  that  "  ilie  general 
l^henomena  of  the  disengagement  of  heat  remain  always  the  same  in  an- 
imals with  lungs,  ifi  those  icithout  them,  and  in  plants,  all  of  which 
have  an  independent  temperatureT — Bichat. 

446,  a.  The  relation  of  the  nervous  power  to  animal  heat  is  the 
same  as  that  of  all  other  products  of  animal  organization ;  its  influ- 
ence, however,  being  sometimes  remarkably  pronounced  in  the  elabo 
ration  of  heat,  as  seen  in  the  quick  transition  of  the  hiberaating  animal 
from  temperatures  below  40°  to  upward  of  90°  F.  This  subject,  how- 
ever, has  been  so  extensively  investigated  in  my  former  work  that  I 
shall  only  say  now  that  the  elaboration  of  animal  heat  does  not  depend 
on  the  nerv'ous  power,  as  often  maintained,  but,  like  other  functions  of 
animals,is  only  influenced  by  it  (§  183-185, 188, 222-233, 489, 492, 500). 
These  are  variously  affected  by  varying  influences  exerted  upon  the 
cerebro-spinal  and  ganglionic  systems,  as,  of  course,  ai-e  also  the  se- 
creted products  in  a  corresponding  manner.  In  the  perfectly  natural 
state,  the  nervous  system  has  no  important  agency  in  the  production 
of  the  phenomena,  but  may  become  powerfully  instrumental  in  modi- 
fying the  properties,  and  actions,  and  products  of  life,  when  unusual 
conditions  exist,  or  when  unusual  impressions  are  transmitted  to  the 
cerebral  and  sympathetic  centers.  Analogy,  also,  as  supplied  by 
the  vegetable  kingdom,  affords  the  strongest  presurrtptive  evid.ence 
that  the  nervous  system  may  have  no  active  participation  in  the  elab- 


PHYSIOLOGY. FUNCTIONS.  263 

oration  of  heat,  in  the  natural  condition  of  the  body,  while  this  induc- 
tion is  strengthened  by  what  is  known  of  other  secreted  products  in 
both  of  the  animated  kingdoms.  Still,  in  respect  to  the  animal  king- 
dom, the  mere  existence  of  the  cerebral  and  ganglionic  systems,  their 
remarkable  properties  and  susceptibilities,  and  their  intimate  connec- 
tion with  all  parts  of  the  organization,  '\^^  prima  facie,  conclusive  that 
they  have  important  offices  in  relation  to  animals,  and  that  their  pres- 
ence, in  the  natui-al  state  of  the  complex  being,  is  indispensable  to  the 
integrity  of  every  function.  This,  as  will  have  been  seen,  has  been  ex- 
perimentally ascertained  in  relation  to  many ;  and  that  unusual,  or 
sudden  impressions  that  are  not  unnatural,  as  the  operation  of  the  pas- 
sions, for  instance,  may  be  extensively  and  profoundly  propagated 
from  the  brain  to  other  organs.  It  has  been  fully  demonstrated  that 
the  natural  condition  of  the  secretions  depends  upon  the  integrity  of 
the  nervous  connection  between  the  secerning  organs  and  the  cerebro- 
spinal axis ;  while  it  has  been  equally  shown  that  the  organic  func- 
tions, and  all  vascular  action,  may  be  immediately  and  powerfully 
influenced  by  impressions  made  upon  the  brain  and  spinal  cord, 
whether  in  a  direct  manner,  as  in  Philip's  Experiments,  or  indirectly 
through  reflex  nervous  action,  as  in  blows  upon  the  stomach,  sur- 
gical operations,  the  action  of  medicines  and  of  poisons  upon  the  in- 
testinal canal,  &c.,  the  ganglionic  nerve  being  the  principal  medium. 

Assuming,  then,  that  animal  heat  is  also  a  secreted  product,  it 
would  come  philosophically  under  the  common  law ;  and  since  it  ap- 
pears from  expei-iment,  that  animal  heat  depends  even  more  upon 
the  presence  of  the  brain  than  an  imperfect  production  of  gastric 
juice  and  other  secreted  fluids,  and  may  be  as  powerfully  influenced 
through  the  nervous  system,  the  physiological  analogy  between  heat 
and  other  secreted  matters  becomes  quite  apparent ;  while  it  ex- 
plains the  remax'kable  effect  of  a  low  atmospheric  temperature  in 
developing  heat  in  the  torpid  hibernating  animal  (§  441,  441^  c) ; 
and  thus  conducts  us,  also,  to  the  philosophy  of  the  operation  of  oth- 
er causes  in  modifying  animal  tempei-ature  (^  461,  1032  c?,  1044). 

To  maintain  the  foregoing  conclusion,  I  have  examined,  in  my  for- 
mer Essay,  the  merits  of  Brodie's,  Philip's,  Chaussat's,  and  other  ex- 
periments upon  the  nervous  system,  the  phenomena  of  hibernating 
animals,  the  modifications  of  temperature  that  spring  from  injuries, 
diseases,  and  other  affections  of  the  nerves,  &c.,  the  admissions  of 
distinguished  chemico-physiologists,  and.  other  important  considera- 
tions. Some  of  these  facts  in  relation  to  the  nervous  influence  upon 
animal  temperature  will  appear  in  the  next  following  section. 

446,  h.  It  should  be  said,  however,  that  it  has  been  stated  by  some 
that  the  experiments  of  Philip  conflict  with  those  of  Brodie  and 
Chaussat,  which  establish  an  influence  of  the  nervous  power  over  the 
phenom-ena  of  animal  heat.  But  that  is  an  error ;  since  the  deduc- 
tion of  Philip  himself  from  his  own  observations  ascribes  to  the  ner- 
vous power  what  is  due  to  the  organic  power.      Thus  : 

"  That  the  maintenance  of  animal  temperature  is  a  function  of  the 
nervous  system,  properly  so  called,  appears  from  a  variety  of  facta 
generally  known ;  the  temperature  either  of  a  part  or  of  the  whole 
body  being  lessened  by  any  cause  that  impairs  the  action  of  particu- 
lar nerves  in  the  former  instance,  or  of  the  whole  nervous  system  in 
die  latter." — Philip,  on  Acute  and  Chronic  Diseases,  p.  48. 


264  INSTITUTES    OF    MEDICINE. 

Again  he  says,  "  I  here  consider  it  as  proved,  by  experiments  al- 
ready laid  before  the  reader,  that  the  evolution  of  caloric  is  a  function 
of  the  nervous  influence." — Philip's  Inquiry  into  the  Laivs  of  the  Vi- 
tal Functions,  Exp.  77.     (Also,  §  437,  c,  Note  Aa  p.  1131.) 

446,  c.  It  is,  of  course,  erroneously  stated  by  "  the  Reformer,"  that, 
"  by  the  division  of  .the  pneumogastric  nerves,  the  motion  of  the  stom- 
ach and  the  secretion  of  the  gasti-ic  juice  are  an-ested."  The  juice  is 
only  modified  in  quality,  w^hile  it  is  actually  increased  in  quantity  (§ 
461,  489). 

"  The  Reformer"  has  also  high  conceptions  of  the  agency  of  the 
nervous  system  in  organic  results,  notwithstanding  they  are  all  exclu- 
sively due,  in  his  estimation,  to  the  merest  chemical  processes  (§  350). 
"  Every  thing  in  the  animal  organism,"  he  says,  "  to  which  the  name 
of  motion  can  be  applied,  proceeds  from  the  nervous  apparatus." 
Our  author,  however,  is  entirely  mistaken  in  his  opinion  that  "  the 
singular  idea  that  the  nerves  produce  animal  heat  has  obviously  arisen 
from  the  notion  that  the  inspired  oxygen  combines  with  carbon  in  the 
blood  itself."  Nevertheless,  we  are  told  by  our  author  that  "  every 
thing  i?i  the  anivial  organism  to  which  the  name  of  motion  can  he  ap 
plied  proceeds  from  the  nervous  aj^paratus  ;^'  and  we  are  also  told  that 
without  this  motion  there  can  be  no  animal  heat  (§  350,  nos.  3,  17^, 
6,  7,  ISi,  19). 

But,  take  the  ordinary  construction  of  those  who  mingle  together 
but  virtually  contradistinguish,  the  powers  and  processes  of  living  and 
dead  matter,  and  impute  to  the  nervous  influence  no  small  share,  along 
with  chemical  agencies,  in  the  production  of  heat  and  other  products 
of  the  livinsr  orsranism,  we  are  asked  to  sanction  one  of  the  most  un- 
philosophical  and  incongruous  medleys  of  powers,  processes,  laws, 
and  principles,  acting  and  reacting  upon  each  other,  that  ever  pre- 
sented itself  for  well-merited  satire.  The  nervous  power  is  also  apt 
to  be  regarded  by  the  chemico-vitalist,  as  by  the  chemist,  a  mere 
chemical  agent.  But,  we  shall  have  seen  that  this  construction  is  en- 
cumbered with  difliculties  (§  222,  &c.,  451/,  500  nn,  638^). 

446,  d.  The  modifying  influence  of  the  nervous  system  upon  the 
generation  of  animal  heat  being  established  not  only  by  experiments, 
but  especially,  also,  by  facts  relating  to  morbid  states  of  the  system, 
to  which  I  shall  soon  advert,  and  by  all  that  is  philosophical  in  physi- 
ological science ,  and  when  we  consider,  also,  how  easily  and  rapidly 
the  nervous  influence  may  be  determined  upon  the  vascular  system 
(as  in  blushing),  and  upon  the  organic  viscera,  we  have  an  intelligible 
explanation  of  the  operation  of  a  very  low  degree  of  cold  in  recall- 
ing into  action  those  vessels  upon  which  depends  the  exaltation  of 
temperature  in  the  torpid  hibernating  animal  (§  441  d,  441^  a).  That 
the  intensity  of  the  cold,  like  the  mechanical  irritant  (§  441,  c,  d),  op- 
erates, also,  in  a  direct  manner,  upon  the  organic  properties,  as  in 
other  instances  of  foreign  agents,  is  undoubtedly  true  (§  189).  The 
law  being  also  universal  explains  the  influences  of  other  causes,  in 
health  and  disease,  in  modifying  animal  temperature,  and  only  regards 
the  agency  of  respiration,  like  that  of  digestion,  &c.,  as  being  instru- 
mental in  perfecting  the  blood,  and  thus  adapting  it  to  the  uses  of  the 
various  organs  which  are  concerned  in  the  elaboration  of  heat  and 
other  products. 

447.  a.  Whatever  is  true,  in  a  fundamental  sense,  of  the  production 


PHYSIOLOGY. FUNCTIONS.  265 

of  lieat  in  the  natural  state  of  the  organic  being,  must  be  equally  so  in 
its  morbid  conditions.  It  is  true,  we  are  told  by  "  the  Reformer," 
that  "  we  cannot  investigate  the  laws  of  life  i?i  an  organized  being  which 
is  diseased  ;^'  but  we  have  seen  that  this  will  not  hold  in  experience 
or  philosophy  (§  303|).  It  serves,  however,  its  useful  purpose  in  the 
chemical  doctrine  of  animal  heat.  But,  since  the  truth  is  just  the  re- 
verse (§  160,  163),  I  shall  present  from  the  Commentaries,  in  this  sec- 
tion, a  series  of  facts  which  contribute  an  important  light  upon  the 
physiology  of  calorification,  and  upon  the  general  constitution  of  or- 
ganic beings.  We  shall  learn  yet  farther,  by  this  demonstration,  that 
the  evolution  of  animal  heat  is  exactly  on  a  par  with  all  other  secreted 
products,  and  has  a  corresponding  dependence  upon  decarbonized 
blood,  and  can  be  regarded  in  no  other  aspect  (§  764,  c).  And  here 
our  author's  philosophy  is  consistent,  since  he  imputes  alike  the  for- 
mation of  animal  heat,  and  all  other  products,  even  the  circulation  of 
the  blood,  nay,  all  diseases,  yea,  death  itself  (§  350,  no.  46),  to  the 
union  of  oxygen  gas  with  the  elements  of  food, — Note  Ddd  p.  1149. 

447,  b.  Indeed,  it  cannot  be  too  often  said,  as  shown  by  the  ques- 
tion before  us,  that  the  phenomena  supplied  by  diseased  conditions 
are  often  the  most  important  in  illustrating  the  properties  and  laws  of 
organic  beings ;  and  upon  no  question  have  they  a  gi'eater  bearing 
than  the  one  under  consideration.  Morbid  states  are  only  physiolog- 
ical changes,  and  the  resulting  products  and  phenomena  are  simply 
modified  conditions  of  such  as  are  more  natural,  and  are  dependent 
upon  the  same  laws,  the  same  causes,  the  same  functions  as  deter- 
mine the  healthy  results  (§  155,  156).  This  is  an  undeniable  propo- 
sition. In  the  conflict  of  doctrines,  therefore,  which  are  predicated 
of  the  perfectly  natural  phenomena,  we  should  seek  for  the  light  of 
such  as  emanate  from  diseased  conditions ;  and  here  the  chemist  is 
even  more  disqualified  for  investigation  than  in  the  dark  mazes  of 
physiology.  To  him,  the  vast  field  of  pathology,  which  every  where 
stamps  with  falsehood  his  chemical  views  of  life,  is  as  hidden  as  undis- 
covered regions ;  and  since  all  pathological  and  therapeutical  conclu- 
sions necessarily  refer  to  the  natural  physiological  conditions,  their 
impracticability,  absurdity,  and  destructiveness,  when  deduced  from 
the  chemical  premises,  as  clearly  demonstrate  the  shallowness  of  their 
foundation.  The  student  of  organic  nature,  therefore,  appreciates,  as 
he  deplores,  the  ignorance  which  is  received  as  the  light  of  knowl- 
edge (§  349,  ^). 

447,  c.  It  should  be  considered,  also,  in  respect  to  the  vast  differ- 
ences in  temperature  that  spring  from  morbid  conditions,  whether 
high  or  low,  the  diet  is  often  the  same,  very  spare,  or  when  the  tem- 
perature is  most  exalted,  as  in  active  forms  of  fever  and  inflammation, 
there  is  a  total  abstinence  from  food.  Consider,  also,  the  brute  ani- 
mal under  the  same  circumstances,  abstaining  totally,  yet  suffering  a 
very  exalted  temperature  (§  440,  nos.  1,  4,  5). 

I  shall  proceed,  therefore,  to  a  statement  of  some  of  the  important 
facts  which  are  supplied  by  disease,  as  set  forth  in  my  former  Essay 
on  Animal  Heat.     For  the  authorities  quoted,  see  the  Essay. 

447,  d.  Diseases  of  the  brain  supply  a  variety  of  facts  which  illus- 
trate our  inquiry.  Thus,  in  phrenitis,  one  arm,  or  one  side  of  the 
body,  is  colder  than  the  other.  "  That  the  temperature  of  a  paralyzed 
part  is  generally  below  the  normal  standard  is  now  universally  admit- 


266  INSTITUTES    OF    MEDICINE. 

ted."  That  this  is  owing  to  impaired  vitality,  is  also  shown  "by  the 
frequent  failure  of  nutrition  in  the  paralyzed  part,  as  well  as  other  co- 
incident phenomena.  In  a  case  related  by  Mr.  Earle,  he  found  the 
temperature  at  70°  F.,  in  the  hand  of  a  paralyzed  arm,  while  that  of 
the  opposite  hand  was  92°.  He  could  also  effect  a  temporary  res- 
toration of  temperature  by  electricity  and  by  blisters.  "The  circula- 
tion of  the  blood  did  not  appear  to  have  suffered,  the  pulse  at  the  wrist 
being  synchronous,  and  equally  strong  with  that  of  the  other  limb." 
In  an  injury  of  the  sympathetic  nerve,  Chaussat  saw  the  temperature 
fall  from  1048S=  to  78-8°  F.,  in  ten  hours. 

On  the  other  hand,  there  is  a  remarkable  exaltation  of  temperature 
m  a  part  at  the  invasion  of  tic  douloureux.  So,  when  the  nerves  are 
mechanically  injured.  There  was  a  patient  at  St.  George's  Hospital, 
whose  temperature  rose  11°  F.,  in  consequence  of  an  injury  of  the 
spinal  column  ;  and  this  took  place  when  the  respirations  did  not  ex- 
ceed ^i;e  or  six  in  a  minute.  It  is  stated  by  Dr.  Macartney  and  other 
observers,  that  when  the  principal  nerve  of  an  extremity  is  divided, 
the  temperature  of  the  limb  is  immediately  exalted  several  degrees. 
The  philosophy  of  this  is  well  expounded  by  an  advocate  of  the  chem- 
ical doctrine.  "We  should  be  disposed,"  he  says,  "to  regard  it  as 
due  to  the  temjDorary  excitement  of  the  molecular  changes  by  the  ir- 
ritation produced  by  the  section  of  the  nerve,  and  propagated  to  its 
extremities."  Now  apply  this  language  to  the  exaltation  of  tempera- 
ture in  any  inanimate  substance,  however  produced,  and  we  mayap- 
preciate  the  merits  of  the  chemical  solution  in  the  former  instance. 

"  In  some  subjects  of  insanity,"  says  Dr.  Cox,  of  Fish  Ponds,  "who 
were  under  strong  coercion  in  the  horizontal  position,  with  the  head 
much  elevated,  whose  face  was  red,  and  the  vessels  turgid,  the  differ- 
ence of  heat  was  very  obvious,  varying  10,  12,  and  even  15  degrees." 

In  apoplexy,  the  temperature  has  been  known  to  rise,  after  death, 
a  number  of  degrees  above  the  natural  standard;  and  its  persistence 
lias  been  found  so  uniform  in  apoplexy,  that  Dr.  Cheyne  regards  it  as 
a  diagnostic  symptom.  The  temperature  of  a  lawyer,  dead  of  apo- 
plexy, was  so  high  at  twenty-four  hours  after  death,  that  Portal  delay- 
ed an  examination  of  the  body.  The  same  phenomenon  is  observed 
after  death  from  other  diseases, — especially  when  the  nervous  system 
has  been  unusually  concerned  in  the  morbid  jH-ocess. 

"  In  opening  bodies  at  the  Hotel  Dieu,"  says  Bichat,  "  I  have  ob- 
served that  the  time  in  which  they  lost  their  animal  heat  was  very  va- 
riable ;  that  a  body  continues  warm  a  greater  or  less  time,  especially 
among  those  who  have  died  suddenly  of  an  acute  affection,  in  the  par- 
oxysm of  an  ataxic  fever,  for  example,  or  by  a  fall ;  for  those  who 
die  of  a  chronic  disease,  lose  almost  immediately  their  caloric.  The 
difference  in  the  first  is  often  three,  four,  or  even  six  hours.  This 
phenomenon  arises  from  the  fact,  that  whenever  death  is  sudden,  it 
interrupts  only  the  great  functions  ;  the  tonic  action  of  the  parts  con- 
tinues for  a  greater  or  less  time  after.  Now  this  action  disengages  a 
little  caloric  from  the  blood  that  is  in  the  general  system."  "  When 
the  disengagement  of  caloric  has  ceased  in  the  body,  that  which  re- 
mains in  it  becomes  in  equilibrium  with  that  of  the  external  air,  ac- 
cording to  the  general  laws  of  this  equilibrium.  Now  these  laws  be- 
ing uniform,  their  effect  would  be  the  same  in  every  case." 

Again,  sometimes  the  temperature  in  apoplexy  is  greatly  depressed 


PHYSIOLOGY. FUNCTIONS.  26*7 

Defore  death  takes  place ;  and  this,  too,  while  the  circulation  is  such 
as  to  admit  of  blood-letting.  Two  cases  of  violent  apoplexy  ("vio- 
lento  paroxysmo")  are  recorded  in  the  Ephemerides  Germanii,  in 
which  the  blood,  as  it  flowed  from  the  veins,  was  actually  cold.  Mor- 
gagni  mentions  an  instance  of  another  affection  in  which  the  blood 
flowed  "  in  an  icy  cold  stream"  from  the  arm.  Thackrah  saw  a  sim- 
ilar phenomenon.  So,  also,  De  Haen.  I  need  scarcely  say,  also,  that 
when  respiration  is  extremely  labored  and  slow  in  apoplexy,  the  nat- 
ural temperature  is  often  either  undiminished  or  considerably  exalted. 
Our  familiarity  with  the  fact,  however,  only  increases  its  importance, 
and  shows,  by  the  frequency  of  the  coincidence,  that  respiration  can 
be  only  remotely  concerned  with  the  generation  of  heat. 
Here  is  another  variety  in  apoplectic  affections : 
"  While  a  gentleman,"  says  Mr.  Hunter,  "  who  was  seized  with  an 
apoplectic  fit,  lay  insensible  in  bed,  covered  with  blankets,  I  found 
that  his  whole  body  would,  in  an  instant,  become  extremely  cold  in 
every  part,  continuing  so  for  some  time ;  and  as  suddenly  would  be- 
come extremely  hot.  While  this  was  going  on  alternately,  there  was 
no  sensible  alteration  in  his  pulse  for  several  hours." 

Here  is  another  case,  from  the  same  observer,  not  less  fatal  to  the 
theory  of  respiration  : 

"  A  man  fell  from  his  horse,  and  pitched  on  his  head,  and  produced 
all  the  symptoms  of  a  violent  injury.  There  was  concussion,  and  per- 
haps extravasation  of  blood.  The  pulse  was  at  first  120,  but  came  to 
100,  and  sometimes  to  90,  and  was  strong,  full,  and  rather  hard.  He 
was  very  Jiot  in  the  skin,  but  breathed  remarkably  slow,  only  half  the 
common  frequency."  Other  injuries  exalt  the  temperatui'e  in  other 
modes  of  an  equally  vital  nature.  Thus,  extirpation  of  the  kidneys 
through  the  increased  stimulus  of  the  blood,  often  raises  the  temper- 
ature of  the  body  more  than  six  degrees. 

The  following  case,  by  Mr.  Hunter,  also,  seems  also  to  have  been 
intended  for  our  special  purpose  : 

"  February,  1781,  a  boy,  about  three  years  old,  appeared  not  quite 
so  well  as  common,  being  attacked  with  a  kind  of  shortness  of  breath- 
ing in  the  night.  It  had  become  excessively  oppressive  about  five 
o'clock  on  Sunday  morning,  so  difficult  that  he  appeared  dying  for 
want  of  breath.  The  common  rate  of  breathing  in  such  a  boy  is  about 
thirty  inspirations  in  a  minute.  At  10  o'clock,  he  was  drawing  his 
breath  with  a  jerk, — about  two  and  a,  lialf  inspirations,  or  even  less, 
in  a  minute.  Pulse  sixty,yam^,  slow.  On  tying  up  the  arm,  the  vein 
did  not  appear  to  rise  in  the  least,  so  that  the  blood  did  not  go  its  round. 
Viod^  purplish,  especially  the  lips.  He  had  ^jine  warmth  on  the  skiti 
all  over  the  body,  although  in  a  room  without  afire, — not  covered  with 
more  clothes  than  common  in  the  month  of  February,  with  snow  fall- 
ing at  noon."- — Hunter. 

This,  and  the  preceding  case,  appear  to  differ  in  some  physiolog- 
ical details.  In  the  former,  the  disposition  of  the  capillaries  to  gener- 
ate heat  seeiTis  to  have  been  a  good  deal  determined  by  the  cerebral 
influence ;  in  the  latter,  the  alteration  of  the  vital  forces  was  probably 
owing  to  other  causes.  Like  other  cases,  therefore,  which  I  have  re- 
cited, they  serve,  by  their  variety,  to  illustrate  the  vital  nature  of  the 
principles  which  are  mainly  concerned  in  the  production  of  animal 
heat.     But,  standing  alone,  they  must  either  subvert  the  hypothesia 


2fi8  INSTITUTES    OF    MEDICINE. 

which  concerns  respiration,  or  we  must  have  a  chemical  theory  for 
the  natural  state  of  the  body,  and  a  vital  one  for  its  morbid  conditions. 
This  would  be  clearly  absurd ;  at  least,  if  there  be  any  such  thing  as 
philosophy,  or  any  consistency  in  the  powers  and  functions  of  life. 
These  examples  show  us,  also,  how  very  probable  it  is,  that  all  our 
chemical  hypotheses  in  relation  to  life  ai-e  the  mere  offspring  of  habit, 
or  imitation,  or  of  narrow  observation.  It  is  certainly  hard  to  give 
up  the  fruit  of  great  toil  and  research ;  but  it  is  harder  for  others  to 
endure  it,  who  prefer  to  be  instructed  by  the  voice  of  nature,  rather 
than  by  artificial  results.* 

I  shall  present  other  examples  to  the  foregoing  effect,  as  supplied 
by  morbid  conditions  of  the  system ;  since  these,  more  than  experi- 
ments, conduct  us  to  the  true  philosophy  of  animal  heat. 

Every  physician  is  familiar  with  the  variations  of  temperature  in 
disease  ;  which,  indeed,  engage  his  attention  in  almost  every  case.  It 
is  often  exalted  when  respiration  is  slow,  and  again  depressed  when 
breathing  is  hurt'ied  ;  and  it  is  one  of  the  most  common  phenomena 
to  find  it  different,  by  many  degrees,  in  different  parts  of  the  body, 
and  under  every  variety  of  respiration  and  circulation.  It  will,  there- 
fore, be  my  purpose  only  to  mention  a  few  of  the  more  unusual  in- 
stances. 

Dr.  Philip  has  known  the  temperature  of  the  skin  at  74°  Fh.  in 
the  cold  stage  of  an  intermittent,  while  in  the  hot  staere  it  rose  to  105°. 
Craigie  found  it  at  107°,  and  109°.  Here  the  respiration  and  circu- 
lation are  often  most  accelerated  during  the  cold  stage.  This,  with 
the  vast  difference  in  temperature,  refei's  the  depression  of  heat  to 
other  causes  than  the  mere  constriction  of  the  capillaries  in  the  cold 
stage.  Here,  too,  as  in  all  analogous  cases,  we  have  a  coincident 
diminution  of  all  other  secretions.  Piorry  has  seen  the  temperature 
in  six  cases  of  typhoid  fever  varying  from  108°  to  117°  ;  and  in  one 
of  these,  the  blood  was  at  113°  Fh.  In  phthisis,  he  has  known  it  at 
114°,  and  in  a  case  of  pneumonia,  the  blood  was  113°.  Prevost 
found  the  temperature  of  the  body  at  110°  in  tetanus.  Granville  says 
it  sometimes  rises  in  the  uterine  system  to  120°  Fh.,  and  that  it  de- 
pends on  the  degree  of  action  in  the  organ.  In  hydrophobia,  where 
respiration  is  probably  always  accelerated,  Currie  found  that  "  there 
was  no  increase  of  animal  heat  in  any  one  of  five  cases." 

"  The  Reformer"  says  that,  ^^for  a  given  amount  of  oxygen  the  heat 
produced  is,  in  all  cases,  exactly  the  same  ;^^  and  that  *'  the  consumption 
of  oxygen  in  equal  times  may  be  expressed  by  the  number  of  respira- 
tions^' (§  440,  no.  5  ;  441,  b).  But,  in  stating  this,  he  did  not  reply  to 
the  following  interrogatories  propounded  in  my  former  Essay.  Thus  : 
How  is  the  natural  temperature  maintained  in  consumption,  where  res- 
piration is  sometimes  so  greatly  impaired  as  not  to  be  compensated 
by  any  acceleration  of  its  movements  ]  Or  why  is  it,  when  the  lungs 
are  impervious  from  condensation,  and  their  function  otherwise  great- 
ly impaired  by  destructive  ulceration,  the  heat  rises  habitually  in  the 
afternoon,  even  to  114°  Fh.,  and  that,  too,  without  any  previous  re- 
duction of  temperature,  and  often  without  any  increase  of  respii'ation  ? 

*  I  commend,  also,  to  our  minute  philosophers  Mr.  Hunter's  experiment  upon  tlie  carp. 
It  was  partly  intended  to  illustrate  a  vision  of  oui-  author,  by  which,  as  he  says,  "like  other 
schemers,  he  thought  he  should  make  his  fortune."  But  our  author  had  not  only  tlie  good 
sense  to  abandon  it,  but  the  magnanimity  to  hold  it  up  as  a  weakness  of  the  human  an 
derstandina:. 


PHYSIOLOGY. FUNCTIONS.  269 

Why  do  the  palms  of  the  hand.  "  burn"  when  the  rest  of  the  surface 
is  cool  ]  Will  chemistry  explain  1  Will  it  explain,  also,  at  the  same 
time,  the  analogous  phenomena,  and  the  vicissitudes  of  heat  and  cold, 
the  quick  transitions  from  one  to  the  other,  that  are  forever  perplex- 
ing the  physician  in  his  treatment  of  continued,  remittent,  and  inter- 
mittent fevers  1  Will  chemistry  maintain,  in  conformity  vs^ith  it^  doc- 
trine, that  these  periodical  evolutions  of  heat  are  due  to  paroxysmal 
combustions  of  the  tissues,  especially  where  little  remains  to  undergo 
the  process,  respii-ation  obstructed,  and  yet  a  high  exaltation  of  tem- 
perature 1  Explain,  I  say,  all  this  in  conformity  with  the  "  oxygen 
and  fuel"  system,  and  vitalism  will  surrender  to  the  devices  of  human 
ingenuity. 

Why  is  it,  that  when  the  general  temperature  of  the  body  is  at 
some  85°  Fh.  it  may  exist  at  the  scrobictihis  cordis  at  106°  and  up- 
ward %*  Mr.  Malcolmson  states,  that  in  the  Asiatic  cholera  "  the 
skin  is  sometimes  colder  during  life  than  after  death,  and  a  partial  rise 
of  temperature  over  the  trunk  is  frequently  a  fatal  symptom."  I  have 
witnessed  the  same  phenomena.  Mr.  M.  also  observes  that  beriberi 
supplies  analogous  instances ;  and  that  when  the  temperature  was 
extremely  reduced,  "  it  was  not  different  when  the  limbs  were  closely 
wrapped  in  woolen,  or  when  the  thermometer  was  held  between  the 
soles  of  the  feet  or  hands,  and  free  evaporation  carefully  prevented." 
Is  it  not  obvious,  in  these  instances,  that  the  power  of  generating  heat 
was  lost  in  consequence  of  modified  vascular  action ;  and  if  so,  then 
the  generation  of  heat  depends  upon  vascular  action,  and  is,  of  course, 
a  vital  product.  This,  too,  is  most  emphatically  shown,  in  the  instan- 
ces here  and  elsewhere  stated,  by  the  "  partial  rise  of  temperature 
over  the  trunk"  just  antecedently  to  death.  It  is  analogous  to  those 
cases  in  which  profuse  perspiration  breaks  out  in  syncope,  or  as  pa- 
tients are  in  the  act  of  expiring.  It  grows  out  of  a  powerful  reflex 
nervous  influence  upon  the  vires  vitce,  by  which  a  sudden  change  of 
action  is  induced  in  the  elaboi^ating  vessels  {^  637). 

Why  is  the  temperature  often  exalted  in  congestions  of  the  lungs, 
"  where  life  is  endangered  by  diminished  communication  with  the 
air;"  and  why,  in  such  a  case,  will  "  the  abstraction  of  blood  dimin- 
ish the  power  of  producing  heat,"t  although,  by  this  means,  we  ex- 
tend the  communication  of  the  lungs  with  the  air  ?  Or,  again,  in 
congestions  of  other  organs,  when  the  respiration  is  natural,  the  cir- 
culation in  the  lungs  unobstructed,  but  the  animal  heat  greatly  re- 
duced, why  does  it  happen  that  the  abstraction  of  blood  will  at  once 
exalt  the  temperature  without  affecting  the  respiration,  or  even  in- 
creasing the  force  or  frequency  of  the  general  circulation  (§  961,  d)  % 

In  the  latter  cases,  the  rationale  appears  to  be,  as  I  have  endeavor- 
ed to  explain  in  my  Essay  on  Blood-letting,  that  a  direct  change  is 
exerted  by  the  abstraction  of  blood  upon  the  instruments  of  all  vital 
actions,  by  which  the  calorific,  as  well  as  other  functions,  are  improv- 
ed or  restoi'ed.  It  is  here,  animating  these  minute  vessels,  that  we 
shall  find  the  principles  residing  by  which  we  are  to  account  for  all 
the  remai'kable  phenomena  of  animal  heat.  As  the  operation  of  these 
forces  is  modified,  whether  by  natural  or  artificial  causes,  so  will  be 
the  phenomena  which  depend  upon  them.     This  is  universally  Ituq 

*  See  my  Letters  on  the  Cholera  Asphyxia,  and  other  authors  upon  this  disease. 
t  Edwards,  on  the  Influence  of  Physical  Agents  on  Life,  p.  275. 


270  INSTITUTES    OF    MEDICINE. 

of  all  the  manifestations  of  the  organic  forces,  whether  they  consist  of 
vital  phenomena,  or  of  material  products.  The  function  of  respira- 
tion is  just  as  much  concerned  with  one  as  with  the  other,  and  prob 
ably  no  more.  It  aids,  like  the  chylopoietic  viscera,  in  perfecting  the 
gi'eat  material  from  which  bile,  urine,  the  gastric  juice,  &c.,  are  elab- 
orated by  the  vital  properties  and  their  instruments.  And  just  so  is 
respiration  concerned  in  the  production  of  animal  heat. 

Again,  "  sympathy,"  says  Bichat,  "  as  we  know,  has  the  gi'eatest  in- 
fluence upon  heat.  According  as  this  or  that  part  is  affected,  there  is 
disengaged  in  others  more  or  less  of  this  fluid.  How  does  all  this 
happen  'i  In  this  way  :  the  affected  organ  acts  sympathetically  on  the 
tonic  forces  of  the  part ;  these  being  raised,  more  caloric  than  usual  is 
disengaged.  It  is  precisely  the  same  as  in  sympathetic  seci'etions  or 
exhalations.  Whether  the  vital  forces  are  raised  by  a  stimulus  direct- 
ly applied,  or  by  the  sympathetic  influence  they  receive,  the  effect 
that  results  from  it  is  exactly  the  same"  (^  1044,  a,  b). 

And  again,  the  same  accurate  philosopher  :  "  Each  system  has  its 
own  degree  of  heat."  This  fact  was  not  so  well  known  in  Bichat's 
time  as  now.  But  it  was  his  induction  from  general  principles.  ] 
shall  only  advert  to  the  example  of  the  dog's  nose,  which  is  familiar 
to  all.  Hunter,  however,  rendered  the  fact  sufficiently  obvious  ; — 
Davy  and  others  have  confirmed  it.  Now,  how  exactly  all  this  cor- 
responds with  what  is  known  of  the  vital  endowments  of  particular  or- 
gans. Where  they  are  most  strongly  pronounced,  there  the  temper- 
ature is  apt  to  be  highest,  there  the  phenomena  of  organic  life  pre- 
dominate, and  there  it  is  that  morbific  causes  make  their  most  fre- 
quent and  deep  impressions,  and  develop  the  most  exalted  tempera- 
ture.— (See  Essay  on  Venous  Congestioji,  §  8,  9,  in  Comm.,  ^  1045). 

447,  e.  Finally,  I  come  to  what  I  consider  an  experimentum  crucis, 
supplied  by  an  able  philosopher,  and  by  one  of  the  most  able  defend- 
ers of  the  chemical  doctrine  of  animal  heat.  He  states  that  great  dif- 
ferences arise  as  to  oxygen,  during  the  respiration  of  atmospheric  air: 

"  The  real  causes  are  chiefly  certain  inherent  differences  in  the  state 
of  the  venous  blood,  which  are  indicated,  indeed,  by  other  physiologi- 
cal facts,  but  by  none  so  unequivocally  as  by  this  variety  in  the' power 
of  altering  the  oxygen  of  atmospheric  air.  The  first  cause  is  a  differ- 
ence in  the  degree  of  venosity  or  venalization  of  the  blood  in  passing 
through  the  capillaries."  The  second  and  last  "  cause  of  diversity  in 
the  action  of  venous  blood  on  atmospheric  air  is  a  difference  in  the 
proportion  of  coloring  matter  contained  in  the  blood." 

Now,  if  the  chemical  doctrine  have  any  foundation,  its  advocates 
should  show  that  there  is  a  greater,  or,  at  least,  as  great  a  consump- 
tion of  oxygen  in  those  states  of  the  system  which  are  attended  by  an 
exaltation  of  temperature,  as  in  the  natural  condition  of  the  body.  On 
the  fcontrary,  however,  they  show  just  the  reverse  of  this.  Thus,  the 
high  authority  whom  I  have  just  quoted  : 

"  The  inferior  action  of  the  blood  on  the  oxygen  of  the  air  in  its 
passage  to  the  arterial  state  simply  indicates,  that  it  is  less  removed 
frorn  a  state  of  arterialization,  that  is,  partakes  less  than  usual  of  the 
characters  of  venous  blood.  Accordingly,  the  least  alteration  of  oxy- 
gen invariably  occurs  in  those  febrile  diseases  where  the  circulation 
is  much  excited^  and  the  respiration  at  the  same  time  free.  These  con- 
ditions exist  most  especially  in  acute  rheumatism  ;  and  it  was,  there- 


PHYSIOLOGY. FUNCTIONS.  271 

fore,  in  cases  of  this  disease  that  the  four  instances  of  diglit  action  (on 
the  air)  formerly  mentioned  have  occurred.  On  all  these  four  occa- 
Bions  the  blood  was  evidently  more  florid  than  usual,  and  in  the  in- 
stance where  the  loss  of  oxygen  was  only  0-57  of  a  cubic  inch,  the 
stream  from  the  vein  was  so  bright,  that  the  gentleman  who  opened 
it  had  at  first  some  suspicion  that  he  had  opened  the  artery."* 

Here,  also,  we  have,  from  a  distinguished  chemist,  a  philosophical 
resort  to  the  modified  condition  of  the  system  in  disease,  for  an  inter 
pretation  of  the  wonderful  peculiarity  of  living  organized  matter  in 
manifesting  the  power  of  generating  heat. 

447,  f.  We  have  thus  again  seen  that  the  chemical  hypotheses 
which  immediately  concern  the  functions  of  resj^iration  are  surround- 
ed by  too  many  exceptions  to  come  within  the  pale  of  nature.  These 
exceptions  meet  us  every  where  in  the  habitual  state  of  the  animal, 
and  in  the  history  of  disease  they  become  almost  as  multiplied  as  the 
individual  cases.  Here  it  is  that  we  may  most  successfully  contem- 
plate the  law  and  its  operations,  in  the  various  modifications  which  it 
sustains  from  the  influence  of  remote  causes,  and  those  within  the 
body.  Among  the  latter,  are  those  of  the  mind,  and  the  derange- 
ments to  which  the  lungs  are  liable,  both  in  their  general  and  organic 
functions.  But  far  more  frequently,  and  more  profoundly,  is  animal 
temperature  directly  exalted,  or  diminished,  by  affections  of  the  stom- 
ach and  of  the  nervous  system.  I  need  scarcely  repeat,  it  would  be 
absurd  to  have  one  theory  to  explain  the  phenomena  of  heat  in 
health,  and  another  in  disease.  It  would  be  a  violation  of  all  philoso- 
phy, as  well  as  a  reckless  disregard  of  all  facts.  According  to  the 
common  designs  of  nature,  there  cannot  be  one  law  for  the  genera- 
tion of  heat  in  the  healthy  state  of  the  body,  and  another  which  deter- 
mines the  exalted  heat  of  fever  and  of  local  inflammations.  While 
the  various  functions  proceed  in  their  natural  manner,  the  evolution 
of  heat,  like  the  other  products,  remains  without  any  radical  alteration. 
But  when  the  latter  are  disturbed  in  their  nature!  character,  the  former 
is  liable  to  corresponding  variations,  which  can  be  explained  only  on 
the  principle  that  the  power  of  generating  heat  is  as  much  an  attri- 
bute of  vitality  as  any  that  may  be  concerned  in  the  process  of  dis- 
ease, and  that  their  various  modifications  are  constantly  determined 
by  analogous  causes.  It  is  a  broad,  fundamental  principle,  that  "  the 
general  phenomena  of  the  disengagement  of  heat  remain  always  the 
same  in  animals  with  lungs,  in  those  without  them,  and  in  plants,  all 
of  which  have  an  independent  temperatui"e." 

447,  g.  Some  chemical  philosophers,  like  the  able  Edwards,  in 
treating  of  animal  heat,  have  called  to  their  aid  the  "  constitution^^  of 
animals  to  explain  certain  anomalies  which  defy  the  chemical  hypoth- 
esis. We  hear  much  about  the  "  power  of  the  system  to  generate 
heat,"  without  being  let  into  the  secret  in  what  that  constitution,  and 
that  power,  consist.  To  allow  that  the  forces  of  life  have  a  large  and 
uniform  share  in  the  generation  of  animal  heat,  would  make  a  repul- 
sive medley,  in  its  connection  with  the  chemical  hyj^othesis.  Now 
that  "  constitution,"  and  that  "  power,"  are  something  more  than  ideal ; 
something  different  from  the  organized  structure  ;  for,  in  the  latter 
case,  many  variable  phenomena,  in  adults,  proceed  from  unvarying 
conditions  of  structure  (^  1047). 

*  Dr.  Christison.  in  Edin.  Med.  and  Surj.'.  Journ.,  1831,  p.  101,  102. 


272  INSTITUTES    OP    MEDICINE. 

Just  SO  is  it  with  all  the  varying  conditions  of  animal  heat.  Ir 
health,  the  varieties  are  owing  to  peculiarities  in  the  natural  condition 
of  the  vital  properties  ;  in  disease,  they  arise,  like  all  the  other  changes 
from  morbid  alterations  of  those  properties  ;  and,  if  the  blood  sustain 
any  want  of  its  proper  influences  from  defect  of  respiration,  this  will 
contribute  toward  the  modifications  of  temperature  in  the  same  way 
that  it  affects  the  other  results  of  life,  and,  I  apprehend,  in  no  other. 

Although  Dr.  Edwards  derives  some  illustrations  regarding  the  con- 
nections of  the  phenomena  of  animal  heat  with  respiration  from  cer- 
tain morbid  conditions  of  the  body,  as  in  asphyxia  from  carbonic  acid, 
syncope,  the  cold  stage  of  intermittents,  &c.,  yet  it  is  manifest  that  he 
looks  upon  disease  as  supplying  facts  which  it  is  prudent  not  to  inves- 
tigate. "  The  question  now  is,"  he  says,  "  what  is  the  influence  of 
the  respiratory  movements  on  the  temperature  of  the  body,  when 
they  are  raised  beyond  the  rate  of  health  ]  We  cannot  answer  this 
inquiry  by  observations  on  the  sick.  The  circumstances  are  then  too 
complicated  to  admit  of  oiir  deriving  conclusions  from  thcm^ — Op.  cii. 

In  this  conclusion  I  do  not  at  all  agree.  It  is  an  unwarrantable 
abandonment  of  nature  for  the  contrivances  of  art.  Morbid  conditions, 
above  all  others,  give  us  a  clew  to  the  true  philosophy.  The  vital 
properties  are  altered  by  disease,  and  with  them  there  is  a  change  in 
all  the  phenomena  and  results,  of  which  the  modifications  of  animal 
heat  are  one.  Hence,  it  appears  to  me,  that  a  very  obvious  "conclu- 
sion" may  be  deduced. 

447,  h.  In  respect  to  the  natural  differences  in  constitution  that  are 
denoted  by  apparently  contradictory  facts  in  relation  to  animal  heat, 
they  are  as  clearly  constituted  by  natural  modifications  of  the  same 
forces,  which  are  as  much,  or  more  influenced  by  other  causes  than  by 
respiration  ;  whose  power  of  evolving  heat  in  young  animals  is  great- 
ly and  rapidly  depressed  by  the  operation  of  cold,  notwithstanding 
the  respiration  is  accelerated,  during  the  first  stages  of  the  decline  of 
temperature ;  but  which,  again,  as  the  same  animals  advance  in  life, 
acquire  the  power  of  completely  resisting  the  same  cause  without  the 
former  acceleration  of  the  respiratory  movements  ;  "  the  animals  thus 
passing  from  the  state  of  cold-blooded  to  that  of  the  warm-blooded," 
while  in  the  hibernating  mammalia  generation  of  heat  still  goes  on 
although  respiration  have  come  to  a  stand,  or,  when  the  cold  be- 
comes intense,  is  carried  to  its  highest  pitch  by  the  very  cause  which 
had  produced  its  great  decline ;  or,  the  same  forces  maintain  a  uniform 
state  of  heat  when  the  respiratory  movements  are  greatly  accelerated 
by  external  heat,  and  resist  equally  the  heat  of  the  sun-ounding  me- 
dium; or,  such  is  their  natural  susceptibility  they  niay^  be  so 
influenced  by  season,  that  their  power  of  producing  heat  is  said  to  be 
less  when  its  production  is  greatest ;  which  power  "  may  be  varied,  in 
some,  by  suitable  food  and  a  graduated  temperature  ;"  which  "  is  gen- 
erally diminished  in  natural  sleep,  though  modifications  occur  which 
chano-e  the  relation;"  which  is  so  modified  in  the  cholera  asphyxia, 
that  the  temperature  may  greatly  fail  while  respiration  is  accelerated, 
and  the  lung.s  free  from  congestion ;  or,  is  undiminished  in  asphyxia 
from  carbonic  acid,  "  when  the  respiratory  movements  are  no  longer 
seen  ;"*  or  may  attain,  as  in  apoplexy,  preternatural  vigor  after  res- 
piration and  circulation  have  entirely  ceased. 

*  Portal  says  tliat  the  heat  has  been  known  to  remain  very  high  in  these  cases,  as  in 
apoplexy,  for  many  hours  after  death. — Sur  I'Apop 


FHYSIOLOGY. FUNCTIONS.  273 

"  Constitution,"  then,  and  the  "power  of  generating  heat,"  mani- 
festly relate  to  the  vital  properties,  and  to  nothing  else.  The  united 
operation  of  these  powers,  through  their  instruments  of  action,  results 
in  the  elaboration  of  bile,  gastric  juice,  heat,  &c.,  from  the  blood. 
That  particular  determination  by  which  they  eliminate  heat,  in  all 
parts  of  the  body,  may  be  called  a  law,  though  it  is  but  the  joint  re- 
sult of  the  vital  powers,  concurring  in  a  certain  manner  to  a  specific 
effect.  The  result  is  variously  affected  by  climate,  season,  the  quality 
and  quantity  of  food,  stimulants  and  sedatives,  cold  or  warm  air  ap 
plied  externally  or  to  the  lungs,  by  morbific  agents,  and  other  causes; 
or,  as  the  vital  properties  happen  to  sustain  peculiarities  in  relation  to 
individuals,  age,  &c.,  so  will  the  generation  of  heat  be  modified  when 
respiration  is  exactly  the  same ;  and  along  with  those  modifications 
of  heat  are  variations,  more  or  less  coincident,  of  other  products.  The 
causes  are  obvious  from  the  effects.  The  former  are  few  and  simple  ; 
the  latter  are  diversified  without  end  (^  1047). 

Most  of  the  reasoning  which  abounds  in  authors  who  believe  animal 
heat  to  depend  specifically  upon  respiration,  or  the  result  of  a  chemi- 
cal process,  consists  in  reconciling  difficulties  by  referring  them  to 
the  vital  powers,  and  sometimes  to  the  entire  exclusion  of  the  chemi- 
cal hypothesis.  True,  they  do  not  say  vital  powers.  They  would 
otherwise  be  non-conformists.  They  speak  of  "  constitution" — "  the 
power  of  evolving  heat," — yet  turn  into  ridicule  the  only  true  philos- 
ophy, and  the  only  possible  thing  which  they  themselves  can  mean.  If 
they  hazard  the  "  term  vitality,^'  it  "  is  employed  for  the  want  of  a  bet- 
ter," but  "  without  any  connection  with  the  mystification  which  some- 
times attends  its  use  ;"  while  others,  like  Dr.  Elliotson,  can  see  noth- 
ing in  "  animal  heat,"  "but  a  -pecuWox  state  only;"  and  here,  as  in  the 
case  of  "  vitality,"  Dr.  E.  "  adopts  the  common  language  in  speak- 
ing of  animal  heat,"  to  make  the  subject  intelligible. 

It  is  from  the  blood,  like  all  other  animal  products,  that  heat  is  de- 
rived. And  since  decarbonization,  and,  perhaps,  an  absorption  of  ox- 
ygen, is  indispensable  to  the  healthy  performance  of  all  other  func- 
tions, it  is  doubtless  important  to  the  generation  of  heat ;  though  man- 
ifestly less  so  in  the  latter  instance,  since  we  see  the  evolution  of  heat 
sometimes  going  on  when  respiration  is  nearly,  or  quite  extinct; 
while  in  the  cold-blooded  animals  it  exerts  but  little,  if  any,  influence 
upon  temperature.  Decarbonization  of  the  blood,  and  probably  the 
absorption  of  oxygen,  are  among  the  numerous  processes  by  which 
its  vivification  is  perfected,  and  by  which  it  is  prepared  for  an  elabora- 
tion of  the  various  animal  products,  and  in  animals  of  a  certain  consti- 
tution for  the  evolution  of  heat.  When  respiration  ceases,  all  the 
most  important  functions  immediately  fail;  but  it  is  remarkable  that 
the  evolution  of  heat  appears  to  be  the  very  last. 

I  conclude,  therefore,  that  the  elaboration  of  animal  heat,  and  all 
other  secretions,  are  on  a  par  in  regard  to  principle.  It  is  true,  a  cer- 
tain proportion  of  latent  heat  may  be  extricated  by  the  conversion  of 
blood  into  the  solid  parts.  But  this  would  be  counterbalanced  by  a 
corresponding  change  of  the  solids,  particle  for  particle,  into  fluids. 
This  appears  to  me  to  be  fatal  to  a  late  doctrin^which  imputes  animal 
heat  to  this  cause ;  as  well,  also,  to  the  condensation  of  gases.  Be- 
sides, what  becomes  of  the  principle  of  condensation  where  the  tern 
perature  rises  after  apparent  death  (§  447,  d)  1     Where  is  oxygen  gas  ] 


274  INSTITUTES    OP    MEDICINE. 

447|,  a.  In  my  former  Essay  I  have  also  considered  the  hypothe- 
sis relative  to  the  absorption  of  oxygen  gas  by  venous  blood,  and  the 
conditions  under  which  it  was  supposed  to  unite  with  carbon,  in  the 
process  of  respiration.  It  only  remains  now  to  state  circumstantially 
the  views  entertained  by  Liebig  upon  this  subject. 

1.  "  During  the  passage  bf  the  venous  blood  through  the  lungs,  it 
absorbs  oxygen  from  the  atmosphere.  Farther,  for  every  volume  of 
oxygen  absorbed,  an  equal  volume  of  carbonic  acid  is,  in  most  cases, 
given  out," 

"  The  globules  of  venous  blood  experience  a  change  of  color,  and 
this  change  depends  on  the  action  of  oxygen." 

"  The  red  globules  contain  a  compound  of  iron  ;  and  no  other  con- 
stituent of  the  body  contains  iron." 

"  The  compound  of  iron  in  the  blood  has  the  characters  of  an  ox- 
ydized  compound."  "  No  other  metal  can  be  compared  with  iron 
for  the  remarkable  properties  of  its  compounds." 

2.  Many  "  observations,  taken  together,  lead  to  the  opinion  that  the 
globules  of  arterial  blood  contain  a  compound  of  iron  saturated  with 
oxygen,  which,  in  the  living  body,  loses  its  oxygen  during  its  passage 
through  the  capillaries." 

The  last  quotation  is  a  universal  theory  with  our  author.  By  it  "  the 
Reformer"  interprets  all  motion,  the  generation  of  all  power  in  the 
animal  body,  the  circulation  of  the  blood,  inflammation  and  fever, 
obesity  and  emaciation,  the  various  phenomena  of  life,  and  even 
death  itself.  "  The  oxygen  of  the  air  and  the  carriers  of  oxygen" 
are  all  in  all.  The  "  carriers  lose  their  oxygen  during  their  passage 
through  the  capillaries,"  when  a  "  combustion  of  the  tissues  is  set 
up,"  which  is  the  true  and  only  cause  of  the  principle  of  life,  of  its 
extinction  at  death,  and  of  all  the  unique  phenomena  of  the  animal 
creation  (§  350,  nos.  3,  4,  5,  7,  8,  9,  10,  15,  18,  19,  46 ;  §  440,  nos  1 
4,  5,  6,  8,  9,  10,  11,  12,  14,  16,  1054). 

It  is  not,  therefore,  remarkable  that  "  the  Reformer"  should  have 
considered  animal  heat  as  life  itself, — both  the  cause  and  effect  of 
life  (§  441  e,  440,  nos.  8,  9,  11,  12,  14,  16), — since  every  known 
process  and  result  in  the  animal  "  machine"  is  due  to  "  combus- 
tion." 

3.  "  The  compound,  rich  with  oxygen  (no.  2),  passes,  therefore,  by 
the  loss  of  oxygen,  into  one  far  less  charged  with  that  element.  One 
of  the  products  of  oxydation  fonned  in  this  process  is  carbonic  acid. 
The  compound  of  iron  in  the  venous  blood  possesses  the  property  of 
combining  with  carbonic  acid,  and  it  is  obvious  that  the  globules  of 
the  arterial  blood,  after  losing  a  part  of  their  oxygen,  will,  if  they  meet 
with  carbonic  acid,  combine  with  that  substance  (§  440y,  no.  18,  and 
K).  When  they  reach  the  lungs,  they  will  again  take  the  oxygen  they 
have  lost ;  for  every  volume  of  oxygen  absorbed,  a  corresponding 
volume  of  carbonic  acid  will  be  separated ;  and  they  will  again  ac 
quire  the  power  of  giving  off  oxygen." 

"  In  their  return  toward  the  heart,  the  globules  which  have  lost 
their  oxygen  combine  with  carbonic  acid,  producing  venous  blood ; 
and  when  they  reach  >he  lungs,  an  exchange  takes  place  between  this 
carhonic  acid  and  the  oxygen  of  the  atmosphere.'" 

"The  ORGANIC  COMPOUND  o{  iron,  which  exists  in  venous  bljod, 
recovers  in  the  lungs  the  oxygen  it  had  lost;  and,  in  consequence  of 


PHYSIOLOGY. FUNCTIONS.  275 

# 

this  absorption  of  oxygen,  the  carbonic  acid  in  combination  with  it  is 
separated." 

4.  "  Hence,  in  the  animal  organism,  two  processes  of  oxydation 
are  going  on  ;  one  in  the  lungs,  the  other  in  the  capillaries.  By 
means  of  the  former,  in  spite  of  the  degree  of  cooling,  and  of  the  in- 
creased evaporation  which  takes  place  there,  the  constant  temperature 
of  the  lungs  is  kept  up  ;  while  the  heat  of  the  rest  of  the  body  is  sup- 
plied by  the  latter." — Animal  Chemistry  (§  438,  h,  c). 

447^,  ^.  If,  therefore,  we  exclude  the  vegetable  kingdom  as  an  im- 
portant element  in  our  interpretation  of  organic  heat,  we  shall  have 
seen  by  this  fundamental  hypothesis  as  to  the  globules  of  blood  that 
there  can  be  no  doubt  that  the  general  theory  of  animal  heat  has 
been  founded  upon  certain  speculations  relative  to  a  limited  number 
of  red-blooded  animals,  and  often,  as  we  have  reason  to  suppose,  to 
man  alone.  It  takes  no  cognizance  of  all  those  white-blooded  races 
that  possess  no  ferruginous  globules,  and  therefore  no  "  earners  of 
oxygen  gas,"  and  whose  temperature  in  some  instances,  as  in  the 
bee,  approximates  that  of  the  human  race  (§  444).  However  much 
a  general  theory  may  draw  upon  contingencies  for  its  support,  it  must 
be  universally  applicable  to  the  same  combination  of  phenomena. 
It  will  not  answer  to  have  "  ferruginous  carriers  of  oxygen"  for  one 
class  of  animals,  and  something  very  different  for  another  class,  to 
explain  what  is  common  to  both.* 

447  J,  c.  In  the  former  Essay  I  have  devoted  to  the  questions  rela 
tive  to  the  elimination  of  carbon  from  the  blood,  and  the  formation  of 
cai-bonic  acid,  all  the  attention  which  the  subject  might  otherwise  now 
require ;  and  in  another  section  of  this  work  an  argument  is  present- 
ed to  sustain  my  former  conclusions  (§  419).  In  the  foregoing  Essay 
I  have  endeavored  to  show  that  the  distinguished  chemical  theorist, 
Dr.  Edwards,  is  right  in  his  position,  that 

"  Carbonic  acid  is  not  formed  at  once,  in  the  act  of  respiration,  by 
the  combination  of  the  oxygen  of  the  air  with  the  carbon  of  the  blood, 
but  is  entirely  the  product  of  exhalation.^' — Edwards. 

I  there  urged,  that  the  carbonic  acid  evolved  from  the  chest  does 
not  exist  in  the  state  of  that  inorganic  compound  in  the  blood ;  but 
that  the  carbonaceous  matter  exists  in  intimate  union  with  the  blood, 
from  which  it  is  eliminated  in  the  form  of  carbonic  acid  gas  by  the 
joint  agency  of  the  pulmonary  mucous  tissue  and  oxygen  ;  the  former 
taking  the  lead  in  the  process  (§  419).  The  carbon  of  the  blood  is 
thus  readily  convertible  into  carbonic  acid  while  undergoing  that 
special  vital  process  of  the  mucous  tissue.  I  may  quote  from  the 
Commentaries  a  remark  which  is  not  less  extensively  applicable  in 
these  Institutes.     Thus : 

"  Before  going  farther,  I  may  say,  that,  in  having  employed,  as  I 
shall  continue  to  do,  the  established  phraseology  of  chemical  science, 
I  have  assigned  many  reasons  in  my  first  volume,  as  I  shall  others  in 
my  Essay  on  Digestion,  for  believing  that  every  product  of  the  ani- 
mal system,  including  the  excrementitious,  is  differently  constituted  in 
its  elements  from  such  as  result  from  the  agency  of  chemical  forces ; 
that,  what  we  may  find  in  our  test  glasses  and  crucibles  has  been 
really  different  before,  or  at  the  time  of  its  elimination  from  the 
body.  Chemical  changes  may  accrue  in  excrementitious  substances 
immediately  after  their   elaboration;  and  the  ultimate  combination 

*  I  have  abstracted  blood  resembling  milk,  of  a  slightly  reddish  tint,  from  a  patient 
in  an  ardent  state  of  remittent  fever,  soon  followed  by  recovery. 


276  INSTITUTES    OF    MEDICINE. 

may  be  uniform,  especially  where,  as  in  carbonic  acid,  only  two  ele- 
ments are  ultimately  concerned." — Med.  and  Phys.  Comm.,  ut  cit. 

Although  our  author,  while  employed  about  the  chemical  rationale 
of  organic  products,  speaks  of  them  as  though  they  were  generated 
by  the  living  organism  as  he  is  accustomed  to  observe  them  in  tlie 
laboratory,  and  looks  upon  carbonic  acid  as  equally  the  product  of 
the  organization  as  of  the  combustion  of  carbon  (or,  in  his  own  lan- 
guage, "the  animal  body  acts  in  this  respect  as  a  furnace  which  we 
supply  tvithfitel,""  §  440,  no.  1),  he  now  and  then  yields  to  the  force 
of  facts,  and  even  allows,  at  one  time,  that  the  iron  of  the  red  glob- 
ules exists  in  the  state  of  an  "organic  compound"  (no.  3,  this  sec- 
tion).—Note  Rp.  1123. 

447i,  e.  It  is  also  important  to  consider  that  the  absorption  of  oxy- 
gen from  the  air,  and  the  excretion  of  carbonaceous  matter,  take  place 
through  a  highly  organized  tissue,  and  the  moment  life  ceases,  so  also 
do  these  processes,  notwithstanding  artificial  respiration.  The  same 
tissue,  too,  which  performs  those  functions,  secretes,  also,  a  mucous 
fluid.  This  secretion  being  distinctly  the  result  of  vital  action,  it  will 
hardly  be  insisted  that  the  same  tissue  is  simultaneously  performing, 
in  respect  to  another  product,  a  mere  chemical,  or  the  physical  func- 
tions o?  endosmose  and  exosmose  (§  419).  There  is  here  the  same  in- 
congruity as  we  have  seen  of  the  chemical  theory  of  digestion,  in  es- 
tablishing antagonizing  processes  for  the  conversion  of  food  into  chyme 
(§  358,  360,  374). 

447^, y.  It  remains  now  to  notice,  of  the  foregoing  quotations  (§ 
447^  a,  nos.  3  and  4),  another  of  those  extraoi'dinary  mistakes  in  fun- 
damental principles,  and  where  pure  chemistry  is  concerned,  which 
so  much  abound  in  our  author's  work  on  A?ii?nal  Chemistry. 

In  the  first  place,  we  had  been  told  again  and  again,  that  "  animal 
heat  is  produced  by  the  combination  of  oxygen  with  carbon  or  hydro- 
gen," and  in  no  other  way  (§  440).  That  is  the  combustion  theory, 
and  without  it  there  is  no  animal  heat  (§  440,  no.  6). 

By  referring,  however,  to  §  447-|-  a,  2  and  3,  it  will  be  seen  that 
oxygen  does  not  unite  with  any  combustible  substance  in  the  process 
of  respiration,  but  only  with  an  oxyd  of  iron;  and  that  in  no.  4,  it  is 
asserted  that  by  this  supposed  union  of  oxygen  with  iron  "  the  con- 
stant temperature  of  the  lungs  is  hep)t  up,  in  spite  of  the  degree  of 
cooling,  and  of  the  increased  evaporation  which  takes  place  there." 
*'  Hence,'"  says  Liebig,  "  in  the  animal  organism,  two  processes  of  oxy- 
dation  are  going  on  ;  one  in  the  lungs  [the  union  of  oxygen  with  an 
"  organic  compound  of  iron"],  the  other  in  the  capillaries  [the  union  of 
the  absorbed  oxygen  with  carbon,  &c.].  By  means  of  the  former,  in 
spite  of  the  degree  of  cooling,  and  of  the  increased  evaptoration  which 
tahes  place  there,  the  constant  temperature  of  the  lungs  is  heft  tip  ;  while 
the  heat  of  the  rest  of  the  body  is  supplied  by  the  latter." — Liebig. 

The  general  concurrence,  even  of  chemists,  in  the  foregoing  expo 
sition  of  the  laws  of  animal  heat,  can  alone  justify  any  farther  com- 
ment. But  the  work  must  be  efficiently  done  to  operate  as  a  perpet- 
ual barrier  to  the  pernicious  invasions  of  chemistry. 

I  say,  then,  in  whatever  aspect  the  foregoing  statement  may  be  re- 
garded, it  is  deeply  discreditable  even  to  chemical  philosophy.  In 
the  first  place,  a  distinct  chemical  provision  is  made  for  the  "lungs" 
and  for  "  the  rest  of  the  body."  respectively,  for  the  maintenance  of 


PHYSIOLOGY. FUNCTIONS.  277 

the  same  uniform  temperature  in  all  the  parts,  while  it  is  assumed 
that  the  union  of  oxygen  with  the  iron  of  the  blood  is  exactly  equiv- 
alent as  a  source  of  heat,  and  under  all  circumstances,  to  the  union  of 
oxygen  with  carbon  and  hydrogen  in  the  process  of  combustion  ; 
without  regarding  the  auxiliaries,  "  clothing,"  "  laborious  efforts," 
"  cold  water,"  &c.,  which  are  brought  to  the  aid  of  the  chemical  pro- 
cess in  "  the  rest  of  the  body." 

But  that  is  not  the  worst  of  the  doctrine  ;  for  it  denies  to  the  lungs 
any  participation  in  that  combustive  process  which  is  not  only  the 
foundation  of  animal  heat  "  in  the  rest  of  the  body,"  but  of  every  re- 
sult which  appertains  to  life.  Chemistry,  of  course,  abandons  the 
ground  ;  but  it  must  carry  with  it  a  mortification  which  is  due  from 
the  physiologist  (§  350,  mottoes  a,  h,  c,  d,  e),  and  a  farther  recognition 
of  the  justice  of  the  rebuke  administered  by  Hunter  (§  350,  no.  97). 

It  will  have  been  seen,  however,  that  the  foregoing  is  only  one  of 
a  constant  succession  of  blunders  whenever  the  chemist  trespasses 
upon  organic  life.  And  were  we  to  look  yet  farther  into  the  last  of 
the  series,  it  would  be  found  laden  with  objections.  The  physiologist, 
for  example,  has  a  right  to  insist  that  the  general  doctrine  shall  apply 
as  well  to  the  lungs  as  to  the  "  rest  of  the  body,"  and  that  there  is  an 
equal  combustion  of  both.  The  chemist,  therefore,  necessarily  places 
the  temperature  of  the  lungs  at  196°,  in  making  the  union  of  oxygen 
with  the  iron  of  the  blood  equivalent  to  the  combustive  process.  And 
having  thus  rectified  the  hypothesis,  we  find  ourselves  presented  with 
a  fundamental  auxiliary  to  the  general  principle,  that  its  integrity  may 
be  preserved  in  the  lungs  which  are  beyond  the  reach  of  "  clothing," 
while  the  surface  of  the  body,  which  is  more  exposed  to  the  operation 
of  cold,  is  left  to  the  general  principle  supported  by  the  contingencies 
of  dress,  along  with  those  other  provisions,  "  food,"  "  laborious  ef- 
forts," "candles,"  &c.,  that  are  designed  for  the  maintenance  of  the 
same  temperature  in  "  the  rest  of  the  body"  which  is  accomplished 
by  the  two  chemical  processes  in  the  lungs  (§  440,  nos.  10,  11,  12, 
13,  14). 

While  now  adverting  to  the  subject  of  carbonic  acid  in  its  supposed 
relation  to  animal  heat,  I  will  place  in  contrast  two  doctrines  by  our 
author,  which  make  up  a  part  of  his  system  of  pathology,  as  the  best 
evidence  I  can  offer,  in  parting  forever  with  Organic  Chemistry,  of 
the  sincerity  of  the  motives  which  have  governed  the  demonstrations 
I  have  endeavored  to  make  in  behalf  of  sound  philosophy,  the  honor 
of  my  profession,  and  the  best  interests  of  man  (§  1  b,  350},  376|  b, 
820). 

Chemistry  as  founded  on  the  basis  Physiology  as  founded  on  tJie  ba- 
of'-''  'Experimental  PhilosopJiy."      sis  of'^  Experiinental  Philosophy.^' 

"  We  find,  in  point  of  fact,  that  "  If  we  consider  the  fatal  acci- 
the  living  blood  is  never,  in  any  dents  which  so  frequently  occur  in 
state,  saturated  with  carbonic  acid ;  wine  countries  from  the  drinking 
that  it  is  capable  of  taking  up  an  of  what  is  called  feather-wine,  we 
additional  quantity,  without  any  can  no  longer  doubt  that  gases  of 
apparent  disturbance  of  the  func-  every  kind,  whether  soluble  or  in- 
tion  of  the  globules.  Thus,  for  soluble  in  water,  possess  the  prop- 
example,  after  drinking  efferves-  erty  oi  permeating  animal  tissues, 
cing  wines,  beer,  or  mineral  wa-  as  water  permeates  unsized  paper 


278  INSTITUTES   OP    MEDICINE. 

ters,  more  cai'bonic  acid  must  ne-  This  poisonous  wine  is  wine  still 
cessarily  be  expired  than  at  other  in  a  state  of  fermentation,  which  is 
times.  Less,  however,  will  be  increased  by  the  heat  of  the  stom- 
given  out  after  the  use  of  vat  and  ach.  The  carbonic  acid  gas  which 
still  wines,  than  after  Champagne."  is  dasenv^agedi,  penetrates  through 
— Liebig's  Animal  Chemistry.         the  par ietes  of  the  stomach,  through 

the  diaphragm,  and  through  all  the 
intervening  membranes,  into  the  air- 
cells  of  the  lungs,  out  of  which  it 
displaces  the  atmospheric  air^ — 
Liebig's  Animal  Chemistry  (§  350, 
nos.  24,  43). 

448,  a.  The  main  objection  to  the  vital  doctrine  of  animal  heat,  or 
that  which  places  it  on  the  common  ground  of  secreted  products, 
seems  to  have  arisen  from  a  difficulty  of  comprehending  the  manner 
in  which  heat  can  be  generated  by  any  process  than  such  as  has  been 
most  familiar  to  the  senses.  The  objectors,  however,  have  no  diffi- 
culty in  assuming  that  the  "  nervous  power  governs  the  chemical  for- 
ces in  the  formation  of  animal  heat."  This  admission  of  the  instru- 
mentality of  the  nervous  power  is  founded  upon  certain  irresistible 
facts  which  chemistry  cannot  appropriate,  and  goes  very  far  in  allow- 
ing the 'force  of  analogy  which  refers  the  production  of  animal  heat 
to  the  same  great  principles  of  life  that  are  known  to  preside  over  all 
other  products  of  animated  beings. 

448,  b.  But,  is  there  any  stability  to  the  doctrines  which  relate  to 
the  evolution  of  caloric  in  the  inanimate  world  ?  None  at  all.  Even 
Lavoisier's  hypothesis  is  overthrown. 

"  A  new  theory  is,  therefore,"  says  Turner,  "  required  to  account 
for  the  chemical  production  of  heat.  But,  it  is  easier  to  perceive  the 
fallacies  of  one  doctrine,  than  to  substitute  another  which  shall  be 
faultless,  and  it  appears  to  me  that  chemists  must,  for  the  present,  be 
satisfied  ivith  the  simfle  statement,  that  energetic  chemical  action  does, 
of  itself  ,  give  rise  to  increase  of  temperature^ — Turner's  Chemistry. 

448,  c.  Let  us  now  borrow  from  the  same  distinguished  chemist, 
an  example  by  which  the  foregoing  statement  is  sustained,  and  which 
will  remove  all  difficulty  as  to  the  problem  that  animal  and  vegetable 
heat  are  elaborated  by  the  organic  force  through  the  instruments  of 
vital  action,  according  to  the  other  products  of  organic  beings.  Facts 
will  receive  their  proper  interpretation,  an  important  analogical  in- 
duction will  remain  inviolate,  while  the  uniformity  of  other  secreted 
products,  coinciding  with  the  uniformity  of  temperature,  or  each  va- 
rying together  under  the  same  vital  influences,  expounds  the  latter 
phenomenon  and  corroborates  the  vital  interpretation.    Thus,  Turner  : 

•'  It  is  a  well-known  fact,  that  increase  of  temperature  frequently 
attends  chemical  action,  though  the  prodticts  contain  much  more  insen- 
sible heat  than  the  substanccb  from  which  they  iv  ere  fanned.  This  hap 
pens  remarkably  in  the  explosion  of  gunpowder,  which  is  attended 
by  intense  heat ;  and  yet  its  materials,  in  passing  from  the  solid  to 
the  gaseous  state,  expand  to  at  least  250  their  volume,  and  conse- 
quently render  latent  a  large  quantity  of  heat." — Turner. 

448,  d.  Now,  although  it  be  allowed  that  phenomena  of  the  fore- 
going nature  may  have  been  explained  by  supposed  differences  be- 


PHYSIOLOGY. FUNCTIONS.  279 

tween  specific  and  latent  heat,  they  show  us  that  heat  exists,  and  is 
developed,  under  different  conditions ;  and  to  expound  the  variety  of 
results  in  the  mineral  world,  it  has  been  necessary  to  multiply  yet 
farther  the  natural  states  of  caloric  (§  448,  c,  1085). 

448,  e.  As  showing  farther,  also  (c),  that  there  is  some  obscurity 
attending  the  phenomena  of  ordinary  combustion,  I  may  quote  the 
high  authority.  Dr.  Kane,  to  that  effect,  who  says,  that, 

"  Laying  aside  altogether  the  attempt  at  deducing  the  phenomena 
of  combustion  from  any  change  in  the  amount  of  latent  or  specific 
heat  in  the  bodies  which  enter  into  combination,  it  remains  only  to  be 
admitted  as  a  general  and  independent  principle,  that  chemical  com- 
bination is  a  source  of  heat  and  light.  It  is,  however,  impossible  to 
aiTest  inquiry  at  that  point ;  and,  accordingly,  the  speculations  of  phi- 
losophers have  been  directed,  in  seeking  a  cause  for  the  phenomena 
of  combustion,  to  the  disengagement  of  electricity,"  &c. — Kane's 
Elements  of  Chemistry,  1841. 

448,^/1  Now,  however  it  may  be  that  the  results  are  the  same  in 
the  inorganic  world,  upon  the  theories  either  of  caloric  or  electricity, 
the  remarkable  differences  in  views  in  that  respect  show  the  difficul- 
ties which  chemistry  must  encounter  when  it  approaches  the  philoso- 
phy of  organic  heat ;  and  this,  especially,  when  we  consider  the  vital 
nature  of  the  development  of  electricity  and  light  in  living  animals. 
—(See  Medical  and  Physiological  Commentaries,  vol.  i.,  p.  107-119.) 

The  physiologist  undertakes  no  explanation  of  the  modus  in  which 
organic  heat  is  elaborated.  He  avoids  all  inquiries  of  that  nature, 
although  he  might  proceed  to  interrogate  the  manner  in  which  the 
vital  principle  operates  with  as  much  propriety  as  the  chemist  "  spec- 
ulates upon  the  cause  of  the  phenomena  of  combustion."  But,  in  do- 
ing this,  he  would  trespass  upon  inscrutable  difficulties,  and  encumber 
philosophy  with  useless  hypotheses. 

8.    GENERATION. 

449,  a.  The  eighth  and  last  great  function  common  to  animals  and 
plants  is  generation.  This  function,  being  alone  designed  for  the  per- 
petuation of  the  species,  is  not  necessary  to  organic  life.  It  is  here, 
however,  in  all  the  processes  that  are  connected  with  the  formation 
of  the  germ,  and  of  semen,  in  the  preparation  of  the  generative  or- 
gans for  impregnation,  in  the  mental  andphysical  circumstances  attend- 
ing the  act  of  copulation,  in  the  impregnation  of  the  ovum,  in  the  de- 
velopment and  growth  of  the  foetus,  in  the  sympathetic  influences  of 
the  uterus  upon  the  mammas  which  result  in  the  formation  of  milk, 
and  in  all  their  individual  and  connected  designs,  and  in  their  great 
final  cause  of  perpetuating  the  species,  and  in  the  various  incidental 
provisions  which  are  supplied  for  the  fulfillment  of  that  end,  that 
chemistry  and  physics  may  be  as  effectually  banished  from  physiol- 
ogy as  by  the  demonstrations  which  I  have  made  in  relation  to  the 
germ,  or  by  those  which  respect  digestion,  or  organic  heat,  or  the 
nervous  power. — See  Youth  p.  376-380,  §  578. 

449,  h.  What  may  be  the  extent  in  which  the  male  participates  in 
producing  tlie  offspring  it  is  impossible  to  know ;  probably  as  impos- 
sible as  a  knowledge  of  Creative  Energy.  We  know,  however,  that 
the  male  and  the  female  impress,  alike,  their  own  moral,  vital,  and 
physical  character  upon  it.     But  the  mother  supplies  the  germ,  also. 


280  INSTITUTES   OF    MEDICINE. 

449,  c.  In  another  work  I  have  examined  the  merits  of  the  old  doc- 
trines of  seminal  animalcula,  and  their  germinal  character ;  lately  re- 
vived along  with  other  illusions  or  pretensions  of  the  microscope. 
The  subject  is  scarcely  worthy  a  renewed  discussion  (§  131). 

449,  d.  It  may  be  finally  said,  that  whatever  is  true  of  the  essen- 
tial physiology  of  generation,  as  it  relates  to  animals,  is  equally  so  of 
plants.  The  coincidences,  too,  which  are  so  striking  in  this  function 
of  the  two  organic  kingdoms,  remove  every  ambiguity  which^has  been 
supposed  to  attend  the  more  important  functions  of  plants,  confirm 
the  vital  character  of  the  whole,  and,  with  the  universal  analogies,  re- 
fer the  whole  to  the  same  properties  of  life  which  caiTy  on  the  organic 
functions  of  the  animal  kingdom.  It  were  impossible,  according  to 
the  ways  of  nature,  that  a  function,  like  generation,  which  depends  in 
animals  upon  a  vital  condition  of  all  other  processes,  and  which  is  a 
great  final  cause  of  all  those  processes,  should,  in  plants,  depend  on 
others  of  a  different  nature.  By  the  coincidences,  therefore,  in  the 
function  of  generation  between  animals  and  plants,  I  prove  a  like 
coincidence  in  the  vital  character  of  all  the  organic  functions  of  both 
animated  kingdoms  (§  185,  1052  c). 

But  little  can  be  said  relative  to  the  function  of  generation,  beyond 
certain  important  relations  that  have  been  considered,  that  can  serve 
as  a  ground  for  Institutes  in  Medicine  (§  63-81).  Its  more  extended 
consideration  belongs  to  elementary  works  on  physiology. 

11.  PECULIAR,  OR  ANIMAL  FUNCTIONS, 

A.  Functions  of  Relation. 

1,    SENSATION. 

450,  a.  Having  distinguished  three  kinds  or  principal  modifications 
of  sensibility,  namely,  common,  specific,  and  syiyipathetic,  and  as  sen- 
sation is  performed  through  that  property,  there  are  naturally  three 
modifications  of  the  function  ;  to  wit,  common  sensation,  specific  sen- 
sation, and  sympathetic  sensation  (§  194-204,  1037  h). 

450,  h.  The  nerves  are  the  organs  of  the  functions,  and  the  nervous 
centres  the  recipients  of  the  transmitted  impressions.  But,  it  is  im- 
portant to  remark,  that  the  parts  most  essential  to  sensation  are  the 
extremities  of  the  nerves  at  their  origin  and  termination,  and  that  the 
trunks  are,  mainly,  the  conductors.  This  is  also  true  of  voluntary  mo- 
tion, and  of  those  involuntary  movements  that  are  excited  by  the  ner- 
vous power.  The  nerves  of  the  organic  viscera,  therefore,  follow  this 
rule,  as  it  respects  all  natural,  morbific,  and  remedial  agents.  A  neg- 
lect of  this  consideration  has  led  to  fallacious  conclusions  in  medicine 
from  experiments  on  the  trunks  of  nerves  (§  110-117,  826  d). 

450,  c.  Common  and  specific  sensation  require  a  continuity  of  the 
nerves  with  the  brain,  and  a  co-operation  of  the  mental  power  per- 
ception. Sympathetic  sensation  may  be  excited  in  the  brain,  or  spi- 
nal cord,  or  certain  parts  of  the  ganglionic  system,  either  in  their 
connected  state,  or  when  disconnected.  In  their  most  natural  con- 
dition it  is  probable  that  all  the  parts  concur  more  or  less  together  in 
giving  rise  to  sympathetic  sensation ;  though  some  parts  more  than 
others,  according  to  the  nature  of  the  impressions  transmitted  and  the 
part  from  which  they  are  transmitted  (§  201,  1037). 


PHYSIOLOGY. FUNCTIONS.  281 

450,  d.  Coinmon  sensation  appertains  to  all  parts,  and  is  the  cause 
of  pain.  In  the  natural  state  of  the  body  it  is  inappreciable,  but  may 
be  greatly  roused  by  injuries  and  by  disease.  Its  intensity  will  then 
depend  upon  the  nature  of  the  part  and  the  exciting  cause.  It  is  apt 
to  be  most  exquisite  in  parts  where  specific  sensation  is  least ;  as  in 
tendons,  ligaments,  membranous  tissues,  &c.  (§  19S). 

450,  e.  Specific  sensation  corresponds  with  specific  sensibility.  It 
is  the  function  through  which  we  acquire  a  knowledge  of  external 
things,  and  is,  therefore,  the  great  inlet  of  knowledge.  It  has,  of 
course,  the  several  modifications  which  appertain  to  specific  sensibil- 
ity (§  199,  200) ;  consisting,  indeed,  of  five  apparently  different  func- 
tions. The  expanded  nerves  of  sense,  which  are  the  organs  of  this 
function,  it  is  supei-fluous  to  say,  are  supplied  with  auxiliary  means, 
such  as  the  various  appendages  to  the  retina,  to  the  auditory  nerve, 
&c.  A  close  analogy  exists  among  the  whole,  and  they  may  be 
brought  more  or  less  to  the  aid  of  each  other.  Although  a  common 
function,  its  remarkable  modifications  are  shown  by  their  uses,  respect- 
ively, and  by  the  necessity  of  certain  specific  stimuli  to  each.  As 
with  common  sensation,  the  specific  kind  requires  the  aid  of  percep- 
tion. The  rationale  of  the  entire  function  is  far  more  wonderful  and 
incomprehensible  than  that  of  sympathetic  sensation  and  its  various 
results  which  terminate  in  the  influence  of  the  nervous  power  on  or- 
ganic actions,  and  for  which  the  grossest  doctrines  in  chemistry  and 
physics  have  been  substituted,  because  the  vital  interpretation  is  "  in- 
conceivable," or  cannot  be  subjected  to  the  ci'itical  inspection  of  that 
far  more  obscure,  but  acknowledged,  causation  in  the  chain  of  per- 
ception, specific  sensation  (§  222-237).  What  can  task  the  under- 
standing more  than  the  step  in  the  process  of  intellection  as  connected 
with  the  functions  of  sense ;  beginning  with  light  and  its  properties, 
or  wdth  the  odor  which  none  but  the  dog  can  discern,  or  the  abstrac- 
tions that  convey  to  the  mind  all  the  varieties  in  taste,  or  the  modified 
undulations  of  air  which  render  so  distinct  from  each  other  all  the 
gradations  of  sound,  from  the  ^olian  harp  to  the  braying  of  a  jack- 
ass ;  the  impressions  of  each  upon  the  extremities  of  the  nerves  of 
sense,  one  alone  upon  the  eye,  another  alone  upon  the  nose,  and  an- 
other upon  the  ear  alone  ;  the  transmission  of  these  impressions  along 
the  trunks  of  the  nerves  to  their  other  extremities  in  the  brain,  and  in 
each  of  the  cases  through  the  aid  of  some  special  mechanism  ;  theii 
excitement  of  the  brain  and  the  co-operation  of  the  mind,  by  which 
the  nature  of  the  primary  impression  is  discerned,  and  the  external 
objects  realized  by  the  inward  immaterial  agent  according  to  their 
real  material  existence  (§  188|,  d,  500,  nn)1 

450,  J".  The  common  hypotheses  which  have  been  propounded  to 
explain  specific  sensation,  such  as  the  motion  of  a  nervous  fluid,  gal- 
vanism, vibration  of  the  nerves,  the  passage  of  light,  of  undulations  of 
air,  &c.,  to  the  brain,  betray  a  general  disposition  to  avoid  the  phe- 
nomena of  life  for  those  which  are  manifested  by  inanimate  objects. 
But,  of  this  I  have  already  had  enough  (§  189,  234-237). 

451,  a.  The  action  of  material  objects  upon  the  mind  through  the 
function  of  sensation,  and  the  astonishing  influences  of  mental  emo- 
tions upon  irritability  (§  188,  a),  and  of  the  will  in  acts  of  voluntary 
motion  ^  227,  1st,  233),  bring  the  laws  of  organization  and  those  of 
the  immaterial  mind  and  instinct  into  harmonious  relation  ;  while  the 


282  INSTITUTES    OF    MEDICINE. 

nature  of  mind  and  the  impressions  it  receives  illustrate  the  character 
of  the  vital  properties  (§  450  e,  and  Medical  and  Physiological  Com- 
mentaries, vol.  i.,  p.  92-102). 

451,  b.  Impressions  upon  the  brain  through  the  medium  of  specific 
sensation  leave  no  transcript;  and  perception  of  objects  without  sen- 
sation, as  in  reveries  and  dreams,  has  led  to  a  denial  of  the  material- 
ity of  the  world ;  supported,  too,  by  far  gi-eater  ingenuity  than  those 
objections  to  a  vital  principle  which  are  regardless  of  all  its  unique 
phenomena. 

451,  c.  It  has  been  seen  that  pei'ception  is  necessary  to  sensation, 
in  the  usual  acceptation  of  this  function,  which  is  essentially  mental. 
This  term,  however,  is  employed  to  represent  the  cerebro-spinal  im- 
pressions which  give  rise  to  involuntary  motions,  whether  in  animal  or 
organic  life ;  and  "  feeling"  is  used  by  Mr,  Hunter,  and  others,  to  de- 
note the  susceptibility  of  organs  to  the  existing  condition  of  each  oth- 
er, by  which  their  concerted  action  is  maintained  through  the  medium 
of  the  nervous  system.  It  is  obvious,  however,  that  the  mind  takes  no 
cognizance  of  those  impressions  which  result  in  involuntary  motions; 
no  pei'ception,  no  act  of  the  will,  is  excited,  so  far  as  it  respects  the 
direct  results.  And,  although  there  be  an  analogy  between  all  the 
influences  of  sensation  in  animal  life,  it  reaches  least  to  the  move- 
ments which  spring  from  the  nervous  system  in  organic  life,  since  the 
impressions  made  upon  the  brain  through  specific  sensation  never  af- 
fect the  organic  actions  ;  while  there  is  a  perfect  idenlity  of  effect  be- 
tween those  impressions  which  give  rise  to  involuntary  movements  in 
animal  and  organic  life.* 

451,  d.  As  the  term  sensation,  therefore,  has  a  very  different  import 
in  the  different  cases ;  and  as  in  one  the  transmitted  impressions  ter- 
minate in  exciting  an  act  of  the  mind,  while  in  the  other  no  such  act 
is  called  into  operation ;  but  differently,  also,  from  the  former  case,  the 
nervous  power  is  excited  in  the  nervous  centres  and  then  reflected 
with  the  effect  of  a  vital  agent  upon  all  other  parts  (§  226) ;  and  since, 
also,  the  impressions  through  specific  sensation  must  be  exerted  upon 
the  brain,  while  in  the  latter  case  the  results  may  be  equally  pro- 
nounced whether  the  impressions  be  made  exclusively  upon  the  brain 
or  on  the  spinal  cord  or  organic  nerve,  I  have  made  a  third  distinction 
in  sensibility  to  separate  its  office  in  the  function  of  sympathy  from  its 
province  as  described  under  the  varieties  of  common  and  specific 
sensibility,  and  to  avoid  the  confusion  which  has  hitherto  prevailed 
by  an  indiscriminate  use  of  the  term  sensation  (§  194,  199^,  201,  204, 
453,  523,  1037  h). 

451,  e.  This  third  distinction  in  sensibility  I  have  called  sympa- 
thetic sensibility  (§  201) ;  and  this  conducts  me  to  a  third  distinction 
in  the  corresponding  function,  and  which  should  be  known  by  the 
same  epithet  (§  464-467,  473  c,  no.  5,  474,  no.  4). 

The  epithet  sympathetic  denotes  the  special  function  of  sympathetic 
sensation,  which  has  been  suflSciently  described  in  the  preceding  sec- 
tion, and  in  what  has  been  said  of  sympathetic  sensibility  (§  201-204). 

451, y*.  The  considerations  made  in  §  450,  e,  illustrate  the  vital  phi- 
losophy of  sympathetic  sensation  as  one  of  the  functions  concerned  in 
the  transmission  of  impressions  from  one  part  to  another  through  the 
medium  of  the  nervous  centres,  and  in  which  the  nervous  power  is 
the  agent  by  which  the  reflected  impressions  are  exerted  (§  222,  &c.). 

*  If  specific  or  common  sensation  affect  organic  actions,  it  is  through  some  mental  emo< 
tion  which  it  excites.     The  mind  is  the  efficient  cause,  p.  77-79,  note. 


PHYSIOLOGY. FUNCTIONS.  283 

The  fads  in  the  former  case  bear  with  the  strongest  force  of  analogy 
in  demonstrating  the  entire  absence  of  all  chemical  agencies  in  the 
phenomena  of  the  nervous  power.  The  alliance  of  the  whole,  through- 
out the  mental  and  physical  results  of  specific  sensation,  places  the 
whole  upon  common  ground  in  respect  to  principle  ;  and  if  it  be  true 
that  nervous  agency  in  one  case  is  chemical,  it  is  equally  so  in  all,  and 
equally  so  with  perception  itself  (§  188^,  d).  Other  demonstrations 
to  the  same  effect  will  be  presented  in  another  section  (§  500,  nn). 

2.    SYMPATHY,  OR  REFLEX  ACTION  OF  THE  NERVOUS  SYSTEM. 

452,  a.  I  now  enter  upon  the  consideration  of  a  function  which  be 
longs  not  only  to  animal  life,  but  has  far  greater  and  more  important 
relations  to  the  organic  life  of  animals.  Althouo^h  it  have  no  existence 
in  the  ves:etable  kingdom,  where  its  anatomical  medium  is  also  want- 
mg,  it  does  not  bestow  those  sti-iking  distinctions  in  the  organic  life 
of  the  two  animated  departments  of  nature  which  the  importance  of 
the  function,  and  the  presence  of  the  nervous  system,  in  the  animal 
economy,  would  denote.  The  organic  actions  are  essentially  alike  in 
both,  conducted  in  both  by  common  properties  appertaining  Icf  the 
various  tissues  and  organs,  and  only  influenced  in  animals  by  reflex 
and  direct  action  of  the  nervous  power  as  a  vital  agent  (§  185). 

452,  h.  Nevertheless,  it  is  a  function  of  wonderful  characteristics,  and 
can  be  appreciated  only  by  an  extensive  investigation  of  its  endless  vari- 
ety of  phenomena.  And  yet  is  this  function  extensively  ridiculed  by 
enlightened  men  ;  and  even  Miiller,  who  has  written  more  luminously 
upon  its  laws  than  any  other  observer,  applies  them  only  in  certain 
natural  processes,  considers  the  nervous  power  the  actual  cause  of 
motion,  construes  the  function  of  absorption  according  to  the  physical 
rationale,  defends  the  hypothesis  of  endosmose  and  exosmose  in  ex- 
tenso,  interprets  all  the  secreted  products  upon  chemical  principles, 
expounds  diseases  by  the  humoral  pathology,  and  recognizes  no  ther- 
apeutical influences  of  medicine  but  through  its  absorption  into  the 
circulation.  For  all  this  he  was  well  commended  by  the  British  and 
Foreign  Medical  Review,  while  the  same  critical  survey  of  that  re- 
markable work  on  Physiology  stamped  its  displeasure  upon  those 
doctrines  of  life  which  render  the  work  a  proud  monument  of  the  age. 

Again,  no  one  has  employed  his  knowledge  of  the  laws  of  sympa- 
thy more  usefully  than  Bichat.  "  The  word,"  he  says,  "is  of  but  little 
consequence,  provided  what  it  expresses  is  understood."  And  yet, 
while  he  also  affirms  that  "  we  know  the  principle  exists,"  he  also 
says,  that  the  "  word  is  only  a  veil  for  our  ignorance  in  respect  to  the 
relations  of  the  organs  to  each  other"  (§  234). 

452,  c.  Sympathy  is  the  most  important  function  which  is  peculiar 
to  animals  ;  since  upon  it  depend,  very  greatly,  the  right  performance 
of  the  organic  functions,  and  a  vast  range  of  pathological  conditions, 
and  the  greatest  amount  of  therapeutical  influences.  It  also  over- 
throws the  venerable  doctrines  in  humoralism,  in  all  their  contempla- 
tions of  vitiated  blood,  morbid  lentor,  "living  putrefaction,"  and  of 
those  conformable  therapeutical  means  which  were  invented  under 
the  significant  names  of  incisives,  deobstruents,  inviscants,  incrassants, 
diluents,  attenuants,  astringents,  relaxants,  refrigerants,  &c. 

453.  Sympathy  has  been  commonly  reputed  as  one  of  the  proper- 
ties peculiar  to  animals ;  but  it  is  not  only  a  function,  but  one  of  great 


284  INSTITUTES    OF    MEDICINE. 

complexity,  since  it  involves  the   united  operation  of  sensibility  and 
the  nervous  power.     The  result  of  that  concerted  action  is  sympathy, 
or  reflex  nervous  action.     This  is  the  established  acceptation  ;  but  the 
nervous  influence  often  operates  through  motor  nerves  alone,  as  in  men- 
tal and  physical  excitements  of  the  nervous  centres ;  and  hence,  in  part, 
my  preservation  of  the  generic  term  sympathy  (§  638^). 
In  the  farther  prosecution  of  this  subject,  I  shall  consider, 
I.  The  general  uses  of  the  nervous  systems. 
11.  The  different  orders  of  nerves  (§  462,  &c.). 
III.  Exp.  to  determine  the  Laws  of  the  Vital  Functions  (§  476,  &c.). 
rV.  The  varieties  or  kinds  of  sympathy  (§  495,  &c.). 
V.  The  laws  of  sympathy,  and  their  application  to  pathology  and 
therapeutics;  the  latter  being  peculiar  to  myself  (p.  912). 

I.    OF   THE    GENERAL    USES    OF   THE    NERVOUS    SYSTEMS. 

454,  a.  The  phenomena  of  the  nervous  systems  (the  cerebro-spinal 
and  ganglionic),  in  their  connection  with  organic  processes,  forcibly 
declare  how  broad  is  the  gulf  between  the  properties  and  laws  of  dead 
and  living  beings,  and  how  vast,  magnificent,  and  profound  is  the  sci- 
ence of  life  in  its  vai'ied  aspects  of  health  and  disease. 

454,  h.  The  nervous  system  having  no  existence  in  plants  has  given 
rise  to  the  fundamental  distinction  of  "animal  and  organic  life"  (§  96— 
123),  although  in  animals  it  belongs  to  both  lives. 

454,  c.  The  cerebro-spinal  system  appertains  particularly  to  the  organs 
of  animal  life,  though  it  contributes  largely  to  the  organic  viscera  (§  Hi- 
ll?, 224,  233|,  356  a,  409  Z;,  461,  478  h,  4881  493  cc,  647^  893^). 

The  ganglionic  system  is  universally  appropriated  to  the  organs  of 
organic  life,  and  pervades  every  part  of  the  animal ;  since  organic  ac- 
tions are  carried  on  as  well  in  the  organs  of  animal  life  as  in  the  organ- 
ic viscera,  and  require  the  influences  of  this  system  (§  115). 

455,  a.  The  great  final  cause  of  the  brain  is  to  subserve  the  intel- 
lectual powers  in  man,  and  instinct  in  the  lower  animals  (§  241,  454  J, 
500  p).  But  reason  and  instinct  would  avail  but  little  were  their  op- 
erations circumscribed  by  the  limits  of  their  organ.  Hence  the  brain 
is  prolonged  into  nerves,  and  various  connections  are  thus  established 
with  all  parts  of  the  body,  and  with  the  external  world.  Admirable 
as  is  this  Design  of  associating  in  harmonious  action  the  immaterial 
with  the  material  parts,  it  would  still  be  defective,  and  the  economy 
of  nature  obviously  violated,  were  not  an  organ  so  prominent  in  the 
animal  mechanism  rendered  subservient  to  the  great  purposes  on  which 
its  existence  depends.  Therefore  that  other  system,  the  ganglionic, 
has  been  established,  with  intimate  connections  with  the  cerebro-spinal, 
through  which  they  co-operate  together,  especially  after  independent 
life  begins.  Nevertheless,  the  essential  influences  in  organic  life  de- 
volve mostly  upon  the  ganglionic  system,  whose  principal  otfices,  besides 
that  of  combining  the  organic  functions  (§  113),  consist  in  so  modifying 
the  functions  as  to  variously  affect  the  secretions  in  their  quantity  and 
quality  (the  organic  in  their  vital  constitution),  and  in  supplying  the 
stimulus  of  nei"vous  influence  to  the  muscular  tissue  in  organic  life 
(§  224,  356  fl,  422,  461,  461^,  473  c,  475i,  483  c,  4881,  500  g,  m, 
524  d,  no.  7,  889  g,  892|,  893  a,  c,  893i,  902  ff). 

455,  b.  It  appears,  therefore,  that  one  of  the  great  secondary  uses 
of  the  cerebral  system  is  that  of  co-operating  with  the  ganglionic  in 


PHYSIOLOGY. FUNCTIONS.  2®l 

establishing  a  circle  of  sympathies  among  the  organs  of  organic  life 
and  preserving  the  whole  in  that  harmony  of  action  that  is  indispensa- 
ble to  the  life  of  complex  animals. 

455,  c.  Thus  we  learn  that  the  various  parts  of  the  organic  mechan 
ism  of  animals  are  not  only  indispensable  to  each  other,  but  that  a  cer 
tain  established  influence  of  one  upon  the  other  is  necessary  to  each, 
and  that  the  functions  of  the  whole  may  be  fatally  deranged,  eithei 
directly,  by  causes  that  may  inteiTupt  the  common  chain  by  which  the 
relations  are  established,  or  indirectly,  as  by  a  blow  on  the  stomach, 
or  by  poisons  acting  upon  some  part  of  the  intestinal  mucous  tissue, 
or  by  withdrawing  some  particular  organ  from  the  symmetrical  whole 
(§  109,  129). 

455,  d.  Whatever,  indeed,  may  affect  the  powers  and  embarrass  the 
functions  of  the  cerebro-spinal  system,  will  more  or  less  disturb  this  con- 
cert of  action,  may  modify  the  functions  of  every  part,  and  may  derange 
the  whole  series  of  vital  phenomena.  The  nature  of  the  disturbances 
will  depend  entirely  upon  the  nature  of  the  impressions  produced  upon 
the  nervous  systems,  as  well  as  upon  the  rapidity  and  violence  with 
which  the  impressions  are  made.  Direct  injuries  do  it  in  one  way, 
and  according  to  their  nature  and  extent.  Morbific,  or  other  causes, 
acting  upon  other  parts,  affect  the  nei-vous  centres,  and  consequently 
give  rise  to  remote  derangements,  in  other  ways,  according  to  theii 
nature,  and  the  violence  with  which  they  operate.  Medicines  do  the 
same  thing,  and  according  to  their  nature,  their  dose,  and  according 
to  the  nature  of  the  part,  as  well  as  the  existing  state  of  the  part  to 
which  they  are  applied,  or  that  of  other  parts  upon  which  they  may 
act  sympathetically.  Intricate  reflex  nervous  actions,  in  all  these 
cases,  are  liable  to  spring  up,  and  that,  too,  in  rapid  succession  (§  222- 
233|,  &c.). 

455,  e.  The  same  laws,  precisely,  are  concerned  throughout.  We 
do  not,  however,  witness  the  display  of  reflex  nervous  actions  in  health 
as  in  disease,  or  as  when  remedial  agents  operate ;  since,  in  the  nat- 
ural state  of  the  body,  the  nervous  influence  is  more  or  less  in  equilib- 
rio  ;  operating  uniformly  and  equally  on  all  the  organic  viscera,  and 
thus  maintaining:  amonoc  them  one  concerted,  harmonious  action.  But 
this  power  being  constituted  with  the  greatest  sensitiveness  to  the  va- 
rious conditions  of  all  parts,  that  it  may  transmit  the  existing  condition 
of  each  one  to  the  whole  (as  strikingly  seen  in  the  almost  instant  inter- 
change of  function  between  the  kidneys  and  skin,  on  the  contact  of 
cold  air,  &c.,  §  422),  it  necessarily  happens  that  when  the  state  of  any 
one  part  is  varied  from  its  natural  standard,  that  part  will  transmit  an 
unnatural  influence  to  the  brain  and  spinal  cord,  will  develop  the  ner- 
vous power  in  an  unnatural  manner,  and  thus  produce  disturbances  in 
other  parts  (§  350,  no.  19).  The  alterative  influences,  therefore,  of 
morbific  and  remedial  agents  necessarily  result  from  the  natural  phys- 
iological laws  of  the  nervous  system  in  connection  with  the  instability 
of  the  organic  properties,  nor  can  it  be  otherwise.  The  principle  is 
absolutely  ingrafted  upon  the  constitution  of  animals. 

A5o,f.  I  say,  therefore,  that  when  unusual  causes  operate,  whether 
upon  the  nerv'ous  centres  or  upon  remote  parts,  they  necessarily  de- 
velop the  nerv'ous  power  in  greater  intensity  than  it  exists  in  health  ; 
when  it  is  reflected  abroad  upon  various  organs,  and  with  the  greatest 
variety  of  effect.     The  parts  upon  which  it  may  fall  will  depend  upon 


286  INSTITUTES    OP    MEDICINE. 

their  existing  susceptibility  and  the  nature  of  the  remote  causes;  and 
the  nature  of  the  effects  produced  will  depend  greatly  upon  the  par- 
ticular virtues  of  the  morbific  or  remedial  agents ;  for  it  is  also  an  im- 
portant law  that  the  nervous  power  itself  will  be  altered  according  to 
the  particular  nature  of  the  impression  which  may  be  produced  upon 
the  part  on  which  the  agent  may  exert  its  direct  effect  (§  222,  &c.). 

455,  g.  The  actions  which  are  thus  influenced  through  the  connect- 
ing medium  of  the  nerves  are  not  alone  the  great  general  functions  of 
organs,  such  as  digestion,  the  action  of  the  heart,  &c.,  but,  also,  those  of 
their  minute  constitutional  organization.  Here  it  is,  indeed,  that  mor- 
bific and  remedial  agents  exert  their  principal  effects  (§  483,  &c.). 

456,  a.  In  the  ordinary  rhythm  of  the  organic  system,  however,  the 
capillary  and  extreme  vessels  are  not  as  dependent  on  the  nervous 
influence  for  the  precision  of  their  functions,  as  the  complex  organs 
(§  455,  e).    It  is  greatly  with  these  vessels  as  with  the  analogous  ones 
in  plants.    They  have  an  independent  function  in  each  particular  part, 
the  performance  of  which  does  not  require  so  much  a  harmonizing  nerv- 
ous influence  as  in  the  collective  sense.     Herein  also  is  seen  a  reason  of 
the  absence  of  a  nervous  system  in  plants,  while  it  is  more  or  less  neces- 
sary to  animals.     The  vessels  go  up  continuously  from  the  roots  to  the 
leaves,  and  continuously  back  again,  and  there  are  only  vessels ;  no 
complex  organs.     Each  part  of  a  plant  has  within  itself  an  organiza- 
tion adequate,  or  nearly  so,  to  its  independent  existence.     It  is  other- 
wise, however,  with  animals.     Here,  other  essential  parts  are  superad- 
ded to  the  simpler  mechanism,  are  made  dependent  on  each  other,  and 
a  certain  correspondence  of  action  rendered  necessary  to  the  integrity 
of  the  whole.     For  the  fulfillment  of  these  ends  the  nervous  system  is 
also  superadded,  with  its  wonderful  attribute,  the  nervous  power,  that 
a  perpetual  change  of  influences  shall  be  maintained  among  the  great 
organic  viscera,  while  it  is  also   made  instrumental  in  exciting  and 
modifying  the  organic  functions  of  every  part,  and  thus  also  afi'ecting 
the  nature  of  the  products  (§  226,  232,  399,  446  a,  461,  473  c,  483  c, 
485,  489,  512,  746  c,  846,  889  g,  902,  952). 

456,  h.  Hence  it  is  that  slight  influences  upon  the  nervous  centres 
will  determine  the  nervous  power,  with  a  very  manifest  effect,  upon  the 
capillary  and  extreme  vessels,  as  seen  in  blushing,  and  in  the  experi- 
ments by  Philip  (§  227,  477,  &c.)  ;  and  coming  to  the  ordinary  opera- 
tion of  disease,  and  of  morbific  and  remedial  agents,  we  have  constant 
demonstrations  of  the  great  susceptibility  of  these  vessels  to  the  action 
of  the  nervous  power,  and  of  strong  reciprocal  sympathies  among  them, 
and  of  consequent  changes  in  the  products  (§  394,  1040). 

457.  One  of  the  most  sticking  peculiarities  of  the  ganglionic  system 
is  that  of  its  not  transmitting  the  influences  of  the  will  to  the  organs 
which  it  supplies,  notwithstanding  it  is  so  intimately  combined  with  the 
cerebro-spinal  nerves ;  while,  on  the  other  hand,  the  passions  operate 
more  powerfully  through  the  ganglionic  than  through  the  cerebro-spinal 
nerves  (§  476  c,  500  e). 

This  fact  shows  us  at  once  that  the  sympathetic  system  must  have 
certain  special  functions ;  and  when  we  trace  out  its  anatomical  con- 
stitution, and  its  distribution  to  the  essential  parts  of  organic  life,  we 
perceive  that  one  special  ofiice  must  be  that  of  maintaining  a  harmony 
of  actions  among  these  parts ;  and  experimental  observation  confirms 
this  induction.     Consequently,  from  the  exquisitely  delicate  nature  of 


PHYSIOLOGY. FUNCTIONS.  287 

this  high  office  the  nerve  is  rendered  intensely  susceptible,  and  from 
the  intimate  manner  in  which  it  pervades  the  organic  tissues  it  ia 
made  to  exercise  a  profound  and  somewhat  governing  influence  upon 
their  organic  actions  (§  456  &,  1040). 

458.  The  relations  of  the  cerebro-spinal  and  ganglionic  systems  to 
each  other,  their  special  or  mutual  functions,  and  those  of  individual 
nerves,  all  having  their  distinct  individuality,  yet  all  more  or  less  re- 
lated and  concurring  in  harmony,  and  for  important  purposes  in  ani- 
mal and  organic  life,  supply  the  most  complex  and  astonishing  in 
stances  of  Design  to  be  found  in  nature  ;  and  their  natural  attributes, 
existing  under  the  most  absolute  laws,  afford  a  ready  interpretation  of 
the  endless  phenomena  of  reflex  actions,  as  the  result  of  disease, 
or  of  morbific  or  remedial  agents. 

459,  a.  All  parts  of  the  nervous  centres  are  not  only  more  or  less 
mutually  connected  in  function,  but  all  parts  of  the  nervous  system 
are  subordinate  to  the  brain.  There  are  no  distinct,  separate,  and 
independent  influences,  of  an  involuntary  nature,  exerted  by  any 
parts  of  the  nervous  centres  in  their  state  of  integrity.  They  all  con- 
cur more  or  less  together.  This  is  experimentally  demonstrable,  as 
well  as  denoted  by  the  natural  phenomena.  If,  therefore,  it  should 
appear  from  experiments  upon  the  spinal  cord,  for  example,  while 
connected  with  the  brain,  through  any  remaining  communications, 
that  the  influences  are  determined  by  the  cord  alone,  we  may  be  as- 
sured that  the  brain  has  participated  (§  201,  473,  481,  Exp.  15). 

459,  h.  I  have  said  in  my  Essay  on  Bloodletting  (in  Med.  and 
Phys.  Comm.),  that  the  injuries  which  are  inflicted  on  the  spinal  cord, 
to  determine  the  specific  functions  which  have  been  assigned  to  it, 
are  so  severely  propagated  to  the  brain,  and  may  so  affect  the  prop- 
erties of  that  organ,  that  the  results  which  appear  to  flow  from  the 
spinal  cord  may  be  actually  due  to  the  cerebral  influence,  or  to  an  in- 
terruption ©f  that  influence  when  the  spinal  cord  is  divided  or  de- 
stroyed. Both  principles,  in  the  latter  case,  may  act  in  co-operation ; 
the  cerebral  influence  being  determined  through  the  superior  nerves 
and  the  ganglionic  system,  and  otherwise  impressed  by  a  reflected 
influence  from  below  that  part  of  the  spinal  cord,  where  its  direct 
connection  with  the  brain  is  interrupted  (§  481,  Exp.  12,  15). 

While,  therefore,  the  brain  remains,  experiments  upon  the  spinal 
cord  are  entitled  to  much  less  confidence  than  those  wliich  are  made 
upon  the  brain.  But  even  when  the  brain  is  removed,  the  vital  prop- 
erties of  all  parts  become  so  profoundly  modified  in  consequence,  that 
we  can  scarcely  infer  with  accuracy  the  specific  functions  of  the  spinal 
cord  fi'om  subsequent  experiments  (§  477,  &c.). 

459,  c.  The  late  experiments  by  Dr.  Stilling,  with  strychnia  applied 
to  the  spinal  cord,  are  entirely  consistent  in  their  results  with  the  fore- 
going remarks  (J).  From  these  experiments  he  supposes  that  the 
spinal  cord  is  greatly  independent  of  the  brain,  and  that  when  divided 
in  numerous  places,  each  portion  is  capable  of  the  same  influences 
upon  the  parts  it  may  supply,  as  when  the  whole  cord  is  in  its  natural 
state.  Thus,  when  the  small  portion  connected  with  the  fore-legs  is 
separated  from  the  rest  of  the  cord  by  two  incisions,  and  strychnia  is 
applied  to  this  isolated  part,  the  legs  will  be  convulsed.  Still,  how- 
ever, there  are  remaining  and  important  communications  of  this  ap- 
parently isolated  part  with  the  head,  and  with  all  other  parts  of  the 


288  INSTITUTES    OF    MEDICINE. 

spinal  cord,  which  will  forever  embarrass  these  critical  inquiries,  un- 
less there  be  a  removal  of  the  brain  (§  473  a,  no.  2,  473  c,  494  d,  514  e). 
459,  d.  "  The  experiments  of  M.  Le  Gallois,"  says  Wilson  Philip, 
"  prove,  in  the  most  satisfactory  manner,  that  a  principal  function  of 
the  spinal  marrow  is  to  excite  the  muscles  of  voluntary  motion,  and 
that  it  can  perform  this  office  independently  of  the  brain,  as  after  the 
removal  of  the  brain.  Yet  we  constantly  see  injuries  of  the  brain  im- 
pairing the  functions  of  the  spinal  maiTow.  Of  this  apparent  incon- 
sistency, M.  Le  Gallois  justly  remarks,  that  two  facts,  well  ascertain- 
ed, however  inconsistent  they  may  seem,  do  not  overturn  each  other, 
but  only  prove  the  imperfection  of  our  knowledge." 

Now,  in  the  foregoing  case,  there  is  no  difficulty  in  reconciling  the 
facts  by  the  interpretation  which  I  have  given  to  tlie  action  of  the  will 
and  of  the  nervous  power.  The  will  operates  as  an  exciting  cause  to 
the  nervous  power,  which  then  determines  voluntary  motion.  But, 
the  motions  are  never  voluntary  after  the  removal  of  the  brain ;  but 
the  nervous  power  pervades  the  whole  system  of  motor  nerves,  and 
when  stimuli  are  applied  to  the  spinal  cord  after  removing  the  brain, 
the  nervous  power  becomes  an  exciting  cause  of  involuntary  motions 
(§  226,  473,  500). 

459,  e.  Every  principal  part  of  the  nervous  system  has  a  certain 
special  office  which  is  exercised  in  conjunction  with  the  whole.  "  The 
cerebrum  does  not  act  like  the  cerebellum,  nor  the  cerebellum  like 
the  medulla  oblongata,  nor  the  medulla  oblongata  like  the  spinal  cord 
and  nerves.  In  the  cerebral  lobes  resides  the  faculty  by  which  the 
animal  thinks,  wills,  recollects,  judges,  becomes  conscious  of  sensa- 
tions, and  commands  its  movements.  From  the  cerebellum  is  derived 
the  faculty  which  co-ordinates  the  movements  of  locomotion  ;  from  the 
tubercula  bigemina  or  quadrigemina,  the  primordial  principle  of  the 
action  of  the  optic  nerve  and  retina ;  from  the  medulla  oblongata,  the 
motor  or  exciting  principle  of  the  respiratory  movements ;  and,  lastly, 
from  the  spinal  cord,  itself,  the  faculty  of  blending  or  associating  into 
combined  movements  the  partial  contractions  immediately  excited  by 
the  nerves  in  the  muscles  of  animal  life." 

459, yi  Enough,  however,  is  known  to  show  us,  that  when  the  cere- 
bro-spinal  and  sympathetic  systems  exist  as  a  whole  and  unimpaired, 
they  act  more  or  less  as  a  whole  ;  but  that  different  parts  have  certain 
peculiarities  of  function,  and  that  when  injuries  befall  any  part  of 
these  great  systems,  a  portion  of  the  whole  may  perform  certain  cir- 
cumscribed functions,  at  least  for  a  limited  time,  and  often,  perhaps, 
as  perfectly  as  the  whole  apparatus  in  its  stajte  of  integrity  (§  201, 
515,  516  d,  no.  8).  _ 

Impressions,  as  I  have  said,  when  transmitted  through  sympathetic 
sensibility,  may  be  received  either  by  the  brain,  spinal  cord,  or  certain 
parts  of  the  ganglionic  system ;  and  either  connectedly  or  independ- 
ently. But,  in  the  natural  state  of  the  nervous  system,  all  such  im- 
pressions, when  received  especially  by  an  individual  part,  are  doubt- 
less propagated  to  the  other  parts,  and  institute  that  harmonious  con- 
currence in  all  the  parts  which  renders  the  whole  nervous  system  in- 
strumental in  determining  the  ultimate  phenomena.  This  is  even 
true  of  so  local  a  phenomenon  as  the  contraction  of  the  sphincter  mus- 
cles, however  that  contraction  may  be  maintained  after  destruction  of 
the  brain  and  of  the  superior  parts  of  the  spinal  cord  (§  461^,  a).    Th«se 


PHYSIOLOGY.^ — FUNCTIONS.  289 

conclusions  are  warranted  in  experiment,  and  by  all  that  is  known  of 
the  dependence  of  the  harmonious  relations  of  organs  upon  the  presiding 
influence  of  the  nervous  system.  There  must  be  harmony  there  as  a 
fundamental  requisite  (§  129). 

459.  g.  In  the  application  which  I  have  made  of  the  nervous  power, 
in  the  present  and  in  my  former  works,  to  the  theory  of  disease  and 
to  the  modus  operandi  of  remedial  agents,  it  is  important  to  regard 
the  whole  nervous  system  in  its  unimpaired  relations  to  its  own  and  to 
other  parts. 

460.  No  experiments  upon  the  sympathetic  nerve  can  show  that  it 
is  more  than  tributary  to  the  organic  processes;  for- the  moment  any 
unusual  impressions  are  made  upon  it,  the  nervous  influence  is  unnatu- 
rally excited,  and  determined  with  more  or  less  violence  upon  the  or- 
ganic properties,  and  thus  deranges  the  functions. 

461.  It  is  an  assumption  to  say  that  the  nerves  are  the  generating 
sources  of  the  secreted  products,  however  certain  it  may  be  that  they 
influence  the  organic  processes  and  their  results.  If  the  products  are 
altered  by  impressions  made  upon  the  brain  or  nerves,  it  is  because  the 
nervous  influence  is  preternaturally  determined,  as  a  morbific  agent, 
upon  the  organic  viscera,  and  because  the  nervous  influence  exerts 
naturally  a  modifying  effect  upon  the  products  of  organic  actions.  A 
division  of  the  pneumogastric  or  of  any  other  nerve  may  have  all  the 
effect  of  a  morbific  agent,  producing  congestion  and  inflammation ;  the 
very  division  of  the  nerve  determining  a  shock  of  the  nervous  power 
upon  the  organic  properties  of  the  part  to  which  the  nerve  is  distrib- 
uted. But,  in  the  instance  of  dividing  the  pneumogastric  nerve  the 
gastric  juice  and  the  pulmonary  mucus  are  secreted  in  preternatural 
abundance.  Digestion,  however,  becomes  at  once  greatly  impaired ; 
but  even  that  may  be  more  or  less  restored  by  rousing  the  nervous  in- 
fluence in  the  divided  portion  of  nerve  leading  to  the  stomach  by  means 
of  galvanism,  or  other  irritants  applied  to  the  nerve,  thus  perfecting  the 
juice  (§  226,  409  k,  446  a,  c,  489,  493  cc). 

461-2^,  a.  The  brain  and  spinal  cord  are  not  necessary  to  the  organic 
life  of  the  foetus,  not  even  to  the  action  of  the  sphincter  muscles ;  since 
both  have  been  wanting  in  the  full-grown  human  fcetus  (§  459/).  In 
the  foetal  case  reported  by  Dr.  Clark  in  the  London  Philosojyhical  Trans- 
actions (1793,  p.  154),  in  which  it  is  said  that  there  Avas  no  trace  of 
nerves,  it  cannot  be  doubted  that  the  sympathetic  existed,  since  the 
laws  in  respect  to  the  organic  compounds  of  animals  are  as  applicable 
to  such  a  monster  as  to  the  perfect  being,  and  since  also  these  com- 
pounds in  the  latter  case  are  imbued  with  special  vital  conditions 
through  influences  of  the  sympathetic  nerve  upon  the  secreting  ves- 
sels. The  sphincter  ani,  the  heart,  «&;c.  requii'e  the  stimulus  ;  feut  there 
was  no  anus  in  the  above  case  (§  409  h,  473  c,  483  c,  488|,  493  c,  d). 

461^,  h.  Hence  it  appears  that  the  sympathetic  nerve  is,  to  a  certain 
extent,  independent  of  the  brain  and  spinal  cord,  and  the  relations  of 
the  latter  to  the  former  become  most  important  after  independent  life 
begins  (§  224,  473  c,  483  c). 

461^,  c.  In  brief,  then,  the  influences  of  the  cerebro-spinal  and  sym- 
pathetic systems  are  more  or  less  reciprocal  in  organic  life.  And, 
although  sympathies  may  be  combined  by  the  ganglia  of  the  sympa- 
thetic nerve,  as  in  contiguous  sympathy  (§  497),  this  nerve  transmits 
the  impressions  it  receives  to  the  brain  and  spinal  cord  in  the  same 

T 


290  INSTITUTES    OF    MEDICINE. 

way  as  the  cerebral  and  spinal  nerves,  and  influences  are  propagated 
from  the  cerebro-spinal  axis  upon  either  system  of  nerves,  and  the  or- 
gans they  supply,  in  a  like  manner  (^  111-117,  227-230,  455,  893). 

11.    OF    THE    DIFFERENT    ORDERS    OF    NERVES. 

462.  Corresponding  with  the  two  important  functions  of  the  brain 
and  spinal  coi'd,  those  of  receiving  impressions  fi'om  external  objects, 
and  of  generating  the  nervous  power,  are  two  orders  of  nerves ; 
whose  distinct  characteristics  were  first  pointed  out  by  Sir  Charles 
Bell.  It  is  the  office  of  one  of  these  orders  of  nerves  to  transmit  the 
impressions  to  the  nervous  centres,  and  of  tlie  other  to  serve  as  a  me- 
dium for  the  exercise  of  the  nervous  power  upon  all  parts  of  the 
body.  This  combined  function  establishes  the  more  complex  one  of 
sympathy,  or  reflex  nervous  action. 

463,  a.  The  foregoing  anatomical  discovery  only  establishes  what 
was  before  known  of  the  laws  of  sympathy  by  accurate  observers  of 
nature.  The  general  attributen  of  sympathy  were  understood  by 
Hippocrates,  and  were  at  the  foundation  of  no  small  part  of  his  med- 
ical philosophy  and  practical  habits.  From  the  origin  of  medicine  to 
the  present  time  the  subject  has  engaged  the  attention  of  the  medi 
cal  world.  Its  impoitant  outlines  were  originally  drawn  from  the  vi 
tal  phenomena  alone.  We  learn  from  Plato,  a  cotemporary  of  Hip- 
pocrates, that  the  general  doctrine  of  sympathy,  in  its  application  to 
the  cure  of  disease,  was  considered  fundamental  by  physicians.  Thus: 
"  Occulorum  morbosos  affectus  sanari  non  posse,  nisi  prius  curetur 
caput,  neque  caput  nisi  prius  curetur  corpus,  neque  coi'pus  sine  ani- 
mo,  aiebat  medicus  quidem  apud  Platonem."     Galen  writes  of  it. 

463.  1).  When  the  nervous  system  became  understood,  this  knowl- 
edge aided  greatly  an  analysis  of  the  laws  of  sympathy.  "  Glisson, 
in  1677,  speaks  of  an  influence  being  '■reflected^  from  one  nerve  at  its 
origin  upon  other  nerves,  so  as  to  cause  consensual  movements." 
Unzer,  in  1771,  was  close  upon  Bell's  discovery,  and  Whytt  and 
Monro  also  earned  on  the  inquiry  in  conformity  with  the  designs  of 
structure.  In  1784,  Prochasca  established  the  theory  of  reflex  action 
of  the  nervous  system.  This  great  theory  has  been  recently  analyzed 
and  reduced  to  a  system  of  magnificent  laws  by  Professor  Miiller,  to 
which  Dr.  Hall  and  others  have  also  made  some  contributions. 

464.  But,  the  present  century  contributes  to  medicine  a  discovery 
which  lays  open  the  precise  mechanism  that  subserves  the  laws  of 
sympathy.  It  consists,  essentially,  in  having  demonstrated  the  two 
orders  of  nerves  (§  462).  With  this  mechanism,  in  its  connection 
with  the  phenomena  of  sympathy,  we  move  forward  with  unerring 
certainty  to  the  exposition  of  principles  and  laws  which  are  as  pecu- 
liar to  organic  beings  as  their  structure  and  results,  and  as  determinate 
as  the  mechanism  is  replete  with  consummate  Design. 

465.  The  posterior  roots  of  the  spinal  nerves,  which  have  a  gang- 
lion upon  them,  denote  the  part  appropriated  to  sensation,  or  to  such 
impressions  as  may  be  transmitted  from  the  periphery  to  the  centre. 
The  anterior  roots,  which  are  without  a  ganglion,  exercise  the  motor 
function,  and  that  range  of  influences  upon  which  all  the  immediate 
and  important  results  of  sympathy  depend  (§  226,  &c.).  The  fibres 
of  these  roots  are  gathered  into  bundles,  forming  the  nerves,  and  are 
thus  distributed  to  various  well-known  parts;  and  what  is  of  the  high 


PHVSIOLOGY. FUNCTIONS  291 

esL  moment  in  organic  life,  and  mainly  important  to  the  purposes  ot 
these  Institutes,  these  nerves  contribute  to  the  great  sympathetic  (§ 
111-117,  129,  500  e-m,  514  c,  d,  515,  520,  891^^,  k,  893  a,  c,  1037  b). 

466.  The  motor  and  sensitive  fibres  of  a  common  nerve  do  not 
unite,  but  are  even  distributed  separately  in  the  organs  w^hich  they 
supply.*  They  have,  therefore,  no  action  upon  each  other  except 
through  the  nervous  centi-es.     The  phenomena,  at  least,  declare  it. 

467.  All  the  late  anatomical  investigations  of  the  spinal  cord  by 
Stilling,  Van  Deen,  Budge,  and  others,  go  to  confirm  the  foregoing 
conclusions  (§  465,  466).  They  have  also  probably  indicated  the 
anatomical  mediums,  in  the  spinal  cord,  by  which  impressions  are 
conducted  to  the  brain,  and  influences  transmitted  from  that  organ. 
Stilling,  for  instance,  supposes  that  the  longitudinal  fibres  of  the 
posterior  gray  substance  of  the  cord  transmit  the  sensitive  impres- 
sions to  the  brain,  and  that  the  longitudinal  fibres  of  the  anterior 
gray  substance  are  the  medium  through  which  the  will  operates  in 
voluntary  motion. — See  ^  1037  b. 

468.  The  foregoing  discovery  has  led  to  the  knowledge  that  one  of 
the  functions  of  a  nerve  may  be  destroyed  without  impairing  the  oth- 
er. If  the  posterior  root  be  paralyzed  or  divided,  sensation  is  de- 
stroyed, but  not  the  power  of  motion.  So,  on  the  other  hand,  if  the 
anterior  root  be  divided  or  paralyzed,  voluntary  motion  is  destroyed, 
but  not  sensation ;  and,  as  organic  motion  is  independent  of  the  will, 
it  is  only  influenced,  not  destroyed,  by  this  injury  of  nerves  (§  205-208, 
226,  257,  500). — See  later  observations,  ^  1037  b. 

469.  The  two  orders  of  nerves  occur  in  the  great  sympathetic,  and 
appertain,  also,  to  those  nerves  which  proceed  directly  from  the  brain, 
where  they  are  either  compounded,  as  in  the  spinal  nerves,  or  make 
up,  respectively,  distinct  nei-ves  of  sensation  and  motion. 

Those  which  proceed  from  the  brain  are  distributed  into  three 
classes  : 

1st.  "  Nerves  of  special  sense ;  namely,  the  olfactory,  optic,  and 
auditory  nerves. 

2d.  "Mixed  nerves  with  the  double  roots;  the  trigeminus, glosso- 
pharyngeus,  ( 1 )  and  the  par  vagum  with  its  accessory,  and,  in  several 
mammalia,  the  hypoglossus. 

3d.  "  Single-rooted  nerves,  for  the  most  part  of  motor  function, 
which  are  either  themselves  entirely  motor,  and  receive  sensitive 
fibres  from  other  nerves,  or  which,  if  their  roots  contain  sensitive 
fibres,  still  cannot  be  classed  with  the  double-rooted  nerves.  These 
are  the  occulo-motorius,  the  trochlearis,  the  abducens,  and  the  facial 
nerve." — Muller. 

470.  The  nerves  of  the  sympathetic  system  are  exquisitely  endow- 
ed with  that  modification  of  sensibility  which  I  have  denominated 
sympathetic  sensibility  (§  201-203,  451,  &c.).  This  modification  is 
not  less  strongly  pronounced  in  the  sympathetic  system  than  specific 
sensibility  in  the  nerves  appropriated  to  the  organs  of  sense ;  for  it  is 
through  this  medium  that  all  the  organic  viscera  "  feel,"  as  it  were, 
the  condition  of  each  other. 

The  nerves  of  the  ganglionic  system  have  only  an  involuntary  mo- 
tor influence  upon  the  parts  to  which  they  are  distributed. 

"  It  being  shown  that  the  sympathetic  regularly  receives  fasciculi 
of  motor  and  sensitive  fibres  from  the  spinal  nerves,  as  their  motor 

*  This  is  \nferaWe  from  the  phenomena,  and /row  these  the  laws  are  deduced  (I)  131,  990^  c). 


292  INSTITUTES    OF   MEDICINE. 

and  sensitive  roots,  the  existence  of  a  similar  relation  between  it  and 
those  cerebral  nerves  vehich  are  analogous  to  the  spinal  nerves,  in  hav- 
ing double  roots,  becomes  very  probable." — Muller, 

Laws  of  the  Action  of  Motor  Nerves  of  tlie  Cerebrospinal  System. 

471.  1.  "  The  motor  influence  is  propagated  only  in  the  direction 
of  the  nervous  fibres  going  to  the  muscles,  or  in  the  direction  of  the 
ramification  of  the  nerve  ;  and  never  in  a  retrograde  course." 

2.  "  The  application  of  mechanical  or  galvanic  irritation  to  a  part 
of  the  fibres  of  a  nerve  does  not  affect  the  motor  powder  of  the  w^hole 
trunk  of  the  nerve,  but  only  of  the  insulated  portion  to  which  the 
stimulus  is  applied." 

3.  "  A  spinal  nerve  entering  a  plexus,  and  contributing  with  other 
nerves  to  the  formation  of  a  great  nervous  trunk,  does  not  impart  its 
motor  power  to  the  whole  trunk,  but  only  to  the  fibres  which  form  its 
continuation  in  the  branches  of  that  trunk." — Muller. 

Laws  of  iJie  Action  of  Sensitive  Nerves  of  the  Cerehro-spinal  System 

472.  1.  "When  the  trunk  of  a  nerve  is  irritated,  the  sensation  is 
felt  in  all  the  parts  which  receive  branches  from  it.  The  effect  is  the 
same  as  if  all  the  ultimate  ramuscules  had  been  irritated." 

2.  "  The  sensation  produced  by  irritation  of  a  branch  of  a  nerve  is 
confined  to  the  part  to  which  the  branch  is  distributed,  and  generally, 
at  least,  does  not  affect  the  branches  which  come  off"  from  the  nerve 
higher  up,  or  from  the  same  plexus." 

3.  "  When,  in  a  part  of  the  body  which  receives  two  nerves  of  sim- 
ilar function,  one  is  paralyzed,  the  other  is  inadequate  to  maintain  the 
sensibility  of  the  entire  part.  On  the  contrary,  the  extent  to  which 
the  sensibility  is  preserved  corresponds  to  the  number  of  the  primi- 
tive fibres  unaffected  by  the  lesion." 

4.  "  When  different  parts  of  the  thickness  of  the  same  nerve  are 
separately  subjected  to  irritation,  the  same  sensations  are  produced 
as  if  the  diffei-ent  terminal  branches  of  these  parts  of  the  nerve  had 
been  irritated."  The  sensations,  however,  are  greatly  less  in  the  for- 
mer instance  (§  826,  d). 

5.  "  The  sensations  excited  in  the  minute  elementary  fibres  are  trans- 
mitted from  the  surface  of  the  brain,  without  being  communicated  to 
the  other  fibrils  of  the  same  nervous  trunk." — Muller. 

The  foregoing  laws  are  relative  to  specific  sensations,  and  are  more 
or  less  applicable  to  sympathetic  sensation  (§  450,  451). 

Of  the  Spinal  Cord. 

473.  a.  1.  "In  a  physiological  point  of  view,  the  spinal  cord  so  far 
agrees  with  the  nerves  that  it  propagates  actions  of  the  nerves,  which 
enter  it,  to  the  brain,  just  as  the  cerebral  nerves  communicate  impres- 
sions made  on  them  immediately  to  the  sensorium  commune ;  and 
that  it  communicates  the  influence  of  the  brain  to  the  nerves  arising 
from  itj  which  thus  receive,  through  the  medium  of  it,  the  cerebral 
influence,  just  as  if  they  arose  from  the  brain  itself.  In  other  respects, 
however,  the  spinal  cord  diffei's  essentially  from  the  nerves  in  possess- 
ing properties  which  belong  to  it  as  a  part  of  the  central  organs,  and 
do  not  reside  in  the  nerves  (§  459). 


PHYSIOLOGY. FUNCTIONS.  293 

2.  "All  the  cerebral  nerves  are  immediately  subject  to  the  influ- 
ence of  the  brain,  and  all  the  spinal  nerves  are  subjected  to  the  same 
influence  through  the  medium  of  the  spinal  cord.  As  soon  as  the 
transmission  of  this  influence  is  interrupted,  impressions  on  sensitive 
nerves  cease  to  be  propagated  to  the  sensorium,  and  the  brain  loses 
the  power  of  voluntarily  exciting  the  motor  action  of  the  nen'es  which 
are  withdrawn  from  its  influence.  When  the  communication  of  the 
brain  and  spinal  cord  with  the  nerves  is  interrupted  by  wounds,  pres- 
sure, or  paralysis,  all  the  branches  which  are  given  off  below  Xhe  af- 
fected spot  cease  to  be  voluntarily  excited  by  the  motor  action ;  and 
the  action  of  external  stimuli  on  the  same  parts  produces  no  sensation. 

473,  b.  "  Those  branches,  on  the  contrary,  which  come  off  from 
the  nerve  above  the  point  of  injury  are  still  subject  to  the  influence  of 
the  brain  and  of  volition,  and,  when  irritated,  give  rise  to  sensation." 

473,  c.  "  The  parts  of  a  nerve  below  the  injured  point  presei've, 
however,  their  motor  power  for  a  certain  time.  It  is  merely  the  influ- 
ence of  the  brain  upon  them  that  is  lost.  The  nerve  does  not  lose  its 
excitability  to  external  agents  until  it  has  been  several  months  cut  off 
from  intei'course  with  the  brain"  (§  459  c,  461). 

In  organic  life  impressions  may  still  be  propagated  to  and  from  the 
brain  upon  parts  situated  below  the  point  of  interruption,  through  the 
sympathetic  nerve,  and  although  there  be  no  other  medium  of  com- 
munication than  by  the  connection  of  the  sympathetic  nerve  with  the 
blood-vessels.  This  is  an  important  consideration  in  forming  conclu- 
sions from  certain  experiments  upon  the  nerves,  with  a  view,  in  part, 
to  ascertain  the  modus  operandi  of  morbific  and  remedial  agents  in 
their  action  upon  organs  distinct  from  each  other. 

3.  "  In  man  and  the  higher  animals  the  spinal  cord  stands  in  the 
same  relafion  as  all  the  cerebral  nerves  to  the  brain.  It  is  to  be  re- 
garded as  the  common  trunk  of  the  nerves  of  the  body ;  although  it  is, 
besides  this,  distinguished  by  special  properties." 

4.  "  The  fibres  of  the  spinal  cord  pass  through  the  medulla  oblon- 
gata to  reach  the  sensorium  commune.  All  the  primitive  fibres  of  the 
nerves  terminate  in  the  brain ;  those  of  the  cerebral  nerves  immedi- 
ately, those  of  the  spinal  nerves  through  the  medium  of  the  spinal 
cord." 

5.  "  The  spinal  cord  has  the  property  of  reflecting  irritations  of  its 
sensitive  nerves  upon  the  motor  nerves,  but  without  itself  perceiving 
the  sensation"  (§  201-204,  451  d-i51f,  1037  b). 

"  The  spinal  cord,  even  when  separated  from  the  brain,  and  without 
any  external  stimulus,  can  excite  automatic  movements." 

6.  "  The  spinal  cord,  although  capable  of  exciting  the  motor  nerves  to 
automatic  actions,  nevertheless,  in  the  healthy  state,  leaves  a  great 
part  of  the  motor  nerves,  those  supplying  the  muscles  of  locomotion 
more  especially,  in  a  quiescent  state  ;  while  on  others  it  exerts  a  con- 
stant motor  influence  (§  500,  k).  It  thus  maintains  constant  involun- 
tary contractions,  which  are  arrested  only  by  the  spinal  cord  becom- 
ing paralyzed.  The  motions  of  this  kind  are,  1st,  those  of  muscles 
which  are  also  subject  to  the  influence  of  the  will,  as  the  sphincter 
ani ;  2d,  those  of  muscles  not  subject  to  the  influence  of  the  will,  as 
the  sphincter  vesicae  urinariae,  the  muscular  coat  of  the  intestines, 
&c," — MiJLi.ER.    Those  muscles  may  be  aSected  by  the  will  (^  500  e). 

474.  1.  "  The  activity  of  all  the  special  functions  of  the  nerves  in 


294  INSTITUTES    OF    MEDICINE. 

detennined  by  the  central  organs,  partly  under  the  influence  of  tho 
mind,  and  partly  independently  of  this  influence." 

2.  "  The  central  organs  connect  all  the  nerves  into  one  system.  To 
this  even  the  sympathetic  nerves  do  not  form  an  exception." 

3.  "  The  central  organs  are  the  exciters  of  the  motor  nerves  which 
conduct  the  motor  influence  of  the  nervous  principle  to  the  muscles. 
This  motor  influence  may  be  constant,  as  we  see  in  the  case  of  the 
sphincters ;  secondly,  it  may  be  evidenced  in  intermittent  rhythmic 
movements,  such  as  those  of  respiration  ;  and,  thirdly,  the  motor  influ- 
ence may  issue  voluntarily  from  the  sc7isorium  commune  (the  part  oi 
the  brain  on  which  the  mind  acts)  to  the  central  organs ;  this  senso- 
rium  commune  being  subject  to  the  spontaneous  actions  of  the  mind. 

"  The  motor  nerves  are  affected  by  this  motor  influence  in  two  ways. 
First,  the  nerves  of  one  class  act  as  mere  conductors  of  it.  In  their 
normal  state  they  do  not  exert  this  power  spontaneously,  but  only  when 
excited  by  the  central  organs.  These  are  the  motor  nerves  of  the  ce- 
rebro-spinal  system. 

"  Secondly,  the  nerves  of  the  other  class,  which  are  quite  withdrawn 
from  the  influence  of  the  sensorium  commune,  as  far  as  regards  vol- 
untary actions  [not  the  passions],  are  likewise  capable  of  being  excited 
to  constant  oxiA.  pei-iodical  action  by  the  central  organs.  But  they  pre- 
sent the  peculiarity  of  affording  independent  discharges  of  the  nervous 
influence ;  although,  after  a  time,  communication  with  the  central  or- 
gans is  found  to  be  necessary  for  the  production  of  the  nervous  power. 
Such  ai'e  the  sympathetic  nerves  with  regard  to  their  motor  actions." 

The  first  of  the  foregoing  varieties  of  motor  influence  is  the  exciting 
cause  of  voluntary  motion.  By  the  second  I  interpret,  mostly,  the 
operation  of  morbific  and  remedial  agents  upon  parts  not  immediately 
connected  with  the  direct  seat  of  their  action,  and  the  phenomena  of 
sympathetic  diseases,  and  other  sympathetic  results  among  separate 
parts. — See  Bights  of  Authors  p.  912. 

The  former  part  of  the  next  following  law,  and  §  473  c,  no.  5,  have 
led  me  to  distinguish  the  third  kind  of  sensibility  and  sensation,  which 
T  have  denominated  sympathetic  (§  201-204,  451).     Thus : 

4.  "  Impressions  conveyed  by  the  sensitive  nerves  to  the  central  or- 
gans are  either  reflected  by  them  upon  the  origin  of  the  motor  nerves, 
without  giving  rise  to  true  sensations,  or  are  conducted  to  the  sensori- 
um, the  seat  of  consciousness." 

5.  "  The  nervous  influence  is  g-enerated  in  the  central  orrans." 
This  as  not  universally  true,  since  "  The  maintenance  of  tJic  excitability 
in  the  nerves  docs  not,  Jioicever,  depend  solely  on  the  continuance  of  the 
influence  of  the  central  organs  on  them.,  hut  also  upon  their  own  activ- 
ity ^ MULLER. 

It  is  Still  a  problem  whether  the  "  activity"  of  the  nerves  here  spo- 
ken of  be  not  equivalent  to  a  partial  production  of  the  nervous  power. 
There  are  many  facts  which  appear  to  denote  a  low  degree  of  this 
office  (§  224,  461,  497). 

475.  It  remains  now  to  say,  under  the  present  section,  that  it  is  im- 
portant that  the  hypothetical  words  motor  and  sensitive,  and  senso-mo- 
tory,  do  not  betray  us  into  the  belief  that  the  nerves  are  the  causes  Oa 
motion,  or  that  there  is  any  sensation  connected  with  the  organic  phe- 
nomena of  sympathy  (§  201-215,  257,  222-233,  451).  The  term  "  ex- 
cito-motory'"  is  far  preferable  to  motor  ;  and  se7isitive  it  might  be  diffi- 
cult to  improve      The  term  reflex  involves  profound  philosophy. 


PHYSIOLOGY, — FUNCTIONS.  295 

475i.  Although  the  nervous  power  is  the  only  immediate  exciting 
cause  of  voluntary  motion  (§  258),  the  mind  is  a  I'emoter  cause  (and 
therefore  a  substantive  agent),  and  so  far  voluntary  motion  is  on  com- 
mon ground  with  motions  in  organic  life,  where,  for  example,  the  blood 
is  the  remote  exciting  cause  for  the  heart  and  blood-vessels,  food  for  the 
intestine,  acting  upon  their  lining  tissues  (§  136),  while  the  nervous 
power,  by  reflected  action,  is  the  stimulus  for  the  muscular  tissue  in 
natural  states.  But  all  muscles  may  be  made  to  act  by  other  stimuli  (§ 
243-246,  476  c,  498  e,  500  m,  o,  514/,  647^,  1042).— Note  A. 

III.    Experiments  to  determine  the  Laws  of  the  Vital  Func- 
tions. 

1st.   On  the  Principle  on  wliicli  the  Action  of  the  Heart  and  Vessels  oj 
Circulation  depend. 

476,  a.  I  now  come  to  certain  important  experiments  by  different 
observers,  especially  by  Dr.  A.  P.  Wilson  Philip,  as  contained  in  his 
work  on  the  Laws  of  the  Vital  Functions.  It  was  the  main  object  of 
those  experiments  to  demonstrate  the  independence  of  organic  func- 
tions of  the  nervous  system ;  to  show  that  those  functions  arise  from 
the  organic  properties  (§  183,  &c.)  ;  and  they  are  perfectly  triumph- 
ant. They  have  been  often  repeated,  and  their  results  as  often  veri- 
fied. It  may,  therefore,  be  thought  that  a  simple  reference  to  those 
results  would  answer  the  objects  of  the  present  work.  But,  an  age  of 
materialism  requires  a  constant  appeal  to  the  senses,  as  the  only  recog- 
nized mode  of  reaching  the  understanding  (§  234,  350J  k) ;  and,  I  have 
in  view  not  only  the  great  original  objects  of  those  experiments,  but 
what  is  still  more  practically  important,  and  peculiar  to  myself,  the 
application  of  the  laws  of  the  nervous  system  which  they  illustrate 
to  the  operation  of  morbific  and  remedial  agents,  having  especially  em- 
ployed them  for  the  last  purpose  to  demonstrate  the  philosophy  of  the 
operation  of  loss  of  blood,  in  the  Medical  and  Physiological  Commen- 
taries., vol.  i.,  p.  161-173,  &c.  The  experiments  show  us  how  it  is 
that  morbific  or  remedial  agents,  when  applied  to  a  part,  may  develop 
and  modify  the  nervous  power,  and  reflect  it  with  various  effect  upon 
other  parts  (§  226).  They  also  place  all  the  processes  of  living  beings 
upon  purely  vital  grounds ;  even  the  vegetable  kingdom,  by  the  force 
of  an  incontrovertible  analogy  (^  1041. — Also,  Rights  of  Authors). 

476,  h.  Prior  to  the  time  of  Haller,  the  nervous  power  was  consid- 
ered, in  one  way  or  another,  as  indispensable  to  the  motions  of  the 
heart,  and  the  brain  was  the  seat  to  which  the  power  was  referred. 
Whytt  had  just  before  laid  the  foundation  for  rejecting  the  supposed 
necessity  of  the  nervous  system  to  organic  life.  Haller  then  took  up 
the  inquiry,  and  carried  it  forward  by  a  multitude  of  experiments,  and 
overthrew  the  doctrine  of  the  necessity  of  the  nervous  system  to  or- 
ganic actions  (§  167).  The  experiments  of  Philip  confirm  those  of 
Haller,  while,  also,  they  are  more  conclusive.  But  he  is  entitled  to 
the  greater  credit  of  demonstrating,  experimentally,  that  organic  ac- 
tions are  influenced  by  the  nervous  power,  although  it  was  clearly 
known  to  Whytt,  Haller,  and  Prochasca,  that  such  an  influence  ob- 
tains ;  while  Haller,  like  Philip,  separates  it  entirely  from  the  natu- 
ral relations  of  the  nervous  system  to  the  organic  functions.  Pro- 
chasca, also,  had  ascertained,  near  the  close  of  the  last  century,  about 
all  that  is  now  more  distinctly  known  of  the  doctrine  of  reflex  nervous 


296  INSTITUTES    OF    MEDICINE. 

action,  or  remote  sympathy ;  but  the  nature  of  the  principle,  and  the 
remarkable  distinction  in  the  constitution  of  the  anatomical  medium, 
were  not  shown  till  demonstrated  by  the  experiments  of  Bell  and 
Philip  (§  462-469).  Hunter,  reasoning  upon  the  natural  phenomena 
of  healthy  and  morbid  conditions,  contributed  largely  to  the  inquiry 
Bichat  followed  immediately  after,  and  pointed  out  the  natural  distinc- 
tion of  the  two  lives,  analyzed  the  tissues  (§  86-88,  96-101),  and  de- 
veloped, more  than  his  predecessors,  the  nature  of  the  vital  proper- 
ties, and  construed  all  the  phenomena  of  life,  healthy  and  morbid,  by 
the  normal  and  abnormal  states  of  the  properties  of  life. 

476,  c.  It  has  been  a  question  of  difficult  solution,  how  the  pas- 
sions should  affect  so  sensibly  the  actions  of  the  heart,  while  the 
will  has  no  influence  upon  this  organ.  And  so  of  all  other  or- 
ganic viscera.  This  problem  I  have  explained  by  showing  that 
the  will  is  a  distinct  element  of  the  mind,  as  the  passions  are  equally 
distinct.  One  determines  the  nervous  power  upon  the  voluntary 
organs,  the  other  upon  the  involuntary ;  each  having  their  great, 
specific,  final  causes  (§  188^  d,  205-208,  226,  233,481  ^>,  486,  487,7i, 
492,  no.  7,  500  d-k,  951).  In  the  latter  respect,  the  passions  are 
exactly  analogous  to  the  influence  of  morbific  or  other  foreign 
agents  that  may  operate  either  directly  or  indirectly  upon  the  brain ; 
being,  like  those  agents,  capable  of  modifying  the  nervous  influence 
in  its  relation  to  the  actions  of  organic  life,  while  the  will  is  incapable 
of  such  modifying  effect  upon  the  nervous  influence  in  its  relation  to 
the  actions  of  animal  life  (§  226-228,  233,  500  d-k).  The  principle 
depends  greatly  upon  the  fact  that  the  will  limits  the  nervous  influence 
to  cerebro-spinal  nerves  (except  §  500  dd,  e),  while  mental  emotions  act 
chiefly  through  the  sympathetic  (§  500  5r,893  a,c,  893-^,  1067, 1072  &).* 

476^,  a.  The  researches  of  Le  Gallois  upon  the  influence  of  the 
medulla  oblongata  and  the  spinal  cord  on  organic  actions  led  immedi- 
ately to  those  by  Wilson  Philip,  and  others  who  embarked  in  the  same 
inquiry.  Le  Gallois  very  happily  analyzed  the  relations  of  the  me 
dulla  oblongata  to  the  respiratory  function,  and  the  various  move- 
ments of  the  process,  and  showed  that  it  was  the  most  mortal  part  of 
the  body,  by  its  immediate  control  over  that  function.  The  subse- 
quent discoveries  of  Sir  Charles  Bell  as  to  the  sensitive  and  motor 
nerves  have  shown,  also,  that  it  is  in  the  medulla  oblongata  that  the 
nervous  respiratory  influences  have  their  centre. 

4765,  b.  Le  Gallois'  experiments  upon  the  spinal  cord,  and  his  in- 
ductions from  them,  and  as  sanctioned  by  others,  are  remarkable  ex- 
emplifications of  the  fallacies  to  which  results,  artificially  obtained, 
may  conduct  us,  and  supply  a  forcible  illustration  of  the  propensity  of 
the  mind  to  grasp  at  a  single  fact,  and  to  draw  important  conclusions 
from  it,  to  the  exclusion  of  all  others,  however  contradictory.  It  is 
mainly,  however,  as  to  the  supposed  dependence  of  the  functions  of 
the  heart,  intestines,  and  other  organic  viscera,  upon  the  spinal  cord, 
that  these  errors  relate.  A  general  summary  of  the  observations  will 
aid  the  inquirer  after  the  philosophy  of  this  subject.  I  am  the  more 
induced  to  present  this  outline  from  the  misapprehensions  which  con- 
tinue to  surround  the  subject,  even  in  the  ranks  of  the  most  erudite 
physiologists.  Thus,  Dr.  Marshall  Hall,  in  his  late  Memoir  on  the 
Nervous  System{\  841), inculcates  the  following  doctrines :  "TAe  s}n- 
nal  riKirroio,^''  says  Dr.  WaW,'-'- exclusive  of  the  cerebrum.,  is  the  source 
*  Also  my  work  on  the  Soul  and  Lnstinctive  Pkinciple,  edition  1870. 


PHYSIOLOGY. FUNCTIONS.  297 

of  animal  hfe?' — "  The  irritability  of  the  muscles  of  organic  life  de- 
pends, prohahhj,  on  the  ganglionic  system"  (§  188-193.  Also,  my  Es- 
say on  the  Modus  Operandi  of  Remedies,  p.  42,  in  Med.  and  Phys 
Com?n.,  vol.  iii.). — '^  1041. 

476^,  c.  Such  were  the  results  of  the  experiments,  and  such  their 
novelty,  that,  having  led  their  author  to  the  conclusion  that  the  func- 
tions of  the  heart,  and  other  organic  viscera,  depend  upon  the  nervous 
power  of  the  spinal  cord,  the  doctrine  was  received  with  eclat  by  the 
French  Institute,  and,  indeed,  by  all  Europe,  in  defiance  of  the  well- 
known  fact  that  foetuses  have  been  born  alive  without  brain  and  spi- 
nal cord,  that  the  heart  will  palpitate  for  hours  after  its  removal  from 
the  body,  that  the  intestines  will  roll  about  upon  the  table,  when  air 
and  injuries,  not  the  nervous  power,  are  exciting  causes.  They  sim- 
ply took,  as  the  ground  of  their  conclusion,  the  safety  of  excision  of 
the  brain,  or  of  its  removal  from  the  cranium,  contrasted  with  the  de- 
structive effects  of  crushing  the  spinal  cord  (§  456,  461^  a,  490,  498  e). 

4761,  d.  The  foregoing  conclusion  was  inferi-ed  from  the  interrup- 
tion of  circulation  by  destroying  the  spinal  cord  by  a  wire  thrust  down 
the  spinal  column.  The  action  of  the  heart,  however,  was  not  wholly 
arrested;  but  it  failed  to  circulate  the  blood  in  the  large  arteries. 
This  was  supposed  to  be  owing  to  a  privation  of  the  nervous  power, 
by  which  the  heart  became  enfeebled.  Le  Gallois  also  supposed  that 
the  actions  of  the  heart  were  irregularly  performed,  which  was  also 
an  error. 

Next,  he  destroyed  only  small  portions  of  the  spinal  cord,  and  the 
results  led  to  the  conclusion  that  it  is  not  from  the  whole  spinal  cord 
that  every  part  of  the  body  derives  its  organic  life,  but  from  that  part 
of  it  only  from  which  the  nerves  are  supplied.  And,  although  this 
philosophy  is  wrong,  the  conclusion  is  right,  that  in  destroying  any 
particular  part  of  the  spinal  cord,  we  only  impair  life  in  those  parts  of 
the  body  which  con-espond  to  that  part  (§  507-510). 

476|,  c.  Now,  although  rabbits  twenty-two  days  old  have  no  diffi 
culty  in  living  for  some  time  after  the  head  is  cut  off,  yet  the  fact  was 
ascertained  that  the  destruction  only  of  the  spinal  cord  destroyed  life, 
at  that  age,  in  less  than  four  minutes  ;  respiration  ceasing  first.  This 
experiment,  especially,  led  to  the  belief  that  the  principle  of  life  upon 
which  the  heart  depends  resides  in  the  spinal  cord. 

Le  Gallois  next  ascertained  that  the  destruction  of  either  the  dor- 
sal or  cervical  portion  of  the  spinal  cord  was  fatal  to  rabbits  of  the 
foregoing  age,  even  in  a  shorter  time  than  that  of  the  lumbar  portion; 
that'is,  in  about  two  minutes.  The  results,  however,  as  to  time,  va- 
ried at  different  ages  ;  and  death  took  place  soonest  in  parts  that  were 
opposite  to  the  portion  of  the  cord  destroyed. 

Now  this  sudden  abolition  of  life,  from  a  partial  destruction  of  the 
spinal  cord,  was  imputed  by  Le  Gallois  to  the  loss  or  extinction  of  the 
circulation ;  and  this,  regarded  as  a  remote  result,  was  in  part  true. 
But,  as  will  have  been  seen,  the  immediate  and  essential  effect  con- 
sisted in  the  destruction  of  the  organic  properties  of  the  heart  and 
blood-vessels,  by  determining  upon  them,  and  all  other  parts  em- 
braced within  the  compass  of  experiment,  a  pernicious  nervous  influ- 
ence by  the  sudden  destruction  of  the  spinal  cord  (§  226,  227,  510) 
It  also  appeared  to  follow  (and  such  was  the  conclusion),  that  the 
power,  on  whicli  the  motion  of  the  heart  depends,  resides  in  the  whola 


298  INSTITUTES    OF    MEDICINE. 

of  the  spinal  marrow;  since  the  destruction  of  either  ce."vical,  dorsal,  or 
lumbar  portion,  arrested  the  circulation.  But  here,  again,  we  see  the 
error  of  the  conclusion ;  since  a  fatal  nervous  influence  would  be 
equally  propagated  upon  the  heart,  not  only  through  the  continuous 
parts  of  the  spinal  cord  and  brain,  but  through  the  sympathetic  nerve, 
by  destroying  any  one  of  the  three  portions  of  the  cord,  and  this,  too, 
without  the  bsart  being  intrinsically  dependent  for  its  motions  upon 
any  part  jf  the  spinal  marrow  (§  458,  459). 

476^, y!  Such,  however,  was  the  effect  of  the  foregoing  influence 
upon  the  powers  of  the  heart ;  and,  as  the  blood-vessels  are,  also,  pros- 
trated in  their  action  by  the  same  cause,  it  is  obvious,  if  the  extent 
over  which  the  blood  circulates  be  lessened  in  proportion  as  the  heart 
is  enfeebled,  the  circulation  will  be  prolonged  in  parts  coiTesponding 
with  the  portions  of  the  spinal  cord  that  are  not  destroyed.  It  is  only 
necessary,  therefore,  to  apply  ligatures  around  the  principal  arteries, 
to  answer  the  intention.  Hence,  rabbits  live  much  longer  if  the  aorta 
be  tied  near  its  emersion  from  the  diaphragm,  before  destroying  the 
respective  parts  of  the  spinal  cord.  By  the  same  rule,  also,  if  the 
head  be  cut  off",  before  destroying  the  cervical  portion  of  the  spinal 
marrow,  life  is  supported  much  longer  than  when  the  head  is  on. 

476^,^.  It  appears,  therefore,  that  death  resulted  in  Le  Gallois' 
experiments  partly  from  the  propagation  of  the  nervous  power  upon 
the  vital  properties,  not  only  of  the  heart,  but  of  all  the  organic  vis- 
cera, and  in  part,  also,  by  withdrawing  the  regulating  medium  of 
concerted  actions,  and  thus  deranging  the  organic  relations  (§  129, 
455,  510). 

476|,  h.  Le  Gallois  found,  to  his  surprise,  and  beyond  his  explana- 
tion, that  if  the  spinal  cord  be  slowly  destroyed,  the  effects  were  great- 
ly different  from  such  as  resulted  from  its  sudden  destruction  ;  that  is 
to  say,  the  circulation  was  at  once  arrested  when  the  cord  was  sud- 
denly destroyed,  but  not  so  when  gradually  destroyed.  This  fact,  in 
itself,  is  subversive  of  his  principal  conclusions ;  and  the  difference  in 
results  depends  upon  the  greater  violence  of  the  nervous  power  when 
suddenly,  than  when  more  slowly  excited  (§  479).  This  is  also  shown 
in  paroxysms  of  joy  and  anger.  These  passions  may  kill  on  the  in- 
stant, if  suddenly  excited,  but  never  when  gradually  produced,  what- 
ever their  ultimate  intensity  (§  230).  So  a  blow  upon  the  region  of 
the  stomach,  which  shall  not  exceed  in  force  ten  pounds,  may  destroy 
life  instantly,  when  a  weight  of  one  hundred  pounds,  gradually  ap- 
plied, may  be  wholly  innoxious  (§  509).  This  is  a  very  important  law 
of  the  nervous  influence,  as  it  is  in  constant  operation  in  the  produc- 
tion and  cure  of  diseases,  whether  the  effects  depend  upon  physical  or 
mental  causes.  It  is  owing  to  the  suddenness  with  which  the  nervous 
power  is  developed,  that  syncope  may  be  occasioned  by  a  very  small 
loss  of  blood  (§  940,  961,  974),  or  when  it  proceeds  from  offensive 
sights,  nauseous  odors,  or  any  mental  emotion  (§  944).  It  is  owing 
to  the  same  principle,  in  part,  that  blisters  often  give  more  relief  when 
they  operate  rapidly  than  slowly.  It  is  an  especial  reason  why  emet- 
ics are  often  so  suddenly  curative  in  croup,  &;c. ;  all  having  their  as 
tonishing  foundation  in  a  common  principle  (^  893  i,  902  ^). 

477,  a.  I  now  approach  the  important  experiments  which  overthrovc 
Le  Gallois',  and  all  the  conclusions  which  were  so  extensively  de- 
rived from  them  as  to  organic  actions,  and  through  which,  in  part,  I 


PHYSIOLOGY. FUNCTIONS.  293 

interpret  all  the  laws  of  remote  sympathy,  all  the  effects  of  moroinc 
and  remedial  agents  upon  distant  parts  when  applied  to  the  stomach, 
or  skin,  or  lungs,  &c.;  of  the  remote  influences  of  disease,  and  all  the 
effects  of  the  passions;  of  blows  upon  the  epigastrium,  and  the  sud- 
denly pernicious  influences  of  surgical  operations  ;  in  short,  every  un- 
usual phenomenon  which  can  be  supposed  to  happen  through  the 
agency  of  the  nervous  power.  It  will  be  seen,  also,  that  they  coiTob- 
orate,  and  are  corroborated  by,  all  the  conclusions  which  I  shall  have 
drawn  as  to  the  nervous  power,  and  its  laws  of  reflex  nervous  action, 
from  the  phenomena  of  natural  and  morbid  conditions,  and  from  the 
discoveries  in  relation  to  the  two  orders  of  nerves  (§  464).* 

Unless  otherwise  stated,  the  experiments  are  by  Philip.  A  large 
number  are  omitted,  as  unnecessary  to  my  purposes. 

477,  b.  Experiment  1.  "  A  rabbit  was  deprived  of  sensation  and 
voluntary  motion  by  a  blow  on  the  occiput.  Respiration  ceased,  but 
was  kept  up  artificially.  The  spinal  marrow  was  then  laid  bare  from 
the  occiput  to  the  dorsal  vertebree.  The  chest  was  next  opened,  and 
the  heart  was  found  beating  with  considerable  force.  The  whole 
cervical  portion  of  the  spinal  marrow  was  then  removed,  and  without 
affecting  the  action  of  the  heart.  The  skull  was  then  opened,  and  the 
whole  brain  removed,  so  that  no  part  of  the  central  organs  remained 
above  the  vertebree.  There  was,  however,  no  abatement  of  the  ac- 
tion of  the  heart.  By  suspending  artificial  respiration,  however, 
about  an  hour  and  a  half  after  the  removal  of  the  brain,  the  heart 
ceased  to  beat;  but  its  action  was  again  restored  on  renewing  the 
respiration;  that  is,  on  receiving  oxygenated  blood. 

Exp.  2.  "  Having  rendered  a  rabbit  insensible  by  a  blow  on  the 
occiput,  Philip  destroyed  the  whole  spinal  marrow  by  a  hot  wire. 
Respiration  was  supported  artificially,  and,  on  dividing  the  carotid  ar- 
tery, the  blood  spouted  out. 

Exp.  3.  "A  rabbit  was  rendered  insensible  by  a  blow  on  the  occiput, 
and  artificial  respiration  performed.  The  spinal  maiTow,  from  the 
base  of  the  skull  to  the  beginning  of  the  dorsal  vertebraj,  was  removed, 
and  the  remaining  part  of  it  was  destroyed  by  a  hot  wire.  The  carot- 
id artery  was  then  found  beating,  and,  on  dividing  it,  the  blood  rushed 
out  with  great  force,  ^;er  saltum. 

Exp.  4.  "  In  another  rabbit,  insensibility  was  produced  in  the  forego- 
ing manner,  the  whole  spinal  marrow  removed,  and  artificial  respira- 
tion not  performed.  The  carotid  artery  being  divided,  dark-colored 
blood  flowed  per  saltum.  The  lungs  were  then  inflated,  and  florid 
blood  began  to  spout  out  of  the  artery. 

Exp.  5.  "  In  this  experiment  the  rabbit  was  rendered  insensible,  but 
not  motionless,  by  a  blow  on  the  occiput,  and  natural  breathing  con- 
tinued. The  spinal  cord  was  then  destroyed  by  a  hot  wire.  A  femo- 
ral artery  was  now  opened,  and  the  blood  spouted  out.  Then  the 
other  femoral  artery  was  opened,  from  which  the  blood  flowed  copi- 
ously, and  continued  to  flow  for  seven  minutes  ;  when  one  of  the  cai"ot- 
ids  was  opened,  from  which  blood  issued  in  a  full  stream,  and  till  most 
of  the  blood  was  evacuated. 

Exp.  6.  "  The  brain  of  a  frog  and  the  spinal  marrow,  as  low  as  the 

dorsal  vertebrae,  were  laid  bare.     The  thorax  was  t4ien  opened,  and 

the  heart  found  acting  vigorously.       The  part  of  the  spinal  man'ow 

which  had  been  laid  bare  was  then  removed,  but  without  at  all  affect- 

*  See  Rights  of  Authors  p.  912. 


300  INSTITUTES    OF    MEDICINE. 

ing  either  the  motion  of  the  heart,  or  the  passage  of  blood  through  it 
The  brain  was  then  removed  with  the  same  result. 

Exp.  7.  "  The  brain  and  spinal  maiTow  of  a  frog  were  removed  at 
the  same  time.  On  opening  the  thorax  the  heart  was  found  perform- 
ing the  circulation  freely. 

Exp.  8.  "  A  ligature  was  applied  to  the  neck  of  a  frog,  the  head  cut 
off,  and  the  spinal  marrow  destroyed  by  a  wii-e.  The  circulation  in 
the  web  continued  afterward,  for  many  minutes,  as  vigorous  as  in  that 
of  a  healthy  frog. 

Exp.  9.  "  The  spinal  marrow  and  brain  of  a  frog  were  destroyed  by 
a  wire.  The  animal  appeared  quite  dead  for  several  minutes,  during 
which  the  circulation  was  seen  in  the  web  as  vigorous  as  in  that  of  a 
healthy  frog." 

478,  a.  The  foregoing  and  following  experiments  disprove  the  con- 
clusions derived  from  Le  Gallois',  that  the  power,  on  which  the  motion 
of  the  heart  depends,  resides  in  the  spinal  cord,  and  in  all  parts  of  it. 
They  also  establish,  what  had  been  sufficiently  shown  by  the  heart 
when  severed  from  the  body,  that  its  action  may  be  continued  Avithout 
brain  and  spinal  cord ;  and  the  proof  extends  equally  to  the  blood-ves- 
sels. "  From  various  trials,"  says  Dr.  Philip,  "  we  found  that  the  cir- 
culation ceases  quite  as  soon  without,  as  with  the  destruction  of  the 
spinal  marrow.  Loss  of  blood  seems  to  be  the  chief  cause."  "  The  re- 
sult is  still  more  striking  in  cold-blooded  animals,  in  which  death  takes 
place  so  slowly  that  the  circulation  continues  long  after  the  total  de- 
struction of  the  brain  and  spinal  marrow"  (§  257). 

478,  b.  The  experiments  prove,  what  will  be  more  fully  shown,  that, 
to  influence  the  heart  and  vessels  through  the  main  nervous  centres  an 
impression  must  be  made  cither  upon  the  brain  or  spinal  cord.  But 
the  sympathetic  nerve,  with  its  central  ganglia,  was  present,  by  which 
an  exciting  influence  was  propagated  upon  the  great  organs  and  blood- 
vessels; and  however  the  heart  and  intestines  maybe  maintained  in 
muscular  action  when  severed  from  the  body  (§  264),  the  whole  nerv- 
ous mechanism,  especially  the  ganglionic,  is  engaged,  in  natural  states, 
in  reflecting  exciting  influences  upon  those  organs,  the  blood-vessels, 
(fee,  and  thus,  also,  modifying  the  organic  products  (§  113,  356  a,  399, 
456  a-459  g,  461,  473  c,  475^,  476  c,  483  c,  889  g,  952). *» 

478,  c.  The  experiments  prove,  in  connection  with  others  to  be  re- 
lated of  the  same  nature,  that  the  actions  of  life  are  carried  on  by  pow- 
ers or  properties  inherent  in  each  part  (§  184). 

478,  d.  They  prove  that  Avhen  death  suddenly  follows  a  division  of  the 
medulla  oblongata,  or  a  simple  removal  of  the  brain  and  spinal  cord,  it 
does  so  essentially  by  abolishing  respiration,  or  rather  as  in  §  510. 

479.  A  practical  consideration  of  great  moment  grows  out  of  the 
difference  in  the  modes  in  which  the  foregoing  experiments  weie  per- 
formed by  Philip  and  Le  Gallois,  and'  the  vast  difference  in  the  re- 
sults. The  discrepances  in  results  were  owing  entirely  to  a  difference 
in  the  size  of  the  wires  by  which  the  two  experimenters  destroyed  the 
spinal  cord  ;  Le  Gallois  having  employed  a  wire  that  filled  the  cavity 
of  the  spinal  column,  and  thus  destroyed  the  spinal  cord  suddenly, 
while  Philip  used  a  smaller  wire,  and  destroyed  the  cord  gradually  ; 
or  it  was  removed,  along  with  the  brain,  without  farther  injury  to  them. 
In  Le  Gallois'  experiments,  therefore,  the  nervous  influence  was  sud- 
denly and  powerfully  transmitted  through  all  the  nerves  leading  from 

♦  See  late  Experiments  with  poisons,  Note  B  p.  1113. — 1862. 


PHYSIOLOGY. FUNCTIONS.  301 

the  spinal  cord,  as  well  as  the  sympathetic;  while  in  I'hilip's,  it  was 
BO  gi-adual  and  imperfect,  that  it  was  not  determined  with  destructive 
violence  upon  the  organic  properties  of  the  heart  and  blood-vessels, 
though  always  with  a  more  or  less  prostrating  effect  at  first.  So,  too, 
of  the  sudden  or  gradual  destruction  or  removal  of  the  brain.  What, 
also,  is  thus  true  of  the  heart  and  blood-vessels  (as  will  farther  appear), 
is  equally  so  of  all  the  other  organic  viscera  (§  476|  It,  509,  510,  947). 

2d.  On  the  Relation  which  subsists  between  the  Heart  and  Vessels  of 
Circulation,  and  the  Nervous  System  ;  and  the  Influence  of  the  Ner- 
vous Syste7n  vpon  the  Capillary  Blood-vessels. 

480.  The  following  experiments  are  much  more  important  than  the 
preceding  in  ascertaining  the  existence  of  the  nervous  power,  how  it 
may  be  variously  excited,  how  variously  modified  by  artificial  causes, 
and  how  it  may  be  determined  with  various  effects  upon  the  organic 
functions.  These,  with  another  group  relative  to  the  stomach  and  in- 
testines, open  to  us  the  modus  operandi  of  the  passions  in  organic  life, 
of  morbific  and  remedial  agents  in  their  effects  upon  parts  distant 
from  the  direct  seat  of  their  operation,  of  sudden  deaths  from  injuries 
distant  from  the  nervous  centres,  of  the  sympathies  from  diseases, 
&c. ;  when  taken  in  connection  with  what  is  known  of  the  sensitive 
and  motor  nerves,  and  the  reflections  of  the  nervous  power,  as  set 
forth  in  the  laws  relative  to  this  subject  (§  462-470,  512-524). 

The  object  in  producing  insensibility  was  to  prevent  all  agitation  of 
the  animals,  that  the  effects  of  the  stimuli,  &c.,  might  be  most  advan- 
tageously observed. 

Experiments  relative  to  the  Heart  in  its  Connection  with  the  Nervoui 

System. 

481,  a.  Expcrime7it  10.  A  rabbit  was  deprived  of  sensation  and 
voluntary  motion  by  a  blow  on  the  occiput,  artificial  respiration  per- 
formed, and  the  brain  and  cervical  part  of  the  spinal  marrow  laid  bare. 
The  thorax  was  then  opened,  and  the  heart  observed  to  beat  with 
strength  and  regularity.  Spirit  of  wine  was  then  applied  to  the  spi- 
nal marrow,  and  a  greatly  increased  action  of  the  heart  was  the  con- 
sequence. It  was  afterward  applied  to  the  brain  with  the  same 
effect.  The  increase  of  action  was  immediate  and  decided  in  both 
cases,  and  as  great  in  one  as  in  the  other.  The  effect  of  the  blow 
upon  the  head,  in  all  the  cases,  was  to  lessen  the  frequency  of  the  pul- 
sations ;  as  generally  happens  in  apoplexy. 

Exp.  11.  The  foi'egoing  experiment  was  repeated,  with  the  differ- 
ence, that  the  whole  of  the  spinal  cord  was  laid  bare.  The  motion 
of  the  heart  was  nearly,  if  not  quite,  as  much  influenced  by  the  ap- 
plication of  the  alcohol  to  the  dorsal,  as  to  the  cervical  portion  of  the 
spinal  marrow ;  but  it  was  very  little  influenced  by  its  application  to 
the  lumbar  portion. 

481,  b.  We  see,  therefore,  that  experiments  10  and  11,  independ- 
ently of  the  more  important  ones  which  follow,  illustrate  the  most 
essential  elements  that  are  concerned  in  remote  sympathy,  and  in  the 
operation  of  the  passions  upon  organic  actions,  in  their  connection 
with  what  has  been  said  of  the  sensitive  and  motor  neiTes  and  their 
relations  to  each  other  (§  462-475).  When,  for  instance,  a  morbific 
or  remedial  agent,  applied  to  the  stomach  or  skin,  influences  a  remote 


302  INSTITUTES    Of    MEDICINE. 

part,  and  produces,  or  removes,  disease  in  that  part,  its  primary  im- 
pression is  transmitted  to  the  brain  and  spinal  cord  by  the  sensitive 
nerves,  where  the  impression  acts  upon  the  central  organs  just  as  the 
alcohol  did  in  the  foregoing  experiments,  and,  like  that,  it  develops 
the  nervous  power  which  is  then  reflected  through  the  incident  nerves 
upon  remote  parts,  just  as  it  was  to  the  heart  in  the  application  of  the 
alcohol;  the  incident  nerves  in  organic  life  being  the  sympathetic. 

As  to  the  passions,  they  are  exactly  equivalent  to  the  action  of 
agents  applied  dii-ectly  to  the  brain,  and  develop  and  modify  the  ner- 
vous power  in  the  same  direct  manner.  Such  as  are  exciting  are 
analogous  in  their  effects  to  those  of  alcohol ;  such  as  are  depressing, 
to  those  of  tobacco,  opium,  8cc.  (§  227-230).  From  the  equal  effect 
of  the  alcohol,  also,  when  applied  directly  to  the  spinal  cord,  it  is  evi- 
dent that  the  nervous  power  is  also  generated  in  this  part,  as  it  is, 
more  or  less,  in  all  the  nerves. 

When,  however,  the  nervous  influence  is  developed  by  the  prima- 
ry action  of  alcohol  on  the  stomach,  and  the  action  of  the  heart  is  in- 
creased in  consequence,  the  development  of  the  nervous  influence  is 
reflex  ;  just  as  it  is  in  respiration  (§  500).  But,  in  all  these  cases, 
the  nervous  influence  is  developed  in  the  brain  and  spinal  cord  by 
the  transmitted  impression,  just  as  it  is  by  the  alcohol  when  applied 
directly  to  the  nervous  centres  ;  the  transmitted  impression  being  ex- 
actly equivalent  to  the  direct  action  of  the  physical  agent  upon  the 
central  parts  (§  1074).     There  is  no  absorption  of  alcohol,  p.  172,  no.  94. 

481,  c.  It  is  now  important  to  observe  in  the  relative  experiments 
upon  the  brain  and  spinal  cord,  that  when  they  exist  in  connection, 
the  influence  of  agents  applied  to  the  cord,  in  developing  the  nei'vous 
power,  may  be  mostly  exerted  upon  the  brain  (§  459,  481  e). 

Ejp.  12.  "  Preparation  the  same  as  in  Exp.  10  and  11,  excepting 
only  the  anterior  part  of  the  brain  was  laid  bare.  The  spirit  of  wine 
applied  to  this  part  of  the  brain  produced  as  decided  an  effect  on  the 
motion  of  the  heart  as  in  Exp.  10  and  11.  The  spirit  of  wine  was 
washed  off",  and  a  watery  solution,  fii'st  of  opium,  then  of  tobacco,  was 
applied,  with  the  effect  of  an  increase,  but  of  a  much  less  increase  of 
the  heart's  action,  than  arose  from  the  spirit  of  wine.  The  increased 
action  was  gi'eater  from  the  opium  than  from  the  tobacco.  The  Jirst 
effect  of  both  was  soon  succeeded  hy  a  more  languid  action  of  the  heart 
than  that  which  preceded  their  application  to  the  brain.  This  effect 
was  greatest  and  came  on  soonest  when  the  tobacco  was  used  ;  and 
there  was  always  observed,  for  the  experiment  was  frequently  repeat- 
ed, an  evident  increase  in  the  action  of  the  heart  when  the  tobacco  was 
loashed  off.  This  was  also  seen,  though  in  a  less  degree,  when  the 
opium  was  washed  off".  Little  or  none  of  this  debilitating  effect  was 
observed  when  the  spirit  of  wine  was  used.  After  its  stimulating  ef- 
fect had  subsided,  the  action  of  the  heart  returned  to  only  about  the 
same  degree  as  before  the  application  of  the  stimulus. 

Exp.  13.  "  The  foregoing  experiment  was  repeated  on  an  animal  of 
cold  blood.  In  this  case  a  frog  was  deprived  of  sensibility,  in  less  than 
a  minute,  by  immersing  the  hind  legs  in  the  tincture  of  opium.  Alco- 
hol, and  watery  solutions  of  opium  and  tobacco,  were  applied  to  the 
brain  and  spinal  cord,  as  in  Exp.  12,  and  with  precisely  the  same  ef- 
fects. The  application  and  washing  offoi  the  stimulant  and  sedatives 
were  frequently  repeated  in  this  experiment  with  the  same  results- 


PHYSIOiiOGY. FUNCTIONS.  303 

ft  is  remarkable  that  we  could  affect  the  motion  of  the  heart  by  the 
agents  applied  to  the  brain  and  spinal  marrow  after  they  had  all 
ceased  to  produce  an  effect  on  the  muscles  of  voluntary  motion  through 
the  medium  of  the  nervous  system.  The  action  of  the  heart  could  be 
also  influenced  by  these  agents  applied  to  the  brain  and  spinal  mar- 
row long  after  the  circulation  had  ceased.'''  Of  course,  therefore,  no 
action  by  absorption. 

Exp.  14.  "  This  experiment  only  differed  from  the  last  in  the  cer 
vical  part  of  the  spinal  marrow  and  lower  part  of  the  brain  being  re 
moved,  and  the  agents  applied  only  to  that  part  of  the  brain  which 
lies  between  the  eyes  of  the  frog.  Spirit  of  wine,  opium,  and  tobac- 
co, thus  applied,  affected  the  motion  of  the  heart  quite  as  much,  and 
precisely  in  the  same  way,  as  when  they  were  applied  to  the  entire 
brain  or  spinal  marrow. 

"  The  action  of  the  heart,  in  the  foregoing  experiment,  could  be  in- 
fluenced by  agents  applied  to  the  brain  and  spinal  marrow  long  after 
the  circulation  had  ceased." — Note  B  p.  1113. 

481,  d.  In  Exp.  12,  13,  and  14,  we  have  an  illustration  of  the  mod- 
ification of  the  nervous  power  according  to  the  nature  of  the  agents 
employed,  while  the  effects  correspond  with  such  as  are  produced  by 
the  same  agents  when  taken  into  the  stomach  (§  226,  &c.).  It  will  be 
also  observed  that  the  effects  are  parallel  with  those  of  the  different 
passions ;  those  of  the  alcohol  corresponding  with  the  effects  of  anger 
and  joy,  and  those  of  opium  and  tobacco  with  such  as  arise  from  grief, 
fear,  &c.  I  hold  that  the  doctrine  which  I  have  propounded  as  to 
modifications  of  the  nervous  power  is  established  by  these  experi- 
ments ;  though  abundantly  shown  by  the  phenomena  arising  from 
morbific  and  remedial  agents.  There  is  no  other  intelligible  solution 
of  the  problems  which  they  supply.  In  the  experiments,  too,  it  will 
be  conceded  that  the  nervous  power  was  the  efficient  remote  cause  of 
the  results;  whence  it  follows  that  the  nervous  power  must  be  in  dif- 
ferent states  when  it  is  excited  by  alcohol,  opium,  and  tobacco,  cor- 
responding with  the  differences  in  effects  (Rights  of  Authors,  p.  912). 

481,  e.  The  foregoing  Exp.  12,  13,  and  14,  independently  of  the 
multitude  of  other  facts,  also  completely  refute  the  doctrine  of  the  op- 
eration of  moi'bific  and  remedial  agents  by  absorption.  It  will  be  ob- 
served that  in  these  experiments  the  action  of  the  heart  could  be  influ- 
enced by  the  agents  applied  to  the  brain  and  spinal  cord  "  long  after 
the  circulation  had  ceased."  This  circumstance,  besides  its  bearing 
upon  the  doctrine  of  absorption,  shows  us  how  the  heart  is  roused  into 
action,  in  cases  of  syncope,  by  the  application  of  stimulants  to  the 
nose,  cold  to  the  surface,  &c.  (§  945). 

Exp.  15.  '•'  The  spine  of  a  rabbit  was  divided  near  the  head,  and 
the  spinal  marrow  destroyed  by  means  of  a  wire.  Spirit  of  wine  was 
then  applied  to  the  brain,  which  influenced  the  action  of  the  heart  as 
readily,  and  to  as  great  a  degree,  as  it  does  when  the  spinal  marrow 
is  entire"  (p.  321,  \  494  e,  Exp.— Note  B  p.  1113). 

481,y!  This  experiment  demonstrates  the  difficulty  of  forming  prop- 
er conclusions  as  to  the  special  functions  of  the  brain  and  spinal  cord, 
and  of  different  parts  of  the  brain,  by  any  experiments  (§  459,  a).  It 
shows,  however,  that  the  action  of  the  heart  may  be  as  powerfully 
influenced  through  the  brain  when  the  spinal  marrow  is  destroyed,  as 
when  it  is  entire.     The  ganglionic  nerve  resolves  the  joi^oblem. 


304  INSTITUTES    OF    MEDICINE. 

481,  ^^•.  I  now  come  to  those  experiments  which  farther  illustrate 
the  principle  concerned  in  the  sudden  production  of  death  by  blows 
on  the  epigastric  region,  surgical  operations,  small  loss  of  blood,  joy. 
anger,  &c.  They  also  go  to  interpret  the  modus  operandi  of  morbific 
and  remedial  agents  as  to  their  rapidity  and  intensity,  especially  when 
taken  in  connection  with  Exp.  10-15,  and  others  which  are  to  follow. 
The  effects  now  supposed  depend  on  the  rapidity  and  intensity  with 
which  the  nervous  power  may  be  excited,  and  reflected  not  only  upon 
the  heart,  blood-vessels,  stomach,  &c.,  but  upon  the  brain  itself,  as  also 
upon  the  manner  in  which  the  nervous  power  may  be  modified  by  the 
nature  of  the  agent,  as  in  Exp.  12  and  13. 

If  the  head  and  spinal  marrow  of  a  frog  be  removed,  the  heart 
continues  to  perform  its  functions  perfectly  for  many  hours,  nor  does 
it  seem  at  all  immediately  affected  by  their  removal.  But,  we  find 
the  effect  very  different  when  the  most  sudden  and  powerful  agent  is 
applied  to  them.  If  they  are  even  destroyed  by  being  sliced  away, 
the  heart,  after  this  mode  of  destruction,  beats  on  as  usual.  But,  if 
either  the  brain  or  spinal  cord  be  instantly  crushed,  the  heart  feels  it 
immediately  and  forcibly.     Thus  : 

Exj).  16.  "  The  thorax  of  a  large  frog  being  opened,  the  brain  was 
crushed  by  the  blow  of  a  hammer.  The  heart  immediately  perform- 
ed a  few  quick,  weak  contractions.  It  then  lay  quite  still  for  about 
half  a  minute.  After  this,  its  beating  returned,  but  it  supported  the 
circulation  very  imperfectly.  In  ten  minutes  after,  its  vigor  was  con- 
siderably restored ;  when  the  spinal  marrow  was  crushed  by  one 
blow.  The  heart  then  beat  quickly  and  feebly  for  a  few  seconds, 
and  then  seemed  wholly  to  have  lost  its  power.  In  about  half  a  min- 
ute, it  again  began  to  beat,  and  in  a  few  minutes  acquired  considera- 
ble power,  and  again  supported  the  circulation.  It  beat  more  feebly, 
however,  than  before  the  spinal  man'ow  was  destroyed.  It  ceased  to 
beat  in  about  an  hour  and  a  half  after  the  brain  had  been  destroyed. 
In  another  frog,  after  the  brain  and  spinal  marrow  had  been  wholly 
removed,  the  heart  beat  nine  hours,  gradually  becoming  more  lan- 
guid." 

Exp.  17.  "  The  foregoing  experiment  cannot  be  performed  in  the 
same  way  on  warm-blooded  animals,  but  it  may  be  performed  in  a 
way  equally  satisfactory.  In  two  rabbits  the  brain  was  crushed  by  a 
blow.  In  both  the  heart  immediately  beat  with  an  extremely  feeble 
and  fluctuating  motion.  The  anterior  part  of  the  brain  only  was 
crushed  in  another  rabbit,  with  the  same  result.  A  strong  ligature 
was  thrown  around^the  neck  of  a  fourth  rabbit,  and  at  the  same  mo- 
ment it  was  tightened,  the  head  was  cut  off".  The  heart  continued 
beating  regularly,  in  this  case,  and  not  more  quickly  than  in  health. 
All  the  rabbits  were  of  the  same  age." 

Exp.  18.  The  following  is  still  more  conclusive  : 

"  The  anterior  part  of  the  brain  of  a  rabbit  was  crushed  by  a  ham- 
mer. No  motion  of  the  heart  was  perceived  by  applying  the  hand  to 
the  side.  The  head  was  cut  off*,  about  three  quarters  of  a  minute  af- 
ter the  brain  had  been  crushed.  No  blood  spouted  out,  and  very  lit- 
tle ran  from  the  vessels.  A  strong  ligature  was  passed  round  the 
neck  of  another  rabbit  of  the  same  age.  It  was  suddenly  tightened, 
and  the  head  cut  off".  In  this  instance  the  heart  was  found  beating 
regularly  under  the  finger  for  about  three  quarters  of  a  minute.     At 


PHYSIOLOGY. FUNCTIONS.  305 

the  end  of  this  time,  the  ligature  was  slackened,  and  the  blood  spout- 
ed out  to  the  distance  of  three  feet,  and  continued  to  spout  out  with 
great  force,  till  nearly  the  whole  blood  was  evacuated," 

481,  li.  The  last  of  the  foregoing  comparative  experiments  goes 
with  others  in  demonstrating  the  error  of  the  common  opinion,  that 
when  the  action  of  the  heart  and  blood-vessels,  or  other  organic  func- 
tions, fail  by  crushing  the  brain,  it  is  owing  to  the  withdrawal  of  the 
nervous  influence.  But,  still  more  conclusive  is  the  fact  that  the  en- 
tire brain  and  spinal  cord  may  be  removed  without  any  present  effect 
•ipon  the  actions  of  the  heart  and  blood-vessels,  as  in  Experiment  7. 
By  this,  and  other  considerations,  I  have  endeavored  to  show  that 
•allien  syncope  arises  from  loss  of  blood,  it  is  not  owing,  as  has  been 
mpposed,  to  the  failure  of  the  nervous  influence  upon  the  organs  of 
circulation,  but  that  this  influence  increases  on  the  approach  of  syn- 
cope, is  a  principal  cause  of  the  paroxysm,  and  is  actually  greatest 
when  the  paroxysm  is  complete  (§  947,  948,  and  Medical  and  Phys- 
iological Commentarits,  vol.  i.,  p.  168-176). 

482,  The  preceding  experiments  determine  a  variety  of  important 
points,  of  extensive  physiological,  pathological,  and  therapeutical  ap- 
plication, and  to  which  brief  references  were  made.  The  whole  should 
DC  viewed  in  connection,  and  also  with  such  as  are  to  follow ;  while 
a  constant  reference  should  be  had  to  the  laws  of  sympathy,  as  set 
forth  in  the  fifth  division  of  our  subject. 

Experiments  relative  to  the  Arteries  in  their  Connection  with  the  Ner- 
vous System. 

483,  a.  The  next  important  step  in  our  inquiry  is  to  ascertain,  in  a 
more  specific  manner  than  the  preceding  experiments,  how  far  the  ves- 
sels of  circtdation  are  capable  of  being  influenced  through  the  brain  and 
spinal  cord  (^  1040). 

To  determine  the  foregoing  problem,  it  is  first  necessary  to  settle 
another ;  namely,  how  far  the  vessels  of  circulation  can  support  the  mo- 
tion of  the  blood  independently  of  the  heart.  That  the  small  arteries 
possess  this  power  in  an  eminent  degree  has  been  already  rendered 
suflttciently  certain ,(§  392,  393.  Also,  Med.  and  Phys.  Comm.,  vol.  ii., 
p.  145-151,  398,  422,  &c.).  But  we  now  arrive  at  the  same  knowl- 
edge by  another  process. — Note  CI  p.  1122. 

As  a  comparative  experiment,  Philip  passed  a  ligature  round  all 
the  vessels  attached  to  the  heart  of  a  frog,  and  then  cut  out  the  heart. 
"  On  bringing  the  web  of  one  of  the  hind  legs  before  the  microscope, 
the  circulation  was  foxmd  to  be  vigorous.,  and  continued  so  for  many 
minutes ;  at  length  gradually  becoming  more  languid." 

Now,  if  the  heart  be  allowed  to  remain,  whatever  impression  made 
upon  the  brain  shall  suddenly  diminish  or  arrest  the  circulation  in  the 
capillary  arteries,  will  prove  that  these  vessels,  as  well  as  the  heart, 
may  be  influenced  by  the  nervous  power. 

Experiment  19.  "  The  web  of  one  of  the  hind  legs  of  a  frog  was 
brought  before  the  microscope,  and  while  Mr.  Hastings  obsei^ed  the 
circulation,  which  was  vigorous,  Dr.  Philip  crushed  the  brain  with  a 
hammer.  The  vessels  of  the  web  instantly  lost  their  power,  the  cir- 
culation ceasing.  In  a  short  time  the  blood  again  began  to  move,  but 
with  less  force  than  natural.     This  experiment  was  repeated,  with  the 

U 


306  INSTITUTES    OF    MEDICINE. 

same  result.     If  the  hrain  he  not  completely  crushed,  the  blow  increases 
the  rapidity  of  the  circulation  in  the  wehy 

The  next  experiment  corresponds  with  those  of  the  foregoing,  which 
denote  that  the  effects  of  the  neiTOus  power  upon  the  organic  proper- 
ties and  functions  depend  upon  the  manner  in  which  it  is  developed, 
modified,  and  reflected.     Will  galvanism  explain  them  (^  893  a)  ? 

Exp.  20.  "  The  spine  of  a  frog  was  laid  open  at  the  lower  end, 
and  a  wire,  of  nearly  the  same  dimensions  with  the  cavity  of  the 
spine,  forced  through  it,  as  in  Le  Gallois'  experiments.  The  circu- 
lation was  found  to  have  wholly  ceased  in  the  web  of  the  hind  leg." 

Now  mark  the  contrast  when  a  small  wire  was  employed ;  for,  in 
another  frog  the  spinal  cord  was  destroyed  by  introducing  in  the  same 
way,  and  moving  in  various  directions,  a  wire  much  smaller  than  the 
cavity  of  the  spine.  The  frog  soon  appeared  to  be  quite  dead ;  but 
the  circulation  in  the  web  was  found  to  be  vigorous. 

Exp.  21.  "  Part  of  the  cranium  of  a  frog  was  removed,  the  web 
of  one  of  the  hind  legs  brought  before  the  microscope,  and  the  cir- 
culation in  it  observed.  The  animal  was  now  rendered  insensible 
by  the  immersion  of  the  other  hind  leg  in  laudanum.  The  insensi- 
bility did  not  in  the  least  affect  the  circulation  in  the  web  before  the 
microscope.  Spirit  of  wine  was  then  applied  to  the  brain  with  an  ev 
ident  increase  of  the  velocity  of  the  blood  in  the  web.  The  same  ef- 
fect was  produced  in  a  less  degree  by  watery  solutions  of  opium  and 
tobacco.  After  the  tobacco  had  been  applied  for  about  half  a  minute, 
the  motion  of  the  blood  was  much  less  rapid  than  before  its  applica- 
tion. On  washing  off  the  tobacco,  the  velocity  of  the  blood  teas  increased, 
and  was  again  lessened  on  applying  it.  This  was  repeated  several 
times  with  the  same  effects.  When  the  circulation  in  the  web  had 
almost  ceased  after  the  tobacco  had  been  washed  off,  its  velocity  was 
increased  on  applying  spirit  of  wine  to  the  brain." 

Analogous  experiments,  but  varied  from  the  foregoing  in  some  of 
the  details,  gave  the  same  results. 

483,  b.  It  may  be  proper  to  add,  that  Dr.  Hall  attempted  to  inval- 
idate Philip's,  experiments  with  alcohol,  &c.,  applied  to  the  nervous 
centres,  by  repeating  just  one  of  them,  and  that  one  the  least  impor- 
tant of  any.  It  was  the  least  important  because  it  was  made  upon  a 
cold-blooded  animal,  and  because,  also,  the  state  of  insensibility  was 
produced  by  laudanum ;  the  experiment  being  no.  21,  or  the  last  of 
the  foregoing  series.  Of  that  experiment  he  says  that  the  motions  of 
the  heart  were  not  affected  on  applying  alcohol  to  the  brain.  It  does 
not  appear  that  he  tried  the  effect  of  the  infusions  of  opium  and  tobac- 
co, nor  that  he  repeated  those  far  more  important  experiments  upon 
warm-blooded  animals. 

The  difference  in  the  results  is  of  the  easiest  explanation.  By  Dr. 
Hall's  method  of  producing  insensibility  by  the  long-continued  and 
extensive  application  of  laudanum  to  the  surface  of  the  animal  the 
sedative  effect  of  the  nervous  influence  was  so  powerfully  determined 
upon  the  circulatory  organs,  that  alcohol,  when  applied  to  the  brain, 
failed  of  rousing  the  action  of  the  heart.  In  Philip's  experiment  it  is 
obvious  that  the  cutaneous  application  of  the  laudanum  was  of  short 
duration,  and  this  was  only  relative  to  a  few  upon  frogs.  Dr.  Hall, 
indeed,  seems  to  have  been  aware  that  this  objection  might  be  raised 
against  his  experiment ;  for  he  remarks  that,  "  I  believe  that  there 


PHYSIOLOGY. FUNCTIONS.  307 

may  be  one  difference  between  Dr.  Philip's  experiment  and  my  own 
(that  is),  I  might  apply  the  laudanum  viore  effectually^  It  is  this  dif- 
ference which  makes  all  the  difference  in  the  results  (^  484  a,  Ex.  C.  D). 

Finally,  the  force  of  Dr.  Philip's  experiment  is  increased  by  the 
very  objection  which  has  been  made  to  the  production  of  insensibility 
by  laudanum  ;  since  his  subsequent  application  of  a  watery  infusion 
of  opium  to  the  brain  influenced  the  heart  and  blood-vessels  as  in 
those  cases  where  insensibility  had  been  effected  by  other  means. 
And  so  of  the  following  like  experiments  by  Alston,  and  by  Dr.  Hall 
himself. 

483,  c.  There  is  one  more  fact  connected  with  the  present  stage  of 
my  inquiry,  which  it  may  be  well  to  consider,  and  by  which  Dr.  Half 
would  invalidate,  still  farther,  the  conclusion  drawn  by  Dr.  Philip 
from  his  experiment  of  crushing  the  brain.  In  this  experiment  the 
action  of  the  heart  is  temporarily  suspended.  Now,  Dr.  Hall  would 
argue  that  this  suspension  is  not  the  result  of  any  special  influence  ex- 
ercised by  the  brain  over  the  heart,  during  the  act  of  violence,  be- 
cause the  same  effect  will  follow  when  the  stomach  is  violently  crushed 
after  removal  of  the  brain  and  spinal  cord.     Thus  : 

"  In  an  eel,  in  which  the  brain  had  been  removed,  and  the  spinal 
marrow  destroyed,  the  stomach  was  violently  crushed  with  a  hammer. 
The  heart,  which  had  previously  beat  vigorously  sixty  times  in  a  min- 
ute, stopped  suddenly  and  remained  motionless  for  many  seconds.  It 
then  contracted ;  after  a  long  interval  it  contracted  again,  and  slowly 
and  gradually  recovered  an  action  of  considerable  frequency  and 
vigor." 

Dr.  Hall,  therefore,  argues  that  the  nervous  system  had  no  agency 
in  transmitting  influences  of  the  injured  stomach  to  the  heart,  and 
that,  "  the  organic  structures  (meaning  others  than  the  nervous)  must 
have  been  the  medium  through  which  the  effect  of  the  violence  was 
conveyed  to  the  heart." 

I  need  not  go  far  to  indicate  the  capital  error  of  Dr.  Hall's  conclu- 
sion, so  opposed  to  the  phenomena  of  the  passions,  and  the  well-knowTi 
effects  of  cerebral  hemorrhage,  and  blows  upon  the  head.  It  is  suffi- 
cient, notwithstanding  the  removal  of  the  brain,  and  the  desti-uction  ot 
the  spinal  cord,  in  the  case  of  the  eel,  that  the  whole  ganglionic  sys- 
tem, all  the  spinal  nerves,  and  the  pneumogastric  besides,  remained 
entire.  It  was  therefore  through  this  vast  range  of  most  important 
nerves,  through  the  great  solar  plexus  of  the  sympathetic,  through  the 
whole  of  the  anancephalous  system  of  nei-ves  (§  461^),  that  the  ner- 
vous influence  was  propagated  to  the  heart  by  crushing  the  stomach 
of  the  animal.  Had,  however,  the  brain  and  spinal  cord  been  per- 
mitted to  remain,  the  demonstrations  of  nervous  influence  upon  the 
heart  would  have  been  more  strongly  pronounced.  Nor  was  it  a  fair 
experiment  to  have  selected  a  cold-blooded  animal,  and  so  tenacious 
of  life  as  the  eel,  to  contrast  an  important  result  with  such  as  had 
been  obtained  by  a  very  different  experiment  upon  a  warm-blooded 
animal. — Note  B  p.  1113. 

But,  as  I  have  said,  slight  blows  over  the  stomach  of  a  man  may 
destroy  his  life  in  an  instant,  when  they  would  be  haiToless  to  an  eel. 
Hunter,  and  others,  relate  instances  of  instant  death  when  extirpa- 
ting a  testicle,  or  performing  minor  operations  ;  and  Mr.  Travers,  and 
others,  from  lancing  a  thecal  abscess  of  the  finger,  and  other  similar 


308  INSTITUTES    OF    MEDICINE. 

slight  causes.  Here,  it  cannot  be  denied,  that  a  fatal  nervous  influ- 
ence was  thus  reflected  over  the  whole  frame  of  a  man,  without  call- 
ing to  the  explanation  "the  ten  thousand"  facts  that  are  well  estab- 
lished as  to  the  influence  of  the  nervous  power  upon  organic  actions; 
while  we  thus  anive  at  the  obvious  conclusion,  that  it  is  through  the 
same  principle  blows  upon  the  epigastrium,  crushing  the  liver,  and 
similar  injuries,  produce  their  fatal  effects. 

But,  if  we  concede  to  Dr.  Hall  the  inconsistency  in  which  he  is  in- 
volved by  his  experiment,  and  by  his  dii'ect  affirmation  that  sympa- 
thies in  organic  life  are  owing  to  the  mutual  influences  of  organs  among 
each  other,  and  without  the  agency  of  the  nerves  with  which  they  are 
supplied,  it  would  not  affect  the  principle  which  relates  to  sympathy 
in  its  aspect  of  an  important  law  which  is  constantly  concerned  in  dis- 
ease and  in  the  operation  of  remedial  agents.  The  dispute  would  then 
turn  only  on  the  nature  of  the  cause  upon  which  the  function  of  sym- 
pathy depends ;  while  the  very  cases  of  disease  which  Dr.  Hall  pro- 
duces to  illustrate  the  existence  and  nature  of  the  principle  are  fatal 
to  his  humoral  hypothesis,  and  go  to  my  doctrine  of  reflex  nervous  action. 
But  the  accuracy  of  all  Dr.  Philip's  experiments  has  been  fully  as- 
certained by  numerous  physiologists. 

484,  a.  I  shall  now  introduce  a  series  of  experiments  by  other  hands 
which  illustrate,  still  farther,  the  applicability  which  I  have  indicated 
as  to  the  preceding  experiments. 

In  the  Edinburgh  Medical  Essays  for  1733,  vol.  v.,  p.  128,  are  to  be 
found  the  first  experiments  which  I  shall  now  mention,  and  which  ap- 
pear to  have  been  neglected  by  later  observers.  They  were  made  by 
Dr.  Alston,  who  had  no  theory  in  view  to  embarrass  his  vision  or 
judgment ;  and  yet  I  have  met  with  no  reference  to  them. 

Exp.  A.  "  I  conveyed,"  says  Alston,  "  through  a  small  glass  tube  a 
ie-vf  drops  of  a  solution  of  opium  in  water  into  a  frog's  stomach,  and 
putting  the  animal  into  a  glass  cylinder,  adapted  it  so  to  a  good  mi- 
croscope, that  we  had  a  distinct  view  of  a  part  of  the  membrane  be- 
tween the  toes  of  its  hinder  foot,  where  the  circulation  of  the  blood 
may  be  easily  seen.  My  design  was,  since  I  found  opium  killed  frogs, 
to  observe  if  there  was  any  visible  change  made  by  it  in  the  blood  it- 
self, or  in  its  motion.  Neither  of  us  could,  indeed,  see  any  alteration 
of  the  blood  as  to  its  consistence,  color  of  the  serum,  magnitude,  fig- 
ure, or  color,  of  the  red  globules  ;  hut  we  very  distinctly  saw  a  surpris- 
ing diminution  of  the  hlood's  velocity,  for  it  did  not  move  half  so  swift- 
ly as  it  naturally  does  in  those  creatures.  We  alternately  looked  at  it, 
again  and  again,  and  in  less  than  half  an  hour  saw  the  velocity  of  the 
hlood  gradually  increase.  The  uneasy  frog  recovered  its  wonted  vig- 
or, and  the  blood  its  common  velocity." 

The  foregoing  experiment  was  repeated,  after  awhile,  upon  the  same 
frog.     Alston  goes  on  thus  : 

Exp.  B.  "  I  put  the  frog  into  a  basin  of  clean  water,  and  allowed  it 
half  an  hour  to  refresh  itself;  then  gave  it  another  dose  of  opium.  The 
blood  then  moved  yet  slower  than  it  did  the  first  time,  and  its  velocity 
gradually  decreasing,  it  at  length  stagnated,  first  in  the  smaller,  then 
in  the  larger  vessels,  and  in  about  a  quarter  of  an  hour  the  animal  died."* 
The  experiments  were  frequently  repeated,  with  the  same  results. 

Exp.  C.  The  following  experiment  was  performed  by  Dr.  Marshall 
Hall: 

*  WuYTT,  in  1755,  made  similar  experimenta  with  the  same  effect. — WoBKS,  4to,  p.  310-327 So3 

Isoic,  p.  320. 


PHYSIOLOGY. FUNCTIONS.  309 

"  I  applied  laudanum,"  he  says,  "  over  the  back  part  of  a  frog,  care- 
fully avoiding  its  contact  vv^ith  the  web.  In  less  than  half  an  hour,  its 
respiration  and  all  sensibility  had  ceased,  and  the  capillary  circulation 
became,  at  the  same  time,  more  indistinctly  pulsatory  in  the  arteries, 
and  more  and  more  slow  and  feeble  in  the  capillary  vessels  and  veins. 
This  effect  became  gradually  more  marked,  and  in  two  hours  the  cir- 
culation Jiad  ceased  almost  entirely  in  all  the  three  sets  of  vessels.  1 
now  washed  off  the  laudanum,  and  placed  the  frog  in  water.  The  cir- 
culation at  first  gradually ,  afterward  more  speedily,  returned,  and  he- 
came  very  vivid  and  vigorous,  even  before  there  was  the  slightest 
RETURN  OF  RESPIRATION  (§  441,  d).  The  respiration  and  sensibility  at 
length  also  returned  completely.  The  laudanum  was  reapplied  and 
again  removed  with  precisely  the  same  effects.  The  insensibility  was 
SO  perfect  that  the  eyes  w^ere  not  retracted  on  being  touched.  The 
recovery  was  prompt  and  complete." — See  §  483  h. 

Exp.  D.  The  foregoing  experiment  was  repeated  with  opium  and 
water  ;  when  the  effects  were  less  rapid,  but  "  at  length  the  circulation 
in  the  web  ceased,  and  the  animal  became  affected  with  complete  te- 
tanus." 

Exp.  E.  "  The  same  effect  was  produced  more  speedily  on  indu- 
cing the  animal  to  swallow  a  few  drops  of  the  opiate  solution."* 

484,  b.  I  have  now  to  notice  six  principal  points  relative  to  the  ex- 
periments A,  B,  C,  D,  and  E. 

1st.  In  Dr.  Hall's  experiments  (C  and  D),  the  opium  was  applied 
to  the  skin  exclusively. 

2d.  The  effects  were  exactly  the  same  as  obtained  by  administering 
opium  by  the  stomach  (Exp.  A,  B,  and  E). 

3d.  The  effects  in  both  cases  were  similar  to  those  obtained  by 
Philip  from  applying  opium  to  the  brain,  both  in  cold  and  warm- 
blooded animals. 

4th.  The  experiments  by  Hall  and  Philip  fully  corroborate  the  ob- 
vious conclusion  from  Alston's  (Dr.  Hall's  being  only  a  repetition  of 
Alston's),  that  opium  does  not  produce  its  effects  by  absorption  into 
the  circulation  (as  is  especially  supposed  of  this  agent),  since  in  all 
the  experiments,  and  the  same  with  tobacco  in  all  (§  483,  Exp. 
21),  the  effects  upon  the  circulation  went  off  as  soon  as  the  solu- 
tions were  washed  from  the  skin,  or  from  the  brain,  and  returned 
when  they  were  again  applied,  and  again  promptly  disappeared  when 
the  solutions  were  washed  off.  Brodie's  experiment  with  tobacco  is 
also  in  direct  proof  of  its  universal  operation  through  the  nervous 
centres  (§  904,  b,  1088  h,  c).t -Notes  B  I  pp.  1113,  1118. 

5th.  It  appears  from  the  foregoing  facts,  that  the  circumstances  at- 
tending the  effects  of  opium  upon  the  system  at  large  are  the  same, 
whether  it  be  applied  to  the  nervous  centres,  to  the  stomach,  or  to  the 
skin.  It  follows,  therefore,  in  connection  with  what  is  known  of  the 
influences  which  the  brain  and  spinal  cord  may  exert  on  the  actions 
of  organic  life,  that  the  remote  effects  of  opium,  applied  to  the  stom- 
ach or  skin,  are  produced  by  a  modification  and  reflected  action  of  the 
nervous  power  upon  distant  parts  (§  224,  226,  &c.). 

Here,  then,  we  see,  more  and  more  clearly,  the  propriety  of  the  ap- 

Elication  which  I  have  made  of  Philip's  experiments,  and  which  will 
ecome  more  strikingly  obvious  by  connecting  them  with  the  sequel, 
•  Hall,  on  the  Influence  of  the  Brain  and  Spinal  Marrow  upon  the  Circulation,  p.  Ill 

t  Whttt  applied  opium  to  a  frog  after  destroying  the  brain  and  spinal  cord,  when  the  heart  waa 

much  lesa  affected  than  when  applied  in  the  natural  state. — Works,  p.  513 See  §  483  c,  aa  to  syrrf 

patlietic  nerve,  and  §  lOSS  b,  as  to  skin. 


i)10  INSTITUTES    OF    MEDICINE. 

and  with  the  lesults  of  Sir  C.  Bell's  discovery.  Let  us  suppose,  for 
instance,  that  we  have  no  other  knowledge  of  the  principle  upon  which 
remote  sympathy  depends,  than  the  natural  phenomena  which  are  con- 
stantly manifested.  We  should  certainly  know,  from  these  results, 
that  such  a  principle  exists ;  but  where,  or  how  developed,  or  how 
varied  in  its  influences,  we  could  not  know  with  certainty  without  di- 
rect experiment.  With  the  advantage,  therefore,  of  such  experiments 
as  Philip's,  we  arrive  at  the  clearest  demonstration  of  the  manner  in 
which  effects  now  under  consideration  are  brought  about,  and  thus  put 
an  end  to  the  worst  speculations  in  medicine.  But,  before  reasoning 
from  these  experiments  we  should  know  the  manner  in  which  impres- 
sions are  transmitted  to  the  brain  and  spinal  cord  by  the  nerves  of 
sensation,  how  they  are  reflected  from  these  central  organs,  and  the 
obvious  results  which  follow  in  animal  life,  and  how  these  results  cor- 
respond with  similar  effects  in  organic  life  (§  500).  The  foundation 
of  an  important  philosophy  is  thus  laid  by  demonstration,  and  render- 
ed acceptable  to  those  who  rely  only  upon  the  plainest  testimony  of 
sense  (§  234). 

6th.  Again,  I  say,  since  the  action  of  opium,  through  the  stomach 
or  skin,  upon  remote  parts,  is  different  from  that  of  tobacco,  alcohol, 
&c.,  and  since  each  produces,  respectively,  the  same  effects  when  ap- 
plied directly  to  the  brain  or  spinal  cord,  and,  in  all  the  cases,  by  ex- 
citing and  reflecting  the  nervous  power,  it  follows  that  this  power,  like 
the  organic  powers,  is  capable  of  being  modified  in  its  nature  accord- 
ing to  the  nature  of  the  causes  by  which  it  is  developed  (§  224-233, 
494  c).— Note  B  p.  1113. 

485.  Finally,  Kriemer  has  multiplied  experiments  to  a  great  extent 
with  reference  to  the  part  which  the  arteries  take  in  the  circulation, 
and  they  all  concur  in  proving  their  independent  action,  and  that  they 
may  be  powerfully  affected  by  impressions  made  upon  the  nerves. 
When  he  tied  the  crural  nerve  of  quadrupeds  it  lessened  immediate- 
ly the  jet  of  blood  from  the  femoral  artery.  The  same  experiment 
on  frogs  arrested  the  capillary  circulation  in  the  web  of  the  foot. 
What  is  also  an  important  fact  as  showing  an  alteration  of  the  organic 
properties  of  a  part  by  the  nervous  influence,  he  observed  that  the  ar- 
terial blood  passed  on  to  the  veins  without  being  converted  into  ve- 
nous blood  (§  399,  507,  952)=^— Note  a  p.  1122. 

3d.  On  the  Principle  on  which  the  Action  of  the  Muscles  of  Voluntary 
Motion  depends,  and  the  Relation  which  they  hear  to  the  Nervous 
System. 

486.  Philip  next  proved  by  experiments  that  the  muscles  of  volun- 
tary motion,  like  the  heart  and  blood-vessels,  are  independent  of  the 
brain  and  spinal  cord,  as  it  respects  their  excitability  and  power  of 
motion ;  but  that  they  are  alike  capable  of  being  stimulated  through 
the  nervous  system.  "We  do  not,  surely,"  he  says,  "in  the  experi- 
ments which  have  been  laid  before  the  reader,  see  any  difference  in 
the  nature  of  the  muscular  power  of  the  heart,  and  that  of  the  muscles 
of  voluntaiy  motion,  except  their  being  fitted  to  obey  different  stimuli ; 
a  difference  which  we  find  in  the  two  sides  of  the  heart  itself"  (§  136, 
188i-190).   Nevertheless,  the  nerves  supply  the  mmeJzate  stimulus. 

*  This  anticipates  the  analogous  experiments  which  have  been  lately  made  by  CI. 
Bernard.— 18G0. 


PnyslOLOGY. FUNCTIONS.  311 

4th.  Interesting  Experiments  were  made  hy  Philip  to  ascertain  the 
comparative  Effects  of  Stimuli  applied  to  the  Brain  and  Spinal  Mar- 
row on  the  Heart  and  Muscles  of  Yoluntary  Motion. 

487,  a.  I  shall  state  only  a  few  of  the  important  practical  conclu 
sions.  Thus  :  "  Another  circumstance,  which  appears  to  be  of  gieat 
importance  in  tracing  the  cause  of  the  different  effects  of  stimuli  ap- 
plied to  the  brain  and  spinal  marrow,  or  the  muscles  of  voluntary  and 
involuntary  motion,  is,  that  the  heart  obeys  a  much  less  powerful  stim- 
ulus than  the  muscles  of  voluntary  motion  do.  We  have  seen  that 
only  the  most  powerful  chemical  stimuli  affect  them,  while  all  that 
were  tried  readily  influenced  the  action  of  the  heart  and  blood- 
vessels."    This  should  be  considered  with  §  493  cc^  500  m,  687-|^-688. 

487,  h.  The  foregoing  shows  us  the  distinction  between  the  irrita- 
bility of  the  heart  and  voluntary  muscles,  &c.,  how  it  is  differently  af- 
fected in  organic  and  animal  life  by  the  same  agents,  how  the  nervous 
power  acts  upon  that  irritability  according  to  the  nature  of  the  agents 
by  which  it  is  excited,  whether  they  be  applied  directly  to  the  nervous 
centres  or  to  the  stomach,  &c.  (§  133-162,  1881-190,  205,  206,  208, 
209,  222-233,  256,  484,  500  m,  826  cc,  893^).  ' 

487,  c.  It  is  also  an  important  fact,  as  well  in  a  therapeutical  as 
physiological  sense,  and  especially  as  distinguished  from  the  action  of 
the  will  and  other  things  (§514  d),  that,  as  the  animal  approached  a 
state  of  death,  he  found  that,  "after  all  stimuli  applied  either  to  the 
brain  or  spinal  cord  had  ceased  to  produce  any  excitement  in  the  mus- 
cles of  voluntary  motion,  both  chemical  and  mechanical  stimuli,  so  ap- 
plied, still  increased  the  action  of  the  heart ;  and  the  irritating  agents 
more  than  the  mechanicar  (§  224,  500  m,  nn,  637,  694f,  829,  893  L). 

487,  d.  It  was  also  found  by  comparative  experiments  on  the  ac- 
tions of  animal  and  organic  life,  "  that  irritating  or  depressing  agents, 
such  as  alcohol,  alkalies,  opium,  tobacco,  &c.,  applied  to  the  brain, 
and  spinal  cord,  exert  a  greater  power  over  the  heart  than  mechani- 
cal stimuli  (such  as  variously  injuring  the  structure  of  the  brain), 
while  the  mechanical  stimuli  exert  a  greater  power  over  the  muscles 
of  voluntary  motion  than  the  agents  possessing  peculiar  intrinsic  vir- 
tues" (References  above). 

487,  e.  Again,  it  was  found  "  that  stimulating  every  part  of  the 
brain  and  spinal  cord  equally  affects  the  action  of  the  heart  (also,  the 
stomach  and  lungs),  while  the  muscles  of  voluntary  motion  are  only 
excited  by  stimuli  applied  to  the  parts  of  those  organs  from  which 
their  nerves  originate ;  that  stimuli  applied  to  the  brain  and  spinal 
cord  never  excite  irregular  action  of  the  heart,  while  nothing  can  be 
more  irregular  than  the  action  they  excite  in  the  muscles  of  voluntary 
motion ;  that  their  effect  on  those  muscles  is  felt  chiefly  on  theiv  first 
application,  but  continues  on  the  heart  (and  blood-vessels)  as  long  as 
the  stimulus  is  applied^''  (§  233|^,  506,  516,  no.  6). 

487, y!  In  connection  with  this  comparative  inquiry,  Philip  has  a 
remark  which  is  worthy  of  deep  consideration.  "  It  is  tme,"  he  says, 
"  that  although  the  heart  is  only  influenced  by  agents  applied  to  a 
large  portion  of  the  brain,  we  may  conceive  them  so  applied  as  to 
produce  irregular  action  in  it;  and  we  find  that  certain  irritations  of 
the  nervous  system  have  this  effect.  But  it  is  evident  that  the  heart, 
not  being  subject  to  stimuli  whose  action  is  confined  to  a  small  por- 


312  INSTITUTES    OP   MEDICINE. 

tion  of  this  organ,  and  being  equally  affected  through  all  parts  of  it; 
must  render  it  much  less  subject  to  irregular  action ;  which  may  be 
one  of  the  final  causes  of  the  heart  (whose  regular  action  is  of  such 
importance  in  the  animal  economy)  being  made  subject  to  the  whole, 
and  not  to  one  part  of  the  brain,  and  readily  accounts  for  our  not  be- 
ing able  to  produce  irregular  action  in  it  by  experiments  upon  the 
brain  and  spinal  marrow."  "  When,  indeed,  the  source  of  the  nerves 
of  the  heart  is  considered,  it  will  be  found  to  derive  its  nei-vous  influ- 
ence from  every  part  of  the  nervous  system,  and  not  very  remarkably 
from  any  one  pait;  a  circumstance  which  particularly  corresponds 
with  the  results  of  the  foregoing  experiments," — and  with  the  phe- 
nomena of  sympathy  as  manifested  in  disease  (§  500  ??i,  1032  (?), 

Analogous  observations  are  also  applicable  to  all  the  other  organic 
viscera ;  which  farther  proves  that  a  great  final  cause  of  the  gangli- 
onic system  is  to  unite  the  organs  of  organic  life  in  one  concerted 
action,  while,  also,  it  subserves  their  functions  {^  488^,  46H  a,  1041). 

487,  g.  By  the  same  facts  we  may  explain  why  the  heart  and  other 
organic  viscera  are  affected  through  the  brain,  and  spinal  cord,  after 
their  power  is  so  far  weakened  as  no  longer  to  convey  the  influence 
of  a  stimulus  to  the  muscles  of  voluntary  motion.  As  these  muscles 
obey  stimuli  applied  to  only  a  part  of  the  brain,  or  spinal  cord,  where 
the  nerve  supplying  a  muscle  originates,  if  the  impression  on  this  part 
be  not  sufficiently  strong  to  produce  a  muscular  movement  it  cannot 
be  assisted  by  any  other  part  of  the  brain  or  spinal  cord.  Thus,  it 
was  found  by  Dr.  Philip,  "  that  a  blow  which  affects  the  brain  gener- 
ally, without  materially  injuring  it,  produces  comparatively  little  ef- 
fect on  the  muscles  of  voluntary  motion,  because  no  one  part  of  the 
brain  suffers  greatly ;  but  it  produces  a  great  effect  on  the  heart,  be- 
cause this  organ  feels  the  su?n  of  all  the  impressions.  (And  so  of  the 
stomach,  liver,  intestines,  &c.)  The  nervous  system,  therefore,  may 
be  so  far  exhausted  (or  affected)  as  not  to  admit  of  the  vivid  impres- 
sions necessary  to  excite  the  muscles  of  voluntary  motion,  and  yet  ca- 
pable of  those  which  influence  the  heart,"  blood-vessels,  &c.  This  is 
strikingly  seen  in  apoplectic  affections. — Note  B  p.  1113. 

The  philosophy  of  this  subject  is  farther  explained  in  the  following 
luminous  manner  by  Dr.  Philip  :  "  Here,"  he  says,  "  the  question 
arises,  by  what  means  is  the  one  set  of  organs  (that  is,  the  heart, 
stomach,  &c.)  subjected  to  the  influence  of  evei-y  part  of  the  brain 
and  spinal  man-ow,  while  others  are  influenced  by  only  small  parts 
of  those  nervous  centres  %  In  these  latter  instances,  we  see  directly 
proceeding  from  those  small  parts  the  nerves  of  the  parts  influenced. 
In  the  former  instances,  we  do  not  see,  in  any  case,  nerves  going  di- 
rectly from  all  parts  of  these  organs  to  the  parts  influenced ;  but  we 
always  see  this  part  receiving  nerves  from  a  chain  of  ganglions,  to 
which  nerves  from  all  parts  of  the  brain  and  spinal  marrow  are  sent. 
It  is  therefore  evident,  from  direct  experiment,  that  the  nerves  issu- 
ing from  the  ganglions  convey  to  the  parts,  to  which  they  send  nerves 
the  influence  of  all  the  nerve(8  which  terminate  in  these  bodies." 

By  the  same  philosophy,  so  clearly  founded  in  nature,  we  readily 
interpret  the  vast  extent  of  influences  which  may  be  propagated  from 
the  stomach,  or  other  parts  in  organic  life,  by  morbific  and  remedial 
agents,  through  impressions  transmitted  to  the  brain  and  spinal  cord 
by  way  of  the  ganglionic  system  ;  while,  also,  all  parts  of  the  nervoup 


PHYSIOLOGY. FUNCTIONS.  313 

centres  may  be  influenced  in  their  organic  condition  by  impressions 
upon  any  distant  part  (§  230).  This  apphcation,  too,  of  the  foregoing 
philosophy  is  divested  of  prejudice,  since  it  was  not  contemplated  by 
the  experimenter  [^  1038). 

487,  gg.  "  The  following  case,  related  by  the  distinguished  Di. 
Parry,  on  the  arterial  pulse,  might  alone  be  regarded  as  proving  the 
existence  of  two  sets  of  nerves  in  the  extremities;  the  one  supplying 
the  muscles  of  voluntary  motion,  the  other  the  powers  supporting  the 
circulation,  and  strikingly  illustrates  what  has  been  said  on  this  sub- 
ject. 'I  have  seen,'  says  Parry,  'a  total  loss  of  pulse  in  one  arm 
with  coldness,  but  complete  power  of  motion  in  that  part ;  while  the 
other  arm  was  warm,  and  possessed  a  perfectly  good  pulse,  but  had 
lost  all  power  of  voluntary  motion'  "  (§  113,  224,  399,  500  nn,  893^). 

487,  h.  We  may  now  readily  perceive,  from  the  vast  difference  in 
the  results  between  the  influence  of  the  nervous  power  upon  animal 
and  organic  life,  how  the  muscular  power,  or  strength,  as  it  is  usually 
called,  may  be  excessively  prostrated  at  the  invasion  of  disease,  while 
organic  actions  may  be  as  greatly  increased,  or  if  depressed,  they  may 
be  so  modified  as  to  require  the  application  of  remedies  from  which 
we  might  shrink  if  we  regarded  alone  the  prostration  of  the  voluntai'y 
muscles.  It  is  an  ignorance  of  the  principle  which  operates  in  these 
cases  (as  in  the  vast  range  of  congestive  fevers),  and  reasoning  from 
the  prostration  of  muscular  power  to  a  supposed  analogous  state  of 
the  great  powers  of  life,  and  thus  mistaking  mere  prostration  of  ani- 
mal life  for  absolute  "debility''^  of  the  organic  viscera,  that  has  led  so 
extensively  to  the  administration  of  stimulants  and  tonics,  where 
bloodletting  and  analogous  agents  are  most  imperatively  required. 
The  mind,  too,  is  inoperative  in  all  these  conditions,  and  the  volun- 
tary muscles  languid,  in  consequence ;  and  the  very  failure  of  the 
will  to  rouse  them  into  action,  where  drowsiness  has  contributed  its 
effect,  has  been  often  regarded  as  an  evidence  of  that  "  debility'''' 
which  calls  for  the  "stimulant  plan  of  treatment"  (§  473,  961,893^). 

It  cannot,  therefore,  be  too  strongly  enforced,  that  in  all  cases  of 
sudden  prostration  at  the  invasion  of  fever  the  nervous  power  has  a 
principal  agency  in  the  phenomenon, — that  its  influences  on  animal 
and.  organic  life  are  widely  different, — that  it  simply  fails  to  stimulate 
the  voluntary  muscles,  and  hence  the  greater  amount  of  apparent 
"debility ;"  while  in  relation  to  the  organic  processes,  it  has  been  so 
modified  as  not  only  to  exalt,  or  perhaps  depress,  the  forces  of  life, 
but  to  alter  profoundly  their  very  nature  (§  476  c,  500  h,  nn,  893^). 

There  is  nothing  in  the  whole  range  of  medical  philosophy  so  prac- 
tically important  as  these  considerations  (§  569,  961,  967).  It  is  a 
subject,  however,  which  requires  thought  for  its  proper  understand- 
ing, as  well  as  a  comprehensive  view  of  profound  laws  in  physiology. 
It  is  therefore  repulsive  to  the  many,  who  will  rather  rest  upon  the 
simple  chemical  and  physical  hypotheses  than  contemplate  Nature  in 
her  dignified  and  rational  aspects.  The  charm  of  simplicity  which 
hung  around  the  celebrated  theory  of  John  Brown  encircles,  also,  the 
humoral  and  other  chemical  hypotheses,  and  adds  its  fatal  delusion  to 
those  prevailing  doctrines  (1068  a). — Notes  Ee  p.  1133,  Ff  p.  1135. 

488.  An  important  remark  is  made  by  Philip  at  the  close  of  his 
experiments  relative  to  the  functions  of  the  heart,  blood-vessels,  and 
voluntary  muscles,  and  their  essential  independence  of  the  nervous 


314  INSTITUTES    OF    MEDICINE. 

system,  which  goes  to  corroborate  the  conclusions  I  have  draAvn  as  to 
the  agency  of  the  nervous  power  in  the  healthy  and  morbid  processes, 
of  its  modifications  according  to  the  nature  of  the  agents  by  which  it 
is  developed,  &c. ;  and  this  the  more  so,  as  Dr.  Philip  had  formed  no 
such  inferences,  but  regarded  the  nervous  power  as  the  galvanic  fluid, 
stimulating  the  various  parts  of  the  system,  and  a  mere  chemical  agent 
in  the  formation  of  the  secretions.  I  refer  particularly  to  the  clause 
in  italics. 

"  It  not  only  appears,"  says  Dr.  Philip,  "  from  the  experiments 
which  I  have  laid  before  the  reader,  that  the  power  of  the  heart  and 
vessels  of  circulation  is  independent  of  the  nervous  system,  but  that 
that  of  the  muscles  of  voluntary  motion  is  so  likewise,  and  that  these, 
like  the  former,  are  only  suhjected  to  this  system  in  the  same  way  in 
which  they  are  suhjected  to  every  other  agent  that  is  capable  of  exciting 
them.  Thus  we  find,  that  all  the  moving  powers  of  the  animal  body, 
as  far  as  we  have  hitherto  traced  them,  are  independent  of  the  ner- 
vous system,  but  that  this  system  is  equally  capable  of  acting  as  a 
stimulus  to  them,  although  in  different  ways,  whether  they  are  subject 
to  the  influence  of  the  will  or  not"  (§  133-162,  188|-190,  222-233, 
205,  206,  208,  209,  256,  476  c,  484,  500  h,  m,  826  cc,  893^). 

488^.  I  shall  now  advert,  once  more,  to  the  remarkable  distinction 
between  the  operations  of  the  nervous  power  as  manifested  in  animal 
and  organic  life  (§  90-110).  In  animal  life,  the  nervous  power  con- 
stantly influences,  in  a  sensible  manner,  all  the  involuntary  actions, 
and  is  obedient  to  the  will  in  respect  to  all  the  voluntary  muscles 
(§  245,  476  c,  500  /*).  Its  intensity  of  action,  and  consequent  mani- 
festations, depend  upon  the  force  or  intensity  of  the  exciting  causes. 
For  these  habitual  functions  of  the  nervous  power  the  cerebro-spinal 
system  is  specifically  pi'ovided.  Coming  to  the  organs  of  organic  life, 
we  find  them  supplied  with  a  system  of  nerves  remarkably  different 
from  the  cerebro-spinal,  and  a  corresponding  difference  in  the  laws  of 
nervous  influence.  This  system  serves  as  a  medium  through  which  the 
cerebro-spinal  operates  in  organic  life,  possesses  in  its  ganglia  centres 
of  reflex  action  which  combine  tributary  influences  from  different  parts 
of  the  cerebro-spinal,  unites  the  organic  viscera,  supplies  the  stimulus 
to  organic  muscular  tissue,  and  contributes  a  vitalizing  effect  upon  or- 
ganic compounds  through  a  modifying  influence  upon  the  organic  func- 
tions (§  224,  220,  409  k,  456  a,  461^  a,  473  c,  475^,  500  m,  893  a,  c.) 

But  there  is  this  coincidence  in  the  actions  of  the  two  lives ;  name- 
ly, the  power  which  generates  motion,  both  in  animal  and  organic  life, 
is  independent  of  the  nervous  system  (§  205-215);  but  the  nervous 
power  is  equally  capable  of  influencing  its  operation,  though  in  differ- 
ent modes  (§  226-233,  454-461^,  500,  893i). 

489.  The  question  is  investigated  by  Philip,  ^^  whether  the  power  of 
secretion  is  also  independent  of,  though  influenced  by,  the  nervous  system." 

Though  settled  by  experiment,  the  analogies  supplied  by  the  vegeta- 
ble kingdom  are  amply  conclusive  that  the  nervous  system  is  only  an 
excitant  to  the  function  of  secretion,  and  dispenses  a  modifying  influ- 
ence upon  organic  compounds  (§  224,  409  h,  456  a,  461^  a,  488^,  893^). 

From  Philip's,  and  the  experiments  of  others,  it  results,  for  exam- 
ple, that  a  division  of  the  pneumogastric  nerves  either  destroys  or 
greatly  impairs  the  digestion  of  food.  But,  says  Philip,  "  it  deserves 
notice,  that  the  food,  in  such  cases,  is  found  covered  with  apparently 


PHYSIOLOGY. — FUNCTIONS.  315 

the  same  semi-fluid  which  we  find  covering  the  food  in  a  healthy  stom- 
ach ;"  and  "  the  lungs  are  found  distended  with  a  frothy  fluid,  which  fills 
the  bronchi  and  air-cells"  (§  461). 

It  follows,  therefore,  that  the  function  of  secretion,  and  its  products, 
are  so  far  independent  of  the  nervous  system  as  to  be  only  influenced 
through  that  system.  Such  is  the  inevitable  conclusion  from  the  ex- 
periments themselves ;  and  yet  their  author  was  led  into  an  important 
error  by  his  hypothesis  of  the  identity  of  the  nervous  power  and  gal- 
vanism (§  409  h/i,  k,  493  cc,  893^,  902,  905  a,  1040). 

5th.  On  the  Principle  on  which  the  Action  of  the  Alimentary  Canal  depends. 

490.  Philip  destroyed  separately,  and  simultaneously,  the  brain  and 
spinal  cord,  and,  in  other  instances  removed  both  at  the  same  time. 
In  all  the  cases  "  the  motion  of  the  stomach  and  intestines  continued 
till  the  parts  became  cold,  so  that  when  the  intestines  exposed  to  the 
air  have  lost  their  power,  that  of  those  beneath  still  remains."  "  It 
appears  from  these  experiments  that  the  power  of  the  stomach  and  in- 
testines, like  that  of  the  heart  and  blood-vessels,  resides  in  themselves, 
and  is  wholly  independent  of  any  influence  derived  from  the  nervous 
system."  This  is  true  as  to  the  moving  jwwer  ;  but  the  experiment  is 
defective  in  neglecting  the  sympathetic  nerve,  by  whose  reflex  action 
the  peristaltic  movements  were  maintained  (§  889  g).  In  §  476^  c  the 
air  and  mechanical  irritation  were  equivalent  to  the  stimulus  of  the 
nervous  power  (§  473  c,  478  b,  483  c,  462-464,  498  e). 

6th.    On  the  Itelation  which  the  Alimentanj  Canal  and  Lungs  hear  to  the 

Nervous  System. 

491.  Direct  experiments,  as  in  the  foregoing  cases,  by  agents  ap- 
plied to  the  brain  and  spinal  cord,  show  that  the  stomach,  intestines, 
and  lungs  may  be  influenced  through  the  nei'vous  centres.  ''  It  often 
appeared,"  says  Philip,  "  that  spirit  of  wine  applied  to  the  brain  and 
spinal  marrow  increased  the  motion  of  the  canal ;"  that  "  the  stomach, 
like  the  heart,  is  capable  of  being  influenced  by  every  part  of  the  brain 
and  spinal  marrow"  (§  487  g).  For  these  important  investigations  the 
reader  is  referred  to  the  work  itself. 

Review  of  the  Inferences  from  the  preceding  Experiments. 

492.  The  following  inferences  are  made  by  Dr.  Philip  in  relation  to 
his  various  experiments,  and  it  will  be  seen  that  they  are  generally 
correct,  and  may  be  applied  to  the  most  important  problems  in  phys- 
iology and  practical  medicine : 

1.  "  That  the  vessels  of  circulation  possess  a  power  capable  of  sup- 
porting a  certain  motion  of  the  blood  independently  of  the  heart. 

2.  "  That  the  power  both  of  the  heart  and  vessels  of  circulation  is 
independent  of  the  brain  and  spinal  marrow. 

3.  "  That  the  nervous  influence  is  capable  of  acting  as  a  stimulus 
both  to  the  heart  and  vessels  of  circulation. 

4.  "  That  the  nervous  influence  is  capable  of  acting  as  a  sedative 
both  to  the  heart  and  vessels  of  circulation,  even  to  such  a  degree  as 
to  destroy  their  power. 

5.  "  That  the  effect  of  the  sedative  is  not  the  result  of  an  excess  of 
stimulus,  but,  like  excitement,  the  direct  operation  of  the  agent. 

6.  "  That  the  power  of  the  muscles  of  voluntary  motion  is  independ- 


316  INSTITUTES    OF    MEDICINE. 

ent  of  the  nervous  system,  and  that  their  relation  to  this  system  is  of  the 
same  nature  with  that  of  the  heart  and  vessels  of  circulation,  the  ner- 
vous power  influencing  them  in  no  other  way  than  as  other  stimuli 
and  sedatives  do. 

7.  "  That  the  cause  of  the  muscles  of  voluntary  and  involuntary  mo- 
tion appearing,  at  first  view,  to  differ  essentially  in  their  nature,  is  their 
being  excited  by  stimuli  essentially  different ;  the  former  being  al- 
ways excited  by  the  nervous  influence,  the  latter,  though  occasionally 
excited  by  this  influence,  in  all  their  usual  functions  obeying  other 
stimuli.    [This  must  be  qualified  as  in  §  456  a,  461^  a,  488^,  893^.] 

8.  "  That  the  brain  and  spinal  marrow  act,  each  of  them,  directly 
on  the  heart,  as  well  as  on  the  muscles  of  voluntary  motion, 

9.  "  That  the  laws  which  regulate  the  effects  of  stimuli  applied  to 
the  brain  and  spinal  marrow,  or  the  heart  and  muscles  of  voluntary 
motion,  are  different. 

[This  affirmation  can  be  made  only  of  certain  diffei'ences  in  the  modea 
in  which  vital  agents  affect  the  heart  and  voluntary  muscles.  A  com-- 
mon  principle  is  at  the  foundation  of  the  whole  (§  500,  h,  893^).] 

10.  "  That  mechanical  stimuli  applied  to  the  brain  and  spinal  mar- 
row are  better  fitted  to  excite  the  muscles  of  voluntary  motion,  and 
chemical  stimuli  the  heart. 

11.  "  That  the  heait  obeys  a  much  less  powerful  stimulus  applied  to 
the  brain  and  spinal  marrow  than  the  muscles  of  voluntary  motion  do. 

12.  "  That  stimuli  applied  to  the  brain  and  spinal  maiTow  excite 
irregular  action  in  the  muscles  of  voluntary  motion. 

13.  "  That  no  stimulus  applied  to  the  brain  and  spinal  marrow  ex- 
cites irregular  action  in  the  heart  or  vessels  of  circulation,  nor  is  their 
action  rendered  irregular  by  sedatives,  unless  a  blow,  which  crushes  a 
considerable  part  of  the  brain  or  spinal  marrow,  be  regarded  as  a  sed- 
ative. 

14.  "  That  the  excitement  of  the  muscles  of  voluntary  motion  takes 
place  chiefly  at  the  moment  at  which  the  stimulus  is  applied  to  the 
brain  and  spinal  marrow,  while  that  of  the  heart  may  generally  be  per- 
ceived as  long  as  the  stimulus  is  applied. 

15.  "  That  after  all  stimuli  applied  to  the  brain  and  spinal  marrow 
fail  to  excite  the  muscles  of  voluntary  motion,  both  mechanical  and 
chemical  stimuli,  so  applied,  still  excite  the  heart. 

16.  "  That  the  vessels  of  secretion,  like  the  vessels  of  circulation, 
are  independent  of,  but  influenced  by,  the  nervous  system. 

17.  "  That  the  peristaltic  motion  of  the  stomach  and  intestines  is 
independent  of  the  nervous  system,  [excepting  its  stimulus  ^  478  i]. 

18.  "  That  their  motion  is  capable  of  being  influenced  through  the 
nervous  system. 

19.  "  That  the  stomach  and  lungs,  like  the  sanguiferous  system,  are 
influenced  by  every  part  of  the  brain  and  spinal  marrow. 

20.  "  That  the  proof  of  the  vessels  possessing  a  principle  of  motion  in 
dependent  of  their  elasticity,  which  bears  the  same  relation  to  the  ner- 
vous system  as  the  excitability  of  the  heart,  not  only  as  far  as  respects 
the  kind  of  influence  which  they  derive  from  that  system,  and  the 
way  in  which  it  is  supplied  to  them,  but  also  as  far  as  respects  the  pur- 
poses for  which  it  seems  to  be  bestowed  on  them,  affords  a  strong  ar- 
gument for  believing  that  this  power  is  of  the  same  nature  with  thaf 

)f  the  heart." 


PHYSIOLOGY. FUNCTIONS.  311 

493,  a.  It  is  remarkable  that  the  sagacious  mind  of  Dr.  Philip  should 
have  fallen  into  the  error  of  deducing  fi-om  his  experiments  the  iden- 
tity of  galvanism  and  the  nervous  power,  and  the  dependence  of  the 
secreted  substances  upon  that  principle.  "  The  vessels  of  secretion," 
he  says,  "  only  convey  the  fluids  to  he  operated  upon  by  the  nervous  in- 
fluence." Here  the  "  influence"  is  regarded  strictly  as  a  chemical 
agent.  But,  at  the  same  time,  he  unavoidably  concludes  that  "the 
vessels  of  secretion,  like  the  vessels  of  circulation,  are  independent  of, 
but  influenced  by,  the  nervous  system  ;"  galvanism,  however,  being 
the  supposed  agent  in  all  the  cases.*  And  yet  Dr.  Philip,  through 
the  light  of  galvanism,  is  led  to  the  contradictory  statement,  "  that, 
although  the  powers  of  circulation  are  independent  of  the  nervous 
system,  those  of  secretion  are  very  far  from  being  so."  And,  as  to 
the  products  themselves,  had  he,  or  had  others  subsequently,  consid 
ered  the  simplicity  of  the  laws  of  Nature,  and  the  remarkable  Unity 
of  Design  which  prevails  in  the  fundamental  constitution  of  all  organic 
jDeings,  from  the  humblest  plant  up  to  man,  it  never  could  have  been 
entertained  that  the  powers  which  circulate  the  blood,  like  those  of 
the  sap  in  the  vegetable  kingdom,  and  govera  the  action  of  the  secre- 
ting vessels,  are  not  derived  from  the  nervous  system,  and  yet  that  the 
formation  of  the  secreted  products  is  the  work  of  the  nerves.  There 
is  nowhere  in  Nature  so  great  a  violation  of  consistency ;  while,  also, 
/secretion  is  just  as  much  a  function  of  vegetables  as  of  animals  (§  638). 
I  am  not,  however,  unmindful  of  the  indisposition  to  predicate  of  final 
causes,  or  of  any  obvious  Design,  the  intentions  to  be  fulfilled,  or  any 
principle  in  philosophy  which  maybe  involved  in  the  Plans  of  the  Cre- 
ator (§  350y,  kk).  But,  since  every  thing  in  nature  emanates  from  its 
fundamental  constitution,  I  can  have  little  doubt  that  we  shall  be  grad- 
ually led  to  recognize  the  connection  of  philosophy  with  the  Works 
of  its  Author,  and  to  acknowledge  that  in  all  philosophy  we  are  em- 
ployed in  seeking  out  the  Institutions  which  He  spoke  into  existence, 
and  in  doing  which  we  may  derive  much  assistance  from  going  be- 
yond the  immediate  phenomena,  and  thus,  also,  render  philosophy 
and  natural  Religion,  and  of  course,  therefore,  Revelation,  subservient 
to  each  other, 

493,  b.  Dr.  Philip  also  adopted  the  eiTor,  which  had  been  long 
propagated,  of  regarding  the  brain  as  a  mere  galvanic  battery,  and 
of  course  designed  for  the  generation  of  galvanic  fluid,  and  thus  gave 
a  farther  impulse  to  those  chemical  hypotheses  of  life  which  have  so 
extensively  usurped  the  place  of  medical  philosophy,  was  compelled 
to  embrace  these  hypotheses  himself,  and  thus  to  advance  the  very 
eiTors  which  have  contributed  to  obscure  the  light  which  his  experi- 
ments reflect  upon  every  department  of  medicine  (§  350,  nos.  5,  18- 
20,  42).  It  was  his  misfortune  to  have  come  upon  the  stage  just  at 
the  overthrow  of  that  philosophy  which  had  been  so  highly  advanced 
by  Hunter,  Bichat,  Cullen,  and  their  compeers,  and  the  revival  of  the 
exploded  physical  and  chemical  doctrines  of  life,  and  of  the  humoral 
pathology.     But  his  experiments  must  endure  forever. 

493,  c.  Again,  having  assumed  that  "  the  brain  and  spinal  marrow 
are  necessary  to  the  function  of  secretion,"  Philip  raises  an  objection 
vvrhich  he  foresaw  would  prevail.     This  objection  consists  in  the  ma- 

*  See  Medical  and  Physiological  Commentaries,  vol.  i.,  p.  52-68,  107-119,  where  the 
snbjcct  of  galvanism  is  ftiUy  examined. 


318  INSTITUTES    OF    MEDICINE. 

turily  of  the  foetus  without  brain  and  spinal  cord ;  and  to  defend  tb^ 
chemical  hypothesis,  and  the  assumed  identity  of  the  nervous  power 
and  galvanism,  and  neglecting  the  sympathetic  nerve,  he  assumes,  that, 
when  the  brain  and  spinal  marrow  are  absent,  the  uterus  performs  the 
functions  of  those  parts  to  the  foetus ;  that  is,  it  acts  exactly  as  the 
brain  and  spinal  cord  in  supplying  the  nervous  power.*  But  this  con- 
jecture, independently  of  the  absence  of  every  fact,  is  contradicted  by 
the  total  want  of  the  requisite  analogy  between  these  two  systems  of 
organs.  To  give  gi-eater  plausibility  to  the  hypothesis,  Philip  remarks, 
that  "  no  writer  has  before  attempted  to  explain  the  difficulty." 

493,  cc  I  shall  have  introduced  many  flicts  to  disprove  the  depend- 
ence of  animal  products  upon  galvanism  or  catalysis.  The  agency 
of  the  former,  as  we  have  seen,  is  positively  contradicted  by  the  fact 
that  plants,  which  are  destitute  of  nerves,  generate  compounds  very 
similar  to  animal  (§  409  hli) ;  and  farther  on  is  an  argument  drawn 
from  the  electrical  circle  (§  893  a).  Again,  cerebro-spinal  nerves  sim- 
ply excite  the  voluntary  muscles,  while  the  sympathetic  not  only  excites 
the  organic  muscular  tissue,  but  exerts  a  peculiar  vitalizing  influence 
upon  the  organic  products  (§  893^).  Now,  I  submit  that  no  reason 
can  be  assigned  why  galvanism  should,  according  to  Chemistry,  act  as 
a  decompounding  agent  upon  the  blood  when  exercised  through  the 
sympathetic  nerve,  but  not  through  cerebro-spinal  nerves — especially 
as  Chemistry  alleges  that  it  is  an  oxydizing  agent  of  all  muscular  fibre. 
It  need  scarcely  be  added  that  whatever  nervous  influence  is  exerted 
upon  the  blood,  it  is,  in  all  parts,  through  the  sympathetic  nerve  (§ 
111-117,  224,  226,  356  a,  409  lih,  h,  456  a,  461,  475^,  488|,  893i). 

493,  d.  Moreover,  the  eminent  man  who  has  contributed  so  largely 
to  the  philosophy  of  life  falls  into  another  common  error  now  taught 
by  the  schools.  Thus  :  "  It  is  not  to  be  overlooked,"  he  says,  "  that 
the  vessels  convey  the  fluids  to  be  operated  upon  by  the  extreme  parts 
of  the  nervous  system  in  a  peculiar  Avay.  By  the  diminished  capacities 
of  the  capillary  vessels  the  blood  is  divided  as  by  a  fine  strainer,  some  of 
its  parts  being  too  gross  to  enter  the  smaller  vessels."  "  This,"  he  adds, 
"  is  necessary  to  prepare  the  blood  for  the  due  action  of  the  nervous 
influence"  (§  188,  &c.,  399,  408-411,  748). 

Now,  what  can  be  more  inadmissible  than  the  comparison  of  the  liv- 
ing, organized  vessels,  whose  actions  are  j^roved  by  Dr.  Philip  to  be  in- 
fluenced by  the  nervous  power,  to  a  set  of  dead,  inorganic  tubes  ? 

In  consequence  of  the  foregoing  mechanical  hypothesis.  Dr.  Philip  is 
compelled  to  give  in  his  adhesion  to  the  present  physical  doctrines  of 
inflammation,  as  set  forth  in  the  sequel  (§  748,  &c.).  This,  too,  may 
be  regarded  as  a  principal  reason  why  his  experiments  have  not  been 
applied  to  the  philosophy  of  disease  and  therapeutics  (§  476  a). 

Philip  thus  lost  the  opportunity  of  applying  his  observations  to  any 
useful  or  practical  purpose.  Nevertheless,  his  very  misapprehension 
of  their  true  import,  and  his  diversion  from  the  path  of  Nature,  impart 
to  them  that  inestimable  value  which  belongs  to  the  conviction  that 
the  facts  lead  only  to  the  truth  where  they  were  intended  for  the  sup- 
port of  error  (§  5^,  188^  d). — See  Rights  of  Authors,  p.  912. 

494,  a.  In  concluding  this  important  subject,  I  shall  bring  up  the 

late  experiments  by  Van  Deen,  Stilling,  Budge,  and  others,  by  which 

those  of  Philip  have  been  again  confirmed,  and  the  results  extended. 

*  This  ma}-  he  placed  in  the  same  category  as  some  other  "vicarious  functions" 
of  distinguished  physiologists,  as  in  §  83  6,  1086. 


PHYSIOLOGY. FUNCTIONS.  3J9 

It  will  be  seen  that  they  have  a  very  specific  bearing  upon  the  doctrines 
of  humoralism  (§  819,  &c.),  and  upon  the  modus  operandi  of  morbific 
and  remedial  agents  (§  893,  &c.).  It  might  have  been  useful  to  have 
stated  them  in  immediate  connection  with  either  of  those  subjects; 
but  they  should  form  a  part  of  the  combined  force  which  marches  in 
advance  upon  the  regular  plan  of  organization. 

494,  b.  Exp. — After  Fontana  had  made  more  than  6000  experiments, 
in  which  he  employed  more  than  3000  vipers,  and  caused  to  be  bitten 
more  than  4000  animals,  to  extort  the  conclusion  that  the  poison  of  the 
viper  kills  all  animals  by  acting  upon  the  blood,  the  whole  of  those 
6000  experiments  were  overturned  by  a  single  one  by  Girtanner; 
ehowing  that  the  poison  will  kill  frogs  entirely  deprived  of  blood  in  as 
short  a  time  as  it  kills  those  which  have  not  lost  their  blood. 

The  conclusive  nature  of  Girtanner's  experiment  has  been  entirely 
disregarded  by  subsequent  humoralists,  whether  as  it  respects  the  oper- 
ation of  morbific,  or  of  remedial  agents  ;  or  more  probably  the  experi- 
,ment  is  unknown  to  most,  or  forgotten. — Note  Aaa  p.  1146. 

The  late  experiments  by  Van  Deen  and  Stilling  are  of  the  same 
import  as  Girtanner's,  and  again  call  upon  physiologists  to  return 
upon  the  path  of  nature.  Of  these  experiments  I  shall  present  one  or 
two  only,  as  being  sufficient  for  every  intelligible  purpose  connected 
with  my  subject. — Note  B  p.  1113. 

It  should  be  premised,  that  when  all  the  viscera,  the  heart,  blood- 
vessels, &c.,  are  removed  from  frogs,  so  that  nothing  remains  but  bones, 
muscle,  and  nerves  (as  was  done  in  Girtanner's  experiment),  the  ani- 
mal will  hop  about  for  half  an  hour,  and  appear  in  all  respects  as  nat- 
ural as  in  its  perfect  state.     (See,  also,  Spallanzani,  §  441,^) 

494,  c.  Ex}). — The  frogs  being  thus  completely  eviscerated,  and  all 
vascular  connections  with  the  spinal  cord  destroyed.  Van  Deen  di- 
vided the  cord  through  the  third  vertebra,  "and  then  introduced  within 
the  mouth  a  drop  or  two  of  the  acetate  of  strychnia.  In  a  few  min- 
utes, the  parts  above  the  section  of  the  cord  were  affected  with  spasm, 
while  those  below  were  unaffected. 

494,  d.  ExjJ. — Again,  Stilling  also  eviscerated  many  frogs,  after  the 
foregoing  manner,  and,  on  applying  acetic  acid  to  the  skin,  as  late  as 
half  an  hour  after  the  evisceration,  he  excited  reflex  movements. 

494,  (id.  Observe,  too,  how  an  important  modification  of  these  ex- 
periments goes  to  the  same  conclusion.  Stilling  exposed  the  spinal 
cord  of  a  frog  thus  completely  eviscerated,  and  touched  it  with  a  so- 
lution of  the  acetate  of  strychnia,  which  gave  rise  to  the  same  gen- 
eral tetanus  as  when  strychnia  was  applied  to  the  mouth  or  skin. 
Even  an  isolated  portion  of  the  cord  would  give  rise  to  spasm  in  parts 
supplied  by  that  portion,  on  being  touched  with  the  solution.  From 
this  fact,  Stilling  draws  the  conclusion,  that  if  the  cord  be  divided  in 
numerous  places,  each  portion  is  a  nervous  system  in  itself,  and  capa- 
ble of  transmitting  influences  through  communicating  motor  nerves, 
independently  of  the  brain,  or  of  other  parts  of  the  cord  (§  459,  828). 

In  the  foregoing  experiments,  which  are  only  examples  of  a  great 
variety  by  the  same  physiologists,  we  have  another  full  confirmation 
of  the  preceding  ones  by  Philip  with  the  additional  advantage  of  oth- 
er agents  to  obtain  th(i  corresponding  results.  Nor  will  the  reader 
fail  to  observe  that  the  same  remarkable  phenomena  occurred  in  the 
eviscerated  frogs  when  acetic  acid  was  applied  to  the  skifi  as  when  the 


S20  INSTITUTES    OF    MEDICINE. 

acetate  of  strychnia  was  applied  within  the  mouth,  as  in  Van  Deen's 
experiment  (§  494,  c).  This  is  an  important  element  in  interpreting 
the  sympathetic  influences  of  remedial  and  morbific  agents  when  ap- 
plied to  the  surface  of  the  body(i^  1088  b). 

It  will  be  also  seen  that  the  foregoing  experiments  upon  the  skin 
coincide  with  those  by  Alston,  made  in  1733  (§  484).* 

These  observations  put  at  rest  Midler's  interpretation  of  the  action 
of  prussic  acid  in  producing  instantaneous  death  when  a  drop  is  ap- 
plied to  the  tongue,  and  which  has  been  extensively  employed  by  the 
humoralists  to  preserve  the  purity  of  their  doctrines.  The  more  we 
consider  the  profound  familiarity  of  the  Berlin  Philosopher  with  the 
laws  of  the  physirological  state  of  the  nervous  system,  and  his  full  rec- 
ognition of  the  vital  principle  and  all  its  attributes,  the  more  are  we 
surprised  at  his  universal  doctrine  of  physical  absorption,  and  his  ex- 
treme defense  of  the  humoral  pathology,  as  evinced  in  the  following 
extract  from  his  Elements  of  Vhysiology.     Thus  : 

"  The  rapid  effects  of  prussic  acid  can  only  be  explained  by  its  pos- 
sessing gi-eat  volatility  and  power  of  expansion,  by  which  it  is  enabled 
to  diffuse  itself  ilirougTi  the  blood  more  rapidly  than  that  fluid  circu- 
lates, to  permeate  the  animal  tissues  very  quickly,  and  in  a  manner 
independent  of  its  distribution  by  means  of  the  blood,"  &c.  And  yet, 
in  the  same  paragraph  he  states  that  nux  vomica,  which  is  not  vola- 
tile, will  produce  the  same  speedy  death  (§  500  c,  826  c,  827  d.  Also, 
Med.  and  Phys.  Comm.,  vol.  i.,  p.  565,  569,  text  and  notes). 

And  again,  says  Miiller,  "  My  experiments,  as  well  as  many  others, 
instituted  by  well-known  physiologists,  prove  that,  before  narcotic 
poisons  can  exert  their  general  effects  on  the  nervous  system,  they 
must  enter  the  circulation"  (^  657,  827  J-829,  904  b,  1032  d,  1066). 

Miiller's  doctrine,  I  may  also  say,  that  the  absorbent  vessels  have 
no  visible  orifices,  and  his  physiological  construction  of  their  func- 
tion, leads  him  to  the  propagation  of  errors  which  have  vitiated  the 
whole  fabric  of  physiology  and  medicine.  The  doctrine  may  be  sum- 
marily expressed  in  the  following  language  of  its  author.     Thus  : 

"  The  primary  phenomenon  of  the  immediate  absorption  of  sub- 
stances in  solution  into  the  blood  is  \he  jjcrmeation  of  animal  tissues 
by  the  fluids.  The  property  of  permeation  by  fluids  possessed  by 
tissues,  even  after  death,  depends  upon  their  invisible  porosity,  and  is 
termed  imbibition^  Some  of  the  consequences  may  be  seen  in  sec- 
tions 289,  291,  350,  no.  24,  350^  n,  514^  h.—See  §  1089. 

494,  e.  What  I  have  now  stated  of  the  experiments  by  Van  Deen 
and  Stilling  relates  particularly  to  influences  exerted  in  animal  life, 
though,  like  Philip,  they  have  corresponding  experiments  in  organic 
life.  These  it  would  be  superfluous  to  repeat,  especially  as  some  of 
the  foregoing  involve  a  complex  agency  of  the  ganglionic  nerve  (§  516, 
no.  13). 

Budge,  however,  has  lately  made  a  multitude  of  experiments  witli 
a  view  to  the  physiological  relations  of  the  cerebro-spinal  and  sympa- 
thetic systems.  There  is  novelty  about  them,  and  they  go  far  in  sus- 
taining my  philosophy  of  remote  sympathy,  and  in  all  its  wonderful 
details,  and  in  corroborating  that  philosophy  which  I  originally  set 
forth  in  the  "  Commentaries"  as  to  the  modus  operandi  of  morbific  and 
remedial  agents  (Rights  of  Authors,  p.  915), — Note  Aaa  p.  1146. 

It  will  be  observed,  also,  of  Budge's  experiments,  that  they  are  anal- 

•  Whttt's  experiment  of  killing  froj^a  deprivecl  of  heart  by  giving  them  opium  (1755)  ia  also  per- 
fectly conclusive  against  absorption  by  the  intestine — Works,  4to,  p.  SOO-302,  310, 320. 


PHYSIOLOGY. FUNCTIONS.  321 

ogous  to  those  which  have  been  made  by  introducing  different  agents 
into  the  stomach  capable  of  affecting  the  great  nervous  centres,  and 
thus  deducing  the  special  influences  of  certain  functions  of  the  brain 
upon  distant  parts.  The  experiments  in  which  the  nervous  centres 
were  irritated  should  be,  particularly,  compared  with  those  by  Philip, 
in  which  he  employed  alcohol  and  tobacco.     Thus  : 

Exp. — The  heart  of  a  frog  having  ceased  to  beat  but  once  in  four- 
teen seconds,  the  anterior  cords  of  the  cervical  portion  of  the  spinal 
marrow  and  of  the  medulla  oblongata  were  imtated,  when  the  heart 
beat  once  in  three  seconds.  On  first  irritating  the  posterior  cords,  no 
effect  ensued.  In  other  experiments  the  action  of  the  heart  was  re- 
stored, after  it  had  ceased  to  beat,  by  irritating  the  anterior  cords  of 
the  medulla  oblongata  with  a  needle,  or  by  caustic  potash.  So,  also, 
irritation  of  the  corpus  callosum  reproduced  the  actions  of  the  heart. 
Irritation  of  the  cerebellum  restored  the  movements  of  the  stomach, 
and  brought  on  vigorous  contractions  of  the  colon  and  urinary  bladder. 
The  last  two  organs  were  also  affected  in  the  same  way  by  irritating 
the  anterior  part  of  the  spinal  cord  (p.  303,  ^  481  e,  Exp.  15). 

The  young  student  should  be  careful  not  to  confound  these  move 
ments  with  those  of  continuous  sympathy,  as  exhibited  in  §  498,  &c. 
The  foregoing  are  effected  by  a  determination  of  the  nervous  power 
upon  the  organic  properties  of  the  several  parts  (§  222,  &c.). 

IV.    OF    THE    VARIETIES    OR   KINDS    OF    SYMPATHY. 

495.  We  have  hitherto  seen  that  the  several  properties  of  life  are 
distinguished  by  remarkable  modifications,  and  that  in  some  of  the 
instances  the  varieties  are  so  great  as  to  amount  to  distinctions  in 
kind  (§  133-163,  175,  177,  185,  190,  191,  197,  200,  215,  217,  219, 
220,  226-230).  And  so,  also,  more  or  less,  of  the  functions.  The 
same  rule  obtains  as  to  sympathy,  this  function  having  been  divided 
by  Mr.  Hunter  into  remote,  contiguous,  and  contimious  (§  452,  &c.). 

496.  Remote  sympathy  is  the  principal  condition  of  the  function. 
Its  office  is  the  transmission  of  impressions,  whether  natural,  morbif- 
ic, or  remedial,  to  and  from  parts  separate  from  each  other,  or  differ- 
ent parts  of  a  compound  organ,  or  through  which  the  nervous  influ- 
ence is  determined  on  parts  which  receive  the  primary  impressions, 
or  when  that  influence  proceeds  from  direct  impressions,  physical  or 
mental,  upon  the  cerebro-spinal  system  itself  (§  230).  In  the  last  case, 
the  rationale  of  the  function  is  very  analogous  to  that  of  voluntary 
motion  (§  233).    In  the  former,  it  is  reflex  action  of  the  nervous  system. 

497.  Contiguous  sympathy  is  a  circumscribed  condition  of  re- 
mote sympathy.  Its  peculiarity  is  shown  by  the  effects  of  blisters, 
leeches,  and  various  other  external  applications,  in  relieving  internal 
disease,  in  proportion  as  they  are  applied  most  immediately  over  the 
internal  part.  Doubtless  the  centre  of  this  kind  of  sympathy,  or 
where  the  nervous  power  is  excited  and  reflected,  is  the  ganglia 
of  the  ganglionic  system,  or  perhaps  some  plexus  of  nerves,  or  some 
parts  of  the  sympathetic  nerve  itself  (§  473,  no.  2,  c  ;  ^  516  d,  893  a, 
905).  It  should  be  observed,  however,  in  these  cases,  that  remote 
sympathy,  in  its  clear  acceptation,  is  brought  into  action  (^  1038). 

ITie  apparent  effects  of  contiguous  sympathy,  however,  may  be 
sometimes  explained,  especially  in  consecutive  morbid  processes,  by 

X 


322  INSTITUTES    OF    MEDICINE. 

the  irritation  from  enlarged  vessels,  or  from  effusions  of  coagulable 
lymph,  or  dryness  of  surface,  &c.,  as  in  pleurisy  and  ophthalmia, 

498,  a.  Continuous  sympathy  is  independent  of  the  nerves,  except 
as  they  enter  into  compound  tissues.  It  is  most  strongly  pronounced 
when  unusual  stimuli  operate,  and  it  always  occurs  in  the  tissue,  or 
another  continuous  with  it,  upon  which  the  primary  impression  is 
made.     I  would  prefer  calling  it  continuous  influence  (^  1042). 

498,  h.  Its  mode  of  propagation  consists  in  the  condition  of  a  par- 
ticular part  of  a  tissue,  where  some  impression  is  made  upon  the  or- 
ganic properties,  being  extended  to  other  paits  continuous  with  it,  in 
uninterrupted  succession ;  though  the  changes  may  be  much  more  in- 
tense in  some  parts  of  the  tissue  than  in  others  (§  516,  no.  2). 

498,  c.  In  the  natural  condition  of  the  being  the  operation  of  this 
principle  is  strikingly  manifested  in  the  various  sensible  motions  of 
plants.     For  example, 

"  To  excite  the  motion  of  the  leaflets  and  petiole  of  the  mimosa,  it 
is  not  necessary  that  either  the  intumescence  itself,  or  even  the  leaves, 
should  be  touched.  The  stimulus  may  be  applied  to  a  more  or  less 
distant  part.  Even  the  roots  transmit  the  excitation  to  the  leaves. 
M.  Dutrochet  moistened  a  small  portion  of  the  roots  of  the  mimosa 
with  sulphuric  acid,  and,  before  there  was  time  for  the  absorption  of  the 
acid  to  have  taken  place,  the  leaves  became  folded"  (§  289). — Mul- 
i-er's  Physiology. 

And  yet  we  learn  from  able  physiologists  that  the  whole  connect- 
ed movements  of  plants,  in  their  circulation,  and  other  organic  ac- 
tions, depend  upon  purely  physical  causes  (§  257,  261,  289-291,  293, 
294,  303,  304,  1053-1055). 

498,  d.  In  the  animal  body,  I  have  shown  that  the  contractions  and 
dilatations  of  the  veins  are  greatly  owing  to  continuous  sympathy,  the 
immediate  exciting  causes  consisting  in  the  existing  state  of  the  com- 
municating arteries  and  the  variable  quantities  of  transmitted  blood. 
Here,  too,  as  in  the  circulation  of  the  sap,  the  propagation  of  the  con- 
tinuous sympathy  or  continuous  influence  is  exceedingly  rapid,  and 
results  in  a  corresponding  development  of  motion  (§  794,  795). 

498,  e.  Again,  as  exemplifying  the  existence  of  continuous  sympa- 
thy, and  its  independence  of  proper  nervous  action,  take  another  fact 
from  the  animal  kingdom,  showing  the  action  of  other  stimuli ; 

In  the  heart  of  many  animals,  "  cut  out  and  left  undisturbed  until 
the  frequency  of  its  beats  shall  have  so  far  diminished  that  considera- 
ble intervals  intervene  between  the  contractions  (or  if  it  have  entirely 
ceased  to  beat),  mechanical  irritation  by  means  of  a  needle  excites  a 
contraction  which  cannot  be  confounded  with  the  regular  beats;  and, 
at  whatever  part  the  irritation  be  applied,  the  reaction  is  the  same  as 
if  the  whole  heart  had  been  irritated ;  that  is  to  say,  there  ensues  a 
contraction  not  at  one  point  only,  but  of  the  whole  organ." — Muller's 
Physiol.  A  central  ganglion  would  be  necessary  to  nervous  action.* 
Bichat  says  of  the  foregoing  experiment,  if  the  action  of  the  heart 
be  allowed  to  cease  entirely,  and  the  organ  be  then  pricked,  it  will 
not  only  begin  to  act  again,  but  that  a  dilatation  of  the  cavities  will 
sometimes  take  place  first.  The  action,  too,  may  not  begin  till  some 
seconds  after  the  part  is  irritated  (§264,265,  475^,  516  d,  637,  647^). 
498, y.  Continuous  sympathy  is  an  important  element  in  the  physi 
ology  of  disease  and  of  therapeutics.  This  is  conspicuously  seen  in 
*  See  Notes  A  p,  1111,  Bb  p.  1131. 


PHYSIOLOGY. FUiSrCTIONS.  323 

the  propagation  of  inflammation  from  a  central  point.  In  a  thera- 
peutical sense,  it  is  seen  in  the  relief  of  hepatic  congestions  by  leech- 
es applied  to  the  anus ;  when,  besides  the  direct  effect  from  loss  of 
blood,  the  peculiar  vital  impression  which  is  made  upon  the  organic 
properties  of  the  mucous  tissue  of  the  rectum  by  this  mode  of  ab- 
stracting blood  is  propagated  progressively  along  the  whole  tract  of 
the  membrane  up  to  the  duct  of  the  liver,  along  which  it  is  extended 
to  the  organ  itself,  whose  secretion  is  thus,  in  part,  increased,  and  the 
organ  otherwise  brought  under  a  salutary  influence.  But,  it  is  also 
true,  that  the  imjjression  which  is  made  upon  the  intestinal  mucous 
membrane  is  propagated  to  the  brain  and  spinal  cord  by  way  of  the 
sympathetic  nerve,  from  whence  the  nervous  power  is  reflected  upon 
the  liver,  skin,  &c.,  with  a  salutary  effect,  through  the  motor  fibres  of 
the  same  nerve  ;  and  thus  remote  sympathy  is  simultaneously  brought 
into  operation  (§  523,  no.  6.  Also,  Medical  and  Physiological  Com- 
mentaries, vol.  i.,  p.  135,  &c.). — Rights  of  Authors,  p.  912. 

498,  g.  The  continuous  impression,  in  the  foregoing  case,  upon  the 
intestinal  mucous  membrane,  is  equivalent,  in  principle,  to  that  which 
is  produced  by  cathartics  ;  so  that  reflex'  nervous  influences  may 
be  propagated  from  all  parts  of  the  canal,  as  well  as  from  the  verge 
of  the  anus.  Exactly  the  same  order  of  influences  springs  from  ene- 
mas and  suppositories,  whether  of  a  sedative  or  purgative  nature 
(§  526).  In  all  the  cases,  the  functions  of  the  liver  are  reached 
through  the  instrumentality  of  the  intestinal  mucous  tissue,  just  as 
mechanical  irritations  of  the  conjunctiva,  or  of  the  membrane  of  the 
mouth,  affect  the  lachrymal,  or  the  salivary  glands  (§  923,  524  a).* 

498,  h.  Whether  continuous  sympathy  will  give  rise  to  reflex  nerv- 
ous actions,  and  to  what  extent,  will  depend  greatly  upon  the  nature  of 
the  causes  and  the  tissue  affected  (§  135-152).  It  is  strongly  mani- 
fested in  all  irritations  of  the  alimentary  mucous  tissue,  but  is  seen  but 
little  or  not  at  all  in  irritations  of  the  muscular  tissue,  animal  or  organic. 

499,  The  brain  and  spinal  cord  are,  therefore,  the  sources  of  gen- 
eral reflex  nervous  action ;  but  the  ganglionic  system  not  only  partici- 
pates in  all  the  reflected  actions  upon  the  organic  viscera  when  pro- 
ceeding from  the  cerebro-spinal,  but  supplies  in  its  ganglia,  plexuses, 
«S:c.,  local  centres  of  reflex  action  known  as  contiguous  sympathy  (§ 
455,  456  a,  458,  459,  473  c,  478  b,  483  c,  490,  893  a,  905  a). 

500,  a.  Remote  sympathy  may  depend  either  upon  impressions 
made  upon  the  sensibility  of  parts  distant  from  the  nervous  centres, 
or  directly  upon  the  centres  themselves.  In  one  case  the  function  is 
associated  with  sympathetic  sensation,  in  the  other  it  is  not  (§  451). 

500,  b.  When  made  upon  distant  parts,  the  impression  is  transmit- 
ted to  the  nervous  centres  through  nerves  of  sensation  or  the  sensitive 
fibres  of  compound  nerves,  and  brings  the  nervous  power  in  those 
centres  into  unusual  operation,  from  which  this  power  is  reflected 
through  nerves  of  motion,  or  the  motor  fibres  of  compound  nerves, 
upon  the  irritability  of  other  parts,  or  of  the  part  which  sustained  the 
primary  impression,  and  thus  gives  rise  to  those  various  results  which 
are  the  prominent  phenomena  of  reflex  nervous  action  (§  455  d,  464- 
471),  and  which  for  brevity,  I  call  remote  sympathy,  or  sympathy. 

500,  c.  The  ordinary  results  of  remote  sympathy  will  follow  im- 
pressions made  directly  upon  the  nervous  centres,  and,  indeed,  upon 
the  trunks  of  nerves  (§  474,  507).  These  impressions  maybe  made 
*  See  Note  U  p.  1126. 


.324  INSTITUTES    OF    MEDICINE. 

upon  the  brain  and  spinal  cord,  and  by  all  kinds  of  physical  agents, 
and  by  the  mind  and  its  passions.  The  physical  and  the  mental 
are  alike  operative.  They  rouse  the  nervous  power,  and  modify 
't  according  to  the  nature  of  the  cause,  as  in  the  former  case  (Z») ; 
when  it  is  transmitted  to  other  parts,  as  in  the  more  complex 
process  (§  222-233,  476-492).  If  the  brain  or  spinal  cord  be  ir- 
ritated by  the  direct  application  of  alcohol,  it  will  increase  the  ac- 
tion of  the  heart  and  blood-vessels ;  or,  on  the  contrary,  their  action 
will  be  diminished  by  the  application  of  tobacco,  opium,  &c.  (§  476, 
&c.).  And  just  so  with  the  different  passions,  and  emotions.  Jo) 
produces  a  lively  action  of  the  heart  and  all  the  cutaneous  vessels ; 
anger  a  more  violent  state  of  general  arterial  excitement ;  shame  suf 
fuses  the  face  in  one  way,  and  love  in  another ;  fear  subdues  the  ac- 
tion of  the  heart  and  capillaries,  induces  palpitation,  covers  the  body 
with  a  cold  sweat,  and  leads  to  unwonted  micturition ;  jealousy  is  at- 
tended by  other  remarkable  results  in  organic  life ;  grief  undermines 
digestion,  &c.  Disgusting  sights,  like  emetics,  produce  vomiting,  as 
will  even  their  recollection.  These  cases  are  all  coincident  with 
those  in  which  organic  actions  are  influenced  by  irritating  the  brain 
or  spinal  cord  mechanically,  and  involve  exactly  the  same  essential 
principle  which  is  concerned  in  the  most  complex  processes  of  reflex 
nervous  action  (^  476,  &c.,  508),     I  call  it  direct  action  (^  227). 

500,  d.  The  operation  of  the  will,  in  producing  voluntary  motion, 
follows  the  same  rule  as  that  of  the  passions.  Each  is  equally  a  cause 
of  development  of  the  nervous  power.  The  will  merely  acts  as  a  stim- 
ulus to  the  brain,  by  which  the  nervous  power  is  developed  and  trans- 
mitted to  the  voluntary  muscles,  where,  by  its  operation  upon  mobil- 
ity, through  irritability,  voluntary  motion  is  produced  (§  215,  226,  233, 
243-246,  258,  467,  476  c,  8181,  1072  h). 

"  Irritability,"  says  the  able  Macbride,  "  is  to  be  held  as  a  requi 
site  foundation  for  the  power  of  voluntary  motion ;  for,  if  we  may  be 
allowed  to  make  a  comparison,  the  soul  would  be  no  more  capable 
of  moving  any  particular  muscle,  or  set  of  muscles,  if  their  fibres,  in 
general,  had  not  the  property  of  irritability,  than  a  musician  would  be 
capable  of  bringing  music  out  of  a  violin,  if  its  strings  were  not  en- 
dowed with  the  property  of  elasticity"  (§  189,  206). 

And  this  shows,  us,  also,  the  final  cause  of  the  exquisite  endowment 
of  all  muscles  in  organic  and  animal  life  with  ii-ritability,  while  they 
possess  only  a  low  degree  of  sensibility  (§  193,  206). 

We  thus  see,  too,  another  remarkable  exemplification  of  the  man- 
ner in  which  the  nervous  power  is  so  excited  by  the  nature  of  the  ex- 
citing cause  that  it  shall  give  rise  to  voluntary  motion.  That  the  will 
acts  as  a  stimulus,  only,  to  the  brain,  and  that  voluntary  motion  is  ex- 
cited by  the  stimulus  of  the  nervous  power  is  manifest  from  the  co- 
incidence between  voluntary  motion  and  the  spasmodic  affections  of 
the  same  muscles  that  arise  from  irritations  of  the  gums  or  of  the  in- 
testinal canal.  The  same  is  shown  by  the  spasmodic  actions  induced 
by  nux  vomica,  in  paralytic  affections ;  which  also  illustrates  the  dis- 
tinction between  irritability  and  sensibility,  and  shows  that  motion 
is  effected  by  the  organic  properties  (^  184  a,  188,  193,  195,  206,  208). 
In  this  case,  sensibility  may  be  very  obtuse  in  the  affected  limb,  while 
the  agent  will  exert  a  greater  spasmodic  effect  on  the  paralyzed  than 
on  the  sound  muscles.     This  greater  effect  is  owing  to  the  morbid 


PHYSIOLOGY. FUNCTIONS.  325 

development  of  irritability.  And  what  farther  illustrates  the  philoso- 
phy as  to  the  action  of  the  nervous  power  upon  irritability  in  rousing 
paralyzed  muscles,  is  the  opposite  effect  of  conia ;  for,  in  this  case^ 
conia  paralyzes  the  muscles  without  impairing  sensibility  (§  487,^^). 

In  all  these  cases  of  spasmodic  action  the  irritations  are  propac^a- 
ted  upon  the  cerebro-spinal  axis,  and  prove  an  exciting  cause  of  the 
nervous  power;  in  the  case  of  the  will  the  irritation  is  direct  in  its 
analogous  function  of  voluntary  motion.  But  the  coincidence  is  more 
perfect  between  the  voluntary  movements  and  the  involuntary  ones  that 
are  consequent  upon  irritations  of  the  brain  or  spinal  cord,  as  in  Philip's 
Experiments,  where  the  physical  irritations  are  direct,  and,  therefore, 
upon  common  ground  with  the  will  and  the  passions  (§  477,  &c.). 

500,  dd.  The  action  of  the  will  generally  terminates  in  the  muscles 
moved,  but  gives  rise  to  reflex  actions  in  roosting,  &c.,  by  placing  the 
muscles  in  a  rigid  position,  which  acts  as  an  exciting  cause.*  Mental 
emotions  are  but  rarely  reverberated  in  cases  like  transient  blushing, 
but  commonly  give  rise  to  reflex  actions  when  they  operate  profoundly, 
as  in  vomiting,  fear,  grief,  kc.  (^  500  i,  k,  514  f-m,  Index  IL,  Roosting). 

500,  e.  Motion  is  produced  in  muscles  that  are  partly  voluntary  and 
partly  involuntary  (as  those  of  respiration)  tlirough  the  principles  now 
stated;  and  the  modus  operandi  of  their  involuntary  movements  also 
illustrates  fully  the  philosophy  of  voluntary  motion.  Thus,  in  the  in- 
voluntaiy  act  of  respiration  some  peculiar  impression  upon  the  lungs, 
arising,  perhaps,  from  Avant  of  air,  is  the  cause  of  that  development  and 
transmission  of  the  nervous  power  to  the  respiratory  muscles  which  in- 
duces an  action  precisely  similar  to  that  which  is  excited  in  the  same 
muscles  by  an  act  of  the  will.  The  only  apparent  difference  is,  that  in 
the  latter  case  the  nervous  power  is  excited  by  the  will,  and  not,  as  in 
the  other  case,  by  an  impression  transmitted  to  the  brain  from  the  pul- 
monary mucous  membrane.  It  appears  to  be  a  common  phenomenon, 
also,  for  the  will  to  determine  the  nervous  power  upon  the  muscular  coat 
of  the  intestine,  just  as  it  is  by  the  reflex  nervous  action  of  a  cathartic. 
This  is  evinced  by  the  quickened  peristaltic  action  when  on  the  way 
to  the  temple  of  Cloicina.  It  is  an  example,  too,  in  which  the  will  is 
seen  to  exert  a  retai'ding  as  well  as  accelerating  effect  upon  the  intes- 
tine. The  will  has  a  still  greater  control  over  the  muscular  coat  of 
the  bladder,  by  which  that  organ  is  excited  into  action  in  the  voluntary 
discharge  of  urine  (§  518).  In  the  foregoing  cases,  however,  the  will 
commonly  operates  upon  the  organic  muscles  through  its  associate  ac- 
tion upon  the  muscles  of  the  abdomen  andperinaeum  (§  243,  519). 

Here,  also,  is  presented  another  fact  in  proof  of  the  exactness  of 
Design,  another  display  of  the  special  modifications  of  the  properties 
of  life,  since  it  is  here,  if  any  where  in  organic  life,  that  the  will  may 
be  instrumental  in  carrying  out  the  final  causes  of  nature,  while  there 
is  no  reason  to  suppose  that  the  will  can  exert  an  influence  on  any 
other  part  of  the  truly  organic  system  (§  72-74,  136,  181^  d,  199). 

500,  ee.  The  principle  concerned  in  the  foregoing  voluntary  and  in- 
voluntary movements  is  the  same  as  when  an  emetic  operates  ;  only, 
in  this  instance,  the  peculiar  impression  transmitted  from  the  mucous 
tissue  of  the  stomach,  through  the  sensitive  fibres  of  the  pneumogastric 
nerve,  modifies  and  directs  the  nervous  power  in  a  way  peculiar  to 
itself;  so  that  besides  taking  its  reflected  course  through  the  respira- 
tory nerves  of  motion,  and  exciting  convulsive  instead  of  respiratory 
*  See  p.  891,  §  1077.  and  Note  A  p.  1111. 


326  INSTITUTES    OF    MEDICINE. 

movemeiits,  it  falls  upon  various  other  parts,  and  may  thus  simultane- 
ously induce  copious  perspiration,  establish  profuse  secretions  from 
the  liver,  intestines,  &c.,  and  break  up  croup,  or  pneumonia.  Exactly 
the  same  law,  also,  is  concerned  when  other  remedial  or  morbific 
ao-ents  exert  their  effects  upon  parts  remote  from  the  direct  seat  of 
their  operation.  See  Rights  of  Authors,  p.  912. 

500, y.  The  foregoing  analogy  between  voluntary  and  spasmodic 
motions,  and  the  mixed  motions  of  respiration,  extends  to  those  move- 
ments which  are  generated  or  influenced  by  the  passions,  and  between 
the  whole  there  is  a  close  analogy  with  the  effects  of  all  physical 
agents,  and  all  morbid  states,  which  influence  organic  actions  through 
reflex  impressions  of  the  ganglionic  nervous  system.  The  passions, 
also,  like  physical  causes,  produce  involuntary  movements  in  animal 
as  well  as  organic  life  (§  245,  844). 

500,  g.  Different  orders  of  nerves  are,  however,  concerned  in  the 
transmission  of  impressions,  more  or  less,  according  to  the  natm-e  of 
the  exciting  causes.  Thus,  the  nerves  of  volition  are  not  those  by 
which  organic  processes  are  influenced.  Even  in  the  voluntary  mus- 
cles the  irritability  which  is  relative  to  their  organic  functions,  as,  also, 
sensibility,  may  be  morbidly  exalted,  and  yet  the  muscles  be  incapable 
of  obeying  the  will,  as  often  happens  in  paralysis  (§  487,  gg).  Again, 
other  muscles,  as  those  of  respiration,  are  influenced  both  through  the 
will  and  by  reflex  nervous  action.  And  while,  in  these  respects, 
we  can  recognize  no  anatomical  distinction,  either  in  stinicture  or  re- 
lation of  the  parts,  this  inscrutable  phenomenon  is  not  less  paradoxical 
than  the  agency  I  have  ascribed  to  the  nervous  power  in  the  produc- 
tion and  cure  of  disease  ;  while  yet  more  astonishing  is  the  institution 
of  different  orders  of  nerves,  even  of  fibres  in  common  nerves,  for  the 
transmission  of  impressions  to  the  nervous  centres,  and  from  those  cen- 
tres to  the  circumference ;  and  more  surprising  still  is  the  reception 
and  transmission  of  impressions  from  these  centres  (§189,234,  450  e). 
And  still  more  remarkable  is  the  manner  in  which  the  will,  the  pas- 
sions, and  other  exciting  causes  of  motion,  through  the  agency  of  the 
nervous  power,  pass  over  intermediate  nerves,  and  elect,  as  their  mo- 
tor channel,  those  which  are  variously  disconnected  in  their  anatomi- 
cal relations  (§  233f  ).=*  And  here  we  may  observe,  farther,  the  analo- 
gy which  subsists  between  the  modus  operandi  of  the  will,  and  of  phys- 
ical agents,  in  developing  motion  {d').  In  all  the  cases,  whether  vol- 
untary or  involuntary,  or  mixed,  as  in  respiration,  the  nervous  power 
is  roused  and  transmitted  through  motor  nerves  upon  the  iriitability 
of  all  the  parts  that  may  be  influenced  (§  188,  205).  In  the  case  of 
the  will,  and  the  passions,  and  of  the  immediate  action  of  physical 
accents  upon  the  nervous  centres,  the  development  of  the  nei"vous 
power  is  direct ;  but,  when  causes  operate  upon  the  nervous  extremi- 
ties, the  nervous  power  is,  of  course,  developed  by  impressions  trans- 
mitted to  the  central  parts  (^  113,  224,  475i,_89U  g,  _893i,_1072). 

500,  li.  Again,  we  learn  from  the  foregoing  considerations,  that, 
since  the  will  determines  voluntary  motion,  but  has  no  influence  upon 
organic  actions,  with  the  exceptions  stated  (e) ;  and  since,  on  the  con- 
trary, the  passions  operate  powerfully  in  organic,  but  imperfectly  and 
only  in  an  involuntary  manner  in  animal  life,  and  as  judgment,  per- 
ception, and  reflection,  exert  no  appreciable  influences  in  either  life, 
unless  as  morbific  causes,  or  sometimes  lessening  the  action  of  the 
*  See  NoTK  Aa  p.  1131. 


PHYSIOLOGY. —  FUNCTIONS.  32'^ 

heart,  while  each  manifests  special  relations  to  the  nervous  system, 
it  appears  that  all  these  causes  or  properties  are  distinct  elements  of 
the  mental  and  instinctive  principle ;  just  as  irritability,  sensibility, 
mobility,  &c.,  are  distinct  properties  or  elements  of  the  vital  principle 
(§  175  b,  183,  188|  d,  234  c,  476  c),  or  equivalent  {§  1067,  1072  b). 

500,  i.  Consider,  again,  how  different  agents  applied  to  different 
parts  will  affect  particular  organs,  remotely  situated,  in  a  very  uni- 
form manner,  and,  by  common  consent,  through  the  nervous  system ; 
as  the  respiratory  muscles,  for  example  (§  137).  "  The  whole  system 
of  respiratory  nerves  can  be  excited  to  action  by  irritation  of  any  part 
of  the  mucous  membrane,  from  the  mouth  to  the  anus,  from  the  nos- 
trils to  the  lungs."  This  irritation  may  be  established,  and  result  in 
increased  respiratory  movements,  by  mechanical  agents,  as  by  tickling 
the  fauces,  and  by  many  others  through  their  intrinsic  virtues,  as  to- 
bacco applied  to  the  nose.  But,  what  is  more  remarkable,  respiration 
may  be  also  accelerated  by  impressions  made  upon  particular  parts  of 
the  surface  of  the  body,  as  by  tickling  the  feet;  and  again,  by  a  strong 
light  impinging  on  the  retina  ;  and  yet,  again,  by  hope  and  fear,  by  love 
and  hatred.  These  examples  embrace  all  the  varieties  that  occur  be- 
tween the  simple  act  of  respiration  and  coughing,  sneezing,  and  con- 
vulsive spasm.  Again,  another  modified  order  of  movements  maybe 
induced  in  the  same  muscles  by  agents  of  yet  other  virtues ;  as  from 
the  irritation  of  emetics.  Mechanical  irritations  of  the  throat  may 
also  determine  either  coughing  or  vomiting;  and  here,  as  with  the  in- 
creased respiratory  movements,  certain  irritations  of  the  surface,  as 
tobacco  to  the  soles  of  the  feet,  will  excite  the  abdominal  muscles  to 
the  act  of  vomiting.  In  this  last  case,  however,  the  irritation  is  first 
transmitted,  by  reflex  action,  to  the  mucous  tissue  of  the  stomach  (§ 
504),  from  whence  it  is  returned  to  the  nervous  centres,  and  from  thence 
reflected  upon  the  respiratory  muscles,  the  skin,  &c.  (§  504,  514  cl,  Jc,  I). 

It  will  be  thus  seen,  that  these  various  agents,  acting  upon  different 
parts,  give  rise  to  analogous  or  similar  phenomena  through  the  me- 
dium of  the  nervous  power,  but  they  involve  a  great  variety  of  sensi- 
tive nerves,  while  the  motor  nerves  are  about  the  same  in  all  the 
cases.     This  reflex  nervous  action  is  our  medical  calculus. 

500,  j.  But,  the  foregoing  complexity,  which  must  find  its  solution 
in  the  attributes  of  the  nervous  power  operating  through  its  anatomi- 
cal medium,  is  vastly  increased  by  the  coincident  phenomena  which 
may  be  determined  by  the  will  and  by  mental  emotions.  Thus,  in- 
creased respiration,  coughing,  vomiting,  &c.,  may  be  produced  by  an 
act  of  the  will ;  gi'ief  occasions  weeping  and  sighing ;  joy,  laughter ; 
yawning  gives  rise  to  yawning  in  another ;  disagreeable  recollections 
produce  vomiting,  &c. 

500,  Jc.  It  is  readily  seen  that  a  common  philosophy  must  interpret 
all  the  foregoing  effects.  The  fundamental  cause  is  the  same  through- 
out. It  is  every  where  the  influence  of  the  nervous  power ;  but  what 
Btrange  variety  in  the  remote  exciting  causes  !  Nor  is  this  all ;  for  the 
same  great  and  simple  law  obtains  in  all  voluntary  movements.  Let 
us  also  especially  remark  the  parallel  which  exists  between  the  deter- 
mination of  the  will  upon  particular  muscles,  according  to  its  own 
choice,  and  thus  constantly  passing  over,  or  isolating,  various  motor 
nerves,  or,  yet  more  remarkably,  sending  its  influences  through  cer- 
tain branches  of  a  compound  nerve  and  holding  in  passive  subjection 


328  INSTITUTES    OF    MEDICINE. 

all  the  rest,  and  of  those  agents  which  we  have  just  seen  to  extend 
their  influence  specifically  to  the  nerves  of  respiration,  and  those  of  a 
remedial  or  morbific  nature  which,  like  the  will,  elect  and  avoid  the 
nerves  without  reference  to  order  (§  2335,  492,  no.  6).  This  aston- 
ishing phenomenon  is  perpetually  in  progress  in  health  among  all  the 
organic  viscera ;  and  when  we  consider,  also,  how  the  well-trained 
juggler  brings  into  simultaneous  action  almost  every  voluntary  mus- 
cle, and  each  one  in  obedience  to  the  foregoing  law  of  elective  influ- 
ence, we  shall  readily  comprehend  how  disease,  and  morbific  and 
remedial  agents,  give  to  the  nervous  power  the  same  complex  direc- 
tion in  organic  life.  But  even  more  remarkable  are  the  various  in- 
tonations of  voice,  and  especially  such  as  form  the  melody  of  song. 
Each  one,  every  variation,  whatever  the  succession  of  change,  is  de- 
termined by  an  act  of  volition,  rousing,  and  determining  the  nervous 
power,  with  all  the  rapidity  and  mutations  of  thought,  with  varying  in- 
tensity, and  incalculable  changes  of  direction,  and  compounded  in  an 
endless  manner,  upon  those  muscles  which  are  the  immediate  instru- 
ments of  the  vocal  apparatus  (^  234  e,  473  c,  no.  6,  526  (V). 

All  the  effects  of  mental  emotions  are  so  many  coincidences  with  the 
operation  of  remedial  and  morbific  agents.  Like  the  will,  their  effects 
may  be  limited  to  excito-motory  nerves,  but  they  are  apt  to  institute 
reflex  nervous  actions ;  each  emotion,  too,  acting  upon  particular  parts 
according  to  its  own  particular  nature  (§  500  c).  Take,  as  an  example 
for  the  whole,  the  coincidences  between  the  effects  of  disgust  and  emet- 
ics. The  latter  irritate  the  gastro-mucous  tissue  and  give  rise  to  vom- 
iting, as  in  §  500  ee.  Equally,  therefore,  must  disgust  institute  the 
same  chain  of  causation ;  but  by  first  determining  the  nervous  influence 
as  a  nauseant  upon  the  stomach  (§,514  i,  c,  1067  aa,  1072  ft,  1077). 

500,  I.  In  what  has  been  said,  therefore,  of  the  various  exciting 
causes  of  motion  in  the  respiratory  muscles,  alone,  we  have  a  great  el- 
ement by  which  we  readily  attain  the  philosophy  of  those  analogous  ex- 
amples in  which  morbific  and  remedial  agents  establish  changes  in  or- 
gans where  the  nervous  communications  with  the  direct  seat  of  the  mor- 
bific or  remedial  action  may  be  obscure,  or  far  less  manifest  than  with 
other  parts  on  which  no  sympathetic  influence  is  simultaneously  exert- 
ed. And,  coming  also  to  those  complex  influences  which  hold  the  iris 
in  complete  obedience  to  the  great  final  cause  for  which  it  was  ordained, 
and  many  other  equally  demonstrable  but  intricate  problems  relative  to 
the  nerves,  and  those  others  which  concern  an  unintermitting  action  of 
the  nervous  power  in  maintaining  some  of  the  most  exact  and  obvious 
conditions  of  animal  life,  as  seen  in  the  permanent  contraction  of  the 
sphincter  muscles,  we  have  a  flood  of  light  upon  the  subject  which  will 
not  fail  to  dissipate  every  remaining  obscurity,  and  establish  forever  an 
impregnable  barrier  against  the  chemical  and  physical  doctrines  and  all 
the  corruptions  of  the  humoral  pathology  (§  1072  a). 

500,  m.  If  we  now  consider  the  actions  of  the  heart  and  blood-ves- 
sels both  in  their  natural  state  and  under  morbid  influences,  it  will  be 
seen  that  no  chemical  or  humoral  dogmas  can  have  the  most  remote 
connection  with  the  philosophy  of  medicine ;  for  here  will  be  found  a 
concentration  of  phenomena  which  embraces  not  only  the  physiological 
conditions  upon  which  all  their  fluctuations  that  emanate  from  the 
modified  states  of  other  parts  depend,  but  a  correspondence  in  the  phe- 
nomena, that  are  wholly  exclusive  of  every  interpretation  which  can  be 


PHYSIOLOGY. — FUNCTIONS.  329 

rendered  by  chemistry  or  humoralism  within  the  entire  range  of  pathol- 
ogy and  therapeutics,  and  a  full  confirmation  of  my  doctrines  relative 
to  the  nervous  system.  In  the  first  place,  then,  we  have  seen  that  the 
motions  of  the  circulatory  organs  depend  upon  the  nervous  influence, 
as  the  immediate  exciting  cause,  reflected  upon  the  muscular  tissue 
(§  475J-488^,  493  cc,  514/),  and  that  in  consequence  of  this  suscep- 
tibility (§  422  h,  487  a,  892|),  and  of  the  liability  of  the  nervous  influ- 
ence to  endless  modifications  according  to  its  exciting  causes  (§  227, 
230,  894  b,  904  a,  990^),  that  influence,  both  reflex  s^nH  direct  (§  222  a, 
227,  903,  990^)5  is  constantly  modifying  the  actions  of  the  heart  and 
arteries,  as  seen  in  the  operation  of  multitudinous  external  natural 
causes  and  the  multifarious  effects  of  mental  emotions,  while  other 
things,  except  when  intermixed  with  the  blood,  fail  of  such  influences 
(§  233f ,  630  c),  and  of  all  which  Chemistry  and  Humoralism  do  not 
pretend  to  make  any  explanation.  Therefore,  by  parity  of  reason  all 
the  disturbances  of  the  circulatory  organs  that  proceed  from  affections 
of  other  parts,  and  all  the  remote  effects  of  medicines,  poisons,  &,q.,  are 
equally  estranged  from  those  assumptions,  and  in  all  the  cases  the  fluc- 
tuations in  the  circulatory  organs  depend  equally  as  in  the  natural  con- 
ditions upon  reflex  or  direct  action  of  the  nervous  power,  and  as  will 
appear  (§  687^^-688,  694f,  826  cc)  we  examine  the  pulse  (when  the 
heart  is  not  diseased)  for  the  purpose  alone  of  ascertaining  how  far  and 
in  what  manner  the  pathological  conditions  of  other  parts,  or  the  oper- 
ation of  remedies,  &c.,  may  reflect  the  nervous  influence  upon  the  cir- 
culatory organs,  and  not  in  the  least  to  ascertain  how  the  blood  is  af- 
fected or  the  remedies  may  be  absorbed — See  ^  829,  1088  * 

500,  n.  Contrasted  with  the  foregoing  should  now  be  stated  the  doc- 
trine of  the  chemical  school,  as  it  comes  applauded  from  the  laboratory. 
The  source  of  motion  with  this  school,  voluntary  and  involuntary,  is  the 
same  with  that  which  Liebig  assigns  for  thought,  namely,  a  chemical 
change  in  the  substance  of  the  organ  (§  350,  nos.  5J,  7-10).  In  this 
way,  too,  the  chemist  expounds  the  balance  between  waste  and  nutri- 
tion ;  and  for  this  purpose  sleep  has  been  ordained,  the  approved  phi- 
losophy of  which  is  the  following : 

"  Now,  since  in  different  individuals,"  says  Liebig,  "  according  to  the 
amount  of  force  consumed  in  producing  voluntary  mechanical  effects, 
unequal  quantities  of  living  tissue  are  wasted,  there  must  occur  in  ev- 
ery individual,  unless  the  phenomena  of  motion  are  to  cease  entirely,  a 
condition  in  which  all  voluntary  motions  are  completely  checked ;  in 
which,  therefore,  these  occasion  no  waste.  This  condition  is  called 
sleep.  Now,  since  the  consumption  of  force  for  the  involuntary  motion 
continues  in  sleep,  it  is  plain  that  a  waste  of  matter  also  continues  in 
that  state ;  and  if  the  original  equilibrium  is  to  be  restored,  we  must 
suppose  that  during  sleep  an  amount  of  force  is  accumulated  in  the  form 
of  living  tissue  exactly  equal  to  that  which  was  consumed  in  voluntary 
and  involuntary  motion  during  the  preceding  waking  period." — Lie- 
big's  Animal  ChemisU-y. 

I  have  quoted  the  foregoing  on  account  of  its  appearance  of  a  ration- 
al philosophy  and  logical  method,  but  apprehend  that  it  has  no  better 
foundation  than  the  gaseous  doctrine  as  presented  in  §  350^  n. 

500,  nn.  But  again,  I  ask  the  chemist  for  the  primary  cause  of  those 
chemical  changes  in  which  originate  the  acts  of  the  mind,  &c.,  and 
which  call  us  from  the  sleeping  to  the  waking  state  (175  c,  349  e, 
*  Also,  §  481,  494,  Note  Ll  p.  1140. 


330  INSTITUTES    OF    MEDICINE. 

3503  ggy  I  ask  the  chemist,  and  the  physical  philosopher  of  life,  to 
explain  the  mechanism  and  the  laws  of  sympathy  by  the  application 
of  any  principle  in  phy;iics  or  chemistry.  Let  the  chemist  consider, 
that  in  every  process  of  remote  sympathy  there  are  involved  very  di- 
verse, yet  very  precise  effects,  and  that  he  must  have  one  species  of 
chemical  change  for  the  transmission  of  impressions  through  the  sen- 
sitive nerves  to  the  nervous  centres,  another  for  the  impressions  ex- 
erted upon  those  centres,  another  for  the  reflection  of  the  influences 
through  the  motor  nerves,  and  yet  another  for  the  effects  exerted  at 
the  ultimate  destination  of  this  amazing  round  of  never-ending  influ- 
ences, as  indispensable  to  the  process  of  respiration  ;  and  coming  to 
morbid  states,  there  must  be  another  series  of  chemical  changes  con- 
forming, respectively,  to  the  nature  of  every  morbid  influence  and 
product  (§  188^  d,  464,  451/,  649  b,  675,  487^^,  1076). 

Take  any  single  attribute  of  the  nervous  system,  and  we  shall  find 
it  as  remarkably  distinguished  from  all  things  else  as  is  the  mental 
principle.  The  power  which  appertains  to  that  system,  and  presides 
over  the  whole  life  of  animals,  is  just  as  unique  in  all  its  operations. 
The  distinction  alone,  in  various  aspects,  between  the  condition  of  the 
sensitive  nei'ves,  or  the  sensitive  fibres  of  compound  nerves,  and  those 
which  are  appropriate  to  the  motor  influence, — those  which  convey 
impressions  to  the  central  parts  and  those  which  transmit  them  to  all 
parts  of  the  organization,  to  the  organic  structure  of  the  fountain 
itself, — those,  I  say,  which  serve  to  awaken  the  mind,  or  to  stamp  on 
the  nervous  centres,  with  all  the  precision  of  thought,  an  inconceivable 
variety  of  influences  which  are  unceasingly  in  progress  in  every  other 
part,  but  with  no  other  appreciable  result  than  the  movements  which 
follow  in  all  the  organic  constitution,  contrasted  with  the  totally  dis- 
tinct prerogative  of  those  nerves,  and  those  fibres  of  compound  nerves, 
which  give  rise  to  the  distant  movements  and  changes, — place,  at  an 
unutterable  distance,  all  analogy  with  the  recognized  imponderable 
substances  and  with  every  other  agent  or  power  in  the  mineral  king- 
dom (§  451  c,  453).  But,  I  would  not  so  far  speculate  upon  the  na- 
ture of  the  nervous  power  as  even  to  assume  for  it  a  place  among  the 
imponderables,  which  the  physical  philosopher,  upon  no  better  evi- 
dence, unhesitatingly  avows  as  the  condition  of  light,  heat,  and  that 
more  inscrutable  substance,  imponderable  magnetism,  which  awakens 
no  sensation,  and  produces  no  effect  upon  organic  life.  Least  of  all 
would  I  place  the  principle  of  life,  or  its  element  the  nervous  power, 
upon  a  par  with  the  imponderables  in  their  designated  condition  as 
material  "  fluids,"  nor  claim  for  the  latter  a  distinct  individuality 
(§  175,  hh).  The  true  physiologist  attempts  not  problems  which  have 
no  relation  to  principles  and  laws,  and  which  divert  philosophy  from 
its  practical  uses.  It  is  true,  he  argues  the  existence  of  the  principle 
of  life,  its  remarkable  attributes,  its  contradistinction  from  all  other 
agents,  upon  the  ground  of  the  philosopher  in  physics,  that  he  may 
meet  the  obti'uder  with  his  own  ratiocination.  He  tells  him  that  his 
premises  are  the  same,  only  more  various,  distinct  in  their  nature, 
and  more  demonstrative.  He  points  him  to  his  "undulations"  of 
light,  the  velocity  of  their  movements,  the  prismatic  analysis,  its 
confirmation  by  life,  his  imponderable  mystery  which  spans  the  globe, 
its  co-operation  with  the  electric  fluid,  their  instant  transmission  of 
a  disturbing  cause  to  the  ends  of  the  earth,  making  the  recoi'd  at  one 


PHYSIOLOGY. FUNCTIONS.  331 

of  its  poles  ere  the  impulse  has  ceased  which  began  at  the  other 
(§  175  hb,  1881  d,  234  c,  d,  e,  281,  872  a,  892  ^>,892^  v,  893  q,  904  «). 

500,  0.  Let  us  now  observe,  summarily,  the  wonderful  system  of 
analogies  which  Nature  has  ordained  among  the  vital  stimuli,  and  learn 
from  this,  and  from  the  same  system  of  relationship  which  distinguish- 
es other  parts  in  the  great  chain  of  existences,  that  her  laws  are  sim- 
ple where  the  phenomena  are  various  and  complex,  and  that  all  her 
designs  and  operations  are  susceptible  of  reduction  to  a  few  general 
principles,  which,  when  once  known,  illuminate  the  darkest  labyrinth, 
and  serve  us  instead  of  the  voluminous  facts  which  have  been  gradu- 
ally accumulating  for  ages.  One  principle  is  a  key  to  a  thousand  phe- 
nomena; and  as  new  ones  spring  up,  having  analogies  with  such  as 
are  known,  the  principle  comes  to  their  ready  interpretation. 

In  respect  to  the  analogies  among  the  vital  stimuli,  the  mind,  being 
connected  with  the  body,  and  acting  upon  it  both  directly  and  through 
the  nervous  power,  should  naturally  be  one  of  them  ;  and  here  we  find 
it  operating  in  peculiar  ways  upon  the  irritability  both  of  organic  and 
animal  life, — first  directly  upon  the  brain,  and  then  producing  volun- 
tary motion  through  the  nervous  power,  or  so  affecting  the  organic 
states  as  to  be  a  morbific  or  a  curative  agent.  Just  so  with  foreign 
agents.  Irritate  the  brain  and  spasms  will  follow,  while  the  same  ir- 
ritation goes  to  the  recesses  of  organic  life.  The  natural  stimuli  of 
life  maintain  the  vital  actions  by  exciting  the  vital  properties.  But, 
there  are  many  foreign  agents  which  are  morbific,  and  these  operate 
in  the  same  way,  only,  at  the  same  time,  they  alter  the  nature  of  the 
vital  properties ;  and  it  is  exactly  in  this  way,  also,  that  the  mind  and 
its  passions  produce  disease.  The  impressions,  however,  in  the  former 
case,  may  be  reflected  from  the  nervous  centres,  while  in  the  latter, 
they  originate  in  those  centres.  Again,  there  are  other  foreign  agents 
which  aid  in  restoi'ing  the  diseased  properties  and  actions  to  a  healthy 
state,  and  their  principle  of  operation  is  exactly  similar  to  that  of  the 
mind  when  this  agent  aids  in  the  removal  of  disease  (§  1067). 

Take  next  the  blood,  the  natural  vital  stimulus  of  organic  actions, 
which  makes  its  impressions  upon  the  same  properties  and  develops 
the  nervous  influence  like  the  mind  and  foreign  agents.  But,  unlike 
the  latter,  it  is  a  living  agent,  and  calls  into  action  the  properties  of 
life  for  the  purpose  of  being  itself  acted  upon,  that  it  may  be  incorpo- 
rated with  the  organized  structure  and  receive  the  plenitude  of  those 
powers  through  which  it  becomes  a  part  of  the  organized  tissues,  that 
this  new  formation  may  again  generate  the  same  fluid,  and  be  acted 
upon,  in  its  turn,  by  other  blood.  Its  analogy,  therefore,  to  the  men- 
tal principle  relates  especially  to  its  property  as  a  vital  agent.  But, 
we  find  in  the  nervous  power  an  agent  of  more  extensive  analogies 
with  the  blood,  since  this  agent,  like  the  blood,  not  only  affects  the 
organic  properties  and  actions,  but  is  also  exquisitely  susceptible  oi 
modifying  influences,  of  changes  in  its  nature,  from  the  action  of  the 
mind  and  from  external  morbific  and  remedial  agents, — acquiring  even 
the  very  character,  as  an  operating  cause,  which  appertains  to  the 
agents,  respectively,  that  may  call  it  into  action  (§  223-232).  The 
range  of  analogies  is,  therefore,  coextensive  between  the  nervous  pow- 
er and  all  other  vital  agents  (§  74  a,  188^  d).  And  so  of  the  semen 
in  its  action  upon  the  organic  properties  of  the  ovum  ;  infusing,  also, 
not  only  a  physical,  but  a  mental  constitution  into  the  ovum.     The 


332  INSTITUTES    OF    MEDICINE. 

corporeal  and  mental  attributes  of  both  parents  are,  in  consequence, 
blended  together  (§  63,  &c.,  475|). 

Consider,  finally,  the  hibernating  animal,  whose  general  modifica- 
tion of  irritability  (§  191)  is  so  constituted  with  a  reference  to  preser- 
vation against  low  degrees  of  external  temperature,  that  mechanical 
irritation,  heat,  and  a  variety  of  agents  applied  to  the  surface,  shall  so 
awaken  the  nervous  influence  that  his  temperature  will  suddenly  rise 
from  below  the  40th  degree  of  Fahrenheit  up  to  its  natural  standard  of 
98°.  But  the  curious  fact  attending  this  remarkable  law  of  preserva- 
tion is  the  same  result  from  an  intensity  of  cold  that  would  otherwise 
destroy  the  animal  (§  441,  d). — Note  Aa  p.  1131. 

500,  p-  In  respect  to  the  subserviency  of  the  brain  to  the  operations 
of  the  mind,  I.  will  add  in  farther  explanation  of  what  I  have  said  in 
section  241,  that,  whatever  may  be  the  reality,  the  apparent  instru- 
mentality of  the  brain  in  the  functions  of  the  will  and  percei^tion  is 
greater  than  in  those  o^ judgment,  reflection,  and  imagination ,'  or,  if 
it  be  preferred,  the  concurrent  action  of  the  mental  faculties  in  man 
and  animals  determines  the  results  which  are  commonly  ascribed 
to  the  loill  as  a  property  of  the  mind.  The  greatest  apparent  final 
cause  of  the  brain  in  respect  to  the  connection  of  the  Soul  with  the 
body,  and  especially  the  Instinctive  Principle,  is  to  serve  as  a  me- 
dium of  communication  with  the  voluntary  muscles  through  the 
nervous  influence. 

In  respect  to  perception,  we  discover  the  relation  of  the  mind  to 
the  brain  in  another  aspect,  and,  also,  another  analogy  between  the 
will  and  physical  agents  as  vital  stimuli.  Through  sensibility  the 
brain  is  acted  upon,  and  this  impression  rouses  the  mind,  or  its  prop- 
erty, perception,  and  sensation  is  the  resulting  effect  (§  175,  c). 

501,  a.  Sympathy  is  active  when  it  produces  sensible  effects.  It  is 
passive  when  its  effects  are  insensible,  as  in  the  natural  rhythm  of  the 
organic  system.    It  is  either  reflex  or  direct  nervous  action  (-^  638J)._ 

501,  b.  In  the  perfectly  natural  condition  of  sympathy  in  organic 
life  the  nervous  influence  is  a  mere  regulator  of  the  organic  proper- 
ties. Its  natural  operation  is  disturbed  by  morbific  and  remedial 
agents,  and  by  mental  emotions. 

501,  c.  It  is  mostly  in  conditions  of  disease  that  we  notice  the  re- 
sults of  sympathy.  In  health  we  see  only  the  universal  harmony ; 
unless  disturbed  by  a  blush,  or  by  the  abundance  of  urine  when  cold 
chills  the  suiface,  or  fear  exerts  its  more  mysterious  sway.  Disease 
affords  the  striking  examples  of  display  in  the  nervous  power,  and 
these  examples  are  what  most  engage  the  attention  of  the  physician. 
To  trace  out  their  complexity,  as  one  part  after  another  gives  rise  to 
disease  consecutively  in  each,  and  as  each  may  exasperate  the  morbid 
states  of  the  whole,  or  as  remedial  agents  may  institute  corresponding 
circles  of  reflex  action,  are  the  most  important  and  difficult  objects  of 
medicine. 

502,  a.  Diseases  generally  begin  with  little  agency  of  the  nerves. 
Morbific  causes  make  their  impression  upon  the  vital  constitution  of 
some  particular  part,  when  it  commonly  happens,  sooner  or  later, 
that  the  affected  state  of  the  part  is  felt  by  the  nervous  centres,  from 
whence  a  disturbing  nervous  influence  is  transmitted  to  other  parts 
C§  133-154,  188-193,  516,  no.  7,  657,  666). 

502,  b.  In  all  the  foregoing  cases,  therefore,  where  remote  parts  be- 
come the  scats  of  morbific  action,  as  in  pneumonia  and  idiopathic  fever, 


PHYSIOLOGY. FUNCTIONS.  333 

sympathetic  sensibility  is  affected  by  the  primary  morbific  cause  as  an 
important  element  in  establishing  the  remote  predisposition  (§  149, 
201,  451  h,  559,  660,  666). 

502.  c.  Remedial  agents  may  operate  directly  upon  a  part  and  re- 
store its  morbid  properties  and  functions  without  reflected  nervous 
action.  This  is  apparent  only  where  the  remedy  is  applied  directly 
to  the  tissue  affected ;  but,  in  all  other  cases  the  nervous  power  is  the 
medium  of  transmission.  Upon  these  fundamental  principles,  the 
main  art  of  therapeutics  is  or  should  be  founded  (227,  644-6470. 

503.  When  disease,  or  morbific,  or  remedial  agents  transmit  their 
influence  from  any  part  to  the  brain  and  spinal  cord,  and  there  develop 
and  modify  the  nervous  power,  the  modification  corresponds  with  the 
nature  of  the  impression  which  is  transmitted  to  the  nervous  centres. 
These  transient  modifications  of  the  nervous  power  are  similar,  in 
principle,  to  the  changes  which  occur  in  the  organic  properties,  and 
which  essentially  constitute  the  disease.  The  passions  also  modifv 
the  nervous  power  in  ways  peculiar  to  each ;  and,  in  all  the  cases, 
corresponding  effects  are  produced  upon  the  condition  of  diseased 
parts  upon  which  the  nervous  power  thus  modified  may  be  reflected. 
That  is  to  say,  the  nature  of  the  nervous  power  is  variously  modified 
in  all  the  cases ;  and,  therefore,  like  external  morbific  or  remedial 
agents  of  different  virtues,  modifies  the  vital  states  according  to  its  own 
acquired  modifications.  The  nervous  power,  therefore,  thus  acquires, 
more  or  less,  the  virtues  of  the  exciting  causes,  and  becomes,  more  or 
less,  a  substitute  for  them  (§  226). 

504.  Various  circles  of  sympathy  are  generated  by  the  action  of 
remedial  agents  upon  the  stomach,  intestines,  &c.  The  first  impres- 
sion of  the  agent  may  set  in  motion  a  great  range  of  reflex  nervous 
actions;  as  the  operation  of  emetics  (§  500,  i) ;  and,  as  new  impres- 
sions are  sympathetically  instituted  they  become  the  points  of  depar- 
ture for  other  reflex  nervous  actions,  and  react  upon  and  increase  those 
in  which  they  originate.  (§  902,^,  Note  D  p.  1114). 

505.  When  the  nervous  power  is  excited  by  remedial  agents  of 
positive  virtues  it  is  essentially  morbific,  like  the  remedial  agents 
themselves.  Each  is,  therefore,  curative  only  by  inducing  new  mor- 
bid conditions  by  which  the  natural  recuperative  tendency  of  the  vital 
properties  is  brought  into  operation.  The  great  difference  is,  that 
morbific  agents  alter  the  vital  conditions  more  profoundly  and  more 
permanently  than  the  remedial  (^^  854  c-858,  893  d,  e,  894  &-901). 

506.  Impressions  once  made  upon  any  part  may  continue  for  an  in- 
definite time  after  the  cause  is  withdrawn,  and  may  continue  to  de- 
velop and  modify  the  nervous  influence,  and  direct  its  operation  upon 
other  parts,  as  when  the  agentwas  in  operation  (^^  516,  no.  6).  Thus,  the 
operation  of  many  active  remedial  or  morbific  agents  will  continue  to 
be  exerted  upon  the  system  at  large,  for  a  longer  or  shorter  time,  af- 
ter they  shall  have  been  thoroughly  removed  from  the  stomach,  &c. 
Inflammations  excited  by  cantharides,  issues,  wounds,  &c.,  hold  an 
unceasing  operation,  curative  or  morbific,  upon  remote  parts.  The 
specific  impression  made  by  the  virus  of  the  mad  dog  becomes  establish- 
ed in  the  bitten  part,  and  generates  a  morbific  reflex  nervous  action 
till,  through  the  law  of  cumulation,  an  explosion  of  disease  ultimately 
follows  (§  558,  a).  The  same  principle,  exactly,  is  applicable  to  mer- 
cury, when  a  small  dose,  or  its  external  application,  produces  saliva- 


334  INSTITUTES    OF    MEDICINE. 

tion,  or  when  miasmata  give  rise  to  fevers  in  a  month,  or  six  months, 
after  their  direct  operation  has  been  withdrawn.  The  principle  is 
constantly  illustrated  in  natural  states  of  the  body ;  as  where  the 
sphincters  remain  permanently  contracted  after  the  expulsion  of  the 
urine  or  fecal  matter  (§  514,  <;,  516,  no.  6, 1059,  ISTote  Aaa  p.  1146). 
Here,  tlien,  we  have  another  important  law  to  interpret  the  true 
modus  operandi  of  remedial  and  morbific  agents  (§  503). 

507.  The  nervous  power  pervades  the  whole  system  of  motor 
nerves ;  and,  although  its  active  operation  in  the  ordinary  function 
of  sympathy  be  developed  mainly,  if  not  altogether,  in  the  central 
parts,  it  may  be  brought  into  operation  by  irritating  any  of  the  motor 
nerves  (§  473  c,  499).  A  division,  or  other  injury  of  nerves  going  to 
the  organic  viscera,  as  the  par  vagum,  may  destroy  their  functions,  or 
otherwise  affect  the  vital  constitution  and  products  of  the  part,  or  in- 
duce inflammation,  by  the  shock  of  nervous  power  thus  inflicted  on 
the  organic  properties  of  the  part  (§  461,  485,  489,  950,  1032  d). 

508.  The  nervous  systems  are  as  liable  as  other  parts  to  be  affect- 
ed in  their  organic  condition  by  the  nervous  power,  which,  in  the 
samo  way,  may  be  actively  determined  upon  them.  But,  there  is  this 
difference.  When  any  part  of  the  nervous  system  is  the  seat  of  dis- 
ease, it  is  liable  to  produce  greater  disturbances  in  remote  parts  than 
other  organs  when  diseased.  These  disturbances  are  occasioned  by 
the  direct  propagation  of  the  nervous  power,  but  they  are  apt  to  be 
less  of  a  moi'bid  nature  than  when  produced  by  the  more  complex 
process  of  reflex  action  (^  500,  a-c). 

509.  The  nervous  power  may  extinguish  life  with  great  instanta- 
neousness.  When  rapidly  fatal,  the  causes  by  which  it  is  brought  into 
operation  mus]>  be  violent  and  sudden  in  their  action  (§  455,  d).  Ex- 
amples occur  in  the  fatal  effects  of  joy,  anger,  blows  on  the  epigastric 
region,  drinking  cold  water,  prussic  acid,  sudden  death  from  small 
losses  of  blood,  apoplexy,  &c.  (§  479,  1040). 

In  the  case  of  joy,  anger,  and  apoplexy,  the  nervous  power  is  de- 
veloped in  a  direct  manner  (§  500,  c),  and  destroys  mainly  by  its  sud- 
den determination  upon  the  organic  properties  of  the  brain  and  heart. 
Blows  on  the  stomach  give  the  same  determination  through  reflex 
nervous  action,  as  do  also  cold  water  and  prussic  acid  (§  476^^,  h).  The 
mode  of  death  from  small  losses  of  blood  will  be  explained  under  the 
philosophy  of  the  operation  of  its  loss  (§  943,  946,  &c.). 

In  the  foregoing  cases,  the  nervous  power  is  also  determined  with 
violence  upon  the  stomach  and  intestines,  and  upon  the  whole  capil- 
lary system  of  blood-vessels  {§  481,  &c.,  490).  The  general  effect  is 
also  increased  by  the  injury  sustained  by  the  brain  itself 

510.  The  foregoing  modus  operandi  of  the  several  agents  is  similar 
to  the  causation  of  sudden  death  from  injuries  of  the  brain  or  spinal 
cord.     Thus : 

If  the  spinal  marrow  be  suddenly  destroyed,  or  only  one  half  of  it, 
by  a  large  stilette,  life  is  immediately  extinguished.  The  modus  op- 
erandi appears  to  be  the  following: — 1st.  An  injury  of  the  vital  prop- 
erties of  all  the  organic  viscera.  2d.  A  violent  interruption  of  the 
concert  of  organic  actions.  3d.  An  interruption  of  respiratory  move- 
ments. 4th.  A  pernicious  nervous  power  is  propagated  from  the  cord 
to  the  organic  powers  of  the  brain.  5th.  Pernicious  influences  are 
propagated  by  the  organic  viscera  to  the  cerebral  and  ganglionic  sys- 


PHYSIOLOGY. FUNCTIONS.  335 

tems, — thus  greatly  increasing  the  destructive  nervous  influence  upon 
themselves  (§  455,  c).  They  are  complex  circles  of  nervous  infllu- 
ence,  but  are  determined  by  exact  laws,  and  each  circle  has  its  distinct 
individuality,  although  involved  in  each  other. 

A  like  explanation  is  also  applicable  when  a  sudden  destruction  of 
life  is  effected  by  crushing  the  brain, 

511.  It  is  upon  the  principle  that  the  effects  of  the  nervous  influ- 
ence depend  upon  the  exact  nature  of  the  impressions  made  upon  the 
nervous  centres,  whether  direct  or  indirect  (§  226,  500),  that  we  must 
explain  the  differences  in  the  results  of  slightly-varied  experiments 
relative  to  these  parts;  those,forinstance,bywhich  the  brain  or  spinal 
cord  is  slowly  destroyed  interrupting  the  harmony  of  actions  and  the 
organic  functions  more  gradually,  and  therefore  less  fatally,  than  such 
as  produce  their  destructive  effects  with  greater  rapidity  (§  476|^). 

V.  THE  LAWS  OF  SYMPATHY,  OR  REFLEX  ACTION  OF  THE  NERVOUS 
SYSTEM,  AND   THEIR  APPLICATION    TO    PATHOLOGY  AND    THERAPEUTCIS. 

General  Facts  and  Laws  relative  to  t/ie  Cerebrospinal  and  Ganglionic 

Systems. 

512,  a.  The  various  nervous  communications  of  the  intestinal  canal 
with  the  brain  and  all  other  organs  are  demonstrative  of  the  ascend- 
ant influence  which  the  stomach,  particularly,  possesses  when  acted 
upon  by  remedial  agents.  We  see  all  this  exemplified,  analogically 
at  least,  in  the  endless  remote  derangements  which  follow  the  com- 
mon irritations  and  morbid  states  of  the  organ,  as,  also,  of  the  intes- 
tines. We  see,  indeed,  the  whole  in  natural  progress.  When,  for 
example,  hunger  operates,  an  actual  sensation  is  then  felt  by  the 
brain,  and  the  mind,  of  course,  participates  (§  323).  Numerous  and 
complex  influences  may  be  thus  brought  into  operation,  of  which  the 
stomach  is  the  primary  source.  The  will,  being  excited,  brings  into 
action  all  those  muscles  which  are  necessary  to  obtain  a  supply  of 
food,  and  other  muscles  to  effect  its  mastication,  and  convey  it  to  the 
stomach.  Various  sympathetic  organic  influences  are,  in  the  mean 
time,  taking  place,  which  it  is  unnecessary,  as  it  might  be  difficult,  to 
explain.  INIany  of  these  organic  influences  spring  from  the  mind  it- 
self. Thus,  the  brain  feeling  the  sensation  of  hunger,  the  salivary 
glands  begin  to  pour  out  their  fluid  at  the  sight  or  smell  of  food,  or 
even  at  its  expectation.  The  food  establishes  an  influence  upon  the 
nervous  centres,  by  which  an  exciting  nervous  power  is  constantly 
reflected  upon  other  parts.  The  bile,  saliva,  &c.,  are  thus  increased, 
while  the  mind  contributes  a  direct  nervous  influence  towards  these 
results.  The  stomach  being  supplied  with  its  wants,  all  these  influ- 
ences cease,  and  a  new  order  arises.  Cut  off  the  par  vagum  and 
none  of  them  will  obtain,  unless  feebly  through  the  ganglionic  and 
spinal  nerves.  When  the  food  has  undergone  digestion,  and  the  ex- 
citing impression  is  removed  from  the  stomach,  all  the  reflected  influ- 
ences of  the  brain  and  spinal  cord  cease  in  consequence. 

512,  b.  The  vascular  action  and  the  glow  of  warmth,  which  are 
lighted  up  in  the  skin  of  the  fasting,  half-frozen  traveler,  and  his  in- 
vigorated strength  before  digestion  has  made  any  advances,  and  the 
flow  of  bile  which  is  determined  by  the  action  of  food  on  the  stom- 
ach, esoecially  where  the  food  is  of  an  animal  nature,  are  manifestly 


336  INSTITUTES    OF   MEDICINE. 

owing  to  an  exciting  reflex  action  of  the  nervous  system ;  or,  again,  the 
copious  perspiration,  and  other  results,  which  often  follow  immediate- 
ly a  draught  of  hot  water,  illustrate  the  whole  philosophy  of  this  ap- 
parently entangled  subject  of  sympathy,  whether  in  relation  to  natu- 
ral, morbific,  or  remedial  agents ;  and  we  learn  from  these  obvious 
examples  that  the  essential  principle  is  simple,  and  readily  explains 
all  the  diversified  phenomena,  which  are  effects  of  reflex  and  direct 
nervous  actions,  whose  original  starting  point  is  the  gastro-intesti- 
nal  mucous  membrane.  But  when,  in  the  case  of  the  food,  it  shall 
have  been  digested,  and  have  entered  the  circulation,  some  of  its  ear- 
liest and  strongest  demonstrations  may  have  disappeared.  It  is  wor- 
thy of  remark,  too,  that  such  is  often  the  immediate  effect  ofTood  upon 
the  great  nervous  centre,  that  sleep  is  almost  irresistible,  or  apoplexy 
follows,  "  paulo  post  prandium,"*  as  no  unusual  result ;  the  nervou3 
power  being  reflected,  in  the  former  case,  upon  the  organic  prop- 
erties mildly  and  agreeably,  in  the  latter  with  sudden  and  destructive 
violence  (§  226-233,  441  c,  476^  A,  500-511,  1040). 

513.  Physiological  conditions,  like  the  foregoing,  are  so  intelligible 
as  to  be  peculiarly  important  in  illustrating  coincident  problems  in 
pathology  and  therapeutics.  Whenever  well-pronounced  reflex  nerv- 
ous actions  are  propagated  from  one  organ  to  others  through  the  cere- 
bro-spinal  and  ganglionic  systems  in  their  natural  states,  and  by  nat- 
ural stimuli,  as  by  food,  these  influences  are  generally  greatly  increas- 
ed, as  well  as  modified  in  kind,  by  morbific  and  by  remedial  agents 
(§  524,  no.  1). 

514,  a.  The  foregoing  considerations  lead  me  to  the  statement  of 
one  of  the  most  important  laws  in  physiology,  which  is  alike  applica- 
ble to  the  cerebro-spinal  and  ganglionic  systems,  namely  : 

"  When  impressions,  made  by  the  action  of  external  stimuli  on  sen- 
sitive nerves,  give  rise  to  motions  in  other  parts,  these  are  never  the 
result  of  the  direct  reaction  of  the  sensitive  and  motor  fibres  of  the 
nerves  on  each  other.  The  irritation  is  conveyed  by  the  sensitive 
fibres  to  the  brain  and  spinal  cord,  and  is  by  those  communicated  to 
the  motor  fibres"  (^  455,  462-472). — Muller. 

The  foregoing  law  is  in  operation  in  all  cases  of  remote  sympathy, 
whether  of  a  physiological,  pathological,  or  therapeutical  nature  (§  455, 
c-h).  It  is  clearly  exemplified  in  the  natural  process  of  respiration, 
oy  the  analogous  results  of  emetics,  &c.  In  respiration,  the  want  of 
air  is  felt  through  the  medium  of  the  sensitive  fibres  of  the  pneumo- 
gastric  and  sympathetic  nerves,  and  appears  to  be  concentrated  about 
the  medulla  oblongata.  The  nei"vous  power  is  thus  developed,  and  is 
then  reflected  upon  the  various  motor  nerves  which  supply  the  mus- 
cles of  respiration  ;  when  the  action  of  these  muscles  follows  as  a  con- 
sequence (§  233,  462-472,  500). 

514,  h.  The  only  remarkable  difference  in  the  physiology  of  vomit- 
ing from  that  of  respiration  consists  in  the  primary  impression  being 
made  upon  the  same  nerves  in  the  mucous  tissue  of  the  stomach,  and 
the  convulsive  movement  of  the  abdominal  muscles.  A  radical  dif- 
ference, however,  obtains  in  the  influences  which  may  be  exerted  by 
an  emetic  upon  the  organic  states ;  especially  in  their  diseased  condi- 
tions. This,  too,  will  depend  greatly  upon  the  cause  of  vomiting ; 
and  so  of  every  other  agent,  according  as  it  may  be  natural,  morbific, 
or  remedial.  When  the  effects  depend  upon  reflex  nervous  influences, 
*  A  term  of  frequent  occurrence  among  Authcis  who  wrote  in  Latin. 


PHYSIOLOGY. FUNCTIONS  33T 

the  morbific  and  remedial  agents  so  modify  the  nervous  power  that  it 
alters  the  existing  condition  of  the  organic  properties  and  functions  of 
all  parts  upon  which  its  positive  action  may  fall  (§  129,  226,  227). 

If  the  stomach  itself  be  the  seat  of  disease,  even  its  mucous  tissue, 
the  remedial  effect  of  any  agent  may  not  be  wholly,  or  principally, 
due  to  its  direct  action  upon  the  organ,  but  may  be  also  exerted 
through  a  chain  of  causation  exactly  similar  to  that  by  which  the  re- 
spiratory muscles  are  thrown  into  action  in  respiration  or  vomiting. 
This  must  be  obvious  enough  in  the  case  of  peritoneal  disease  of  the 
stomach  ;  and  it  is  equally  true  of  diseases  of  its  mucous  coat,  that  the 
impression  of  the  remedy  is  transmitted,  more  or  less,  through  the 
sensitive  fibres  of  the  pneumogastric  and  ganglionic  nerves  to  the 
brain  and  spinal  cord,  when  the  nervous  power  is  reflected,  with  an 
alterative  effect,  through  the  motor  fibres  of  the  same  nerves  upon  the 
mucous,  as  upon  the  serous,  tissue  of  the  stomach.  The  same  philos- 
ophy applies  to  the  muscular  coat  of  the  stomach  in  the  action  of  an 
emetic,  and  to  the  same  tissue  of  the  intestines  when  peristaltic  move- 
ments are  excited  by  cathartics  (§  657  a,  658,  889  a,  902  g). 

Again,  the  bile  which  is  ejected  during  the  action  of  an  emetic  or  a  ca- 
thartic may  have  been  mostly  generated  under  their  influences ;  the  emet- 
ic or  the  cathartic  establishing  a  hilific  reflex  nervous  action  over  the  liver, 
in  conjunction  also  with  continuous  sympathy  (§  498) ;  and  those  influ- 
ences, in  connection  with  the  more  efficient  direct  irritation  of  the  intes- 
tinal mucous  tissue,  instituting  the  increased  product  of  that  membrane. 
These  palpable  facts  associate  themselves  with  the  immediate  exciting 
cause  of  the  muscular  movements  in  vomiting  and  defecation,  and  with 
an  endless  extent  of  analogous  results  that  flow  from  other  unusual  influ- 
ences, and  thus  evince  the  dependence  of  the  whole  upon  the  foregoing  caus- 
ations, of  which  alterative  reflex  nervous  actions  are  apt  tobe  the  principal. 

514,  c.  We  thus  comprehend  how  an  emetic  of  the  most  simple  na- 
ture may  suddenly  arrest  a  paroxysm  of  hooping-cough,  or  of  spas- 
modic asthma,  or  of  hysteria.  The  emetic,  through  the  foregoing 
process,  induces  new  movements  in  the  affected  muscles,  and  thus 
ends  the  paroxysm.  Dr.  Greenhow,  for  example,  has  lately  related, 
in  the  London  Medical  Gazette,  the  case  of  a  man,  who  was  affected 
with  a  choking,  as  if  a  ball  was  rising  in  his  throat,  and  shortly  after 
a  violent  hiccough  began,  which  continued  for  several  days.  About 
the  eighth  day,  his  wife,  sister,  and  maid-servant,  "  got  into  the  same 
state  ;"  the  affection  being  communicated  in  the  last  three  cases  or  in- 
duced by  the  operation  of  the  mind  (^  227,  no.  1,  844  a).  "  It  was  a 
painful  spectacle,  though  a  somewhat  ludicrous  one,  to  see  four  indi- 
viduals all  hiccoughing  at  the  same  time."  Opium,  valerian,  asafoet- 
ida,  camphor,  magnesia,  &c.,  failed  entirely  of  affording  relief.  "How- 
ever, somethmg  taken  by  the  maid-servant  made  her  vomit,  and  from 
that  moment  the  complaint  ceased.  A  mustard  emetic  was  immedi- 
ately ordered  for  the  others,  when  the  sister  and  wife  were  also  re- 
lieved ;  but  not  so  the  husband,  whose  attack,  however,  was  always 
suspended  by  vomiting,  but  soon  returned."  In  the  case  of  the  hus- 
band, there  was  present  a  state  of  disease,  which  continued  to  repro-' 
duce  the  paroxysms  ;  but  in  the  other  three  there  was  little  else  than 
the  spasmodic  action  of  the  muscles.  Dr.  G.  says  he  "  always  after- 
ward found  that  vomiting  put  an  end  to  attacks  of  hysteria,  and  be- 
lieves that  the  dread  of  an  emetic  has  often  had  the  effect  of  checking 

Y 


338  INSTITUTES    OF    MEDICINE. 

ail  hysterical  attack;"  in  which  case  the  mind  develops  a  controlling 
nervous  influence. — Note  Cc  p.  1132, 

514,  d.  Consider,  next,  an  example  of  the  manifestation  of  sympa- 
thy between  the  skin  and  other  parts,  as  indicative  of  the  modus  ope 
randi  of  remedial  and  morbific  agents  when  they  establish  their  influ- 
ences upon  distant  parts  through  the  medium  of  the  skin. 

Volkmann,  in  pointing  out  the  great  difference  between  the  trunks 
and  the  minute  terminations  of  the  nerves  in  the  power  of  exciting 
reflex  motions,  prefers  the  skin  for  illustration ;  which,  he  says,  sur- 
passes all  other  organs  in  the  property  of  exciting  these  motions.  When 
an  animal,  for  example,  is  under  the  influence  of  opium,  the  slightest 
touch  of  the  skin  is  frequently  sufficient  to  give  rise  to  strong  spasms, 
while  reflex  actions  excited  by  irritating  the  distinct  nerves  of  the 
skin  are  generally  less.  The  philosophy  is  the  same  when  cold  air, 
or  cold  water,  restores  a  patient  from  a  state  of  syncope.  A  drop  of 
cold  water,  when  snapped  upon  the  face,  rouses  the  subject  by  trans- 
mitting an  impression  through  the  cutaneous  nerves  to  the  nervous 
centres,  which  instantly  develops  an  exciting  nervous  influence  that  is 
then  reflected  upon  the  muscles  of  respiration,  and  upon  the  heart  and 
extreme  blood-vessels.  The  same  law  governs,  also,  the  constant  mu- 
tual interchange  of  action  between  the  skin  and  alimentary  canal,  the 
skin  and  kidneys,  &c.,  whether  in  health  or  disease.  From  these  ex- 
amples of  a  great  fundamental  law,  we  readily  obtain  the  modus 
operandi  of  mercury,  iodine,  blisters,  issues,  &c.,  when  applied  to  the 
skin,  and  of  cold  in  reducing  hernia  (§  224,  232,  527  h,  1088  h,  c). 

514,  e.  With  the  qualifications  stated  in  sections  458,  459,  it  is  "a 
general  law,  that,  whenever  general  spasms  are  excited  by  local  im- 
pressions, the  phenomenon  depends  on  no  other  communication  be- 
tween the  sensitive  and  motor  fibres  than  exists  in  the  spinal  cord.  In 
many  cases,  however,  local  irritation  of  the  nerves  gives  rise,  not  to 
general,  but  to  local  muscular  spasms."  "  In  the  contraction  of  all 
the  perineal  muscles  in  expelling  the  semen,  which  are  excited  by 
irritation  of  the  sensitive  fibres  of  the  penis,  the  spinal  cord  is  the 
medium  of  communication  between  the  sensorial  impressions  and  the 
movements." — Muller. 

514, y!  Many  "muscles  invested  by  sensitive  membranes,  and  are 
not  themselves  exposed  to  the  direct  stimulus,  can  only  be  excited  to 
action  by  irritation  of  the  sensitive  property  of  their  investing  mem- 
brane, the  transmission  of  this  irritation  to  the  nervous  centres,  and 
the  propagation  of  the  motor  influence  from  the  nervous  centres  to 
themselves.  Thus,  the  contractions  of  the  glottis  and  air-passages, 
excited  by  the  contact  of  irritating  gases,  are  not  the  immediate  result 
of  the  irritation  of  the  parts  themselves,  but  of  the  excitement  of  the 
sensitive  fibres  distributed  to  the  mucous  membrane  and  the  reflected 
iiyfluence  of  the  brain  and  spinal  cord  upon  the  motor  nerves  of  the 
muscles.  The  movements  of  deglutition  belong  to  this  class.  The 
stimulus  of  the  morsel  in  the  fauces  excites  the  act  of  deglutition.  In 
this  case,  the  sensitive  nerves  which  transmit  the  impression  to  the 
•nervous  centres  are,  according  to  Dr.  Reid,  the  glosso-pharyngeal,  the 
superior  laryngeal,  and  the  branches  of  the  fifth,  sent  to  the  soft  palate 
and  isthmus  of  the  fauces.  The  motor  nerves  for  the  movements  of 
deglutition  are  the  pharyngeal  branches  of  the  par  vagum.  A  like 
explanation  applies,  also,  to  the  irritations  of  the  sphincter  ani  and  the 


PHVSIOLOGY. FUNCTIONS.  339 

sphincters  of  the  bladder.  The  muscles  cannot  be  themselves  stimu- 
lated by  the  excrement  and  the  urine  ;  but  these  matters  act  upon  the 
sensitive  nerves  of  the  mucous  membrane  and  excite  the  spinal  cord, 
which,  as  if  constantly  charged,  with  motor  influence,  reacts  upon  the 
muscles.  In  this  case  the  phenomenon  appears  to  depend  on  no  other 
communication  between  the  sensitive  and  motor  fibres  than  exists  in 
the  spina]  cord.  Hence,  after  injury  of  the  spinal  marrow,  these 
sphincters  become  relaxed." — Muller. 

The  operation  of  cathartics  involves  more  complex  laws.  These 
are  agents  of  specific  virtues,  and  are  capable  of  modifying  the  vital 
states  of  the  intestinal  canal  and  of  parts  remotely  situated.  Their  di- 
rect impression  is  exerted  upon  the  intestinal  mucous  tissue ;  but  the 
muscular  is  brought  into  increased  action  both  by  contiguous  and  re- 
mote sympathy  (§  497).  This  renders  it  manifest  that  reflex  nervous 
action  is  concerned  in  the  ordinary  peristaltic  movements  that  are  in- 
duced by  the  natural  contents  of  the  alimentary  canal  (§  475^,  490) ; 
nor,  indeed,  is  it  conceivable  that  either  the  intestinal  muscular  tissue 
or  that  of  the  heart  can  be  reached  in  any  other  way  than  by  the  stim- 
ulus of  the  nervous  influence  excited  as  in  §  475^,  490.  But  in  the 
case  of  cathartics,  something  more  happens.  The  influence  being  ex- 
tended to  the  nervous  centres,  the  nervous  power  is  propagated  through 
motor  fibres  of  the  pneumdgastric  and  sympathetic  nerves  upon  the  in- 
testinal mucous  tissue,  by  which  the  various  influences  of  these  agents 
are  increased,  as  in  the  experiments  by  Wilson  Philip  (§  113,  224,  226, 
4751,  491,  889  a,  1042,  1088  cZ).— Notes  A  p.  1111,  Bb  p.  1131. 

514,  g.  The  sphincters  remain  contracted  after  the  expulsion  of  the 
faeces  and  urine.  This  is  owing  to  the  permanence  of  the  impression 
upon  the  mucous  tissue,  which  maintains  an  excitement  of  the  nervous 
influence  till  the  excrements  are  again  deposited.  And  so  of  the  con- 
tinued influences  of  remedial  and  morbific  agents  long  after  the  agents 
themselves  have  ceased  to  operate  ;  the  impressions  remaining  upon  the 
parts  where  their  direct  action  had  been  exerted.  In  this  way  miasma- 
ta, the  virus  of  the  mad  dog,  mercurial  and  other  remedies  which  may 
be  slow  in  the  full  development  of  their  effects,  establish  their  influences 
where  their  direct  action  may  fall,  and  these  are  subsequently  and 
slowly  propagated  to  other  parts  by  unceasing  alterative  reflex  nervous 
actions  (§  516,  nos.  2  and  6,  578  cZ,  657  a).     See  also  roosting  (§  500  dd). 

514,  h,  More  complex  examples  of  the  law  with  which  this  section 
was  begun  will  be  presented  hereafter.  Such  as  have  been  stated  are 
intended  as  introductory  to  the  series  of  laws  which  are  soon  to  fol- 
low. But  we  see  from  examples  already  produced,  that  when  sym- 
pathies are  set  up  in  one  part  they  may  become  the  cause  of  sympa- 
thies in  other  parts,  and  that  in  this  manner  remedial  and  morbific 
agents,  which  begin  their  action  on  some  given  part,  may  establish 
very  complex  sympathetic  effects,  each  modifying  the  others  through 
new  influences  upon  the  nervous  power  (§  228).  When  the  food,  for 
instance,  as  in  §  512,  induces  vascular  action  and  warmth  in  the  skin 
before  digestion  commences,  that  organ  excites  salutary  reflex  nervous 
influences  on  the  digestive  organs,  and  thus  promotes  digestion.  When 
tartarized  antimony,  in  small  doses,  induces  a  sudorific  nervous  in- 
fluence, the  skin  becomes  the  source  of  many  reflex  nervous  actions 
upon  other  organs ;  thus  showing,  also,  that  it  is  not  the  perspiration, 
but  the  vital  change  in  the  organ  itself,  which  leads  to  results  that  can- 


340  INSTITUTES    OF    MEDICINE. 

not  be  imitated  by  any  other  mode  of  exciting  this  excretory  function 
And  so,  more  or  less,  of  other  parts  upon  which  the  antimony  may 
exert  its  primary  sympathetic  eftect  (§  863,  e,  902  g). 

Thus  it  happens,  that  whether  certain  remedial  agents  are  ajDplied 
to  the  stomach  or  skin,  reflex  nervous  actions  are  propagated  to  each, 
as  well  as  from  each  to  other  organs,  while  each,  in  its  turn,  reflects 
the  impressions  back  to  the  brain  and  spinal  cord,  from  whence  they 
are  again  returned  with  increased  intensity ;  or  organs  not  before  in- 
volved are  ultimately  brought  under  their  influence  f§  129  h,  674  d). 
And  so  of  disease  of  any  given  organ  ;  which  is  only  equivalent  to  the 
influences  of  morbific  causes  (§  647,  660). 

If  two  or  more  remedial  agents  be  united,  it  is  readily  seen  that 
their  combined  effect  may  be  extended  from  the  stomach  to  various 
parts  of  the  body,  and  thus  other  alterative  reflex  actions  propagated 
among  themselves,  and  variously  determined  upon  other  parts  {\  872  c). 

514,  i.  We  may  now  regard  an  example  which  presents  a  union  of 
the  physiological,  pathological,  and  therapeutical  principles,  as  set 
forth  by  myself,  in  their  relation  to  the  nervous  influence ;  all  refera- 
ble to  one  common  law  in  its  connection  with  modifications  of  the  ner- 
vous power  (§  226).  Thus :  "  Certain  cases,"  according  to  Marshall 
Hall,  "  as  hydrophobia,  epilepsy,  hysteria,  and  certain  remedies,  as 
stiychnia,  cantharides,  &c.,  not  only  induce  augmented  excitability, 
but  manifest  their  effects  upon  the  organs  which  are  physiologically 
under  the  dominion  of  the  excito-motory  power." 

514,  k.  Finally,  a  glance  at  the  physiology  of  the  contraction  of  the 
iris  may  aid  our  understanding  of  the  complex  sympathetic  influences 
of  morbific  and  remedial  agents,  and  of  the  applicability  of  the  follow- 
ing physiological  laws  to  the  modus  operandi  of  such  agents. 

It  is  first  worthy  of  observation,  that  the  iris  maybe  pricked  with  a 
knife  without  exciting  contraction,  while  it  is  exquisitely  sensitive  to 
the  action  of  light  (§  74  a,  ISS-I^  d,  136,  137).  The  co-operation  of  a 
sensitive  and  motor  nerve,  through  the  medium  of  the  brain,  is  neces- 
sary to  this  phenomenon.  The  impression  upon  the  retina,  being 
transmitted  to  the  brain  through  the  optic  nerve,  is  reflected  upon  the 
iris  through  the  motor  ciliary  nerve.  This  may,  perhaps,  open  the 
eyes  of  the  chemist  as  to  the  true  doctrine  of  vision  (§188^  d,  500  nn). 
But  it  is  a  more  interesting  fact,  that  when  one  eye  is  closed,  and  the 
other  open,  the  pupil  of  the  closed  eye  will  follow,  in  a  measure,  the 
movements  of  the  open  eye ;  and  this  will  happen  to  an  amaurotic  eye 
when  the  sound  one  is  exposed  to  the  stimulus  of  light.  This  sympa- 
thy between  the  two  eyes,  as  well  as  in  other  respects,  and  the  har- 
mony between  the  two  ears,  involve  very  delicate  considerations  as  to 
the  influences  of  the  nervous  centres,  and  may  be  employed  in  tracing 
out  the  philosophy  of  many  obscure  interchanges  of  action  among  dif- 
ferent organs,  either  in  their  natural  states,  or  when  they  are  disturb- 
ed by  morbific  or  remedial  agents  (^  1072,  a,  note). 

514,  I.  A  multitude  of  illustrations  may  be  brought  to  the  same 
purpose,  which  show  us,  also,  how  complex  may  be  the  influences  of 
morbific  and  remedial  agents,  and  how  the  mind  may  participate, 
when  these  agents  operate  upon  the  organic  properties  which  con- 
duct the  insensible  movements.  Thus,  sneezing  is  commonly  produ- 
ced by  the  action  of  stimuli  upon  a  nerve  of  common  sensibility  dis- 
tributed from  the  fifth  pair  to  the  mucous  tissue  of  the  nose,  and  the 


PHYSIOLOGY. FUNCTIONS.  341 

reflection  of  this  irritation  upon  the  respiratory  nerves.  But  the 
stimulus  of  the  sun's  light  may  produce  sneezing  by  acting  first  upon 
the  optic  nerve,  and  through  that  medium  upon  the  nervous  centres. 
The  nervous  power  thus  developed  is  reflected  upon  the  Schneiderian 
membrane  through  the  motor  branches  of  the  fifth  pair  which  im- 
parts common  sensibility  to  the  nose  (§  1 98).  Here  a  new  sensation 
arises,  which  is  sent  back  to  the  brain  and  spinal  cord,  the  nervous 
power  again  developed,  and,  according  to  relations  between  that 
membrane  and.  the  respiratory  organs,  and  the  nature  of  the  re- 
mote cause,  the  nervous  power  is  reflected  upon  the  respiratory- 
muscles,  when  sneezing  follows  as  the  result  of  the  convulsive 
movement.     (See,  in  connection,  §  188|  d,  500  n7i.) 

The  mind  itself  will  do  the  same  thing  by  dwelling  intensely  on  a 
former  paroxysm  of  sneezing.  Here  the  nei-vous  power  is  excited  in 
a  direct  manner  by  the  mind,  and  is  then,  as  in  the  foregoing  case, 
directed  upon  the  nasal  branch  of  the  fifth  pair.  And  so  of  sympa- 
thetic yawning,  sympathetic  micturiaon,  vomiting  from  disgust,  hcc. 

514,  m.  The  olfactory  nerve  is  mostly  endowed  with  specific  sensi- 
bility, and  is  only  excited  by  odors,  while  they  have  no  such  effect 
upon  the  nasal  branches  of  the  fifth  pair,  unless  the  odors  be  at  the 
same  time  of  a  pungent  nature ;  and  then  it  is  the  pungency,  not  the 
odor,  that  operates.  Odors  affect  the  mind  agreeably  or  disagreea- 
bly. The  smell  of  a  rose  may  have  no  other  effect  than  that  of  so 
impressing  the  brain  as  to  give  rise  to  a  pleasurable  sensation.  But, 
in  some  constitutions  its  impression  will  excite  a  variety  of  reflex  ner- 
vous actions.  Its  effect  may  be  at  first  pleasurable,  but  followed 
immediately  by  the  transmission  of  a  disturbing  influence  to  the 
heart,  or  stomach,  or  even  to  the  intestines.  The  heart  may  be  thus 
depressed  in  its  action,  the  stomach  nauseated,  and  the  bowels  have 
been  purged  by  the  same  cause.  Hence  the  poet's  expression,  to 
"  die  of  a  rose  in  aromatic  pain."  Even  the  recollection  of  disagree- 
able results  from  offensive  odors  brings  on  nausea  and  vomiting  (§ 
500,2,  A^.    See,  in  connection,  ^  188  j,  d). — Note  Dp.  1114. 

Laws  of  Action  of  the  Sympathetic  Nerve,  and  the  Propagatioii  of  Iiiv- 
pressions  in  it. 

514^,  a.  Having  now,  and  in  former  sections  (§  471-475,  477-496, 
500),  stated  the  most  important  facts  and  laws  which  relate  to  the 
cerebro-spinal  system,  whether  acting  independently,  or  in  connec- 
tion with  the  sympathetic  nerve,  I  shall  proceed  to  speak  of  those 
which  concern  especially  the  latter  system.  But  the  cerebro-spinal 
is  so  interwoven  with  the  sympathetic  nerve,  it  is  obvious  that  the 
influences  which  appertain  to  the  brain  and  spinal  cord  must  be  more 
or  less  common  to  the  ganglionic  nerve  (§  115,  4.58-460,  893  a). 

514J,  b.  The  following  laws  are  generally  inferable  from  what  has 
been  already  said  of  .the  nervous  power,  and  of  sympathy.  But,  I 
have  deemed  it  most  useful  to  the  young  student  of  medicine,  and 
possibly  to  the  more  advanced,  to  present  them  in  a  brief  and  sys- 
tematic form,  with  comments  of  a  practical  nature.  The  quotations 
are  from  Miiller,  unless  otherwise  stated.  In  this  branch  of  physiol- 
ogy Miiller  is  emuiently  philosophical ;  and  in  thus  adhering  to  the 
path  of  nature,  he  is  arrayed  in  opposition  to  those  chemical  and 
physical  views  with  which  he  has  thought  proper  to  oblige  the  mate- 


342  INSTITUTES    OF    MEDICINE. 

rialists  of  the  age,  and  which  prevail  in  other  parts  of  his  work  on 
Physiology.  After  variously  expounding  the  laws  of  the  vital  prin. 
ciple,  and  reasoning  as  a  philosopher  upon  the  abstract  subject  of  re- 
flex nervous  influence,  like  Marshall  Hall,  and  others,  he  cuts  loose 
from  all  analogies,  and  from  the  whole  philosophy  of  the  vital  prop- 
erties. As  in  the  equally  remarkable  case  of  Wilson  Philip,  he  as- 
cribes all  the  organic  functions  and  products  to  physical  and  chemi- 
cal agencies, — maintaining  that, 

"  The  formation  of  any  one  of  the  peculiar  secretions,  the  essential 
proximate  constituents  of  which  do  not  exist  in  the  blood,  presupposes 
the  operation  qf  a  special  chemical  apparatus,  whether  this  be  a  mem- 
brane  or  a  gland.^''  Of  all  morbid  states,  he  affirms,  that  "  All  these 
phenomena  are  owing  to  a  noxious  'matter  absorbed  into  the  blood,  or 
generated  in  itT 

The  same  humoral  interpretation  is  applied  to  the  modus  operandi 
of  remedies,  which,  like  morbific  agents,  are  supposed  to  be  taken  into 
the  circulation  by  endosmosis  or  by  capillary  attraction,  and  it  is  quite 
'■'■uncertain^''  he  says,  '■'^  whether  the  matters  are  first  received  into  the 
blood-vessels  or  lymphatics^ — Muller's  Elemetits  of  Physiology.  Also, 
Medical  and  Physiological  Commentaries,  vol.  i.,  p.  37,  note,  56,  note, 
565,  570,  684,  685  ;  and  this  work,  §  494,  dd. 

I  have  thus  adverted  again  to  the  discrepances  in  the  views  of  this 
philosopher,  that  the  reader  may  appreciate  the  value  of  his  luminous 
exposition  of  the  laws  of  sympathy,  since  they  contemplated  no  theo- 
retical conclusions  in  pathology  or  therapeutics, 

515.  It  is  still  a  controverted  question  how  far  the  sympathetic 
nerve  is  independent  of  the  brain  and  spinal  cord,  though  in  their  nat- 
ural state  the  intimate  physiological  relations  of  the  latter  to  the  for- 
mer admit  of  no  doubt  (§  459).  Microscopical  investigations  have 
been  carried  on  extensively  with  reference  to  this  inquiry  by  Valentin, 
Volkmann,  Bidder,  Midler,  Remack,  Henl6,  Purkinje,  Rosensthat,  Pap- 
penheim,  and  some  others  less  known  in  the  walks  of  physiology.  As 
may  be  readily  supposed  from  the  nature  of  the  investigation,  and  the 
means  relied  upon,  there  has  been  great  discrepancy,  and  even  entire 
opposition,  in  the  principal  statements  and  conclusions  ;  all  tending 
to  strengthen  my  objections  to  the  use  of  the  microscope  in  anatomical 
and  physiological  inquiries  (§  131.*  A\so,  Med.  and  Phys.  Comtn.,\o\. 
i.,  p.  699-712;  and  Examination  of  Revieios,  in  vol.  iii.,  p.  6,  89). 

We  know  enough,  however,  of  the  relations  of  the  sympathetic 
nerve  and  cerebro-spinal  systems,  and  of  their  connections  with  other 
parts,  and  enough  of  the  phenomena  which  grow  out  of  those  rela- 
tions, to  lay  down  the  important  laws  of  sympathy ;  and  these  are 
what  we  require  for  practical  purposes. 

Of  the  Actions  of  the  Sympathetic  Nerve  iii  Involuntary  Motions. 

516,  a.  1.  "All  the  parts  subject  to  the  influence  of  the  sympathet- 
ic nerve  are  incapable  of  voluntary  motion,"  except  as  in  §  500  e. 

2.  "  The  parts  which  are  supplied  with  motor  power  by  the  sympa- 
thetic nerve  still  continue  to  move,  though  more  feebly  than  before, 
when  they  are  separated  from  their  natural  connections  with  the  rest 
of  the  sympathetic  system,  and  wholly  7-ciaoved  from  the  hodyT 

This  is  an  important  fact,  as  contributing  to  prove  that  the  viscera 

of  oi'ganic  life  obey  not  only  the  nervous  power,  but  other  stimuli,  and 

*  Observations  have  become  more  accurate  and  f^reatly  multiplied,  but  the  essential 
oV)jections  remain,  as  in  most  other  phj'siological  processes. — 1860. 


PHYSIOLOGY. FUNCTIONS.  343 

that  all  the  essential  processes  are  carried  on  by  properties  peculiar  to 
themselves  (§  184,  188,  205-216,  222-232,  475^,  476-492,  494,  500), 
though  constantly  influenced  by  the  nerves  (§  456  a,  746  c). 

516,  b.  Clear  demonstrations  of  the  foregoing  law  abound  in  the  his- 
tory of  organic  life.  That  in  relation  to  the  extirpated  heart,  where  the 
air  and  mechanical  irritants  were  equivalent  to  the  nervous  stimulus, 
illustrates  the  subject  (§  264,  498  e,  637). 

516,  c.  Again,  if  the  intestines  be  removed  from  the  body,  and  some 
part  of  them  irritated,  their  motion  is  increased,  "  and  this  effect  con- 
tinues long  after  the  stimulus  is  withdrawn,  and  does  not  immediately  at- 
tain its  greatest  degree."  And  so  with  the  heart.  Its  contractions  may 
not  begin  till  some  seconds  after  it  is  irritated,  and  they  may  then  be 
long  continued  (§  516,  nos.  6  and  7).  This  does  not  show,  however,  that 
the  nerves  do  not  supply  the  natural  stimulus  of  the  muscular  tissue, 
but  only  that  other  stimuli  will  excite  its  action  (§  475 1,  478  b,  490). 

516,  d.  We'l^ave,  therefore,  in  these  examples,  a  type  of  all  the  move- 
ments which  arise  from  continuous  sympathy*  (§  498,  524,  no.  2),  and 
a  proof  of  the  existence  of  the  organic  properties,  of  their  independence 
of  the  nervous  system,  and  of  the  active,  vital  nature  of  the  dilatation  of 
the  heart  (§  498  e).  The  principle  is  of  great  moment  in  a  pathological 
and  therapeutical  aspect.  We  see,  for  example,  that  the  direct  facts, 
and  the  analogy  supplied  by  the  active  dilatation  and  contraction  of  the 
lioirt,  substantiate  a  rythmic,  consentaneous  movement  of  the  arteries 
(§  384).  We  carry  this  with  the  other  facts  to  pathological  conditions. 
Thus,  when  the  extreme  capillaries  of  the  skin,  as  of  the  finger,  for  in- 
stance, or  any  other  part,  are  irritated  mechanically,  or  by  any  chemic- 
al or  other  agent,  an  inflammation  may  be  excited  at  the  point  irritated  ; 
just  as  the  heart,  or  intestine,  is  roused  into  action  by  the  prick  of  a  pin. 
The  inflammation  then  extends,  progressively,  from  the  point  irritated, 
the  finger  throbs,  its  principal  artery  begins  to  pulsate,  and  finally  the 
radial.  And  so  of  the  irritation  of  the  ducts  of  glands,  by  which  the 
glandular  secretion  is  increased.  Generally,  also,  remote  sympathy,  or 
reflex  action  of  the  nervous  power,  is  simultaneously  brought  into  efiect. 

3.  "Hence,  all  the  parts  endowed  with  motion  and  supplied  with 
nerves  from  the  sympathetic,  are,  in  a  certain  degree,  independent  of  the 
brain  and  spinal  cord."  This  can  apply  only  to  the  structures  of  organ- 
ic life,  and  as  they  may  enter  those  of  animal  life — thus  distinguishing  the 
cerebro-spinal  from  the  ganglionic  system  (§  215,  233,  475^,  487,  893J). 

4.  "  The  central  organs  of  the  nervous  system  can,  however,  exert 
aij  active  influence  on  the  sympathetic  nerves  and  their  motor  power"' 
(§  222-232,  475). 

This  is  a  very  important  physiological  fact  to  the  physician,  and  is 
fully  established  by  the  experiments  of  Philip,  Valentin,  Miiller,  and 
others,  and  is  conspicuously  shown  by  the  effects  of  the  passions. 

It  is  through  the  liability  of  the  whole  body  to  be  influenced  by  the 
nervous  power  of  the  brain  and  spinal  cord  through  the  sympathetic 
nerve,  and  as  generated  by  the  central  parts  of  that  nerve  that  I  in- 
terpret the  whole  philosophy  of  sympathetic  diseases,  and  the  operation 
of  all  morbific  and  remedial  agents  when  they  affect  parts  that  are  dis- 
tant from  the  direct  seat  of  their  action. — Rights  of  Authors  p.  912. 

5.  "The  experiments  of  Dr.  Philip  tend  to  show  that  distinct 
parts  of  the  sympathetic,  and  the  movements  dependent  upon  them, 
*  Continuous  influence  of  these  Institutes  (§  129  e,/,  498  «). 


344  INSTITUTES   OF    MEDICINE. 

a3  of  the  heart,  foi*  example,  do  not  derive  their  nei-vous  influence 
from  distinct  regions  of  tlie  brain  and  spinal  cord  ;  but,  on  the  contra- 
ry, that  the  whole  brain  and  spinal  cord,  or  every  part  of  them,  can 
exert  an  influence  on  the  motions  of  the  heart,"  of  the  capillary  blood- 
vessels, of  the  intestinal  canal,  &c.  (§  476-492,  494  d). 

6.  Next  follows  a  most  important  physiological  law,  when  applied 
pathologically  and  therapeutically,  and  by  which  I  explain  the  con* 
tinned  operation  of  morbific  and  remedial  agents  long  after  the  ces- 
sation of  their  direct  action. 

"  The  movements  excited  in  organs  which  are  under  the  influence 
of  the  sympathetic  nerve,  by  irritation  applied  to  them  or  to  their 
nerves,  are  not  transitory  and  momentary  contractions.  They  are 
either  enduring  contractions,  or  they  consist  of  a  long-continued  modi- 
fication of  the  ordinary  rhythmic  action  of  the  organ.  Hence,  in  these 
organs,  the  reaction  consequent  on  the  irritation  is  entirely  of  longer 
duration  than  the  action  of  the  stimulus'^  (§  514  g,  516,  no.  2,  c,  487  c). 

Now,  what  is  true  of  the  nervous  influence  as  it  respects  its  effect 
on  the  great  organs  is,  according  to  the  experiments  of  Dr.  Philip, 
and  others,  equally  so  of  the  small  blood-vessels,  and  the  vessels  of  se- 
cretion, and  as  a  consequence,  of  their  products. 

The  foregoing  law  is  founded  upon  experiments  in  which  the  irri- 
tation produced  by  agents  is  not  directly  morbific,  such  as  galvanism 
and  mechanical  irritants.  If  such  causes,  therefore,  will  continue  to 
derange  the  actions  of  the  organic  viscera  after  the  operation  of  the 
causes  is  withdrawn,  those  which  are  truly  morbific  will  continue  in 
action  longer,  and  establish  disease  more  permanently  through  the 
same  channel.  And  so  of  remedial  agents.  The  law  is  shown,  nat- 
urally, by  the  unabated  contraction  of  the  sphincter  muscles  after  the 
evacuation  of  urine  and  of  fecal  matter  (See  Belladonna  &c.,  p.  674). 

This  physiological  law,  therefore,  is  of  vast  moment  in  interpreting 
the  effects  of  remedial  agents,  corresponds  with  that  natural  condition 
which  is  set  forth  in  §  514,^,  shows  us  how  the  influence  of  an  emetic 
or  cathartic  may  continue  to  be  felt  by  the  lungs,  the  brain,  &c.,  long 
after  their  most  characteristic  effects  are  over ;  or  how  an  uninter- 
rupted and  cumulative  action  of  the  foregoing  natui'e  may  be  main- 
tained by  small  and  repeated  doses  of  mercury,  antimony,  &c.,  or  by 
the  peculiar  change  which  leeches  establish  in  the  vessels  to  which 
they  are  applied,  and,  finally,  how  a  morbific  cause  of  yet  other  spe- 
cific virtues  may,  by  its  momentary  action  on  the  mucous  tissue  of  the 
stomach,  or  lungs,  &c.,  be  kept  up  in  those  tissues  long  after  the  re- 
mote cause  is  withdrawn,  and  progressively  shed  a  morbific  influence 
over  all  the  organs  of  the  body  ('§  150,  498/  545,  549,  550,  558  a, 
559,  666).  The  impression  is  maintained,  in  all  the  cases,  upon  the 
organic  constitution  of  the  organs  immediately  impressed,  for  an  in- 
definite time  after  the  agents  themselves  have  ceased  their  operation. 
While  that  impi'ession  remains  the  influence  which  has  been  thus  ex- 
erted continues  to  modify,  more  or  less,  the  vital  nature  of  the  parts, 
and  to  be  reflected  with  various  effect  upon  distant  organs.  We 
have  seen  the  simple  physiological  elements  operating  through  the 
combined  media  of  the  cerebro-spinal  and  sympathetic  systems,  in 
§  514,  f,  g,  as  it  respects  the  permanent  contraction  of  the  sphinc- 
ter muscles,  and  in  the  explanation  which  I  have  given  of  the  persist- 
nnce  of  their  contrrction  after  the  expulsion  of  the  urine  and  faeces. 


PHYSIOLOGY. FUNCTIONS.  345 

Now,  thaf  principle  which  physiologists  have  limited  to  an  expla- 
nation of  the  natural  phenomena  in  relation  to  the  sphincters  is  most 
extensively  applicable  in  resolving  the  problems  of  disease  and  of  re- 
medial influences,  and  I  shall  carry  it,  in  connection  with  the  forego- 
ing law,  far  into  the  labyrinth  of  organic  life,  as  it  may  fall  under  the 
cognizancQ  of  the  pathologist  and  therapeutist.  In  the  aspect,  alone, 
of  its  bearing  upon  the  amount  and  frequency  of  doses,  &c.,  in  the 
treatment  of  disease,  the  law  is  of  incalculable  magnitude  (§  857), 
The  same  impressions  which  are  left  upon  the  bladder  and  rectum 
after  the  evacuation  of  their  contents,  and  which  continue  to  propa- 
gate reflex  nervous  actions  to  the  sphincter  muscles,  and  thus  maintain 
them  in  a  state  of  contraction  till  the  urine  or  the  faeces  again  accu- 
mulate, equally  appertain  to  morbific  and  remedial  agents.  Hence  1 
deduce  an  important  practical  rule  for  the  regulation  of  doses,  the 
frequency  of  their  repetition,  the  order  of  their  application,  &c.,  ac- 
cording to  the  nature  of  disease,  the  nature  of  the  agents  employed, 
the  duration  of  their  effect,  &c. ;  all  of  which  is  amply  sustained  by 
the  results  of  practice,  especially  those  which  so  constantly  accrue  from 
excessive  doses,  and  their  repetition  before  the  influences  of  the  pre- 
ceding shall  have  duly  abated,  or  where  other  means  should  have 
been  substituted.  There  is  nothing,  I  say,  of  greater  practical  impor- 
tance in  the  whole  circuit  of  medicine  than  what  is  involved  in  this 
section,  and  in  those  which  I  shall  have  brought  to  its  illustration. 
We  must  attend  to  the  physiological  facts.  The  effects  of  mistaken 
practice  are  entirely  insufficient  to  enlighten  the  understanding.  Phys- 
iology must  be  bi'ought  back  as  the  basis  of  pathology,  the  ground- 
work of  therapeutics ;  keeping  ever  before  us  those  natural  laws 
through  which  the  evil  and  the  good  of  practical  medicine  are  essen- 
tially determined.  However  various  the  causes  and  the  phenomena, 
a  concurrence  of  principle  and  of  laws  obtains-  among  the  whole ; 
which  is  the  surest  proof  that  the  doctrines  here  taught  have  their 
deep  foundation  in  nature  (§  237).  There  is  nothing  that  can  assure 
us  more  emphatically  of  the  importance  of  sweeping  away  the  chem- 
ical and  physical  doctrines  of  life,  of  disease,  of  therapeutics,  than  the 
facts  about  which  I  am  now  interested,  and  the  mischief  which  has 
arisen  either  from  removing  pathology  and  therapeutics  from  their 
proper  foundation,  or  in  dei'iving  their  foundation  from  the  laboratory 
of  the  chemist  (§  5h  a,  350|,  350^,  819,  &c.).— Note  Ff  p.  1135. 

7.  The  next  following  law  shows  that  the  organs  of  organic  life  are 
essentially  a  system  by  themselves,  that  their  actions  are  carried  on 
by  their  own  inherent  powers,  and  are  essentially  independent  of  the 
nerves,  and  that  the  great  oflSce  of  the  sympathetic  nerve  is  to  pro- 
vide a  stimulus,  and  animalize  organic  compounds.  It  will  be  seen, 
however,  that  a  common  error  occurs,  that  "  tJie  immediate  cause  of  the 
involuntary  motions  lies  in  the  symjpailietic  nerve'"'  (§  516,  no.  2). 

*'  The  immediate  cause  of  the?  involuntary  motions,  and  the  cause 
of  their  type,  lies  neither  in  the  brain  nor  in  the  spinal  cord,  but  in 
the  sympathetic  nerve  itself.  Even  the  influence  of  the  ganglia  is  not 
necessary.  The  branches  of  the  sympathetic  going  to  an  organ  may 
be  entirely  removed,  the  twigs  distributed  to  the  substance  of  the  or- 
gan only  being  left,  and  the  motions  will  be  maintained  as  before,  the 
reciprocal  action  between  the  muscular  fibres  and  these  ultimate  ner- 
vous twigs  being  apparently  adequate  to  their  production."* 
*  See  Note  Bb  p.  1131. 


346  INSTITUTES    OF    MEDICINE. 

The  phenomena  are  the  same  in  plants.  They  depend,  not  on  the 
nervous  power,  but  on  the  organic  properties  of  every  part.  This  ap- 
pears from  Miiller  himself,  who  says  that,  "  to  excite  the  motion  of 
the  leaflets  and  petioles  of  the  mimosa,  it  is  not  necessary  that  either 
the  intumescence,  or  even  the  leaves,  should  be  touched.  The  stimu- 
lus may  be  applied  to  a  more  or  less  distant  part"  (§  184,  207,  208, 
233,  257,  490,  502,  524,  no.  2).  Had  Miiller  said  the  exciting  instead 
of  the  "  immediate  cause,"  there  would  have  been  less  objection ;  but 
the  present  case  is  like  that  in  §  2G4,  498  e,  516  c,  1042. 

8.  Now  follows  the  great  law,  that,  notwithstanding  the  foregoing 
separate  nature  of  the  organic  properties  and  their  essential  independ- 
ence of  the  nervous  power,  the  organic  properties  are  constantly  influ- 
enced through  the  cerebro-spinal  and  sympathetic  systems.  What  is 
said,  however,  of  the  "extreme  branches  of  the  sympathetic"  must  be 
regarded  as  erroneous  (no.  7),  though  it  be  certain  that  influences  may 
be  determined  by  reflex  action  through  the  ganglia  and  plexuses  of  the 
sympathetic  nerve  (§  459).     The  law  is  thus  expressed  by  Miiller: 

"  Although,  from  the  foregoing  observations  (no.  7),  it  is  certain  that 
the  extreme  minute  branches  of  the  sympathetic  have  still  the  power 
of  regulating  the  movements  of  the  parts  not  subject  to  the  will  (when 
such  parts  are  abstracted  from  the  body),  yet  it  is  not  less  true  that 
both  the  brain  and  spinal  cord,  and  the  ganglia  themselves,  when  in 
a  state  of  irritation,  exert  an  influence  on  these  movements  as  long  as 
the  contractile  organs  are  connected  with  them  through  the  medium 
of  the  nerves.  The  brain  and  spinal  cord  are,  however,  also  to  be 
regarded  as  the  source  of  the  power  of  the  sympathetic  itself,  which 
would,  without  them,  become  exhausted"  (§  473  c,  524,  no.  6). 

The  last  clause  of  the  foregoing  law  is  inapplicable  to  the  foetus 
without  brain  and  spinal  cord  (§  493  c).  As  to  the  exciting  cause  of 
motion  in  the  extirpated  heart  and  intestine,  the  question  is  important 
only  as  it  relates  to  the  proof  that  motion  depends  essentially  upon 
properties  inherent  in  the  tissues,  and  as  involving  an  implication  that 
the  sympathetic  nerve  embraces  in  its  minute  ramifications  centres  of 
reflex  nervous  actions.  In  its  larger  branches  such  centres  probably 
exist  (§  262,  263,  473  c,  498  e,  516,  nos.  2,  3,  1042). 

The  preceding  law  involves  the  sum  of  reflected  nervous  actions,  of 
the  operation  of  the  passions,  and  of  other  direct  cerebro-spinal  influ- 
ences on  the  organic  viscera  (§  227,  230). 

9.  I  would  vary  the  phraseology  of  the  following  law,  to  render  it 
more  conformable  with  the  facts.  I  do  not  believe  that  the  sympa- 
thetic nerve  is  any  longer  charged  with  the  influence  derived  from  the 
brain  and  spinal  cord  than  during  its  connection  with  those  parts.  So 
far  as  this  nerve  manifests  an  influence  after  that  connection  is  sever- 
ed, it  is  itself  the  source  of  that  influence  ;  and  this  conclusion  is  sus- 
tained by  the  foetus  without  brain  or  spinal  cord  (§  1038). 

"  It  results,"  says  Miiller,  "  from  the  fact  already  stated  (nos.  7  and 
8),  that  the  sympathetic  nerve  is  charged,  as  it  were,  with  nervous 
power  by  the  bram  and  spinal  cord,  which  may  be  regarded  as  the 
sources  of  nervous  influence  ;  but  that,  when  once  charged,  it  con- 
tinues to  emit  this  influence  in  the  manner  peculiar  to  itself,  even 
when  the  farther  supply  is,  for  a  lime,  diminished"  (§  516,  nos.  7  and 
8 ;  §  520,  524,  no.  5). 

If  the  "  fact"  show  anything,  it  is  a  certain  independence  of  tho 


PHYSIOLOGY. FUNCTIONS.  347 

sympathetic  of  the  cerebro-spinal  system,  which  becomes  strongly 
pronounced  when  the  latter  is  wanting  in  the  foetal  state,  or  when  de- 
ranged in  some  chronic  maladies. 

10.  The  next  law  shows  that  the  action  of  agents  is  incomparably 
greater  upon  the  minute  terminations  of  the  nerves  than  upon  their 
trunks.  It  is  equally  applicable  to  the  cerebro-spinal  as  to  the  sym- 
pathetic.    Thus : 

"  The  influence  of  narcotics  locally  applied  to  the  sympathetic 
nerve,  does  not  extend  to  the  distant  organs  which  the  nerve  sup- 
plies ;  but  these  organs  may  be  paralyzed  by  the  direct  narcotization 
of  the  minute  nervous  fibrils  which  are  distributed  to  them." 

The  principle  is  general,  extending  to  all  other  agents,  and  has 
been  misapplied  by  Miiller,  and  many  others,  to  sustain  the  humoral 
pathology  (§  826,  d.     Med.  and  Phys.  Comm.,  vol.  i.,  p.  563,  564). 

11.  The  next  following  law  will  be  seen  to  be  important  in  inter- 
preting some  of  the  various  phenomena  of  sympathy,  when  they  orig- 
inate in  the  sympathetic  nerve.     Thus : 

"  The  laws  of  reflection  (in  the  cerebro-spinal  system)  stated  in  the 
third  chapter  of  this  section  prevail,  likewise,  in  the  actions  of  the 
sympathetic  nerve.  Strong  impressions  on  parts  supplied  by  the 
sympathetic  nerve  may  be  propagated  to  the  spinal  cord  [and  brain], 
and  give  rise  to  motions  of  parts  which  derive  their  nerves  from  the 
cerebro-spinal  system." 

As  an  illustration  of  this  law,  "Volkmann  has  observed  convulsions 
of  the  body  produced  by  irritating  the  intestines  of  a  decapitated 

With  the  head  on,  and  in  animals  more  susceptible  than  frogs,  the 
foi'egoing  law  becomes  extensively  applicable  to  agents  applied  to  the 
intestinal  canal,  or  other  viscera  that  are  especially  supplied  by  the 
sympathetic  nerve.  Thus,  nux  vomica  produces  spasmodic  action  of 
the  voluntary  muscles,  while  opium,  &c.,  relieves  them  in  the  same 
way.  Indeed,  it  is  well  ascertained  that  all  the  spasmodic  movements 
of  the  voluntary  and  respiratory  muscles  that  arise  from  affections  of 
the  abdominal  organs  depend  upon  irritations  transmitted  to  the  brain 
and  spinal  cord,  and  their  subsequent  reflection  upon  cerebro-spinal 
nerves.  Hence,  also,  the  action  of  the  abdominal  muscles  in  the 
vomiting  excited  by  imtation  of  the  intestines,  by  irritation  of  the  kid- 
neys, of  the  uterus,  &c.  And  so  of  the  natural  movements  of  the  re- 
spiratory muscles  (§  500,  839  g,  891^  g,  k,  903  a,  902  g). 

12.  "  Impressions  on  parts  of  which  the  nerves  are  derived  from 
the  sympathetic  are  communicated  to  the  spinal  cord  and  brain,  and 
excite  the  motor  influence  of  the  sympathetic  nerve  by  reflection." 

The  foregoing  law  is  an  extension  of  no.  4,  and  is  the  most  impor- 
tant of  well-ascertained  laws  in  medicine,  as  explaining  all  the  sym- 
pathetic influences  of  disease,  all  the  influences  of  remedial  and  mor- 
bific agents  exerted  upon  parts  distant  from  the  seat  of  their  direct 
action ;  except  such  phenomena  as  may  also  fall  more  or  less  under 
the  laws  11  and  13,  in  connection  with  which  this  law  should  be  con- 
sidered.— {Med.  and  Phys.  Comm.,  vol.  i.,  p.  569-572.)* 

13.  "  Reflected  action  of  the  sympathetic,  from  an  impression  com- 
municated to  the  spinal  cord  by  cerebro-spinal  nerves,  is  a  frequent 
occurrence"  {^  893  a,  c). 

The  "  frequency  of  the  occurrence"  is  such,  that  it  is  through  the 
*  See  Rights  of  Authors,  p.  912. 


348  INSTITUTES    OF    MEDICINE. 

foregoing  law,  and  the  12th,  that  remedial  agents  opei'ate  upon  the 
organic  system  when  applied  to  the  skin,  that  diseases  of  the  skin  af- 
fect the  abdominal  viscera,  that  the  contact  of  cold  air  suddenly  in- 
creases the  excretion,  or  the  discharge,  of  urine,  &c.  The  12th  law 
is  involved,  since  both  the  cerebro-spinal  and  sympathetic  nerves  of 
the  skin  are  the  media  of  transmitted  impressions.  The  chain  of  in- 
volved influences  is  of  the  highest  importance,  pathologically  and  ther- 
apeutically. As  one  of  a  thousand  illustrations,  if  tobacco  applied  to 
the  skin  produce  vomiting  the  effect  is  first  propagated  to  the  ner- 
vous centres,  from  which  it  is  reflected  upon  the  stomach  through  the 
motor  fibres  of  the  par  vagum  and  sympathetic  nerve.  This  irritation 
of  the  stomach  is  equivalent  to  a  direct  impression  from  tobacco  upon 
its  mucous  tissue  (§  503).  It  is  then  returned  to  the  nervous  centres 
through  the  sensitive  fibres  of  the  par  vagum  and  sympathetic  nerve, 
and  reflected  upon  the  respiratory  muscles  through  the  motor  nerves 
of  those  organs  (§  113,  224,  226,  475^,  500  k,  893,  893^). 

But  there  are  other  profound  influences,  and  other  circles  of  sym- 
pathy simultaneously  established.  The  organic  properties  of  the 
stomach  are  affected,  reflex  nervous  actions  are  reverberated  upon 
the  skin,  displayed  in  the  heart  and  blood-vessels,  in  the  liver,  and  oth- 
er important  organic  viscera,  while  these  influences  also  mutually  re- 
act upon  the  several  organs,  respectively,  and  involve  other  parts, 
such  as  the  uterus,  the  kidneys,  the  bladder,  the  voluntary  muscles, 
the  sphincters,  the  senses,  the  mind,  &c.,  in  the  deep  complexity  of 
results.  And  all  this  astonishing  consecutive  series  of  effects,  moving 
forward  under  the  most  precise  and  fundamental  laws  of  nature,  and 
all  the  work  of  a  moment,  is  set  in  motion  by  the  simple  application 
of  a  leaf  of  tobacco  to  the  sole  of  the  foot  (§  502,  902^). 

517.  Finally,  the  nervous  power  may  be  determined  upon  the  or- 
ganic properties  of  the  brain,  or  of  any  part  of  the  nervous  system,  by 
physical  and  mental  causes,  with  much  of  the  variety  of  effect  which  it 
produces  on  other  parts  (§  230,  512,  1040).— Note  Q,  p.  1122. 

518,  a.  "  In  certain  organs,  which  are  subject  to  the  influence  of 
the  sympathetic  and  of  the  cerebro-spinal  nerves  at  the  same  time,  a 
voluntary  influence  seems  to  be  exerted  only  after  the  long  continu- 
ance of  a  centripetal  or  sensitive  impression." 

So  far  as  this  principle  is  operative,  it  goes  to  demonstrate  the  re- 
markable peculiarities,  the  versatile  and  complex  nature,  of  the  func- 
tions of  the  nervous  system  (§  500,^'  and  k).  The  urinary  bladder, 
for  example,  which  is  under  the  influence  of  the  will,  presents  the  fol- 
lowing phenomenon :  "  The  will  does  not  come  into  operation  until 
a  considerable  accumulation  of  urine  has  taken  place  ;  in  other  words, 
not  until  the  fluid  has  made  a  long-continued  impression  on  the  sensi- 
tive nerves  of  the  bladder,  and  through  the  medium  of  these  upon  the 
cerebro-spinal  axis"  (§  500,  e). 

518,  b.  Analogies  evidently  occur  in  the  viscera  over  which  the  will 
has  no  control,  while  the  facts  are  illusti*ated  by  the  principle  as  ascer 
tained  in  the  foregoing  manner ;  such,  for  example,  as  the  long  incuba- 
tion of  miasmata,  of  the  hydrophobic  virus,  mercurial  influences,  &c., 
and  the  sudden  accession  of  the  phenomena  to  which  they  respectively 
give  rise  (§  500  e,  514  g,  516,  no.  6).  In  sections  500,^;'  and  k,  are 
some  remarkable  facts  which  will  deter  us  from  rejecting  diflficult 
problems  in  sympathy  (§  473,  no.  6,  523,  nos.  6  and  7). 


PHYSIOLOGY. FUNCTIONS.  349 

519.  The  following  law  is  a  farther  exemplification  of  the  forego- 
ing comments  (§  518,  b),  and  should  be  considered  in  connection  with 
the  11th  and  12th  laws.     Thus  : 

"  Many  parts  which  are  supplied  by  the  sympathetic  nerve,  and  ca- 
pable of  involuntary  motion  only,  become  associated  with  the  motions 
of  parts  subject  to  volition ;  a  part  of  the  voluntary  motor  influence 
being  communicated  involuntarily  to  them  ;  just  as  in  the  associate 
motions  of  the  voluntary  muscles." 

Of  this,  examples  are  afforded  by  the  iris,  the  vesicula  seminalis, 
and  intestine  (§  500,  e).     It  is  in  this  way  the  will  affects  the  iris. 

520.  The  problem  is  propounded  by  Miiller,  "  Can  reflex  phenom- 
ena be  produced  in  the  sympathetic  nerve  through  the  influence  of  the 
ganglia,  and  independently  of  the  brain  and  spinal  cord  V 

He  is  disposed  to  answer  the  question  negatively,  and  observes  that, 
"  We  are  at  present  entirely  ignorant  as  to  whether  irritations  in  one 
organ  ever,  through  the  medium  of  the  sympathetic,  give  rise  to  sym- 
pathetic movements  in  another."  And  yet  when  he  comes  to  reason 
from  the  phenomena  of  nature,  he  remarks  that,  "  in  many  cases,  it  is 
probable  that  the  reflections  are  produced  through  the  medium  of  the 
sympathetic  alone;"  and  again,  that  in  such  cases,  "it  is  probable 
that  the  sympathetic  nerve  alone  is  engaged  in  the  production  of  the 
phenomena."  This  is  enforced  by  the  considerations,  that,  "  the  pe- 
culiarity of  the  organic  or  sympathetic  nerves,  namely,  the  difficulty 
of  distinguishing  either  origin  or  termination  of  them,  their  want  of 
(definite)  arrangement  into  trunks  and  branches,  and  the  increase  in 
their  course  which  they  frequently  undergo,  is  certainly  in  favor  of 
their  actions  being  propagated  in  all  diixecliona  from  the  central  points 
of  the  ganglia^ 

Tliis  was  tlie  old  doctrine,  which  concerned  itself  mostly  about 
the  sympathetic  nerve,  and  the  fact  is  distinctly  evinced  by  many 
of  the  phenomena  of  contiguous  sympathy  (§  497),  and  by  the  fcetus 
without  brain  and  spinal  cord.  It  seems,  also,  to  have  been  shown 
by  the  experiments  of  Henle,  Grangier,  and  Valentin,  upon  the  in- 
testines. But  careful  attention  is  necessary,  in  these  cases,  to  distin- 
guish what  is  due  alone  to  the  independent  organic  properties  of 
any  part,  from  that  which  is  owing  to  an  influence  exerted  upon 
those  properties  by  the  nervous  power  (§  222,  &c.,  507,  516,  nos.  7 
and  8,  1038).     In  the  former  case  other  stimuli  operate  (^  490,  498  e). 

521.  "  It  is  not  proved,  and  several  facts  have  been  observed 
which  are  opposed  to  the  belief,  that  the  ganglia  can  exert  an  insula- 
ting action  so  as  to  impede  the  transmission  of  motor  influence  frorr. 
the  brain  and  spinal  cord"  (§  523,  no.  4). 

All  the  phenomena  of  sympathy  in  organic  life  appear  to  be  oppo- 
sed to  this  belief. 

522.  "  It  is  not  certain  that  the  ganglia  are  the  cause  of  the  parts 
supplied  by  the  sympathetic  nerve  being  withdrawn  from  the  influ- 
ence of  the  will." 

It  is  probable  that  the  cause  is  inscrutable,  since  it  is  owing  to  pe- 
culiarities in  the  vital  as  well  as  mechanical  constitution  of  the  two 
systems  of  nerves.  We  see,  however,  that  influences  are  as  readily 
transmitted  from  the  brain  to  the  organic  viscera  as  the  will  operates 
on  the  voluntary  muscles  ;  and  while  the  passions  scarcely  operate  in 
animal  life,  they  have  a  powerful  and  rapid  effect  on  organic. 


350  INSTITUTES    OP   MEDICINE. 


Laws  of  the  Sensitive  Functions  of  the  Sympathetic  Ncrte. 

523.  1.  "  The  sensations  in  parts,  the  nerves  of  which  belong  to 
the  sympathetic  system,  are  faint,  indistinct,  and  undefined ;  distinct 
and  defined  sensations  being  excited  in  them  only  by  violent  causes 
of  irritation"  (§  201,  b). 

2.  "  The  sensitive  impressions  received  by  the  sympathetic  nerve, 
although  conveyed  to  the  cerebro-spinal  axis,  may  not  be  perceived 
by  the  sensorium"  (§  199|,  451). 

3.  "  The  impressions  which  give  rise  to  reflex  motions,  when  con- 
veyed to  the  spinal  cord  by  the  sympathetic  nerve,  are,  in  most  in- 
stances, not  productive  of  sensations ;  while  those  impressions  which 
are  received  by  cerebro-spinal  nerves  always  give  rise  to  sensations" 
in  natural  states.    The  refex  is  our  sympathetic  sensation  (§  201,  451). 

4.  "  The  ganglia  of  the  sympathetic  nerve  do  not  prevent  the 
transmission  of  centripetal  actions  in  that  nerve  to  the  spinal  cord. 
They  have  not  an  insulating  power  over  its  centripetal  currents" 
(§  521,  1038). 

5.  "  The  ganglia  are  likewise  not  the  cause  of  the  impressions  on 
the  sympathetic  nerve  being  unattended  with  true  sensation." 

6.  "  In  many  cases,  irritation  of  a  violent  nature  in  organs  supplied 
by  the  sympathetic  nerve  gives  rise  to  sensations  in  those  parts.  In 
otlier  cases,  the  irritation  being  less  violent,  the  sensations  in  the 
parts  affected  are  indistinct,  while  distinct  sensations  are  present  in 
other  parts  supplied  with  cerehro-spinal  nerves'^  (§  518,  V). 

We  have  examples  of  the  first  kind  in  inflammations  of  the  intes- 
tines and  liver;  of  those  of  the  second  kind,  in  the  troublesome  itch- 
ing of  the  nose  and  anus  in  affections  of  the  intestinal  canal,  and  pain 
of  the  shoulder  in  hepatic  and  cardiac  diseases,  of  itching  of  the 
glans  penis  in  chronic  affections  of  the  bladder  and  kidneys. 

7.  "  The  secondary  sensations  in  cerebro-spinal  nerves,  consequent 
on  irritation  of  the  branches  of  the  sympathetic,  occur  especially  at 
the  extreme  parts  of  the  organs  affected." 

Morbid  states  of  the  stomach  produce  a  sense  of  irritation  in  the 
throat ;  and  nothing  is  more  common  than  obstinate  inflammation  of 
the  mucous  tissue  of  the  fauces  from  gastric  derangements,  which  are 
not  inflammatory.*  In  all  these  cases,  remote  and  continuous  sympa- 
thy are  more  or  less  in  combined  operation.  An  ignorance  of  the 
laws  which  govern  in  such  instances  leads  many  physicians  to  apply 
their  remedies  to  the  parts  where  the  sensation  is  felt,  or  the  inflam- 
mation appears.  There  is  also  a  special  sympathy  between  the  ex- 
tremities of  the  intestinal  mucous  membrane.  Smoking,  for  instance, 
often  brings  on  an  attack  of  the  piles ;  though  an  intermediate  chain 
of  morbific  influences  is  also  propagated  to  the  anus  through  the 
stomach  and  liver  (§  498/,  514  h,  689  I). 

Laivs  of  the  Organic  Functions  of  the  Sympathetic  Nerve. 

524,  a.  1.  "When,  in  consequence  of  impressions  on  sensitive 
nerves,  secretions  take  place  in  distant  parts,  the  brain  and  spinal 
cord  are  probably  the  medium  of  communication."  Thus,  "  impres- 
sions on  internal  mucous  membranes,  as  by  hot  drinks,  frequently 
give  rise  immediately  to  a  general  sweat." 

*  Diphtheria  and  FothergilVs  Sore-throat  are  merely  sympathetic  results  of  profound, 
insidious,  venous  congestion  of  the  abdominal  organs  (§  689  /) — Note  Kk  p.  1140. 


PHYSIOLOGY. FUNCTIONS.  351 

This  is  precisely  similar  to  what  I  have  said  of  the  effect  of  food  m 
lighting  up  a  warmth  in  a  cold  skin  (§  512). 

The  foregoing  law  is  true,  in  a  general  sense  (§  455,  458,  459,  490 
493  b,  516,  nos.  7  and  8).  It  lies  at  the  foundation  of  the  whole  doc- 
trine which  I  have  projected  of  alterative  reflex  action,  through 
which  I  interpret  all  diseases  that  spring  up  as  consequences  of  each 
other,  and  the  operation  of  morbific  and  remedial  agents  upon  parts 
remote  from  the  seat  of  their  direct  influence.  It  is  variously  express- 
ed in  the  preceding  laws. 

If  hot  water  operate  upon  the  stomach  and  transmit  its  influence 
through  the  cerebro-spinal  and  sympathetic  system  to  the  whole  sur- 
face of  the  body,  it  is  clearly  in  the  same  way  that  tartarized  antimo- 
ny produces  a  sweat  over  the  whole  cutaneous  organ  when  it  deter- 
mines nausea,  or  the  act  of  vomiting,  and  therefore,  also,  when  it  acts 
upon  the  stomach  in  a  more  insensible  manner.  And  so  of  the  re- 
mote influences  of  other  remedies,  or  of  morbific  agents,  or  of  gastric, 
or  any  other  primary  disease.  If  it  be  the  principle  as  laid  down 
physiologically,  it  must  be  equally  the  same  for  analogous  effects  in 
disease,  or  in  its  treatment. — See  Rights  of  Authors,  p.  913. 

2.  "  There  prevails  a  consent  of  action  between  the  different  parts 
of  a  secreting  membrane.  Thus,  the  state  of  one  spot  influences  the 
condition  of  the  whole  extent  of  a  mucous  membrane"  (§  498y,  516, 
nos.  2,  3,  and  7). 

This  is  the  continuous  sympathy  as  expounded  in  this  work.  It  is 
more  or  less  manifested  in  most  of  the  diseases  of  all  tissues,  and  al- 
though not  a  function  of  the  sympathetic  nerve,  I  have  retained  tht- 
law  under  that  denomination  (§  141,  498,  520,  923). 

3.  "  A  particular  state  of  one  organ,  such  as  inflammation,  or  a  se 
creting  action  in  it,  often  causes  the  production  of  a  similar  state  in 
other  parts." 

This  proposition  is  intended  in  a  specific,  not  in  the  general  sense 
in  which  disease  of  one  part  gives  rise,  by  reflex  action,  to  diverse  af- 
fections of  other  parts.  It  refers  to  peculiar  states  of  disease  in  which 
remote  sympathy  is  often  remarkably  characterized.  Thus,  "inflam- 
mation of  the  testicle  may  be  replaced  by  inflammation  of  the  parotid  ; 
erysipelatous  inflammation  of  the  skin  may  be  transferred  to  the  mem- 
branes of  the  brain  ;  suppression  of  the  secretion  of  one  organ  may 
give  rise  to  inci-eased  secretion  in  another."  So  of  the  extension  of 
rheumatism  and  gout  from  one  part  to  another  of  very  different  or- 
ganization (§  142,  893  n,  905  a). 

524,  h.  Where  sympathies  of  the  foregoing  nature  arise,  there  is 
often  a  special  relation  of  natural  functions  between  the  respective 
parts,  as  between  the  uterus  and  mammae.  Or  such  relation  appears 
to  be  pronounced  only  by  morbid  states,  as  between  the  parotid  and 
testis,  and  the  parotid  and  mammae,  in  the  mumps  (§  142). 

524,  c.  As  resulting  from  the  foregoing  (no.  3),  though  apparently 
the  reverse  of  it,  we  have  the  important  reflex  influences,  that  when 
disease  springs  up  in  distant  parts  as  a  consequence  of  some  affection 
of  other  parts,  the  secondary  affection  often  proves  curative  of  the 
primary  one.  It  is  the  same,  in  principle,  as  when  blisters,  setons, 
&c.,  relieve  some  internal  malady.  Many  sympathetic  diseases  have, 
as  it  were,  a  great  final  cause,  as  a  part  of  the  natural  constitution  of 
animals.     The  ordinary  forms  of  inflammation  which  supervene  on 


352  IN'STITUTES    OF    MEDIf/INE. 

venous  congestion  often  relieve  a  more  formidable  affection  of  the 
veins  (§  803,  804,  905.  Also,  Med.  and  Phys.  Covim.,  vol.  ii.,  j).  519- 
524).  Inflammation  of  the  bronchial  mucous  membrane,  or  of  the 
pleura,  supervening  on  pneumonia,  may  assuage  the  latter  affection- 
Phthisis,  supervening  on  gastric  disease,  sometimes  removes  the  lat- 
ter condition.  Eruptions  of  the  skin  relieve  disease  of  the  internal 
viscera.  The  hepatic  action  which  leads  to  morbid  redundances  of 
bile  mitigates  cerebral  or  other  congestions  and  inflammations,  and 
the  effusion  relieves  the  liver ;  while  it  is  the  tendency  of  inflamma- 
t'on  of  all  parts  to  relieve  itself  by  some  morbid  product,  whether  the 
disease  be  primary  or  secondary.  Nature,  in  these  cases,  has  suppli- 
ed indications  for  the  hand  of  art ;  and,  instead  of  waiting  for  the  in- 
direct and  spontaneous  course,  we  should  abstract  blood,  or  hasten 
to  establish  those  changes  which  result  in  increased  secretions,  &c. 
While,  also,  we  are  accomplishing  these  results,  which,  abstractedly 
considered,  are  depletive,  we  are  acting,  at  the  same  time,  upon  the 
diseased  properties,  eitjier  by  a  direct  impression  upon  them  by  the 
remedies,  or  indirectly  by  reflex  nervous  action  (§  503).  But  this  is 
mainly  true  of  the  natural  processes  as  it  respects  spontaneous  hem- 
orrhage. All  the  other  natural  effusions  are  greatly  wanting  in  those 
direct  remedial  effects  which  are  exerted  by  therapeutical  agents  that 
lead  to  similar  products. 

"  The  principle  of  the  balance  of  sympathy  teaches  us  how  we  must 
avoid  aggravating  the  morbid  condition  of  one  organ  by  the  means 
which  we  apply  to  another ;  but  it  also  teaches  us  how  we  may  pro- 
duce a  change  in  the  state  of  one  organ  directly  inaccessible  to  us  by 
effecting  an  appropriate  change  in  another." — Mullek.  Here  Miiller 
is  any  thing  but  a  humoralist,  as,  also,  throughout  his  disquisition  on 
the  laws  of  sympathy  ;  though  in  other  places  he  lays  down  the  broad 
doctrine  that  morbific  and  remedial  agents  produce  their  effects  by 
absorption  into  the  circulation  (§  494  dd,  514|  h.  Also,  Med.  and 
Phys.  Comm.,  vol.  i.,  p.  563-571). 

524,  d.  It  might  seem,  at  first  glance,  that  the  fact  of  the  vital  prop- 
erties and  actions  being  liable  to  disease  is  inconsistent  with  the  great 
laws  of  recuperation  and  self-preservation.  But  it  is  not  so ;  since 
morbific  agents  being  permitted,  their  occasional  deleterious  action 
grows  out  of  the  natural  constitution  of  the  properties  of  life,  which 
is  physiologically  designed  for  the  healthy  processes.  That  these 
processes  may  be  carried  on,  the  properties  of  life  must  be  susceptible 
of  being  acted  upon  by  foi'eign  agents,  as  food,  &c.,  and  universally 
by  the  blood.  They  must  also  be  liable  to  modifications  in  their  na- 
ture, that  certain  specific  functions  may  be  instituted  from  time  to 
time,  as  the  pi'ocesses  of  gestation,  lactation,  &c.,  and  the  powers  oi 
all  other  parts  must  be  so  constituted  as  to  adapt  themselves  to  these 
transient  modifications.  And  so  of  other  changes,  as  from  infancy  to 
childhood,  from  childhood  to  puberty,  &c.  (§  153-159).  Now  the 
changes  which  arise  in  disease  are  analogous  to  those  of  gestation, 
lactation,  and  more  remotely  to  those  which  occur  at  puberty;  and  they 
are,  therefore,  necessary  consequences  of  the  natural  and  essential 
constitution  of  the  vital  properties  when  noxious  agents  act  upon  them. 
We  therefore  return  again  to  our  proposition  that  it  is  even  a  neces- 
sary consequence  of  the  final  cause  of  the  adaptation  of  the  properties 
of  life  to  the  influence  of  salutary  agents.     And  hence,  also,  the  natu- 


PHYSIOLOGY. FUNCTIONS.  353 

ral  law  of  adaptation  (§  136)  extends  to  morbid  states  of  the  system ; 
being,  fox*  example,  the  principle  already  adverted  to,  which  pro- 
tects the  general  system  against  those  morbid  changes  in  the  blood 
that  ensue  upon  local  diseases,  and  diseased  parts  against  the  irrita- 
tion of  their  morbid  products  {§  74,  129,  137  c,  143  c,  150-152,  155, 
156,  387,  524  c,  944  c,  980,  1019,  847-850). 

4.  "  The  ganglia  appear  to  be  the  central  parts  from  Avhich  the 
vegetative  influence  is  distributed  to  the  different  organs." 

5.  "  This  radiating  influence  appears  to  be,  in  a  certain  degree,  in- 
dependent of  the  brain  and  spinal  cord"  (§  520,  516,  no.  9). 

6.  "It  appears,  however,  that  the  brain  and  spinal  cord  are  the 
main  source  whence  the  power  of  the  organic  nerves  is  gradually  ren 
ovated"  (^  1038). 

7.  The  sympathetic  nerve  modifies  organic  functions  and  their  prod- 
ucts, and  supplies  the  stimulus  of  the  nervous  power  to  muscular  fibre 
in  organic  life  (§  224,  455  a).  Every  organ,  through  this  channel,  is 
rendered  sensitive  to  the  condition  of  each  other,  and  they  so  interchange 
their  influences  upon  each,  that  the  whole  are  maintained  in  those  rel- 
ative states  of  action  which  are  most  conducive  to  the  good  of  the  whole. 
From  the  exquisite  susceptibility  of  the  nervous  power,  and  of  sympa- 
thetic sensibility,  which  is  so  conspicuous  in  this  function,  arise  those 
disturbances  that  are  inflicted  by  organs  upon  each  other,  and  the  re- 
flected influences  of  remedial  and  morbific  agents  (§  113,  224,  455,  461, 
4611,  475i  487  /^,  500  g,  516  d,  nos.  7-9,  647^,  893,  8931). 

SYMPATHIES   OF   THE   INDIVIDUAL   TISSUES KEFLEX   AND   CONTINUOUS. 

Sympathies  of  Similar  Tissues. 

525,  a.  Enough,  perhaps,  has  been  said  upon  this  subject(^  85-117, 
133-143).  We  have  seen  that  tissues  of  a  similar  vital  constitution 
have  the  greatest  tendency  to  sympathize  with  each  other ;  but  it  is 
not  necessary  that  the  secondary  disease  should  be  of  the  same  na- 
ture as  the  primary,  though  such  is  apt  to  be  the  case  (§  140,  141, 
149-152). 

The  most  frequent  instances  of  morbid  sympathies  in  tissues  of  the 
same  nature,  but  remote  from  each  other,  occur  in  the  following  or- 
der (§  162) : 

1.  The  venous  tissue,  in  the  form  of  venous  congestion  (§  786,  &c.). 

2.  The  fibrous  tissue,  as  in  rheumatic  inflammation. 

3.  The  serous  tissue,  as  seen,  especially,  in  dropsical  affections. 

4.  The  mucous  tissue. 

5.  The  cellular  tissue. 

6.  The  lymphatic  tissue. 

7.  The  nervous  tissue. 

8.  The  arterial  tissue. 

9.  The  muscular  tissue. 

10.  The  osseous  and  cartilaginous  tissues. 

525,  b.  When  similar  tissues  sympathize  with  each  other,  the  sym- 
pathetic disease  and  its  phenomena  are  apt  to  be  similar  to  the  pri- 
mary affection ;  while,  in  the  case  of  sympathies  arising  among  dif- 
ferent tissues,  the  phenomena  are  different  in  each,  even  though  the 
primary  and  secondary  affections  be  of  the  same  general  natuie,  as, 

Z 


354  INSTITLTES    OF    MEDICINE. 

however,  they  are  not  wont  to  be.  When  like  tissues  sympathize 
with  each  other,  the  diseases  and  the  phenomena  are  most  analogous; 
because  the  same  tissue  in  different  compound  organs  has,  respect- 
ively, modifications  of  the  organic  properties  that  are  more  alike  than 
those  of  different  tissues.  And  hence,  mainly,  the  greater  difference 
between  the  primary  and  secondary  diseases  of  different  tissues  (§ 
133-140). 

525,  c.  When  disease  springs  up  in  tissues  of  the  same  organiza- 
tion, but  remote  from  each  other,  as  in  rheumatic  inflammation  of  the 
fibrous  tissues,  for  example,  the  piimary  affection  often  exists  in  some 
other  part  or  parts,  as  the  digestive  organs,  and  is  generally  of  a  dif- 
ferent character  from  the  secondary  affection.  In  these  cases,  which 
are  common,  the  successive  secondary  affections  may  be  more  owing 
to  reflex  influences  of  the  parts  primarily  diseased  than  to  the  sym- 
pathetic influence  of  the  tissue  secondarily  affected  upon  other  parts 
of  its  own  denomination.  This  is  an  important  practical  considera- 
tion, for  upon  its  just  estimate  will  depend  much  of  the  treatment  in 
any  given  case  of  disease  (§  902  m,  905).  It  is  also  equally  true  that 
the  sympathetic  affections  which  supervene  among  compound  organs 
are  apt  to  be  more  or  less  different  from  the  primary  affection. 

526,  a.  Tissues  morbidly  affected  sympathize,  continuously,  in  their 
several  parts,  most  readily  in  the  following  order  (§  133-136,  498) : 

1.  The  venous  tissue,  in  congestion  or  sub-inflammation. 

2.  The  lymphatic  tissue. 

3.  The  cellular  tissue. 

4.  The  mucous  tissue. 

5.  The  fibrous  tissue. 

6.  The  serous  tissue. 

7.  The  glandular  tissue. 

8.  The  dermoid  tissue. 

9.  The  nervous  tissue. 

10.  The  muscular  tissue. 

11.  The  cartilaginous  and  osseous  tissues. 

12.  The  arterial  tissue. 

Owing  to  the  peculiar  vital  constitution  of  each  tissue,  disease  is 
apt  to  be  confined  to  that  which  it  fii-st  invades,  but  tq,  disturb  the 
condition  of  other  parts  with  which  it  may  be  associated  (§  133—136). 
There  are,  indeed,  some  striking  exceptions  to  the  generqj  rule ;  as, 
rheumatic  inflammation  of  the  ligaments  is  often  propagated  to  the 
heart,  and  sometimes  to  a  mucous  tissue.  Inflammation  of  the  pul- 
monary air-cells  is  vei'y  apt  to  be  extended  to  the  serous  tissue  of  the 
lungs,  or  inflammation  of  the  liver  to  its  investing  membrane.  In- 
deed, the  serous  membranes  generally  participate  •in  the  morbid 
states  of  the  other  tissues  with  which  the^  are  associated ;  nor  can 
mach  intensity  of  disease  affect  any  tissue  without  disturbing,  more 
or  less,  the  condition  of  its  associate  tissues.  But  there  is  much  va- 
riety in  these  respects,  even  in  continuous  organs,  as  between  the 
stomach  and  the  small  and  large  intestines.  If  the  mucous  coat  of 
the  small  intestine  be  actively  inflamed,  it  is  frequently  the  cause  of  a 
like  condition  in  the  peritoneal  coat,  when  the  mucous  inflammation 
may  subside  as  a  sympathetic  consequence ;  thus  representing  the 
doublo  operation  of  the  law  in  i^  524,  no.  3.     But,  however  severe- 


PIIVSIOLOGV. FUNCTIONS.  35!) 

ly  the  mucous  coat  of  the  stomach  maybe  affected,  with  inflammation, 
the  disease  is  rarely  propagated  to  the  serous  tissue  of  the  organ,  but 
far  more  readily  to  the  serous  or  other  tissues  of  the  lungs,  &c. 

In  respect  to  the  arterial  tissue,  when  we  regard  the  extreine  and 
capillary  series  as  the  instruments  of  all  diseases,  and,  therefore,  al- 
ways involved  in  morbid  action  in  the  diseased  states  of  all  other  tis- 
sues, it  must  rank  as  the  first  in  its  liability  to  continuous  and  remote 
sympathetic  influences  (§  1040). 

The  arterial  tissue  itself  is  but  little  subject  to  other  conditions  of 
morbid  action;  and  when  the  large  arteries  become  inflamed  in  any 
pai't,  the  disease  remains  very  circumscribed.  They  have,  also,  no 
great  action  in  their  natural  state ;  it  being  their  office,  mainly,  to 
serve  as  conduits  for  the  blood.  Nevertheless,  they  are  constantly 
liable  to  sympathetic  irritations,  either  by  continuous  influence  or  re- 
flected nervous  action.  The  next  series,  or  the  capillary  arteries, 
are  reservoirs  of  blood  to  the  extreme  vessels ;  and  to  meet  the  exi- 
gencies of  this  function,  they  have  their  vital  properties  and  actions 
more  strongly  pronounced,  and  are  readily  and  manifestly  influenced 
by  the  nervous  power,  as  abundantly  shown  in  blushing,  &c.  (§  512,  b). 
Hence,  from  this  natural,  physiological  constitution,  this  series  of  the 
arterial  system  is  more  liable  than  the  larger  to  irritations  and  aug- 
mented actions,  as  manifested  in  most  inflammations  (§  715—719). 

We  come  next  to  the  extreme  series,  in  which  the  capillary  arte- 
ries terminate ;  and  here  we  find  the  vital  properties  developed  in  an 
eminent  degree.  This  is  known  from  their  being  the  essential  in- 
struments of  all  healthy  and  morbid  processes ;  and  the  changes  in 
their  phenomena  and  products  during  disease  evince  the  rapidity  and 
great  extent  in  which  these  properties  and  actions  may  be  modified 
by  the  nervous  power,  and  which  are  brought  about  in  an  instant  of 
time  when  that  power  is  developed  by  the  mind  (§  227,  500,  516  d). 
Reflex  nervous  action  plays  an  incessant  and  extensive  round  among 
this  extreme  series  of  vessels,  both  in  health  and  disease.  A  breath 
of  cold  air  may  arrest  the  secretion  of  sweat,  and  simultaneously  de- 
termine an  increased  flow  of  urine,  or  fear  will  as  suddenly  aug- 
ment both  excretions.  Coming  to  disease,  and  the  influence  of  reme- 
dial agents,  this  natural  relationship  of  the  extreme  vessels,  and  the 
same  physiological  principle,  are  at  the  foundation  of  the  principal 
philosophy.  Indeed,  the  organic  properties  being  now  more  suscep- 
tible than  in  health,  and  the  nervous  power  more  intensely  developed 
by  morbific  and  remedial  agents,  its  operation  must  be  more  rapid, 
extensive,  and  profound,  in  the  latter  than  the  former  case.  Hence, 
in  part,  inflammations,  &c.,  are  liable  to  spring  up  in  rapid  succession 
in  various  remote  organs,  after  their  invasion  of  any  onepart(<^  1056). 

526,  b.  Next,  as  to  the  venous  tissue.  Here  the  sympathies  are 
great,  both  of  the  remote  and  continuous  kind,  particularly  the  latter 
(§  498).  It  is  especially  through  the  natural  physiological  sympathies 
of  the  veins,  that  I  have  endeavored  to  show  how  they  co-operate  in 
circulating  the  blood,  as  also  the  error  of  the  physical  doctrine  of  ve- 
nous congestion,  which  supposed  that  this  most  prevalent  and  fatal 
disease  depends  on  obstacles  to  the  circulation  and  consequent  stag- 
nation of  the  blood.  I  have,  therefore,  endeavored  to  expound  the 
pathology  of  this  affection  upon  purely  vital  grounds,  and  in  conform- 
ity with  physiok)gical  laws  (§  786,  &c.).    The  main  physiological  prin- 


356  INSTITUTES    OF    MEDICINE. 

ciple  of  a  sympathetic  nature,  however,  should  be  stated  in  connec- 
tion with  the  subject  before  us.  The  venous  radicles  possess  a  vigor- 
ous action  which  is  constantly  influenced,  through  continuous  sympa- 
thy, by  the  corresponding  state  of  the  capillary  arteries,  and  by  the 
quantities  of  blood  transmitted  to  them ;  and  that  the  trunks  of  the 
veins  have  a  most  visible  action  is  shown  by  their  rapid  contraction 
and  dilatation  when  cold  or  heat  may  operate  upon  the  skin.  This 
action  is  simultaneous,  or  nearly  so,  over  a  large  extent  of  the  veins, 
and  is  the  result  of  continuous  sympathy  with  the  arterial  system,  as 
well  as  dependent  on  the  quantities  of  blood  transmitted  and  upon  re- 
flex nervous  action.  But,  when  an  increased  quantity  is  transmitted, 
the  enlargement  of  the  veins  is  in  no  respect  mechanical,  but  produced, 
in  part,  by  the  greater  impression  which  is  thus  made  upon  the  ex- 
quisite susceptibility  of  the  organic  properties  of  the  veins. 

From  these  few  remarks  as  to  the  vital  endowments  of  the  veins, 
and  of  the  active  functions  they  perform,  it  is  evident  that  they  must 
be  quite  liable  to  morbific  influences,  and  that  remote  and  continuous 
sympathy  of  a  morbid  nature  must  have  a  ready  operation  among 
them  (§  74,  117,  137,  155,  156,  387,  422,  514  A,  524  d). 

526,  c.  In  respect  to  the  lymphatic  system,  the  principle  of  continu- 
ous sympathy,  as  in  the  veins,  is  strongly  exhibited  under  the  influence 
of  irritating  agents.  If  a  lymphatic  become  inflamed  at  some  point  in 
the  skin,  the  inflammation  may  extend  rapidly  along  the  course  of  the 
vessel,  while  the  glands,  also,  will  take  on  the  same  condition.  Here 
is  the  great  bulwark  of  humoralism.  Here  it  is,  and  in  the  lacteals, 
that  the  humoral  pathologists  suppose  that  morbific  agents  enter  the 
circulation  and  corrupt  the  blood,  or  remedial  ones  are  equally  absorb- 
ed, and  transmute  it  from  a  morbid  to  a  healthy  state !  But,  since  the 
needle,  whose  prick  may  propagate  an  extensive  inflammation  along 
the  course  of  a  lymphatic  vessel,  is  not  absorbed,  nor  the  leeches  which 
remove  the  inflammation,  we  may  rest  satisfied  that  the  poison  of  the 
viper,  of  the  mad  dog,  &c.,  do  not  produce  their  effects  upon  the  prin- 
ciple of  absorption  (§  268,  &c.  Also,  Med.  and  Phys.  Comm.,  vol.  i., 
p.  480-514).— Also  \  494  a-e,  514  g,  828-829. 

Diseases  of  the  lymphatic  glands  are  especially  owing  to  constitu- 
tional predispositions,  as  in  scrofula.  When  disease  is  developed  in 
any  one  or  more  of  these  glands,  others  readily  take  on  the  same  state 
of  inflammation.  While,  therefore,  under  special  circumstances,  re- 
mote sympathy  predominates  in  the  lymphatic  glands,  the  continuous 
form  is  mostly  witnessed  in  the  lymphatic  vessels. 

In  the  great  plan  of  organic  Design,  those  inlets  of  the  absorbent 
system,  the  lacteals,  are  greatly  exempt  from  morbific  influences. 

526,  d.  Sympathies  between  the  brain,  spinal  cord,  and  nerves,  and 
between  the  nerves  themselves,  are  more  or  less  in  progress,  in  the 
natural  state  of  the  body.  Their  phenomena,  however,  are  not  very 
•manifest,  unless  the  nei-\'es  of  some  particular  part  sustain  an  irrita- 
tion (§  501).  Thus,  the  irritation  from  stone  in  the  bladder  occasions 
morbid  sensations  in  the  penis.  Other  examples  occur  in  §  523,  no.  6. 
When  disease  is  produced,  sympathetically,  in  the  brain,  or  spinal 
cord,  or  nerves,  by  morbid  states  of  other  organs,  it  is  not  due,  as  sup- 
posed by  Miillei",  to  sympathy  with  the  nerves  of  the  parts  so  affected, 
but  to  the  morbid  change  in  the  general  vital  constitution  of  such  parts. 
Tn  this  respect,  the  sympathies  of  the  nervous  system"  with  other  or- 


PHYSIOLOGY. FUNCTIONS.  357 

gans  observe  the  same  laws  as  apply  to  other  sympathizing  parts 
both  as  to  disease  and  its  resulting  reflex  nervous  actions  (^  230). 

It  is  difficult  to  analyze  the  sympathies  which  occur,  specifically,  in 
the  nervous  tissue,  since  it  is  the  medium  through  which  remote  sym- 
pathies take  place.  Continuous  sympathy  we  know  to  be  of  very 
limited  extent,  and  have  every  reason  to  believe  that  the  great  final 
cause  of  the  nervous  system  is  protected  by  an  unusual  exemption  of 
this  system,  especially  such  parts  as  supply  the  organic  viscera,  from 
severe  morbid  conditions,  which  never  fail  to  inflict  great  injuries  upon 
other  parts.  It  is  also  true  that  diseased  conditions  of  the  nervous 
tissue  are  not  easily  reached  by  remedial  agents  ;  and  the  injury  they 
inflict  on  other  parts  constantly  reacts  in  maintaining  morbid  states  of 
the  nervous  tissue. 

The  sympathies  of  which  I  am  speaking  refer  to  the  changes  which 
may  be  produced  in  the  organic  state  of  the  nervous  system,  not  to 
the  transmission  of  impressions,  nor  to  the  development  and  influences 
of  the  nervous  power,  excepting  so  far  as  this  power  may  be  produc- 
tive of  direct  changes  in  the  organic  properties  and  actions  of  the  ner- 
vous tissue  (§  230).  The  general  convulsions  that  arise  from  irritation 
of  the  nervous  expanse  in  the  intestinal  canal,  or  from  teething,  &c., 
imply  no  absolute  disease  of  any  part  of  the  nervous  system  ;  but  only 
a  strong  development  of  the  nervous  power,  and  its  forcible  reflex  ac- 
tion upon  the  muscles  that  may  be  spasmodically  affected  (§  223-226, 
233,  500,  891-1-  b,  g,  k,  8931   993,  934  5).— Note  Q,  p.  1122. 

I  therefore  think  that  authors,  as  Marshall  Hall,  for  example,  in  his 
work  on  the  Nervous  System,  are  Virong  in  considering  "  all  convul- 
sive affections  to  be  diseases  of  the  true  spinal  or  excito-motory  sys- 
tem." On  the  contrary,  I  apprehend  that  in  most  of  these  cases  there 
is  no  actual  disease  of  any  part  of  the  nervous  system  ;  and  it  is  of  no 
little  practical  importance  that  this  question  should  be  rightly  settled. 
The  "  principal  causes,"  says  Dr.  Hall,  "  are  dental  irritation  acting 
through  the  fifth  nerve ;  gastric  irritation  acting  through  the  pneumo- 
gastric ;  and  intestinal  irritation  acting  through  the  spinal  nerves." 

Now,  we  have  variously  seen  how  the  nervous  power  may  be  pre- 
ternaturally  excited,  and  determined  with  various  effect  upon  the  or- 
gans of  organic  and  animal  life ;  being  so  constituted  as  to  be  exquis- 
itely susceptible  to  a  vast  variety  of  natural  causes  (§  226,  227,  500). 
The  muscles  of  animal  life  are  naturally  under  the  powerful  influence 
of  the  nerves ;  this  being  a  special  ordination  in  relation  to  the  ner- 
vous power  and  the  mobility  of  muscles  of  animal  life,  to  enable  the 
will  to  detei'mine  the  nervous  power  so  as  to  produce  voluntary  mo- 
tion, and  other  causes  to  render  it  subservient  to  respiration  (§  205, 
208,  226,  233,  500  c).  Hence  convulsions  readily  spring  up;  while, 
from  the  nervous  system  being  designed  for  vital  objects  in  organic 
life,  preternatural  influences  of  the  nervous  power  give  rise  to  other 
phenomena  in  that  division  of  life.  Owing,  also,  to  these  constitu- 
tional peculiarities,  as  well  as  to  the  natural  modifications  of  the  vital 
properties  of  the  animal  muscles,  the  nervous  power,  when  determin- 
ed with  violence  upon  them,  rarely  occasions  disease  ;  while  in  respect 
to  the  same  properties  in  the  organic  system,  where  they  have  a  dif- 
ferent modification,  and  the  nervous  power  a  different  physiological 
function,  it  readily  proves  morbific  (§  133-150,  452-456,  893J). 

We  have,  therefore,  all  the  elements  that  are  necessary  to  show  that 


358  INS'HTUTES    OF    MEDICINE. 

Dr.  Hall's  pathology  is  wrong.  The  convulsions  to  which  he  refer? 
as  actual  diseases  of  the  spinal  system  affect  the  muscles  of  animal 
life,  upon  which  the  will  may  operate  with  violence  in  an  instant,  or 
which  are  perpetually  held  in  action  by  the  nervous  power  fcjr  the  per- 
formance of  the  resjiiratory  movements,  and  to  caiTy  out  the  office  oi 
the  sphincters.  A  slight  irritation,  therefore,  propagated  to  the  nej-- 
vous  centres  may  rouse  these  natural  motions  into  irregular  and  more 
violent  ones,  without  producing  any  more  disease  in  the  nerves  or  the 
muscles  than  is  produced  by  the  operation  of  the  will,  or  by  those 
causes  which  maintain  the  movements  of  respiration.  Again,  if  a  cere- 
bro-spinal  nerve  be  irritated,  convulsions  are  produced,  and  the  same 
is  done  by  a  shock  of  the  electric  fluid.  Now,  these  results  are  ex- 
actly analogous  to  the  natural  convulsions  which  are  supposed  to  de- 
pend on  "disease  of  the  true  spinal  system  of  nei-^^es."  If  we  analyze 
the  supposed  cases,  the  same  conclusions  will  follow.  When,  in  one 
case,  the  gum  is  lanced  down  ujion  the  tooth,  the  convulsions  may 
cease  immediately.  In  another,  or  when  the  convulsions  depend  on 
gastric  or  intestinal  irritation,  a  dose  of  morphia,  or  an  emetic,  or  an 
enema,  or  warm  bath,  will  generally  remove  the  convulsions  veiy 
speedily,  and  they  are  not  apt  to  return  (i^  SQSg^). 

Diseases  of  the  membranes  of  the  brain  or  spinal  cord,  or  of  the 
substance  of  the  brain  or  of  the  spinal  cord  itself,  do  not  often  occa- 
sion convulsions  ;  which,  indeed,  are  commonly  independent  of  any 
disease  of  the  nervous  system.  When,  however,  they  do  give  rise  to 
convulsive  movements,  or  when  such  result  follows  an  affection  of  a 
nerve,  as  in  traumatic  tetanus,  there  is  no  morbid  state  sympatheti- 
cally induced  in  any  other  part  of  the  nervous  system,  but  the  convul- 
sions are  owing  to  a  propagation  of  the  nervous  power  upon  the  mus- 
cles as  in  the  foregoing  cases.  Here,  the  disease  of  the  nervous  tis- 
sue is  exactly  equivalent,  in  developing  the  nervous  power,  to  the 
ii'ritation  propagated  to  the  nervous  centres  by  dentition,  intestinal 
irritation,  &c.  It  sometimes  happens,  therefore,  that  a  division  of  the 
affected  nerve,  in  tetanus,  will  at  once  remove  the  spasms. 

When,  therefore,  convulsions  arise  from  dentition,  or  intestinal  irri- 
tation, we  apply  our  remedies  to  the  gums,  &c.,  and  not  to  the  spi- 
nal cord,  or  to  its  nerves.  Such  as  may  depend  upon  disease  of  the 
nervous  centres,  or  of  a  nerve,  are  obstinate,  and  the  treatment  is 
then  dii'ected  with  a  special  reference  to  the  part  which  may  be  thus 
affected.     Here  the  nerve-action  is  direct,  there  reflex  (^  227,  500  c,  d). 

Here,  also,  we  learn  the  importance  of  an  intimate  acquaintance 
with  the  laws  of  the  nen'ous  power,  and  of  correct  theory.  Convul- 
sive movements,  under  most  circximstances,  have  a  very  similar  chai-- 
acter ;  and  to  ascertain  their  causes,  we  must  apply  ourselves  to  other 
symptoms  and  other  considerations.  Nevertheless,  they  are  apt  to 
have  certain  differences  in  some  affections.  Those  of  tetanus  have 
the  strongest  peculiarities  ;  and  here  there  is  a  very  limited  state  ot 
disease  at  the  wounded  part,  but  idiopathic  tetanus  may  depend  upon 
intestinal  disease.  But,  there  is  often  a  comj)lete  resemblance  be- 
tween the  ordinary  convulsions  from  dentition,  and  gastric,  and  intes- 
tinal irritation,  and  those  of  hysteria  and  epilepsy ;  whatever  may  be 
the  exciting  causes  in  either  case.  Since,  therefore,  it  may  be  of  the 
highest  importance  to  ascertain  the  particular  causes,  we  institute  a 
diagnosis  through  other  attending  facts  (^  893J). 


PHYSIOLOGY. FUNCTIONS.  359 

Si/inpathies  of  Dissimilar  Tissues. 

527,  a.  Morbific  reflex  nervous  actions  occur  less  frequently  among 
organs  of  different  organization  than  among  many  of  those  which  are 
constituted  aUke,  with  the  exception  of  the  mucous  tissue  of  the  ali- 
mentary canal  and  other  parts,  and  between  the  skin  and  other  parts. 
Between  these  two  organs  and  all  others  there  is,  on  the  part  of  the 
latter,  the  most  intimate  connection  by  reflex  nervous  actions,  especial- 
ly the  mucous  tissue  of  the  stomach  (§  512)  ;  and  it  is  through  this  nat- 
ural relation,  and  the  increased  susceptibility  of  diseased  parts,  that  re- 
medial agents  so  readily  exert  their  effects  upon  the  diseases  of  all  or- 
gans, when  such  agents  are  applied  to  the  intestinal  canal  or  to  the  skin 
(§  113,  465,  516  d,  nos.  12,  13,  889  g,  891^  g,  k,  892  g,  h,  893  a,  c). 

527,  b.  Morbific  reflex  nervous  actions  between  the  alimentary  ca- 
nal and  other  tissues  are  variously  considered  in  the  progress  of  this 
work.  Those  between  the  skin  and  other  tissues  deserve  farther  con- 
sideration in  this  place.  Their  predominance  and  intensity  between 
that  organ  and  the  alimentary  mucous  tissue  are  shown  in  the  depend- 
ence of  a  vast  proportion  of  cutaneous  eruptions  upon  primary  dis- 
ease of  the  latter  tissue.  There  is  great  reason  to  believe  that  such 
is  the  fact  even  in  rela-tion  to  measles,  scarlet  fever,  and  small-pox, 
when  it  occurs  spontaneously,  and  probably  also  in  the  inoculated 
form ;  though,  in  the  last  case,  there  must  be  first  a  reflected  influ- 
ence from  the  artificial  pustule  of  the  skin  upon  the  intestinal  mucous 
membrane,  from  whence  the  influence  is  propagated  back  to  the  whole 
surface  of  the  body  (§  902,  m).  This  construction,  so  opposed  to  the 
humoral  pathology,  is  sustained  by  the  analogy  which  is  supplied 
by  most  other  cutaneous  affections,  and  by  the  direct  fact  that  the 
eruption  of  scai'latina  and  of  measles  appears  in  the  mucous  membrane 
of  the  throat  before  it  does  upon  the  skin.  The  eruption,  especially 
of  measles,  is  apt  to  be  preceded,  also,  by  inflammation  of  the  mu- 
cous tissue  of  the  eye,  the  nose,  and  lungs,  as  well  as  by  cough.  But, 
as  will  have  been  seen,  it  is  not  necessary  that  the  secondary,  or  sym- 
pathetic, disease  should  be  like  the  primary ;  especially  in  parts  that 
are  dissimilar  (§  527,  d).  If  this  pathology  as  to  the  consecutive  or- 
der of  developments  be  true.  It  Is  of  great  practical  importance  ;  since 
it  assures  us  that  great  care  must  be  bestowed  upon  the  intestinal  mu- 
cous membrane,  as  a  principal  seat  of  the  radiating  morbific  Influen- 
ces. But  the  severity  of  small-pox,  &c.,  depends  greatly  upon  the  ex- 
tent of  the  cutaneous  affection,  and  its  consequent  reaction  upon  the 
abdominal  organs  (p.  347,  §  516  d,  no.  13);  and  hence  the  advantage 
of  moderating  the  eruptions  by  local  applications.  Can  humoralism 
explain  ?     Why  such  definite  periods  of  rise  and  decline  (§  654  b) "? 

Sympathies  between  the  skin  and  kidneys  are  naturally  instituted 
for  special  exigencies  of  the  animal  economy ;  but  these  organs  are  so 
constituted  in  their  relative  susceptibilities,  that  the  great  final  cause 
of  their  physiological  relations  shall  not  be  defeated  by  the  propagation 
of  morbific  reflex  nervous  Influences  from  one  to  the  other  (§  422,  &c.). 

Sympathies  between  the  mucous  and  serous  tissues  are  compara- 
tively rare  in  health,  and,  therefore,  in  disease.  Since,  also,  the  same 
principles,  in  a  general  sense,  are  concerned  in  the  remote  influences 
of  remedial  agents,  we  thus  understand  why  medicine  taken  inwardly 
has  so  moderate  an  effect  upon  peritonitis,  or  pleuritis,  &c. ;  and  this 


360  INSTITUTES    OF    MEDICINE. 

philosophy  is  clearly  confirmed  by  the  ready  action  of  cold  upon  the 
skin  in  developing  inflammation  of  the  pleura,  and  by  the  manner  in 
which  that  inflammation  may  be  often  overcome  by  blisters  or  other 
initants  applied  to  the  skin.  Indeed,  so  extensive  are  the  natural 
sympathetic  relations  of  the  skin  to  most  internal  parts  that  there  is 
scarcely  an  inflammation  of  an  internal  tissue  or  organ  that  may  not 
be  more  or  less  mitigated  by  irritants  applied  over  the  neighboring 
surface,  if  the  application  be  not  prematurely  made(^  514  d,  893  a,  c). 

There  is  a  very  intimate  sympathy  betw^een  the  fibrous  membranes 
and  the  cartilaginous  and  osseous  tissues,  w^hich  leads  to  the  determi- 
nation of  morbific  reflex  nervous  influences  among  them  {^  141,  b). 

527,  c.  Sympathies  of  different  tissues  with  each  other,  of  much  in- 
tensity, are  more  common  in  parts  that  are  distant  than  among  the 
tissues  of  one  and  the  same  compound  organ. 

527,  d.  "When  disorders  arise  among  different  tissues,  they  are,  as 
1  have  said,  apt  to  be  more  or  less  different  from  the  primary  affec- 
tion, or  if  alike,  their  phenomena  more  variable  than  among  tissues 
of  the  same  organization  (§  525).  The  primary  affections  may  be 
mild  while  the  sympathetic  are  severe.  This  relative  mildness  and 
intensity  is  constantly  seen  in  the  supervention  of  inflammations  and 
congestions  in  remote  parts  as  consequences  of  some  minor  derange- 
ment of  the  stomach,  or  other  digestive  organs,  and  in  the  manner  in 
which  severe  diseases  of  all  parts  are  subdued  by  the  action  of  reme- 
dial agents  upon  the  stomach.  So,  again,  the  action  of  cold  upon 
the  skin  induces,  by  reflex  action,  inflammation  of  any  of  the  tissues 
of  the  lungs,  or  of  the  intestines,  uterus,  liver,  ligaments,  &c. ;  but 
here  no  actual  disease  is  produced  in  the  skin,  and  the  morbific  agent 
is  also  of  a  negative  nature.  Hence  a  difficulty,  notwithstanding  its 
importance,  of  detecting  the  original  source  when  a  complex  series 
of  sympathetic  affections   has  ensued  (§  514  d,  h,  527,  b). 

HympatJiies  of  Individual  Tissues  in  tlieir  Relation  to  each  other  %n 
Compound  Organs,  and  with  entire  Organs. 

528.  "When  any  tissue  of  a  compound  organ  becomes  the  seat  of 
disease,  the  influence  of  such  disease  is  felt,  more  or  less,  by  all  the 
tissues  of  such  an  organ,  where  the  primary  disease  is  at  all  severe ; 
especially  in  the  organs  of  organic  life.  The  tissues,  as  we  have 
seen,  which  are  secondarily  affected  may  or  may  not  sustain  the  same 
character  of  disease  as  the  original  affection ;  and  this  will  depend 
much  upon  the  nature  of  the  organ.  The  sympathies,  for  instance, 
between  the  different  tissues  of  the  lungs  are  far  greater  than  be- 
tween the  different  tissues  of  the  stomach,  and  I  may  say,  indeed,  of 
any  other  organ.  If  the  mucous  coat  of  the  stomach  be  even  severe- 
ly inflamed,  the  disease  generally  remains  limited  to  that  tissue,  and 
will  far  sooner  give  rise  to  inflammation  of  the  pulmonary  mucous 
membrane  than  it  will  be  extended  to  the  cellular,  muscular,  or  se- 
rous tissue  of  the  stomach,  however  much  it  may  otherwise  disturb 
their  functions.  On  the  contrary,  however,  it  is  quite  otherwise  with 
the  lungs ;  especially  when  the  cellular  or  parenchymatous  tissue  of 
these  orrrans  is  actively  inflamed,  or  when  chronic  disorganizing 
inflammation  invades  the  same  tissue.  In  either  of  the  cases,  the  in- 
flammation is  apt  to  be  propagated,  sooner  or  later,  both  to  the  serous 
and  mucous  tissues  of  the  organ  (§  115-117,  129,  132-155).     And 


•  PHYSIOLOGY. FUNCTIONS.  361 

here  may  be  observed  a  wise  ordination  of  Nature  for  the  ultimata 
relief  of  so  grave  a  disease  as  acute  or  chronic  inflammation  of  the 
main  substance  of  the  lungs ;  an  augmented  seci'etion  of  mucus  or 
serum  contributing  to  that  result,  in  connection  with  a  reflected  sym- 
pathetic influence  of  the  action  which  is  necessary  to  those  increased 
products  (§  74,  117,  129,  137,  155,  156,  387,  422,  524  d,  525).  When 
these  redundant  secretions  take  place,  the  general  law  is  that  the 
primary  and  secondary  inflammations  begin  to  abate.  The  salutary  in- 
fluence of  the  secondary  disease^  independently  of  the  depletive  effect, 
is  seen  in  the  frequent  abatement  of  chronic  muco-inflammation  of 
the  lungs  or  of  the  stomach  when  it  may  supervene  in  one  organ  or 
the  other  as  a  sympathetic  consequence  of  a  primary  inflammation  of 
either,  the  philosophy  of  which  is  fully  expounded  in  ^  905  a. 

SYMPATHIES  OF  COMPOUND  ORGANS  WITH  EACH  OTHER. 

529,  a.  Compound  organs  generally  sympathize  most  readily  with 
each  other  in  proportion  to  the  relation  of  certain  functions  which  they 
may  perform,  and  the  importance  of  those  functions,  the  stomach  al- 
ways excepted  (§  528).  These  groups  or  systems  of  organs  have  been 
already  specified,  and  the  sympathies  to  which  they  respectively  give 
rise  among  their  component  parts  sufficiently  designated  (§  124-130, 

149,  150). 

529,  b.  Morbid  sympathies  are  influenced  by  a  great  variety  of  ac- 
cidental causes,  although  they  depend  essentially  upon  the  constitu- 
tional relations  of  the  various  parts  of  the  organism  to  each  other.  One 
of  the  most  remarkable  is  the  determination  which  is  given  to  reflec- 
ted nervous  actions  by  almost  inappreciable  impressions  exerted  by 
morbific  and  remedial  agents  upon  some  particular  part,  according  to 
the  nature  of  their  virtues,  one  agent  ultimately  involving  the  whole 
system  in  morbid  action,  or  one  remedy  being  as  extensively  curative 
(§  149) ;  while  others,  far  more  intense  and  rapid  in  their  operation, 
are  very  circumscribed  in  their  analogous  sympathetic  effects  (§  149, 

150,  163).  In  the  case  of  the  morbific  agents  where  many  organs 
are  brought  into  sympathetic  derangement,  the  various  results  may 
be  mostly  due  to  the  action  alone  of  a  single  cause,  as  with  the  mias- 
mata of  fever,  the  yirus  of  small-pox,  of  scarlatina,  &c. ;  or,  the  com- 
plex results  may  be  greatly  owing  to  the  united  action  of  many  causes. 
In  the  case  of  remedial  agents,  their  effect  as  to  extent,  intensity,  &c., 
will  depend  much  upon  the  exact  nature  of  the  pathological  states. 

530.  Having  now  arrived  at  the  end  of  our  long  journey  over  the 
enchanting  paths  of  sympathy,  I  cannot  but  hope  that  they,  to  whom 
the  mere  physiological  explorations  may  be  new,  will  have  gained 
many  treasures  that  will  adorn  their  knowledge,  and  render  medicine 
a  subject  of  their  profound  veneration  and  care.  An  attentive  sur- 
vey of  all  the  facts  will  assure  them  how  far  they  have  lived  on  in  ig- 
norance, how  much  intellectual  enjoyment  has  been  lost,  how  they 
have  been  beguiled  into  the  chemical  and  physical  doctrines  of  life ; 
and,  if  what  I  have  propounded  of  the  applicability  of  the  natural 
laws  of  reflected  actions  of  the  nervous  system  to  pathology  and 
therapeutics  be  founded  in  truth,  the  realities  of  Nature  and  the  sub- 
stitutes of  art  will  strike  with  greater  force,  and  supply  a  never-failing 
source  of  advancing  knowledge,  a  shield  against  the  corruptions  of 
ignorance  or  ambition,  a  guide  to  practical  habits,  and  a  blessing  to 


302  INSTITUTES    OF    3IEDICINE.  • 

the  sick.  The  natural  laws  of  the  nervous  system  are  settled  by  dem- 
onstration ;  as  well  settled  as  the  laws  of  gravitation,  or  any  of  the 
most  undoubted  in  physics  or  chemistry.  Such  as  are  immediately 
applicable  to  the  higher  and  more  difficult  branches  of  medicine  1 
have  selected  from  authors  who  have  had  no  such  objects  in  contem- 
plation, that  they  might  come  unalloyed  with  the  suspicions  attendant 
on  theory.  My  attention,  in  this  respect,  has  been  mostly  turned  to 
the  great  Prussian  Physiologist,  by  far  the  gi'eatest  of  the  age,  and  to 
the  invaluable  experiments  by  Wilson  Philip.  I  commend  them  again 
and  again  to  all  those  who  would  study  medicine  as  founded  in  Na- 
ture, and  escape  the  temptations  which  have  been  devised  for  the 
gratification  of  indolence,  or  for  the  accommodation  of  imbecility.  We 
have  seen  it  said,  in  high  quartei's,  that  "  the  time  is  approacbing  when 
the  foundation  of  practice  on  the  laws  of  Organic  Chemistry  will  form 
the  distinction  between  the  enlightened  physician  and  the  mere  pre- 
tender" (§  5*  a,  289-292,  349  d-Zl&l,  438-448).  I  repeat  the  decla- 
ration as  expressing  the  ascendant  spirit  of  the  age,  and  that  all  who 
may  be  disposed  to  encounter  the  threatened  degradation  may  duly 
realize  the  importance  of  a  firm  determination  to  maintain  their 
ground  (§  440,  b). 

B.  Functions  especially  relative  to  the  Mental  Principle  and  Instinct 

531.  The  present  subdivision  of  Peculiar  Functions  having  no  spe- 
cial relations  to  organic  life  embraces  but  transient  subjects  for  con- 
sideration in  this  work  (§  450).     It  comprehends, 

1st.    Voluntary  motion. 

2d.  Functions  by  which  the  mind  and  instinct  act  on  external  objects 

3d,   Other  mental  and  instinctive  functions. 

532.  The  subject  of  voluntary  motion  has  been  already  sufficiently 
examined  (§  215,  227,  232,  256,  257,  486,  487,  500). 

533.  The  functions  by  which  we  act  on  external  objects  are  per- 
formed through  volition  and  the  voluntary  muscles.  The  philosophy 
is  the  same  as  in  §  532. 

534.  a.  The  brain  co-operates  with  the  mind,  and  with  the  in- 
stinctive principle,  in  the  acts  of  intellection  or  instinctive  functions 
(§  241,  500  o,  p). 

534,  h.  Although  the  soul  be  an  immaterial  and  imperishable  sub- 
stance, it  is  so  associated  with  the  brain  that  a  healthy  state  of  this 
organ  is  generally  necessary  to  the  ordinary  functions  of  the  mind,  as 
it  is,  also,  to  those  of  instinct. 

In  a  general  sense,  the  mental  functions  suffer  in  proportion  to  the 
extent  and  suddenness  of  cerebral  disease ;  and  the  same  is  true  of 
the  influences  of  the  brain  upon  organic  life.  There  is  not  always, 
however,  a  correspondence  between  injuries  and  diseases  of  the  brain 
and  the  resulting  affections  of  the  mental  principle.  Apparently 
slight  injuries  or  diseases  of  the  organ  will  suspend  or  abolish  the 
faculties  of  the  mind,  while  in  other  cases  their  integrity  is  pre- 
served under  the  most  appalling  affections  of  the  brain.  It  is  also  re- 
markable in  those  cases  where  the  mind  is  least  affected  or  unimpair- 
ed, that  the  organic  functions  are  apt  to  suffer  least, — [Med.  and  Phya 
Comm.,  vol.  ii.,  p.  139,  note.) 


* 


* 


Subject  continued  in  Appendix,  article  Soul  &  Instinct. 


rHYSIOLOGY. FUNCTIONS.  363 


VITAL  HABIT. 


535.  Vital  habit  relates  to  the  modifications  of  functions,  and  the 
variations  of  their  results,  in  organic  and  animal  life,  as  arising  from 
the  repeated  or  continued  operation  of  natural,  morbific,  or  remedial 
agents.  It  frequently  happens,  however,  that  the  single  application 
of  a  vital  agent  will  establish  this  condition  (§  516  d,  no.  6;  §  545), 

This  simple  principle  is  at  the  foundation  of  some  of  the  most  pro- 
found and  comprehensive  laws  in  medicine  (Rights  &c.,  p.  919,  no.  19) 

536.  The  functions  of  organic  beings,  plants  as  well  as  animals,  are 
liable  to  great  and  more  or  less  durable  changes  from  the  foregoing 
causes.  I  have  applied  the  epithet  vital  to  distinguish  this  constitu- 
tional law  from  those  ordinary  p?ij/sical  habits  which  are  almost  pecu- 
liar to  man,  and  of  which  vital  habit  is  a  common  result. 

537.  The  functions  of  animal  life,  in  man  especially,  are  more  un* 
der  the  influence  of  vital  habit  than  the  organic.  The  latter  are  vari- 
ously affected,  as  to  habit,  by  climate,  season,  food,  and  morbific  and 
remedial  agents,  and  by  disease.  The  results  of  habit  are  most  im- 
portant in  its  relation  to  the  groups  of  causes  now  mentioned. 

538.  Habit  is  liable  to  be  more  strongly  pronounced  in  plants  and 
animals  by  certain  influences,  particularly  domestication,  climate,  and 
soil,  than  in  man.  Thus,  as  to  vegetables,  the  ricinus  communis  is  an 
annual  herbaceous  plant  in  America,  while  in  India  and  Spain  it  is  a 
woody  perennial  tree.  The  acquired  power  of  enduring  cold  is  stri- 
kingly manifested  in  man,  animals,  and  plants  (§  442,  104G-1050), 

539.  a.  The  philosophy  of  vital  habit  consists  either  in  a  tendency 
of  any  given  condition  of  the  vital  states  to  remain  without  change, 
as  a  consequence  of  its  duration,  or  in  certain  impressions  or  changes 
that  are  produced  in  irritability,  sensibility,  and  mobility,  in  their  re- 
lation to  each  operating  cause,  by  which  their  susceptibility  to  the 
action  of  the  particular  cause  or  causes  is  diminished  or  increased 
(§  176-215),  The  philosophy  is  alike  applicable  to  the  properties  of 
the  mind  as  to  those  of  the  vital  principle,  and,  of  course,  to  the  func- 
tions of  each  (§  173-176). 

539,  b.  In  animal  life,  therefore,  habit  concerns  the  senses,  volun- 
tary muscles,  and  the  intellectual  and  instinctive  faculties.  In  organ- 
ic life,  it  I'efers  to  the  organic  properties  and  functions  of  every  part, 
whether  organic  or  animal,  and  takes  in  the  various  and  important 
influences  of  the  nervous  system  (^  110-117,  224,  226,  495,  &c,). 

539.  c.  Since,  also,  the  influence  of  habit  in  either  life  generally 
relates  to  the  particular  agents  only  by  which  it  is  induced,  we  learn 
the  advantages  of  interchanging  cathartics,  anodynes,  &c,  (§  149,  163, 
550).  And  so  of  the  different  modes  of  exercise,  as  it  concerns  both 
organic  and  animal  life ;  and  so,  too,  of  the  employments  of  the  in- 
tellectual faculties,  that  a  due  improvement  may  be  imparted  to  each 
(§  565,  566,  855,  872  a). 

540.  The  principle  of  habit  is  every  where  the  same;  always  rela- 
tive to  impressions,  more  or  less  durable,  upon  the  vital  or  mental 
constitution.  The  analogy  is  perfect  throughout,  in  all  its  details, 
and  is  utterly  subversive  of  eveiy  chemical  or  physical  view  of  life  or 
disease  (^  1047). 

541.  It  illustrates  the  instability  of  the  vital  properties  (^  177-223). 


364  INSTITUTES    OF    MEDICINE. 

542.  The  modifications  arising  from  vital  habit  exercise  an  impor- 
tant sway  in  the  treatment  of  disease ;  since  remedial  agents  must  be 
varied  in  kind,  force,  quantity,  time  of  repetition,  &c.,  according  to 
the  artificial  modifications  of  irritability  and  sensibility,  especially  the 
former  (§  150,  188-204,  857). 

543.  Habit  is  liable  to  obtain  under  the  repeated  or  continued  op 
eration  of  almost  all  agents  which  are  capable  of  affecting  the  vital 
or  mental  properties.  Exceptions  occur  in  sensibility  as  it  respects 
pain  from  injuries,  and  in  the  ordinary  pleasures  of  sense,  which  are 
always  about  the  same,  however  frequently  repeated.  But  the  pain 
on  tasting  acrids,  the  nausea  from  tobacco,  &c.,  may  cease  to  be  pro- 
duced by  repetition  of  the  causes.  So,  also,  of  the  bougie,  music, 
landscapes,  the  verdure  of  spring,  &c.,  which  are  more  or  less  varia- 
ble in  effect.  An  interval  of  suspension,  however,  in  these  cases,  re- 
stores the  original  effect  of  the  causes. 

544.  It  is  by  vital  habit  that  morbific  agents,  such  as  miasmata, 
cease  to  be  injurious.  This  is  most  likely  to  happen  if  the  individual 
reside  from  infancy  in  the  miasmatic  region,  or,  in  the  unacclimated, 
after  recovery  from  an  attack  of  the  miasmatic  disease.  Such  is  the 
philosophy  of  acclimation  (§  539,  551) ;  and  the  same  is  alike  appli- 
cable to  tobacco,  &c.,  and  to  its  ultimate  conversion  into  a  luxury. 

545.  Sometimes  the  single  application  of  a  particular  agent  will  so 
confirm  the  intensity  and  permanence  of  habit  that  it  becomes  for- 
ever afterward  inoperative.  Such  is  not  unfrequently  the  case  with 
miasmata,  and  it  is  conspicuously  shown  in  small-pox,  measles,  scar- 
latina, &c.  And  so  of  vaccination  in  its  relation  to  small-pox  ;  though 
repetitions  of  the  vaccine  disease  may  be  necessary  to  even  a  tempo- 
rary exemption  from  small-pox,  while  at  other  times  the  effect  goes  off", 
leaving  individuals  exposed  to  small-pox  (§  350,  no.  45,  543).  All  this 
shows,  too,  a  near  identity  between  the  vaccine  and  variolous  dis- 
eases (§  75-79,  552  a,  654  h,  Note  Aaa  p.  1146). 

546.  The  law  of  habit  applies  extensively,  also,  to  remedial  agents ; 
these  having  the  eflTect,  by  repetition,  of  lessening  or  increasing  the 
susceptibility  of  organs  to  their  respective  virtues. 

547.  Habit,  in  respect  to  remedies,  as,  also,  to  morbific  causes,  dem- 
onstrates their  reflex  nervous  influences,  and  that  they  do  not  operate 
by  absorption.  Introduce  the  agents  with  any  frequency  into  the  cir- 
culation, there  will  be  no  such  manifestations  of  the  laws  of  habit. 

548.  a.  The  effects  of  habit  in  organic  life  are  generally  most  per- 
manent when  induced  by  causes  of  unceasing  and  long-continued  op- 
eration, such  as  climate,  the  presence  or  absence  of  light,  &c.  There  is 
then  some  very  persisting  or  permanent  modification  of  the  organic 
properties,  and  sometimes  very  remarkably  of  the  structure  (§  74, 
538,  545). 

548,  b.  The  foregoing  law  is  of  very  extensive  application  in  the 
philosophy  of  disease,  and  replete  with  practical  bearings.  Its  illus- 
trations are  constantly  seen  in  the  obstinacy  of  chronic  diseases,  and 
in  the  comparative  ineflSciency  of  remedies  when  the  treatment  of 
fevers  is  neglected  for  a  single  day. 

548^,  a.  In  a  general  sense,  the  natural  vital  stimuli,  such  as  food 
which  is  of  easy  digestion,  heat,  water,  &c.,  for  obvious  final  causes, 
produce,  like  the  blood,  nearly  the  same  impressions  upon  the  organic 
properties,  at  every  age,  and  at  every  hour,  under  equal  circumstan 
ces  C§  136>  137). — See  Causes,  Final,  Index  I. 


PHYSIOLOGY. FUNCTIONS.  365 

548J,  h.  Nevertheless,  ceitain  kinds  of  food,  and  analogous  stimuli, 
as  wine,  &c.,  come  within  the  law  of  habit.  This  is  where  the  kin<l 
of  food  may  not  be  natural  to  the  age  of  the  individual  (§  568) ;  or 
when  it  may  be  at  first  oppressive  or  detrimental  at  any  age,  it  may 
become,  by  use,  inoffensive  and  nutritious.  During  the  first  experi- 
ments the  food  may  escape  the  stomach  undigested,  having,  also,  irri- 
tated that  organ,  induced  headache,  &c.  But,  in  a  process  of  time, 
the  iriitability  of  the  stomach  becomes  adapted,  by  habit,  to  the  pres- 
ence of  that  particular  kind  of  food,  its  ready  digestion  follows,  and 
all  sympathetic  results  disappear.  It  is  exactly  the  same  law  that 
renders  tobacco,  asafoetida,  &c.,  luxuries  (§  543). 

549.  The  law  of  habit,  in  respect  to  morbific  and  remedial  agents, 
follows  the  law  which  governs  the  relative  duration  of  disease  when 
produced  by  remedial  agents  and  such  as  are  truly  morbific.  Disease 
excited  by  the  former,  if  not  in  great  intensity,  soon  subsides  sponta- 
neously ;  but  when  by  the  latter,  it  is  far  more  lasting.  This  princi- 
ple, also,  as  it  relates  to  remedial  agents,  is  at  the  foundation  of  their 
curative  effects  (§  893,  &c.,  926). 

550.  Since  habit  subsides  in  various  degrees,  and  at  various  times, 
after  the  removal  of  its  causes,  and  the  properties  of  life  acquire, 
therefore,  more  or  less,  their  original  susceptibility  to  the  particular 
agents  or  causes  (§  539,  543),  and  since  the  effects  of  remedial  agents 
are  commonly  transient  in  respect  to  habit  (§  549),  we  may,  in  most 
cases,  soon  resume  the  suspended  remedy,  and  obtain  its  original  ef- 
fect (§  539  c,  857).  And  just  so  of  acclimation ;  its  influences  ceasing 
on  change  of  residence,  when  miasms  will  be  again  morbific  on  return- 
ing to  the  former  acclimated  region.  And  so  of  pleasure  and  pain  (§ 
543).     The  coincidences  demonstrate  the  fallacy  of  humoralism  (§  665). 

551.  Again,  it  is  through  the  principle  of  vital  habit  that  we  must 
interpret  the  ability  of  the  system  to  sustain,  with  the  same  or  dimin- 
ished effect,  increased  doses  of  remedial  agents,  as  opium,  tartarized 
antimony,  &c.,  while  this  peculiarity  will  be  limited  to  the  agents 
which  are  thus  employed.  The  eighth  of  a  grain  of  tartarizad  anti- 
mony may  produce  vomiting  at  the  first  dose ;  but,  by  gradually  in- 
creased doses  every  two  hours,  it  may  be  sometimes  raised  in  twelve 
hours,  by  lessening  gastric  irritability  in  relation  to  its  own  virtues, 
to  two  grains  at  a  dose,  without  vomiting  again  (§  556).  But  gastric 
irritability  will  not  be  thus  reduced  in  relatimi  to  any  other  emetic. 
And  so  of  miasmata,  &:c. ;  and  I  may  add  to  §  544,  that  if  the  unac- 
climated  pass  gradually  through  a  series  of  climates  having  gradations 
of  miasmatic  intensity,  he  will  ultimately  reach  its  highest  virulence 
with  far  greater  safety  than  if  he  plunged  at  once  into  its  fury.  Should, 
however,  epidemic  influences  occur  of  an  unusual  nature,  he  will  still 
be  as  much,  or  more  exposed  to  their  malign  effects  than  in  uninfect- 
ed countries  (§  150). 

552.  a.  Other  parallels  hold,  also,  in  the  foregoing  cases  (§  551).  If, 
for  example,  the  antimony  be  suspended  for  twelve  hours,  gastric  ir- 
ritability will  recover  its  natural  relation  to  that  substance,  &c.  And 
so  of  the  miasmatic  agent,  if  the  acclimated  subject  retire  to  a  salubri- 
ous region,  and  subsequently  revisit  the  insalubrious  (§  557,  b). 

552,  b.  Again,  the»antimony  impresses  the  system  in  the  ratio  of  its 
action  upon  the  stomach,  or  of  the  duration  of  its  action.  Fever,  or 
pneumonia,  &c.,  will  fail  to  be  assuaged  unless  the  gastric  effect  be 


366  INSTITUTES   OF    MEDICINE. 

kept  up,  if  the  agent  be  employed  in  its  small  alterative  doses.  Oi* 
a  single  dose,  operating  as  an  emetic,  may  at  once  overthrow  the  dis* 
ease  (§  524  a,  no.  1).  And  so  of  miasmata  ;  since,  in  the  case  sup- 
posed (§  551),  the  individual  may  be  gradually  brought  under  its  in- 
fluence, till,  at  last,  its  greatest  intensity  may  produce  an  explosion  of 
disease ;  or,  this  may  ensue  w^ith  great  rapidity  in  the  same  subject  if 
the  gradual  acclimation  be  neglected  (§  514  g^  516  c,  518  h,  557  h). 

553.  No  two  agents  being  precisely  alike  in  their  effects,  habit  will 
vary  according  to  the  exact  nature  of  its  causes  (§  150,  191,  649). 
Some,  like  antimony,  often  lessen  irritability  with  great  rapidity,  and 
the  property  will  recover  its  relation  to  the  agent  after  a  short  inter- 
val of  suspension.  Others  as  frequently  require  a  much  longer  time, 
and  irritability  will  take  various  intervals  of  repose,  often  months  or 
years,  to  recover  its  relation  to  these  agents. 

554.  It  is  fundamental  in  medicine  that  the  foregoing  intervals  (§ 
553)  are  not  long  as  it  respects  remedial  agents,  in  their  ordinary  use, 
but  much  longer  m  respect  to  the  truly  morbific  causes.  In  the  case, 
for  instance,  of  acclimation  (§  551),  if  the  subject  return  to  a  salubri- 
ous climate,  it  may  be  many  months,  or  years,  before  the  system  will 
have  recovered  its  susceptibility  to  the  miasmatic  agent, 

bbb.  The  foregoing  exemplification  of  habit  in  respect  to  morbific 
and  remedial  agents  (§  554)  is  allied  to  the  principle  which  lies  at  the 
foundation  of  disease,  and  of  its  cure  by  remedies,  whether  physical 
or  mental.  Disease  consists,  essentially,  in  a  more  or  less  permanent 
alteration  of  the  organic  properties ;  while  remedial  agents  establish 
more  transient  alterations,  which  enables  the  morbid  properties  and 
actions  to  obey  their  natural  tendency  to  a  state  of  health. 

556,  a.  Vital  habit  appears,  also,  under  an  aspect  opposite  to  that 
of  diminished  irritability.  It  then  presents  itself  more  in  the  condi- 
tion of  a  morbid  change  of  the  organic  conditions.  Thus,  tartarized 
antimony,  instead  of  reducing  gastric  irritability,  as  in  §  551,  may  ex- 
alt it ;  so  that,  beginning  with  the  eighth  of  a  grain,  as  in  the  former 
example,  but  without  an  emetic  effect,  and  I'epeating  it  without  even 
increasing  the  dose,  vomiting  will  take  place  at  the  second  or  third 
dose  (§  514  g,  516  c  and  d,  no.  6).  In  these  cases,  we  must  some- 
times progressively  reduce  the  dose  to  the  fiflieth  part  of  a  grain,  or 
vomiting  will  ensue.  In  this  particular  case  irritability  is  also  increas- 
ed in  its  relation  to  ipecacuanha,  and  to  most  other  irritants  (§  841). 

556,  h.  This  lets  us  into  the  philosophy  of  the  most  successful  mode 
of  overcoming  habitual  and  obstinate  constipation,  by  small  doses  of 
cathartic  medicine,  repeated  once  or  twice  daily ;  as  the  fourth  of  a 
grain  of  blue  pill,  and  half  a  grain  or  a  grain  of  aloes.  The  irrita- 
bility of  the  intestine  is  thus  permanently  exalted,  by  which  it  is  soon 
rendered  so  sensitive  to  the  increased  quantity  of  bile  as  to  require 
a  diminution  or  discontinuance  of  the  medicine.  The  impression  of 
each  dose  remains  till  the  next  is  repeated  (§  514  g,  516  c,  516  d,  no. 
6).  The  law  of  increased  susceptibility  is  brought  into  operation  § 
137,  <i,  and  alterative  reflex  action  increases  the  bile  {^  889  Z,  m). 

What  I  have  thus  stated  in  this  section  involves  some  of  the  most 
important  philosophy  in  medicine.  In  its  practical  natui-e  it  takes  in 
a  wide  range  of  therapeutical  problems,  some  (Jf  the  most  essential  of 
which  are  relative  to  the  dose  or  the  amount  of  a  remedy,  and  the  prop- 
er time  for  its  repetition  (§  857). 


PHYSIOLOGY  FUNCTIONS.  367 

556,  c.  The  foregoing  principle  is  farther  shown  by  the  effect  of  sa- 
line and  other  cathartics  in  promoting  salivation  when  given  a  few 
hours  after  the  exhibition  of  a  full  dose  of  calomel.  The  fact  was  as- 
certained by  George  Fordyce,  and  has  been  often  verified  in  my  own 
person  after  the  use  of  blue  pill.  The  mercurial  agent  will  not  ex- 
ert, in  the  cases  supposed,  this  profound  constitutional  effect  with- 
out the  subsequent  aid  of  the  other  agents,  which  so  increase  intesti- 
nal irritability,  and  that  of  the  whole  system,  that  the  mercury  operates 
with  greater  local  and  general  intensity ;  a  fact,  by-the-way,  which  is 
also  opposed  to  the  doctrine  of  operation  by  absorption.  J  ust  so,  too, 
bloodletting  increases  the  susceptibility  of  the  system  to  the  constitu- 
tional and  local  action  of  mercury,  cathartics,  and  many  other  agents, 
while  it  also  lessens  much  their  doses.  A  common  principle  lies  at 
the  foundation  of  the  whole  (§  150,  890^°-,  892^  u,  893  q,  904  c,  1088). 

556,  d.  Augmented  irritability,  sensibility,  and  mobility,  in  their 
proper  relation  to  habit,  depend  often  upon  peculiar  states  of  the 
stomach,  on  constitution,  climate,  &c.  Hence  in  some  climates  cer- 
tain remedies,  as  antimony,  are  borne  much  better  than  in  others;  ca- 
thartics often  exalt  irritability  (especially  of  the  direct  seat  of  action) 
in  an  intense  degree,  &c. 

But  other  influences  in  connection  with  the  foregoing  are  often  in 
operation,  and  may  be  the  main  cause  of  the  effects  which  are,  at  oth- 
er times,  due  to  the  causes  now  supposed.  Thus,  cathartics  are  lia- 
ble to  be  surrounded  by  such  influences,  especially  by  increased  irri- 
tability from  the  presence  of  disease,  or  as  the  effect  of  passion,  or 
the  play  of  sympathy,  or  the  bile  may  be  increased  in  quantity  or  in 
its  stimulating  virtues.  These  modifying  influences  may  be  variously 
applied. 

557,  a.  The  difference  in  the  I'esults  of  the  same  remedy  in  anal- 
ogous conditions  of  disease  often  depends  upon,  and  illustrates,  the 
law  of  habit.  Thus,  an  emetic  and  cathartic,  exhibited  near  the  in- 
vasion of  continued  fever,  will  often  break  up  the  disease ;  but  not  so 
if  the  fever  have  been  neglected  for  twenty-four  hours.  The  moi'bid 
action  is  then  under  the  power  of  habit.  On  the  contrary,  an  emetic 
will  often  remove  an  intermittent  fever  of  long  duration  if  administer- 
ed during  the  intermission.  Plere,  the  febrile  action  being  greatly 
suspended  at  regular  intervals,  the  force  of  habit  is  constantly  broken, 
and  nature  puts  on  its  recuperative  tendency  (§  555,  &c.,  715,  926). 

557,  b.  A  special  exception  occurs,  however,  in  the  abstraction  of 
blood  as  it  regards  its  remedial  effects  upon  disease  which  has  ac- 
quired the  force  of  habit.  In  active  or  chronic  forms  of  inflammation, 
and  in  fevers  of  considerable  duration,  general  bloodletting,  particu- 
larly, when  carried  to  its  just  extent,  may  at  once  subvert  the  disease, 
or,  at  least,  greatly  cripple  its  force  and  its  habitual  tendency.  Here, 
an  impression  is  simultaneously  and  powerfully  made  upon  the  whole 
circulatory  system,  and  that  which  is  thus  exerted  upon  the  immedir 
ate  instruments  of  disease  is  greatly  advanced  by  reflex  nervous  actions 
from  all  parts  of  the  capillary  blood-vessels  (§  921,  931-934).  There 
is,  therefore,  a  clear  analogy  in  a  and  b  with  the  modus  operandi  of 
miasmata  when  they  prove  the  exciting  as  well  as  predisposing  cause 
of  disease  near  the  first  moment  of  their  contact  with  the  body  (§ 
552,  b) — philosophically  considered  (^  654  a). 

558,  a.  The  principle  involved  in  §  556  embraces  what  is  called  the 


368  INSTITUTES    OF    MEDICINE. 

cumulative  effect  of  remedies,  and  of  which  digitalis,  hydrocyanic  acm, 
mercury,  narcotics,  &c.,  supply  examples,  in  their  small  repeated 
doses  (§  514,  g).  And  yet  some  of  the  same  agents,  as  the  narcotics, 
by  longer  use,  will  establish  the  opposite  condition  of  habit,  or  that  of 
diminished  effect ;  thus  illustrating  the  different  aspects  of  the  laws  of 
vital  habit. 

558,  b.  In  the  cumulative  aspect  of  habit,  the  agent,  as  digitalis,  oi 
mercury,  or  cantharides,  for  instance,  establishes  progressive  impres-  < 
sions  on  the  vital  states,  proportioned  to  the  amount  and  frequency  of 
the  dose,  cceteris  paribus  (§  926).  When  that  impression  reaches  a 
certain  degree  of  intensity,  the  organic  properties  are  brought  into  so 
full  a  relation  with  the  morbific  virtues  of  the  agent,  that  they  under- 
go, abruptly,  a  greater  change ;  when  the  phenomena  of  full  mercu- 
rial action,  of  digitalis,  &c.,  take  place  suddenly,  and  perhaps  with 
violence.  The  last  is  morbid,  and  exactly  the  same  as  we  have  seen 
of  the  progi'essive  operation  of  miasmata  (§  552,  h).  But  we  often 
see  manifested  by  digitalis,  prussic  acid,  &c.,  the  same  variety  of 
habit  as  was  stated  of  tartarized  antimony  in  §  551,  since  we  must 
often  increase  the  dose  to  maintain  the  original  effect.  And  so,  ao^ain, 
of  miasmata  (§  551).  This,  however,  is  not  true  of  some  of  the  cumu 
lative  remedies,  such  as  the  mercurial  (^  516,  d,  no.  6). 

558.  c.  And  now,  to  illustrate  the  alterative  reflex  action  of  reme 
dial  agents  by  the  process  of  removing  the  morbid  effects  of  the  fore- 
going cumulative  remedies  (Z»),  we  have  but  to  interrogate  the  only 
possible  manner  in  which  we  may  speedily  subdue  those  effects  by 
other  remedies,  and  as  explained  in  \  891 J  A:,  984  h. 

559.  Exactly  the  same  philosophy  (§  558)  is  applicable  to  what  is 
called  predisposition  to  disease  (§  148,  503,  538,  539,  544,  547,  552 
h).  Nevertheless,  predisposition  may  differ  from  the  cumulative  im- 
pression of  remedies  in  being  established  by  a  single,  and  even  mo- 
mentary action  of  the  morbific  agent,  when  the  organic  states  may  go 
on  with  their  morbid  tendency  till  an  explosion  follows,  as  in  §  148, 
653.  So,  often,  of  a  single  dose  of  mercury  in  respect  to  its  curative 
effects  (§  514,  g).  But,  the  difference  lies  in  the  greater  intensity  of 
the  agent,  or  in  a  gi'eater  susceptibility  of  the  subject  to  its  action,  or 
in  both  (§  549,  666,  516  d,  no.  6). 

560.  Another  aspect  of  habit,  as  it  respects  morbific  agents,  and 
which  goes  with  the  rest  to  illustrate  important  principles  in  medi- 
cine, is  the  tenacity  of  many  diseases,  as  shown  in  periodical  returns 
of  intermittent  fever,  at  inters'als  of  months,  even  after  the  subject 
shall  have  removed  to  a  climate  exempt  from  the  causes.  Here  the 
original  impression  remains  (§  514,  ^),  and  frequently,  also,  some  lo- 
cal form  of  disease,  by  which  the  general  predisposition  is  maintained, 
and  its  explosions  more  or  less  produced  (§  148). 

561.  What  concerns  the  acquired  habits  that  appertain  more  or  less 
to  the  constitution  of  all  men,  and  Avhich  have  a  modifying,  and  often 
a  great,  influence  in  determining  the  operation  of  morbific  and  reme- 
dial agents,  comes  entirely  within  the  foregoing  principles  relative  to 
vital  habit ;  and  this  is  more  obviously  true  of  the  accidental  modifi- 
cations of  temperament  that  arise  in  individuals  from  the  influence  of 
climate,  heat,  cold,  &c.  (§  78,  442  h,  c,  535,  539).  Where  the  pecu- 
liarity of  constitution  is  transmitted  from  parent  to  child  the  modify- 
ing causes  have,  of  course,  onerated  upon  the  ancestor.      But  the 


PHYSIOLOGY. FUNCTIONS.  369 

transmitted  peculiarity  is  equivalent  to  that  which  is  generated  by  the 
direct  action  of  the  modifying  agent  (§  75-80,  585,  587,  591,  659). 

Here,  too,  we  may  observe  how  the  incubation  of  fever,  for  a  week 
or  for  months,  is  analogous  to  the  slow  progress  of  the  artificial  tem- 
peraments ;  though,  in  the  former  case  the  remote  causes  may  operate 
for  an  hour  only,  and  thus  establish  a  tendency  in  the  organic  proper- 
ties to  advance  in  their  morbid  predisposition,  till,  reaching  a  certain 
amount  of  change,  a  development  of  fever  is  suddenly  displayed  •, 
while,  in  the  artificial  temperaments  the  changes  are  commonly  the 
result  of  the  continued  operation  of  the  remote  cause. 

562.  The  luxuries  and  customs  of  civilized  man  affect  his  natural 
constitution  upon  the  same  principles  as  morbific  agents  produce  dis- 
ease, or  as  the  remedial  alter  the  properties  of  life  back  again  to  a 
state  of  health.  In  all  the  cases,  the  results  are  owing  to  impressions 
variously  made  upon  the  properties  of  life  (§  191  h,  535,  539). 

563.  So  simple  is  Nature  in  her  elementary  laws  that  the  periodi- 
cal desire  of  food,  and  many  little  usages  of  the  body,  fall,  more  oi 
less,  under  the  comprehensive  law  which  I  have  exemplified  by  prom- 
inent instances  of  habit.  And  here,  too,  we  glance  at  the  philos- 
ophy of  instinct  in  its  magnificent  relations  to  certain  natural  habits  ; 
and  realize,  also,  in  the  phenomena,  the  principles  which  are  con- 
cerned in  the  analogous  relations  of  the  will  to  voluntary  motion  (§ 
500,  c-h). 

564.  In  my  last  proposition  I  was  on  the  borders  of  education,  which 
is  mostly  confined  to  animal  life,  or  extended  to  both  where  animal 
and  organic  are  associated  in  functions. 

Education  is  allied  to  habit  in  its  philosophy,  as  manifested  both  in 
the  cultivation  of  muscular  power  and  the  properties  of  the  mind 
(§  175  h,  241). 

5^5,  a.  Education  often  improves  some  of  the  animal  functions  at 
the  expense  of  others ;  but  this  mostly  where  some  are  more  the  sub- 
jects of  cultivation  than  others,  as  seeing,  hearing,  &c.,  or  the  muscu- 
lar action  of  the  arms,  &c.  (§  539,  c).  When  one  sense,  as  sight,  is 
extinct,  others,  as  hearing  and  touch,  become  very  exquisite.  In  the 
case  of  the  muscles,  mobility  is  augmented,  and  their  nutrition  in- 
creased ;  in  that  of  the  senses,  sensibility. 

565.  h.  A  more  critical  analysis,  in  the  case  of  the  muscles,  shows 
us  that  mobility  in  organic,  and  its  modification  in  animal  life,  are 
both  advanced  (§  205,  215).  Hence  result  the  increase  of  voluntary 
power  and  the  increased  size  of  the  muscles.  By  this  muscular  ex- 
ercise the  function  of  digestion  is  also  increased,  the  elaboration  of 
bile,  and  important  vigor  is  imparted  to  the  whole  organic  mecha- 
nism. The  principle  is  exactly  the  same  as  in  all  the  preceding  ex- 
amples relative  to  vital  habit. 

566.  a.  This  chain  of  exact  analogies  brings  us  to  the  properties  of 
the  mind,  which  are  improved  upon  the  same  principle  (§  175  h,  241, 
565).  Here,  as  in  the  foregoing  instances  (§  b^b),  one  or  more  of  the 
properties  is  apt  to  be  exalted  at  the  expense  of  the  i-est  (§  539,  c). 
The  poet,  therefore,  thinks  differently  from  the  man  of  cultivated  judg- 
ment ;  the  lawyer  is  prone  to  sophistry  and  skepticism ;  the  mathema- 
tician is  wrapped  in  abstract  truths,  and  deficient  in  practical  business  ; 
the  clergyman,  from  his  well-disciplined  trust  in  Revelation,  and  his 
scholastic  habits,  suffers  that  trust  to  degenerate  into  credulity,  and  too 

A  A 


370  INSTITUTES    OF   MEDICINE. 

often  patronizes  homoeopathy, or  delights  in  animal  magnetism, or  even 
in  the  anti-scriptural  speculations  of  the  geologists.  The  history  of  na- 
ture is  nothing  to  the  chemist  out  of  his  laboratory ;  in  physiology  he 
is  like  the  astrologer  among  the  stars.  Shall  I  speak  of  the  physi- 
cian ?  It  is  said  by  Samuel  Johnson  that  he  is  more  apt  to  cultivate 
all  the  powers  of  his  understanding,  and  all  departments  of  nature, 
together,  and  that  he  has  therefore  been  more  distinguished  for  an  en- 
lightened and  comprehensive  view  of  the  various  subjects  for  reason 
than  any  other  class  of  mankind. 

56G,  h.  And  now  we  are  prepared  to  comprehend  the  analogies  be- 
tween those  impressions  which  are  brought  about  by  the  habitual  ac- 
tion of  external  objects  upon  the  senses,  and  in  which  the  mind  is  con- 
cerned, as  in  the  satiety  of  spring,  the  increasing  enjoyment  of  paint- 
ing, sculpture,  and  music,  and  the  increasing  acumen  with  which 
their  beauties  and  refinements  are  discerned,  and,  also,  those  other 
changes  that  are  incident  to  the  organic  properties  from  the  habitual 
use  of  tobacco,  of  stimulants  to  the  nose,  to  the  stomach,  &c.,  or  such 
as  arise  from  tartarized  antimony,  acclimation,  and  those  moral  influ- 
ences through  which  the  black  skin,  the  low  forehead,  and  the  flat 
nose,  are  rendered  more  beautiful  to  the  African  than  the  analogous 
features  of  the  white  man,  or  which  render  the  flattened  head,  and  the 
scarified  face,  an  ornament  to  the  eye  of  the  American  Indian,  or  the 
deformities  of  the  corset,  or  the  artificial  rump,  elegances  in  polished 
society,  while  the  few  that  worship  at  the  Graces'  shrine  become  ob- 
jects of  dislike.  The  same  fundamental  philosophy  obtains  through- 
out. 

567.  From  the  foregoing  analogies  between  the  mental  and  vital 
powers  (§  566),  it  appears  that  the  former  are  cultivated  through  the 
medium  of  the  senses  and  brain,  and  as  well  by  external  influences  as 
by  the  operation  of  the  sensorium  commune,  upon  the  same  principle 
that  the  vital  properties  are  influenced,  more  or  less  permanently,  by 
the  operation  of  foreign  agents  (§  175  h,  241).  The  impressions  in 
respect  to  mind,  however,  are  more  complex,  since,  in  this  case,  they 
come  to  the  spiritual  part  through  material  organs. 

568.  We  may  now  see  the  nature  of  the  analogies  between  the 
special  injuries  which  result  from  too  much  or  improper  food  in  the 
early  stages  of  life,  and  crowding  the  mind  with  study  or  with  topics 
beyond  its  easy  comprehension  ;  and  those  between  the  ultimate  adap- 
tation of  the  properties  of  the  stomach  to  what  was  once  offensive,  and 
the  corresponding  development  of  the  properties  of  the  mind  and  of 
its  organs  by  which  it  sustains  what  had  been  detrimental  to  both,  and 
to  the  general  health.  These  principles  He  deeply  at  the  foundation 
of  a  proper  elementary  education  of  the  mind  (175  Z>,  548J  h,  567). 

STRENGTH,   AND    VTEAKNESS    OR   DEBILITY. 

569.  a.  Much  of  what  has  been  now  considered  under  the  various 
aspects  of  habit  is  often  vaguely  defined  by  the  terms  strength,  and 
u'calcness  or  debility.  The  terms  are  without  any  true  meaning,  and 
have  led  to  very  extensive  practical  errors.  If  the  finger  become  in- 
flamed, muscular  action  is  impaired  in  the  hand,  or  arm.  This  is  call- 
ed weakness,  debilitjf,  both  of  the  vessels  which  are  engaged  in  the 
morbid  process,  and  of  the  muscles.  But,  bloodletting,  either  gen- 
eral or  by  leeches,  will  cure  the  disease  and  restore  muscular  action. 


PHYSIOLOGY. FUNCTIONS.  371 

Here  the  nature  of  the  remedy  contradicts  the  supposed  philosophy 
(§  743,  801,  964). 

569,  b.  Strength  and  dehility  are,  also,  often  confounded,  leading 
to  still  greater  confusion  and  error.  Thus,  manifestations  of  full 
muscular  power  are  said  to  denote  strength,  while  the  high  vascular 
action  of  inflammation  is  supposed  to  depend  on  debility.  The  for- 
mar  is  also  often  seen  in  deplorable  states  of  disease  where  debility 
is  thought  to  reign  supreme.  On  the  contrary,  also,  the  mere  pros- 
tration of  voluntary  motion  at  the  very  invasion  of  disease  is  as  con- 
stantly considered  a  state  of  debility,  however  exalted  may  be  inflam- 
matory or  febrile  affections  upon  which  that  contingency  in  animal 
life  may  depend.  Tonics  and  stimulants,  therefore,  have  their  sway 
according  to  these  supposed  imaginary  conditions, — imaginary,  since 
disease  consists  neither  in  one  nor  the  other,  so  far  as  they  have  any 
intelligible  import.  The  designations,  for  the  most  part,  are  borrow- 
ed from  the  inorganic  world ;  and  even  at  this  day  some  physiologists 
are  making  experiments  upon  the  dead  muscular  tissue  by  immersing 
it  in  solutions  of  tonics  and  astringents,  to  learn  the  value,  and  the 
modus  operandi,  of  those  agents  when  applied  to  morbid  states  of  the 
living  being.  Dr.  Adair  Crawford,  for  example,  in  his  Experimental 
Inquiry  into  the  Effects  of  Tonics  and  Astringents  (1816),  attributes 
their  influence  entirely  to  the  tanning  process,  by  which  physical  co- 
hesion is  established.  His  pi'emises  are  those  upon  which  the  illus- 
trious and  able  Pringle,  and  his  compeers,  rested  the  same  conclu- 
sion ;  animal  membranes  having  been  immersed  in  various  infusions, 
and  comparisons  made  of  their  resistance  to  weight  with  the  same 
membranes  soaked  in  watei*.  Strength  was  implied  in  the  former  in- 
stance (^  487  A,  1001-1008, 1019, 1068).— Notes  Ff  p.  1 135,  Ii  p.  1139. 

569,  c.  If  strength  and  weakness,  or  debility,  be  applied  to  organic 
states,  it  must  be  in  a  totally  different  acceptation  from  their  ordinary 
meaning.  In  their  vital  applications,  they  can  relate  alone  to  any 
present  condition  of  the  vital  powers.  In  this  sense,  the  greatest 
strength  of  the  body  consists  in  a  natural  performance,  by  all  the  or- 
gans respectively,  of  the  functions  appropriate  to  each,  without  ei- 
ther borrowing  from  the  others  any  assistance  which  it  does  not  con- 
stitutionally enjoy,  and  without  taking  upon  itself  any  undue  amount 
of  labor.  In  a  state  of  undisturbed  health,  and  temperate  habits,  the 
functions  of  all  organs  move  on  in  harmony,  each  administering  to  the 
others  a  certain  allotted  contribution.  But,  in  impaired  constitutions, 
the  whole  of  this  natural  harmony  is  more  or  less  disturbed.  Digestion 
is  imperfectly  performed,  and  every  meal  tasks  the  stomach  beyond  its 
natural  ability.  The  other  organs  suffer,  sympathetically,  in  conse- 
quence, and  often  seem  to  bend  their  actions  toward  a  co-operative 
effort  in  aid  of  the  diseased  actions  of  the  stomach.  In  this  sense, 
therefore,  all  the  powers  of  the  system  may  be  said  to  be  unnaturally 
tasked.  But,  in  the  mean  time,  all  the  sympathizing  organs  are  them- 
selves afflicted,  and  just  in  proportion  as  they  sympathize  with  the 
stomach.  The  food  escapes  from  this  organ  in  a  half-digested  state, 
in  which  chemical  changes  have  also  occurred.  These  changes  beget 
acids  and  flatulence,  and,  as  the  crude  mass  traverses  the  intestines, 
it  ii-ritates,  and  increases  the  sympathetic  derangement  of  those  or- 
gans, while  these,  again,  reflect  back  pernicious  influences  upon  the 
stomach  and  all  other  parts.     Increased  and  unnatural  mucus,  diar- 


372  INSTITUTES    OF    MEDICINE. 

rhoea,  &c.,  follow  in  the  train  of  intestinal  symptoms,  urged  on  by  an 
unhealthy  production  of  bile ;  while  an  offensive  taste  in  the  mouth, 
a  foul  breath,  or  a  coated  tongue,  tell  us  of  the  sympathies  which  are 
going  on  in  that  region.  The  red  or  tui'bid  urine  shows  us  that  the 
kidneys  have  joined  in  the  disordered  actions.  The  pulse  may  be 
languid,  or  it  may  beat  high,  according  as  inflammation  may  be  ab- 
sent, or  have  set  in  as  one  of  the  sequelae ;  but  according  to  the  acci- 
dental state  of  this  symptom  tlie  degree  of  weakness  is  greatly  meas- 
ured in  this  complex  and  very  common  condition  of  disease  (§  423). 
But,  whatever  the  symptoms,  the  system  is  said  to  be  xoedlc^  to  be  de- 
hilitated.  There  is,  however,  no  truth  in  this  construction,  as  it  is 
ordinarily  understood.  The  powers  may  be  all  exalted ;  aftd  that 
this  is  generally  so,  is  shown  by  the  increased  secretions  from  the 
liver  and  intestines ;  while  it  is  fully  demonstrated  by  the  nature  of 
the  curative  means,  which  consist  especially  of  a  low  diet.  The  sup- 
posed debility  is  nothing  but  an  altered  condition  of  the  properties 
and  functions  of  life,  and  the  very  remedies  which  the  idea  of  debility 
would  suggest,  such  as  stimulants  and  tonics,  are  generally  aggrava- 
ting causes.  Such  is  the  exaltation  of  irritabihty,  especially  in  the 
intestinal  canal,  that  it  may  not  bear  even  the  stimulus  of  broth,  nor 
the  mechanical  irritation  of  solid  food. 

569,  d.  The  nearest  approach  to  the  popular  sense  in  which  debili- 
ty is  properly  applied   consists  in  the  exhaustion  of  the  organic  pow- 
ers that  attends  the  advanced  stages  of  prolonged  disease. — See  §  487  h. 
So  far,  therefore,  as  debility  has  an  existence,  and  as  connected  with 
disease,  it  is  nothing  but  a  symptom  resulting  from  some  modified  con- 
dition of  the  functions  of  one  or  more  organs,  in  which  the  true  patho- 
logical cause  consists,  and  to  which  alone  our  remedial  treatment  should 
be    addressed.       The  humoral  terms  ancemia,  leuccemia,  cachexia,  and 
chlorosis,  in  their  connection  with  iron  and  debility,  are,  therefore,  re- 
sponsible for  an  incalculable  amount  of  mortality.     But  as  I  have  said, 
much  of  this  symptom  (always  mostly  so  in  the  early  stages  of  disease) 
is  owing  to  the  failure  of  the  Will  to  act  upon  the  voluntary  muscles 
(§  487  h,  961);  and  Avhen  this  circumstance  is  duly  considered  it  may 
result  in  a  profitable  inquiry  into  the  probable  extent  of  mortality  that 
may  be  ascribed  to  the  tonic  and  stimulant  treatment  of  disease  (§  621  a, 
1001  a,  1065  c,  1068  a).     No  writer  who  has  discarded  loss  of  blood 
as  a  principal  remedy  for  inflammations  and  congestions,  or  inculcated 
"  the  stimulating    plan,"  has  survived  his  own  generation  excepting 
John  Brown,  and  his  work  exists  only  as  a  curiosity  in  medical  litera- 
ture (§  1068  a).     The  practice  is  perpetuated  by  individual  prejudices 
and  impulses  (§  960  g),  not  by  the  authority  of  enlightened  or  recog- 
nized experience,  nor  by  any  thing  in  the  pathology  of  disease  (p.  872). 
569,  e.  Finally,  I  may  conclude  this  subject  with  the  nervous  lan- 
guage of  Southwood  Smith  {On  Fever):  Thus — even  "in  the  intense 
forms  of  congestive  fever,  I  look    upon  the  notion  of  debility  to  be 
an  error  not  less  palpable  in  its  nature,  than  destructive  in  its  conse- 
quences ;  and  if  the  havoc  it  produces  do  not  confer  upon  it  a  pre-emi- 
nence as  bad  as  that  of  the  very  disease  of  which  it  is  supposed  to  con- 
stitute the  essence,  it  at  least  entitles  it,  in  comparison  with  every  oth- 
er error  in  medicine,  to  the  distinction  recognized  in  society  between 
the  hero  and  the  murderer.     The  one  destroys  a  single  human  being 
now  and  then,  but  the  other  numbers  its  victims  by  thousands." 


PHYSIOLOGY. AGE.  373 


FIFTH  DIVISION  OF  PHYSIOLOGY. 

MODIFICATIONS  OF  THE  VITAL  PROPERTIES  AND 
FUNCTIONS  ARISING  FROM  AGE,  TEMPERAMENT, 
CONSTITUTION,  SEX,  VOLUNTARY  HABITS,  &c. 

570.  The  differences  among  individuals,  and  classes  of  mankind, 
which  arise  from  age,  sex,  temperament,  &c.,  may  be  regarded  in 
the  light  of  qualifications  of  the  four  preceding  grand  attributes  ot 
organic  beings. 

571.  Organic  beings  are  liable  not  only  to  permanent  changes  in 
their  constitution  from  external  influences,  but  to  others  of  an  inhe- 
rent nature.  Constitution  and  temperament  supply  examples  of  the 
former ;  age  and  sex  of  the  latter. 

572.  These  changes  (§  571)  consist  in  varying  conditions  of  the 
properties  of  life,  and  possess,  therefore,  not  only  important  relations 
to  the  physical  agents  of  life,  but  modify,  according  to  their  different 
circumstances,  the  operation  of  morbific  causes,  and  our  therapeutical 
treatment. 

573.  All  the  foregoing  conditions  spring  from  the  natural  instabili- 
ty of  the  vital  properties ;  and  such  as  are  brought  about  by  external 
influences  involve  exactly  the  same  philosophy  that  is  concerned  in 
vital  habit  (§  177,  539).  Under  the  present  division  of  Physiology, 
however,  the  modified  conditions  are,  in  a  general  sense,  of  a  far  more 
permanent  nature  than  such  as  I  have  assigned  to  vital  habit. 

I.    AGE. 

574.  As  our  bodies  undergo  progressive  changes  from  the  time  of 
birth  to  the  end  of  life,  the  duration  of  human  existence  has  been  di- 
vided into  five  periods ;  namely,  1st.  Infancy ;  2d.  Childhood ;  3d. 
Youth ;  4th.  Adult  or  middle  age ;  5th.  Old  age.  They  mark  the 
times  during  which  the  greatest  physiological  changes  take  place. 

575.  The  differences  which  grow  out  of  age  consist  in  variations  of 
the  external  form,  and  of  the  forms  and  density  of  the  internal  parts, 
of  variations  of  structure,  and  of  natural  modifications  of  the  vital 
properties  and  functions.  Upon  these  last  depend  all  the  other  chan- 
ges (§  153-155,  237). 

1.    INFANCY. 

576.  a.  Infancy  extends  from  the  time  of  birth  to  the  end  of  the 
first  dentition. 

576,  h.  At  this  age  the  fluids  predominate.  The  organs  are  now 
softest.  The  bones  are  imperfectly  ossified.  The  muscles  small. 
The  arteries  are  as  numerous  as  in  the  adult,  but  more  capacious. 
The  cutaneous  veins  small,  while  those  of  the  brain,  and  some  other 
internal  organs,  are  well  developed.  The  skin  warm,  thin,  and  deli- 
cate, covered  with  soft  hairs  and  underlaid  with  fat,  which,  in  the 
adult,  is  removed  to  the  internal  viscera ;  acute  in  iiTitability,  obtuse 
in  sensibility.  The  eyes  are.  large,  but  inobservant,  resting,  for  the 
most  part,  on  dazzling  objects.  The  organ  of  hearing  is  imperfect 
and  dull,  and  attracted  only  by  acute  or  loud  noises.     The  nose  small 


374  INSTITUTES    OF    MEDICINE.  ^ 

and  irritable,  sensitive  in  the  nasal  bi-ancli,  but  dull  in  the  olfactory. 
Taste  indiscriminate.  Sensibility  and  initability  are  highly  develop- 
ed in  the  intestinal  canal.  The  teeth  are  making  their  way,  one  after 
another,  till  at  the  end  of  two  and  a  half  years,  the  first  dentition  is 
completed.  Digestion  and  nutrition  are  in  rapid  progress,  and  the 
secretions  and  excretions  copious.  The  appetite  great,  and  returns 
almost  as  soon  as  appeased.  The  development  of  the  digestive  sys- 
tem keeps  pace  with  the  progress  of  the  teeth,  and  when  eight  or  ten 
shall  have  appeared,  the  stomach  is  ready  for  a  gradual  change  of  nu- 
triment. The  limbs  are  feebly  controlled.  Sleep  is  often  repeated 
and  long  continued,  being  scarcely  interrupted  for  the  first  week,  even 
by  hunger,  so  powerfully  is  the  new  being  under  the  influence  of  its 
foetal  habits.  Few  mental  impressions  being  made  there  is  no  trou- 
ble from  dreams.  Sleep  is  therefore  calm  while  the  organs  maintain 
their  healthy  round.  It  is  all  sleep  or  all  wakefulness,  with  but  little 
of  the  revery  of  later  years.  The  pleasures  are  sensual  and  without 
alloy,  but  very  limited.  The  gratification  of  appetite  is  the  highest 
enjoyment,  and  hunger  the  greatest  suffering.  Judgment  and  reflec- 
tion are  in  a  dormant  state.  The  mind  is  easily  irritated,  but  as  easi- 
ly appeased ;  and  crying  is  as  natural  and  salutary  as  laughing  at  a 
later  age. 

576,  c.  The  most  important  peculiarities  of  infancy,  physiologically, 
pathologically,  and  therapeutically  considered,  are  the  general  imper- 
fect development  of  sensibility,  and  the  greater  general  development 
of  irritability,  mobility,  and  sympathy,  than  at  any  other  period  of  life. 

576,  d.  As  the  diseases  of  infancy,  like  other  ages,  correspond  with 
the  physiological  characteristics  (§  155,  156),  they  are  not  liable  to  be 
aggravated  by  causes  which  operate  through  common  and  specific 
sensibility ;  but  the  greater  development  of  irritability,  especially  of 
the  brain  and  intestinal  canal,  than  at  any  other  period  of  life,  subjects 
the  infant  to  a  pi'edominance  of  cerebral  and  intestinal  diseases.  It 
is  owing,  also,  to  this  physiological  condition  of  the  alimentary  canal 
that  any  excess  of  food  is  readily  rejected  by  the  stomach.  But  iiri- 
tability,  in  being  thus  susceptible  of  the  influences  of  the  natural  vital 
stimuli,  that  all  its  contingent  purposes  may  be  fulfilled,  is  especially 
liable  to  morbific  impressions  (§  137  d,  150).  It  is  owing  to  the  im- 
perfect development  of  the  cutaneous  veins  in  infancy,  and  childhood, 
that  there  is  an  absence  of  varix  ;  and,  on  the  other  hand,  cerebral 
congestion  and  hydrocephalus  are  now  common,  because  the  cerebral 
veins,  and  the  brain  itself,  are  large  and  highly  endowed  with  irritabili- 
ty. Croup  also  prevails,  and  is  more  or  less  attended  with  a  produc- 
tion of  coagulable  lymph,  because  of  a  peculiar  natural  modification 
of  the  organic  properties  of  the  mucous  tissue  of  the  larynx,  which 
changing  at  later  periods  gives  rise  to  catarrhal  inflammation  (§  134, 
135).  Morbid  sympathies  are  common  and  strongly  pronounced,  es- 
pecially between  the  intestinal  canal  and  the  skin,  and  between  the 
former  and  the  brain.  The  sympathies,  however,  are  mostly  on  the 
side  of  the  skin  and  the  brain,  the  primary  affections  being  in  the  in- 
testinal canal.  Next,  the  lungs  are  liable  to  pneumonia,  but  most  so 
after  dentition  begins.  The  appearance  of  the  teeth  is  attended  with 
some  new  physiological  conditions,  and  dentition  aggravates  or  gives 
rise  to  intestinal  derangements,  disturbs  the  natural  sympathies  of  or- 
gans, and  provokes  convulsions  of  the  voluntary  muscles  (§  526,  d). 


PHYSIOLOGY. AGE.  375 

576  e.  Diseases  being  rapid  and  active  in  infancy,  and  injurious 
Bympaihies  speedily  and  powerfully  determined,  it  is  obvious  that 
remedies  must  be  prompt,  decisive,  and  of  quick  operation.  But,  it 
is  also  an  important  consideration  that  nature  is  now  strongly  recupe- 
rative ;  that  the  same  physiological  susceptibilities  of  infants  to  dis- 
ease, and  to  its  rapid  advances,  render  them  also  peculiarly  sensible  to 
remedial  agents,  when  timely  and  happily  applied  ;  and  that  they  now 
operate  speedily  and  with  power  on  account  of  the  great  development 
of  irritability,  mobility,  and  sympathy  (^  150).  Hence  it  is,  that  mild- 
er means  which  fail  at  adult  age  may  succeed  under  apparently  the 
same  circumstances  in  infancy.  An  emetic,  therefore,  or  cathartic,  or 
alterative  doses  of  tartarized  antimony,  &c.,  may  become  a  substitute 
for  a  certain  quantity  of  blood,  whose  abstraction  in  the  same  condi- 
tion of  disease  would  be  indispensable  at  adult  age ;  or  leeching  may 
be  sufficient  in  the  former  case,  when  general  bloodletting  would  be 
necessary  in  the  latter.  But,  since  the  dangers  of  disease  are  great- 
er, and  there  is  less  time  for  delay,  in  the  diseases  of  infants  than  of 
adults,  we  should  be  sure  of  the  right  before  we  decide  on  neglecting 
or  procrastinating  the  more  vigorous  treatment.  This  observation, 
however,  is  intended  to  apply  especially  to  the  abstraction  of  blood. 
Active  internal  remedies  should  be  delayed  in  cases  of  doubt.  On  the 
other  hand,  an  early  loss  of  blood  is  far  less  likely  to  be  detrimental ; 
and  where  it  may  be  required,  but  delayed,  the  chance  of  its  useful 
application  may  be  lost,  not  only  through  the  advances  of  disease,  but 
by  the  prostrating  effects  of  other  remedies  (§  155,  156,  925  a,  b,  c, 
964  d,  974  c,  1058  p). 

576, y.  It  may  be  finally  said  of  the  characteristics  of  infancy,  that 
ihe  first  few  weeks  of  independent  life  are  marked  by  peculiarities 
which  go  to  illusti'ate  the  philosophy  of  life  as  expounded  in  these 
Institutes.  Sleep,  for  example,  is  remarkably  continued ;  cutaneous 
sensibility  so  dormant  that  injuries  of  the  surface  are  scarcely  felt, 
&c.  But  it  is  in  organic  life  that  we  meet  with  functions  that  are 
destined  for  speedy  modifications,  of  which  the  generation  of  heat  is 
the  most  remarkable  (§  441,  b). 

2.    CHILDHOOD. 

577,  a.  Childhood  extends  from  the  age  of  two  and  a  half  to  fif- 
teen or  seventeen  years  in  males,  and  to  fourteen  or  sixteen  in  fe- 
males. 

577,  b.  Irritability,  and  the  other  organic  properties,  become  mod- 
ified, and  variously,  in  different  parts.  Those  of  the  brain  settle 
down  into  that  modification  which  is  only  necessary  to  established 
functions  (§  156) ;  or,  at  most,  do  but  undergo  slighter  changes  at  the 
subsequent  periods  of  life.  Consequently,  the  brain  sheds  a  new  in- 
fluence over  other  organs ;  and  irritability,  being  less  strongly  pro- 
nounced in  all  other  parts  than  in  infancy,  they  are  less  disposed  to 
sympathize  with  diseases  of  the  brain,  and  of  each  other,  or  the  brain 
with  them.  The  digestive  system  has  undergone  manifest  changes ; 
and  here,  too,  irritability  is  particularly  diminished.  Solid  food  has 
become  indispensable,  while  it  was  inadmissible  in  early  infancy ;  is 
less  frequently  desired,  and  can  be  digested  only  when  taken  at 
longer  intervals.  The  secretions  and  excretions  have  lessened,  as  a 
consequence  of  the  changes  in  the  organic  states. 


376  INSTITUTES    OF    MEDICINE. 

Sensibility,  especially  specific,  had  made  advances  in  infancy,  and 
increases  rapidly  in  childhood.  The  various  organs  of  sense  are 
turned  with  increasing  attention  to  surrounding  objects.  This  de- 
notes an  increase  of  perception  and  with  it  the  other  mental  faculties 
hold  a  progressive  but  more  tardy  pace.  As  knowledge  pours  in, 
the  faculties  of  the  mind  increase  in  an  increasing  ratio.  The  or- 
gans of  speech  are  unfolded,  and  there  is  great  volubility  of  tongue 
The  skin  has  become  less  delicate,  and  the  sub-cutaneous  fat  has  un- 
dergone diminution  (§  440  hh,  440  c,  no.  11^,  441  c).  The  chin  loses 
its  double  character,  and  the  general  features  acquire  a  contour  in 
which  that  of  infancy  is  nearly  lost.  They  reflect  the  operations  of 
the  mind,  and  beam  with  enjoyment  when  not  disturbed  by  the  angry 
passions  that  now  spring  up  along  with  knowledge  and  reason. 

577,  c.  The  foregoing  new  state  of  things  gives  rise  to  new  dis- 
eases, or  to  new  modifications  of  infantile  diseases.  Morbific  causes 
operate  according  to  the  new  modifications  of  the  vital  properties. 
There  are  new  and  modified  circles  of  sympathy  (§  156,  566).  New 
parts  become  the  seat  of  disease,  as  the  ligaments,  the  mesenteric 
glands,  the  lymphatic  glands,  the  joints.  Disease,  too,  is  now  ajst  to 
result  in  disorganization,  from  which  infancy  is  greatly  exempt.  "VVe 
have  seen  that  some  diseases  become  less  frequent,  as  those  of  the 
brain.  The  diminution  of  intestinal  irritability  lessens  the  frequency 
and  force  of  abdominal  derangements ;  and  this  relative  exemption 
cuts  off  that  exuberance  of  sympathies  which  was  displayed  in  the 
intestinal  irritations  of  infancy.  Croup  disappears  at  the  age  of 
twelve.  Among  the  new  causes  of  disease  may  be  reckoned  the 
passions,  and  the  new  avenues  of  external  influences  through  the 
senses ;  though  the  absence  of  grief  and  the  predominance  of  hope 
are  favorable  to  childhood.  This  is  the  age  when  severe  mental  labor 
does  its  worst  with  the  constitution. 

577,  d.  Remedial  agents  bear  a  general  relative  correspondence 
with  the  new  physiological  conditions,  like  the  morbific,  as  we  have 
seen  of  infancy,  varied,  however,  from  the  latter  by  the  modifications 
induced  by  disease  (§  149,  150). 

3.    YOUTH. 

578,  a.  Youth  extends  from  the  end  of  childhood  to  the  age  of 
twenty  or  twenty-five  years. 

578,  h.  As  the  characteristics  of  infancy  pass  by  imperceptible  de- 
grees into  those  of  childhood,  so  do  those  of  the  latter  gradually  fade 
into  the  condition  of  puberty.  New  phenomena  are  alike  presented 
by  the  mind  and  body  ;  all  springing  from  natural  modifications  of 
the  same  powers  which  conducted  the  development  of  the  ovum 
through  all  its  stages  to  that  of  the  infant ;  which  carried  along  the 
exact  vicissitudes  of  infant  life  to  that  of  childhood,  and  which  trans- 
form the  child  into  a  being  capable  of  procreating  his  species.  The 
developments  of  structure  go  hand  in  hand  with  those  of  the  vital 
powers,  the  latter  always  taking  the  lead,  according  to  the  oi-dination 
of  the  Creator  ;  and  for  Whose  direct  Agency,  as  exerted  at  the  begin- 
ning of  organic  life,  these  formative  powers  are  designed  as  a  subor- 
dinate substitute, — always  fashioning  the  new  being  according  to  the 
^jriginal  model  (§  63,  64,  155). 

The  most  remarkable  peculiarity  by  which  youth  is  introduced  is 


PHYSIOLOGY. AGE.  371 

the  development  of  the  organs  of  generation,  which,  as  in  plants,  may  be 
regarded,  in  a  physiological  sense,  as  the  great  final  object  of  the  devel- 
opment of  all  the  other  organs  from  the  embryo  state ;  new  beings  be- 
ing thus  produced  that  other  new  ones  may  follow.  Such,  then,  being 
the  ultimate  tendency  of  all  the  physical  and  vital  developments,  it  ob- 
viously follows  that  a  new  condition  has  taken  place  in  all  the  animal 
and  organic  powers  at  the  age  of  puberty,  and  that  the  development 
of  the  generative  organs  will,  in  their  turn,  so  modify  the  conditions 
of  life  as  to  carry  out  the  design  of  nature  in  perpetuating  the  species. 

578,  c.  Specific  sensibility  is  now  at  its  acme  of  development,  and 
its  corresponding  mental  power,  perception,  is  in  full  and  rapid  oper- 
ation. Knowledge  of  external  things  pours  in  as  rapidly  as  the  eye 
can  glance  from  object  to  object,  or  the  ear  distinguish  the  tones  of 
music  as  they  run  into  each  other.  The  mind  now  seizes  this  knowl- 
edge, and  appropriates  it  more  extensively  than  before  to  the  improve- 
ment of  its  own  powers.  It  compares  phenomena  with  each  other, 
observes  their  resemblances  and  contrasts,  and  as  the  judgment,  un- 
der this  exercise  of  reflection,  acquires  maturity,  it  deduces  the  greal 
laws  by  which  the  phenomena  are  regulated,  and  finally  carries  them 
up  to  the  very  powers  from  which  they  emanate.  But  it  does  not  so 
clearly  follow  that  the  provision  which  nature  has  made  for  the  right 
government  of  the  mind  or  the  body  will  be  duly  employed.  No 
sooner,  indeed,  are  we  born,  than  abuses  begin, — if  not  on  the  part 
of  infancy,  on  that,  at  least,  of  its  natural  guides  and  protectors.  The 
stomach  is  crowded  with  solid  food  instead  of  its  natural  fluid,  or 
when  solids  become  appropriate  the  least  appropriate  are  often  se- 
lected. The  properties  of  life  being  thus  abused,  they  suffer,  and  not 
unfrequently  perish  in  consequence.  The  passions,  yea,  even  anger, 
..are  designed  for  our  happiness  or  for  our  protection.  But  judgment  is 
permitted  to  fail  of  its  legitimate  sway,  and  the  passions  are  let  loose 
to  fill  us  with  disease,  to  imbitter  our  corporeal  and  intellectual  exist- 
ences, to  incarcerate  our  bodies,  or  to  hang  us  upon  the  gallows. 

Coming  to  the  abstract  operations  of  mind,  do  we  not  find  a  like 
abuse  of  the  understanding  1  Do  we  not  constantly  find  that  the 
knowledge  which  has  been  acquired  is  perverted  to  the  worst  conclu- 
sions ]  Are  not  the  phenomena  of  nature  which  are  opposed  to  each 
other  made  to  assume  resemblances,  and  such  as  are  clearly  allied 
equally  estranged  ]  And  do  we  not  then,  by  this  abuse  of  reason, 
proceed  to  refer  these  incongruous  results  to  common  laws  and  com- 
mon causes  ]  We  need  not  go  beyond  the  subjects  before  us  for  an 
affirmative  answer.  Are  not  all  the  unique  phenomena  of  life,  all 
those  which  mark  the  distinctions  between  infancy,  childhood,  and 
youth,  all  those  which  attend  the  consummation  of  the  body  for  the  de- 
velopment of  the  generative  organs,  for  the  production  of  the  ovum, 
of  the  seminal  fluid,  even  sexual  desire  itself,  and  its  ultimate  termina- 
tion in  new  beings,  ay,  the  very  thoughts  which  go  up  to  Heaven, 
most  extensively  referred,  at  this  thinking,  speculative  age,  to  the  for- 
ces which  rule  over  dead,  inorganic  matter  1*  But  there  is  a  stage  of 
human  existence,  which  that  modified  materialism  that  acknowledges 
a  soul  has  not  yet  dared  to  invade.  That  stage  begins  when  both  pa- 
rents infuse  themselves  into  their  future  offspring,  when  a  new  soul, 
like  a  new  body,  is  generated ;  and  it  extends  .throughout  the  foetal 
development.  The  same  processes,  as  we  have  seen,  are  now  in  prog- 
*  See  my  work  on  the  Soul  and  Instinctive  Pkinciple,  edition  1870. 


378  INSTITUTES    OF    MEDICINE 

ress  as  at  every  subsequent  stage  of  life.  The  same  powers,  theie- 
fore,  and  no  others,  are  alike  at  all  times  the  causes  of  the  coincident 
results  (^  65-76). 

Returning  to  the  characteristics  of  youth,  we  find  that  the  testes 
now  enlarge,  and  secrete  the  seminal  fluid  ;  the  uterus  becomes  rap- 
idly unfolded  in  its  powers  and  structure ;  the  menses  take  place  ; 
and,  in  both  sexes,  the  arrangements  for  generation  are  established. 
While  these  peculiar  changes  are  in  progress,  sensibility  and  irrita- 
bility are  acutely  susceptible,  and  give  rise  to  restlessness,  impatience, 
and  often  to  anxiety  and  distress,  without  absolute  disease.  The 
mammae  also  prepare  for  the  work  of  nutrition,  swell  out,  and  assume 
that  peculiar  rotundity  which  is  considered  the  beau  ideal  of  beauty. 
The  beard  puts  forth.  The  face  swells  with  blood,  that  the  features 
may  be  supplied  abundantly  with  the  material  which  is  necessary  for 
their  full  development ;  and  it  is  now  that  physiognomy  begins  to 
take  its  rank  among  the  sciences.  The  muscles  obtain  greater  firm- 
ness, greater  power,  and  greater  action.  The  cutaneous  veins  enlarge 
beyond  their  former  capacity.  The  organs  of  speech  undergo  another 
change,  as  denoted  by  the  hoai'se  and  rough  voice.  The  body  spreads, 
becomes  firm  and  erect,  and  often  shoots  up,  in  early  youth,  with 
amazing  rapidity. 

So  much  elaboration  of  structure,  and  the  institution  of  the  gen- 
erative functions,  cannot  fail,  according  to  our  doctrine  of  life,  as  sour- 
ces of  many  new  reflex  nervous  actions,  of  new  diseases,  or  mod- 
ifications of  former  disease.  The  principle,  indeed,  is  fundamental, 
that  diseases  vary  according  to  the  natural  variations  that  may  spring 
up  in  tlie  vital  states  of  different  parts,  or  of  the  entire  body,  at  differ- 
ent periods  of  our  existence  (^  150,  &c.).  These  fluctuations  of  the 
natural  states  of  the  system,  as  also  disease  itself,  and  its  very  cure, 
as  we  have  seen,  grow  out  of  the  natural  instability  of  the  properties 
of  life  (§  177).  The  natural  instability,  or  liability  to  definite  changes 
at  the  progressive  stages  of  life,  is  ordained  not  only  for  the  new  phys- 
ical developments  that  are  taking  place,  but  also  for  certain  incidental 
conditions,  such  as  gestation,  lactation,  &c.  (§  155,  156).  Will  chem- 
istry explain  1 

We  consequently  find  that  the  concerted  action  of  organs  is  liable 
to  be  disturbed  at  the  beginning  of  youth,  independently  of  disease. 
The  heart  beats  irregularly,  respiration  is  hurried,  or  slow,  or  labori- 
ous, and  fluctuates  as  the  passions  rise  or  fall,  or  as  the  mind  may 
happen  to  poise;  and  the  heart,  and  the  cutaneous  vessels  of  the  face, 
obey  the  same  influences.  These  susceptibilities  may  be  more  or  less 
extended  to  all  other  parts,  without  the  intervention  of  disease.  Among 
these  physiological  results  are  frequent  bleedings  of  the  nose,  head- 
ache, constipation,  and  partial  disturbances  of  digestion.  So,  also,  is 
that  pain  and  distress  which  attend  menstruation,  and  all  the  reflex 
nervous  influences  which  are  inflicted  upon  the  system  at  large  during 
the  progress  of  this  excretion.  It  is  the  vital,  not  the  chemical  pow- 
ers, which  are  thus  disturbed,  but  not  morbidly  affected  (§  237). 

578,  d.  Where,  however,  nature  introduces  so  much  novelty  there 
must  be  new  diseases,  and  new  sympathetic  results  of  a  morbid  char- 
acter. And  now  mark  the  coincidence  between  the  progressive  de- 
velopment of  the  vital  states  and  their  liability  to  morbid  affections. 
The  uterus,  for  instance,  has  hitherto  been  merely  in  a  vegetative 


PHYSIOLOGY. AGE.  379 

State.  It  lias  had  no  specific  function,  and  its  organic  pi'operties  Jmve 
existed  only  in  that  condition  which  is  essential  to  nutrition.  This 
organ,  therefore,  has  been  scarcely  liable  to  any  disturbance,  not  even 
of  a  sympathetic  nature  ;  for  the  organ,  hitherto,  has  taken  no  part  in 
the  general  operations  of  the  body.  And  how  clearly  this  illustrates 
the  laws  of  reflex  nervous  action  in  their  application  to  disease, 
and  exposes  the  absurdities  of  the  humoral  pathology!  But,  as  puber- 
ty arrives  the  uterus  takes  on  its  specific  function ;  and,  that  this  may 
be  performed  there  must  be  a  great  modification  of  the  organic  life 
of  this  organ.  Agreeably,  therefore,  to  the  universal  law  the  uterus 
must  be  now  liable  to  direct  disease,  and  to  morbific  reflex  nerv- 
ous actions  from  diseases  of  other  organs  ;  while  primary  diseases  of 
the  uterus,  in  their  turn,  develop  sympathetic  affections  in  other  and 
distant  parts.  Diseases  of  the  digestive  organs  inflict  diseases  upon 
the  womb,  and  menstruation  is  suspended  as  one  of  the  consequen- 
ces. Again,  when  the  uterus  is  most  actively  engaged,  as  during 
menstruation,  it  should,  according  to  our  principles,  be  most  liable  to 
disturbance,  either  from  the  direct  operation  of  foreign  causes,  or 
from  reflex  nervous  influences  of  other  diseased  organs.  Accordingly, 
even  exposures  to  a  chilling  atmosphere,  damp  and  cold  feet,  &c., 
will  so  disturb  the  uterus,  when  engaged  in  excreting  the  menses,  as 
to  arrest  its  function.  And  what  are  the  frequent  consequences  1  A 
long  chain  of  sympathetic  diseases,  which,  from  the  beginning  of  their 
primary  cause,  we  might  as  well  attempt  to  explain  by  lunar  influ- 
ence, or  by  the  ebbing  and  flowing  of  the  tides,  as  by  any  principle 
in  the  humoral  pathology,  or  by  any  laws  that  rule  in  the  world  of 
dead  matter.  And  yet  does  the  intellectual  world  abound  with  phys- 
ical hypotheses  of  life  and  disease  for  the  interpretation  of  phenome- 
na of  which  those  now  under  consideration  are  only  simple  elements. 
Now,  too,  the  mammae,  for  the  first  time,  have  their  organic  powers 
brought  forth,  to  be  in  readiness  for  the  secretion  of  milk.  And 
mark,  as  we  go  along,  the  harmony  of  Design,  and  the  coincidence 
between  the  preparation  of  the  mammas  and  that  of  the  uterus.  The 
development  of  the  latter  takes  the  lead,  while  that  of  the  mammas 
is  the  work  of  sympathy,  and  this  ascendency  is  maintained  in  the 
pregnant  state.  And  yet  we  are  told  that  final  causes  should  have  no 
place  in  philosophy.  But  the  mammae,  like  the  uterus,  now,  and  for 
the  first  time,  become  the  seat  of  morbid  conditions  ;  and,  from  what 
we  have  seen  of  their  natural  relations  to  the  uterus,  we  readily  com- 
prehend the  reason  why  they  inflame  when  the  uterus  undergoes  its 
sudden  and  violent  change  in  parturition,  and  why  the  secretion  of 
milk  is  now  started,  and  why  they  are  liable  to  diseases,  such  as  car- 
cinoma, which,  at  least,  seldom  occur  before  this  organ  is  brought  un- 
der the  uterine  influences  {§  138,  524  b,  d).  How  forcibly  do  all 
such  problems  admonish  the  chemist  and  physical  philosopher  to  re- 
gard all  others  relative  to  life,  in  its  natural  and  morbid  conditions,  as 
a  part  of  that  great  whole,  of  which  the  former  are  only  more  striking 
examples ! 

Again,  the  testes  now,  also,  for  the  first  time,  have  their  vital  state 
so  modified  as  to  perform  their  function  of  secreting  semen  (§  155). 
Of  course,  therefore,  for  the  first  time,  these  organs  should  be  liable 
to  morbid  affections,  should  now,  for  the  first  time,  sympathize  with 
the  diseases    of  other   parts,  and    inflict   reflex   actions    upon  dis- 


380  INSTITUTES    OF    MEDICINE. 

tant  organs.  But,  besides  the  general  functions,  susceptibilities,  and 
influences  in  which  the  testes,  the  uterus,  and  the  mammae  now  par- 
ticipate in  common  with  other  organs,  there  are  some  special  charac- 
teristics relative  to  each  part  that  reflect  no  little  light  upon  our  doc- 
trines of  life  and  disease.  The  development  of  the  testes,  for  exam- 
ple, exerts  a  powerful  reflex  nervous  influence  on  the  changes  which 
are  simultaneously  going  on  in  other  parts,  as  denoted  by  its  well- 
known  effect  upon  the  voice.  If  the  parotids  be  invaded  by  mumps, 
the  testes  and  mammae  are  liable  to  inflame  by  sympathy,  &c.  The 
natural  and  pathological  conditions  harmonize  together ;  the  latter  be- 
ing strongly  associated  through  the  nervous  system  with  the  new  devel- 
opments of  structure  and  modifications  of  the  vital  states,  all  of  which 
are  owing  essentially  to  alterative  reflex  nervous  influences  unceasingly 
excited  by  the  evolution  of  the  generative  organs  (§516  d,  no.  6). 

From  the  vital  elaborations  which  are  in  progress  about  the  face, 
it  is  liable  to  eruptive  affections,  and  the  throat  to  inflammation.  Ar- 
ticular rheumatism  is  now  more  rife  than  in  childhood,  and  more  so 
than  at  any  other  stage  of  life.  If  disposition  to  scrofula  exist,  it  still 
manifests  itself,  as  in  childhood,  in  the  lymphatics  of  the  neck ;  but 
now,  especially,  it  invades  the  lungs.  This,  therefore,  is  the  age  for 
tuberculous  phthisis.  The  brain,  having  already  nearly  acquired  its 
plenitude  of  development,  and  moving  on  in  quiet  stability  of  its  or- 
ganic powers,  and  the  mental  faculties  employed  in  undisturbed  op- 
erations, is  comparatively  exempt  from  disease.  The  passions,  it  is 
true,  are  now  at  work ;  but  they  are  not  of  the  morbific  kind,  either 
as  it  respects  the  brain  or  distant  organs.  Anger  is  the  worst,  but 
goes  off"  in  explosions.  Envy  has  not  been  whetted.  Grief  is  tran- 
sient. Malice  has  not  had  its  incentives.  Avarice  awaits  the  matu- 
rity of  judgment.  Hope  and  love  hold  a  sway  over  the  whole,  and 
these  are  conducive  to  health,  whfen  love  does  not  run  into  excess. 
Nevertheless,  there  are  transitions  from  excessive  hilarity  to  the 
gloom  of  melancholy,  and  the  mind  by  fits  is  fanciful,  and  by  fits  is 
dull.  But,  by  more  than  all  things  else,  it  is  subject  to  depressing  in- 
fluences from  the  development  of  the  generative  organs,  and  this  in 
proportion  to  its  rapidity ;  and  the  state  of  the  mind,  as  to  its  dull- 
ness, is  an  index  of  what  is  in  progress  for  the  procreation  of  the 
species.  When  the  organs  of  generation  have  attained  their  matu- 
rity, the  mind  acquires  its  equilibrium ;  and  its  faculties,  by  this  pro- 
cess, have  obtained  an  immense  accession  to  their  vigor.  These  in- 
fluences are  alike  felt  by  both  sexes.  As  youth  approaches  the  adult 
state,  the  body,  like  the  mind,  increases  in  vigor,  and  is  capable  of 
all  the  labor  of  maturer  years.  Now  is  the  period  for  athletic  exer- 
cise, and  feats  of  strength,  and  now  the  awkwardness  of  youth  sub- 
sides into  the  gracefulness  and  dignity  of  manhood  (^  237) . 

4.    ADULT  OR   MIDDLE   AGE. 

579,  a.  Manhood  begins  at  the  age  of  twenty  to  twenty-five,  and 
reaches  to  about  sixty  years. 

579,  h.  At  the  beginning  of  this  age,  all  the  faculties  of  the  mind 
are  approaching  their  state  of  maturity.  "  He,"  says  Zimmerman, 
"  who,  at  thirty  years  of  age,  is  not  an  able  minister,  an  able  general, 
or  an  able  physician,  will  never  be  so."  The  stature  of  the  body  is 
.soon  completed,  its  form  perfected   and  all  the  organs  fully  devel 


PHYSIOLOGY. AGE.  381 

oped.  "We  have,  therefore,  but  Httle  novelty  in  disease  during  the 
age  of  manhood,  except  such  as  may  spring  from  the  operation  of 
new  accidental  causes.  The  buoyant  hilarity  of  youth  is  succeeded 
by  greater  steadiness  of  mind,  tempered  by  sobriety  and  judgment. 
The  passions  are  now  in  full  operation,  and  those  of  the  worst  kind 
become  more  strongly  pronounced ;  of  which,  avarice  and  envy  are 
predominant.  The  disappointments  and  the  trials  of  life  have  be- 
come manifold,  and  fall  with  their  heaviest  effect ;  and,  as  one  suc- 
ceeds another,  hope  is  more  or  less  supplanted  by  anticipation  of  evil. 
The  passions,  therefore,  at  this  period  of  life,  are  of  a  morbific  na- 
ture, and  lay  deeply  the  foundations  of  disease,  or  emban-ass  the  op- 
eration of  our  curative  means,  and  the  salutary  efforts  of  nature. 
Diseases  of  the  digestive  organs,  especially,  and  their  sympathetic  re- 
sults, are  the  frequent  consequences  of  grief  and  disappointment. 
And,  although  the  appetite  has  diminished,  and  is  less  frequent  than 
at  former  ages,  habits  have  become  more  artificial,  temperance  gives 
way  to  excesses,  and  the  activity  of  youth  yields  to  sedentary  pur- 
suits. Numerous  arts,  and  the  seductions  of  the  stAdy,  call  us,  also, 
from  the  genial  influence  of  the  open  air,  and  in  various  other  ways, 
contribute  morbific  influences. 

Most  of  the  injurious  tendencies  which  are  superadded  to  the  age 
of  manhood  beset,  in  the  first  place,  the  organs  of  digestion ;  dyspep- 
sy  being  one  of  the  most  frequent  forms  in  which  disease  is  now 
presented,  and  can-ies  in  its  train  a  multitude  of  sympathetic  evils. 
It  is  not,  however,  till  the  age  of  thirty-five  that  these  manifestations 
become  common,  unless  the  foundation  have  been  laid,  as  is  fre- 
quently the  case,  by  violations  of  nature  in  childhood  or  in  youth,  or 
by  transmitted  predisposition.  This  is  also  the  period  of  pregnancy ; 
and,  although  a  natural  condition,  the  artificial  habits  of  society  have 
so  modified  the  natural  state  of  the  system,  that  pregnancy,  parturi- 
tion, and  the  period  of  nursing,  give  rise  to  no  small  amount  of  dis- 
ease. For  the  same  reason,  also,  menstruation  is  often  inteiTupted, 
while  this  interruption  deranges  other  organs.  Owing,  in  no  small 
degree,  to  these  acquired  peculiarities  and  the  diseases  of  women, 
midwifery  has  become  a  distinct  and  important  department  of  medi- 
cine. From  forty-five  to  fifty  menstruation  ceases,  and  with  it  the 
period  of  childbearing.  This  new  change  in  the  uterus  is  apt  to  de- 
velop sympathetic  disturbances  in  other  parts,  and  to  become  a  cause 
of  disease  in  the  uterine  organs.  But,  as  a  compensation,  there  is 
now  an  exemption  from  those  maladies  and  that  suffering  which  re- 
sult from  the  menstrual  function. 

From  the  age  of  45  to  70,  the  cerebral  veins  take  on  that  peculiar 
modification  of  congestion  which  results  in  a  secretion  of  blood,  and 
which,  as  occuiTing  in  the  brain,  determines  the  common  form  of 
apoplexy.  This  condition  decreases  toward  the  age  of  70.  But,  I 
shall  not  dilate  farther  upon  the  peculiarities  of  this  era  of  life,  since 
they  are  all  referable  to  the  great  principles  which  govern  the  char- 
acteristics of  every  other  period,  and  all  require  the  same  considera- 
tions in  the  aspects  of  pathology  and  therapeutics.  As  at  all  other 
stages  of  existence,  also,  the  characteristics  of  manhood  are  grad- 
ually changing  till  they  are  finally  blended  or  disappear  in  those  of 
old  age,  or  that  stage  of  life  when  it  is  very  erroneously  supposed  that 
"fAe  machi7\e  is  wearing  out"  (^^  237,  581  b,  584  b,  633). 


382  INSTITUTES    OF    MEDICINE. 


5.    OLD    AGE. 


580.  The  last  period  of  life  has  been  subdivided  into  incipient  or 
green  old  age,  which  extends  from  60  to  70 ;  confirmed  old  age,  or 
caducity,  from  70  to  85  ;  and  decrepitude,  from  85  years,  upward. 

581,  a.  More  remarkable  changes  now  take  place  in  certain  parts 
of  the  organization  than  from  the  beginning  of  youth  upward ;  but, 
&,s  they  occur  not  in  the  essential  organic  parts,  modifications  of  the 
organic  properties  and  functions  are  less  the  cause  of  certain  promi- 
nent phenomena  than  the  physical  deviations  in  comparatively  unes- 
sential parts  ;  such  as  ossification  of  the  cardiac  valves,  of  the  arteries, 
&c.  The  senses  are  failing  as  an  avenue  of  knowledge.  The  eye 
becomes  dim,  and  the  ear  is  only  arrested  by  acute,  or  distinct,  or 
loud  noises.  The  motions  of  the  body  are  slow,  the  back  stiff",  and 
more  or  less  curved.  The  intervertebral  cartilages,  also,  shrink,  and 
the  stature  lessens  in  consequence.  The  joints  and  tendons  become 
rigid ;  the  sutures  coalesce ;  the  skin  is  darker  and  more  wrrinkled ; 
the  fat  retires  from  the  circumference  to  the  internal  organs,  by 
which  the  superficial  veins  are  rendered  more  prominent,  and  the  eyes 
sunken. 

581,  h.  Nevertheless,  rigidity  and  other  changes  go  on  in  the  most 
essential  organization,  which  are  principally  characterized  by  a  nat- 
ural decline  of  the  vital  properties  and  functions ;  but  none  are  ab- 
rupt, and  there  are  no  new  functions  introduced,  and  none  are  arrest- 
ed. All  these  new  conditions,  too,  as  at  all  other  stages  of  life,  are 
the  work  of  the  organic  properties, — always  creative,  but  ultimately 
giving  rise  to  physical  changes  of  a  suicidal  nature,  and  which  end  in 
their  destruction.  Irritability  and  sensibility  are,  therefore,  upon  the 
wane,  and  mobility  is  alike  embarrassejl  by  the  foregoing  physical 
changes.     The  nervous  system  has  mostly  played  out  its  part. 

581,  c.  The  mind,  too,  in  ordinary  cases,  is  going  with  the  organic 
powers ;  but  it  is  worth  observing,  as  a  characteristic  distinction  be- 
tween the  soul  and  the  organic  properties  which  animate  its  abode, 
that  genius  rarely  weai's  out.  It  sparkles  as  bright  as  ever  when  the 
flickering  lamp  of  life  is  but  dimly  seen. 

581,  d.  The  decline  of  the  mental  powers  is  accompanied  by  a 
subsidence  of  the  passions ;  and  as  sensibility  also  fails,  former  mor- 
bific causes  and  avenues  to  disease  are  thus  greatly  diminished. 

581,  e.  The  old  man  waits  his  certain  doom  in  calm  serenity,  or 
only  impatient  for  its  approach.  He  is  satiated  with  the  pleasures  of 
life ;  perhaps  because  he  can  enjoy  no  longer.  His  reminiscences 
are  rather  of  his  pains  than  of  his  delights,  because  the  former  are 
more  indelibly  established,  and  are  not  now  counteracted  by  present 
enjoyments. 

582,  From  what  we  have  now  seen  of  the  physiological  conditions 
of  old  age  it  is  evident  that  diseases  vary  but  little  from  those  which 
prevail  after  40  or  45  years ;  only  from  the  gradual  embarrassments 
sustained  by  the  organic  powers  disease  is  apt  to  be  less  violent, 
while,  also,  for  the  same  reason,  there  is  less  of  the  recuperative  abil- 
ity. Apoplexy,  palsy,  organic  affections  of  the  heart,  and  urinary  dif- 
ficulties, are  the  predominating  accidents  of  old  age. 

583,  a.  Although,  therefore,  morbific  causes  are  less  energetic  in 
old  age  than  at  other  stages  of  life,  remedial  agents  are,  also,  less  op- 


PHYSIOLOGY. TEMPERAMENT.  383 

erative,  nature  less  recuperative,  diseases  less  easily  arrested,  are 
Booner  beyond  the  reach  of  art,  and  often  eventuate  suddenly  in  death, 
without  having  attained  any  degree  of  severity.  Life  often  snaps  when 
the  old  man  is  quaffing  his  wine,  or  as  he  "  shoulders  his  crutch  to 
show  how  fields  were  won." 

583,  b.  Hence  it  is  apparent  that  remedies  must  be  prompt  and  ef- 
ficient in  proportion  to  the  exigencies  of  disease ;  as  is  more  exten- 
sively set  forth  in  the  article  on  Bloodletting  (§  1014). 

584,  a.  Finally,  it  appears  from  the  characteristics  of  life  at  its  va- 
rious stages ;  the  progressive  variations  in  the  vital  states  ;  the  suc- 
cessive developments  of  important  organs  ;  of  the  new  functions  which 
are  instituted  and  again  extinguished ;  till  we  come  to  that  period 
when  the  properties  of  life  lay  the  foundation  of  their  own  ruin  by  in- 
stituting disorganizations  of  structure ;  and  from  what,  also,  we  have 
seen  of  the  corresponding  modifications  of  disease  at  the  various  eras, 
and  of  the  new  ones  which  appear,  with  their  new  train  of  sympa- 
thies, it  is  obvious,  I  say,  that  there  must  be  some  corresponding  va- 
riation of  treatment  which  may  be  relative  to  a  common  character  of 
disease  (§  117,  134-160).  But,  at  every  varying  stage  of  life,  all 
things  proceed  upon  established  laws  ;  and,  however  modified  the 
powers  which  may  be  in  operation,  and  by  which  every  result  is 
brought  about,  and  whether  so  by  nature,  or  by  morbific  causes,  or 
by  art,  there  are  precise  laws  by  which  all  the  phenomena  are  deter- 
mined according  to  the  particular  combination  of  existing  circumstan- 
ces. It  is  an  important  object  of  art  to  find  out  all  the  conditions 
which  may  attend  any  given  state  of  the  properties  and  functions  of 
life,  whether  natural  or  morbid,  that  the  most  appropriate  regimen 
may  be  adopted,  or  remedial  agents  be  applied  with  the  greatest  pre- 
cision.    In  all  this  the  nervous  system  demands  a  critical  attention. 

584,  b.  Every  remedy  would  always  operate  in  one  uniform  way, 
were  the  conditions  of  the  vital  properties  and  functions,  and  the  struc- 
ture which  they  animate,  always  the  same ;  just  as  the  blood  always 
affects  the  heart  and  vessels  in  one  uniform  manner,  in  health.  But, 
such  is  the  instability  of  the  properties  of  life,  and  such,  in  consequence, 
the  variableness  of  morbid  conditions,  that  these  modifications  are 
rarely  precisely  the  same  in  any  two  instances,  or  at  any  two  succes- 
sive days.  To  find  out  these  varieties,  and  to  adapt  accordingly  the 
general  principles  of  treatment,  and  in  their  relatively  specific  details, 
is  one  of  the  highest  and  most  difficult  aims  of  medicine  ;  and  demands, 
as  an  indispensable  qualification,  a  profound  knowledge  of  the  phi- 
losophy of  life. 

TI.    INDIVIDUAL  AND    GENERAL   PECULIARITIES,  CONSISTING  OF  TEMPERA 
MENT,  CONSTITUTION,  IDIOSYNCRASY,  AND  NATIONAL  ATTRIBUTES. 

A.    Temperament,  Constitution,  Idiosyncrasy. 

585,  a.  Under  our  fifth  division  of  physiology  we  have  next  in  or- 
der the  Temperaments,  &c.,  or  those  peculiarities  of  life  which  natU' 
rally  distinguish  one  individual  from  another.  The  temperaments, 
therefore,  may  be  regarded  as  embracing  the  innate  as  well  as  ac- 
quinid  peculiarities  of  constitution  ;  for,  although  the  latter  depend 
upon  causes  that  are  relative  alone  to  the  individual,  the  former,  or 
innate  constitution,  has  been  brought  about,  at  some  anterior  genera- 


384  INSTITUIES   OF   MEDICINE 

tion,  by  the  physical  agencies  of  hfe.  This  is  the  true  temperament, 
,  and  belongs  to  masses  of  mankind. 

5S5,  b.  Idiosyncrasy  is  only  a  variety  of  temperament  and  constitu- 
tion, and  like  those,  therefore,  depends  upon  some  peculiar  modifica- 
tion of  the  properties  of  life,  especially  in-itability ;  but  only  so  in  re- 
lation to  a  very  few  particular  agents.  It  is  peculiar  to  individuals, 
rather  rare,  and  may  be  hereditary  or  acquired.  This  peculiarity  is 
not  unfrequently  the  cause  of  the  favorable  or  deleterious  effects  of 
certain  remedial  agents,  of  certain  kinds  of  food,  &c.  We  see  the 
important  principle  illustrated  every  day,  every  hour.  Here  is  a  sub- 
ject who  is  salivated  by  the  external  application  of  a  few  grains  of 
mercurial  ointment,  and  in  whom  syphilis,  or  fever,  may  be  speedily 
extinguished  by  this  simple  use  of  the  remedy.  But  here  is  another, 
in  whom  the  internal  administration  of  an  ounce  of  calomel  may  pro- 
duce no  constitutional  result,  and  make  no  impression  upon  syphilis. 
Or,  it  may  be  in  another  case  of  extreme  susceptibility  to  the  action 
of  mercui-y,  that  the  agent  always  displays  the  effects  of  a  profound 
poison,  aggravating  fever  and  syphilis,  or,  in  the  absence  of  disease, 
greatly  deranging  all  the  functions  of  life.  Most  men  are  poisoned 
by  the  slightest  contact  with  the  rhus  vemix  ;  but  now  and  then  an  in- 
dividual handles  it  with  impunity.  Muscles,  and  some  other  animals, 
ai-e  always  poisonous  when  eaten  by  some  people,  though  generally 
good  articles  of  food. 

585,  c.  Constitution  comprehends  all  the  peculiarities  of  the  indi- 
vidual,— the  temperament,  idiosyncrasy,  conditions  relative  to  age,  sex, 
habits,  &c.  It  is  therefore  liable  to  many  variations  at  all  periods  of 
life.  The  prevailing  characteristics  of  each  of  the  elements  may  re- 
main, but  yet  so  modified  that  what  is  known  as  constitution  may  be 
"  broken  down." 

585,  d.  The  same  principle  is  concerned  throughout,  whether  in 
respect  to  constitution,  temperament,  or  idiosyncrasy.  It  is  the  same 
as  prevails  habitually  in  respect  to  the  naturally  modified  irritability 
of  different  organs  in  man,  and  in  all  animals,  and  in  plants ;  that 
which  renders  urine  innoxious  to  the  bladder,  but  morbific  to  all 
other  parts, — that  which  renders  the  eye  susceptible  to  the  undula- 
tions of  light,  the  ear  to  the  undulations  of  air ;  and  so  on  (§  133-159). 
The  principle,  and  its  everlasting,  unchanging  laws,  are  every  where, 
in  all  that  relates  to  organic  beings,  whether  in  respect  to  the  system 
in  its  abstract  condition,  or  as  relative  to  external  agencies.  It  is  a 
great  and  wonderful  principle,  a  perpetual  study  for  the  philosopher, 
ever  pregnant  of  variety,  ever  illustrative  of  the  peculiar  character  of 
the  properties  of  life,  of  their  natural  modifications,  of  their  instability, 
and  forever  supplying  fresh  sources  of  interpretation  of  the  laws  which 
the  properties  and  actions  of  life  obey. 

586.  It  is  evident,  therefore,  that  temperament,  constitution,  and 
idiosyncrasy,  are  constituted  by  certain  acquired  or  transmitted  con- 
ditions of  the  vital  properties,  which  form  a  part  of  the  natural  or  ha- 
bitual state  of  each  individual,  and  from  which  arise  various  degrees 
and  kinds  in  the  susceptibilities  to  the  action  of  physical  agents,  and 
certain  peculiarities,  also,  in  the  material  condition  and  conformation 
of  parts,  especially  the  external.  By  studying  these  sensible  peculiari- 
ties, as  well  as  the  phenomena  of  life  in  their  natural  and  morbid  con- 
ditions, we  infer  the  peculiarities  of  the  natural  vital  conditions  in  dif- 


PHYSIOLOGY. TEMPERAMENT.  385 

ferent  individuals,  or  their  natural  constitution  and  temperament,  or 
any  more  remarkable  idiosyncrasy.  They  reach,  also,  to  the  mind, 
which  is  apt  to  bear  certain  relative  peculiarities  to  those  of  the  or- 
ganic states. 

588.  In  the  farther  consideration  of  this  subject,  I  shall  regard  those 
peculiarities  of  constitution  which  are  mostly  of  a  determinate  nature, 
and  include  them  under  the  general  denomination  of  temperament. 

589.  The  physiological  differences  between  temperament,  idiosyn- 
crasy, and  constitution,  are  neither  great,  nor  of  much  practical  im- 
portance. Indeed,  so  allied  are  they  in  principle,  that  a  common 
philosophy  determines  the  remedial  treatment,  which  is  always  more 
or  less  modified  by  temperament.  Each  should  be  considered  along 
with  the  modifying  influences  of  habits,  climate,  &c. 

590.  Temperament  and  constitution  do  not  depend,  as  supposed  by 
some  writers,  upon  the  special  development  of  particular  organs ; 
though  this  is  true  of  some  of  the  vicissitudes  of  age  (§  153-159,  596). 
The  former  have  their  foundation  in  the  system  at  large,  and  are  apt 
to  be  transmitted  by  one  or  both  parents;  or  the  transmitted  pecu- 
liarities may  come  from  a  remote  ancestor,  and  not  from  the  imme- 
diate progenitor.  This  last  peculiarity  is  analogous  to  one  of  the 
characteristics  of  the  scrofulous  diathesis,  where  it  passes  over  one 
generation  and  reappears  in  the  third. 

591.  It  appears,  therefore,  that  temperament,  whether  innate  or  ac- 
quired, is  due  to  the  slow  operation  of  causes  upon  the  vital  constitu- 
tion ;  just  as  we  have  seen  of  the  law  of  vital  habit  (§  535-568).  In 
the  latter  case,  the  modifications  are  more  or  less  transitory  ;  but  may 
be  so  ingrafted  as  to  be  transmitted,  for  a  time,  like  the  permanent 
temperaments,  from  parent  to  child,  as  seen  of  some  diseases,  such  as 
lues,  or  of  predispositions  to  disease  of  a  transient  nature,  as  in  small- 
pox, or  even  ordinary  fever.  Coming  to  hereditary  disease  of  a  per- 
manent nature,  as  scrofula,  we  run  from  the  transitory  phenomena  of 
vital  habit,  by  an  intimate  analogy,  into  the  permanent  temperaments; 
and  from  these  we  are  conducted  by  the  same  philosophy,  which  re- 
spects the  operation  of  physical  agents  in  modifying  the  properties  of 
life,  to  those  more  remarkable  peculiarities  which  spring  uj^in  ani- 
mals from  domestication,  and  in  plants  from  changes  of  climate  and 
soil  (§  75-80,  143-147,  220,  327-331,  559,  561-563,  659,  666  b, 
674). 

592.  It  is  scarcely  probable  that  differences  in  temperament  have, 
often,  any  appreciable  effect  on  the  elementary  composition.  Differ- 
ences, however,  obtain  in  respect  to  structure,  as  seen  in  the  general 
form,  the  proportions  of  the  limbs,  the  features,  &c. ;  while  more  re- 
markable corresponding  analogies  are  witnessed  in  the  herbaceous  and 
arborescent  habits  of  the  same  plant,  as  it  may  be  subject  to  the  influ- 
ences of  a  tropical  or  cold  climate,  as  the  ricinus  communis  (§  538). 

593.  Great  differences  arise  not  only  in  respect  to  the  influences 
of  the  same  remedial  agents  from  the  mere  circumstances  of  temper- 
ament, but  morbific  causes  may  be  equally  various  in  their  operation. 
The  same  causes  may  also  be  very  apt  to  affect  one  temperament, 
while  they  will  rarely  have  an  effect  on  another  temperament  (§  142 
145, 740).  The  nervous  system  is  much  interested  in  those  modifications. 

594.  The  temperaments,  as  designated  by  the  ancients,  and  re- 
>:ained  by  the  moderns,  are  divided  into  the  sangv,ine,  the  melancholic ^ 

B  B 


386  INSTITUTES    OF    MEDICINE. 

the  choleric,  and  the  plilegmatic.     The  artificial  habits  of  the  modems 
have  added  a  fifth,  or  the  nervous. 

595.  It  is  not  usual  to  find  all  the  attributes  of  each  temperament 
united,  while  some  of  the  whole  may  be  blended  in  the  same  individ- 
ual. Nevertheless,  the  characteristics  of  one  or  another  generally 
predominate. 

596.  Temperament  is  most  distinctly  pronounced  at  adult  age,  af- 
ter the  influences  of  development  have  ceased  (§  590). 

1.    THE   SANGUINE   TEMPERAMENT. 

597.  a.  Unlike  the  other  temperaments,  the  characteristics  of  the 
sanguine  are  perpetuated  from  infancy,  and  perhaps,  therefore,  may 
be  considered  the  most  natural.  The  skin  remains  soft  and  delicate ; 
the  limbs  rounded  and  full ;  the  superficial  veins,  unlike  those  of  in- 
fancy, large,  conspicuous,  and  blue,  especially  about  the  head  and 
temple ;  the  complexion  fair,  florid,  and  animated  ;  the  eyes  large  and 
blue  ;  the  hair  light,  or  red,  or  of  intermediate  hues. 

597,  b.  Sensibility  and  imtability  are  strongly  pronounced;  the 
great  development  of  the  latter  giving  the  principal  determination  to 
the  sanguine  temperament.  The  blood,  in  consequence,  stimulates 
the  heart  to  more  frequent,  high,  and  regular  action,  maintains  the 
capillaries  in  a  lively  and  plethoric  state,  and  thus  determines  the 
redness  and  softness  of  the  skin.  Other  vital  stimuli  also  operate 
with  greater  intensity  than  in  other  temperaments.  For  the  same 
reason,  the  secretions  and  excretions  are  rapid  and  copious,  and  are 
little  liable  to  vacillation,  in  the  ordinary  conditions  of  health.  All 
things  else  move  on  in  a  corresponding  manner;  the  whole  assem- 
blage of  which  beautifully  illustrates  the  true  philosophy  of  life. 

The  great  development  of  sensibility  contributes,  also,  its  consid- 
erable part  to  this  temperament.  The  senses  are  ever  on  the  alert ; 
and  here,  as  with  irritability,  external  objects  make  their  impressions 
with  great  effect  and  rapidity.  Perception  is  rapid,  reflection  quick, 
imagination  lively,  memory  prompt.  The  succession  of  ideas  is  too 
rapid  for  comparison,  and  hence  the  judgment  is  infirm,  unless  asso- 
ciated^ith  genius  ;  when  it  is  distinguished  for  eccentricities.  This 
is  exemplified  in  the  poet,  Byron,  and  in  the  warrior,  the  Marshal 
Duke  of  Richelieu, — "  that  man,  so  fortunate  and  brave  in  arms,  light 
and  inconstant,  to  the  end  of  his  long  and  brilliant  career." 

597,  c.  Inconstancy  and  levity  are  the  great  moral  attributes  of  the 
sanguine.  Variety  and  enjoyment  never  satiate.  Devoted  to  sensual 
gratifications,  they  are  in  love  with  all  female  beauty,  and  are  incon- 
stant to  a  mistress,  if  not  to  a  wife ;  yet  are  they  honorable  in  all 
things  else.  It  has  been  said  of  Newton,  that  he  was  of  the  sanguine 
temperament ;  but,  had  he  been  so,  it  is  replied,  "  he  never  would 
have  carried,  as  he  did,  his  maidenhead  with  him  to  the  grave,  at  the 
age  of  fourscore."  Nor  do  the  senses  afford  that  leisure  for  profound 
meditation,  nor  admit  of  those  intellectual  operations  which  are  in- 
dispensable to  the  mathematician  and  astronomer  ;  whose  habits,  also, 
ai'e  more  adverse  to  this  than  to  any  other  temperament. 

The  sanguine  is  eminently  generous  or  prodigal,  and  the  end  of 
gain  is  the  purchase  of  pleasure.  Quick  in  anger,  he  is  soon  cool ; 
or  he  is  impelled  to  hasty  decisions  that  arc  soon  regretted.  A  chal- 
lenge to  a  duel  would  be  gladly  abandoned,  did  not  a  sense  of  pride 


PHYSIOLOGY. TEMPERAMENT.  387 

uige  him  on  to  the  combat.     Revenge  and  envy  have  no  hold  upon 
this  constitution. 

597,  d.  It  is  evident,  therefoi'e,  that  the  prevailing  diseases  of  the 
sanguine  temperament  are  active  and  inflammatory ;  that  the  organs 
sympathize  I'eadily  and  greatly  w^ith  each  other,  and  that  the  sympa- 
thetic affections  are  disproportionately  greater  than  the  primary  af- 
fections. Infancy  always  partakes  of  this  temperament;  but  if  it  be 
truly  constitutional,  the  infant  is  liable  to  extraordinary  demonstrations 
of  its  fundamental  nature.  The  irritation  of  a  tooth,  for  example,  is 
more  apt  to  produce  convulsions,  and  intestinal  derangements  still 
more  so,  or  to  lay  the  foundation  of  cerebral  disease,  &c.  At  adult 
age,  slight  disturbances  of  the  womb  bring  on  hysteria,  or  indigestion 
contributes  to  a  more  sudden  accession,  more  violent  phenomena,  and 
a  more  rapid  progress,  and  lights  up  the  flame  of  other  diseases  more 
speedily,  and  more  violently,  than  in  other  temperaments.  Anger, 
being  quick  and  vehement,  here  displays  its  instant  effect  in  develop- 
ing inflammations,  and  hemorrhages.  But  love  is  too  instable  to  un- 
dermine the  health ;  and  as  envy,  grief,  and  jealousy,  torture  not  the 
mind,  so  do  they  not  the  body.    The  nervous  system  is  in  lively  force. 

697,  e.  As  external  causes,  whether  natural  or  morbific,  make 
their  impressions  rapidly  and  profoundly  upon  the  sanguine  tempera- 
ment, and  its  diseases  being  active  and  violent,  remedial  agents  should 
be  prompt,  and  decisive,  as  in  infancy;  but  here,  also,  for  the  reasons 
which  are  relative  to  the  first  period  of  life,  and  for  such  as  are  as- 
signed in  section  597  b,  remedies  are  also  profound  and  speedy  in 
their  operation.  And  since  the  prevailing  disease  of  this  tempera- 
ment is  inflammation,  bloodletting  is  the  principal  means  of  cure,  and 
will  require  but  little  co-operation  from  other  agents.  If  early  appli- 
ed, and  carried  to  its  proper  extent,  it  will  often  nearly  extinguish 
the  most  violent  inflammations  during  its  fii'St  application.  The  test 
of  this  extent  will  be  also  more  exactly  determined  in  this  than  in 
other  temperaments  by  the  subsidence  of  symptoms  during  the  prog- 
ress of  the  operation.  It  is  in  this  temperament,  also,  that  the  philos- 
ophy of  the  vital  influences  of  loss  of  blood  is  most  evidently  shown 
(§  191),  and  morbific  and  therapeutical  aspects  of  reflex  nervous  actions. 

2.    THE    MELANCHOLIC    TEMPERAMENT. 

598,  a.  The  melayicliolic  temperament  has  certain  points  of  resem- 
blance to  the  sanguine,  though  they  are  strongly  contradistinguished. 
The  general  external  aspect  of  the  latter  is  cheerful  ;  that  of  the  mel- 
ancholic, dry,  stern,  or  gloomy,  and  excites  no  liveliness  in  others, 
though  it  command  respect  and  even  admiration.  The  solids  pre- 
dominate in  the  melancholic ;  the  capillaries  show  less  blood,  though 
the  veins  are  large  and  more  prominent,  but  less  transparent  thah  in 
the  sanguine  ;  and,  unlike  the  latter,  the  skin  is  darkish,  or  inclining 
to  yellow,  thick,  coarse,  and  hard  to  the  lancet.  The  blood  flows 
more  freely  from  the  sanguine  when  the  skin  is  pricked ;  and  this  ex- 
emplifies the  state  of  the  capillary  circulation  at  large.  The  same 
principle  obtains,  therefore,  in  the  pulmonary  circulation,  and  hence, 
in  part,  the  blood  is  darker  in  the  melancholic  than  in  the  sanguine. 
The  eyes  of  the  former  are  darker  and  less  prominent  than  in  the  lat- 
ter ;  and  the  hair  is  dark,  coarse  or  stiff;  eyebrows  large,  black,  and 
-■ften  projecting;  the  muscles  and  tendons,  like  the  superficial  veins 


388  INSTITUTES    OF    MEDICINE. 

Stand  out,  from  the  absence  of  that  cutaneous  fat  which  gives  rotun- 
dity to  the  body  of  the  sanguine  (§  440  bb,  440  c,  no.  II5,  441  c). 

598,  b.  It  is  easily  seen,  therefore,  that  irritabiUty  and  sensibility 
are  comparatively  dull  in  the  melancholic.  External  objects  do  not 
make  the  strong  and  rapid  impression  upon  the  senses  as  in  the  san- 
guine ;  and,  from  the  obtuseness  of  irritability,  the  action  of  the  heart 
is  slower,  the  capillary  blood-vessels  are  less  charged  with  the  vital 
fluid,  the  secretions  and  excretions  less,  and  more  slowly  performed 
(§  191).     The  nervous  system  evinces  great  stability  of  functions. 

598,  c.  The  melancholic  temperament  is  the  principal  abode  of  ge- 
nius ;  embracing  a  large  proportion  of  those  great  men  who  have  un- 
folded the  laws  of  nature,  or  have  made  the  highest  advances  in  the 
arts,  or  have  astonished  the  world  with  deeds  in  arms,  or  with  the 
achievements  of  the  statesman,  or  the  orator,  or  the  painter,  or  the 
poet.  The  melancholic  is  the  man  of  men.  I  had  almost  said,  in 
moral  constitution,  he  is  perpetuated,  unchanged,  from  the  model  ot 
his  race.  Here  is  witnessed  the  highest  intellectual  renown  at  the 
very  dawn  of  manhood ;  and  here  it  is  that  we  so  often  meet  with  ge- 
nius struesline  with  those  adversities  which  aiTest  the  ambition  of 
other  temperaments.  The  melancholic  is  forever  mdomitable  ;  rismg 
in  determination  as  obstacles  rise  before  him.  Inflexible  in  purjDOse, 
the  passions  are  disciplined  to  urge  on  an  arduous  enterprise,  or  if 
allowed  to  become  impetuous,  it  is  to  accomplish  the  decisions  of  the 
understanding.  With  equal  facility  he  concentrates  his  mind  upon 
abstract  inquiries,  or  at  the  next  moment  sends  it  abroad  over  the 
widest  theatre  of  its  operations.  He  is  bold  and  brave,  never  fearing 
death,  nor  wantonly  incurring  danger.  He  moves  steadily  forward, 
though  he  does  not  move  till  the  path  before  him  has  been  explored. 
His  imagination,  therefore,  is  of  the  highest  order,  being  disciplined 
by  the  sterner  faculties.  It  is  such  an  imagination  as  is  always  an 
element  of  genius  ;  such  as  contemplates  the  realities  of  life  and  the 
truths  of  Revelation.  He  is  thoughtful,  gi'ave,  or  sad,  but  may  tune 
his  mind  to  great  elevation  and  great  sublimity  and  enthusiasm,  and 
often  soars  on  poetic  wings  through  the  regions  of  Heaven.  The  san- 
guine, on  the  contrary,  delights  in  the  romance  of  fiction. 

Honor  holds  its  empire  in  this  temperament,  however  it  may  be 
wanting  in  human  sympathies.  If  pledged  to  a  good  or  a  bad  action, 
it  is  fulfilled.  The  melancholic  is  generally  fervent  but  dignified  in 
his  attachments,  or  looks  with  indifference  or  with  scorn  upon  human- 
ity. A  few,  like  Tiberius,  are  fearful,  perfidious,  suspicious,  and 
cruel ;  and  others,  like  Nero,  or  Richard,  insensible  to  danger,  and 
ever  ready  for  the  work  of  death. 

598,  d.  As  with  sensibility  and  imtability  in  their  natural  aspects, 
so  is  it  in  their  relation  to  morbific  and  remedial  agents.  The  coin- 
cidence is  universal.  The  former  are  slow  in  establishing  morbid 
changes,  many  are  inoperative  which  readily  light  up  the  flame  of  dis- 
ease in  other  temperaments ;  and  the  passions,  a  prolific  cause  with 
others,  are  subdued  by  the  melancholic  into  mere  agents  of  the  un 
derstanding.  But  when  morbific  causes  have  made  their  impression, 
the  dullness  of  irritability  and  mobility  explains  why  disease  is  apt  to 
be  obstinate,  and  why  remedial  agents  operate  with  less  rapidity  than 
in  the  sanguine.  The  vital  properties  and  functions  being  slowly  sus- 
ceptible of  morbid  changes,  they  are  slowly  altered  from  their  morbid 
states,  and  with  this  coiucide  the  actions  of  the  nervous  system. 


PHYSIOLOGY. TEMPERAMENT.  389 

It  is  easily  inferred  that  the  diseases  of  the  melancholic  are  mostly 
of  the  diofestive  orsrans,  and  that  their  i-emoval  is  tedious.  It  is  also 
manifest  that  these,  and  other  affections,  are  slow  in  developing  dis 
eases  of  other  parts,  and  that  the  brain  and  the  mind  must  be  most 
likely  to  sympathetic  disturbances.  Hence  it  is  that  hypochondriacism 
and  insanity  are  apt  to  supervene  on  the  melancholic  temperament. 

Cathartics  are  demanded  more  by  the  melancholic  than  by  any 
other  temperament ;  though  their  exigencies  have  a  special  relation 
to  the  disorders  of  the  digestive  functions.  Bloodletting,  also,  is  often 
necessary  to  reach  these  chronic  maladies ;  and,  although  its  delay  in 
the  grave  forms  of  inflammation  be  less  hazardous  than  w^ith  the  san- 
guine, its  necessity  is  as  great,  and  its  extent  and  frequency  of  repe- 
tition are  greater.  It  is  here,  too,  that  the  greatest  demand  is  made 
upon  the  materia  medica  for  auxiliary  means. 

3.    THE    CHOLERIC    TEMPERAMENT. 

599,  a.  The  CJioleric  is  intermediate  between  the  sanguine  and  mel- 
ancholic temperaments ;  and  although  it  form  the  sanguineo-melan- 
cholic,  it  possesses  characteristics  which  give  to  it  an  individuality. 

The  skin  has  greater  fullness  of  the  capillaries  than  in  the  melan- 
cholic, and  therefore  greater  softness,  and  warmth,  but  less  than  in 
the  sanguine.  The  pulse  is  intermediate  in  fullness  and  frequency. 
The  secretions  and  excretions  moderate  and  uniform ;  the  healthy 
functions  performed  with  regularity  and  ease. 

599,  b.  The  passions  are  easily  roused,  though  not  impetuous,  and 
therefore  less  transient  and  less  easily  appeased  than  in  the  sanguine, 
though  not  so  persevering  as  in  the  melancholic.  The  choleric  is  te- 
nacious of  his  own  rights,  but  less  disposed  to  infringe  upon  the  rights 
of  others  than  the  melancholic,  while  he  has  less  generosity  than  the 
sanguine.  The  higher  faculties  of  the  mind  coiTCspond  with  the  oth- 
er characteristics  of  this  temperament,  being  generally  distinguished 
■for  their  moderation. 

599,  c.  Irritability  and  sensibility  holding  an  intermediate  degree 
between  those  of  the  sanguine  and  melancholic,  external  agents  op- 
erate with  a  relative  effect  and  rapidity;  so  that  the  organic  func- 
tions move  on  without  frequent  or  profound  interruptions,  and  dis- 
eases yield  to  a  more  compound  treatment,  though  less  readily  than 
to  the  simpler  means  required  by  the  sanguine,  but  more  speedily 
than  in  the  melancholic. 

4.    THE    PHLEGMATIC,    OR   LYMPHATIC    TEMPERAMENT. 

600,  a.  The  'Phlegmatic  is  characterized  by  slothfulness  of  mind, 
and  by  a  simpler  display  of  vegetative  life  than  any  other  tempera- 
ment. The  flesh  is  soft,  the  countenance  pale,  the  hair  delicate,  and 
the  fat  amounts  to  an  encumbrance.  The  limbs  are  rounded,  feeble, 
and  without  expression.  The  veins  are  small,  and  lie  deep.  The 
pulse  is  small,  feeble,  and  soft;  arteries  small,  and  the  capillaries  de- 
ficient in  blood.  Irritability  is  dull.  The  secretions  and  excretions 
are  performed  slowly,  and  their  products  are  thin  or  watery.  Sensi- 
bilif.y  is  also  obtuse,  and  perception  weak,  which  greatly  circum 
scribes  the  senses  as  an  avenue  to  the  mind ;  while 

"Fat  bolds  ideas  by  the  legs  and  wings" 
(§  440  U,  440  c.  no.  \\\,  441  c). 


390  INSTITUTES    OF    MEDICINE. 

But,  with  all  the  intellectual  dullness  and  bodily  indolence  which 
distinguish  this  temperament,  it  is  obstinate,  fearful,  suspicious,  and 
avaincious.     The  nervous  system  is  blunt  and  on  the  side  of  evil. 

600,  h.  The  organic  properties  of  the  phlegmatic  are  easily  liable 
to  inten-uption,  though  morbific  causes,  unless  intense  in  their  nature, 
make  their  impressions  feebly.  The  mind,  and  its  predominant  pas- 
sions, have,  of  course,  but  little  agency  in  the  production  of  its  dis- 
eases. Disturbances,  however,  seem  to  arise  from  the  mere  inertia 
of  the  vital  powers ;  and  when  morbific  causes  make  strong  impres- 
sions the  properties  of  life  often  go  down  at  once  to  near  the  verge 
of  extinction.  So,  also,  do  active  remedial  agents  operate  with  a 
relative  effect.  Emetics  are  scarcely  admissible  ;  violent  cathartics 
prostrate  excessively  ;  and  any  unnecessary  extent  of  bloodletting 
breaks  down  the  whole  energies  of  the  body.  This  temperament, 
therefore,  requires  great  moderation  of  treatment  (§  150). 

5.    THE    NERVOUS    TEMPERAMENT. 

601,  a.  The  Nervous  temperament  displayed  itself  feebly  among 
the  ancients,  but  has  been  brought  to  a  high  maturity  by  the  progress 
of  civilization.  It  is  the  only  temperament  where  the  primary  causes 
may  be  traced,  which  consist  mainly  of  such  as  are  attendant  on  indo- 
lence and  sedentary  pursuits.  It  involves  alike,  therefore,  the  rich 
and  the  poor,  the  sensual  devotees  of  fashion  and  the  plodding  shoe- 
maker, the  laborious  student  and  the  readers  of  romance. 

601,  h.  The  nervous  temperament  is  founded  upon  the  sanguine, 
or  the  sanguineo-melancholic,  and  is  either  transmitted,  or  springs  up 
originally  in  the  individual.  It  is  therefore  the  most  artificial  of  all 
the  temperaments,  and  is  susceptible,  individually,  of  great  improve- 
ment. It  is  shown  externally  by  a  general  aspect  of  feebleness,  a 
spare  body,  and  small,  soft  muscles,  which  are  incapable  of  much  ex- 
ertion. 

601,  c,  Disturbing  reflex  nervous  actions  are  the  leading  char- 
acteristic. Irritability  is  also  strongly  pronounced.  Hence,  slight 
disturbances,  even  of  unimportant  parts,  give  rise  to  greatly  dispro- 
portionate sympathies  in  the  more  important  organs ;  and  these  sec- 
ondax-y  results  will  be  still  more  intense  if  the  primary  disease  be  seat- 
ed in  any  important  organ. 

The  functions  are  constantly  subject  to  irregularities,  especially 
those  of  the  abdominal  viscera.  If  the  subject  be  addicted  to  the 
causes  of  this  temperament  he  is  rarely  free  from  indigestion,  and  an 
attendant  train  of  other  evils,  according  to  the  nature  of  his  indul- 
gences br  pursuits.  Diseases,  however,  are  not  as  violent  as  with 
the  sanguine,  nor  as  profound  as  with  the  melancholic.  The  mind  is 
irritable,  but  the  passions  not  violent,  though  they  readily  disturb  the 
organic  functions.  Such  as  display  themselves  depend  much  upon 
the  habits  and  occupation  of  the  subject. 

601,  d.  Remedial  agents  operate  with  power ;  the  same  coinci- 
dences existing  between  their  effects  and  those  of  a  moi'bific  nature, 
as  in  other  temperaments.  Moderate  impressions,  therefore,  made 
upon  the  intestinal  canal  are  sensibly  felt  by  remote  parts  ;  and  in  this 
temperament,  particularly,  the  peculiar  principle  upon  which  leeching 
operates  is  well  illustrated  (§  145,  147,  914,  &c.). 


PHYSIOLOGY. RACE.  391 

General  Remarks  on  Temperament. 

602,  a.  Different  epochs  of  life  appear  often  to  partake  of  a  par- 
ticular temperament ;  one  subsiding  into  another.  The  sanguine  is 
most  characteristic  of  infancy  and  childhood  ;  the  melancholic  and 
choleric  of  middle  age  ;   and  the  phlegmatic  of  old  age. 

602,  b.  The  several  temperaments  are  also  often  blended,  more  or 
less,  with  each  other  in  the  same  individual,  though  the  characteristics 
of  one  generally  predominate.  When  combined  in  the  same  individ- 
ual, they  are  called  the  sanguineo-melancholic,  the  sanguineo-phleg- 
matic,  &c.  They  are  also  liable  not  only  to  the  foregoing  modifica- 
tions from  age,  but  from  sex,  climate,  habits,  education,  &c.  So  great, 
indeed,  is  the  influence  of  climate,  that  a  change  of  residence  (as  from 
a  northern  to  a  tropical  country)  will  sometimes  gradually  transmute 
one  temperament  into  another ;  and  this  is  particularly  true  of  the 
sanguine,  the  melancholic,  and  the  choleric. 

602,  c.  The  foregoing  accidental  influences  are  sometimes  such  as 
to  generate  anomalies,  in  which  it  is  difl[icult  to  recognize  any  distinct 
features  of  the  prevailing  modifications  of  temperament,  and  which 
may  disappear  with  the  individual,  or  be  transmitted  to  his  descend- 
ants. 

602.  d.  All  the  varieties  comprehended  in  this  section  are  more  or 
less  liable  to  modifications  of  a  common  form  of  disease,  and  require 
corresponding  variations  in  the  details  of  treatment.  They  concur  to- 
gether, therefore,  in  forming  a  part  of  the  difficulties  of  medicine,  and 
in  demonstrating  the  complete  abstraction  of  organic  beings  from  the 
forces  and  laws  of  the  inorganic  (§  659). 

603.  I  say,  organic  beings  in  their  most  comprehensive  sense  (§ 
602,  d).  For  are  not  the  varieties  which  have  sprung  from  domesti- 
cation, and  cultivation,  among  animals  and  plants,  and  which  are 
equally,  and  more  perfectly  transmitted  than  temperament,  constitu- 
tion, &c.,  in  relation  to  man,  integral  parts  of  a  common  principle  ] 
Exactly  the  same  philosophy  lies  at  the  foundation  of  the  whole,  and 
is  another  broad  field  of  evidence  to  substantiate  the  unity  of  the  Vi- 
tal Principle,  of  its  common  laws  and  functions  throughout  animated 
nature,  and  presents  the  whole  in  a  magnificence  of  Grandeur,  a  Har- 
mony and  Unity  of  unfathomable  Designs,  which  stamps  an  unutter- 
able contrast  on  the  confusion  and  imbecility  of  the  chemical  and 
physical  hypotheses  of  life.     (See  Climate.) 

B.  Races  of  Mankind. 

604.  Corresponding,  in  principle,  with  Temperament,  &c.,  though 
different  in  their  manifestations,  are  those  peculiarities  which  have 
distinguished  mankind  into  various  Races.  They  correspond  more 
nearly,  in  the  physical  characteristics,  with  those  sensible  changes 
which  are  established  by  the  domestication  of  animals,  and  by  the 
cultivation  of  plants  (§  603).  As  with  many  species  of  the  latter,  the 
varieties  of  mankind  have  existed  without  change  as  far  back  as  his- 
tory begins  its  record.  This  circumstance  has  often  led  the  specula- 
tive mind  to  imagine  as  many  original  ancestors  as  it  may  distribute 
the  human  species  into  varieties  of  race  (§  350|,  kk).  But,  with  ex- 
actly the  same  reason  may  we  ascume  that  the  black  and  the  white 
barn-yard  fowl,  and  all  the  other  varieties  of  this  animal,  or  the  red 


392  INSTITUTES    OF    MEDICINE. 

and  the  white  potato,  and  other  varieties  of  this  root,  the  sloe  and 
the  plumb,  the  crab  and  the  apple,  are  equally  distinct,  and  that 
each  has  descended  from  a  distinct  original  progenitor.  Or  take  the 
yet  more  remarkable  transmutation  of  a  salt  and  bitter  weed  into  the 
varieties  of  the  cabbage  and  cauliflower  by  transplanting  it  from 
the  sea-shore  into  the  rich  mold  of  gardens,  and  which  are  as  dissimi- 
lar as  each  from  the  original  species. 

605,  a.  The  attributes  of  Race  are  mostly  of  a  physical  and  moral 
nature  ;  and,  unlike  the  temperaments,  but  analogous  to  the  foregoing 
varieties  of  animals  and  plants  (§  604),  they  are  not  attended  by  any 
special  modifications  of  the  propeities  and  functions  of  life  ;  but  all  the 
races  ai'e  liable,  individually,  to  the  physiological  conditions  of  tem- 
perament. The  general  attributes,  therefore,  admit  of  no  physiolog- 
ical, pathological,  or  therapeutical  applications. 

605.  h.  And  here  it  is  worthy  of  remark,  as  illustrative  of  the  com- 
mon nature  of  the  properties  and  functions  of  life,  that  other  changes 
to  which  animals  and  plants  are  liable  from  unaccustomed  physical 
agents  are  attended  by  distinct  modifications  of  their  vital  states,  and 
remarkable  variations  of  structure.  An  animal,  for  example,  trans- 
ferred from  the  tropical  to  colder  regions,  undergoes  a  change  in  its 
hairy  or  woolen  vesture,  or  from  summer  to  winter  in  the  same  cli- 
mate. The  tree,  transplanted  from  the  tropics  to  a  northern  latitude, 
may  be  made  to  resist  the  inclemencies  of  winter,  and  finally  puts  on 
a  denser  bark,  and  a  hibernaculum  for  its  leaf  and  flower-buds.  Or 
yet  more  strikingly,  what  is  herbaceous  in  equatorial  regions  may  be- 
come a  shrub  or  a  tree  in  temperate  climates.  These  mutations, 
therefore,  are  strictly  analogous  to  the  temperaments  of  man.  Or, 
again,  what  is  more  emphatically  characteristic  of  the  analogies  of  na- 
ture in  any  of  her  grand  departments  consists  in  the  fact  that  the  va- 
rieties which  are  constituted  by  hybrid  animals  and  plants  are,  equal- 
ly with  the  foregoing,  both  in  respect  to  cause  and  effect,  correspond- 
ing phenomena  with  the  varieties  of  temperament  (^  72). 

606.  From  what  is  known  of  the  analogous  varieties  among  differ- 
ent species  of  animals  and  plants  (§  604),  we  shall  have  little  difficulty 
in  referring  the  characteristics  of  race  to  the  influence  of  physical 
agents  upon  the  properties  of  life  ;  and  of  these  there  are  none  so  ob- 
vious as  climate.  Like  temperament,  &c.,  the  whole  falls  under  the 
laws  of  vital  habit  (^  535,  &c.). 

607.  Perhaps  there  is  no  better  classification  of  Race  than  Lace- 
pede's;  who  reckons  only  the  European  Arab,  the  Mogul,  the  Ne- 
gro, and  the  Hyperborean.      These  have  been  variously  subdivided. 

Blumenbach's  division  of  the  races  is  also  simple  and  just;  namely, 
the  Caucasian,  the  Mongolian,  the  Ethiopian,  the  American,  and  the 
Malay.  The  Caucasian  variety  answers  to  the  European  Aiab  of 
Lacepede;  the  Mongolian  to  the  Mogul;  the  Ethiopian  to  the  Negro; 
the  American  embraces  all  the  natives  of  North  and  South  America, 
excepting  the  Esquimaux  ;  and  the  Malay  includes  the  inhabitants  of 
Sumatra,  Borneo,  New  Holland,  and  many  other  islands  of  the  South 
Sea ;  most  of  whom  speak  the  Malay  language. 

608.  The  Eui'opean  Arab  comprises  the  people  of  Europe,  Egypt, 
Syria,  Arabia,  Barbary,  Tartary,  Persia,  the  North  American  In- 
diana, &c. 

The  fundamental  characteristics  are  an  oval  face  from  forehead  to 


PHYSIOLOGY. SEX.  39tj 

chin,  a  prominent  skull  anteriorly,  a  long  nose,  skin  more  or  less 
white,  and  long,  straight  hair. 

609.  The  Mogul  race  is  composed  of  the  Chinese,  the  inhabitants 
of  Eastern  India,  Tonquin,  Cochin  China,  Japan,  Siam,  and  the  South 
American  Indians.     This  race  is  more  numerous  than  all  the  others. 

Its  characteristics  are  a  flattish  forehead,  eyes  turned  rather  oblique- 
ly outward,  cheeks  prominent,  oval  face  between  the  two  cheek  bones. 

610,  a.  The  Negro,  a  native  of  Africa,  possesses  the  most  perfect 
characteristics.  The  black  skin,  the  low,  flat  forehead,  the  depressed 
nose,  the  thick  lips,  the  crisped  hair,  the  dullness  of  understanding,  and 
the  acuteness  of  his  senses,  mark  him  as  the  greatest  phenomenon 
among  the  physical  changes  of  our  species.  This  is  the  only  race  of 
whom  it  can  be  surmised  that  the  change  has  been  miraculous. 

610.  h.  The  bondage  to  which  the  Negro  has  been  subjected  has 
naturally  excited  the  sympathies  of  the  humane,  and  has  led  them  to 
assume  in  his  behalf  an  ideal  rank  in  the  scale  of  mind.  I  would  not 
oppose  this  harmless  prejudice  were  it  not  in  collision  with  fundamen- 
tal laws  which  it  is  my  duty  to  interpret,  as  far  as  may  be,  as  nature 
teaches.  The  brain  has  sustained  in  this  degraded  race  (degraded 
as  well  by  nature  as  by  man)  that  failure  of  development,  which, 
as  universally  admitted,  stamps  the  white  man  with  intellectual  inferi- 
ority- But,  degraded  as  is  the  Negro  in  mind,  in  body,  and  in  bond- 
age, he  is  yet  a  man,  and,  like  the  rest  of  the  human  family,  descend- 
ed from  common  parents.  His  very  imbecilities,  therefore,  entitle 
him  the  moi'e  to  our  sympathies  and  protection  (^  1078,  s). 

611.  The  Hyperborean  stands,  also,  in  strong  relief  from  the  rest 
of  mankind.  This  race  comprises  the  Laplanders,  the  Esquimaux, 
Saraoiedes,  Ostiacs,  Tschutski,  &c. 

They  have  Iwoad  faces,  flat  features,  swarthy  skin,  and  are  stinted 
in  growth.     In  the  scale  of  intellect  they  rank  next  above  the  Negro. 

III.    SEX. 

612.  Certain  physiological  differences  in  the  sexes  appear  to  have 
been  impi'essed  originally  upon  the  constitution  ;  and  this,  indeed,  was 
necessary  to  the  perpetuation  of  the  species.  But,  although  our  first 
parents  were  created  in  a  state  of  maturity,  there  were  ingrafted  up- 
on the  constitution  {^  64  &c.)  the  laws  of  development  for  natu- 
ral growth,  and  which  are  designed  to  conduct  the  individual  to  that 
mature  condition  in  which  he  came  from  the  Hands  of  the  Creator. 

613.  Besides  the  special  difference  in  the  organs  of  generation, 
woman  is  of  a  lower  stature  than  man,  less  rigid  in  organization,  soft- 
er and  more  delicate  in  her  skin  and  complexion,  abounds  more  with 
cutaneous  cellular  tissue  and  fat,  (§  440  hh,  440  c,  no.  Ill,  441  c), 
which  gives  greater  rotundity  to  her  limbs  and  greater  concealment 
to  the  muscles.      Laws  of  nervous  system  more  strongly  pronounced. 

Her  mind  is  quick  in  its  operations,  arrives  earlier  at  maturity,  but 
is  less  vigorous,  than  in  man.  The  passion  of  love,  although  indom- 
itable, is  more  a  sentiment  with  her  than  with  the  other  sex.  She 
seems,  however,  especially  designed  for  the  repi-oduction  of  the  spe- 
cies, and  for  the  early  care  of  her  offspring. 

614.  Sensibility,  irritability,  and  therefore  mobility,  are  more  ex- 
quisite than  in  the  male,  and,  for  a  like  reason,  she  is  more  suscepti- 
ble, as  with  the  infant,  and  the  sanguine  and  nervous  temperaments, 


394  INSTITUTES    OF   MEDICINE. 

to  the  action  of  morbific  causes.  Sympathy  predominates,  also,  in 
the  female ;  and  hence  local  diseases  are  more  apt,  than  in  the  other 
sex,  to  disturb  other  parts.  But  she  is  not,  therefore,  more  liable  to 
death ;  since  the  vital  powers  being  more  strongly  pronounced,  they 
are  more  recuperative,  and  the  same  susceptibility  to  morbific  causes 
renders  her,  also,  more  susceptible  of  the  genial  effect  of  remedial 
agents.  What  Providence  has  denied  to  one.  He  has  given  to  the 
other. 

IV.    CLIMATE. 

615.  The  influences  of  climate  in  modifying  the  physiological 
character  of  man  are  great  and  various,  and  still  greater  and  more 
various  in  predisposing  him  to  disease.  The  physiological  effects  of 
climate  are  also  strongly  shown  in  animals,  though  often  far  less  in 
their  organic  than  their  animal  economy  ;  while  in  the  vegetable  tribes 
these  or  analogous  results  are  often  strongly  manifested  in  organic 
life.     The  nervous  system  takes  its  usual  modifyiug  share  (^  578  d). 

616.  I  shall  speak  now  mostly  of  those  permament  effects  of  cli- 
mate which  are  known  under  the  denomination  of  temperaments,  for 
the  purpose  of  illustrating  still  farther  the  radical  changes  which  may 
be  established  in  the  vital  states  by  physical  agencies  (§  585-603). 
This,  also,  will  show  how  profoundly  climate  may  operate  in  dispos- 
ing the  organic  functions  to  a  state  of  disease,  and  will  contribute, 
with  what  has  been  said  in  other  places,  in  inducting  us  into  a  knowl- 
edge of  the  philosophy  which  relates  to  predisposition  to  disease, 

617.  The  extremes  of  heat  and  cold  are  conducive  to  the  foiTnation 
of  the  sanguine  temperament,  either  in  maintaining  it  as  an  inherited 
peculiarity,  or  in  developing  it  out  of  other  constitutions.  But,  it  is 
mainly  the  dry  heat  of  the  tropics  which  goes  to  the  formation  of  the 
sanguine  temperament.  The  phlegmatic  and  sanguineo-phlegmatic 
belong  mostly  to  warm  climates,  especially  to  such  as  are  moist.  The 
choleric  and  melancholic  occupy  the  temperate  regions ;  and  here, 
therefore,  we  may  look  for  the  demonstrations  of  genius.  The  chol- 
eric and  melancholic  gradually  merge  into  the  sanguine,  or  phleg- 
matic, in  tropical  regions  (^  1047). 

618.  a.  The  philosophy  of  life,  as  already  expounded,  enables  us 
to  comprehend  the  manner  in  which  the  foregoing  transitions  and  va- 
rieties are  brought  about;  while  the  changes  confirm  that  philosophy 
(§  617).  Thus,  when  the  melancholic  migrates  from  the  temperate 
to  a  tropical  climate  the  uninterrupted  and  powerful  action  of  heat 
upon  irritability  and  sensibility  renders  these  properties  more  and 
more  susceptible  to  the  action  of  blood,  and  all  vital  stimuli.  The 
secretions  and  excretions  become,  in  consequence,  more  abundant  ; 
morbific  and  remedial  agents  manifest  corresponding  variations  in 
effect;  and  since,  also,  the  organic  properties  of  the  brain  sustain  the 
modifications  incident  to  other  organs,  and  the  senses  acquire  greater 
liveliness,  the  whole  character  of  the  mental  faculties  takes  on  that  of 
the  sanguine  temperament,  and  what  was  once  an  uninterrupted  efful- 
gence of  mind  dwindles  down  to  occasional  scintillations.  This  is 
especially  the  course  of  the  transplanted  melancholic  if  the  tempera- 
ment incline  to  the  sanguine.  But  here,  as  with  the  choleric,  or 
where  the  sanguine  and  melancholic  are  distinctly  associated,  if  the 
temperament  lean  to  the  phlegmatic    the  vital  properties  are  rather 


PHYSIOLOGY. CLIMATE.  395 

depressed  by  heat,  and  the  functions  of  the  body  and  mind  are  more 
slowly  and  feebly  performed ;  being  influenced  even  by  the  vicissi- 
tudes of  season,  and  by  the  daily  atmospheric  changes. 

In  the  tropics,  therefore,  man  is  indolent,  given  to  pleasure,  and 
lives  only  for  himself.  With  the  natives  of  high  northern  lati- 
tudes the  properties  of  life  are  under  the  perpetual  influence  of 
cold,  which  fails,  in  consequence,  of  its  usual  action  as  a  stimulus  in 
temperate  climes,  and  all  the  functions  are  slowly  performed ;  save 
only  the  generation  of  heat,  which  has  its  special  final  cause. 
Growth  must  therefore  be  slow  and  stinted,  and  there  must  be  [ccetcris 
paribus)  great  capability  of  resisting  morbific  causes,  and  a  gradual 
recovery  from  disease.  As  the  temperate  climates  hold  an  interme- 
diate rank  in  their  vital  relations,  it  must  be  here  that  we  shall  find 
mankind  representing  the  most  perfect  attributes  of  their  nature. 

618,  h.  The  same  philosophy  holds  in  respect  to  animals  and  plants, 
since  all  observation  teaches  that  they  are  as  sensibly  affected,  in  cer- 
tain aspects,  by  the  diversities  of  climate,  as  the  human  race  ;  being, 
also,  like  man,  subject  to  modifications  from  education,  soil,  &c.  (§ 
605,  b),  allowing  for  differences  in  organization  and  life  (§  185). 

619,  We  thus  see  that  climate  contributes  largely  to  the  formation 
of  temperament,  and  exerts  direct  modifying  influences  upon  the  gen- 
eral character  of  disease.  In  this  last  acceptation  it  embraces  all  the 
predisposing  causes  which  appertain  to  different  regions ;  such  as  the 
various  kinds  of  miasmata,  temperature  in  its  general  aspect  and  as 
liable  to  vicissitudes,  moisture  and  dryness,  and  other  obvious  condi- 
tions.    Physiological  principles  lie  at  the  foundation  of  the  whole. 

620,  a.  From  the  considerations  which  have  been  now  made,  as 
well  as  for  other  reasons,  chronic  diseases  should  abound  in  the  tem- 
perate zones,  while  they  are  comparatively  rare  in  equatorial  climates. 
Consumption  is  a  gi-and  characteristic  of  the  former,  especially  of  the 
sea-board  and  other  humid  regions.* 

620,  b.  The  principle  about  which  the  facts  just  stated  are  concerned, 
as  well  as  others  that  are  relative  to  climate,  is  well  illustrated  by  the 
rapidity  with  which  the  chronic  maladies  of  horses  yield  to  tropical  in- 
fluences ;  a  large  proportion  of  these  animals  which  are  destined  for 
the  West  India  markets  being  thus  affected,  and  thus  relieved. 

621,  a.  The  remarks  which  have  been  now  made  in  respect  to  cli- 
mate lead  me  to  indicate  an  important  duty  of  the  physician  as  it  re- 
spects the  inhabitants  in  an  individual  sense ;  though  I  have  in  view 
its  philosophical  as  well  as  practical  bearing. 

*  True,  it  has  been  lately  stated  on  the  authority  of  the  British  Army  Statistics,  that 
consumption  is  more  rife  on  the  West  India  stations  than  in  any  other  quarter  of  the  globe  ; 
from  which  the  conclusion  was  drawn  that  the  disease  was  especially  incident  to  those 
climates.  This  important  fallacy  I  have  pointed  out  in  the  Medical  and  Physiological 
Commentaries  (vol.  ii.,  p.  619-622).  In  that  work,  also,  especially  in  the  Essays  on  Blood- 
letting, and  on  the  writings  of  M.  Louis,  I  have  set  forth  the  facts,  which,  with  the  pre- 
ceding, and  others  of  a  coincident  nature,  enforce  the  importance  of  rejecting  all  ai-my  sta- 
tistics, and  other  hospital  reports,  as  forming  any  proper  foundation  for  gi-eat  pathological 
and  therapeutical  conclusions ;  and  have  endeavored  to  show  that  all  such  conclusions 
should  be  dravm  exclusively  from  the  private  wallis  of  the  profession,  where  the  consti- 
tution is  natural,  the  habits  good,  and  disease  early  and  judiciously  treated,  and  where, 
especially,  the  superintending  physician  is,  bona  fide,  the  prescriber  and  critical  observ- 
er, and  more  anxious  for  the  recovery  of  his  patient  than  for  a  post  mortem  examination. 
Hospital  reports  represent  nature  in  her  most  distorted  aspects,  the  treatment  of  disease 
being  often  begun  at  its  moribund  stages,  and  when  the  system  is  full  of  organic  lesions- 
this  treatment,  too,  often  experimental,  and  without  reference  to  fundamental  ijhysiolog- 
ical  principles  (§  623). 


396  INSTITUTES    OP    MEDICINE. 

The  native  and  the  acclimated  are  apt  to  possess  very  different  sus- 
ceptibilities from  the  new-comer,  from  which  it  results  that  the  treat- 
ment of  their  diseases,  respectively,  should  be  more  or  less  governed 
by  these  considerations ;  while  it  will  be,  also,  the  impor!,ant  business 
of  the  physician  to  point  out  to  the  stranger  the  means  of  averting  the 
new  morbific  influences  to  which  he  is  subjected,  and  his  modified 
susceptibilities.  The  means  are  various,  and  of  the  highest  moment. 
It  was  from  their  neglect,  as  I  have  shown,  that  the  mortality  from 
consumption  has  been  so  great  upon  the  West  India  stations,  and  the 
Report  of  which  has  led  to  so  many  theoretical  and  practical  errors  (§ 
620,  note).  And  as  to  the  importance  of  a  proper  adaptation  of  treat 
ment  to  the  acute  forms  of  disease  upon  the  same  military  stations, 
it  is  only  necessary  to  consider  the  appalling  contrast  between  the  re- 
sults of  practice  as  introduced  by  Robert  Jackson,  and  that  which  im 
mediately  preceded  his  superintendence  as  surgeon-general.  By  di- 
minishing, also,  the  allowance  of  "  salt  beef  and  rum"  to  the  sick,  he 
saved  the  British  government  $400,000  per  annum.  And  who  does 
not  know  that  it  is  the  same  now  as  in  Zimmerman's  day  1  "I  know," 
says  Zimmerman,  "  a  certain  Esculapius  who  has  fifty  or  sixty  pa- 
tients every  morning  in  his  antechamber.  He  just  listens  a  moment 
to  the  complaints  of  each,  and  then  arranges  them  in  four  divisions. 
To  the  first  he  prescribes  bloodletting ;  to  the  second  a  purge ;  to  the 
thii'd  a  clyster ;  and  to  the  fourth  change  of  air  !  The  same  vulgar 
prejudice  leads  people  to  have  a  great  idea  of  the  practice  of  large 
hospitals.  I  have  seen,  in  my  travels,  some  of  the  largest  hospitals 
in  Europe  ;  and  I  have  often  said  to  myself,  Heaven,  surely,  will  have 
pity  on  these  miserable  victims"  {i}  1065  c,  1068  a). — NoTEFp.  1114. 

621,  b.  In  connection  with  the  foregoing  should  appear  the  modifi- 
cations which  arise  from  peculiarities  in  the  specific  nature  of  the 
remote  causes  of  disease,  which  are  almost  as  vai'ious  as  the  causes 
themselves.  We  know,  indeed,  that  the  pathological  cause  of  inflam- 
mation may  be  varied  by  the  manner  in  which  wounds  are  inflicted  ; 
and  more  various,  therefore,  must  be  the  exact  modifications  which 
are  determined  by  agents  which  possess  specific  properties.  To  know 
those  modifications  presupposes,  in  no  small  degree,  a  knowledge  of 
their  special  causes.  They  demand  a  great  versatility  of  treatment 
where  common  principles  may  apply  ;  and  this  may  be  determined 
more  by  a  knowledge  of  the  remote  causes  than  by  any  resulting  phe- 
nomena (§  644,  &c.). 

V.    HABITS,  OR  USAGES. 

622.  It  now  remains  to  speak  briefly  of  the  last  subdivision  of  our 
fifth  grand  division  of  Physiology.  Under  the  denomination  of  Habits 
are  included  the  various  pursuits  of  mankind,  their  social  and  political 
relations  and  institutions,  their  modes  of  living  in  respect  to  food,  ex- 
ercise, clothing,  &c. ;  with  a  special  reference  to  their  physiological 
and  pathological  influences,  which  are  great  and  numerous. 

Much  of  this  subject  is  considered  under  the  direct  physiological 
aspect  of  vital  habit  (§  535,  &c.),  and  the  same  principles  obtain 
throughout.  The  usages  of  man  not  only  variously  modify  his  vital 
condition  in  a  transient  manner,  but,  like  the  eflfects  of  climate,  incom- 
patible habits  may  establish  permanent  and  transmissible  changes  ot 
constitution.      The  glass-blower,  the  brazier,  the  painter,  the  type 


PHYSIOLOGY. HABITS.  397 

settei',  &c.,  have,  respectively,  modifications  of  a  common  disease, 
vv^hich  are  still  different  from  those  of  the  sedentary  divine,  lawyer, 
and  shoemaker.  And  so  of  the  various  pursuits  which  demand  more 
or  less  exercise  in  the  open  air. 

623.  Habits,  in  their  most  extended  sense,  open  upon  us  a  field  for 
endless  observation.  Here  it  is,  in  the  neglect  of  the  natural  means 
of  preserving  health,  in  the  pinches  of  poverty,  in  the  filth  of  indo- 
lence, in  Bacchanalian  indulgences,  and  in  the  various  resources  of  li- 
centiousness, we  meet  with  nature  so  turned  from  her  physiological 
condition,  that  when  disease  sets  in  it  presents  the  most  embarrassing 
anomalies.  The. hospitals  of  all  countries,  especially  of  Europe,  show 
a  disgusting  amount  of  these  artificial  deformities.  And  yet  are  they 
sent  forth  as  legitimate  grounds  for  important  conclusions  in  patholo- 
gy and  therapeutics  (§  620,  note). 

All  the  foregoing  varieties  of  disease,  which  grow  out  of  deleteri- 
ous habits,  or  pursuits,  may  yield  to  the  substitution  of  natural  means, 
or  to  change  of  employment. 

624.  As  to  the  active  treatment  of  the  cases  last  recited,  I  can  only 
say,  that,  while  the  great  principles  obtain  as  in  less  artificial  states,  they 
demand  greater  modifications  of  practice  than  all  other  special  condi- 
tions that  are  incident  to  man.  But,  let  us  remember,  that  when  we 
meet  with  phrenitis,  or  pneumonia,  or  any  other  grave  inflammation, 
ay,  or  even  erysipelas,  affecting  the  most  broken-down  constitution  of 
the  most  dissolute  man,  stimulants  will  be  pernicious,  and  he  must 
take  his  chance  from  a  modified  antiphlogistic  plan. 

625.  Under  the  category  of  habits  may  be  arranged  the  modifica- 
tions which  are  exerted  upon  the  constitution  by  subdued  diseases. 
There  are  many  affections  which  leave  their  subjects  not  only  unusu- 
ally susceptible  of  morbific  agencies,  but  modify  the  pathological 
character  of  the  diseases  which  may  subsequently  spring  up.  The 
dyspeptic  affections  that  follow  recoveries  from  fever  are  more  obsti- 
nate, and  require  a  more  varied  treatment,  than  such  as  arise  from 
simple  indolence,  or  even  from  high  living.  Syphilis,  though  cured, 
predisposes  to  an  obstinate  form  of  rheumatism,  which  requires  a  dif- 
ferent detail  of  treatment  from  that  which  is  induced  by  cold,  or  by 
hepatic  and  intestinal  disease. 

625^.  The  usages  and  habits  of  man  supply  a  fruitful  field  of  inquiry 
into  the  modifying  influences  of  the  nervous  system  upon  his  organic 
states,  and  for  tracing  out  their  analogies  with  those  reflex  actions  which 
contribute  to  the  development  of  structure,  and  most  remarkably  at  the 
age  of  puberty,  when  the  evolution  of  the  generative  organs,  starting 
in  the  same  inscrutable  laws  of  organic  life  as  are  provided  for  the  anal- 
ogous organs  in  plants,  establishes  that  profound  labyrinth  of  reflected 
nervous  actions  which  bring  under  their  sway  the  whole  animal  fabric, 
and  through  which  we  may  look  as  a  guide  at  all  the  more  obscure  re- 
lations of  the  nervous  system  to  the  organic  fluctuations  of  man  and 
animals,  even  the  exalted  grade  of  their  organic  compounds,  and  to 
which  influences  are  owing,  in  part,  the  peculiarities  that  distinguish 
the  animal  from  analogous  conditions  of  the  vegetable  tribes ;  while, 
also,  we  may  find  in  the  same  pronunciations  of  the  generative  organs 
a  clear  physiological  ground  for  interpreting  the  mochis  ojjerandi  of  mor- 
bific and  remedial  agents  and  the  multifarious  influences  of  organs  upon 
each  other  either  for  good  or  for  evil  (^514  g-?n,  578,  896   902  i-m). 


398  INSTITUTES    OF    MEDICINE. 


SIXTH  DIVISION  OF  PHYSIOLOGY. 

THE  RELATION  OF  ORGANIC  BEINGS  TO  EXTER. 
NAL  OBJECTS. 

626,  a.  That  division  of  physiology  which  concerns  the  relations 
between  living  beings  and  external  nature  is  very  comprehensive, 
and  brings  into  immediate  connection  the  three  great  departments  of 
medicine ;  and  it  is  an  object  of  these  Institutes  to  consider  the  sub- 
ject under  this  limited  aspect.  Here  it  is  that  these  several  branches 
meet  together,  and  here  it  is  that  we  learn  that  pathology  and  thera- 
peutics are  only  modified  aspects  of  physiology.  They  are  all  imme- 
diately interested  about  the  properties  of  life  ;  physiology  regarding 
the  healthy  influences  of  external  agents  upon  those  properties,  pa- 
thology their  morbific  effects,  and  therapeutics  those  changes  which 
are  exerted  upon  the  morbid  properties  by  remedial  agents.  A  com- 
mon principle  is,  therefore,  concerned  throughout.  All  the  diversified 
results,  whether  physical,  or  vital,  are  directly  dependent  upon  the 
existing  condition  of  those  properties.  That  condition  is  ascertained, 
in  all  its  mutations,  by  the  resulting  phenomena, 

626,  h.  Upon  this  ground,  also,  as  upon  that  of  the  more  internal 
economy,  may  be  utterly  exploded  all  the  chemical  and  physical  hy- 
potheses of  life  and  disease  ;  since,  were  any  of  those  doctrines 
founded  in  truth,  the  action  of  external  causes  should  be  directly  upon 
the  composition  and  structure.  And  so  should  the  blood  itself  upon 
the  sanguiferous  system,  urine  upon  the  bladder,  bile  upon  the  intes- 
tine, &c. 

The  moment  we  begin  the  study  of  effects  as  manifested  by  living 
beings,  whether  induced  by  internal  or  external  causes,  or  those 
which  arise  from  the  action  of  living  beings  upon  outward  objects,  we 
find  ourselves  surrounded  by  an  endless  variety  of  phenomena  which 
denote  the  existence  of  a  formative  principle,  upon  which  all  the  im- 
pressions are  made,  and  which  is  the  primary  cause  of  all  that  are  made 
upon  external  bodies, — which  moves  the  body  from  one  place  to  an- 
other, exerts  all  the  changes  that  are  effected  in  food,  elaborates  that, 
and  that  only,  from  the  universal  mass  which  is  suitable  for  the  for- 
mation of  blood,  which  governs  all  the  processes  of  organization, 
which  is  susceptible  of  alterations  in  its  condition  in  consequence  of 
the  action  upon  it  of  many  external  objects,  which  is  liable  to  analo- 
gous influences,  healthy  and  morbid,  from  the  operations  of  the  mind 
and  its  passions,  and  which  possesses  an  inherent  tendency  to  return 
from  a  morbid  to  its  natural  state,  the  essential  cause  of  preservation. 
Surrender  these  doctrines,  and  all  our  reasoning  about  organic  be 
ings,  all  our  physiological  and  medical  philosophy,  would  be  a  mere 
jargon  of  words.  Hence  it  may  be  always  seen,  that  those  philoso- 
phers who  deny  the  existence  of  a  principle  of  life,  or  substitute  the 
chemical  forces,  are  driven  to  the  necessity  of  speaking  and  writing 
as  if  allowino-  its  full  operation  the  moment  they  concern  themselves 
about  the  phenomena' of  life.  They  must  have,  and  they  know  it,  a 
peculiar  cause  for  effects  so  peculiar  as  those  of  organic  beings. 

627.  In  my  examination  of  the  constitution  of  the  different  tissues, 


PHYSIOLOGY. EXTERNAL   RELATIONS.  399 

and  of  the  properties  and  functions  of  life,  the  topics  embraced  with- 
in the  present  division  of  Physiology  came,  unavoidably,  under  anal- 
ysis ;  and  have  been  variously  reproduced  when  investigating  the 
laws  of  vital  habit,  the  influences  of  age,  temperament,  climate,  &;c. 
But  little,  therefore,  remains  to  be  added. 

628.  In  regarding  our  relations  to  external  objects  we  should 
carefully  discriminate  between  irritability  and  sensibility,  the  two 
properties  through  which  the  relations  are  established ;  the  former 
connecting  organic  life,  the  latter  animal  life,  with  the  external  world 
(§  188,  &c.,  194,  &c.).  Vegetables,  therefore,  hold  their  connection 
through  irritability  alone ;  so  that  their  organization  is  intimately  as- 
sociated with  outward  objects.  The  connecting  anatomical  structure 
in  the  organic  life  of  animals  consists  of  the  alimentary  canal,  the 
lungs,  and  the  skin ;  in  plants,  of  the  radicles  and  leaves  (§  268,  &c.). 
630,  a.  In  organic  life,  as  has  been  already  seen,  agents  of  all 
kinds  operate  through  the  medium  of  irritability  (§  188).  Their  ef- 
fect depends  upon  the  degree,  and  the  kind  of  irritability,  and  upon 
the  kind,  energy,  and  quantity  of  the  agents  (§  133,  &c.).  Owing  to 
changes  in  the  degree  of  irritability  the  same  stimulus  or  sedative, 
and  in  the  same  quantity,  does  not  always  produce  the  same  amount 
of  effect.  It  will  be  more,  or  less,  on  one  day  than  on  another,  even 
at  one  hour  than  another.  This  is  constantly  exemplified  in  the  natu- 
ral states  of  the  body,  but  distinctly  in  disease,  when  irritability  is 
also  modified  in  kind  as  well  as  in  degree.  The  law  is  of  great  im- 
portance in  medicine,  and  is  subject  to  many  contingent  influences, 
both  in  health  and  disease,  especially  that  of  vital  habit.  These  in- 
fluences involve  some  of  the  most  difficult  and  delicate  considerations 
in  the  practice  of  medicine,  and  more  so  from  nervous  complications. 
630,  b.  Again,  the  alterations  of  irritability  in  morbid  states, 
whether  in  degree  or  kind,  will  depend  upon  the  virtues  of  the  mor- 
bific agent,  and  upon  the  natural  modification  of  the  vital  properties 
in  any  paiticular  part.  This  combined  condition,  and  according  to 
its  nature,  requires  particular  adaptations  of  remedies,  whose  opera- 
tion, also,  will  be  in  conformity  with  their  own  virtues,  and  with  the 
natural  and  acquired  conditions  of  the  organic  properties  (§  150,  &c.). 
The  principle  is,  also,  equally  true  of  all  diseases  in  their  develop- 
ment of  sympathetic  affections. 

630,  c.  From  what  has  been  said  of  the  natural  modifications  of  the 
vital  properties  in  different  parts,  and  of  the  specific  relation  of  nat- 
ural and  remedial  agents  to  those  various  conditions,  it  is  obvious  that 
the  same  morbific  agent  will  affect  one  organ  more  or  less  differently 
from  what  it  will  another  part  (§  133,  &c.).  Cantharides  will  not  of- 
fend the  stomach,  but  will  excite  inflammation  of  the  bladder,  and  of 
no  other  part,  in  its  proper  therapeutical  doses.  And  just  so,  though 
less  remarkably,  of  the  ordinary  causes  of  disease.  Cold  and  damp- 
ness constantly  excite  inflammation  of  the  mucous  coat  of  the  nose, 
trachea,  and  lungs,  while  they  far  more  rarely  affect  other  parts. 
One  poison  strikes  at  the  brain,  another  at  the  liver,  and  another  at 
the  skin,  though  their  primary  action  may  be  often  exerted  upon  the 
stomach.  Other  directions,  however,  may  be  given  to  each  of  these 
morbific  causes  when  they  are  brought  to  act  upon  parts  which  are 
already  diverted  from  their  natural  states,  and  will  be  liable  to  other 
variations  from  the  numei'ous  accidental  influences  by  which  every 


400  INSTITUTES    OF    MEDICINE. 

indhidual  is  surrounded.  It  is  these  fluctuating  influences  which 
render  measles,  scarlet  fever,  the  intennittent  and  yellow  fevers,  ty- 
phus, &c.,  more  malignant  at  one  time  than  at  another,  or  more  vio- 
lent in  one  person  than  another.  The  same  law  obtains  even  in  re- 
spect to  idiosyncrasy,  as  in  those  subjects  who  are  not  affected  by  the 
poison  of  the  rhus,  &c.  (§  585,  b).  The  differences  result  mainly 
from  different  modifications  of  instability,  and  corresponding  influen- 
ces of  various  causes,  not  from  "  absorption  and  elective  affinity." 

630,  d.  As  all  morbific  agents  differ  in  their  kind,  so  are  the  effects 
of  all  more  or  less  different  from  each  other.  Each  one,  or  according 
to  their  combined  influences,  other  circumstances  being  equal,  affects 
the  organic  states  in  one  uniform  way ;  and  this  is  as  true  of  the  ma- 
laria which  generate  typhus  and  yellow  fever,  the  plague,  &c.,  as  of 
the  virus  of  small-pox,  measles,  hydrophobia,  &c.  The  differences 
in  results  will,  of  course,  be  most  strongly  pronounced  when  the  mor- 
bific causes  differ  most  from  each  other. 

630,  e.  Many  important   pi'actical  considerations    grow  out  of  the 
principles  involved  in  this  section  (§  630),  and  which  will  come  up  for 
general  remark  under  the  remote  causes  of  disease  (§  644,  &c.).     As 
an  illustratidn,  in  greater  detail,  of  a  single  element  of  this  complex 
subject,  let  us  now  analyze  the  compounded  influences  which  impart  to 
measles,   scarlatina,   &c.,    their   epidemic  character,  and  their  gi-eater 
complexities  when  thus  distinguished  than  in  their  sporadic  form ;  and 
it  will  be  seen,  also,  that  the  same  principles  are  of  extensive  applica- 
tion to  individual  cases  of  all  forms  of  disease,  whatever  be  the  nature 
of  the  compounded  causes.     Take,  in  the  first  place,  epidemic  fevers, 
epidemic  dysentery,  epidemic  bilious  pneumonia,  &c.     Here  the  causes 
may  be  mainly  some  special  miasmata  of  intensely  morbific  properties, 
though  more  or  less  aided  by  the  use  of  stimulants  and  stimulating  food, 
&c.,  operating  as  predisposing  causes  subordinate  to  the  miasmatic  or 
essential  cause  (§  648  c,  650-659,  602-663,  666,  870  aa).     Coming  to 
the  contagious  diseases,  each  malady  has  a  more  clearly  defined  predis- 
posing cause,  which  is  always  generated  by  the  special  morbid  states 
of  these  diseases  respectively  (§  653).      But  in  these  affections  when 
oceurring  epidemically,  and  sometimes  in  their  sporadic  forms,  the  mi- 
asmata that  are  indispensable  to  fevers  contribute  their  malign  influ- 
ences in  rendering  the  system  more  susceptible  to  the  morbific  effects 
of  the  contagious  principle,  increase  the  intensity  of  its  operation,  and 
lay  the  foundation  of  those  local  congestions  of  the  abdominal  organs 
which  arg  attendant  on  epidemic   fever,  epidemic  bilious  pneumonia, 
&c.  (§  961-970,  1002-1005),  just   as  stimulants  and  stimulating  food 
operate  in  these  miasmatic  diseases.     The  same  philosophy  is  applicable 
to  the  malignant  cholera,  which  has  for  its  indispensable  cause  some 
specific  atmospheric  virus,  but  often  greatly  promoted  in  its  morbific  ef- 
fects by  the  predisposing  causes  of  miasmatic  fevers,  and  which  concur 
in  instituting  the  local  congestions  that  are  incident  to  those  fevers  (§ 
654  a).     The  principle  is  the  same,  also,  with  those  diseases  where  a 
predisposition  to  some  specific  form  is  impressed  upon  the  constitution, 
as  in  scrofula,  rheumatism,  lues,  &c.  (§  72-73,  75-79),  and  which  mod- 
ifies, or  is  modified  by,  the  miasmatic  influences  that  generate  fevers 
(§  (j52  b,  660-062,  858),     Superficial  diseases,  such  as  "putrid  sore 
throat,"  erysipelas,  &c.,  often  spring  from  profound  abdominal  conges- 
tions, and  are  apt  to  be  fatally  mistaken  for  simply  local  affections 
(§  689  /,  961  a,  970  c).— Note  Oo  p.  1141. 


PHYSIOLOGY. DEATH.  401 

SEVENTH  DIVISION  OF  PHYSIOLOGY. 

DEATH. 

631.  Organic  beings  die  ;  nothing  else.  What  is  it,  then,  that  dies; 
and  why,  in  consequence,  do  living  beings  return  to  the  mineral  king- 
dom 1  The  functions,  it  is  answered  by  many  philosophers.  But 
the  functions  are  merely  results.  It  is  their  causes,  then,  that  perish. 
And  what  are  the  causes  1  The  chemical  philosophers  answer,  the 
forces  which  are  capable  of  so  many  results  in  the  inorganic  world, — 
the  chemical  forces.  But  the  facts  contradict  that  philosophy;  for  no 
sooner  is  the  organic  being  dead,  than  we  witness  an  exactly  oppo- 
site series  of  results  as  the  effects  of  chemical  changes.  We  witness, 
[  say,  a  demonstration  of  chemical  results  beyond  any  other  example 
in  the  natural  world,  and  it  is  then  only  that  we  witness  them  at  all. 
The  causes  which  are  withdrawn  must  have  been  as  peculiar  as  the 
universal  phenomena  that  have  disappeared,  and  as  opposite  to  those 
chemical  forces  which  take  possession  as  their  power  of  resisting 
them  during  life  is  unquestionable.  These  causes  have  been  called 
the  vital  properties,  which,  like  the  powers  or  properties  of  the  mind, 
are  elements  of  one  principle,  which  is  known  by  the  name  of  the 
vital  principle.  It  is  the  extinction  of  this  substantive  principle  which 
essentially  constitutes  death,  as  its  existence  essentially  constitutes 
life.  Those  who  deny  its  existence  are  generally,  also,  materialists  in 
respect  to  the  soul,  if  they  be  not  chargeable  with  a  greater  vice. 

632,  a.  The  tendency  to  death,  in  man  alone,  having  been  intro- 
duced since  his  creation,  the  properties  of  life  must  have  undergone 
some  miraculous  change.     Man  was  created  imperishable.     By  sin 

■  came  man's  death,  by  perseverance  in  sin,  a  farther  abbreviation  of  life. 
We  must  admit  this  doctrine  of  Holy  Writ,  and  apply  it  philosophi- 
cally. We  may  not  reason  as  to  the  Order  of  Providence,  had  the 
material  man  been  immortal.  Doubtless,  ample  "room"  would  have 
been  provided  for  his  indefinite  multiplication,  at  least  in  the  ultimate 
abode  of  the  translated  Prophet. 

632,  Z».  But,  assuming  that  life  has  been  shortened  from  a  thousand 
years  to  "  three-score  and  ten"  by  the  agency  of  physical  causes, 
there  must  have  been  a  miraculous  change  in  the  condition  of  the  in- 
organic world,  since  it  has  been  without  change,  in  its  relations  to 
disease,  up  to  the  earliest  records ;  but  the  very  face  of  the  earth  as- 
sures us  that  there  has  been  neither  a  natural  nor  a  supernatural  change 
in  the  condition  of  matter,  or  in  the  laws  of  inorganic  nature.  We 
are  therefore  compelled  to  take  the  Revelation  of  Heaven  as  it 
stands ;  or,  in  denying  one  part,  to  deny,  also,  the  longevity  of  pri- 
meval man;  which  Avill  obliterate  all  common  ground  between  the 
disputants. — Notes  C  p.  1113,  Pp  p.  1142,  Gio.  p.  1145. 

633.  Life  does  not  generally  reach  what  may  be  called  its  natural 
termination.  We  have  already  seen  that  its  natural  extinction  is  the 
work  of  its  own  progressive  movements ;  that  it  is  the  result  of  tlie 
same  creative  operations  that  developed  the  ovum  into  the  new-born 
offspring, — that  continued  the  same  process  through  the  various  stages 
of  life  xrp  to  the  time  of  full  maturity, — that  still  went  on  with  the 

C  c 


402  INSTITUTES    OF    MEDICINE. 

work  of  superaddition,  till  at  last,  by  the  progressive  condensation  of 
organs,  by  clogging  the  sanguiferous  system  with  interstitial  deposits 
of  bony  matter,  &;c.,  it  loses  its  control  over  its  own  instruments  of 
action,  and  fails  for  want  of  means  to  carry  on  its  productive  opera- 
tions. It  is  not,  therefore,  from  any  natural  failure  of  the  properties 
of  life,  or  any  "  wearing  out  of  the  machinery,"  as  is  commonly  sup- 
posed, that  life  ultimately  becomes  extinct,  but  from  the  prolongation 
of  that  process  by  which  it  laid  the  substratum  for  those  active  oper- 
ations, which,  when  once  begun,  must  be  continued  in  uninterrupted 
progress  along  with  the  original  creative  function  (§  63-82,  123,  170  c, 
175  b,  176,  237,  584).  This  ultimate  effect,  as  well,  also,  as  the  ex- 
posure of  life  to  the  influence  of  morbific  causes,  is  a  striking  exem- 
plification of  the  Order  of  Providence  in  carrying  out  His  final  pur- 
poses in  the  natural  world,  where  the  general  plan  has  been  miracu- 
lously diverted  from  its  original  design  (§  632,  b). 

634.  The  principal  elements  in  the  production  of  death  may  be 
found  in  the  modes  by  which  it  may  be  suddenly  effected.  1st.  By  the 
failure  of  the  circulation,  as  in  syncope.  2d.  By  the  failure  of  respira- 
tion. 3d.  By  sudden  and  pernicious  determinations  of  the  nervous  pow- 
er upon  the  circulatory  and  other  important  organs.  4th.  By  the  same 
determination  of  the  nervous  power  upon  the  organic  properties  oi 
the  brain,  as  seen  in  instant  death  from  apoplexy,  anger,  joy,  surgical 
operations,  blows  on  the  stomach,  &c.,  though,  in  these  cases,  there 
is  also  a  pernicious  nervous  influence  propagated  to  the  heart,  &c.  (§ 
230,  510,  511).  Death  from  syncope  is  immediately  owing  to  the 
failure  of  the  heart  to  supply  other  parts  with  blood ;  though  the  ner- 
vous power  is  especially  instrumental  in  prostrating  the  organs  of  cir- 
culation (§  940-942,  947-949).  Death  from  abolition  of  the  respira- 
tory function  is  owing  especially  to  a  consequent  failure  of  the  decar- 
bonization  of  the  blood.  It  is  remarkable  how  speedily  a  loss  of  con 
gciousness,  and,  of  course,  of  all  sensation,  is  sustained  by  the  suspen-  ■ 
sion  of  this  function  ;  and  it  may  be  of  interest  to  some  to  know  the  facts 
as  lately  experienced  in  my  own  person.  Being  precipitated  into  a 
stream  of  water  by  the  upsetting  of  a  stage  (my  head  through  the  win- 
dow of  the  carriage),  and  perfectly  conscious  when  first  beneath  the 
watei",  the  reflections  which  occujiied  my  mind  could  not  have  contin- 
ued one  minute.  There  remains  the  most  distinct  recollection  of  that 
brief  period.  The  subsequent  details,  till  consciousness  was  restored 
may  not  be  without  an  interest.  My  momentary  efforts  at  extrica- 
tion were  defeated  by  the  weight  of  the  passengers,  and  I  continued 
to  occupy  the  foregoing  position  till  nine  of  them,  and  mostly  females, 
could  be  lifted  through  the  uppermost  door,  and  while  the  carriage, 
heavily  laden  with  baggage,  could  be  rolled  over.  This  process  con- 
sumed at  least  some  seven  or  eight  minutes,  and  three  or  four  more 
had  elapsed  after  my  extiication  before  signs  of  reanimation  began  to 
take  place.*  A  large  assemblage  of  farmers  from  the  neighboring 
fields  were  standing  around,  when  the  first  moment  of  consciousness 
was  announced  by  a  noise  as  of  distant  speakers,  and  a  simultaneous 
view  of  the  spectators.  Vision  was  at  once  perfect;  but  the  sounds 
advanced  pi-ogressively  nearer  and  nearer,  and  within  a  quarter  of  a 
minute  had  identified  themselves  with  their  proper  sources  ;  when, 
also,  consciousness  was  completely  re-established.  It  may  be  also  worth 
saying,  that  only  a  very  slight  uneasiness  attended  the  suffocation. 

*  I  have  lieen  since  informed  that  the  interval  was  more  thaatwentj'  minutes.     No- 
thing was  done  toward  reanimation. 


PHYSIOLOGY. DEATH.  403 

635.  Nothing  extinguishes  life  more  immediately  than  a  destruction 
of  all  the  functions  of  the  brain,  whether  by  a  direct  injury  of  the  or- 
gan, or  by  an  abolition  of  tlie  circulation.  The  effect  is  nearly  as  great 
when  interrupting  the  respiratory  process  by  dividing  the  medulla 
oblongata.  But  in  this  case  the  influences  are  different  from  such  as 
obtain  in  diseases  of  the  brain,  or  in  injuries  done  to  that  organ.  If 
sufficient  to  embarrass  or  to  suspend  respiration,  the  nervous  power  is 
determined  with  a  pernicious  effect  upon  all  the  organic  viscera ;  but 
very  variously,  according  to  the  nature  of  the  injury  or  of  the  disease 
(§  478-482,  510,  634,  948).  A  simple  removal  of  the  brain  and  spi- 
nal cord  occasions  death  not  only  by  suspending  respiration,  but  by 
interrupting  their  influence  upon  the  great  organs  of  life  ;  which  must 
be  also  true  within  greater  limits  of  the  division  below  the  medulla 
oblongata.  In  the  former  case,  as  we  have  seen,  no  pernicious  influ- 
ence of  the  nervous  power  is  determined  upon  the  organic  viscera ; 
in  the  latter,  a  direct  violence  being  inflicted  upon  the  spinal  cord,  a 
destructive  effect  is  propagated  upon  the  organic  properties,  which 
reaches  to  the  brain  itself  (§  129,  455,  456,  476*  h,  478,  479,  489, 
507,  1032  d,  1037). 

636.  Death  from  disease  generally  depends  upon  complicated 
causes,  and  upon  profound  aftections  of  more  organs  than  one.  In  a 
general  sense,  also,  the  particular  mode  of  death  will  depend  upon 
the  organs  diseased,  upon  the  violence  and  kind  of  affection,  and  upon 
the  particular  condition  of  other  parts. 

637.  It  is  rare  that  absolute  death  takes  place  at  once  in  all  parts. 
Evidences  of  this  are  seen  in  the  peristaltic  movements,  in  the  con- 
traction of  the  voluntary  muscles,  in  the  discharge  of  the  arterial  blood 
into  the  venous  system,  in  the  occasional  exaltation  of  heat,  &c.,  after 
apparent  death  (§  447,  d).  We  have  seen,  also,  how  remarkably  the 
heart  may  be  roused  into  action  long  after  its  pulsations  have  ceased 
(§  262,  498  e,  516  d,  no.  7),  continuing,  in  some  animals,  to  pulsate 
with  a  "  rustling  noise  for  ten  hours  after  being  hung  up  to  dry" 
{M.ed.  and  Physiolog.  Comm.,  vol.  i.,  p.  17).  In  other  instances,  the 
heart  has  been  "  often  seen  to  raise  a  weight  of  twenty  pounds,"  soon 
after  apparent  death  ;  and  Lord  Bacon  states  that  he  has  seen  the 
heart  of  a  criminal,  when  the  organ  was  thrown  into  a  fire,  leap  up 
one  foot  and  a  half,  and  to  continue  these  movements,  with  a 
gradual  decrease,  for  the  space  of  seven  or  eight  minutes  (§  188,  233, 
264,  265,  475|^,  498  e,  647-2).  In  my  work  on  the  Cholera  Asphyxia 
of  New  York,  1832,  I  have  spoken  of  contractions  of  the  voluntary 
muscles  which  continued  in  progress,  drawing  up  the  legs,  &c.,  for  an 
hour  and  a  half  after  apparent  death  (p.  141).  These  contractions  took 
place  without  the  application  of  any  exciting  cause,  apparently  like  the 
movements  of  the  extirpated  heart  and  intestine  (§  262,  476^  c,  490, 
498  e) ;  but  the  latter  are  due  to  the  stimulus  of  the  air  or  other  phys- 
ical causes.  There  remains,  therefore,  no  other  conceivable  exciting 
cause  of  the  contractions  than  the  stimulus  of  the  nervous  power  arising 
from  influences  incident  to  the  radical  change  in  the  organic  constitu- 
tion, analogous  to  that  development  which  is  attendant  on  syncope, 
and  which  in  this  case,  besides  its  powerful  demonstration  upon  or- 
ganic actions,  often  induces  spasm  of  the  voluntary  muscles  (§  948). 
The  analogies  in  this  respect,  and  such  as  are  represented  in  section 
500,  are  strongly  in  favor  of  reflex  nervous  action,  while  the  corres- 


404  INSTITUTES    OF    MEDICINE. 

25onding  action  of  the  extirpated  heart  and  intestine  may  seem  to  be. 
opposed  to  it.  The  analysis,  also,  of  sympathy  which  I  have  made  in 
preceding  sections  (500,  &c.)  shows  a  special  difference  in  the  mo- 
tive constitution  of  the  organic  viscera  and  of  the  voluntary  muscles, 
and  in  the  relative  agency  of  the  nervous  power  as  it  respects  their 
motions.  In  the  former  case  this  power  is  particularly  a  modifying 
agent  in  organic  actions ;  in  the  latter  it  is  simply  an  exciting  cause 
(§  188,  205,  215,  222,  &c.,  258,  500,  524  d,  no.  7,  891^  g,  k,  893^). 

If  the  foreoroinor  construction  be  true,  then  the  muscular  contrac- 
tions  which  follow,  after  apparent  death,  from  blows  upon  the  limbs, 
are  equally  due  to  the  development  and  action  of  the  nervous  power 
(§  516  d,  nos.  8,  9)  ;  and  the  whole  conclusion  is  farther  strengthened 
by  the  involuntary  movements  of  decapitated  animals,  and  by  the  mus- 
cular contractions  which  are  effected  by  the  stimulus  of  galvanism, 
both  in  life  and  apparent  death,  and  especially  when  consequent  on 
pricking  the  skin  after  removal  of  the  head.  The  latter  case,  indeed, 
is  exactly  analogous  to  motions  produced  in  the  limbs  of  the  human 
subject  by  mechanical  violence ;  since  in  the  case  of  the  decapitated 
animal  there  is  no  direct  irritation  of  the  muscles,  and,  therefore,  no 
joossible  mode  of  propagating  the  impression  upon  the  skin  to  the 
muscles,  excepting  by  reflex  nervous  action.  All  this,  too,  shows 
us  that,  whatever  differences  may  exist  between  the  vital  constitution 
of  man  and  animals,  and  among  animals,  they  are  essentially  consti- 
tuted alike,  subject  to  the  same  fundamental  laws,  and  having  only 
modifications  ingrafted  upon  them. — Note  A  p.  1111. 

It  may  be  thought  that  all  this  is  a  useless  refinement  in  philoso- 
phy. But  such  is  not  my  opinion ;  nor  have  I  any  doubt  that  better 
minds  will  carry  out  these  suggestions  to  more  important  develop- 
ments in  the  philosophy  of  life.  Even  in  death  itself  much  may  be 
gained  that  will  be  useful  in  physiology  ;  and  if  we  follow  the  organic 
being  till  he  is  resolved  into  elementary  substances,  we  shall  gather 
something  at  every  stage  of  the  process  that  will  contribute  light  to 
organic  science,  and  yield  an  interest  to  the  study  of  putrefaction  (§ 
/>4  a,  56,  62  e). 


PHYSIOLOGY. ITS    UNITY    OF    DESIGN. 


SUMMARY  CONCLUSION  OF  PHYSIOLOGY. 

638.  From  what  has  been  hitherto  said,  it  appears  that  medicine, 
in  all  its  branches,  is  a  perfect  whole,  bound  together  by  intimate  re- 
lations and  dependences,  nowhere  contradictory,  but  all  in  unison, 
and  irresistibly  flowing  from  one  great  system  of  Unity  of  D-esign, 
which  is  the  grand  characteristic.  The  foundation  is  laid  in  the  Prin- 
ciple  of  Life,  and  its  various  attributes.  The  demonstrations  of  that 
principle,  and  of  those  attributes,  begin  with  the  elements  of  organic 
beings,  their  number,  the  modes  in  which  they  are  united,  &c. ;  and 
the  sameness  of  the  principle  throughout,  and  the  coincidences  in  its 
laws,  are  attested  by  every  fact  in  physiology  and  medical  philosophy. 

By  recurring  to  the  demonstrations  already  set  forth,  it  will  be  seen 
that  my  fundamental  ground  is  clearly  established  ;  for,  whether  it  be 
the  elements  of  organic  beings  which  are  combined  in  peculiar  num- 
bers, proportions,  and  modes,  and  forever  in  one  peculiar  and  exact 
manner  in  every  distinct  part  of  every  organic  being,  and  which  are 
maintained  in  combination  against  the  adversities  of  disease,  and 
against  those  chemical  agencies  which  may  produce  their  almost  in- 
stant dissolution  when  the  vital  chain  is  severed  ;  and  whether  we  con- 
sider, also,  the  remarkable  nature  of  those  elements,  and  that  in  the 
animal  kingdom,  especially,  nitrogen  gas  abounds  in  the  various  tis- 
sues, notwithstanding  the  entire  kingdom  is  far  more  liable,  than  the 
vegetable,  to  chemical  decomposition  after  death  ;  or,  whether  we 
pause  at  the  threshold  of  life,  and  consider  all  the  unvarying  facts  at- 
tendant on  the  development  of  the  ovum,  how  one  part  after  another 
spi'ings  into  existence  in  a  never-deviating,  foreordained  manner,  and 
as  each  part  may  be  necessary  to  the  next  succeeding,  how  the  same 
exact  process  of  formation,  and  no  other,  is  continued  till  the  being 
becomes  again  a  subject  for  the  mineral  kingdom ;  how  the  semen, 
also,  is  a  type  of  all  the  various  subsequent  agents  of  life ;  how  we 
may  here  detect  the  nascent  causes  of  transmitted  disease,  operating 
in  conformity  with  those  which  play  their  part  in  the  external  world ; 
how  mind  itself  is  impressed  upon  the  embryo,  and  how  the  intellect- 
ual peculiarities  of  either  parent  maybe  ingi'afted  upon  the  offspring, 
as  are  their  physical  traits,  their  temperament,  their  constitution,  their 
very  manners, — where,  I  say,  all  is  uniformity  in  the  grand  movement 
of  organization,  and  nothing  but  coincidences  in  the  fluctuations  that 
may  arise  from  preternatural  causes,  and  always  the  same  according 
to  the  precise  nature  of  those  causes ;  or,  if  we  follow  the  immature 
being  to  its  state  of  maturity,  and  observe  that  the  progress  of  devel- 
opment is  always  the  same,  under  equal  circumstances,  at  every  stage 
of  its  progress,  whether  in  the  animal  or  the  plant,  and  notice,  also, 
the  coincidences  which  obtain  between  the  two  organic  kingdoms,  as 
in  the  changes  of  tissues,  in  the  variations  of  products,  up  to  the  con- 
summation of  the  whole  in  that  pei-fect  state  which  is  characterized 
by  the  development  of  the  generative  organs,  the  flower,  the  ovum, 
the  seed,  and  the  mutual  office  of  sexual  intercourse ;  or,  whether  it 
be  a  corresponding  exact  organization  and  vital  endowment  of  every 
part  of  every  organic  being,  yet  different  in  every  organ,  and  often  so 
in  different  parts  of  one  and  the  same  continuous  tissue  as  it  traverses 


406  INSTITUTES    OF    MEDICINE. 

different  parts  of  the  compound  organism ;  or,  whether  we  regard 
the  products  of  each  organ,  or  of  each  tissue,  or  of  the  several  parts 
of  a  continuous  tissue,  respectively,  and  observe  that  they  are  forever 
the  same  in  the  same  animal  or  plant,  under  equal  circumstances,  yet 
different  in  every  part,  and  more  or  less  different  from  each  other  in 
every  species,  whatever  the  similitude,  or  consider  that  the  same 
products  are  forever  modified  in  health  and  in  disease  in  one  exact 
manner,  under  any  given  modifying  influences,  whether  natural,  mor- 
bific, or  remedial ;  or,  whether  we  interrogate  the  nature  of  the  rela- 
tions by  which  external  or  internal  causes  divert  the  phenomena  from 
their  natural  states,  and  observe  that  the  results  depend  upon  the  ex- 
act original  and  acquired  nature  of  the  part  and  the  nature  of  the  in- 
fluences, and  that  they  are  in  perfect  harmony  with  such  as  emanate 
from  the  natural  stimuli  of  life ;  or,  whether  we  consider  how  the 
manifestations  of  disease  denote,  like  those  which  emanate  from  the 
natural  stimuli  of  life,  an  established  difference  in  the  closely-allied 
constitution  of  the  same  or  diflerent  tissues,  and  different  parts  of  a 
continuous  tissue,  as  in  the  inflammatory  affections  of  various  parts  of 
the  mucous,  or  the  serous  tissues,  and  the  more  remarkable  peculiari- 
ties attending  the  inflammations  of  the  lining  membrane  of  the  veins, 
— prostrating  the  circulation  and  giving  to  fever  its  malignancy ;  or, 
whether  it  be  a  small  current  of  air  impinging  upon  the  neck,  which 
will  suddenly  induce  an  attack  of  catarrh,  or  of  pneumonia,  or  of 
rheumatism,  when  no  such  effect  may  follow  an  equal  exposure  of  any 
other  part  of  the  surface,  or  even  of  the  entire  skin  for  an  equal  time ; 
or  whether,  in  a  remedial  aspect,  leeches,  or  a  warm  bath  applied  to 
the  feet,  may  restore  menstruation  when  the  same  applications  to  oth- 
er parts  might  be  insufficient,  or  other  analogous  phenomena  which 
abound  in  the  history  of  morbific  and  remedial  agents  ;  or,  if  we  con- 
sider the  philosophy  which  concerns  the  first  act  of  inspiration  as  gen- 
erated by  the  contact  of  air  with  the  surface  of  the  body,  and  that  it  is 
exactly  the  same  as  that  which  is  relative  to  the  first  inspiration  in  syn- 
cope when  cold  water  or  cold  air  are  applied  to  the  face,  or  stimulants 
to  the  Schneiderian  membrane,  and  even  the  same  when  the  mucous 
tissue  of  the  lungs  becomes  the  point  of  departure, — the  same,  too, 
which  concerns  all  those  modifications  of  respiration  which  are  known 
as  coughing,  laughing,  crying,  sneezing,  hiccough, — the  same  as  ob- 
tains when  light,  impinging  upon  the  retina,  produces  either  a  con- 
traction of  the  iris  or  a  paroxysm  of  sneezing, — the  same  as  when  a 
leaf  of  tobacco  applied  to  the  sole  of  the  foot  may  disturb  every  func- 
tion of  the  body, — the  same  when  cathartics,  or  emetics,  or  altera- 
tives, &c.,  may  send  their  influences  abroad  through  the  medium  of 
the  gastro-intestinal  mucous  membrane, — the  same  when  shame  mounts 
to  the  face,  or  fear  expels  the  blood  from  the  surface,  or  covers  it  with 
moisture,  or  stimulates  both  kidneys  and  bladder,  or  as  anger  con- 
vulses the  heart  and  braces  up  the  animal  muscles, — the  same,  in  prin- 
ciple, whether  one  or  the  other  be  applied  in  a  physiological,  patho- 
logical, or  therapeutical  sense ;  or,  whether  we  regard  the  organism 
as  a  whole,  and  consider  how  all  parts  concur  in  harmony  together ; 
how  numerous  parts  are  supplied  by  natural  stimuli,  consisting  of 
blood  or  of  products  from  it,  which  conspire  together  in  maintaining  the 
good  of  the  whole,  but  either  of  which  would  be  offensive  to  other 
parts,  and  disturb  the  hai'mony  of  the  whole ;  or  how  the  nervous 


PHYSIOLOGY. ITS    UNITY   >DF   DESIGN.  407 

power  sheds  its  regulating  influence  upon  all  parts  of  the  animal 
mechanism,  and  how,  through  that  same  power,  from  its  natural  sus- 
ceptibility to  the  existing  healthy  state  of  every  organ,  both  external 
and  internal  causes  may  lay  the  foundation  of  disease,  or  effect  its  re- 
moval, or  occasion  the  most  violent  commotions,  or  extinguish  life  in 
a  moment ;  or,  whether  we  consider  that  the  same  relative  facts  pre- 
vail in  respect  to  the  vital  signs  that  distinguish  the  physical  products, 
and  that  they  go  hand  in  hand  together,  under  the  same  established 
or  contingent  influences,  natural,  morbific,  or  remedial ;  oi",  whether 
we  scrutinize  the  coincidences  between  the  facts  that  are  relative  to 
the  changes  that  happen  at  the  different  eras  of  life,  and  to  gestation, 
lactation,  &c.,  and  such  as  are  brought  about  by  morbific  and  reme- 
dial agents,  and  consider  that  the  latter  are  a  necessary  consequence 
of  the  natural  mutability  of  the  fundamental  constitution  from  which 
the  former  emanate ;  and  that  those  which  are  natural  are  an  exact 
type  of  the  influences  and  their  mode  of  production  when  morbific  or 
remedial  agents  operate  upon  distant  parts  by  impressions  exerted 
upon  the  stomach  or  skin,  or  when  disease  of  one  organ  gives  rise  to 
disease  in  another ;  or,  whether  we  regard  the  con-esponding  facts  which 
are  relative  to  vital  habit,  or  those  which  result  from  the  influences 
of  climate,  &c.,  and  which  bestow  the  radical  modifications  that  form 
the  peculiarities  of  temperament,  &c.,  and  see,  also,  that  all  these  varia- 
tions are  produced  by  causes  that  operate  through  the  same  fundamen- 
tal constitution ;  or,  whether  our  hygienic  and  therapeutical  treatment 
may  be  greatly  regulated  by  each  of  the  foregoing  conditions,  wheth- 
er natural  or  acquired ;  or,  whether  it  be  the  peculiarities  of  idiosyn- 
crasy that  render  certain  ordinary  articles  of  food  morbific  to  certain 
individuals,  or  the  analogous  constitution  of  marine  and  terrestrial 
plants  which  demands  for  the  former  the  briny  waters  of  the  ocean, 
while  they  are  fatal  to  the  latter  ;  or,  whether,  in  like  way,  the  mere 
approach  within  ten  feet  of  the  poison  rhus  will  produce  a  violent 
erysipelatous  imflammation  over  the  whole  surface  of  one  person, 
when  even  the  handling  the  plant  will  never  affect  another;  or, 
whether  the  rolling  of  a  few  blue  pills  with  the  fingers  will  establish 
salivation,  and  affect  the  adult  constitution  of  some,  while  a  pound  of 
calomel  taken  by  the  stomach  will  not  affect  others  in  a  similar  man- 
ner, and  rarely  at  the  early  stages  of  life ;  or,  whether  it  be  blood- 
letting, or  the  mercurial  or  the  antimonial  alteratives,  that  are  often 
baffled  by  the  precise  modifications  of  the  specific  forms  of  active  in- 
flammation, while  they  readily  subdue  the  common  form  and  many 
specific  chronic  inflammations,  and  whose  differences  in  results  de- 
note the  modifying  influences  of  the  remote  causes  of  closely  analo- 
gous affections ;  or,  whether  mercurial  agents  be  strictly  morbific  in 
their  action  upon  the  salivary  glands,  while  they  are  simultaneously 
and  powerfully  curative  of  hepatic  and  other  diseases  ;  or,  whether  a 
mercurial  cathartic  will  induce  salivation  if  the  susceptibility  of  the 
system  be  increased  by  the  associate  use  of  other  cathartics  or  by  loss 
of  blood,  when, per  se,  no  such  effect  may  be  produced;  or,  whether 
the  same  effect  follow  the  mitigation  of  fever,  when  no  extent  of  the 
remedy  may  reach  the  constitution  in  high  grades  of  febrile  action ; 
or,  whether  the  bite  of  the  mad  dog  will  produce  hydrophobia  in 
all  mammalia,  while  the  disease  cannot  be  imparted  by  any  other 
than  the  caniae  and  feline  tribes ;  or,  whether  the  poison  of  the  rat- 


408  INSTITUTES    OF    MEDICINE. 

tle-snake,  or  of  the  wourari  tree,  or  numerous  other  poisons  which 
are  certainly  and  rapidly  fatal  when  inserted  beneath  the  skin,  be 
perfectly  innoxious  when  taken  into  the  stomach  or  applied  to  the 
surface  of  the  brain ;  or,  whether  it  be  the  virus  of  the  small-pox,  of 
measles,  &c.,  that  effects  certain  modifications  of  the  vital  states  rel- 
ative to  each  particular  agent,  and  to  no  other,  that  forever  protect 
the  system,  in  a  general  sense,  against  a  second  attack  ;  or,  whether 
it  be  the  cow  alone,  as  with  other  animals  in  respect  to  the  virus  of 
hydrophobia,  that  can  so  modify  the  variolous  poison  as  to  generate 
in  man  the  equally  protective  vaccine  disease  ;  or,  whether  the  sus- 
ceptibility sometimes  remain  so  as  to  give  rise  to  another  modifica- 
tion, while  the  varioloid,  in  its  mildest  state,  but  not  the  vaccine,  will 
generate,  by  contagion,  in  the  unprotected,  the  most  virulent  form  of 
the  original  disease ;  or,  whether  it  be  the  analogous  miasmata  that 
only  slowly  extinguish  the  susceptibility  to  their  morbific  effects  after 
repeated  attacks  of  the  particular  forms  of  fever  which  they  are,  re- 
spectively, capable  of  producing,  or,  if  the  subject  thus  acclimated  re- 
move to  another  region,  his  original  susceptibility  may  return, — being 
analogous,  also,  to  those  physical  agencies  which  establish  the  temper- 
aments, and  which  change  from  one  to  another  as  the  old  influences 
may  cease,  and  new  ones  operate,  while  analogies,  in  these  respects, 
are  also  supplied  by  the  variolous'  and  vaccine  diseases ;  or,  whether 
it  be  bloodletting,  or  an  emetic,  or  a  cathartic,  that  produce  their  al- 
terative effects  with  a  rapidity  proportioned  to  the  rapidity  in  which 
their  sensible  operation  goes  on ;  or,  whether  it  be  the  alterative  in 
small  doses,  and  in  its  abstract  sense,  that  slowly  establishes  analogous 
changes  in  the  morbid  states  ;  or,  whether  an  alterative,  as  antimony, 
for  example,  must  be  generally  increased  in  its  successive  doses  to 
keep  up  the  effect  of  the  first  dose,  or,  if  there  be,  in  respect  to  an- 
timony, a  suspension  of  the  remedy  for  at  least  twelve  hours,  wt 
must  then  go  back  to  the  original  smaller  quantity  to  avoid  an  exces 
sive  effect ;  or,  whether,  on  the  other  hand,  other  alteratives,  like 
mercury,  or  foxglove,  or  cantharides,  or  arsenic,  or  quinine,  or  ipecac- 
uanha, will  manifest  no  sign  of  their  influence  for  several  succes- 
sive doses,  but  will,  at  last,  without  any  increase  of  the  dose,  sud- 
denly display  the  full  effect  of  their  virtues ;  or,  whether  by  associa- 
ting ipecacuanha  with  the  sulphate  of  zinc,  the  latter  will  so  exalt  the 
susceptibility  of  the  stomach  that  the  two  agents,  otherwise  une- 
qual in  time,  will  simultaneously  co-operate  in  their  emetic  effects 
or  whether,  in  the  same  way,  a  diffusible  stimulant,  associated  with 
a  permanent  tonic,  will  quicken  greatly  the  action  of  the  latter ; 
or  whether,  in  like  manner,  and  like  the  virus  of  small-pox,  of  mea- 
sles, &c.,  or  like  the  miasmata,  it  be  opium,  or  hyoscyamus,  or 
digitalis,  or  mercury,  &c.,  that  reduce  or  increase  the  suscepti- 
bility of  the  stomach  and  of  the  general  system  in  relation  to 
the  virtues  of  each  agent,  respectively,  but  to  those  of  no  other ; 
or,  whether  we  consider  other  examples  of  vital  habit,  and  observe 
how  pungent  stimuli  cease  to  annoy  the  nose,  the  mouth,  the  stomach, 
&c.,  but  only  so  Iti  relation  to  each  of  the  agents,  respectively,  or  how 
tobacco,  which  is  morbific  in  most  diseases,  and  originally  offensive 
to  all,  finally  becomes  the  most  universal  luxury  of  man ;  or  whether 
we  consider  the  manner  in  which  the  alteratives,  in  there  small  and 
oft-repeated  doses,  maintain  their  influence,  and  extend  their  silent 


PHYSIOLOGY. ITS    UNITY    OF    DESIGN.  409 

invasions  upon  disease,  or  how  emetics,  or  cathartics,  continue  to 
propagate  their  curative  effects  after  their  complete  expulsion  from 
the  body,  and  see  that  the  principle  is  disclosed  by  the  natural  phe- 
nomenon of  the  permanent  contraction  of  the  sphincter  muscles,  which, 
although  the  urine  or  the  contents  of  the  rectum  be  evacuated,  are 
maintained  in  equal  contraction  by  the  irritation  which  remains  upon 
the  mucous  tissue,  and  through  which  the  nervous  power  is  uninter- 
ruptedly reflected  upon  the  sphincter  muscles  ;  or  whether  we  re- 
gard the  coincidence  between  respiration,  spasmodic  affections,  and 
the  voluntary  movements  of  the  respiratory,  or  of  other  muscles,  and 
observe  that  each  is  alike  due  to  the  jiropagation  of  the  nervous  pow- 
er upon  those  muscles  ;  or  whether  we  contemplate  the  same  vital 
agent  in  its  production  or  removal  of  disease,  and  in  its  absolute  mode 
of  operation,  and  see  that  the  changes  which  are  thus  effected  consist 
in  some  alteration  of  the  natural  or  morbid  states,  and  according  to 
the  nature  of  the  remote  cause,  whether  it  be  positive,  like  mercury, 
or  negative,  like  cold,  or  immaterial,  like  the  mind  and  its  passions, 
and  according,  also,  to  the  special  exercise  of  one  mental  power  or 
another,  or  the  operation  of  one  passion  or  another,  and  thus  proving 
the  susceptibility  of  the  nervous  power  to  various  modifications  that 
coincide  with  the  virtues  of  the  remote  cause,  and  a  coincidence,  in 
this  respect,  with  the  changes  which  are  perpetually  exhibited  in  the 
organic  vital  conditions,  and  which  are  even  brought  about  by  the  ner- 
vous power  itself;  or,  whether  we  realize  the  foundation  of  these  last 
phenomena  in  the  naturally  exquisite  susceptibility  of  the  nervous 
power  to  various  influences,  that  it  may  constantly  operate  as  a  regu- 
lator of  the  rhythmic  movements  of  all  parts,  and  through  a  law  of  the 
nervous  system  by  which  all  parts  are  exquisitely  sensitive  to  the  con- 
dition of  each  other,  and  through  which  all  remote  morbific  and  re- 
medial influences  are  exerted  ;  or  whether,  in  like  way,  inflammations 
are  varied  in  their  character  by  contused,  and  punctured,  and  incised 
wounds,  or  more  greatly  so  by  all  animal  and  vegetable  poisons, 
whether  morbid  or  natural,  and  mostly  so  according  to  the  special  na- 
ture of  the  remote  causes,  respectively,  or,  if  subordinate  influences 
diversify  the  effects  of  many  principal  causes,  there  be  others  which 
control  all  other  influences,  as  in  small-pox,  measles,  scarlatina,  &c.  ; 
or  whether  in  fever,  as  in  inflammation,  there  be  analogous  varieties, 
corresponding,  in  like  manner,  with  the  special  virtues  of  each  cause, 
while  the  fundamental  pathology  is  of  one  common  nature  in  all  the 
varieties  of  inflammation,  and  of  another  common  nature  in  all  fevers  ; 
or  whether  an  ephemera  be  the  type  of  the  intermittent,  the  remittent, 
and  continued  fevers,  and  of  their  several  modifications,  and  consider 
how  the  paroxysms  of  the  intermittent  commonly  observe  established 
intervals  of  twenty-four,  forty-eight,  and  seventy-two  hours,  or,  if  the 
usual  time  be  anticipated  or  delayed,  the  paroxysms  are  then  apt  to 
go  on  with  the  particular  irregularity  with  which  they  began,  or  when, 
by  regular  anticipations  of  the  period  of  each  last  preceding  paroxysm 
they  approach  the  night,  one  paroxysm  is  often  lost ;  or  whether  we 
look  at  the  effects  of  all  our  best  and  most  universally  remedial  agents, 
as  bloodletting,  mercury,  antimonials,  cathartics,  &c.,  and  see  that  they 
are  strictly  morbific  to  the  healthy  system,  in  their  remedial  doses, 
and  that,  therefore,  they  are  at  least  equally  so  in  their  action  upon 
diseased  organs,  yet  contributing  to  their  cure ;  and  while,  also,  we 


410  INSTITUTES    OF    MEDICINE. 

know  that  neither  such  nor  other  agents  can,  of  themselves,  transmute 
the  morbid  organic  changes  to  those  conditions  which  are  natural  to 
the  being,  we  yet  discern  the  reasons  of  their  favorable  effects  in  the 
spontaneous  and  successful  efforts  of  unaided  nature,  and  in  those 
epeedy  recoveries  from  morbid  states  that  are  induced  in  the  healthy 
system  by  remedial  agents,  in  their  remedial  doses,  and  thus  infer 
that  remedies  only  contribute  to  the  cure  of  all  diseases  by  instituting 
morbid  changes  that  are  more  conducive  to  the  naturally  recuperative 
process  ;  or,  whether  the  cure  of  intermittents  be  effected  by  bark,  or 
arsenic,  or  cobweb,  or  opium,  or  an  emetic,  or  bloodletting,  or  absti- 
nence, or  by  an  emotion  of  the  mind,  &c. ;  or  whether  it  be  stimulants 
or  sedatives,  bark  or  bloodletting,  conjointly  or  separately,  that  may 
subdue  many  inflammations,  acute  or  chronic,  and  thus,  also,  prove 
the  near  identity  of  the  pathological  state  in  all  the  varieties,  and  that 
nature  recognizes  no  such  opposite  conditions  as  active  and  ^as^iVe  in- 
flammation ;  or  whether  it  be  the  abi"upt  removal  of  pertussis  by  an 
hour's  exposure  to  the  open  air  where  all  other  means  had  failed,  or 
the  improvement  of  an  ulcerated  limb  by  the  same  temporary  influ- 
ence ;  or  whether  ice,  or  ipecacuanha,  or  common  salt,  or  opium,  or 
bloodletting,  or  the  sulphates  of  zinc,  and  of  copper,  or  catechu,  or 
kino,  &c.,  will  alike  aiTest  capillary  hemorrhage  or  redundant  secre- 
tions, by  modifying  the  action  of  the  capillary  vessels  ;  or  whether  loss 
of  blood,  and  tartarized  antimony,  or  a  dash  of  cold  water  upon  the 
surface  of  the  body,  or  even  a  warm  bath,  be  far  better  "  refrigerants" 
than  pounds  of  ice,  or  of  lemonade,  taken  into  the  stomach  ;  or  wheth- 
er, among  the  "  sudorijlcs,^^  the  drinking  of  hot  water,  of  mint-teas, 
&c.,  will  excite  a  more  immediate  and  more  profuse  perspiration  than 
tartarized  antimony,  or  ipecacuanha,  &c.,  and  the  fonner  exert  no 
other  apparent  effect,  while  the  latter  may  be  profoundly  curative  or 
morbific,  or  bloodletting  surpass  the  whole  in  all  these  respects ;  or 
whether  it  be  the  "  sialogogue,"  like  horse-radish,  which  only  exerts 
an  effect  on  the  salivary  glands  through  a  continuous  irritation  along 
the  salivary  ducts,  or  mercury,  which  induces  salivation  only  by  consti- 
tutional influences  ;  or,  whether  we  turn  our  attention  to  other  corre- 
sponding laws,  and  to  other  analogous  coincidences,  and  consider,  for 
example,  how  all  but  chyme  is  prevented  from  passing  the  pyloric  ori- 
fice, how  all  but  the  air  is  excluded  from  the  lungs,  how  all  but  chyle 
from  the  lacteals,  how  all  but  white  blood  from  the  serous  vessels  of  the 
arterial  system,  notwithstanding  the  far  greater  diameters  of  some  than 
those  of  the  red  globules,  and  yet  that  when  the  irritability  of  one  is  mor- 
bidly affected,  as  in  indigestion,  solid  food  will  pass  out  of  the  stomach ; 
or  of  another,  as  when  certain  morbid  impressions  are  made  upon  the 
lacteals,  the  deleterious  agents  may  obtain  a  sparing  admission;  or  of 
another,  as  in  inflammation,  the  red  globules  are  allowed  to  pass  freely 
in ;  or,  if  we  glance  at  those  more  astonishing  phenomena  which  at- 
tend the  generation  of  animal  heat,  and  observe  that  all  non-hiberna- 
ting mammalia  maintain  one  uniform  temperature,  under  all  circum- 
stances of  food,  clothing,  &c.,  whether  at  the  poles  or  at  the  equator, 
yet  each  species,  respectively,  possessing  a  temperature  of  its  own, 
and  that  the  very  giant  of  the  mammiferous  trilse,  in  the  midst  of 
everlasting  icebergs,  obeys  this  law  of  uniform  and  exalted  heat, — 
exalted  not  less  than  four  degrees  above  that  of  man ;  or  turn  our 
admiring  contemplation  to  the  few  exceptions  that  occur  in  the  hi- 


PHYSIOLOGY. ITS    UNITY    OP   DESIGN,  -  41] 

Dernating  group,  and  see  how  that  temperature,  which  is  equally  uni- 
form under  all  torrid  and  temperate  degrees  of  the  circumambient 
air,  sinks  down  as  the  thermometer  descends  from  40°  F.  till  the  ani- 
mal scale  reaches  nearly  the  freezing  point,  and  then  rises,  with  a 
bound,  to  its  original  exalted  standard,  while  the  mercury  goes  on  to 
the  point  of  zero ;  or,  if  we  drop  from  this  gradation  in  analogy,  to 
the  cold-blooded  race,  and  observe  how  they  obey  the  physical  law 
of  an  interchange  of  caloric  with  the  surrounding  medium,  yet  within 
the  limitation  of  a  specific  and  independent  power  of  maintaining  a 
counteracting  influence  that  preserves  them  at  a  few  degrees  of  heat 
above  the  lowest  of  the  external  medium  which  may  be  endured, — 
eating,  digesting,  and  perfoi-ming,  too,  the  same  organic  functions  as 
the  mammalia ;  or,  if  we  consider,  also,  the  same  peculiarities  in  the 
living  egg,  and  their  absence  where  its  incubating  property  is  extinct; 
or,  if  we  turn  ourselves  to  the  vicissitudes  of  temperature  which  at- 
tend the  phenomena  of  disease,  and  remark  how  they  correspond 
with  all  the  admitted  vital  changes, — risinor,  in  one  case,  to  a  desrree 
of  mtensity  where  there  is  almost  a  total  privation  of  food,  and  an  ex- 
tensive destruction  of  the  lungs,  or  sinking,  in  another,  to  an  almost 
icy  coldness,  where  the  subject  is  plethoric  and  the  stomach  is  crowd- 
ed with  food  and  alcoholic  stimulants ;  or  whether,  also,  we  regard 
the  same  principle  in  its  natural  state,  as  seen  in  the  process  attend- 
ing the  reproduction  of  the  stag's  horn,  or  in  that  of  lactation,  and 
consider  that  here  is  the  fundamental  element  implanted  in  the  con- 
stitution for  great  and  wise  purposes,  and  that  every  other  consideration 
points  us  directly  to  the  natural  constitution  itself  for  an  interpretation 
of  every  phenomenon  in  the  history  of  animal  temperature,  and  dedu- 
ces a  coincidence  between  these  phenomena  and  those  of  the  organic 
processes,  under  every  aspect  of  stability,  individuality,  and  of  change; 
or  whether  it  be  a  thousand  other  diff*erent,  but  analogous  considera- 
tions, relative  to  the  influences  of  foreign,  natural,  morbific,  or  reme- 
dial agents  upon  man  or  other  organic  beings  ;  or  whether  we  again 
look  to  the  mind  and  its  passions,  and  see  the  long  exercise  of  judg- 
ment impairing  digestion,  while  imagination  comes  in  as  a  speedy  re- 
storative ;  or  whether  it  be  anger  or  joy,  like  a  blow  on  the  stomach, 
or  like  the  shock  of  a  surgical  operation,  that  strike  us  dead  in  a  mo- 
ment, or  grief  that  does  but  slowly  undermine,  or  hope  that  throws 
its  balmy  influence  over  every  disease,  by  whatever  cause  produced  ; — 
whether,  I  say,  it  be  one  or  the  other  of  the  considerations  now  men- 
tioned, or  thousands  of  thousands  of  similar  import,  which  crowd  the 
history  of  living  objects,  each  and  all  are  in  harmony  with  each  other, 
and  concur  together  in  one  universal  demonstration  of  the  peculiar  con- 
stitution of  animated  beings  as  distinguished  from  the  inorganic  king- 
dom, and  declare  their  essential  dependence  upon  one  principle,  name- 
ly, a  Vital  Principle,  of  various  elements  or  properties,  whose  definite 
character  in  their  natural  conditions,  and  whose  instability  or  liability 
to  permanent  and  temporary  modifications  and  changes,  and  whose 
disposition  to  return  from  such  as  are  only  temporary  to  their  original 
state,  lie  at  the  foundation  of  all  the  phenomena,  will  explain  every 
phenomenon,  and  whose  unity  as  a  whole  is  supported  by  every  phe- 
nomenon of  organic  beings.  This  consideration,  therefore,^  assures  us 
that  we  have  already  compassed  the  general  philosophy  of  life,  of  dis- 
ease, and  of  medicine ;  and  we  contemplate  with  admiration  the  a^m- 


412  INSTITUTES    OF    MEDICINE. 

plicity,  yet  complexity,  of  the  principles,  the  stupendous  whole,  as  it 
swells  from  the  comparatively  simple  phenomena  of  the  development  of 
the  ovum,  when  the  properties  of  Hfe  are  exposed  to  no  influences  that 
shall  affect  their  instable  nature,  till  we  have  traversed  the  animal  king- 
dom in  all  its  exposures  to  those  influences,  and  have  witnessed  the  in- 
calculable variety  of  change  which  the  organic  properties  and  functions 
sustain  in  consequence  of  those  exposures,  and  observe  that  the  whole 
immense  system,  all  the  variety,  springs  from  the  simple  influences  of 
external  and  internal  causes  upon  the  properties  of  life,  and  that  slight 
changes  in  these  properties,  like  the  differences  which  prevail  among 
the  results  of  their  natural  modifications  in  different  animals,  and  in  dif- 
ferent parts  of  a  common  or  a  continuous  tissue,  give  rise  to  all  the  dif- 
ferences between  health,  disease,  and  convalescence ; — in  the  contem- 
plation of  all  these  things,  I  say,  we  are  employed  in  witnessing  the  most 
comprehensive  and  sublime  system  of  Unity  of  Design,  and  enjoy  the 
conviction  that  we  are  cultivating  a  science  whose  foundations  are  laid 
in  the  most  Consummate  Wisdom  (§  1085). — Note  Re  p.  1145. 

REVIEW  OF  THE  LAWS  OF  REFLEX  ACTION  OF  THE  NERVOUS  SYSTEM,  AND 
AS  APPLIED  PATHOLOGICALLY  AND  THERAPEUTICALLY. 

638|.  A  large  space  has  been  given  to  the  consideration  of  the  nerv- 
ous system,  especially  to  experimental  observations  upon  it,  for  the 
purpose  of  developing  the  Laivs  of  Reflex  Nervous  Action^  or,  as  I  have 
called  them,  also,  for  obvious  advantages,  Remote  and  Contiguous  Sym- 
pathj^  or,  indifferently,  Sympathy.  All  this  inquiry  has  been  made 
Avith  a  sole  reference  to  the  application  of  those  laws  to  many  important 
problems  in  Physiology,  particularly  nutrition,  secretion,  modifications 
of  structural  development,  calorification,  and  circulation,  and  to  erect- 
ing upon  them  a  substantial  and  philosophical  fabric  of  Pathology  and 
Therapeutics,  which  still  lies  extensively  before  us,  and  for  the  purpose, 
also,  of  simultaneously  accomplishing  the  overthrow  of  the  chemical  and 
physical  doctrines  now  prevailing  in  all  the  departments  of  medicine. 
Although  I  am  about  to  enter  upon  the  specific  application  of  the  Laws 
of  Reflex  Action  of  the  Nervous  System  to  Pathology  and  Therapeutics,  I 
have,  nevertheless,  been  constantly  employed  in  exemplifying  the  mor- 
bific and  therapeutical  aspects  of  those  laws  as  founded  upon  their  nat- 
ural conditions.  An  indispensable  requisite  for  this  application  is  a  rea- 
sonable proof  of  the  modification  of  the  nervous  power  according  to  the 
nature  of  the  cause,  whether  physical  or  moral,  by  which  it  is  brought 
into  pi'eternatural  operation,  nor  is  there  any  other  consistent  or  intelli- 
gible mode  of  interpreting  the  great  range  of  pathological  and  therapeu- 
tical problems,  and  the  multifarious  displays  of  the  passions  in  organic 
life,  according  to  their  individual  natui*e.  The  whole  of  the  Author's  phi- 
losophy upon  this  vast  subject  is  predicated  of  the  well-established  laws 
of  reflex  action  of  the  nervous  system,  nor  is  he  aware  of  any  fact  by 
which  that  philosophy  is  contradicted,  Avhile,  besides  the  admitted  prem- 
ises, it  is  sustained  by  the  whole  history  of  morbific  and  remedial  agents, 
and  by  the  diseases  which  grow  out  of,  and  are  maintained  by,  each  other. 
It  may  be  finally  added,  that,  although  the  Author  has  shown  that  the 
passions,  the  will,  cerebral  diseases,  and  other  causes  acting  directly  upon 
the  nervous  centres,  develop  and  project  the  nervous  power  without  the 
intervention  of  sensitive  nerves,  he  has  also  shown  that  the  essential  phi- 
losophy is  the  same  as  that  which  respects  reflex  nervous  action  (^  453). 


PATHOLOGY.  413 


PATHOLOGY. 

639,  a.  Having  now  laid  a  broad  foundation  for  the  superstructuie 
of  pathology  and  therapeutics,  in  the  exposition  of  the  properties,  the 
functions,  and  the  laws  of  organic  beings  in  their  natural  states,  and 
in  contrasting  the  philosophy  of  the  more  difficult  problems  with  those 
interpretations  which  have  been  borrowed  from  the  phenomena  of 
the  inorganic  world,  that  nothing  may  obstruct  our  way,  and  that 
whatever  is  true  in  any  of  the  conflicting  views  may  shine  with  great- 
er lustre,  I  am  thus  prepared  to  go  on  with  those  lofty  objects  about 
which  the  healing  a'.t  is  immediately  interested.  I  say,  to  go  on;  for 
in  all  my  physiological  inquiries  I  have  endeavored  to  indicate  their 
relations  to  the  ultimate  branches  of  medicine,  and  to  approach  these 
branches  already  prepared  with  a  connected  view  of  their  depend- 
ence upon  natural  institutions.  The  complexities  in  physiology  give 
rise  to  corresponding  intricacies  in  pathology  and  therapeutics,  and  it 
has  been  therefore  necessary  to  explore  the  ground-work  in  such  vuri- 
ous  methods,  and  with  such  variety  of  illustration,  as  shall  impart  to 
pathology  and  therapeutics  a  consistency  in  principles,  a  ready  inter- 
pretation of  their  endless  problems,  and  give  to  the  hand  of  art  en- 
lightened confidence  and  firmness  in  the  right.  I  have  designed  that 
this  right  shall  follow  naturally  and  easily  from  the  premises  hitherto 
laid  down,  and  if  I  have  come  short  of  that,  then  have  I  failed  in  fun- 
damental requisites.  No  system  in  physiology  can  stand  which  is  not 
true  to  Nature  in  her  altered  aspects  ;  none  that  does  not  come  to  her 
interpretation  under  all  the  varied  conditions  and  phenomena  of  dis- 
ease ;  none  whose  elements  conflict  with  each  other  (§  516  d,  no.  6, 
524  a,  524  d).  There  must  be  clearness,  individuality,  harmony,  dem- 
onstration. I  claim  not  that  I  have  accomplished  all  this.  I  do  but 
say  that  I  have  attempted  it,  and  with  an  earnest  hope  that  the  effort 
may  not  prove  abortive.  As  much  has  been  said,  and  much  remains, 
which  is  original  with  myself,  and  generally  relative  to  the  most  pro- 
found and  important  topics,  and,  as  there  has  existed  the  necessity  of 
exhibiting  in  a  satisfactory  manner  those  conflicting  errors  which 
have  obtained  such  general  ascendency,  I  have  been  impelled  to  all 
the  amplitude  of  inquiry  which  may  obtain  either  the  acquiescence  of 
the  profession  in  the  doctrines  which  I  have  taught,  or  their  ready  re- 
jection (§  1,  285,  1067). — See  Rights  of  Authors,  p.  912. 

639,  b.  Pathology  concerns  the  changes  which  the  vital  propei- 
ties  and  functions  undergo  in  disease,  and  the  resulting  changes  in 
the  vital  and  physical  signs,  and  finally  reaches  to  those  lesions  of 
organization  that  fall  within  the  purview  of  morbid  anatomy  (§  695, 
&c.). 

Pathology  consists  essentially,  therefore,  of  those  modified  states  of 
the  physiological  conditions  which  constitute  disease. 

640.  Such,  also,  are  the  relations  between  the  natural  physiological 
conditions  and  those  diversions  which  make  up  disease  that  the  latter 
often  reflect  the  most  important  light  upon  the  natural  ones.  The 
properties  of  life,  in  all  their  aspects,  as  well  as  their  corresponding 


414  INSTITUTES   OF    MEDICINE. 

functions,  are  not  unfrequently  best  comprehended  through  the  phe- 
nomena which  distinguish  their  various  departures  from  the  normal 
standard  (§  198,  303|).   Chemists,  therefore,  cannot  be  physiologists. 

641.  Pathology  is  divided  into  general  and  special.  The  first  con- 
siders diseases  in  common  ;  the  second  treats  of  the  particular  history 
of  diseases.  A  distinction  has  been  also  made  into  medical  and  sur- 
gical pathology ;  but  it  is  unfounded  in  nature,  though  it  may  be  con- 
venient in  practice. 

642,  a.  As  all  diseases  have  their  remote  causes,  which  often  reflect 
much  light  upon  pathological  conditions,  these  should  be  embraced  in 
the  department  of  pathology. 

642,  b.  The  vital  properties  are  so  susceptible  in  their  nature  that 
the  good,  as  well  as  the  evils  of  life,  is  constantly  inflicting  disease. 
Whatever  is  salubrious  in  due  proportions  becomes  morbific  in  excess. 
The  mildest  nutriment  in  excessive  quantities,  or  at  unseasonable 
times, — an  unrestrained  indulgence  of  the  passions, — inordinate  exer- 
cise, &c.,  prove  the  instability  of  the  vital  powers.  We  are  also  sur- 
rounded by  agents  of  noxious  virtues,  some  of  which  we  may  avoid, 
but  covet  as  luxuries, — while  others,  if  we  would  avoid,  are  beyond 
our  control  (§  150,  152). 

643.  We  are  therefore  led  to  consider  pathology  under  three  prin- 
cipal heads ;  namely, 

I,  Remote  Causes  of  Disease. 
II.  Proximate  or  Pathological  Causes. 
III.  Symptoms. 

1.    REMOTE    CAUSES. 

644.  The  remote  causes  of  disease  are  the  first  in  the  series.  By 
their  deleterious  action  on  the  properties  of  life  they  give  rise  to 
those  changes  which  constitute  the  proximate  or  pathological  causes, 
or  the  essential  conditions  of  disease  (^  188-192). 

645,  a.  Remote  causes  are  subdivided  into  predisposing  and  exci- 
ting or  occasional  causes. 

645,  b.  The  predisposing  causes  are  the  most  important;  being  in- 
dispensable to  all  idiopathic  fevers,  and  to  all  specific  forms  of  disease. 

645,  c.  The  exciting  or  occasional  causes  are  such  as  develop  an  at- 
tack of  disease  after  the  predisposing  have  laid  the  foundation.  The 
latter,  therefore,  may  produce  their  full  impression,  and  the  subject 
escape  an  attack,  unless  afterward  exposed  to  the  exciting  causes. 
The  predisposing,  however,  often  operate  with  such  intensity  as  to 
prove  exciting,  also ;  as  in  small-pox,  measles,  hydrophobia,  poisons, 
injuries,  malaria,  &c.  (§  559).  But  the  mildness,  or  intensity,  of 
many  of  these  affections,  as  in  the  contagious  diseases,  may  depend 
upon  the  antecedent  operation  of  other  modifying  causes  ;  whether 
of' a  predisposing  or  pi-otective  nature  (§  630  e). 

Again,  the  exciting  cause  often  consists  of  something  which,  under 
ordinary  circumstances,  may  be  perfectly  inoffensive  ;  such  as  a  full 
meal,  a  few  glasses  of  wine,  privation  of  sleep,  anxiety,  grief  In 
such  cases  there  has  always  been  an  antecedent  predisposing  cause 
in  operation  ;  but  either  of  the  foregoing  may  operate  both  as  predis- 
posing and  exciting  causes. 

646,  a.  Remote  causes  are  either  internal  or  external. 

646,  b.  The  internal  consist,  for  example,  of  the  passions,  laborious 


PATHOLOGY. REJIOTE    CAUSES.  415 

Study,  retention  of  the  faeces,  hereditary  predispositions,  &c.  (§  75-80, 
144,  561). 

646,  c.  The  external  consist,  1st.  Of  such  as  are  ordinarily  sahitary, 
but  become  morbific  by  their  excessive  or  too  frequent  use,  or  when 
used  at  undue  seasons,  or  when  the  body  is  disqualified  for  their  use. 
8d.  Such  agents  as  injure  mechanically  the  structure  of  our  bodies. 
3d.  The  great  class  of  truly  morbific  agents,  which  embraces  a  large 
variety  in  the  several  departments  of  nature,  comprehending,  even,  a 
large  proportion  of  the  materia  medica,  when  exceeding  the  thera- 
peutical doses,  or  when  employed  in  these  doses  under  circumstances 
of  health  (§  177,  191  b,  237-240,  524  d,  854  c-/,  893,  900,  901,  905). 

647,  Among  the  most  important  of  the  internal  remote  causes  of 
disease  ai'e  morbid  conditions  already  formed.  They  may  be  either 
exciting  or  predisposing,  or  operate  as  conjoint  causes.  In  the  former 
case  other  causes  have  brought  about  the  predisposition.  Thoy  are 
the  great  fountain  of  sympathetic  developments. 

647^.  The  nervous  influence,  reflex  or  direct,  is  the  immediate  remote 
cause  (predisposing  or  exciting),  of  nearly  all  disordered  states  beyond 
the  seat  of  the  direct  action  of  other  causes  (§  222-2334). 

648,  a.  The  predisposing  causes  are  general  and  specific. 

648,  h.  The  general  are  such  as  may  be  in  simultaneous  operation 
upon  many  individuals,  and.  are,  then,  mostly  connected  with  the  at- 
mosphere, giving  rise  to  influenza,  and  other  catarrhal  affections,  &c. 
Of  these  there  are  commonly  several  in  combined  operation ;  though 
there  is  generally  one  more  important  than  the  rest,  especially  in 
acute  forms  of  disease. 

They  consist,  also,  of  all  those  causes  which  give  rise  to  the  various 
forms  of  common  inflammation,  and  all  other  conditions  of  disease 
which  do  not  fall  under  the  next  subdivision. 

648,  c.  The  specific  causes  form  a  far  more  numerous  class  than 
the  general.  They  consist  of  all  the  natural  or  healthy  and  morbid 
poisons,  animal  and  vegetable,  and  the  principal  agents  of  the  materia 
medica.  Each  of  these  will  generally  establish  the  predisposition  by 
itself  alone,  and  is  generally  the  exciting  as  well  as  the  pi-edisposin<T 
cause.  Among  these  causes  must  be  ranked  all  those  which  generate 
idiopathic  fever ;  and  these  being  of  vegetable  origin  must  float  in 
the  atmosphere,  and  around  the  multitude.  They  are,  tiierefore,  the 
main  causes  of  epidemics,  properly  so  called  (§  650,  663).  Such 
causes  are  generally  aided  in  the  development  of  disease  by  others 
which  are  simply  exciting  (§  654,  a). 

648,  d.  The  predisposing  causes  of  sporadic  diseases  are  apt  to  be 
more  numerous  than  those  of  epidemics. 

649,  a.  Remote  external  causes  do  not  produce  their  effects  indis- 
criminately on  all  parts  to  which  they  are  applied.  Some  are  per- 
fectly inert  upon  the  skin,  while  others  exert  their  principal  effects 
upon  this  organ.  And  so  of  other  parts.  The  surfaces  upon  which 
they  operate  are,  1st.  The  mucous  tissue ;  2d.  The  skin ;  3d.  The 
surface  of  wounds  and  abraded  parts ;  4th.  By  being  forced  into  the ' 
vessels  when  wounds  are  made  by  instruments  charged  with  poisons. 
It  is  in  the  last  two  ways  alone  that  many  of  the  most  active  poisons 
produce  their  effects ;  such  as  the  hydrophobic  virus,  the  poison  of 
serpents,  the  poison  of  dissection-wounds,  &c. 

649,  h.  Some  parts  of  a  continuous  mucous  tissue  &i'e  more  suscep- 


416  INSTITUTES    OF   MEDICINE, 

tible  than  other  parts  of  the  same  tissue  (§  ISSr-lSl).  And  so  of  the 
skin.  A  curi-ent  of  cold  air,  for  example,  striking  the  neck  more 
readily  produces  catarrh  than  when  impinging  on  any  other  part ; 
while  its  direct  action  upon  the  healthy  mucous  tissue  of  the  lungs  is 
never  deleterious  (§  136).  Mensti-uation  is  most  readily  suppressed 
by  cold  applied  to  the  feet,  &c. 

The  foregoing  facts  depend  upon  a  principle  of  vast  importance  in 
evei-y  branch  of  medicine.  Thus,  in  relation  to  the  pulmonary  intes- 
tinal mucous  membrane,  we  learn  from  it,  physiologically,  that  the 
generation  of  gastric  juice,  and  the  elaboration  of  carbon  from  the 
blood,  are  conducted  by  special  vital  processes,  &c.  (§  135,  419),  and 
this,  with  various  other  relative  facts,  such  as  the  variety  in  effects  of 
natural  stimuli,  goes  to  illustrate  what  is  denoted  by  morbid  phenom- 
ena of  the  special  susceptibilities  of  different  parts  of  a  continuous  tis- 
sue to  the  action  of  moi"bific  causes,  and  how  the  same  disease  pre- 
sents important  varieties  in  the  several  parts ;  and,  carrying  these  im- 
portant considerations  to  therapeutics,  we  readily  come  to  a  distinct 
apprehension  of  the  reason  of  the  differences,  local  and  constitutional, 
which  spring  from  the  action  of  the  same  remedy  upon  one  part  or 
another  of  that  same  tissue  ;  as,  for  example,  why  tartarized  antimony 
may  relieve  croup  by  its  action  upon  the  stomach,  but  may  kill  in  the 
same  case  by  an  equal  effect  upon  the  intestine.  And  now,  casting  a 
glance  at  the  universal  body,  we  see  the  same  law  prevailing  in  other 
tissues,  and  among  all  parts  which  differ  in  organization.  These  com- 
bined circumstances  open  an  immense  field  of  philosophi-cal  and  prac- 
tical inquiry,  and  should  forever  employ  the  physician  in  a  critical 
study  of  the  therapeutical  relations  of  the  various  articles  of  the  ma- 
teria medica  to  one  part  or  another,  in  their  local  and  sympathetic 
effects,  and  according  to  the  precise  pathological  conditions  of  all  the 
parts  which  are  likely  to  feel  the  influence  of  the  remedy,  or  as  it  may 
affect  the  more  natural  conditions  of  other  parts,  and,  therefore,  their 
favorable  or  unfavorable  reflected  sympathies  (§  129-152,  500,  n?i, 
514  7i,  6381). 

649,  c.  There  are  probably  but  few  ordinary  morbific  agents  which 
affect  the  skin  in  its  sound  state,  though  some  may  which  are  not  sus- 
pected. Cold  is  one  of  the  most  remarkable.  There  are  but  a  few 
of  the  active  poisons  of  the  materia  medica  that  affect  either  this  or- 
gan sensibly,  or  other  organs  sympathetically  through  it.  Mercury, 
tartarized  antimony,  and  cantharides,  are  among  the  strongest  ex- 
amples of  the  action  of  remedial  agents  upon  the  skin,  and  through 
that  organ  upon  remote  parts.  But,  while  blue  pill,  and  the  blue 
mercurial  ointment,  which  are  demonstrably  not  absorbed,  produce  in- 
flammation of  the  salivary  glands,  and  affect  the  system  at  large,  after 
their  application  to  the  skin,  they  exert  no  more  manifest  effect  upon 
the  skin  itself  than  when  a  cold  current  of  air  gives  rise  to  pneumonia 
or  rheumatism  (§  657  a).  And  since  the  foregoing  preparations  of  mer- 
cury are  no  more  absorbed  than  the  cold  air,  it  is  evident  that  their  di- 
rect action,  like  that  of  cold,  must  be  exerted  through  the  cuticle  upon 
the  susceptible  properties  of  the  skin  (§  514  d,  826  c,  1059,  1088  5). 

Cantharides  and  tartarized  antimony,  on  the  contrary,  affect  the  skin 
sensibly,  and  in  a  direct  manner,  and  other  parts,  as  in  the  foregoing 
case,  by  sympathy.  But,  tartarized  antimony  applied  to  the  skin  will 
not  induce  nausea,  nor  affect  the  constitution  at  large,  whatever  its 


PATHOLOGY. REMOTE    CAUSES.  417 

morbid  susceptibilities,  but  only  certain  parts  in  the  vicinity  >f  its  ap- 
plication, and  then  only  when  those  parts  are  preternaturally  suscep- 
tible (§  143).  It  then  operates,  like  blisters,  through  contiguous  sym- 
pathy (§  497, 1088  b).     And  so  equally  of  croton  oil  (^  893  a,  905). 

When,  however,  almost  any  article  of  the  materia  medica  is  taken 
into  the  stomach  it  produces  an  obvious  impression  upon  that  organ, 
or  upon  the  intestines.  Reflex  nervous  influences  are  then  transmitted 
to  other  parts ;  and  it  is  upon  this  great  law  in  relation  to  the  intesti- 
nal canal  especially  that  the  curative  effects  of  remedies  depend.  A 
strong  analogy  is  also  thus  supplied  in  proof  of  the  primary  action  of 
many  of  the  profoundly  morbific  agents  upon  the  alimentary  mucous 
tissue ;  since  the  positive  remedial  agents  are  as  truly,  though  more 
transiently,  morbific  (§  901).  It  may  be  one  part  or  another  of  that 
tissue, — where  it  traverses  the  nose,  or  the  mouth,  or  intestines,  ac' 
cording  to  the  special  virtues  of  the  operating  cause,  and  the  natural  or 
acquii'ed  modifications  of  the  vital  states  in  either  part  (§  150,  649  b), 
just  as  one  mental  emotion  or  another  will,  through  t?tVec<  nervous  ac- 
tion, strike  at  this  part  or  at  that  of  the  foregoing  tissue,  or  again 
descend  upon  other  parts  of  the  organ  as  it  may  fluctuate  in  its  vital 
states  ;  or,  at  other  times,  may  aim  at  other  organs  (§  227,  500).  The 
mucous  texture  of  the  lungs  is,  also,  doubtless,  often  the  seat  of  mor- 
bific influences  from  external  agents  ;  though  here  we  have  no  great 
range  of  analogies. 

649,  d.  The  reason  why  the  skin  is  so  little  susceptible  of  the  influ- 
ence of  morbific  and  remedial  agents  consists  partly  in  the  protection 
which  is  afforded  by  the  cuticle  ;  not,  however,  because  of  its  sup- 
posed impeiTious  nature  which  is  inculcated  by  the  mechanical  phi- 
losophy, but  that  the  cuticle  is  a  mere  shield  to  the  very  susceptible 
properties  of  the  true  skin.  When,  therefore,  that  guard  is  removed, 
numerous  agents  operate  with  great  and  rapid  effect,  and  send  their 
influences  abroad  with  great  power  over  the  system.  Hence,  one  of 
the  obvious  final  causes  of  the  cuticle. — See  p.  930,  §  1088  b. 

650.  Every  distinct  morbific  agent  (and  every  remedy),  however 
allied  to  others,  has  its  peculiar  virtues,  which  produce,  cceteris  pari- 
bus, a  general  corresponding  modification  of  the  vital  properties  and 
functions  (§  52).  If  two  or  more  be  united,  chemically  or  mechani- 
cally, the  compound  is  an  agent  of  new  virtues,  and  produces  corre- 
sponding effects  (§  188^,  d).  This  is  the  reason  for  combining  reme- 
dial agents.  Hence  arise  many  varieties  of  inflammation,  and  of  idio- 
pathic fever  ;  the  differences  being  greater  where  the  morbific  causes 
differ  most  from  each  other,  or,  as  two  or  more  may  operate  (§  766). 
This  is  rendered  distinctly  obvious  by  the  specific  character  of  those 
diseases  which  follow  the  application  of  morbid  or  healthy  animal 
poisons  in  each  of  the  cases,  respectively.  Thus,  the  poisons  of  small- 
pox, of  measles,  of  scarlet  fever,  &c.,  always  affect  the  vital  condition 
in  nearly  one  uniform  way.  From  these  distinct  and  strongly-mark- 
ed affections  we  might  safely  reason  to  all  other  morbific  agents ;  but, 
independently  of  this  analogy,  which  rarely  fails  in  relation  to  any  or- 
ganic laws,  we  have  the  same  proof,  though  less  remarkable,  in  respect 
to  other  affections.  In  the  great  family  of  idiopathic  fevers,  among 
which  there  are  close  resemblances,  there  is  no  rational  doubt  that 
each  variety  depends  upon  specifically  diflerent  predisposing  causes. 
It  appears,  also,  to  be  well  ascertained  that  these  causes  are  of  vege- 

Dd 


418  INSTITUTES    OF    MEDICINE. 

table  origin,  and  that  the  differences  in  their  nature  depend  upon  differ- 
ent combinations  of  their  elementary  principles,  that  take  place  dm-ing 
the  decomposition  of  vegetable  matter.  This  difference  in  decompo- 
sition, and  the  consequent  generation  of  each  peculiar  poison,  accord- 
ing to  the  new  and  exact  modes  in  which  the  elements  recombine,  is 
owing  to  various  chemical  influences ;  such  as  peculiar  states  of  the 
atmosphere  as  to  heat,  moisture,  light,  &c. ;  and  also  upon  the  kind 
of  vegetable  matter,  its  simplicity  or  variety,  the  nature  of  the  soil, 
whether  wet  or  dry,  whether  impregnated  with  fresh  or  salt  water,  or 
whether  the  vegetable  matter  be  superficial  or  mixed  with  earth,  &c. 
Certain  climates,  cities,  &c.,  will  generate  varieties  of  fever,  and  of 
other  diseases,  which  never  happen  in  other  places  (^  1068,  h,  note). 

All  the  foregoing  has  its  exact  analogies  in  the  natural  agents  of 
life  (§  136). 

651,  a.  The  predisposing  causes,  nevertheless,  give  to  disease  no 
small  part  of  its  special  character,  while  in  each  tissue,  or  part  of  a 
tissue,  of  any  given  organ,  the  exact  pathology  also  depends  on  the 
special  vital  constitution  of  that  part  (§  132-152). 

651,  h.  Age,  sex,  habits,  &c.,  exert,  also,  certain  influences  upon 
the  results  of  the  remote  causes  of  disease ;  and  it  is  owing  to  analo- 
gous changes  in  the  vital  states  that  the  usual  effects  of  any  morbific 
cause  in  ordinary  constitutions  may  be  variously  modified  in  constitu- 
tions which  possess  natural  or  acquired  peculiarities,  &c.  The  influ- 
ences left  by  former  diseases,  and  whatever  may  have  diverted  the 
properties  of  life  from  their  perfectly  natural  character,  or  have  in- 
creased their  susceptibility,  will  be  conducive  to  the  deleterious  ac- 
tion of  morbific  causes,  and  of  many  of  the  ordinary  stimuli  of  life, 
and  may  variously  modify  the  results  in  the  several  cases,  respectively. 
Hence  there  is  scarcely  a  limit  to  the  modifications  of  disease,  while 
they  may  agree  in  the  general  outlines  (§  153-156,  163,  535-630). 

652,  a.  By  no  circumstances,  however,  is  the  pathology  of  disease 
so  greatly  determined  as  by  the  predisposing  causes ;  and  this  impor- 
tant result,  therefore,  will  be  more  or  less  aff'ected  by  the  simplicity 
or  the  variety,  and  intensity,  of  the  causes,  as  well  as  by  their  naturo 
(§722). 

oo2,  h.  But,  there  is  not  only  one  predisposing  cause  which  is  gen- 
erally most  important,  and  which  mostly  rules  the  pathology,  but  there 
are  many  morbific  agents  which  are  capable  of  so  controlling  all 
other  influences  as  to  determine  certain  uniform  morbid  conditions, 
whose  symptoms  may  be  foretold  ;  particularly  the  healthy  and  mor- 
bid animal  poisons.  The  contribution,  however,  which  is  often  made 
by  other  causes  as  to  the  intensity  and  complications  of  exact  diseases 
is  well  manifested  in  epidemic  scarlatina,  epidemic  measles,  and  epi- 
demic dysentery  (§  630  e,  663,  827  e,  961-970,  1002-1005). 

652,  c.  The  precise  vital  influences  of  any  remote  cause,  their  de- 
pendence upon  the  exact  natui-e  of  that  cause  (all  other  things  being 
equal),  is  critically  displayed  by  the  effects  of  slightly  varied  mechan- 
ical agents.  Thus,  "  a  mere  prick  or  scratch  is  usually  followed  by 
cutaneous  erysipelas ;  but  not  so  with  a  deeper  wound  ;  and  a  punc- 
tured wound  is  less  likely  to  induce  it  than  a  lacerated  one"  (§  722, 
725.  Also,  Med.  and  Phys.  Comm.,  vol.  i.,  p.  610  ;  vol.  ii.,  p.  474-480). 
And  so  in  the  same  critical  sense  of  the  acclimated  subject  when  a 
new  epidemic  influence  may  pi'evail.  as  set  forth  in  section  551. 


PATHOLOGY. REMOTE    CAUSES.  419 

More  striking  distinctions,  and  according  to  the  nature  of  the  cause, 
are  shown  by  such  agents  as  opium,  cantharides,  mercui'y,  the  virus 
of  snakes,  of  the  mad  dog,  of  small-pox,  measles,  scarlatina,  &c. 

The  importance  of  enforcing  this  fact,  in  a  practical  sense  at  least, 
is  shown  by  a  common  disregard  of  the  subject,  as  occurs  in  the  fol- 
lowing example.  Thus, — Pereira,  in  his  erudite  work  on  the  Mate- 
ria Medica,  very  justly  says,  that,  "  \kiQ  precise  pathological  condition 
of  the  brain  and  spinal  cord  of  an  animal  under  the  influence  of  hy- 
drocyanic acid  is  matter  of  conjecture."  But  he  adds, — "  Whatever 
it  may  be,  it  is  probably  identical  with  that  which  occurs  during  an 
epileptic  paroxysm,  and  with  that  induced  by  loss  of  blood."  Now, 
loss  of  blood  will  often  remove  an  epileptic  paroxysm,  at  once  ;  and 
is  the  best  remedy  for  the  cerebral  congestion  induced  by  hydrocy- 
anic acid,  after  the  depressing  effect  of  the  acid  is  over. 

652,  d.  The  physiological  inquirer  will  not  fail  to  apply  the  fore- 
going facts  in  opposition  to  the  chemical  and  physical  hypotheses  of 
life  and  disease. 

653,  a.  Animal  or  vegetable  poisons,  if  natural  or  healthy,  are  the 
product  of  natural  organic  actions ;  if  morbid,  they  are  generated  by 
diseased  actions ;  if  altered  from  the  foregoing  conditions,  they  are 
more  or  less  the  product  of  chemical  decomposition. 

653,  h.  Since,  also,  every  specific  disease  requires  its  exact  cause, 
and  as  every  cause  of  disease  which  is  elaborated  by  the  living  or- 
ganism requires  a  certain  precise  state  of  the  organic  properties  and 
functions  for  its  production,  (or  if  more  or  less  of  a  chemical  nature 
it  has  lost  its  original  peculiarities,)  it  follows  that  the  disease  which  is 
produced  by  a  healthy  animal  or  vegetable  poison  cannot  be  gener- 
ated by  a  morbid  one,  and  vice  versa,  nor  can  a  chemical  product  be- 
come the  cause  of  a  disease  which  is  induced  by  poisons  that  are  ex- 
clusively the  product  of  organic  action,  as  in  small-pox,  measles, 
yellow  and  typhus  fevers,  &c.  And  since  small-pox  is  produced  by 
a  morbid  organic  product,  and  can  never,  therefore,  arise  from  an- 
other cause,  and  can  be  alone  propagated  by  contagion,  so,  also,  as 
the  foregoing  fevers  depend,  in  certain  known  instances,  upon  the 
products  of  vegetable  decay,  they  can  never  be  of  a  communicable 
nature.  Nevertheless,  other  causes  may  predispose  the  body  to  the 
operation  of  the  more  specific  predisposing  agents,  so  that  small-pox, 
measles,  &c.,  may  be  unusually  epidemic  and  malignant  (§  630  e). 

653,  c.  Healthy  animal  poisons,  therefore,  are  never  generated  by 
the  diseased  processes  which  they  excite ;  but  the  morbid  ones  are 
reproduced  by  such  processes,  and  by  no  other,  and  mostly  by  indi- 
viduals of  the  same  species,  while  the  same  law  of  individuality  is 
universal  as  to  healthy  animal  poisons. 

653,  d.  For  the  foregoing  reasons  no  contagious  disease  can  ever 
be  propagated  by  any  other  cause  than  such  as  is  generated  by  that 
precise  modification  of  the  vital  states  which  constitutes  the  essence  of 
the  disease.  By  the  same  inductive  process  all  those  affections  which 
have  for  their  causes  the  products  of  laws  which  govern  inorganic 
matter  can  neither  be  I'egarded  as  contagious  by  the  philosopher,  nor 
shown  to  be  so  by  the  man  who  doubts  every  thing  but  his  senses. 
The  laws  of  life  and  the  laws  of  chemistry  are  as  wide  as  the  poles 
from  each  other.  No  organic  action  can  form  the  chemical  combina- 
tions of  dead  matter,  nor  can  the  forces  of  chemistry  imitate  the  mor- 


420  INSTITUTES    OF    MEDICINE. 

bid  any  more  than  the  healthy  products  of  life  (§  43,  44,  52,  53,  150, 
191  a,  409  c,  d,  447^  c,  630  e,  758,  773,  777-780,  1057  e-g). 

Since,  therefore,  miasmata  produce  yellow  fever,  plague,  typhus,  &c., 
it  clearly  follows  that  the  living  system,  when  affected  by  those  diseases, ' 
cannot  generate  a  poison  capable  of  producing  the  same  affection  in  oth^ 
ers,  since  the  poison  depended  originally  upon  vegetable  decomposition 
(§  657  b,  741  b).     " Veritas  Met  in puteo"* 

But,  independently  of  this  incontrovertible  law  which  is  predicated 
of  numerous  facts  in  physiology  and  pathology,  and  without  one  to  in- 
validate its  force,  the  whole  of  this  question  as  to  the  contagiousness 
of  fevers  is  settled  negatively  by  a  great  variety  of  direct  observations. 
(See  Objections  to  the  supj^osed  Contagiousness  of  Yelloio  Fever,  &c.,  in 
Med.  and  PIujs.  Comm.,  vol.  i.,  p.  445-453,  note,  532-534 ;  vol.  ii.,  p. 
511.) — Also,  §  1068  b,  note.     [Just  now,  1860,  suddenly  abandoned.] 

654,  a.  Specific  predisposing  causes,  consisting  of  animal,  and  min- 
eral, and  most  of  the  vegetable  poisons,  generally  produce  their  sen- 
sible effects  with  great  rapidity.  Even  vegetable  miasmata,  in  a  state 
of  concentration,  may  determine  an  attack  of  idiopathic  fever  as  soon 
as  their  operation  begins  (§  648).  It  is  upon  this  rapidity  of  effect 
that  much  of  the  utility  of  the  materia  medica  depends  (§  554).  I  have 
accumulated  examples  of  this  nature  in  the  Medical  and  Physiological 
Commentaries  (vol.  i.,  p.  471-474,  &c.).  But  as  no  small  number 
believe,  with  Louis,  that  "it  is  not  true,  as  has  been  said  too  often, 
that  facts  do  not  become  old,  and  the  immense  majority  of  them  have 
become  so ;  and,  moreover,  those  which  we  collect  in  these  times, 
will,  in  like  manner,  in  their  turn,  become  old"  (the  "  numerical 
method"  to  the  contrary  notwithstanding,  ibid.,  vol.  ii.,  p.  810),  I 
shall,  I  say,  in  view  of  this  skepticism  in  respect  to  "facts"  (§  [>\,a,e), 
present  an  instance  fresh  from  Bombay  (1846)  relative  to  the  malig- 
nant cholera,  and  as  yielding  "  food  for  the  mind  contemplative." 
Thus,  the  writer  : 

"Who  shall  depict  the  scene  in  the  hospitals]  I  speak  more  of  the 
Fusiliers,  because  of  that  I  saw  much  ;  every  cot  was  filled — delirium 
here,  death  there — the  fearful  shrieks  of  pain  and  anguish.  Men 
whom  you  had  seen  a  short  time  before  hale  and  strong,  were  rolling 
in  at  every  door,  crowding  every  space — countenances  so  full  of  mis- 
ery— eyes  sunken  and  glaring,  shriveled  and  blackened  cheeks.  This, 
too,  the  work  of  five  short  minutes  or  less !  So  sudden  was  death 
with  some,  that  they  were  seized,  cramped,  collapsed,  dead,  almost 
as  fast  as  I  have  written  the  words.  Previous  health  and  strength 
were  no  guaranties ;  men  attending  the  burials  of  their  comrades 
were  attacked,  borne  to  the  hospital,  and  buried  themselves  the  next 
morning.  Pits  were  dug  in  the  church-yard  morning  and  evening; 
sewed  up  in  their  beddings,  coffinless,  they  were  laid  side  by  side,  one 
service  read  over  all." 

The  foregoing  paragraph,  as  well  as  the  facts  to  which  I  have  just 
referred,  in  another  work,  may  remind  the  reader  of  what  has  been 
said  of  the  action  of  hydrocyanic  acid,  nux  vomica,  &c.,  and  lead  him 
to  appreciate  the  analogies  in  the  modes  in  which  morbific  and  reme- 
dial agents  bring  about  their  results,  and  strengthen  his  philosophy  of 
the  properties  and  laws  of  organic  beings  (§  494  dd,  827  d). 

654,  h.  The  foregoing,  however,  is  not  equally  true  of  morbid  ani- 
mal poisons,  which  are  alike  specific.     I  may  also  say,  as  farther  il- 

*  A  remarkable  plagiarism  of  the  foregoing  argument  (§  G53  a-d)  was  exposed  b}- 
a  correspondent  in  American  Medical  Gazette  (N.Y.),  December.  1859.    "  Veritas  vincit." 


PATHOLOGY. REMOTE  CAUSES.  421 

lustrativc  of  great  vital  laws,  that  morbid  animal  poisons  have,  com- 
monly, the  remarkable  attribute  of  producing  their  sensible  efl'ects  at 
more  determinate  periods  than  any  olher  predisposing  causes,  with  a 
tjiw  exceptions  like  the  liydrophobic  virus.  It  is  also  another  striking 
fact,  that  natural  small-pox  occurs  iu  about  fourteen  days  after  expo- 
sure, but  tliat  the  intermediate  period  is  only  eight  days  where  the 
same  disease  is  communicated  by  inoculation.  The  disease,  too,  is 
violent  in  the  former,  and  comparatively  mild  iu  the  latter  case  ;  thus 
showing  that  slight  variations  in  the  condition  of  the  predisposing 
causes  will  not  only  vary  the  duration  of  the  predisposition,  but  mod- 
ify all  the  phenomena  of  the  ensuing  disease  (§  650,  G51).  This  is 
more  particularly  seen  in  the  relative  history  of  natural  small-pox  and 
the  cow-pox,  which  are,  essentially,  one  disease.  It  is  an  example, 
also,  which  illustrates  the  specific  modifications  of  the  properties  of 
life  in  diflerent  animals;  since  we  know  of  no  other  than  the  cow 
(certainly  not  the  human  species)  that  can  so  alter  the  variolous  poi- 
son (§  545.     Also,  Med.  and  Phys.  Com??!.,  vol.  ii.,  p.  184,  195-200). 

654,  c.  Again,  there  may  be  an  intei'val  of  weeks,  months,  and 
yeai's,  after  the  application  and  the  removal  of  the  predisposing  cause, 
before  disease  ensues.  This  is  witnessed  particularly  in  some  re- 
markable exceptions  which  occur  among  the  specific  causes ;  as  those 
which  generate  intermittent  fever,  while  the  same  causes  may  also 
develop  an  attack  with  great  rapidity  (§  654,  a).  "  When  a  cause  is 
applied  which  produces  fever,"  says  the  philosophical  Fordyce,  "  it 
produces  it  utio  ictu,  although  the  cause  be  no  longer  applied.  Nei- 
ther is  it  increased,  diminislied,  or  altered,  by  the  farther  application 
of  its  cause." 

654,  d,  AVhere  the  sensible  eftects  follow  rapidly  the  application  of 
the  causes,  the  predisposing  is  generally  adequate  to  the  full  produc- 
tion of  disease  ;  and  it  may  be  equally  so  where  the  interval  is  longer, 
as  in  small-pox,  hydrophobia,  &c.,  though  more  commonly  some  ex- 
citing causes  are  necessary,  as  probably  in  a  large  proportion  of  idio- 
pathic fevers.  Hence,  an  attack  of  these  diseases  may  be  often  pre- 
vented by  a  proper  regimen,  but  not  by  medicine. — Note  S  p.  1124. 

0)55.  Specific  causes  commonly  operate  with  greater  certainty  than 
the  general  (§  646) ;  and  this  is  owing,  in  part,  to  the  circumstance, 
that  the  former  generally  act  both  as  predisposing  and  exciting  causes. 
But,  even  the  effects  of  these  may  be  moderated  by  a  proper  regimen. 
Low  diet,  for  instance,  after  exposure  to  small-pox,  measles,  scarlati- 
na, &c.,  or  after  inoculation,  or  exposure  to  the  causes  of  fever,  will 
lessen  the  severity  of  the  disease.  The  principle  is  the  same  as  when 
a  stimulant  diet,  &:c.,  contribute  to  their  production  (§  663). 

656.  The  ordinary  exciting  causes,  which,  in  their  usual  force,  com- 
monly fail  of  producing  disease  where  a  morbid  tendency  has  not  been 
induced  by  predisposing  causes,  may  readily  become  predisposing,  or 
both  together,  by  a  greater  intensity  of  action. 

657,  a.  It  commonly  happens,  especially  in  acute  diseases,  that, 
when  predisposing  causes  are  not  followed  immediately  by  a  devel- 
opment of  disease,  the  principal  morbid  states  take  place  in  organs 
distant  from  that  on  which  the  morbific  causes  exert  their  direct  ac- 
tion. The  main  predisposition,  therefore,  is  produced  by  reflected 
nervous  action  ;  and  of  course  it  is  there  that  the  principal  explo- 
sion of  disease  takes  place.     It  is  subsequent  to  this,  that  the  surfaces 


422  INSTITUTES    OF    MEDICINE. 

on  which  the  agents  exert  their  direct  action  become  sensibly  involved 
in  disease ;  and  then  it  is  probably  quite  as  much  a  result  of  sympa- 
thetic reaction  from  the  organs  where  the  main  explosion  takes  place 
(§  148,  514  li,  524  c,  743).  This  is  especially  true  of  the  alimentaiy 
and  pulmonary  mucous  tissue,  and  of  the  skin,  upon  the  former  of 
which  malaria  appear  to  exert  their  direct  action.  The  principle  is 
seen  distinctly  in  the  pulmonic  inflammation,  rheumatism,  &c.,  which 
follow  the  action  of  cold  upon  the  skin,  and  in  the  application  of  mer- 
curial ointment,  and  other  unirritating  remedial  agents,  to  the  unde- 
nuded  surface  (§  649,  c).  And  so  of  other  remedies  addressed  to  the 
stomach.  They  commonly  exert  their  most  sensible  effects  upon  the 
remote  parts  now  rendered  particularly  susceptible  by  the  presence 
of  disease  (§  137,  d).  But  examples  of  remedial  influences  more  in 
point  occur  in  subsequent  sections  (§  902  m,  905).  In  respect  to  mor- 
bific causes,  however,  there  may  not  exist  any  preternatural  suscep- 
tibility of  the  distant  parts,  but  the  agents  establish  their  effects  in  con- 
formity with  laws  already  indicated  (§  150,  &c.).  The  propagation 
of  their  influences  in  the  foregoing  manner  is  replete  with  problems 
of  the  deepest  interest  in  medicine,  and  reason  is  often  conducted  to 
the  truth  by  a  firm  hold  upon  a  long  chain  of  analogies.  In  this  way, 
for  example,  we  arrive  at  a  knowledge  that  hydrophobia  follows  the 
law  of  propagation  by  nervous  influence.  The  hydrophobic  virus  es- 
tablishes certain  imperceptible  morbid  influences  upon  the  bitten  part, 
which  are  by  reflex  action  propagated  over  the  system ;  and  here,  as 
in  miasmatic  fever,  the  predisposition  is  sufficiently  formed  in  various 
other  parts  as  not  to  require,  for  the  general  explosion,  a  full  devel- 
opment of  disease  in  the  bitten  part.  There  are  commonly  present, 
however,  in  hydrophobia,  symptoms  which  denote  either  inflammation 
or  morbid  irritation  of  the  injured  part,  just  antecedently  to  the  gen- 
eral explosion,  which  is  precipitated  by  it.  Hence,  also,  the  reason 
why  the  removal  of  the  bitten  jDart,  many  days,  or  even  weeks,  after 
the  infliction  of  the  wound,  may  prevent  hydrophobia;  which  it  would 
be  absurd  to  explain  by  the  humoral  philosophy  of  this  disease  (Med- 
ical and  Physiological  Commcntai-ics,  vol.  i.,  p.  499-505). — Note  D. 

657,  b.  It  will  have  been  seen  that  a  peculiarity  attends  idiopathic 
feyer  in  its  universal  invasion  of  the  body  (§  148,  757,  &c.) ;  and  this 
leads  me  to  indicate  a  certain  difference  in  the  sympathetic  proj^aga- 
tion  of  the  predisposing  influences  from  what  may  obtain  in  the  more 
circumscribed  forms  of  disease.  In  the  operation  of  the  predisposing 
causes  of  fever,  the  reflected  nervous  influence  from  the  direct 
seat  of  morbific  action  gives  rise  to  coincident  pathological  states 
throughout  the  system,  where  there  is  no  interference  from  inflamma- 
tion or  venous  congestion  ;  while  other  morbific  causes  are  apt  to  re- 
sult in  various  modes  of  disease,  as  the  effects  of  sympathetic  influ- 
ences radiated  from  their  seat  of  action.  In  the  former  case,  there- 
fore, the  general  extension  of  reflex  nervous  actions  is  equivalent, 
in  principle,  to  a  specific  universal  action  of  the  original  predisposing 
cause  (§  228,  653,  516  d,  no.  6,  6381). 

658.  If  disease  be  limited  to  the  part  on  which  the  morbific  cause 
makes  its  direct  impression  the  changes  may  be  then  instituted  by  the 
direct  action  of  the  cause  upon  the  organic  properties,  and  without  any 
necessary  intervention  of  the  nervous  power.  And  so  of  remedial  agents, 
as  when  caustic  is  applied  to  ulcers,  unguents  to  the  skin,  &c.     But, 


PATHOLOGY. REMOTE    CAUSES.  423 

it  more  commonly  happens  that  the  reflected  nervous  powci  is  the 
immediate  agent  in  the  production  or  cure  of  disease,  though  seated 
in  the  part  to  which  the  morbific  or  remedial  agent  is  applied.  This 
reflection  of  the  nervous  power  may  come  either  directly  through  the 
nerves  supplying  the  part,  or  from  organs  more  remote  (§  184,  188, 205 
-216,  222-2331,  475-492,  493  cc,  500,  514  h,  6471,  8931,  902,  905  a). 

659,  a.  Predisposing  causes  are  often  involved  in  much  obscurity, 
especially  when  of  a  complex  nature.  Their  operation  may  have  be- 
gun at  some  remote  period,  and  there  may  have  been  a  long  consec- 
iitive  series  without  much  relation  to  each  other.  Neither  may  be 
sufficient  to  lay  the  foundation  of  disease ;  but  each  renders  the 
properties  of  life  more  and  more  susceptible  to  morbific  influences 
from  other  causes,  but  which,  otherwise,  might  have  been  innoxious. 
These  new  causes  being  applied,  one  after  another,  alter  more  and 
more  the  natural  condition  of  the  vital  properties  and  functions,  till, 
at  last,  some  new,  and  perhaps  as  mild  a  cause,  produces  a  sudden 
explosion  of  disease.  This  last  cause  is  often  mistaken,  and  often  fa- 
tally for  the  patient,  as  the  principal,  or  only  source  of  a  malady 
which  has  been  the  slow  consequence  of  a  long  series  of  causes. 
And  so  of  the  last  remedy,  after  a  series  of  remedial  influences. 

Thus  it  frequently  happens  that  the  first  in  the  chain  of  predispos- 
ing causes  begins  in  childhood,  and  the  last  does  not  take  place  till 
adult  age.  The  gastric  and  hepatic  inflainmations  which  supervene 
on  the  indigestion  of  adult  life  have  often  grown  out  of  improper 
food  in  childhood,  and  a  neglect  of  other  natural  habits,  which  are 
continued  till  habitual  indigestion  sets  in.  It  then  becomes  difficult, 
from  the  influence  of  habit,  to  accomplish  a  cure ;  and  these  patients, 
too  often  indisposed  to  exercise  self-denial,  go  on  with  persevering 
indulgence,  and  carry  forward  the  morbid  changes  till  obstinate  and 
even  disorganizing  inflammations  ensue  (§  548).  Such,  too,  is  the 
frequent  history  of  intemperate  drinkers,  excessive  tobacco  chewers 
and  smokers,  opium  eaters,  &c. ;  the  poison  being  slowly  morbific  in 
all  the  cases,  but  aided  in  its  operation  by  many  concurring  causes 
(§  524  c,  527  &,  d,  548,  578,  630  e,  714,  902  c,  m,  905  a,  970  c,  1066). 

From  this  combined  series  of  causes,  and  their  gradual  influences 
upon  the  vital  conditions,  there  is  every  variety  and  gradation,  as  to 
number,  time,  activity,  &c.,  down  to  those  which,  like  a  scald,  or  the 
bite  of  a  venomous  snake,  develop  inflammation  at  once,  or,  like 
prussic  acid,  extinguish  on  the  instant,  and  without  any  other  antece- 
dent change,  the  entire  powers  of  the  organic  being. 

659,  b.  The  foregoing  gradual  operation  of  morbific  agents  lays 
the  foundation  of  the  scrofulous  diathesis  (§  836),  and  is  analogous, 
in  principle,  to  the  philosophy  of  acclimation,  and  to  the  formation  of 
artificial  temperaments  (§  558,  560-563,  591).  The  causes,  indeed, 
being  perhaps  not  remarkably  different,  and  only  morbific  under  spe- 
cial circumstances,  may  transform  the  melancholic  into  the  sanguineo- 
melancholic,  or  into  the  nervous  temperament,  instead  of  producing 
chronic  indigestion,  or  some  habit  of  feeble  health  (§  535-540,  602). 

660.  In  the  last  section  we  have  examples  of  what  is  in  constant 
progress  in  disease,  namely,  the  predisposing  influence  which  a  dis- 
eased organ  exerts  on  others  which  were  not  diseased.  These  mor- 
bific reflex  actions,  leading  to  various  sympathetic  diseases,  then  fall 
within  the  category  of  predisposing  causes  ;  as  may  also  the  resulting 


424  INSTITUTES   OF    MEDICINE. 

diseases ;  but,  if  they  concur  only  in  a  secondary  manner  with  other 
causes,  then  they  may  be  only  exciting-,  or  both  exciting  and  predis- 
posing causes  (§  143  h,  222-232,  514  A,  647,  715). 

661.  Finally,  all  those  hereditary  peculiarities,  in  which  there  is  a 
natural  tendency  in  the  vital  states  to  take  on  diseased  conditions, 
may  be  included  under  remote  predisposing  causes.  But  this  is 
rather  for  the  sake  of  convenience,  since,  in  the  hereditary  constitu- 
tions, the  tendency  to  disease  is  virtually  no  more  than  the  common 
predisposition  to  disease,  and  is  equally  owing  to  remote  causes 
which  have  exerted  their  predisposing  effects  upon  our  ancestors.  It 
is  convenient,  therefore,  to  assume  these  transmitted  peculiarities  as 
equivalent  to  the  remote  causes  themselves.  And,  although  we  can- 
not trace  out  the  remote  influences  which  lay  the  foundation  of  the 
scrofulous  constitution,  or  of  other  hereditary  predispositions,  the 
known  characteristic  peculiarities  of  the  accidental  constitutions  is 
equivalent  to  a  knowledge  of  the  nature  of  the  remote  predisposing 
causes  ;  since  in  other  affections  we  do  but  employ  our  knowledge  of 
the  predisposing  causes  in  finding  out  the  exact  pathological  character 
of  disease.    And  so,  also,  of  the  several  temperaments  (§  561,  585,  &c.). 

662,  a.  A  knowledge  of  the  remote  causes  of  diease  is  often  indis- 
pensable to  the  successful  treatment  of  disease.  Catarrh,  for  in- 
stance, arising  from  cold,  in  a  sound  constitution,  although  prolonged, 
may  be  suffered  to  pass  without  much  remedial  care ;  but,  if  it  have 

.for  one  of  its  remote  causes  a  natural  tendency  to  pulmonar).'  phthi- 
sis, it  should  awaken  all  our  vigilance  for  its  removal.  The  reason  is 
obvious.  In  the  ordinary  catari'h  all  the  remote  causes  soon  cease 
their  operation,  exert  no  profound  nor  specific  changes,  and  the  vital 
states  soon  obey  their  natural  tendency  to  the  standard  of  health. 
In  the  other  case  remote  causes  had  been  in  prolonged  operation, 
are  more  or  less  of  a  specific  character,  and  the  resulting  predisposi- 
tion has  almost  the  fixedness  of  the  tempei'aments  (§  543,  548,  561, 
562,  585,  &c.).  In  these  cases,  therefore,  the  tendency  of  nature  is 
to  go  the  wrong  way ;  and  in  proportion  to  this  she  requires  the  in- 
tervention of  art.  We  must  then  make  repeated  impressions  upon 
the  diseased  conditions  before  we  can  establish  the  artifical  changes, 
before  we  may  counteract  the  naturally  morbific  tendency.  This  be- 
ing accomplished,  a  favorable  inclination  is  given  to  the  balance  of 
nature,  and  she  comes  in  with  languid  efforts  at  restoration. — Note  F. 
662,  b.  Again,  a  fever,  or  inflammation,  with  partial  remissions, 
presents  itself.  The  fate  of  the  patient  may  now  depend  upon  our 
Knowledge  of  whether  the  principal  remote  cause  consisted  of  marsh 
miasmata,  or  of  some  other  morbific  agent,  although  it  have  long 
ceased  to  operate ;  since,  in  the  former  case,  the  Peruvian  bark,  arse- 
nic, &c.,  may  be  indispensable,  while  in  the  latter  they  would  be  de- 
structive (§  870).  It  often  happens,  also,  where  the  remote  cause  is 
still  in  operation,  that  its  removal  alone,  especially  those  of  a  general 
nature,  may  be  all  that  is  necessary  to  a  speedy  cure  (§  648,  815). 

Venous  congestions,  as  will  be  seen  hereafter,  may  be  also  attend- 
ant on  intermittent  fever,  which  shall  ultimately  require  the  Peruvian 
febrifuge,  but  which  would  be  aggravated  in  most  other  cases.  After 
bloodletting,  it  is  the  great  remedy  for  the  intermitting  apoplexies  of 
Italy,  &c.  In  all  these  cases,  the  congestive  affection  is  peculiarly 
modified  by  the  nature  of  the  predisposing  cause  (§  816,  817j. 


PATHOLOGY. REMOTE    CAUSES.  425 

662.  c.  Again,  it  has  been  always  found,  on  dissection,  that  delirium 
«  potu  was  attended  with  venous  congestion  of  the  brain  ;  and  such  is 
the  modifying  influence  of  the  remote  cause  that  one  of  its  frequent 
remedies  is  opium,  and  in  quantities  that  would  induce  another  modi- 
fication of  the  same  disease  if  administered  in  heakhy  states  of  the 
system,  and  for  which  bloodletting  and  coffee  would  be  the  remedies. 
This  peculiar  fact  impresses  us  forcibly  as  to  the  wonderful  modifica- 
tions which  different  morbific  agents  establish  in  particular  forms  of 
disease,  and  enforces  the  importance  of  ascertaining  the  nature  of  the 
predisposing  cause.  Striking  examples  occur  in  the  self-limited  dis- 
eases (§  858,  861).     In  delirium  a  potu  antiphlogistics  should  prevail.* 

663.  The  remote  causes  which  readily  produce  disease  in  one  man 
may  not  in  another.  Thus,  during  the  prevalence  of  an  epidemic  fe- 
ver, or  the  malignant  cholera,  or  influenza,  a  greater  portion  of  the  in- 
habitants may  escape  the  disease.  There  is,  therefoi-e,  something  ap- 
pertaining to  that  part  of  the  multitude  which  escapes  that  enables 
them  to  resist  the  morbific  effects  of  the  prevailing  remote  cause  (§ 
648,  b).  And  here  observation,  as  well  as  vital  philosophy,  enables 
us  to  understand  the  reasons,  and  how  epidemics  may  be  baffled. 

We  find,  for  instance,  in  respect  to  yellow  fever,  and  all  other  con- 
gestive fevers,  prevailing  epidemically,  that  their  subjects  are  apt  to 
live  on,  after  the  appearance  of  the  distemper,  without  much  regard 
to  their  habits.  They  eat  as  freely  as  usual  of  animal  food,  drink 
their  wine,  and  perhaps  more  ardent  spirits.  Others  have  become  in- 
firm from  irregular  habits,  and  such  are,  in  consequence,  rendered 
more  susceptible  of  the  epidemical  influence  (§  827  c,  e). 

On  the  contrary,  we  observe  that  the  class  who  escape  are  more 
generally  abstemious,  eat  less  stimulating  food,  or  renounce  it  alto- 
gether, abandon  all  alcoholic  liquors,  avoid  the  night  air,  retire  early 
to  rest,  &c.  (§  615,  &c.,  623-625,  645  h,  630  e). 

And  so,  where  there  exist  constitutional  or  other  tendencies  to  dis- 
ease ;  its  attack  may  be  averted  by  habitually  avoiding  many  agents 
which  are  inoffensive  to  others  (§  150).  Peculiarities  in  respect  to 
temperament  are,  also,  often  concerned  in  the  degrees  of  susceptibil- 
ity to  the  influence  of  morbific  agents ;  just  as  they  are  in  respect  tu 
remedial.  The  sanguine,  for  example,  will  be  more  the  subjects  than 
the  melancholic  or  the  phlegmatic ;  and  the  former  require  greater 
vigilance  as  to  exciting  causes  (§  551,  597,  598). — Note  Oo  p.  1141. 

664.  Certain  predisposing  causes  sometimes  extinguish  the  suscep- 
tibility to  their  morbific  action  even  in  concentrated  degrees  when 
they  have  been  long  in  operation  in  degrees  less  intense ;  as  in  accli- 
mation, the  use  of  tobacco,  &c.  (§  544,  545,  551).  Some  other  causes 
always,  or  nearly  so,  destroy  the  susceptibility  to  their  action  through 
all  future  time  after  having  once  produced  disease.  These  consist, 
mostly,  of  a  few  morbid  animal  poisons;  namely,  of  small-pox,  mea- 
sles, scarlatina,  hooping-cough,  and  mumps.  It  is  remarkable,  too, 
that  all  these  diseases  are  contagious  without  contact,  and  are  the  only 
ones  to  which  this  combined  law  applies  (§  545,  654  h). 

665.  Predisposition  often  remains  after  disease  shall  have  been  ap- 
parently eradicated ;  as  seen  particularly  in  intermittent  fever,  and  in 
chronic  indigestion  (§  514  g,  560).  This  persistence  of  predisposi- 
tion is  most  likely  to.  occur  where  some  organic  derangement  may 
have  supervened,  or  wheie  a  low  chronic  state  of  disease  tnay  estab- 

*  In  the  Med.  and  Phys.  Comm.  (vol.  2.  p.  485-491),  I  have  shown  that  tart,  anti- 
mon.,  cathartics,  and  often  bloodletting,  are  generally  the  best  remedies  for  delirium 
a  potu  (§  1058  y). 


426  INSTITUTES    OF    MEDICINE. 

lish  itself  in  some  comparatively  circumscribed  part,  and  which  not 
only  contributes  to  maintain-  the  general  predisposition,  but  afterward 
increasing,  becomes  one  of  the  exciting  causes  of  another  attack  of  fe- 
ver (§  S06).  These  local  conditions  are  generally  owing  to  imperfect 
treatment ;  to  the  neglect,  perhaps,  in  intermittent  and  remittent  fe- 
vers, of  proper  depletion,  or  to  the  use  of  excessive  doses  of  quinia,  &c. 
Acquired  predisposition  to  particular  diseases,  however,  often  apj)ears 
to  be  almost  as  firmly  ingrafted  upon  the  constitution  as  those  of  an 
hereditai-y  nature,  with  intervals  of  apj^arent  absence  of  all  disease 
§  535,  &c.).     Acclimation  is  also  a  study  for  the  philosopher  (§  554). 

666,  «.  Predisposition  to  disease  consists  in  some  indefinite  change 
which  has  befallen  the  organic  properties,  and  corresponds,  in  a  general 
sense,  with  the  peculiar  virtues  of  the  predisposing  causes  (§  650,  652). 
Where  the  subsequent  development  of  disease  is  severe,  and  especially 
if  sudden,  there  has  been,  obviously,  some  profound  antecedent  impres- 
sion upon  the  properties  of  life,  instituted  by  the  local  operation  of  the 
remote  causes,  and  propagated  to  other  parts  by  alterative  reflex  ac- 
tions of  the  nervous  system.  In  fevers,  especially,  obscure  symptoms 
may  be  seen  some  time  before  the  sudden  and  full  explosion  of  disease 
(§  143,  227,  500  cZcZ,  514^,  685,  686,  764,  777,  785,  807,  811). 

A  morbific  impression  being  once  made  on  the  changeable  proper- 
ties of  life  it  may  go  on  increasing  in  intensity,  although  the  remote 
cause  have  been  early  withdrawn,  till,  having  acquired  a  certain  de- 
gree of  force,  disease  may  either  explode  spontaneously,  or  some  mild 
exciting  cause  may  institute  a  sudden  and  violent  change  in  the  now 
highly-susceptible  jjroperties  of  life  (§  506,  512-514,  516  d,  no.  6, 
518  b,  561,  618  a).  At  other  times  the  predisposition  appears  to  be 
stationary,  perhaps  for  months,  and  even  for  years,  as  seen  in  fevers 
and  hydrophobia ;  the  former  having  been  known  to  exist  in  a  dor- 
mant state  for  a  year  or  more,  and  the  latter  for  seven  years.*  In  these 
cases,  it  appears  ultimately  to  assume,  of  itself,  a  tendency  toward  a 
full  development  (§  148,  514  g,  559,  561,  715,  826,  657  a). 

666,  h.  A  distinct  apprehension  of  the  nature  of  acquired  predispo- 
sition to  disease  may  be  had  by  referring  to  the  philosophy  of  artifi- 
cial temperaments  (§  591,  602,  603),  and  to  those  naturally  modified 
states  of  the  vital  properties  which  so  frequently  result  in  hereditary 
diseases ;  as  in  scrofula,  gout,  bronchocele,  &c.  In  some  of  those 
natural  conditions  which  predispose  us  to  specific  modes  of  disease 
(§  661)  there  is  no  apparent  departure  from  a  state  of  health,  unless 
disease  be  developed  by  exciting  causes  (§  646,  c) ;  and  this  will  be 
true  in  proportion  as  the  predisposition  is  limited  to  a  few  parts,  and 
especially  if  those  few  be  not  important  to  organic  life.  Thus,  the 
predisposition  to  gout  is  greatly  limited  to  the  small  joints,  though  it 
may  affect  other  parts,  especially  the  intestinal  mucous  membrane. 
So,  in  bronchocele  the  predisposition  resides  in  the  thyroid  gland. 
In  such  constitutions,  therefore,  there  is  not  generally  any  thing  pres- 
ent, under  ordinary  circumstances  of  health,  to  denote  any  modifica- 
tion of  the  properties  of  life  which  approximates  a  condition  of  obvi- 
ous disease.  These  cases  arc  so  far  closely  allied  to  those  conditions 
in  which  the  predisposition  to  fever,  or  to  hydrophobia,  is  in  a  state 
of  incubation  for  many  months,  or  for  years  (^  238). 

But,  in  scrofulous  subjects  it  is  generally  otherwise;  since  in  those 
who  are  naturally  predisposed  to  scrofula  the  tendency  to  the  disease 
*  An  apparently  clear  case  in  London  Lancet,  February  3,  1838. 


PATHOLOGY. PATHOLOGICAL  CAUSE.  427 

is  more  or  less  universal,  and  may  affect  almost  every  tissue  and  or- 
gan. There  is,  therefore,  a  natural  radical  fault  in  all  the  organic  en- 
dowments of  the  system,  and  this  fault  or  natural  modification  consti- 
tutes the  predisposition  (§  661).  Hence,  in  such  subjects,  the  very 
elements  of  the  body  are  diverted  more  or  less  from  their  perfect 
standard,  and  the  union  of  their  compounds  into  tissues  and  organs 
deviates,  more  or  less,  from  that  of  natural  subjects  (§  220).  Irrita- 
bility, especially,  is  not  only  permanently  turned  from  its  natural 
character,  but  is  at  all  times  preternaturally  susceptible ;  and  hence 
it  happens  that  occasional  causes,  innocent  in  health,  operate  nowr 
with  morbific  effect  (§  143-150).  These  cases  approximate  those  ac- 
quired predispositions  where  incubation  is  of  short  duration,  and 
where  there  can  be  no  doubt  that  the  organic  properties  sustain  a 
profound  lesion  during  the  early  operation  of  the  predisposing  cause, 
or  take  on,  at  an  early  time,  a  progressive  tendency  toward  an  explo- 
sion of  disease  (§  76,  181,  638J,  645  c). 

II.    PROXIMATE,   OR   PATHOLOGICAL   CAUSE. 

667.  The  inoximatc  cause,  as  implied  by  the  term,  is  that  from 
which  all  the  direct  phenomena  of  disease  arise.  It  must  there- 
fore constitute  the  essence  of  disease  itself;  and  hence  I  substituted 
in  the  Medical  and  Physiological  Commentaries  the  term  2^<^i^iological 
for  proximate,  and  have  since  retained  it  as  moi'e  expressive  than  the 
original  name  when  used  in  the  sense  here  intended. 

668.  The  remote  causes,  by  their  action  upon  the  properties  of  life, 
lead  to  that  change  in  their  condition  which  forms  the  essential  path- 
ological cause,  or  the  essence  of  disease  (§  644,  658,  666).  As  a 
necessary  result,  there  also  follows  a  corresponding  change  in  the 
functions  over  which  the  j^roperties  preside,  and  therefore  a  more  or 
less  modified  action  of  the  vessels  which  are  the  instruments  of  disease 
(§  247).  All  the  symptoms,  altered  secretions,  lesions  of  structure, 
&c.,  are  only  consequences,  more  or  less  remote,  of  tliose  primary 
changes. 

669.  Since,  also,  it  appears  that  all  remote  causes  which  differ  in 
their  virtues,  or  in  their  modes  of  influence,  establish  changes  in  the 
properties  and  functions  of  life  corresponding,  in  a  general  sense, 
with  the  nature  of  the  causes,  and  with  the  modes  and  intensity  of 
their  operation,  it  follows  that  the  pathological  causes,  or  results  of 
the  predisposing,  must  vary  in  a  coiTesponding  manner  (§  650,  651). 

670.  But  there  are  many  remote  causes  that  are  so  nearly  allied  in 
their  morbific  virtues  that  they  must  produce  pathological  conditions 
of  near  resemblance.  Such  are  the  various  remote  causes  of  inflam- 
mation, and  that  other  class  which  gives  rise  to  idiopathic  fevers. 
Since,  however,  many  of  the  causes  belonging  to  each  class  have  cer- 
tain very  peculiar  virtues  of  their  own,  there  must  necessarily  arise 
corresponding  peculiarities  in  the  pathological  conditions  which  they 
produce.  Hence  the  very  obvious  differences  which  prevail  among 
inflammations  and  fevers ;  though  more  or  less  is  due  to  the  nature 
of  the  affected  parts,  and  often  to  many  contingent  influences.  In- 
flammation of  the  venous  tissue,  for  example,  presents  a  combina- 
tion of  phenomena  that  distinguish  it  at  once  from  inflammation  of 
any  other  tissue,  though  the  remote  causes  be  the  same.  Much  of 
the  variety  in  congestive  fevers  is  also  owing  to  some  inflammatory 


428  INSTITUTES    OF    MEDICINE. 

Stale  of  one  or  more  organs ;  while,  also,  venous  inflammation  is  va- 
riously modified,  as  in  all  other  tissues,  according  to  the  nature  of  the 
remote  causes  (§  132-140,  149-152,  652,  722,  765,  766.  Also,  Med. 
and  Phys.  Comm.,  vol.  ii.,  p.  427-514). 

t  671.  Summarily,  then,  the  precise  nature  of  the  pathological  cause 
I  will  depend  upon  the  nature  and  action  of  the  remote  cause,  or  their 
combined  nature  when  two  or  more  operate  efficiently,  and  upon  the 
natural  or  other  antecedent  modifications  of  the  vital  properties  of 
the  affected  parts,  and  the  general  nature  and  vital  relations  of  any 
compound  organ  of  which  an  affected  tissue  may  form  a  component 
part ;  subject,  however,  to  modifications  from  temperament,  age,  hab- 
its, &c.  (§150). 

672.  Every  disease  consists  of  a  succession  of  pathological  causes, 
till  they  end  in  health,  or  in  death.  These  changes  are  the  result  of 
the  natural  mutability  of  the  propeities  of  life,  especially  when  once 
diverted  from  their  healthy  standard.  The  morbid  states  are  rarely 
stationary  from  one  hour  to  another.  They  fluctuate,  favorably,  from 
the  inherent  tendency  of  the  properties  to  return  to  their  natural  con- 
dition, or  from  artificial  impressions  from  remedial  agents ;  or,  unfa- 
vorably, from  the  intensity  of  disease,  the  force  of  predisposition  and 
of  habit,  or  from  the  continued  operation  of  predisposing  or  exciting 
causes,  &c.  (§  177-184,  535,  &c.,  666,  733  e).  The  progressive 
changes  may  be  gradual,  and  require  but  slight  modifications  of  treat- 
ment, or  gi'eat  and  abrupt ;  and  either  condition  may  follow  the  same 
morbific  and  remedial  agents,  according  to  the  surrounding  influences. 

The  absolute  condition  of  disease,  therefore,  is  changing  not  only 
spontaneously  during  its  progress  or  decline,  but  is  variously  modi- 
fied by  remedial  agents,  and  by  other  contingent  causes  (§  733,  d). 

673.  It  is  to  the  actual  condition  of  disease,  and  the  organs  involv- 
ed, that  remedies  should  be  directed.  A  knowledge,  indeed,  of  the 
seat  of  disease,  and  of  its  exact  pathology  as  far  as  may  be  attained, 
is  often  indispensable  to  a  successful  treatment ;  and  here  a  knowl- 
edge of  the  remote  causes  may  contribute  the  greatest  light  (§  650). 

So,  also,  at  every  successive  application  of  remedial  agents  the 
new  pathological  conditions  should  form  the  ground  of  the  new  pre- 
scriptions. 

674.  a.  Upon  the  modified  conditions  of  the  properties  of  life,  or 
their  pathological  states,  therefore,  all  the  modified  actions  of  the 
vessels  which  are  the  instruments  of  disease,  all  the  vital  phenomena, 
and  all  the  physical  products  depend ;  just  as  the  healthy  actions, 
phenomena,  and  products  depend  upon  the  same  properties  in  their 
state  of  health  (§  177,  410).  It  is  for  this  reason,  the  modification  of 
the  vital  properties  in  disease,  or  the  essence  of  disease  itself,  is  called 
the  proximate  or  pathological  cause  ;  all  the  rest  being  merely  results 
or  effects. 

But,  there  are  only  certain  facts  that  may  be  understood  in  relation 
to  the  changes  which  the  organic  conditions  sustain  from  the  opera- 
tion of  morbific  causes.  We  can  see  distinctly  that  they  are  exalted 
in  inflammation,  and  exalted  or  depressed  in  fevers.  But  these  are 
comparatively  unimportant  elements  of  the  changes.  There  is  also 
the  greater  change  which  consists  in  some  absolute  modification  of 
the  nature  of  the  properties,  some  positive  change  in  hind  (§  177 
666).     What  that  change  is  it  is  impossible  to  comprehend,  though  it 


PATHOLOGV. PATHOLOGICAL  CAUSE.  429 

be  tlie  essential  part  of  the  disease.  We  know  net,  indeed,  the  ab- 
solute nature  of  the  vital  properties  in  their  healthy  state,  and  have, 
therefore,  no  standard  of  comparison  in  disease.  We  may,  neverthe- 
less, by  the  phenomena,  as  of  all  other  forces  of  nature,  learn  all  the 
laws  of  the  vital  properties,  and  the  modifications  to  which  they  are 
liable  (§  234).  The  physiologist,  I  again  say,  concerns  himself  about 
the  facts,  the  anatomical  medium,  the  existence  of  the  forces  and  the 
laws  which  they  obey.  He  interrogates  not  the  intrinsic  nature  of 
the  powers,  nor  the  proximate  modes  in  which  the  results  are  pro- 
duced. 

674,  h.  For  the  purpose  of  having  some  visible  or  tangible  condi- 
tion before  us  in  considering  the  pathology  of  disease,  we  often  in- 
clude some  of  the  results  as  elements  of  the  proximate  cause,  or  even 
substitute  some  of  the  results  for  the  cause  itself  Thus,  increased 
action  of  the  capillary  blood-vessels  is  often  said  to  be  the  proximate 
or  pathological  cause  of  inflammation,  though  this  is  only  a  conse- 
quence, however  a  necessary  one,  of  a  certain  morbid  alteration  of 
the  vital  properties  of  the  vessels  concerned  in  the  morbid  process. 
So,  the  pathological  cause  of  venous  congestion  is  said  to  consist  in 
an  accumulation  of  blood  in  the  veins,  though  this  is  a  very  remote 
consequence.  As  a  better  designation,  according  to  my  exposition  of  the 
pathology,  and  since  venous  congestion  is  assumed  as  a  particular  dis- 
ease, I  would  say,  for  the  sake  of  brevity  and  convenience,  that  its 
pathological  cause  is  sub-inflammation  of  the  veins  ;  the  accumulation 
of  blood  being  only  a  remote  effect.  And  so  of  active  phlebitis,  or  of 
any  other  inflammation  which  derives  its  name  from  the  part  affected. 
Such,  indeed,  has  become  the  specification  of  common  inflammation 
in  almost  every  part  of  the  body.  But,  in  all  these  cases,  inflamma- 
tion is  an  aggregate  term  which  stands  for  that  chansre  in  the  orsranic 
properties  which  is  the  true  pathology. 

674,  c.  But  what  is  the  pathological  cause,  in  the  foregoing  com- 
prehensive sense,  of  other  diseases,  as  fever,  &c.  ?  Here  we  have 
less  light  as  to  the  nature  of  the  changes,  even  of  function  ;  and  hence 
there  is  less  guide  from  general  principles,  and  more  abstract  de- 
pendence upon  symptoms  and  experience.  Still,  as  will  be  seen,  the 
pathology  and  treatment  of  fever  are  not  without  their  important  gen- 
eral precepts.  We  reach  a  knowledge  of  the  modifications  which  the 
physiological  laws  undergo,  and  this  is  the  most  that  we  require  for 
the  institution  of  medical  principles. 

674,  d.  The  vital  states  of  a  part  or  of  the  whole  system  may  be 
vaiiously  modified  in  their  condition  so  as  to  approach  nearly  to  actual 
disease,  and  yet  the  modification  fall  short  of  the  absolute  change. 
This  has  been  already  seen  in  what  I  have  said  of  predisposition  to 
disease,  whether  accidental  or  hereditary.  It  is  also  constantly  illus- 
trated by  the  manner  in  which  the  heart  sympathizes  with  every  part 
which  may  be  the  seat  of  morbid  action,  and  upon  which  the  variable 
state  of  the  pulse  greatly  depends.  This  prominent  demonstration  of 
reflex  nervous  action  may  be  carried  to  all  other  organs,  which,  in 
like  manner,  are  liable  to  sustain  sympathetic  disturbances  short  of 
disease,  but  according  to  their  owoi  natural  modification  of  the  prop- 
erties of  life,  especially  of  irritability  (§  133-136,  188).  And,  although 
these  conditions  do  not  amount  to  absolute  disease  in  its  common  ac- 
ceptation, they  may  reverberate  morbific  influences  upon  parts  sus» 


430  INSTITUTES    OF    MEDICINE. 

taining  a  greater  lesion,  and  often  call  for  the  intervention  of  art  (§ 
714,  848).  Or,  such  influences  may  give  rise  to  severe  forms  of  dis- 
ease in  other  parts.  Thus,  gastric  derangements,  not  inflammatory, 
may  induce  severe  inflammation  of  the  mucous  tissue  of  the  throat, 
or  hepatic  or  cerebral  congestion,  &c.  (§  500,  689  I).  Again,  certain 
morbific  causes,  acting  upon  the  stomach,  make  their  principal  demon- 
strations in  remote  parts  ;  as  the  narcotics,  cantharides,  &c.  A  sim- 
ple element  of  this  is  constantly  seen  in  the  manner  in  which  cold  on 
striking  the  skin  will  develop  catarrh,  pneumonia,  &c. ;  though,  in  the 
former  cases,  there  may  be  specific  relations  of  the  morbific  agents  to 
particular  parts,  while  in  the  latter,  other  predisposing  causes  m'ay 
have  operated  (§  147-151,  649  c,  657,  722  b).  This  principle  lies  at 
the  foundation  of  all  the  consecutive  developments  which  may  spring 
up  in  different  parts  as  the  consequences  of  some  primary  derange- 
ment of  a  particular  part,  or  of  some  local  morbific  impression  which 
may  come  short  of  apparent  disease  in  the  organ  impressed. 

In  sections  143,  666,  847,  848, 1  have  endeavored  to  show  how  the 
whole  system  may  be  brought,  by  reflex  nervous  actions,  into  that 
condition,  and  how,  in  consequence,  remedial  agents  Avill  then  exert 
a  salutary  effect  upon  all  parts,  when  they  might  fail  of  any  effect  upon 
the  same  parts  in  their  state  of  health  ;  and  how,  also,  in  consequence 
of  such  remedial  influences,  the  morbidly  sympathizing  parts  may  be 
made  the  sources  of  salutary  reflex  actions  upon  the  primary  dis- 
ease ;  as  may,  also,  such  as  have  not  sustained  a  morbific  influence 
(§  514  h,  638i,  657  &).— Note  D  p.  1114. 

675.  As  illustrative  of  some  of  the  foregoing  sections,  particularly 
the  last  three,  I  shall  now  present  an  example  of  a  therapeutical  na- 
ture, but  which  takes,  in  its  comprehensive  range,  the  causation  and 
philosophy  of  disease,  the  principle  upon  which  morbific  and  reme- 
dial agents  operate,  whether  directly  upon  the  vital  properties  or 
tln-ough  the  medium  of  the  nervous  influence,  the  analogy  between 
the  operation  of  morbific  agents  and  remedies,  and  how  the  last  may 
prove,  through  a  common  pi'inciple,  either  remedial  or  morbific. 

I  shall  assume,  for  the  foregoing  purpose,  the  intermittent  fever, 
in  which  the  whole  system  is  engaged  ;  and  to  simplify  the  treatment, 
bloodletting,  nauseants,  and  quinine,  may  be  the  agents  employed. 
Each  of  these  agents,  like  all  other  therapeutical  means,  operate  en- 
tirely upon  vital  principles,  as  set  forth  in  the  appropriate  places  in 
this  work.     "Will  the  chemist  and  humoralist  give  their  attention  1 

Now,  without  the  aid  of  the  philosophy  which  has  been  hitherto 
considered  we  could  not  comprehend,  in  the  least,  any  of  the  phenom- 
ena of  this  disease,  much  less  their  consecutive  relations,  as  they  are 
regularly  presented  at  the  several  stages  of  the  complaint ;  nor  could 
we  any  better  understand  the  salutary  or  the  conflicting  results  of  our 
remedial  agents.  But,  the  true  philosophy  of  life  places  the  whole 
subject  in  a  consistent,  intelligible,  and  even  sublime  aspect.  At 
each  of  the  several  stages  of  an  intermittent,  the  properties  of  life 
are  in  different  states  of  modification,  and  the  remedies  must  be 
adapted  to  their  particular  modification  at  the  diff*erent  stages  of  the 
disease ;  or  such  as  may  be  curative  at  one  stage  will  either  fail  of 
their  effect  at  all  other  stages,  or  exasperate  the  complaint.  In  the 
first,  or  cold  stage,  the  properties  of  life  are  profoundly  altered  ;  and, 
as  this  is  the  beginning  of  the  paroxysm,  the  alteration  has  not  ac- 


PATHOLOGY. PATHOLOGICAL  CAUSE.  431 

quired  that  fixedness,  or  that  influence  of  habit,  which  results  from 
its  prolongation  (§  535,  &c.).  Powerful  impressions  may,  therefore, 
be  made  upon  the  morbid  properties,  and,  if  rightly  made,  they  may 
at  once  arrest  the  paroxysm.  But  no  remedy  can  be  applied  with 
safety  at  the  cold  stage  which  would  add  to  the  excitement  if  applied 
at  the  hot  stage.  No  stimulants,  therefore,  not  even  quinine,  which 
is  so  eminently  curative  during  the  intennission,  can  be  employed  in 
the  cold  stage  without  proving  morbific,  and  an  aggravating  cause  to 
the  hot  stage.  But,  many  remedies  which  are  appropriate  to  the  hot 
stage  will  tend,  more  or  less,  if  applied  during  the  cold  stage,  to  pro- 
duce a  change  that  will  mitigate  the  hot  stage,  or  bring  on  at  once 
the  sweating  stage.  Of  the  three  remedies  proposed,  there  are  two 
which  will  often  accomplish  this  result,  and  cut  short  the  disease  at 
this  stage  of  the  paroxysm,  or  at  least  conduct  nature  to  an  immediate 
consummation  of  her  cure  in  the  sweating  stage.  But,  the  nearer 
the  beginning  of  the  cold  stage  either  of  the  two  remedies  are  applied, 
whether  loss  of  blood  or  an  emetic,  the  more  salutary,  for  the  reason 
already  stated,  will  be  their  effect.  Numerous  and  striking  examples 
of  this  important  principle  might  be  stated  ;  as,  for  instance,  an 
emetic  will  often  subdue,  at  once,  pneumonia  or  croup,  if  exhibited 
at  their  very  invasion,  when  it  may  be  perfectly  powerless  in  a  few 
hours  afterward.  And  so,  in  a  more  limited  sense,  of  the  abstrac- 
tion of  blood,  which  reaches  more  profoundly  and  more  universally 
all  the  organic  properties,  and  determines  upon  them,  when  syncope 
approaches,  a  greater  and  more  universal  impression  of  the  nervous 
power  (§  947,  948).  This  remedy,  therefore,  may  often  answer  well 
at  any  period  of  the  cold  stage,  should  we  determine  upon  its  use. 

But,  suppose  that  the  hot  stage  supervene.  A  new  condition  of  the 
vital  states  has  now  sprung  up,  and  it  must  be  treated  accordingly. 
Whatever  will  lessen  and  otherwise  favorably  modify  initability 
(§  188,  &c.),  and  contribute  to  the  production  of  the  sweating  pro- 
cess, will  be  salutary  at  all  periods  of  the  hot  stage,  and  whatever  in- 
creases irritability  and  mobility  will,  as  at  the  cold  stage,  exasperate 
the  hot  stage  and  embarrass  the  sweating  stage.  It  is  evident,  there- 
fore, that  quinine  will  still  prove  morbific.  But  we  have  in  certain 
nauseating  remedies,  as  tartarized  antimony,  and  in  bloodletting,  ap- 
propriate means  for  reducing  and  otherwise  modifying  the  morbid 
state  of  irritability,  in  the  hot  stage.  Alterative  closes  of  antimony, 
even  short  of  nauseating,  may  now  exert  a  powerful  tendency  to 
bring  about  that  favorable  change  which  ensues  naturally ;  while  in 
its  full  emetic  dose,  so  often  favorable  near  the  invasion,  or  at  the  on- 
set, of  the  cold  stage,  this  agent  is  rarely  useful  and  frequently  inju 
rious.  Abstraction  of  blood  has  the  same  useful  tendency.  But, 
this  remedy,  unlike  its  effect,  and  that  of  emetics,  in  the  cold  stage, 
will  not  operate  with  the  greatest  force  at  the  beginning  of  the  hot 
stage,  but  near  the  termination  of  this  stage  in  the  sweating  process. 
The  properties  of  life  have  now  assumed  a  radically  different  condi- 
tion. They  are  rapidly  throwing  off"  the  influence  of  predisposition 
and  of  morbid  habit,  and  their  tendency  is  toward  a  restoration  of 
their  natural  state.  Nature  is  therefore  more  successfully  aided  in 
this  new  condition  as  she  approaches  the  sweating  or  more  curative 
process,  which  is  the  final  cause  of  the  hot  stage.  Hence  it  follows, 
where  the  advantage  of  one  impression  only  can  be  had  from  a  remn- 


432  INSTITUTES    OF    MEDICINE. 

dial  agent,  although  it  be  useful,  like  bloodletting,  at  other  periods  of 
this  stage,  it  should  generally  be  delayed,  at  least,  till  the  stage  of  ex- 
citement has  reached  its  acme.  If  cathartics  be  employed  at  thia 
stage,  they  should  be  delayed,  at  least,  till  the  sweating  process  has 
begun ;  and  now  an  emetic  may  be  sometimes  salutary.  But,  the 
fonner,  partly  on  account  of  their  irritation,  should  rather  be  defended 
till  the  sweating  stage  is  over,  while  emetics  are  most  salutary  just 
before  the  invasion  of  a  paroxysm,  which,  as  in  the  hot  stage,  is  al- 
ways an  inauspicious  time  for  cathartics. 

In  propoi'tion  as  nature  is  going  on  with  a  progressive  march  toward 
a  comparatively  healthy  result,  as  in  the  sweating  process,  there  should 
be  no  gi-eat  interference  from  art.  No  help  is  wanted,  for  the  restor- 
ative process  will  be  soon  spontaneously  completed,  and,  at  an  ad- 
vanced stage  of  this  process,  and  before  it  is  finished,  there  will  be 
always  danger  of  making  some  unfavorable  impression,  unless  it  be 
from  remedies  of  a  mild  character,  whose  uniform  result  is  that  of 
acting  as  sudorifics,  and  coinciding  in  other  respects  with  the  changes 
which  are  in  progress  during  the  sweating  stage.  Such  a  remedy,  for 
instance,  is  tartarized  antimony,  in  doses  short  of  nausea. 

Finally  comes  the  interval  of  repose,  which  is  remarkable  for  its 
specific,  but  various,  duration  ;  giving  to  intermittent  fever  its  quotid- 
ian, tertian,  or  quarteiTi  type.  There  is,  however,  notwithstanding 
the  apparent  state  of  tranquillity,  very  often  some  morbid  condition  re- 
maining; as  sufficiently  denoted  by  any  subsequent  return  of  the  par- 
oxysm. In  all  such  cases,  there  is  a  progressive  change  going  on  in 
the  «vital  properties  from  the  time  of  their  comparatively  natural  state 
at  the  close  of  the  sweating  process  toward  that  profoundly  morbid 
alteration  which  constitutes  the  cold  stage.  The  disease  is  again  in  a 
state  of  incubation,  and  tlierefore  the  tendency  to  change  in  th^  or- 
ganic properties  is  exactly  the  reverse  of  what  had  just  antecedently 
existed  during  the  hot  stage  and  its  termination  in  the  sweating  pro- 
cess (§  666).  It  is  now  the  object  of  art  to  prevent  a  repetition  of  the 
paroxysm.  This  may  be  often  accomplished  by  mere  rest  in  a  hori- 
zontal posture,  and  abstinence  from  all  solid  food  ;  for  the  tendency  of 
nature  may  be  the  right  way,  if  she  be  not  embarrassed  by  exciting 
causes  ;  the  slightest  of  which,  as  a  shock  of  the  mind,  may  throw  her 
into  a  state  of  incubation.  This  shows  not  only  the  great  susceptibil- 
ity of  the  vital  properties,  during  the  intermission,  to  morbid  changes, 
but,  also,  their  frequent  disposition  to  return,  unaided,  to  their  natural 
state.  Should  they  require  any  other  intervention  from  ait  than  the 
mere  act  of  withholding  exciting  causes,  it  is  manifest,  from  what  1 
have  now  said,  that  slight  influences  from  remedial  agents  will  be  am- 
ply sufficient ;  so  only  we  discard  pernicious  causes,  and  there  be  no 
severe  local  disease.  The  remedies  for  this  purpose  consist  of  a  group 
that  are  called  specifics,  and  have  been  suggested  by  experience  inde- 
pendently of  any  general  principles ;  so  very  peculiar  is  the  state  of 
the  vital  properties  during  the  period  of  intermission.  Of  these  specific 
agents  the  Peruvian  bark  and  its  alkaloids  is  one,  arsenic  another,  and 
cobweb  another;  coming  severally  from  each  of  the  three  great  king- 
doms, and  each  exerting  nearly  an  equal  control  over  the  progress  of 
incubation,  but  without  any  other  known  analogies  to  each  other ;  cer- 
tainly none  of  a  chemical  nature.  The  quinine,  or  arsenic,  which  would 
have  been  surely  morbific  at  any  other  stage  of  the  paroxysm,  may 


PATHOLOGY, PATHOLOGICAL  CAUSE.  433 

now  be  employed  with  a  remarkably  curative  effect.  But,  a  great  er- 
ror is  often  committed  in  exhibiting  quinine,  in  this  very  tangible  state 
of  the  organic  properties,  in  excessive  quantities ;  by  which  the  dis- 
ease is  either  prolonged,  or  the  predisposition  only  temporarily  sub- 
dued, or  local  affections  induced  or  aggravated.  As  an  invariable  and 
important  rule,  also,  just  in  proportion  as  the  organic  properties  are 
approaching  a  state  of  health,  so  should  our  treatment  be  cautiously 
mild,  or  it  will  light  up  disease  (§  764.  Also,  Med.  and  Phys.  Coinm., 
voh  i.,  p.  443,  &c.).— Note  K  p.  1119. 

676,  a.  In  the  foregoing  section  I  have  stated  a  problem  for  the  spe- 
cific object  of  showing  the  variety  of  changes  which  diseases  are  liable 
to  sustain  in  their  pathological  character  during  a  short  period  of  their 
progress,  and  the  importance  of  adapting  the  treatment  to  the  changes 
which  may  ensue,  with  no  other  reference  to  symptoms  than  as  they 
are  indicative  of  the  seat  of  disease  and  its  true  pathology  (§  762). 
But  I  have  also,  incidentally,  at  the  same  time,  demonsti'ated  the  ab- 
surdity of  attempting  any  part  of  the  problems  of  disease,  or  the  mo- 
dus operandi  of  remedial  agents,  by  any  philosophy  boirowed  from 
the  inorganic  world,  or  by  any  hypothesis  in  the  humoral  pathology. 
The  vital  solidists,  however,  being  numerically  small,  claim  to  be 
little  ceremonious  with  error ;  and  once  more,  therefore,  I  shall  bring 
into  contrast  the  adverse  doctrines  (§  350i-376j,  433-450).  With 
this  intention  I  shall  submit  the  philosophy  as  now  taught  in  Great 
Britain  and  France,  and  leave  it  to  the  reader  to  interpret  by  that 
philosophy,  if  he  can,  the  problems  contained  in  the  last  preceding 
section. 

676,  h.  It  is  scarcely  necessary  to  remind  the  reader  that  Liebig's 
speculations  in  medicine  are  in  general  vogue  in  Great  Britain  (§ 
349,  d),  and  have  become  incorporated  in  medical  works  of  every  de- 
scription (§  433).  Take  the  following  example,  relative  to  my  pres- 
ent topic,  from  the  long-celebrated  and  able,  but  now  completely  met- 
amorphosed, Pharmacologia  of  Dr.  Paris  {^  339,  h). 

"  In  a  recent  work  by  Professor  Liebig,  to  which  I  have  frequently 
referred,"  says  Dr.  Paris,  "  we  are  presented  with  views  not  only  ap- 
plicable to  the  question  under  discussion,  but  well  calculated  to  ex- 
tend our  knowledge  with  regard  to  the  modus  operandi  of  contagious 
matter,  and  its  reproduction  in  the  living  body.  I  have  already  ex- 
plained his  important  application  of  the  dynamic  law  of  La  Place  to 
chemical  action ;  viz.,  that  a  body,  the  atoms  of  which  are  in  a  state 
of  transformation,  may  impart  its  peculiar  condition  to  compounds  with 
which  it  may  happen  to  communicate." 

Dr.  Paris  then  proceeds  to  say,  that  it  "  was  reserved  for  the  genius 
of  Liebig"  to  apply  this  doctrine  of  "fermentation,"  "putrefaction," 
&c.,  to  the  living  body,  in  explanation  of  "  the  modus  operandi  of  con- 
tagious matter,"  &c.  I  had  occasion  to  set  forth  this  philosophy  of  the 
Continental  Chemist  in  my  Examination  of  Reviews,  together  with 
the  principal  examples  by  which  it  was  sustained  (p.  55).  Some  of 
them  occur,  also,  in  the  present  work  (§  350,  nos.  29  to  46,  and  78  to 
97).  Of  the  "  sausages,"  by-the-way  (to  illustrate  the  extent  of  acqui- 
escence), it  is  said  by  Dr.  Paris  that,  "  by  entering  the  blood,  they  im- 
part their  peculiar  action  to  the  constituents  of  that  fluid,  and  a,ll  the 
substances  in  the  body  are  induced  to  undergo  a  modified  putrefaction'^ 
(§  339  b,  349  d,  350,  no.  44). 

E  E 


434  INSTITUTES    OF    MEDICINE. 

I  shall  not  pursue  this  subject  farther,  having,  in  the  Medical  and 
Physiological  Commentaries  (vol.  i.,  p.  385-716),  devoted  an  Essay  to 
the  merits  of  the  Humoral  Pathology,  where  all  the  foregoing  points, 
the  "  sausages,"  &c.,  are  duly  investigated  (§  282). 

And  now  to  complete  this  example  of  sudden  and  general  illumina- 
tion, and  to  exemplify,  again  and  again,  "  the  recent  progress  of  med- 
ical science"  under  the  auspices  of"  expei'imental  philosophy,"  let  urf 
hear  Dr.  Paris  as  he  was  at  a  former  edition  of  his  Pharmacologia, 
and  when  he  and  others  were  just  as  much  enlightened  as  to  the  con- 
nection of  chemistry  with  the  healthy  and  morbid  processes  of  man  aa 
when  he  put  forth  the  ninth  and  last  edition  of  that  distinguished 
work.     Thus : 

"  Every  rational  physician  must  feel,  in  its  full  force,  the  ahsurdity 
of  expecting  to  account  for  the  phenomena  of  life  upon  principles  de- 
duced from  the  analogies  of  inert  matter ;  and  we  therefore  find  that 
the  most  intelligent  physiologists  of  modern  times  have  been  anxious  to 
discourage  the  attempt,  and  to  deprecate  its  folly  T 

In  descanting  upon  the  interference  of  the  celebrated  chemist,  Mr. 
Brande,  with  medical  topics,  Dr.  Paris  remarked,  that 

^'■Whenever  the  chemist  forsakes  his  laboratory  for  the  hed-sidc,  he 

FORFEITS  ALL  HIS  CLAIMS  TO  OUR  RESPECT  AND  HIS  TITLE  TO  OUR  CON- 
FIDENCE" (§  709,  1006  a,  1034). 

III.    SYMPTOMS. 

677.  Symptomatology  is  the  third  and  last  division  of  pathology ;  be- 
ing the  doctrine  of  symptoms.  It  embraces  all  the  phenomena  which 
result  either  directly  or  indirectly  from  morbid  states,  and  includes, 
therefore,  the  physical  as  well  as  vital  signs  (§  883). 

678.  During  the  healthy  state  of  the  vital  properties  all  the  results 
of  life  progress  in  one  uniform  way,  according  to  the  nature  of  the 
several  parts  of  the  organic  being  (§  249).  But,  as  soon  as  the  prop- 
erties of  any  part  undergo  changes  there  arise  corresponding  changes 
in  the  motions  of  the  vessels,  and  in  all  the  phenomena  and  products 
(§  177). 

679.  Now  it  is  owing  to  the  insensible,  recondite  nature  of  the  effi- 
cient causes  of  all  phenomena  that  we  are  compelled  to  apply  our- 
selves to  the  study  of  the  phenomena  to  obtain  a  knowledge  of  the 
powers  or  properties  upon  which  they  depend,  the  modifications 
which  the  powers  or  properties  may  undergo,  and  the  laws  which 
they  obey.  It  is  obvious,  therefore,  that  the  nearer  the  phenomena 
are  to  the  direct  operation  of  the  causes  the  more  significant  will 
they  be  of  their  nature  and  existing  condition.  This  undeniable  fact 
shows  us  the  superiority  of  the  primary  effects  of  disease,  as  a  guide 
to  pathological  conditions,  over  those  ultimate  results  which  are  dis- 
closed by  morbid  anatomy. 

680.  In  entering  upon  this  inductive  branch  of  pathology  it  is  im- 
portant to  bear  in  mind,  that,  however  complex  the  nature  and  varie- 
ty of  symptoms  they  have  always  as  much  an  absolute  cause  as  any 
effect  in  the  inorganic  world;  and  I  am  led  to  this  remark  for  the  pui'- 
pose  of  adding  another, — that  it  is  of  incomparably  greater  importance 
to  ascertain  the  former  than  the  latter.  AVhen  motions  are  disturbed 
in  the  subordinate  kingdom  it  is  the  first  impulse  of  reason  to  trace 
out  the  cause ;  but  that  is  the  measure  of  its  compass.     The  Power 


PATHOLOGY, SYiMPTOMS  435 

that  gave  to  matter  its  being,  oi*  natural  influences,  can  alone  rectify 
the  cause.  But,  how  different  with  organic  nature  !  How  expres- 
sive of  the  radical  distinction  between  the  causes  of  motion  in  the 
dead  and  the  living  world!  In  the  latter  all  is  fluctuating  in  its  na- 
ture, yet  all  controllable  in  that  very  nature  by  the  hand  of  man.  AVe 
see  in  the  principle  of  life  the  cause  of  organic  results.  We  see 
those  results  vacillating  in  every  possible  aspect ;  and,  as  with  the 
chemist,  or  the  astronomer,  in  the  former  case,  we  interrogate  the 
cause.  But  we  do  so  with  a  far  higher  aim ;  for  we  know  that  the 
cause  is  amenable  to  rectifying  influences.  In  the  world  of  matter 
and  in  the  world  of  life  the  causes  of  erratic  phenomena  may  be  on 
a  par  in  principle.  The  disturbing  influences  may  be  alike  due  to  a 
common  cause  in  each  department,  respectively.  But,  in  the  miner- 
al kingdom  there  are  numerous  fundamental  causes  in  operation,  and 
the  jDhenomena,  therefore,  may  depend  upon  opposing  influences.  In 
the  organic,  from  the  mushroom  to  man,  there  is  but  one  cause ;  and 
hence  the  obvious  induction  that  certain  changes  in  the  natural  condi- 
tion of  that  one  give  rise  to  all  those  diversified  effects  which  form 
the  transient  phenomena  of  disease,  or  those  more  stable  changes 
which  are  seen  in  the  progress  of  the  being  from  its  embryo  to  its 
adult  state,  or  in  the  vicissitudes  of  temperament,  &c. 

We  therefore  apply  ourselves,  I  say,  to  the  cause  itself;  and  here 
all  analogy  disappears  with  any  known  cause  in  the  inorganic  kino-- 
dom.  The  former  is  changeable  in  its  nature,  and  as  the  changes  go 
on,  its  existence  comes  to  an  end.  But  the  same  First  Cause  Who 
imparted  that  instability  for  great  and  wise  purposes  ordained,  also, 
that  when  the  principle  of  life  should  be  diverted  from  its  natural 
condition  by  untoward  agents,  it  should  still  possess,  through  the  same 
law  of  mutability,  a  capacity  of  receiving  impressions  from  other 
agents  that  shall  awaken  its  inherent  tendency  to  a  state  of  integrity. 
In  tracing  out  the  nature  and  the  seat  of  disease  through  the  at- 
tendant phenomena,  we  are  also  animated  with  the  conviction  that 
organic  beings  are  subject  to  laws  as  precise  as  those  which  rule  in 
the  inorganic  world,  under  all  their  fluctuations  ;  and  the  greater  com- 
plexity in  the  elements  of  their  laws  than  such  as  relate  to  physics 
and  chemistry  should  stimulate  the  most  exact  investigation  of  symp- 
toms wherever  nature  may  demand  the  active  interference  of  art,  sc 
that  the  latter  may  make  the  best  use  of  her  laws  (§  237,  447  b). 

681,  a.  The  symptoms,  or  effects  to  be  employed  as  guides  to  the 
nature  and  seats  of  disease,  are,  1st.  Those  which  are  denominated 
vital  signs,  and  which  are  independent  of  physical  products.  2d. 
The  changes  of  motion  and  other  conditions  relating  to  the  vessels 
which  are  the  instruments  of  disease,  but  which  are  independent  of 
structural  changes.  3d.  The  physical  products  which  are  compre- 
hended under  the  denominations  of  secretions  and  excretions.  4th. 
Symptoms  of  the  foregoing  nature  which  are  determined  or  modified 
by  changes  of  organization,  and  about  which  morbid  anatomy  is  in- 
terested. 5th.  Signs  of  a  physical  nature  which  depend  upon  either 
some  change  of  structure,  or  on  the  accumulation  of  fluids,  or  the 
presence  of  some  unusual  fluid,  or  other  substance,  within  the  body. 
These  last  signs  come  to  us  principally  through  the  medium  of  sound 
and  touch.  The  first  three  of  the  foregoing  classes  of  symptoms  may 
be  denominated  ^r/wary,  the  last  two  secondary. 


436  INSTITUTES    OF    MEDICINE. 

6S1,  h.  The  five  divisions  into  which  I  have  distributed  the  symp- 
toms of  disease,  and  the  remaining  facts  which  we  derive  from  mor- 
bid anatomy,  and  what  we  learn  from  remote  causes,  and  the  effects 
of  remedial  agents,  supply  all  the  knowledge  we  can  obtain  of  the 
pathology  of  disease, 

681,  c.  We  must,  therefore,  constantly  concern  ourselves  about  ef- 
fects, whether  investigating  the  natural  world,  the  powers  by  which 
it  is  governed,  or  spiritual  existences. 

Symptoms,  then,  are  the  language  of  disease,  as  effects  are  of  all 
other  real  existences. 

682,  a.  Certain  symptoms  are  called  diagnostic.  By  these,  in  part, 
we  distinguish  diseases  from  each  other.  A  symptom,  therefore,  to 
be  diagnostic,  must  be  peculiar  to  one  affection.  Thus,  hydrophobia 
is  the  diagnostic  symptom  of  the  disease  which  is  called,  like  some 
other  affections,  after  the  name  of  its  diagnostic.  But  it  is  only  pecu- 
liar to  the  disease  as  it  affects  the  human  species.  The  diagnostic  of 
intermittent  fever  is  the  intermission  between  the  paroxysms ;  and  so 
of  their  attendant  intermittent  apoplexies  ;  and  paroxysmal  increase 
of  those  inflammations  that  are  relieved  by  bark,  and  the  intermission 
of  periodical  headaches,  and  of  tic  douloureux,  are  their  diagnostics. 

682,  Z».  Some  diseases  may  have  several  diagnostic  symptoms.  Thus, 
in  pneumonia,  a  good  diagnostic  is  found  in  the  tenacity  of  the  mucus. 
Another  diagnostic  is  the  crepitating  noise  which  is  heard  on  applying 
the  ear  to  the  chest.  The  first  symptom,  however,  is  often  absent, 
and  the  other  is  not  always  present,  especially  in  infants.  The  crep- 
itus, also,  disappears  when  condensation  of  the  air-cells  takes  place, 
and  this  disappearance  is  diagnostic  of  condensation.  But  if  the  pa- 
tient recover,  the  condensation  generally  disappears,  and  while  the 
process  of  absorption  is  going  on  the  crepitus  returns,  and  this  is  di- 
agnostic of  the  absorption.  Many  diagnostics  are  supplied  by  aus- 
cultation as  to  the  particular  parts  which  are  affected  in  diseases  of 
the  heart,  and  which  are  significant  of  the  precise  nature  of  the  affec- 
tion. And  so  of  the  lungs.  Percussion  has  also  its  peculiar  diagnos- 
tic signs.  We  are  doubtful,  for  instance,  whether  a  tumid  state  of  the 
abdomen  be  owing  to  flatulency  or  to  something  else.  A  hollow 
sound,  on  percussion,  assures  us  that  it  depends,  in  part,  at  least,  upon 
the  presence  of  some  gaseous  substance.  % 

682,  c.  Many  diseases  have  certain  symptoms  which  are  nearly 
always  present  at  certain  stages  of  their  progress,  but  are  more  or 
less  attendant  on  some  other  affections.  This  is  the  case  with  the 
hectic  fever  of  consumption.  In  such  instances  the  other  attending 
symptoms  will  determine  whether  the  prevailing  one  in  any  particu- 
lar affection  is  significant  of  that  disease  in  the  case  before  us.  In- 
compressibility  of  the  pulse  is  perhaps  always  significant  of  inflamma- 
tion ;  but  it  often  requires  much  skill  to  detect  it.  The  attendant 
hai-dness  of  the  pulse  may  be  then  taken  as  a  good  diagnostic ;  but 
this  also  is  often  ascertained  only  by  a  delicacy  of  touch,  and  may  not 
be  always  distinguished  from  the  pulse  of  pregnancy.  An  auxiliary 
diagnostic  will  then  be  found  in  a  buffiness  of  the  blood ;  but  here, 
too,  that  appearance  is  often  presented  by  the  blood  of  pregnant  fe- 
males. There  then  remains  an  unequivocal  diagnostic  of  inflammation 
in  the  associated  cupping  and  fimbriated  edges  of  the  blood  (§  688,<Z,e) 

On  the  other  hand,  there  are  many  affections  which  have  no  diag- 


PATHOLOGY. SYMPTOMS.  437 

nostic  symptom ;  and  we  must  then  rely  upon  the  combined  symp- 
toms, the  remote  causes,  &c. 

682.  d.  Such,  then,  are  symptoms  which  impart  a  general  appre- 
hension of  the  nature  of  disease,  or  of  its  variations,  &c.  They  serve 
as  an  aggregate  of  the  other  attending  phenomena,  and,  in  a  general 
sense,  should  be  employed  only  as  starting  points  to  a  critical  investi- 
gation of  those  numerous  details  which  may  alone  conduct  us  to  a 
knowledge  of  the  extent  and  force  of  disease,  its  complications,  &c. 

683.  There  are  other  symptoms  which  are  called  prognostic.  It  is 
by  these,  in  part,  that  we  judge  of  the  degree  of  danger,  and  of  the 
probable  issue  of  disease.  Hence  arise  the  X.evms,  favorable  and  Jictal, 
and  various  other  expressions  of  an  intermediate  import. 

684.  We  acquire  our  knowledge  of  symptoms,  or  deviations  from 
the  natural  states  of  the  body,  by  comparing  the  former  with  the  phe- 
nomena of  the  latter;  and  we  distinguish  diseases  from  each  other, 
and  learn  the  changes  which  are  in  progress,  by  comparing  symptoms 
with  each  other.  By  the  same  system  of  comparison  we  judge,  also, 
of  the  effects  of  remedies,  form  our  prognosis,  &c. 

685.  It  is  evident,  therefore,  that  the  young  practitioner,  at  least, 
should  acquire  a  habit  of  methodical  analysis  of  disease,  with  a  steady 
view  to  its  pathological  cause,  and  the  successive  changes  which  may 
arise  in  respect  to  this  cause  (§  673,  675).     He  should  begin, 

1st.  With  an  inquiry  into  the  natural  temperament  of  the  subject, 
his  age,  habits,  &c. 

2d.  Make  a  general  survey  of  the  symptoms,  the  organs  from  which 
they  spring,  their  general  aspect,  number,  variety,  &c. 

3d.  In  all  cases  of  severity,  the  remote  causes  should  be  ascertain- 
ed as  far  as  possible. 

4th.  All  the  great  organs  should  be  next  critically  interrogated,  that 
the  primary  seat  of  disease  may  be  ascertained  and  understood,  and 
how  far  it  may  have  involved,  by  reflex  nervous  actions,  other  or- 
gans, both  in  their  compound  nature  and  in  their  individual  tissues 
(§  133,  &c.),  and  how  far,  also,  the  sympathetic  results  may  react 
upon  the  primary  disease,  or  institute  morbific  reflex  influences  among 
themselves. 

This  inquiry  embraces  all  the  vital  signs,  the  state  of  the  secretions 
and  excretions,  and  the  physical  signs  afforded  by  auscultation  and 
percussion.  The  countenance,  the  organs  of  sense,  and  all  that  re- 
lates to  the  external  body,  the  state  of  the  tongue,  pulse,  &c.,  should 
come  under  review. 

5th.  A  careful  comparison  of  all  the  symptoms  should  be  instituted 
with  the  analogous  phenomena  in  health ;  with  the  symptoms  of  the 
same  disease  as  it  may  affect  other  parts ;  with  the  symptoms  as  they 
may  have  been  observed  in  various  degrees  and  at  different  stages  of 
the  same  malady ;  with  the  symptoms  of  convalescence ;  and  with 
Buch  as  follow  the  action  of  medicines ;  and  with  the  symptoms  of 
other  diseases. 

6th.  Inquire  into  the  mode  in  which  the  symptoms  occur,  whether 
suddenly  or  gradually,  distinctly  or  confusedly,  &c. 

7th.  Consider  their  progress,  their  changes,  the  mode  of  their  prog- 
ress, &c. 

8th.  Examine  the  relation  of  different  symptoms  to  each  other ;  as^ 
their  relative  duration,  order  of  occurrence,  &c. 


438  INSTITUTES    OF    MEDICINE 

9th.  Calculate  the  degree  or  force  of  the  symptoms;  a  point  of  dif 
ficult  attainment,  requiring  a  correct  appreciation  of  the  properties  ot 
life,  a  profound  knowledge  of  physiology,  an  extensive  acquaintance 
with  its  modifications  in  disease,  habits  of  a  close  analysis  of  symp- 
toms, much  thought,  and  a  well-disciplined  mind.  To  one  thus  quali- 
fied the  eye  of  the  patient  alone  may  be  a  luminous  index  to  the  de- 
gree or  force  of  the  general  symptoms  (§  163,  714). 

686,  a.  And  now,  as  a  consummation,  next  to  the  direct  application 
of  remedies,  of  all  that  has  been  hitherto  submitted  to  my  reader,  as 
immediately  indispensable  to  the  ultimate  aim  of  all  that  has  been  said, 
and  without  which  the  Institutes  of  Medicine  would  only  serve  as  an 
intellectual  exercise,  I  shall  introduce  a  practical  example,  as  a  gen- 
eral standard  for  investigating  any  given  form  of  disease  with  a  view 
to  its  treatment  (§  714). 

686,  b.  Let  us,  then,  suppose  ourselves  called  to  a  case  of  idiopathic 
fever  of  some  three  or  four  days'  duration,  in  which,  from  the  length 
of  its  continuance,  there  have  probably  arisen  some  local  inflamma- 
tions, and,  perhaps,  venous  congestions. 

We  proceed,  according  to  the  foregoing  method  (§  685),  to  inquire, 

1st.  Into  some  general  facts,  and  take  a  general  survey  of  the  case. 
AVe  inquire  how  long  the  patient  has  been  sick,  with  what  symptoms 
■he  was  attacked,  what  new  ones  have  subsequently  sprung  up.  wheth- 
er they  have  undergone  an  increase  in  the  afternoon,  and  a  decline 
toward  morning,  whether  the  attack  was  preceded  by  unusual  sen- 
sations, or  by  any  signs  of  beginning  disease,  what  is  his  age,  consti- 
tution, habits,  &c.  The  knowledge  thus  acquired  gives  us  a  general 
apprehension  of  the  nature  of  the  case,  and  we  come,  at  once,  to  the 
conclusion,  that  it  is  a  case  of  idiopathic  fever,  affecting  an  individual 
of  a  certain  age,  temperament,  habits,  &c.     This  leads  us  to  inquire, 

2d.  Into  the  nature  of  the  pi'edisposing  causes  (§  662),  and  as  they 
are  atmospheric  (§  648,  b),  we  ascertain  his  place  of  residence  for  a 
few  preceding  months.  We  find,  perhaps,  that  he  has  lately  come 
from  a  city  where  yellow  fever  prevailed,  or  had  resided  from  one  to 
six  months  ago  where  typhus  was  rife,  or  where  it  is  known  to  occur, 
or  from  one  to  twelve  months  since  he  had  been  in  some  marshy  dis- 
trict, or  upon  some  new  rich  soil,  where  the  remittent  fever  delights ; 
or,  there  may  be  reason  to  suppose  that  the  causes  originated  in  the 
place  where  he  is  attacked.  A  knowledge  of  any  of  these  facts, 
whichever  may  be  true,  goes  far  in  ascertaining  the  particular  modifi- 
cation of  fever  he  may  suffer  (§  650-653).  Let  us  suppose  him  an 
Irish  emigrant,  just  landed  in  New  York.  We  suspect  at  once  ty- 
phus fever,  though  we  have  no  such  fever  originating  with  us.*  It  is 
a  very  common  form  of  fever,  however,  in  Ireland ;  and  we  learn  far- 
ther from  our  patient  that  it  prevailed  in  his  neighborhood  when  he 
left  that  country.  This  knowledge  influences  our  subsequent  inqui- 
ries, when  we  proceed, 

3d.  To  inquire  specifically  into  the  symptoms  attendant  on  all  the 
organs,  and  to  compare  them  with  the  natuial  phenomena  of  each. 
We  begin  where  they  are  most  strongly  pronounced,  and  pass  from 
one  organ  to  another  as  may  be  suggested  by  the  most  obvious  symp- 
toms, or  as  they  may  seem  to  be  related  by  sympathetic  influences 
(§  6G0).  The  disease  being  typhus,  the  brain,  or  its  membranes,  are 
probably  the  seat  of  inflammation  or  venous  congestion.  We  inquire 
♦  See  Note  S  p.  1124. 


PATHOLOGY. SYMPTOMS.  439 

as  to  headache,  whether  obtuse   or  acute,  in  what  part  of  tlio  head, 
&c. ;  whether  there  be  drowsiness  or  wakefuhiess  ;  whether  there  bo 
an  unusual  pulsation  of  the  carotids,  or  of  the  temporal  arteries,  or 
an  exalted  temperature  of  the  head ;  whether  the  face  be  suffused 
with  blood,  and  if  so,  whether  the  plethora  be  in  the  arteries  or 
veins, — being  florid  in  one  case  and  purplish  in  the  other.     We  look 
critically  at  the  eyes,  observe  how  their  lustJ'e  or  other  expression  is 
affected ;  whether  the  pupil  be  dilated  or  contracted,  and,  if  the  sight 
be  dim,  we  inquire  whether  it  be  owing  to  an  affection  of  the  ictina,  or 
h  )w  far  to  actual  cerebral  disease  or  to  sympathy  of  the  eyes  with  any 
gastro-intestinal  derangement;  whether  the  conjunctiva  or  the  eye- 
lids be  red  or  purplish,  whether  moist  or  dry,  &c.     We  attend  to  the 
hearing,  whether  dull  or  acute ;  observe  how  far  speech  may  be  af- 
fected, and  how  much  any  impediment  may  be  due  to  cerebral  disease, 
or  to  dryness  of  the  mouth,  or  to  inattention,  &:c.     These  inquiries 
relative  to.  the  senses  should  be  accompanied  by  others  respecting 
the  mind,  whether  memory  be  much  affected,  perception  and  reflec- 
tion impaired,  whether  there  be  hallucinations  when  awake,  or  talking 
in  sleep,  and  whether  sleep  be  comatose,  or  how  long  continued,  &c. 
These  inquiries  may  leave  little  doubt  that  there  is  both  inflammation 
and  venous  congestion  within  the  head,  which  will  be  cleared  up  by 
an  investigation  of  symptoms  relative  to  other  organs  (§  803,  &c.). 
Our  attention  may  be  next  attracted  to  the  chest  by  cough,  or  some 
embarrassment  of  respiration.     We  inquire  when  the  cough  began, 
what  its  frequency  and  severity,  how  far  it  may  be  independent,  in 
its  origin,  of  other  local  burdens  of  disease,  or  how  far  consequent 
on  abdominal  affections,  and  whether  attended  by  expectoration,  and 
what  the  nature  of  the  matter  expectorated.     We  count  the  respira- 
tions, and  observe  their  equality  or  inequality.     We  see,  perhaps, 
that  the  brain  influences  the  respiration  unfavorably,  especially  if 
slow,  and  this  adds  to  our  conviction  that  mischief   exists   in    the 
head;  or,  if  the  breathing  be  hurried,  it  may  be  due  to  febrile  excite- 
ment, or  to  abdominal  derangement.     The  cough  and  expectoration 
show  us  that  some  inflammatoiy  action  is  going  on  in  the  lungs ;  but 
we  are  doubtful,  perhaps,  on  account  of  some  thoracic  pain,  and  as 
the  sputa  is  rather  adhesive,  whether  inflammation  be  confined  to  the 
mucous  membrane  of  the  bronchi,  or  have  reached  the  air-cells  and 
cellular  tissue,  and  thus  constituting  pneumonia.    We  therefore  resort 
to  auscultation  and  percussion  to  resolve  the  doubt.     I'^i'om  the  for- 
mer we  learn  that  there  is  no  crepitus,  that  the  murmur  is  clear  and 
free,  and  there  is  only  a  mucous  rale ;  by  percussion,  we  find  that 
the  resonance  is  good,  and  we  therefore  dismiss  our  fears  as  to  the 
possible  existence  of  pneumonia,  or  of  tubercle.     But  the  patient 
complains  of  pain  in  his  chest.     We  ask  him  to  breathe  dee])ly,  and 
the  pain  is  much  increased,  as  it  is  also  on  coughing.      From  this 
symptom,  and  the  absence  of  pneumonia,  we  are  sure  of  the  exist- 
ence of  inflammation  in  the  pleura,  while  the  cough  and  expectora- 
tion tell  us  of  catarrhal  inflammation  in  the  pulmonary  mucous  tissue. 
It  is  now  time  to  feel  of  the  pulse,  to  learn  how  far  reflex  nervous 
actions  may  affect  the  heart  and  arteries,  since  the  extent  of  the  influ- 
ences on  tiac  circulatory  organs  may  show  us  considerably  the  sever- 
ity of  the  local  inflammations.     But  this  system  is  also  under  the  influ- 
ence of  the  general  idiopathic  disease,  and  it  is  often  one  of  the  nicest 


440  INSTITUTES    OF    MEDICINE. 

points  to  determine  how  much  of  its  character  is  due  to  the  febrile  af- 
fection and  how  much  to  reflex  nervous  actions.  And  the  difficul- 
ty  is  enhanced  if  influences  are  directly  propagated  abroad  by  cere- 
bral disease.  We  find  the  pulse,  perhaps,  not  so  hard  or  full  as  we 
had  expected,  and  this  leads  us  to  infer  more  of  venous  congestion 
than  of  ordinary  inflammation  of  the  brain  ;  or,  that  there  may  be  ve- 
nous congestion  in  some  other  organ  not  yet  examined,  since  these 
congestions  are  very  apt  to  spring  up  in  typhus,  and  to  moderate  a 
hardness  of  the  pulse  which  the  coexisting  inflammations  of  the  mem- 
branes of  the  brain  and  lungs  would  otherwise  produce  (§  815,  &c.). 
Perhaps  we  discover,  also,  in  the  pulse,  some  intermission  or  other 
irregularity  in  its  stroke.  This  may  be  owing  to  some  organic  affec- 
tion of  the  heart,  and  to  resolve  this  doubt,  we  again  resort  to  auscul- 
tation. We  find,  however,  all  the  sounds  good,  and  we  are  now  led 
by  the  foregoing  symptom,  along  with  the  subdued  hardness  of  the 
pulse,  and  its  want  of  any  great  incompressibility,  to  suspect  venous 
congestion  of  the  liver,  since  intermission  and  other  irregularities  of 
the  pulse,  without  organic  disease  of  the  heart,  commonly  depend 
upon  that  state  of  hepatic  disease,  though,  also,  on  cerebral  inflam- 
mation ;  but  in  the  latter  the  pulse  is  more  frequent  than  in  the  former 
case,  when,  also,  in  the  absence  of  fever,  it  is  often  preternaturally 
slow;  or,  if  slowness  of  pulse  depend  on  venous  congestion  of  the 
brain,  as  it  sometimes  does,  the  respiration  is  also  apt  to  be  slow, 
while  it  is  unaffected  in  simple  hepatic  congestion  (§  390,  h).  We 
then  take  the  liver  next  in  our  range  of  inquiry.  We  find,  perhaps, 
some  obscure  tenderness  on  pressing  its  region,  and  the  patient  may 
have  had  some  pain  in  this  quarter.  We  then  look  at  the  skin,  to  see 
whether  there  be  any  shade  of  yellow,  and  when  our  cathartics  oper- 
ate, we  examine  the  discharges  with  various  references,  but  partic- 
ularly as  to  the  state  of  the  visceral  secretions.  If  they  are  blackish,  or 
green,  this  strengthens  our  conclusion  as  to  congestion  of  the  liver, 
though  the  congestion  may  be  so  profound  that  little  or  no  bile  is  se- 
creted. This  condition  of  the  liver,  however,  is  more  apt  to  attend 
remittent,  intermittent,  and  yellow  fevers.  We  observe  whether  there 
be  a  redundancy  of  intestinal  mucus,  as  this  would  denote  some  in- 
flammation of  the  mucous  tissue,  and  has  often  an  important  bearing 
upon  the  treatment  of  the  case,  as  does  also  that  irritable  state  of  the 
intestine  which  is  denoted  by  the  diarrhoea  that  often  supervenes  in 
i\\G  progress  of  typhus  fever.  We  look  at  the  urine,  and  find  it  per- 
haps scanty,  scalding,  very  high-colored,  and  depositing  a  sediment. 
This,  however,  would  imply  nothing  distinctly,  but  that  the  kidneys 
suffer  in  their  powers  and  functions,  though  great  scantiness  of  urine 
and  a  high  color  would  denote  a  considerable  burden  of  disease  upon 
one  or  more  important  remote  organs,  and  those  particularly  the  di- 
gestive organs.  We  now  turn  our  attention  more  particularly  to  the 
alimentary  canal,  partly  with  a  reference  to  its  morbid  state,  and  in 
part  to  aid  our  judgment  in  the  right  administration  of  medicines. 
Here,  too,  we  may  find  a  great  focus  of  disturbing  reflex  nervous  in- 
fluences radiating  from  the  gastro-intestinal  mucous  membrane,  light- 
ing up  inflammations  or  congestions  of  other  parts,  or  maintaining  and 
aggravating  such  as  may  have  sprung  from  other  causes,  and  sustain- 
ing itself  reverberated  nervous  influences  (§  514  h,  647,  889  g).  We 
press,  for  example,  the  region  of  the  stomach,  to  learn  whether  it  be 


PATHOLOGY. SYMPTOMS.  441 

tender,  and  in  like  manner  examine  the  whole,  or  special  regions,  of 
the  abdomen,  if  there  be  pain  or  uneasiness  in  the  intestines,  &c.,  and 
we  make  percussion  to  see  if  there  be  flatulency.  We  inquire  what 
food  the  patient  has  recently  taken,  and  whether  the  bowels  have  beer, 
constipated  or  loose.  In  all  this  part  of  the  inquiry  we  are  often  great- 
ly aided  by  the  appearances  of  the  intestinal  evacuations,  which  should 
be  carefully  observed  throughout  the  continuance  of  disease  (§  6945). 
We  also  examine  the  tongue  with  a  reference  to  several  objects,  but 
especially  with  a  view  to  the  condition  of  the  stomach  and  intestines. 
We  notice  its  color  at  its  edges  and  in  the  centre  ;  whether  coated,  and 
how  extensively,  and  what  the  color  of  the  coating  in  its  different  parts; 
whether  light  and  loose,  smooth  or  rough  ;  whether  dry  or  moist, 
and  the  extent  of  each  ;  whether  the  tongue  be  enlarged  or  conti'acted, 
pointed  or  obtuse,  smooth  or  indented  at  its  edges,  what  its  color,  &c. 
We  look  at  the  fauces,  to  learn  if  they  be  red  or  purplish,  as  indica- 
tive of  inflammation  or  venous  conpcestion,  or  other  derano-ement  in  the 
important  organs  below ;  observe  whether  there  be  glutinous  matter 
on  the  teeth,  and  what  its  color,  and  the  rapidity  with  which  it  may 
collect. 

We  now  turn  our  attention  more  distinctly  than  before  to  the 
functions  of  the  skin ;  whether  it  be  dry  or  moist,  or  each  alternate- 
ly, and  the  duration  of  each,  whether  hot,  wann,  or  cold,  and  at  what 
times,  and  how  long,  whether  the  heat  be  distributed  equally,  whether 
the  feet  be  cold  when  the  rest  of  the  surface  is  hot,  whether  the  skin 
be  rough  or  smooth,  what  its  color,  whether  there  be  "  sudamina," 
"  rose-colored  spots,"*  &c. 

The  patient  may  require  the  loss  of  blood,  and  we  observe  its  col- 
or, whether  dark  or  florid,  the  manner  in  which  it  flows  from  the  arm, 
whether  in  a  full  stream  or  whether  it  trickle,  whether  it  throw  up  a 
buffy  coat,  be  indented  or  cupped  in  its  centre,  or  fimbriated  at  its 
edges;  and,  that  these  observations  maybe  perfect,  we  take  an  ounce 
in  a  fumiel-shaped  vessel  for  examination  (^  682  c,  688  ee). 

If,  in  the  case  of  fever  now  under  examination,  there  be  a  predom- 
inating influence  of  the  venous  congestions  over  the  membranous  in- 
flammations, the  blood  will  be  dark,  will  trickle  from  the  arm,  or  flow 
in  a  languid  stream,  at  first,  and  will  throw  up  a  buffy  coat,  without 
as  much  indentation  as  when  membranous  inflammation  exists  with- 
out venous  congestion. 

686,  c.  The  foregoing  analysis  of  symptoms  is,  to  the  young  practi- 
tioner, necessary  to  a  clear  apprehension  of  many  severe  diseases,  but 
must  be  more  or  less  varied  according  to  the  nature  of  the  disease. 
It  may  be  apparently  tedious,  but  is  accomplished  with  rapidity  by  a 
little  practice.  Nor  have  I  stated  all  the  inquiries  which  should  have 
been  instituted,  and  which  may  be  of  essential  moment.  Thus,  it  may 
be  necessary  to  call  irithe  aid  of  smell  to  ascertain  whether  any  foetor 
we  may  observe  come  from  the  mouth,  or  stomach,  or  lungs,  or  from 
the  surface  of  the  body.  The  patient  may  also  supply  a  variety  of 
facts  as  to  his  sensations, — whether  restless,  weary,  prostrated  in  his 
voluntary  muscles,  what  as  to  pain,  or  sensations  of  heat,  chilliness, 
&c.  We  vary  his  posture,  to  learn  how  it  may  affect  respiration,  or 
the  state  of  his  pulse.     I  have  also  left  out  of  my  examination  of  the 

*  See  Essay  on  tho  Writings  of  Louis,  in  Medical  and  Physiological  Commentaries 
Tol.  ii.  p.  724.  &c. 


4-12  INSTITUTES    OF    MEDICINE. 

Toregoing  case  an  inquiry  as  to  the  mode  in  which  the  symptoms  took 
place, — whether  suddenly  or  gradually,  distinctly  or  confusedly,  wheth- 
er they  began  with  a  chill,  or  with  a  paroxysm  of  heat,  &c.,  about 
which  the  patient  should  be  specifically  interrogated.  Nor  did  I  ex- 
amine sufficiently  the  relation  of  the  different  symptoms  to  each  other, 
as  their  relative  duration,  their  order  of  occurrence,  &c.,  by  which  we 
ascertain  which  organ  was  first  inflamed  or  congested,  an<^what  oth- 
ers are  more  or  less  affected  by  reflex  nervous  action.  And  there 
yet  remains  to  be  considered  the  progress  of  the  symptoms,  their  mode 
of  progress,  their  spontaneous  changes,  or  such  as  may  arise  from  in- 
cidental exciting  causes,  or  from  the  action  of  remedies,  &c.,  and, 
also,  their  comparison  with  those  of  other  modifications  of  fever,  or 
other  forms  of  disease.  I  said  nothing,  specifically,  as  to  an  inquiry 
into  the  degree  or  force  of  the  symptoms,  which  is  always  a  subject 
for  accurate  consideration,  as  it  goes  far  in  denoting  the  severity  of 
disease  in  different  parts,  and  is  one  important  guide  to  the  nature 
and  extent  of  the  remedies.  But  this  is  an  attainment,  as  already  im- 
plied, which  cannot  be  imparted  by  a  description  of  symptoms,  since 
their  force  cannot  be  expressed  in  language.  Their  estimate  must 
come,  as  it  were,  by  intuition.     Chemistry  contributes  nothing. 

686,  d.  In  propoition  as  our  knowledge  of  physiology  enlarges,  and 
we  apply  it  to  the  investigation  of  disease,  the  practice  of  a  minute 
analysis  of  symptoms  becomes  less  and  less  necessary.  But,  to  ac- 
quire this  professional  tact  or  skill,  we  must  first  go  through  the 
school  of  elementary  instruction  and  practice.  But  industry  will  at 
last  triumph,  and  what  seemed  at  first  obscure  in  diseases  may  be- 
come luminous  at  a  comparatively  superficial  view.  We  then  begin 
to  neglect,  more  or  less,  many  of  the  minutiae.  We  confine  ourselves 
more  to  the  most  prominent  or  characteristic  symptoms.  The  coun- 
tenance alone  may  tell  us  of  a  labyrinth  of  disease.  But,  it  will  still 
often  happen  that  no  prominent  symptoms  are  present,  and  it  may 
then  be  necessary  to  go  into  the  details ;  or  they  may  be  so  confused 
and  indistinct  as  to  render  us  undecided  as  to  the  seat  or  the  nature 
of  the  disease  till  other  symptoms  are  developed.  This  may  be  il- 
lustrated by  the  growth  of  a  plant.  When  it  first  emerges  from  the 
ground  it  may  have  no  specific  characters  by  which  we  can  determine 
whether  it  be  destined  for  a  tree  or  a  weed.  AVe  must  therefore 
await  the  development  of  its  charactei's,  which,  if  it  continue  to 
grow,  it  will  certainly  put  forth.  There  is  often  an  obscurity  of  a  like 
nature  in  diseases,  at  their  early  invasion,  and  even  when  jDrofound. 
The  soundest  judgment  may  be  baffled  in  the  adaptation  of  certain 
remedies;  and  if  these  are  to  be  administered  internally,  especially  if 
active,  no  risk  should  be  taken,  but  farther  developments  awaited. 

OF   CERTAIN   SPECIAL    SYMPTOMS. 

687.  It  had  been  my  purpose  to  have  limited  my  remarks  to  the 
general  principles  which  respect  the  present  branch  of  my  inquiries. 
But,  in  consideration  of  what  I  shall  say  of  the  pathology  and  treat- 
ment of  inflammation,  venous  congestion,  and  fever,  as  also  on  the  sub- 
ject of  bloodletting,  I  have  determined  to  express  my  own  views  as 
to  some  of  the  symptoms  which  take  a  prominent  rank  in  diseases.  It 
is  also  my  desire  to  associate  the  results  of  disease  with  the  philoso- 
phy which  concerns  tiiem,  that  these  important  sources  of  pathological 


PATHOLOGY. SYMPTOMS.  443 

knowledge  may  be  studied  in  connection  with  those  inquiries  which 
distinguish  the  philosophical  physician  from  the  mere  empyric  (5|,  a). 

The  Pulse. 

687^.  There  is  one  system  of  organs,  particularly,  whose  motions 
.ire  so  constantly  affected  by  reflex  nervous  actions,  and  whose  phe- 
nomena are  universally  employed  in  estimating  the  nature,  force,  &c., 
of  all  diseases,  and  at  all  stages  of  their  progress,  and  which  are  also 
elementary  in  denoting  the  effects  of  remedies,  especially  of  loss  of 
blood,  that  I  shall  make  a  general  analysis  of  the  prominent  charac- 
teristics. We  generally  learn  the  influences  exerted  upon  this  system 
of  organs  by  the  varying  states  of  the  pulse,  and  the  radial  artery  af- 
fords the  best  opportunity  for  this  purpose,  though  the  pulse  may  be 
often  advantageously  examined  in  other  places.  Thus,  in  inflamma- 
tions and  congestions  of  the  brain  it  is  useful  to  learn  how  far  the 
pulsation  of  the  carotids  may  be  specifically  affected.  So,  in  similar 
affections  of  the  liver  we  attend  to  any  unusual  pulsation  of  the  aorta 
in  the  region  of  the  stomach.  In  all  such  cases  irritations  are  apt  to 
be  propagated  by  continuous  sympathy  along  the  principal  communi- 
cating arteries,  by  which  their  action  is  more  or  less  increased  (§  498). 
It  may  be  also  important,  sometimes,  to  examine  the  heart  itself,  es- 
pecially when  it  may  be  suspected  of  being  the  seat  of  absolute  dis- 
ease ;  and,  although  the  pulse  be  generally  regulated  by  the  action  of 
the  heart,  the  arteries,  as  we  have  now  and  before  seen,  are  liable  to 
independent  influences,  arising  from  reflex  nervous  action,  and  from 
continuous  sympathy.  As  to  the  latter,  if  there  be  inflammation 
of  the  hand  or  arm,  we  shall  be  very  likely  to  find  the  pulse  on  that 
side  with  greater  characteristics  of  disease  than  on  the  other;  and 
differences  will  arise  from  mere  differences  in  the  size  of  the  arteries. 
In  inflammations  and  congestions  of  the  brain,  the  nervous  influence 
will  often  exert  an  effect,  less  marked  in  similar  affections  of  other 
organs,  upon  the  capillary  vessels,  and  this  effect  is  sometimes  strongly 
pronounced  by  an  inequality  in  the  radial  arteries  (§  929-936,  973, 
974).  In  various  forms  of  disease  the  heart  sometimes  beats  with 
greater  force  than  is  denoted  by  the  pulse  at  the  wrist,  and  sometimes 
the  pulse  is  very  voluminous  without  a  corresponding  action  of  the 
heart,  according  to  the  nature  of  reflected  nervous  actions. — Note  Ll. 

688,  a.  When  the  radial  pulse  is  examined,  the  four  fingers  should 
be  applied  along  the  course  of  the  aitery,  and  various  degrees  of 
pressure  should  be  made.  The  blood  taken  for  examination  should 
be  into  a  conical  wine-glass,  and,  if  possible,  in  a  full  stream. 

688,  J.  Certain  general  conditions  of  the  pulse  worth  noticing  are 
the  followmg  : — its  quickness,  slowness,  frequency,  hardness,  softness,  in- 
comjyressihility,  compressibility ,  fullness,  smallness,  strength,  weakness, 
obstruction,  freedom,  intermission,  redoubling,  trembling,  and  other  ine- 
qualities (See  an  extensive  application  of  all  this  in  §  500  m,  694f ,  826  cc). 

688,  c.  Quickness. — This  term  does  not  stand  in  opposition  to  slow- 
ness, although  it  is  genei'ally  so  considered.  Frequency  is  the  opposite 
o^  slowness.  Quickness  arises  from  the  systole  of  the  heart  occupying 
less  time  than  its  diastole  ;  so  that  a  quick  may  be  a  slow  pulse.  The 
stroke  is  then  sudden,  the  dilatation  more  prolonged,  with  an  interval 
somewhat  distinct.  A.  frequent  pulse,  on  the  contrary,  is  always  what 
the  term  denotes.  The  systole  and  diastole  of  the  heart  succeed  each 
other  rapidly,  and  in  about  equal  times. 


444  INSTITUTES    OF    MEDICINE. 

A  slow  pulse  is,  also,  like  2^  frequent  one,  uniform  as  it  respects  the 
systole  and  diastole,  both  of  which  are  prolonged.  It  is  most  apt  to 
be  attendant  on  chronic  venous  congestions,  though,  as  the  affection 
advances,  or  undergoes  any  sudden  increase,  it  may  hecoxne  frequent. 
When  slow  in  such  conditions,  the  pulse  is  also  often  intermittent  or 
otherwise  irregular,  and  if  it  subsequently  become  frequent,  the  irreg- 
ularities are  apt  to  disappear.  Venous  congestion  is  always  to  be 
suspected,  and  especially  in  the  liver,  when  the  pulse  is  preternatu- 
rally  slow,  without  other  manifest  signs  of  disease  (§  390,  b). 

Quickness  of  pulse  is  not  an  important  symptom,  in  a  general  sense. 

688,  d.  Hardness  and  Softness. — These  terms  stand  in  opposition  to 
each  other.  Softness  is  a  natural  state,  and  hardness  a  morbid  one ; 
though  a  pulse  may  be  preternaturally  soft.  Hardness  of  pulse  is  one 
of  its  most  important  modifications.  In  nearly  all  cases  it  is  indica- 
tive of  inflammation,  and  no  considerable  inflammation  can  exist  long 
without  producing  it.  It  appears  to  depend  upon  some  direct  modi- 
fication of  the  action  of  the  vessels,  and  not  connected  with  that  of  the 
heart ;  the  nervous  influence  being  determined  in  a  peculiar  manner, 
by  inflammatory  affections,  upon  the  whole  arterial  system  (§  226,  233, 
973,  &c.).  The  term  hardness  may  be  well  understood  by  comparing 
the  sensation  to  that  which  is  produced  by  a  solid  rod  rising  simulta- 
neously, and  not  successively,  against  the  four  fingers. 

688,  dd.  Hardness  is  often  confounded  with  strength  on^  fullness ; 
but  the  three  symptoms  ai-e  very  different  from  each  other.  A  Jiard 
pulse  is  perfectly  compatible  with  smallness  and  xoeakness  ;  the  former 
of  which  is  seen  especially  in  peritoneal  inflammation  of  the  intestine, 
and  iu  pulmonary  consumption ;  the  latter  in  unsubdued  inflamma- 
tions after  repeated  abstractions  of  blood,  and  often  in  congestive  fe- 
vers, and  in  phlebitis.  To  distinguish  the  hardness  fully,  in  these  lat- 
ter cases,  requires  a  careful  regulation  of  the  pressure  ;  scarcely  more 
than  a  gentle  touch  with  the  four  fingers.  Greater  pressure  may 
extinguish  the  symptom,  and  the  pulse  may  even  appear  to  be  soft. 
The  distinction  is  often  of  great  importance,  especially  in  congestive 
diseases,  as  upon  it  may  depend  the  decision  of  those  who  are  apt  to 
be  governed  by  the  state  of  the  pulse  in  the  important  matter  of  blood- 
letting (§  961-965,  971).— Note  Ll  p.  1140. 

688,  e.  Compressibility  and  Incompressibility. — Incompressibility  of 
pulse  is  probably  peculiar  to  inflammatory  conditions,  and  one  of  the 
most  uniform  characteristics  of  the  pulse  when  such  conditions  disturb 
the  general  circulatory  system  by  reflex  nervous  actions.  But  when 
inflammation  is  fully  overcome,  especially  if  general  bloodletting  have 
been  freely  practiced,  the  pulse  is  often  more  easily  compressed  than 
in  health.  So  long,  however,  as  the  disease  continues  to  affect  the 
general  circulatory  system,  that  peculiar  characteristic  remains,  in  va- 
rious det^rees,  unless  the  remedies  be  very  depressing,  or  the  powers 
of  life  vero-ino-  toward  a  state  of  extinction.  But,  as  might  be  ex- 
pected fi'om  what  I  have  said  of  hardness  of  pulse  in  venous  conges- 
tions, incompressibility  is  less  marked  in  all  forms  of  venous  inflamma- 
tion than  in  equal  conditions  of  inflammation  of  other  tissues.  Here, 
too,  as  with  hardness  of  pulse,  the  observer  is  very  liable  to  be  deceiv- 
ed ;  since  the  general  volume  of  the  pulse  may  give  way  under  a  slight 
pressure,  and  yet  the  pulse  be  incompressible  (§  688,  d). 

The  proper  method  of  ascertaining  this  symptom,  in  doubtful  cases, 


PATHOLOGY. SYMPTOMS.  445 

is  to  make  a  hard  pressure  with  one  finger,  and  a  moderate  pressure 
with  another  on  the  distant  side,  when  a  thread-like  stream  will  be 
felt  by  that  finger.     It  depends  upon  reflected  nervous  influence. 

Hardness  and  incompressibility  generally  demand  the  loss  of  blood ; 
though  whether  local  or  general,  and  the  necessary  extent,  must  be 
determined  by  other  symptoms  ;  the  extent,  especially,  by  the  effects 
produced  during  the  operation  of  general  bloodletting  (§  826  cc). 

688,  ee.  Coincident  with  Jiardness  and  incompressibilitij  of  pulse, 
and  almost  peculiar  to  inflammation,  is  the  huffrj  coat,  with  its  depress- 
ed centre,  and  often  fimbriated  edges.  The  buff"  which  forms  on  the 
blood  in  pregnancy  is  due  to  the  increased  vascular  action  of  the  ute- 
rus, and  a  modification  of  its  vital  properties  not  very  dissimilar  to 
what  obtains  in  some  varieties  of  inflammation,  and  which  predis- 
poses to  those  active  forms  of  the  disease  which  so  often  beset  the 
uterus  and  other  parts  in  the  early  stages  of  childbed ;  and  should  the 
indented  centre  and  fimbriated  edge  make  their  appearance,  we  shall 
scarcely  fail  of  deriving  farther  confirmation  of  the  actual  presence  of 
inflammation  in  an  attendant  hardness  and  incompressibility  of  the 
pulse,  and  probably,  also,  in  some  local  symptoms.  And  so  of  the 
buff"  which  is  sometimes  apparently  consequent  on  violent  exercise ; 
but  more  probably  dependent  upon  some  obscure  inflammation.  We 
may  not  trust,  in  these  rare  instances,  to  the  carelessness  of  many 
observers,  and  the  incapacity  of  others,  while  the  fact  should  not  be 
neglected  that  this  exception  to  a  significant  indication  for  loss  of 
blood  has  been  raised  by  such  as  are  adverse  to  the  use  of  the  lancet 
in  the  treatment  of  inflammation  (§  826  cc,  952,  1020-1024). 

The  indentation,  or  cupping,  is  generally  less  strongly  pronounced 
after  each  abstraction  of  blood,  and  may  disappear  altogether,  under 
the  lancet,  before  the  inflammation  is  subdued  (§  952  b). 

The  fimbriated  edge  is  most  common  where  inflammation  is  se- 
vere, and  has  established  a  strong  reflex  nervous  action  upon  the 
general  circulatory  system.  In  such  cases,  also,  it  will  often  continue 
to  occur  after  the  cupping  ceases  to  be  formed. 

Like  hardness  and  incompressibility  of  the  pulse,  the  buffing  and 
cupping  of  blood,  for  reasons  already  stated,  are  less  ptrongly  marked 
in  venous  congestions  than  in  membranous  inflammations. 

The  formation  of  the  buff",  and  the  central  depression,  and  the  fim- 
briated edge,  ai'e  remarkably  aff"ected  by  the  shape  of  the  vessel,  and 
by  the  manner  in  which  the  blood  flows  from  the  veins.  A  shallow 
vessel  is  the  worst,  the  form  of  a  funnel  is  the  best. 

688,  yi  Fullness  and  Smallness  of  pulse. — These  terms  are  also  in 
opposition,  and  both  may  imply  a  preternatural  state  of  the  pulse, 
being  now  employed  in  their  morbid  acceptations.  Fullness  is  also 
synonymous  with  largeness. 

These  morbid  states  of  the  pulse  are  owing  to  reflex  nervous  ac- 
tions determined  both  upon  the  heart  and  arteries.  The  extent  of 
these  influences,  in  that  respect,  is  very  variable,  and  must  be  judged 
of  by  direct  examination  of  the  pulse  at  the  heart  and  extremities. 

It  does  not  necessarily  follow  that  an  unusual  quantity  of  blood  is 
sent  out  by  the  heart,  since  the  volume  of  the  arteries  may  depend 
greatly  upon  a  direct  expansion  of  the  vessels.  So  in  a  small  pulse, 
the  direct  morbid  influences  may  be  more  upon  the  arteries  than 
upon  the  heart,  by  which  the  vessels  are  held  in  a  contracted  state. 


446  INSTITUTES    OF    MEDICINE. 

This  is  especially  seen  in  the  cold,  stage  of  fever,  and  in  peritoneal 
enteritis.  Tt  is  also  seen  in  the  depressing  states  of  venous  con- 
gestion. In  all  such  cases  an  influence  is  propagated  from  the  arte- 
ries to  the  heart,  by  which,  as  well  as  by  other  influences,  its  actior 
is  accelerated ;  or,  if  not  accelerated,  then  the  blood  accumulates  ir 
the  venous  system,  especially  about  the  right  cavities  of  the  heart. 
In  all  these  cases  there  are  profound  reflex  nervous  actions  well 
worthy  an  inquiring  mind  (§  222,  &c.,  514  d,  k,  I,  914-919,  929-936, 
973,  974). 

Smallness  of  pulse  is  generally  a  much  more  important  symptom 
than  fullness  ;  commonly  implying  the  presence  of  greater  evil. 
Connected  with  hardness,  it  is  always  bad,  when  it  is  also  Jrequent. 

688,  g.  Strength  and  Weakness. — I  have  already  remarked  that 
these  symptoms  are  often  mistaken  for  Jiardness  and  softness.  They 
depend,  principally,  upon  reflex  nervous  actions  that  are  exerted 
upon  the  heart  by  remote  organs,  though  certainly  not  altogether. 
It  is  doubtful,  indeed,  whether  morbid  reflex  nervous  actions  are  ever 
exerted  upon  the  heart  without  being  simultaneously  extended,  more 
or  less,  to  the  arteries ;  especially  to  the  capillary  series  (§  481-485, 
973,  974).  But,  all  parts  of  any  one  division  of  the  arterial  system 
may  not  be  equally  affected,  or  one  part  may  be  sensibly  affected  and 
not  the  rest,  as  in  blushing,  when  the  nervous  influence  is  direct. 

688,  h.  Obstruction  and  Freedom. — Obstruction  is  an  obscure  con- 
dition of  the  pulse  which  it  is  difficult  to  describe,  but  is  recognized 
in  practice.  It  is  not  easy  to  know  its  cause,  as  it  probably  does  not 
actually  arise  from  any  obstacle  to  the  passage  of  the  blood,  though 
it  may  be  owing  to  a  want  of  harmony  between  the  action  of  the 
heart  and  the  capillary  blood-vessels  (§  386). 

688,  i.  Frequency  and  Slowness. — These  are  two  very  important 
symptoms  in  some  of  their  morbid  aspects,  and  are  often  replete  with 
information,  especially  as  to  the  force  of  disease  and  the  degree  of 
danger. 

To  ascertain  these  characters,  the  patient,  for  obvious  reasons, 
should  be  at  rest ;  and  if  a  child,  should  be  asleep. 

No  writer  has  so  well  described  the  conclusions  to  be  derived  from 
^frequent  and  slow  pulse  as  Di*.  Heberden,  in  his  "  Commentaries." 
From  their  importance,  and  as  I  cannot  improve  Heberden's  descrip- 
tion, I  shall  quote  it. 

"  The  pulse  of  a  healthy  infant  asleep,"  he  says,  "  on  the  day  of 
its  biith,  is  between  130  and  140  in  a  minute;  and  the  mean  rate  of 
the  first  month  is  120.  I  have  never  found  it  beat  slower  than  108. 
During  the  fii'st  year,  the  limits  may  be  fixed  at  108  and  120.  For 
the  second  year  at  90  and  108.  For  the  third  year  at  80  and  100. 
The  same  will  very  nearly  serve  for  the  fourth,  fifth,  and  sixth  years. 
In  the  seventh  year  the  pulsations  will  be  sometimes  so  few  as  72, 
though  generally  more  ;  and  in  the  twelfth  year  they  will  often  be  not 
more  than  70 ;  and,  therefore  (except  only  that  they  are  much  more 
easily  quickened  by  illness,  or  any  other  cause),  they  will  differ  but 
little  from  the  healthy  pulse  of  an  adult,  the  range  of  which  is  from 
a  little  below  60  to  a  little  above  80.  It  must  be  remembered  that 
the  pulse  becomes  more  frequent,  by  10  or  12  in  a  minute,  after  a  full 
meal.      [Miiller,  remarkably,  states  the  same  rates]. 

"  If  the  pulse  either  of  a  child,  or  an  adult,  be  quickened  so  as  to 


PATHOLOGY. SYMPTOMS.  447 

exceed  the  utmost  healthy  Umit  by  10  in  a  minute,  it  is  an  indication 
of  some  little  disorder.  But  a  child  is  so  irritable,  that,  during  the 
first  year,  a  very  slight  fever  will  make  the  artery  beat  140  times,  and 
it  may  beat  even  160  times  without  danger  [Heberden  meaning  either 
idiopathic  fever,  or  the  constitutional  effects  of  inflammation] ;  and,  as 
there  begins  to  be  some  difficulty  in  counting  the  pulse  when  the  mo- 
tion is  so  rapid,  the  thirst,  quickness  of  breathing,  aversion  to  food, 
and,  above  all,  the  want  of  sleep,  enable  us,  better  than  the  pulse,  to 
judge  of  the  degree  of  disease  in  infants. 

"  If  the  pulse  of  a  child  be  15  or  20  below  the  lowest  limit  of  the 
natural  standard,  and  there  be,  at  the  same  time,  signs  of  a  considera- 
ole  illness,  it  is  a  certain  indication  that  the  brain  is  affected,  and  con- 
sequently such  a  quiet  pulse,  instead  of  giving  us  hope,  should  alarm 
us  with  the  probability  of  imminent  danger. 

[An  important  exception  to  the  foregoing  remark  is  frequently  pre- 
sented by  venous  congestions  of  the  liver,  when  'the  pulse  may  be 
equally  diminished  in  frequency,  but  not  indicative  of  present  danger.] 

"  In  adults  ill  of  an  inflammatory  fever,  the  danger  is  generally  not 
very  gr-eat  where  the  beats  are  fewer  than  100  ; — 120  shows  the  be- 
ginning of  danger ;  and  they  seldom  exceed  this  number  unattended 
with  some  deliriousness.  There  are  two  exceptions  to  this  observa- 
tion. The  first  is,  that  before  some  critical  swelling  or  deposit  of 
matter  begins  to  show  itself  in  fevers,  the  pulse  may  be  so  rapid  and 
indistinct,  as  hardly  to  admit  of  being  counted  ;  and  I  have  known  it 
certainly  not  less  than  130,  and  yet  the  patient  has  recovered.  And 
rheumatism  affords  a  second  exception ;  in  which  the  artery  will  often 
beat  above  120  times  without  any  sort  of  danger. 

[Those  exceptions  are  relative  to  inflammation  as  limited  to  parts 
unimportant  to  organic  life.  They  are  presented,  also,  in  other  in- 
stances of  this  natui-e,  and  in  intermittent  fever.] 

"  In  an  illness  where  the  pulse  all  at  once  becomes  quiet,  from  be- 
ing much  accelerated,  while  all  the  other  bad  signs  are  aggravated,  it 
is  a  proof,  not  of  a  decrease  of  the  disorder,  but  of  the  lessened  irrita- 
bility of  the  patient,  and  that  the  brain  has  become  involved  in  the 
disease. 

"  In  low  fevers,  and  in  exhausted  old  men,  the  pulse  will  often  con- 
tinue below  100,  or  even  90,  and  yet  the  disease  be  attended  with 
want  of  sleep,  deliriousness,  restlessness,  and  a  parched  tongue,  and 
end  in  death,  without  any  comatose  or  lethargic  appearances. 

"  A  pulse  increased  in  frequency  more  certainly  denotes  danger 
than  a  natural  one  does  security,  where  disorders  of  the  viscera  are 
suspected." 

Finally,  in  countries  where  local  congestions  of  the  liver  occur,  as 
in  the  regions  of  intermittent  and  remittent  fever,  the  pulse  often  falls, 
in  hepatic  congestions,  far  below  its  natural  frequency.  Considered 
abstractedly  in  these  cases,  and  often  in  the  preceding,  it  affords  but 
little  information  as  to  the  force  of  disease.  There  may  be  great  dan- 
ger, or  but  very  little,  when  the  pulse  is  slow  in  hepatic  congestions,' 
and  all  other  symptoms  obscurely  marked  ;  but  if  the  slowness  be 
supported  by  restlessness,  sighing,  thirst,  wakefulness,  &c.,  the  dan- 
ger is  great. 

A  good  pulse,  excepting  a  moderate  hardness,  and  incompressibil- 
ity,  as  sometimes  happens  in  pneumonia,  may  be  attended  with  great 


448  INSTITUTES    OF    MEDICINE. 

danger,  which  can  only  be  inferred  from  other  syraptorcs.  Indeed,  1 
may  say  in  a  universal  sense,  that  the  state  of  the  pulse  alone  should 
rarely  guide  our  conclusions,  either  as  to  the  force  of  disease,  or  its 
treatment.  The  circulatory  organs  are  so  readily  and  variously  dis- 
turbed by  the  nervous  influence,  and  that  influence  so  constantly  gen- 
erated by  physical  and  mental  causes,  that  disease  offers  but  few  oppor- 
tunities when  the  pulse  may  be  safely  trusted  for  the  just  application 
of  remedies  without  the  support  of  other  symptoms  (§  826  cc,  829).* 

688,  /.;.  Intermission. — An  intermitting  pulse  arises  from  an  abrupt 
suspension  of  a  pulsation  of  the  heart.  It  is  not  an  alarming  symptom, 
unless  it  depend  upon  some  organic  affection  of  the  heart,  or  some 
disease  of  the  brain.  It  is  a  frequent  attendant  upon  venous  conges- 
tions of  the  liver,  and  often  presents  itself  for  the  first  time  after  the 
patient  becomes  convalescent,  and  may  continue  till  the  flesh  and 
strength  are  restored.  It  is  most  apt  to  appear  when  the  pulse  is  also 
preternaturally  slow,  and  frequently  vanishes  temporarily  if  the  circu- 
lation happen  to  be  accelerated  by  transient  causes,  or  a  great  irreg- 
ularity of  the  pulse  may  be  the  temporary  consequence.  Its  philoso- 
phy is  explained  in  a  foregoing  section  (§  390,  h). 

688,  I.  Irregularities  of  pulse. — These  consist  of  iiTegularities  in  its 
successive  beats,  redoublings,  trembling,  hobbling,  &c.,  and  are  rarely 
of  much  importance  unless  proceeding,  as  in  cases  of  intermission, 
from  organic  affections  of  the  heart,  or  disease  of  the  bi'ain. 

The  Tongue. 

689,  a.  We  will  now  turn  a  brief  attention  to  the  morbid  appear- 
ances of  the  tongue.  It  is  by  these,  and  the  secreted  products,  that 
we  obtain  our  most  direct  intelligence  from  the  internal  viscera, 
though  other  less  sensible  results  may  be  more  significant  of  the  na- 
ture and  force  of  disease. 

689,  h.  The  tongue  is  covered  by  a  secreting  membrane,  whose 
action  is  liable  to  great  and  various  changes,  and  which  are  attended 
by  visible  results.  In  its  healthy  state  this  membrane  is  covered  by 
a  thin  fluid,  which  is  partly  composed  of  its  own  mucous  product, 
and,  in  part,  of  saliva.  The  natural  color  of  the  tongue  is  a  light 
florid  hue,  and  it  is  studded  with  short  minute  papillae,  particularly 
at  its  edges.  In  disease  these  appearances  are  apt  to  undergo  va- 
rious changes ;  the  tongue  being  often  covered  more  or  less  exten- 
sively with  a  coat  of  variable  hues,  white,  yellow,  brown,  or  black, 
barely  attached,  or  closely  adherent,  rough  or  smooth,  &c.  At  other 
times  the  organ  is  preternaturally  red  or  livid,  dry  or  moist,  enlarged 
or  contracted,  pointed  or  obtuse,  its  natural  coat  thickened  or  appa- 
rently scraped  off",  or  covered  with  patches,  vermiform  marks,  &c.,  its 
edges  jagged,  the  papillae  enlarged  and  elevated,  &c.  These  condi- 
tions depend  upon  various  modifications  of  the  organic  functions  of 
the  tongue  ;  and  as  the  organ  is  not  much  liable  to  independent  dis- 
ease, it  is  obvious  that  its  morbid  aspects  are  mostly  sympathetic  re- 
sults ;  and  from  its  being  continuous  with  the  alimentary  canal  and 
the  lungs,  morbific  influences  are  readily  propagated  upon  it  from 
either  of  its  remote  connections  {%).  But,  the  vital  relations  of  the 
tongue  to  the  alimentary  canal  are  far  greater  than  to  the  lungs, 
though  not  strongly  pronounced  in  health ;  and  as  intestinal  derange- 
ments are  more  common  than  pulmonary,  a  far  greater  proportion  of 
*  Note  Ll  p.  1140. 


PATHOLOGY. SYMPTOMS.  449 

the  morbid  and  intense  influences  from  these  two  sources  are  exerted 
by  abdominal  disease  (§  129  i,  135,  142). — See  Index  II,  Art.  Tongue. 

689,  c.  The  coating  which  forms  upon  the  tongue  may  consist 
mostly  of  mucus,  or  of  a  substance  resembling  coagulable  lymph,  or 
intermixtures  of  both,  in  various  proportions,  and  of  a  morbid  char- 
acter. 

689,  d.  All  the  phases  which  the  tongue  is  liable  to  undergo  may 
be  influenced  by  the  peculiar  constitution  of  the  patient,  though  in  a 
general  sense,  where  the  constitution  is  sound,  these  appearances  are 
less  subject  to  the  contingencies  of  temperament  than  many  other 
symptoms, 

689,  €.  We  often  observe,  under  various  circumstances  of  disease, 
that  the  coating  has  suddenly  disappeared,  and  we  may  be  led  into 
error  in  consequence,  since,  in  many  of  these  cases,  the  coating  has 
been  removed  by  the  mechanical  friction  of  food, 

689,  y^  It  would  be  in  vain  to  attempt  a  definition  of  the  vai'ious 
changes  in  the  aspect  of  the  tongue  which  are  produced  by  disease, 
according  to  its  nature  and  seat,  accidental  causes,  &c.  The  appear- 
ances may  vary  much  under  apparently  the  same  conditions  ;  and  it 
is  not  one  symptom  alone  which  may  attend  the  tongue,  but  the 
whole  in  combination,  that  must  guide  our  judgment.  It  is  important, 
also,  to  observe  that  the  tongue  may  be  veiy  natural  in  profound  dis- 
eases, even  of  the  alimentary  canal  and  liver;  but  as  observation 
enlarges,  and  the  depths  of  physiology  are  explored,  we  shall  find 
the  morbid  sims  of  the  tonijue  a  luminous  index  of  disease. 

689,  g.  But,  there  is  one  remark  more  important  than  the  rest ; 
namely,  that  there  are  no  other  symptoms  which  borrow  so  much 
light  from  others  as  those  which  relate  to  the  tongue ;  while,  in  their 
turn,  they  reflect  back  a  light  upon  the  other  symptoms.  Inflamma- 
tions of  various  parts,  and  idiopathic  fevers,  at  their  onset  may  pre- 
sent nearly  the  same  appearance  of  that  organ,  especially  as  it  regards 
the  coating.  The  general  symptoms  now  contribute  largely  in  deter- 
mining the  import  of  the  tongue ;  though  we  shall  generally  find,  on 
close  inspection,  that  not  only  each  class  of  diseases  will  offer  certain 
peculiarities  in  the  morbid  aspects  of  the  tongue,  but  as  inflammation 
may  affect  one  important  organ  or  another ;  and  the  appearances  will 
vary  in  the  early  stages  of  idiopathic  fever  as  the  burden  of  disease 
may  happen  to  be  distributed.  In  the  progress  of  the  same  affections, 
the  tongue  is  continually  fluctuating  in  the  indications  it  may  supply. 

689,  h.  The  disappearance  of  the  coating  in  fevers  and  inflamma- 
tions generally  begins  at  the  edges  of  the  tongue,  and  is  commonly 
indicative  of  an  improvement  of  health,  though  not  always.  When 
these  exceptions  occur  some  other  morbid  appearance  is  apt  to  fol- 
low immediately  ;  as  preternatural  redness,  or  nakedness,  or  dryness, 
&c.  If  indicative  of  improvement  the  tongue  commonly  clears  up 
fast,  along  with  other  auspicious  changes  ;  though  it  will  be  frequently 
kept  up,  more  or  less,  by  remaining  though  slight  visceral  derange- 
ments in  the  abdomen. 

689,  i.  Absolute  diseases  of  the  digestive  organs  affect  the  tongue 
more  variously  and  distinctly  than  other  parts ;  according  to  their 
nature,  seat,  intensity,  duration,  peculiarities  of  constitution,  habits, 
&c.  (§  129  i,  142).  In  indolent  affections  of  the  stomach,  a  thick, 
dirty,  yellow  coat,  easily  scraped  off"  in  part,   appears  particularly 

Ff 


450  INSTITUTES    OP  MEDICINE. 

toward  the  root  of  the  tongue ;  when,  also,  the  tongue  often  becomes 
furrowed,  or  covered  with  patches  of  various  forms,  indented  at  its 
edges,  or  apthee  arise  ;  the  coat,  too,  varying  according  to  the  varying 
states  of  the  intestinal  canal,  or  of  the  liver,  &c. 

689,  ii.  If  the  tongue  be  very  red,  it  denotes  more  or  less  active  in- 
flammation of  some  part  of  the  intestinal  mucous  tissue  ;  and  if  also 
dry,  and  especially  if  at  the  same  time  denuded,  it  shows  inflammation 
of  greater  intensity  in  that  membrane.  A  tongue  preternatu rally 
naked,  even  if  moist,  and  of  no  great  redness,  shows  moderate  or  sub- 
inflammation  of  the  mucous  tract ;  probably  of  the  small  intestine.  A 
livid  tongue  shows  venous  congestion  of  the  alimentary  mucous  mem- 
brane, and  probably  also  of  the  liver.  It  is  always  indicative  of  for- 
midable disease. — See  Index  IT,  Art.  Tongue,  Heart,  Kidney,  Pulse. 

689.  I.  In  connection  with  the  foregoing  subject  I  may  advert  to  an 
inflammatory  state  of  the  mucous  tissue  of  the  fauces  which  ensuea 
upon  congestive  affections  of  the  chylopoietic  viscera,  and  which  is  too 
often  regarded  as  an  independent  disease,  and  treated  accordingly. 
But,  the  condition  of  which  I  speak  is  so  comparatively  unimportant 
with  the  primary  affection  upon  which  it  depends,  and  is  so  often  sig 
nificant  of  the  force  of  obscure,  but  dangerous  forms  of  abdominal  con 
gestion,  especially  of  the  liver  and  intestinal  mucous  tissue,  that  1 
would  rather  place  it  among  the  symptoms  than  designate  it,  in  its 
true  chaiacter,  as  a  sympathetic  form  of  disease.  This  inflammatory 
affection  is  commonly  of  an  erysipelatous  nature,  attended  by  more 
or  less  tumefax;tion  of  the  tissue,  and  often  of  the  tonsils.  It  varies 
greatly  in  intensity,  and  presents  different  hues  from  bright  scarlet 
to  livid  ;  the  latter  being  the  worst,  and  denoting  a  profound  and  dan- 
gerous modification  of  venous  congestion  (§  813-816).  In  its  worst 
Ibrms,  the  throat  is  quite  liable  to  ulceration,  and  often  to  sloughing. 
In  the  latter  case  it  is  commonly  denominated  the  "  putrid  sore  throat," 
and,  most  unhappily,  this  symptom,  as  it  were,  has  been  extensively 
regarded  as  the  main  disease.  These  appearances  of  the  throat  are 
also  a  common  attendant  on  bad  forms  of  scarlatina,  and  are  due  to 
profound  congestion  of  the  liver  and  intestinal  mucous  tissue,  associ- 
ated, more  or  less,  with  a  peculiarly  modified  form  of  inflammation 
of  the  same  tissue  {§  803,  816  b).  The  whole  of  this  secondary  evil 
is,  abstractedly,  of  little  comparative  moment,  and  is  analogous  in  its 
import  to  those  forms  of  erysipelas  which  affect  the  surface  when  this 
symptom  is  epidemic  (§  463  a,  523,  no.  7,  630  e,  713,  961  a,  970  c).* 

Secretions  and  Excretions. 

690.  The  secreted  and  excreted  products,  which  fall  under  the  cog- 
nizance of  the  practitioner,  are  messengers  of  intelligence  either  di- 
rectly from  the  citadel  of  disease,  or  from  organs  which  participate 
sympathetically  with  affections  of  other  parts,  or  which  may  scarcely 
do  more  than  minister  to  the  general  wants  of  the  body.  They  are, 
therefore,  to  be  received  according  to  their  several  degrees  of  impor- 
tance.    They  consist  of  urine,  sweat,  mucus,  and  the  alvine  discharges. 

691.  Tlbc  Urine. — No  product  is  so  variable  as  the  urine,  both  in 
health  and  disease.  The  kidneys,  being  designed  for  great  and  im- 
mediate common  purposes  in  the  animal  economy,  in  depurating  the 
blood,  or  in  transiently  fulfilling  the  office  of  the  skin,  &c.,  are  render- 
ed highly  sensitive  to  the  presence  of  ledundances  in  the  blood,  and 

*  Such,  also,  is  equally  true  of  the  various  phases  of  Bretonneau's  Diphthkijia,  and 
which  is  generally  considered  a  local  or  a  humoral  attection. — Noxic  Kk  p.  1140. 


PATHOLOGY. SYMPTOMS.  451 

to  the  variable  states  of  other  parts,  especially  of  the  skin,  whose  anal- 
ogous office  is  so  liable  to  interruption.  The  same  Great  Intelligence, 
which  ordained  these  final  causes,  also  endowed  the  kidneys  with  a 
stability  of  function  unknown  to  other  parts  (excepting  the  heart,  for  a 
like  principle),  where  irritability  is  easily  impressed.  Being,  there- 
fore, but  little  subject  to  actual  disease,  the  variable  product  of  the 
kidneys  commonly  supplies  only  a  report  of  the  nature  of  the  ingesta, 
or  of  the  influences  which  the  skin  or  other  parts,  and  even  the  mind, 
may  exert  upon  these  organs  in  a  healthy  state,  or  of  the  n^utable 
states  of  the  body  in  regard  to  nutrition,  or  of  any  disturbing  reflex 
influences,  short  of  disease,  which  may  be  extended  to  the  kidneys  by 
diseases  of  other  parts  (§  426).  It  is  thence  obvious,  that  but  little 
dependence,  in  a  general  sense,  can  be  placed  upon  the  sensible 
changes  of  the  urine  as  indicative  of  the  nature  or  force  of  disease ; 
and  I  bave  endeavored  to  show,  here  and  elsewhere,  that  we  may 
rarely  trust  to  chemical  analyses  of  this  product  (§  417,  427).  Be- 
yond a  transient  inspection,  occasional  evaporation  is  about  all  that 
we  require,  unless,  also,  some  practicable  test  in  calculous  affections. 
The  aspects  of  the  urine  become  more  important  in  renal  diseases, 
and  in  those  of  the  bladder.  Albuminous  urine  appears  in  organic 
affections  of  the  kidneys,  in  dropsy,  and  after  pastry  and  other  indi- 
gestible food,  and  is  produced  by  mercury  and  cantbarides.  It  is  evi- 
dent, therefore,  that  the  presence  of  albumen,  about  which  so  much 
has  been  written,  indicates  nothing  specifically,  unless  supported  by 
other  symptoms  (§  421-427.  Also,  Medical  and  Physiological  Com- 
mentaries, vol.  i.,  p.  674-682). —  Vide  Lehmann,  p.  780. 

A  sensation  like  that  of  strangury  is  often  felt  when  the  urine  is 
high-colored  and  scanty.  This  is  commonly  owing  to  abdominal  dis- 
ease ;  particularly  hepatic  congestion. 

692,  a.  Sweat. — The  perspirable  matter  is  the  least  important  of 
any  of  the  tangible  products  of  disease,  unless  as  it  respects  the 
amount  of  sweat  in  its  connection  with  the  other  attending  symptoms, 
or  as  significant  of  the  effects  of  certain  remedial  agents.  Not  much 
can  be  inferred  from  its  quality,  and  this  little  is  gathered  from  its 
taste  and  odor.  Dryness  of  the  skin  is  oftener  an  important  charac- 
ter ;  and  it  is  usually  one  of  the  best  signs  supplied  by  the  skin  when 
its  dryness  yields  spontaneously.  Perspiration  induced  by  medicine 
is  of  little  moment,  unless  the  remedy  simultaneously  impresses,  di- 
rectly or  indirectly,  the  parts  diseased  ;  and  then  the  salutary  results, 
so  far  as  the  surface  is  concerned,  depend  upon  special  vital  influen- 
ces exerted  by  the  remedy  upon  the  skin,  and  reacting  sympathies. 
This  is  exemplified  by  the  profound  effects  of  tartarized  antimony 
and  ipecacuanha,  the  uselessness  of  hot  water,  and  the  frequent  per- 
nicious results  of  the  compound  powder  of  ipecacuanha,  when  free 
perspiration  may  follow  the  administration  of  either  (§  514,  h).  The 
effect,  therefore,  upon  disease  depends  but  very  little  upon  the  evacu- 
ation from  the  skin,  as  produced  by  what  are  called  sudorifics ;  but 
upon  the  peculiar  action  which  may  determine  the  evacuation,  and  its 
consequent  alterative  reflex  nervous  influences.  And  this,  by-the- 
way  (for  these  opportunities  may  not  be  neglected),  shows  us  the 
futility  of  the  chemical  hypothesis  of  the  formation  of  the  secretions.* 

692,  b.  Though  sweating  be  generally  a  symptom  of  good  omen, 
it  may  be  one  of  the  worst.  Thus,  a  person  suddenly  falls  down,  in- 
*  See  Note  D  p.  1114. 


452  INSTITUTES    OF    MEDICINE. 

sensiolo,  and  copious  perspiration  ensues.  It  may  be  death  from  hem- 
orrhage, or  from  a  sudden  cessation  of  the  action  of  the  heart,  or  it 
may  be  temporary  syncope.  Again,  profuse  perspiration  often  ap- 
pears suddenly  in  protracted  stages  of  disease.  If  the  other  symp- 
toms are  bad,  the  sweating  is  still  more  so.  In  these  cases  the  pulse 
is  generally  small  and  rapid.  But  it  sometimes  denotes  the  near  ex- 
tinction of  life  when  the  pulse  gives  no  sign  of  danger,  and  the  sweat- 
ing may  be  even  considered  favorable  if  the  whole  circumstances  of 
the  case  be  not  carefully  weighed. — A  viscid  state  of  the  perspiration 
is  commonly  significant  of  great  force  of  disease.  In  some  fatal  cases 
of  the  cholera  asphyxia  there  was  only  an  insensible  perspiration, 
throughout  (In  my  "Cholera  Asphyxia  of  New  York,'"  1832). 

693.  Mucus. — The  mucous  tissue  being  every  where  more  or  less 
exposed  to  irritating  agents  is  naturally  protected  by  mucus,  as  the 
skin  is  by  the  cuticle ;  but  only  in  quantity  sufficient  to  cover  the  sur- 
face of  the  membrane.  When,  thei-efore,  it  is  continuously  discharged 
from  the  nose,  expectorated  from  the  lungs,  or  voided  by  the  intes- 
tine, bladder,  or  uterus,  it  denotes  a  morbid  state  of  the  tissue ;  and 
that  state  is  of  an  inflammatory  nature.  This  is  plain  enough  in  re- 
spect to  the  nose,  throat,  lungs,  and  bladder;  but  the  analogy  is  neg- 
lected in  relation  to  the  intestine,  where  it  often  supplies  an  impor- 
tant indication  in  the  absence  of  other  prominent  signs  of  inflamma- 
tion. This  morbid  organic  product  is  liable  to  great  varieties  in  its 
appearance  and  properties,  each  one  of  which  depends  upon  a  spe- 
cial modification  of  inflammatory  action  (§  409  h,  410,  415,  682  b). 
Its  exact  condition  will  also  conform  to  the  natural  modifications  of 
the  vital  properties  of  that  portion  of  the  tissue  which  may  be  the  seat 
of  disease.  Hence,  in  part,  the  varieties  attending  the  morbid  condi- 
tions of  mucus,  as  it  may  proceed  from  the  eye,  nose,  throat,  lungs, 
and  intestine  (§  133-135,  682  h). 

Unlike  the  excrementitious  products  urine  and  sweat,  the  product  of 
the  mucous  tissue,  like  all  other  organic  compounds,  is  uniformly  the 
same  in  health  in  the  same  parts  of  the  tissue,  nor  is  it  liable,  like  the 
former,  to  undergo  chemical  changes  as  soon  as  secreted  (§  417).  Its 
morbid  changes  are  determined  by  the  same  precise  laws  as  is  its  nat- 
ural condition,  and  therefore  each  change  depends  upon  some  pre- 
cise accidental  modification  of  the  vital  properties  and  actions,  and  ac- 
cording to  their  natural  modification  in  the  part  from  which  the  dis- 
charge may  proceed.  Could  we,  therefore,  always  ascertain  the  pre- 
cise character  of  its  morbid  changes  we  should  arrive  as  nearly  as 
possible  at  the  particular  condition  of  the  existing  disease  (§  237, 
682  b.     Also,  Med.  and  Physiolog.  Comvi.,  vol.  ii.,  p.  197,  note). 

694,  a.  Alvine  Discharges. — The  fasces  consist  of  the  superfluities 
of  food,  and  the  remains  of  various  secreted  products  which  are  pour- 
ed into  the  intestine  from  the  liver,  salivary  and  pancreatic  glands, 
and  mucous  tissue.  But,  neither  the  bile,  nor  saliva,  nor  intestinal 
mucus,  nor  the  gastric  juice,  appear  in  the  fteces  in  their  natural 
state.  Combined,  however,  with  the  fasces,  they  offer  a  general  natu- 
ral standard  for  comparison  with  the  morbid  conditions. 

694,  b.  In  disease,  the  foregoing  natural  conditions  as  to  quantity 
and  quality  of  the  secretions,  and  the  state  of  the  residual  food,  are 
more  or  less  affected,  according  to  the  nature  of  the  morbid  states 
which  may  attend  the  various  parts  concerned  in  digestion.    From  the 


PATHOLOGY. SYMPTOMS.  453 

number  of  organs,  therefore,  that  are  liable  to  be  simultaneously  in- 
volved in  morbid  processes,  and  which  contribute  their  fluids  to  the 
alvine  dejections,  as  well  as  the  imperfect  changes  which  the  food 
undergoes  in  the  stomach,  it  would  seem  more  difiicult  than  it  is,  in 
reality,  to  derive  any  just  conclusions  as  to  the  nature  of  disease  fron:» 
the  condition  of  the  faeces. 

The  following  are  the  most  important  signs  to  be  noticed  in  the  al- 
vine discharges : 

1st.  The  Residual  Food. — This  gives  us  intelligence  as  to  the  state 
of  the  stomach.  It  is  mainly  important  in  chronic  affections  of  that 
organ,  or  during  convalescence  from  acute  disease  ;  since,  till  the  subsi- 
dence of  acute  diseases,  the  food  should  consist  mostly  of  fluids,  wheth- 
er the  stomach  be  the  direct  seat  of  the  affection,  or  disturbed  by  re- 
flex nervous  actions,  or  liable  to  irritation  from  solid  food  in  the  absence 
of  those  conditions  (§  512,  514  h,  &c.).  We  may  be  thus  guided,  also, 
as  to  the  food  which  should  be  avoided. 

2d.  The  nature  a?id  quantity  of  the  matter  discharged. — This,  in 
acute  diseases,  will  consist,  principally,  of  the  secreted  fluids,  which, 
so  far  as  produced,  may  cease  to  be  in  any  way  appropriated,  and  ac- 
cumulate in  the  intestine,  though  much,  in  respect  to  the  apparent  ac- 
cumulation, may  be  due  to  the  absence  of  residual  food  with  which 
the  secreted  products  are  habitually  intermixed.  Their  deficiency, 
during  the  operation  of  a  cathartic,  denotes  severe  disease  in  the  or- 
gans of  digestion,  especially  the  glandular,  or  that  an  unsuitable  ca- 
thartic has  been  applied.  If  the  evacuation  be  large,  watery,  and  col- 
orless, the  cathartic  was  bad.  It  has  irritated,  morbidly,  the  intestinal 
mucous  tissue,  has  not  reached  the  glandular  function  of  the  liver,  or 
may  have  propagated  injurious  influences  upon  that  organ.  If  a  ju- 
dicious cathartic  have  been  employed,  and  not  in  excess,  and  mucus 
alone  follow,  it  shows  inflammation  of  the  intestinal  mucous  tissue,  and 
disordered  action,  probably  congestion,  of  the  liver  (§  693),  which  will 
be  aggravated  by  a  repetition  of  cathartics  till  the  disease  be  lessened 
by  other  remedies  ;  of  which  general  bloodletting,  leeching,  and  blis- 
tering, are  the  principal.  Or  delay  of  all  remedies  may  be  suflScient 
(§  856,  a).  Again,  a  redundavaj  of  bile  may  be  either  unfavorable  or 
favorable,  and  its  proper  interpretation  may  depend  upon  a  variety  of 
considerations  ;  such  as  color,  the  period  and  past  history  of  the  dis- 
ease, the  general  and  local  vital  signs,  the  nature  of  the  remedies,  es- 
pecially of  the  cathartic,  employed,  &c. 

When  the  bile  is  redundant,  the  mucus  is  apt  to  be  at  least  natural 
in  quantity,  and  when  the  latter  is  in  excess  the  bile  is  commonly  de- 
ficient, since,  in  the  latter  case,  the  formation  of  bile  is  diminished  by 
morbific  reflex  nervous  actions  propagated  upon  the  liver  by  the 
mucous  tissue.  It  is  the  same  as  when  morbidly-irritating  cathartics 
diminish  or  stop  the  secretion  of  bile.  And  here  I  will  say,  that  I  am 
far  from  meaning  alone  what  are  denominated  the  drastic  cathartics  ; 
since  calomel,  blue  pill,  and  even  the  neutral  salts,  may  be  more  mor- 
bific in  a  given  state  of  disease  than  scammony,  colocynth,  aloes,  and 
especially  jalap,  in  doses  of  corresponding  energy  (§  889  g). 

When  tiie  secreted  products  increase  after  having  sustained  a  dimi- 
nution, the  sign  is,  perhaps,  always  favorable ;  but  how  far  so  will  de- 
pend upon  other  symptoms,  and  upon  the  amount  which  is  due  to 
nature.     In  some  hepatic  congestions    cathartic?  procure  but  small 


454  INSTITUTES   OF    MEDICINE, 

evacuations  till  the  disease  is  considerably  overcome.  The  secretions 
then  start,  become  abundant,  long  continued,  and  a  salutary  bilious 
diarrhoea  sometimes  sets  in.  The  same  is  also  true  of  jaundice, 
whether  arising  from  disease  of  the  liver,  or  from  obstruction  by  gall- 
stones. 

3d.  The  appearance  of  the  fecal  matter  as  to  coIo7\ — This  is  a  very 
important  index  in  many  respects.  We  should  distinguish  carefully, 
however,  what  may  be  owing  to  color  of  food,  or  what  may  be  im- 
parted by  medicine,  from  that  which  is  morbid. 

If  the  discharges  be  light  it  shows  a  suspended  secretion  of  bile, 
which  may  be  owing  to  the  irritation  of  an  improper  cathartic,  or  to 
inflammation  of  the  intestinal  mucous  tissue,  or  to  inflammation  or 
congestion  of  the  liver,  or  to  jaundice,  &c.,  and  the  other  symptoms 
will  clear  up  our  knowledge  upon  the  subject.  In  all  these  cases,  as 
disease  gives  way  the  bile  is  secreted  in  redundance,  is  apt,  at  first, 
to  be  blackish,  or  of  a  deep  gi-een,  then  changing  to  brown,  or  to  a 
dark  yellow,  till  it  finally  becomes  of  a  lightish  yellow. 

Calomel  and  acids  ai-e  very  generally  supposed  to  render  the  bile 
green.  This  they  will  do  when  mixed  with  the  bile  out  of  the  body; 
but  this  chemical  effect  is  counteracted  by  vital  resistances  afforded  in 
the  intestinal  canal,  just  as  putrefaction  is  arrested  in  food  by  the 
same  agencies  (§  339,  h).  No  quantity  of  calomel  will  impart  a 
green  color  to  the  discharges  of  a  healthy  subject,  nor  will  any  acids; 
being  an  inquiry  which  I  have  sufficiently  submitted  to  experiment. 
When,  also,  the  bile  becomes  redundant  and  yellow  during  the  de- 
cline of  abdominal  disease  neither  calomel  nor  acids  will  affect  its 
hue,  unless  a  morbid  irritation  be  produced.  At  the  onset  of  disease 
there  may  be  no  green  appearance  of  the  dejections  till  calomel  or 
blue  pill  be  given ;  but  the  reason  is,  that,  till  then,  the  secretion  of 
bile  was  suspended,  and  what  was  accumulated  in  the  gall-bladder  is 
now  dislodged.  The  mercurial  agents  excite  the  liver  and  it  pours 
out  its  morbid  product;  or,  if  they  aggravate  the  existing  hepatic  de- 
rangement the  green  may  be  increased  by  this  vital  influence  of  the 
agents,  or  the  secretion  of  bile  may  be  wholly  arrested. 

It  is  important  to  do  away  with  these  misapprehensions  ;  since  they 
lead  us  to  regard  what  is  truly  an  important  symptom  of  disease  as 
the  mere  result  of  accident.  The  experiments,  also,  oict  of  the  body 
show  us  how  fallacious  are  all  such  pursuits  (§  1058  b). 

The  worst  appearance  of  the  bile,  ^?er  sc,  whether  vomited  or  de- 
jected, is  a  bluish  color.  It  shows  severe  and  obstinate  congestion 
of  the  liver.  Bloody  mucus  denotes  more  intense  inflammation  of 
the  intestinal  mucous  tissue  than  a  redundancy  of  simple  mucus  (§ 
693).  It  shows  dysentery  if  attended  with  pain  and  tenesmus.  Hem- 
oiThage  from  the  bowels  or  stomach  denotes  venous  congestion  and 
inflammation  of  the  mucous  tissue  in  most  cases ;  though  now  and 
then  in  congestive  fevers  the  hemon-hage  comes  from  the  liver.  In 
all  the  cases  it  is  an  effort  of  nature  to  relieve  a  very  formidable  con- 
dition of  disease  (§  805.  Also,  Med.  and  Phys.  Comm.,  vol.  i.,  p. 
371-384;  vol.  ii.,  p.  546-566). 

4th.  Of  the  sensations  produced  by  the  fecal  discharges  on  passing 
the  anus. — These  are  mostly  of  a  burning  or  excoriating  nature  and 
denote  either  the  presence  of  a  morbid  condition  of  the  bile,  or  of 
acids  that  are  generated  by  the  decomposition  of  food.     The  suff'Br- 


PHYSIOLOGY. SYMPTOMS.  455 

ing,  liowr.ver,  generally  arises  from  an  acrimony  of  the  bile.  Aloes 
will,  doubtless,  produce  irritation  of  the  anus  in  some  degi'ee ;  but, 
when  consequent  on  the  use  of  that  medicine,  it  arises  mostly  from 
the  bile  which  aloes  is  particularly  instrumental  in  eliciting  from  the 
liver ;  while  its  sympathetic  irritation  of  that  organ  will  also  increase 
the  morbid  acridity  of  the  bile.  The  fact  is  practically  important,  as 
will  be  readily  seen  from  its  bearing  upon  our  conceptions  of  disease, 
and  of  the  virtues  of  remedial  agents  (^  1063  b). 

694|.  From  what  has  been  now  said,  it  is  evident  that  the  dejec- 
tions should  be  always  examined  in  all  diseases  of  any  severity  and 
obstinacy ;  and,  if  produced  by  a  cathartic,  they  should  be  all  exam- 
ined, and  each  one  in  the  order  in  which  it  may  take  place.  Thia  is 
the  only  way  of  practicing  medicine  intelligibly.  The  evacuations 
often  supply  more  information  as  to  the  state  of  the  abdominal  viscera 
than  all  other  symptoms.  I  say,  therefore,  when  cathartics  operate, 
it  is  often  important  to  examine  the  dejections  in  the  order  in  which 
they  may  take  place.  The  first  may  consist  only  of  the  faeces  result- 
ing from  food,  and  of  secretions  which  had  not  assumed  a  morbid  as- 
pect. With  this  partial  inquiry,  as  is  often  the  case,  we  may  conclude 
that  all  is  right  with  the  abdominal  viscera,  or  that  they  are  in  a  state 
to  bear  any  violent  remedies  we  may  choose  to  exhibit  for  other  pur- 
poses. But,  on  inspecting  the  second  dejection,  we  may  find  it  like 
chopped  grass,  or  of  a  black,  pitchy  aspect.  This  brings  us  to  the 
conclusion  that  mischief  prevails  at  the  fountain  of  life.  What  was 
evacuated  at  this  second  discharge  was  perhaps  nearly  the  whole 
contents  of  the  intestinal  canal ;  and  what  may  be  evacuated  at  the 
third,  or  fourth,  or  farther  dejections,  will  have  been  secreted  after 
each  successive  evacuation. 

If  any  salutary  changes,  then,  be  exerted  by  the  continued  opera- 
tion of  cathartics,  we  shall  be  likely  to  discover  them  in  the  color  and 
other  appearances  of  the  discharges,  as  they  come  away  one  after  an- 
other.    If  they  remain  without  change  more  work  is  to  be  done. 

694|.  It  appears,  therefore,  that  modifications  of  mucus,  wheresoever 
it  occurs,  and  of  the  component  parts  of  the  alvine  discharges,  are  essen- 
tially different  from  the  morbid  phenomena  attending  the  pulse,  the 
tongue,  and  the  urine,  as  indicative  of  the  nature  and  force  of  disease. 
The  first  being  the  direct  results  of  organs  morbidly  affected  are  critic- 
ally significant  of  the  pathological  conditions  (§  741  b).  The  last  three, 
when  the  organs  are  not  the  seats  of  absolute  disease,  are  indirect  me- 
dia which  denote  the  intensity  and  modifications  of  the  nervous  influence 
that  may  be  reflected  upon  the  organs  by  diseases  of  other  parts.  In 
our  ordinary  investigations  of  symptoms,  therefore,  which  relate  to 
the  tongue,  the  circulatory  organs,  and  the  kidneys,  we  are  employed, 
however  unconsciously,  in  estimating  the  relative  conditions  of  reflected 
nervous  influence,  and  by  which  Ave  judge  of  the  nature  of  the  patholog- 
ical conditions  in  which  these  influences  originate  ;  although  in  respect 
to  the  tongue  its  morbid  phenomena  may  be  more  or  less  owing  to  con- 
tinuous sympathy  in  affections  of  the  alimentary  mucous  tissue  (§  498  f, 
500  m,  526  a,  715-719).    And  yet  this  is  the  great  field  of  Humoralism. 

This  analysis  may  serve  the  useful  purpose  of  drawing  attention,  for 
the  first  time,  to  the  philosophy  of  the  subject,  and  thus  contribute  to- 
ward an  understanding  of  the  same  philosophy  as  it  respects  diseases 
which  grow  out  of  each  other,  and  the  operation  of  morbific  and  reme- 
dial agents  (§  826  cc,  961  a,  970  c). 


456  INSTITUTES    OP    MEDICINE. 


PATHOLOGICAL  INDICATIONS  FROM  MORBIE 
ANATOMY. 

695.  Lesions  of  organization,  and  all  deviations  from  natural  condi- 
tions which  occur  during  life  and  are  obvious  to  the  sensos  after 
death,  are  embraced  under  the  denomination  of  morbid  anatomy. 

696.  All  the  foregoing  results  are  owing  to  the  pathological  states 
which  essentially  constitute  disease,  and  would  not,  therefore,  ensue, 
could  disease  be  removed  soon  after  its  invasion,  or  in  its  formative 
stage  (§  639,  &c.).  It  is  a  great  object  of  art  to  prevent  their  occur- 
rence, or,  as  it  is  termed  in  the  treatment  of  inflammation,  to  effect  a 
resolution  of  disease. 

697.  Morbid  anatomy  has  been  pursued  with  various  opinions  as  to 
its  relative  value  to  the  vital  signs  of  disease.  Those  who  have  re- 
garded it  of  paramount  importance  have  entertained  but  very  limited 
views  in  physiology,  or  of  the  laws  of  disease.  They  have  always 
considered  the  organ  which  was  most  frequently  altered  in  its  condi- 
tion as  the  great  primary  seat  of  disease,  and  the  cause  of  all  the  oth- 
er lesions  and  phenomena,  and  even  the  cause  of  death.  This  doc- 
trine, and  its  fallacies,  I  have  considered  very  extensively  in  an  Essay 
on  the  writings  of  Louis,  and  in  another  article  devoted  specifically  to 
the  inquiry ;  both  of  which  appear  in  the  Medical  and  Physiological 
Commentaries. 

698.  Morbid  anatomy  is  indebted  to  Bichat  for  its  rank  in  science, 
by  whom  it  was  cultivated  in  its  most  philosophical  aspects.  It  was 
this  great  man  who  first  employed  it,  extensively,  in  illustrating  phys- 
iological and  pathological  problems;  but  more  especially  did  he  con- 
vert the  living  phenomena  of  disease  to  the  uses  of  physiology. 

The  fruits  which  were  thus  gathered  from  morbid  anatomy  ap- 
peared to  represent  the  field  as  a  terra  incognita,  where  great  discov- 
eries were  to  be  made,  and,  therefore,  great  fame  to  be  realized.  The 
older  pathologists  were  either  unknown,  or  crowded  aside  ;  while  the 
very  ground  which  they  had  gone  over  was  brought  forward  as  new- 
ly-discovered land.  The  multitude  lost  sight  of  disease  in  its  vital  as 
pects,  and  undertook  a  system  of  pathology  out  of  the  last  wrecks  ot 
disease  ;  not  unfrequently  confounding  the  results  of  putrefaction  with 
those  of  vital  actions.  Such  was  the  general  state  of  this  branch  ot 
science,  upon  which,  also,  humoralism  had  again  reared  its  venerable 
form,  along  with  many  other  physical  and  chemical  doctrines,  when  1 
undertook  their  systematic  examination.  Nor  do  I  say  this  in  a  spirit 
of  arrogance,  but  as  simply  due  to  the  philosophy  which  I  have  en- 
deavored to  defend. — See  Rights  of  Authors,  p.  912. 

699.  a.  There  has  constantly  been,  however,  a  group  of  medical 
philosophers  who  have  remained  ti'ue  to  nature ;  and  the  profession, 
therefore,  split  into  two  classes,  taking  the  names  of  the  Hippocratic 
and  the  Necroscopic  or  Anatomical  schools.  The  Hippocratists  are 
observers  of  Nature  in  all  her  aspects ;  while  the  Necroscopists  only 
contemplate  her  ruins. 

699,  h.  The  Hippocratists  maintain  that  Nature  is  most  significant 
of  her  existing  conditions  while  those  conditions  actually  exist,  and 


PATHOLOGY. MORBID    ANATOMY.  457 

that  we  may  better  infer  the  nature  of  present  causes  by  their  imme- 
diate effects,  than  by  the  effects  of  other  causes  which  may  happen  a 
week,  or  a  month,  or  a  year  afterward. 

699,  c.  The  Necroscopic  or  Anatomical  school  maintain  exactly  the 
reverse  of  the  foregoing.  If,  for  example,  a  case  of  inflammation  of 
she  lungs  occur,  they  allow  no  satisfactory  conclusions  as  to  the  nature 
of  the  disease  till  the  patient  is  dead,  and  it  can  be  seen  whether  there 
be  certain  morbid  changes  of  structure,  or  certain  physical  products, 
which  they  assume  as  necessary  to  constitute  inflammation.  "  In  this 
country,"  says  the  British  and  Foreign  Medical  Review,  "  few  would 
be  disposed  to  admit  that  inflammation  had  existed,  unless  some  of 
its  known  products  were  brought  forward  as  proofs."  If,  therefore,  a 
patient  die  of  inflammation  in  its  formative  stage,  and  before  any  of 
its  peculiar  products  take  place,  it  is  contended  that  there  was  no  in- 
flammation, however  violent  and  characteristic  may  have  been  the  vi- 
tal signs.  Hence  it  is  assumed  that  the  cause  of  death,  in  cases  of 
that  nature,  is  wholly  unknown  (§  748),  or,  "they  are  like  inflaroma- 
tion,  yet  totally  differe7iV  (§  1024  d).  The  London  Lancet  has  a  more 
proximate  philosojjhy.  Thus  :  •'  Inflammation  consists  in  this,  name- 
ly, that  the  fibrin,  Sec,  which  should  pass  firo??i  the  arterial  into  the 
lymphatic  system,  [ !  ]  passes  into  the  venous.  The  true  nature  of 
inflammation  lies  in  the  above  few  words"  (April  8,  1843). 

A  few  of  the  most  eminent  of  the  Necroscopic  school  have  exploded 
inflammation  as  a  disease.  This  is  extensively  true  of  Louis,  and  uni- 
versally so  of  Magendie  and  Andral ;  the  last  of  whom  affirms  that 
"  it  is  like  an  old  worn-out  coin,  which  ought  to  be  discarded  from 
circulation"  (§  753).  Of  fever,  he  says,  "  The  progress  of  science  has 
induced  me  not  to  devote,  as  in  the  former  edition,  a  special  volume 
to  fevers." — "Singular  'progress'  that!"  exclaims  Cayol ;  "a  few 
such  steps,  and  medical  science  would  be  down  at  zero"  (§  740  b, 
744).  The  distinguished  Travers,  in  commenting  upon  the  Anatomi- 
cal school,  especially  its  corruptions  in  France,  remarks  that,  "  out  of 
the  debris  of  the  dead  subject,  however  accurately  inspected,  examin- 
ed, and  arranged,  to  attempt  a  solution  of  the  great  problem  of  living 
actions,  and  to  build  upon  such  a  foundation  an  edifice  of  pathology  of 
self-support,  is  as  injurious  a  fallacy,  and  scarcely  less  arrogant  and 
absurd,  than  that  of  the  Cartesian  Philosophers,  who  undertook,  out  of 
the  depth  of  their  anatomical  sagacity,  to  make  a  man." — Note  F. 

699,  d.  Again,  in  another  case  where  there  may  have  been  a  suc- 
cession of  inflammations  in  different  organs,  and,  although  one  or  more 
in  the  series  shall  have  entirely  subsided,  but  the  real  cause  of  all  that 
followed,'  it  is  assumed  by  the  Necroscopic  school  that  the  last  in  the 
series  had  been  the  cause  of  all  the  phenomena  from  the  beginning 
of  the  complaint.  Such,  indeed,  as  well  as  the  preceding  doctrines 
(§  699,  c),  is  the  natural  result  of  that  large  school  of  materialism 
which  pretends  to  discover  in  the  structure  of  organs,  even  in  their 
molecules,  the  various  conditions  of  hfe,  and  all  its  diversified  phe- 
nomena (§  131). 

700,  a.  Take  any  case,  in  the  wide  range  of  diseases,  and  ere  its 
termination,  it  may  present  many  new  problems  for  the  pathologist. 
It  may  have  lost  its  original  character,  or  its  variations  may  consist  of 
such  modifications  of  a  common  pathological  cause,  that  the  cure  shall 
require  alternations  of  opposite  remedies.     Every  pathological  change 


458  INSTITUTES    OF    MEDICINE. 

IS  ascertained  through  the  direct  phenomena,  and  is  a  far  more  diffi- 
cult effort  than  the  primary  conditions.  Morbid  anatomy  contributes 
nothing  through  all  the  intermediate  changes  ;  and  what,  tnerefore,  is 
its  positive  benefit  in  any  given  case  of  disease  at  its  invasion  or  ter- 
mination if  it  supply  us  nothing  throughout  its  progress  ]  The  whole 
matter  is  settled  before  morbid  anatomy  can  yield  its  light ;  and  Na- 
ture would  have  been  untrue  to  herself  had  she  left  her  dependence 
upon  art  to  her  own  ruins. 

700.  1).  The  physical  products  of  disease  can,  at  best,  only  denote 
the  nature  of  an  antecedent  functional  action  in  which  the  essence  of 
the  disease  consists,  and  which  has  more  or  less  terminated  in  the 
particular  part  when  the  lesions  of  structure  and  morbid  depositions 
have  taken  place  (§  732  J,  863).  On  the  contrai-y,  if  disease  consist 
in  structural  lesions,  or  other  physical  products,  to  what  practical  re- 
sult does  morbid  anatomy  conduct  us,  if  it  inculcate  such  a  doctrine? 
Organic  lesions,  and  often  preternatural  formations,  are  to  the  physi- 
cian what  they  are  to  nature, — ulterior  results ;  and  they  are  equally 
unacceptable  to  both.  If  the  positive  symptoms  of  inflammation  are 
to  be  set  aside  from  want  of  some  of  its  terminations,  or  even  of  vas- 
cularity, the  foundation  of  practical  medicine  will  be  swept  away,  and 
clinical  lectures  should  be  confined  to  the  dissecting-room  (§  730 
732  I). 

701.  Morbid  anatomy,  as  taught  by  the  materialist  school,  has  pre- 
cluded all  regard  for  those  pathological  conditions  upon  which  the 
lesions  of  structure  and  physical  products  truly  depend,  and  about 
which  the  art  of  medicine  is  mainly  interested.  In  its  indiscriminate 
career,  indeed,  it  cuts  off  all  diseases  except  such  as  are  known  to  the 
vitalist  under  the  name  of  inflammation,  and  to  which  he  refers  those 
lesions  of  organic  action  and  those  new  formations  which  alone  en- 
gage the  school  of  materialism.  But  the  vitalist  believes  that  "  it  is  a 
rule  of  no  small  moment,  in  acute  diseases,"  as  expressed  by  Senac, 
"  that  there  may  be  great  disorder  in  the  functions  of  the  body  without 
real  inflammation,  or  any  Jixed  disease  in  the  solid  parts.  Yet  these 
parts,  which  have  experienced  such  deep  and  distressing  affections, 
may,  in  a  short  time,  be  entirely  relieved."  "  At  the  termination  of 
a  paroxysm  of  malignant  fever,  the  terrible  symptoms  abate,  and  often- 
times disappear." 

702.  Morbid  anatomy  has  not,  in  an  original  sense,  ever  given  us  a 
solitaiy  clew  to  the  pathology  of  disease,  any  more  than  healthy  anat- 
omy to  the  natural  organic  functions.  We  revert,  at  last,  to  the  vital 
indications,  or  other  immediate  results,  for  this  knowledge.  The  local 
symptoms  are  often  an  unerring  guide,  and  many  which  spring  from 
reflex  nervous  actions,  where  morbid  anatomy  professes  nothing,  yield 
also  their  flood  of  light.  We  analyze  the  whole  group  of  phenome- 
na, and,  by  the  aid  of  experience  and  principles,  we  go  to  the  work 
of  cure  without  a  doubt  or  hesitation.  There  is  no  other  mode  of 
practicing  medicine.  Or,  suppose  the  anatomist  to  attempt  a  thera- 
peutical application  of  his  own  materialism,  physiological  and  patho- 
loo-ical ;  could  he  even  begin  to  consider  the  condition  of  disease,  or 
the  nature  of  its  treatment  (^  500  m,  5Uf-m,  6471,  694^,  904  «,  990^  a)l 

703.  The  legitimate  objects  of  morbid  anatomy  are  to  expound  the 
sensible  changes  which  may  take  place  in  the  instruments  of  morbid 
action,  the  lesions  of  structure,  and  other  new  formations,  which  may 


PATHOLOGY. MORBID    ANATOMY.  459 

supervene  upon  disease.  These  it  associates  with  what  had  been  de- 
termined by  the  phenomena  during  life  as  to  the  essential  patho- 
logical conditions;  and,  when  doubtful  cases  may  arise,  from  the  ab- 
sence of  symptoms,  should  the  physical  results  occur  which  have  been 
found  to  be  the  regular  sequelee  of  certain  known  pathological  states, 
it  is  then  that  morbid  anatomy  reflects  its  posthumous  light  with  vari- 
ous degrees  of  importance.  Yet  certain  it  is  that  morbid  anatomy 
can  be  of  no  advantage,  so  long  as  the  symptoms,  the  true  indices  of 
disease,  may  be  absent  in  any  subsequent  cases  of  the  same  nature, 
till  the  patient  is  again  subjected  to  the  scrutiny  of  the  scalpel. 

All  physical  results  stand  as  the  ultimate  signs  that  a  certain  mode 
of  action  had  existed,  since  these  aj*e  the  consequences  of  that  action, 
of  which  the  vital  signs  had  been  the  attendants,  and  which  had  form- 
ed the  sole  ground  of  that  pathological  induction,  which,  after  a  seiies 
of  observations,  the  physical  products  illustrate,  and  are  taken  merely 
as  an  indication  that  these  vital  signs,  the  basis  of  pathological  induc- 
tions, had  been  present. 

704.  It  is  manifest,  therefore,  that  the  materialism  inculcated  by 
morbid  anatomy  destroys  all  rational  attempts  at  pathological  induc- 
tions during  the  treatment  of  disease;  since,  if  the  true  import  of  the 
vital  signs  depend  upon  the  ultimate  contingency  supposed,  no  jusl 
conclusions  can  be  formed,  either  as  to  the  nature  of  disease,  or  tho 
mode  of  treatment,  till  the  patient  is  dead.  This,  it  will  be  allowed, 
is  repugnant  to  reason ;  from  which  it  will  follow  that  the  premises 
are  wrong,  and  that  true  pathology  reposes  upon  the  vital  emanations 
of  disease  (§  756,  i).— Note  F  p.  1114. 

705,  a.  It  is,  then,  upon  the  symptoms  of  disease,  its  remote  causes, 
and  the  effects  of  remedies,  that  we  are  to  depend  in  reaching  all 
practical  knowledge  of  any  individual  case,  and,  therefore,  all  cases 
of  disease.  But,  since  the  physical  products  of  disease  which  are 
comprised  under  morbid  anatomy  are  the  results  of  the  same  prop- 
erties and  actions  upon  which  the  vital  phenomena  depend,  they 
form  an  ultimate  and  subordinate  source  of  information  ;  and  since 
they  concur,  more  or  less,  with  the  primary  remote  causes  of  disease 
in  ultimately  modifying  the  phenomena,  it  is  important  to  know,  as  far 
as  may  be,  the  extent  of  their  influence  in  this  respect. 

705,  h.  I  may  say,  therefore,  that  the  greatest  practical  use  of  mor- 
bid anatomy  is  the  knowledge  it  supplies  of  the  tendency  of  certain 
pathological  conditions  to  result  in  the  formation  of  physical  products, 
or  in  disorganization  ;  thus  giving  that  direction  and  energy  to  prac- 
tice that  may  be  necessary  to  counteract  the  supervention  of  these 
deplorable  consequences  of  disease.  A  second  important  practical 
advantage  is  the  discrimination  which  morbid  anatomy  enables  us 
to  make  between  those  phenomena  which  are  the  result  of  simple 
morbid  conditions,  and  such  as  depend  upon,  or  are  modified  by,  the 
supervention  of  physical  products. 

706.  Morbid  anatomy  can  never  alter  the  general  principles  which 
it  may  have  assisted  in  forming.  When,  for  example,  the  nature  of 
common  inflammation  is  ascertained  in  one  part,  principles  are  estab- 
lished which  are  applicable  to  this  disease  in  all  other  pai'ts,  and  at 
all  times,  and  under  all  circumstances.  The  varieties  must  be  ascer. 
tained  by  interrogating  the  particular  phenomena  in  each  individual 
case,  and  the  treatment  adapted  accordingly.     The  great  principles 


460  INSTITUTES    OF    MEDICINE. 

will,  of  course,  be  always  under  the  modifying  influence  of  the  phe- 
nomena from  which  they  have  been  deduced,  according  as  the  princi- 
pal phenomena  may  fluctuate. 

707.  When  the  structure  of  parts  becomes  deranged,  or  the  proper- 
ties of  life  are  verging  toward  an  extinction,  we  have  totally  a  new 
order  of  things.  Pathological  principles  are  then  upon  the  decline, 
and  thei'apeutics  is  more  or  less  afloat,  and  without  compass,  on  the 
broad  ocean  of  experiment.  The  organic  being  is  fundamentally 
changed  in  his  structure,  and  the  laws  by  which  he  is  naturally  gov- 
erned are  more  or  less  broken  up.  And  I  may  also  add,  without  in- 
tending to  discourage  its  legitimate  pursuit,  that  here  it  is  that  mor- 
bid anatomy  begins,  and  has  reared  its  pathological  fabric  on  the  ru- 
ins of  organization. 

708.  Whenever  morbid  anatomy  has  been  in  the  ascendant,  the 
practice  of  medicine  has  been  either  experimental  and  empyrical,  or 
lias  run  into  a  mere  system  of  "  watching,"  or  what  was  anciently 
denominated  "  a  meditation  upon  death."  We  need  only  turn  to  the 
present  state  of  medicine  in  the  Capital  of  France  for  a  melancholy 
exemplification  of  what  I  now  state,  and  which  I  have  set  forth  ex- 
tensively in  my  Essay  on  the  Writings  of  Louis. 

709.  The  foregoing  section  leads  me  to  a  review  of  the  past,  and 
to  inquire  how  far  events  have  justified  jny  former  conclusions  as  to 
the  superiority  of  American  practice,  and  of  American  medical  edu- 
cation, over  European,  as  expressed  in  my  Essay  on  the  Comparative 
Merils  of  the  Hippocratic  and  Anatomical  Schools.  I  had  deprecated 
more  especially  the  corruptions  of  French  medical  philosophy,  and 
was  led  to  remark,  that,  "  already  our  young  men  are  crowding  the 
schools  of  the  French  Metropolis  in  pursuit  of  a  more  thorough 
knowledge  of  morbid  anatomy;  and  immuring  themselves  within  the 
walls  of  Parisian  hospitals,  to  contemplate  the  worst  ravages  of  dis- 
ease upon  subjects  of  broken-down  constitutions,  and  who  have  pass- 
ed the  ordeal,  of  French  hospital  practice.  They  return  home  with 
Gallic  pathology,  and  the  results  of  Gallic  therapeutics,  which  they 
could  not  realize  in  their  own  country,  and  will  never  witness  again 
but  by  carrying  out  the  principles  which  have  supplied  them  with  their 
means  of  information." — Note  W  p.  1127. 

It  is  true  that  a  few  have  been  not  a  little  employed  in  dissemina- 
ting these  corruptions  in  this  stable  land  of  sound  medical  philoso- 
phy ;  but,  nevertheless,  I  am  still  able  to  repeat,  that,  "  What  Amer- 
icans have  received  from  the  devotees  of  Morbid  Anatomy,  or  from 
such  as  would  make  Chemistry  the  basis  of  organic  science,  has  only 
tended  to  show  them  more  distinctly,  that  the  phenomena  of  life,  in 
their  various  relations,  are  the  true  foundation  of  principles  in  med- 
icine" (§  350-350f,  744,  821,  830). 

And  now,  having  obtained  the  requisite  permission  from  one  ven- 
erable in  years,  profound  in  science,  and  long  eminent  as  an  ex- 
pounder and  teacher  of  medicine,  and  practically  familiar  with  Euro- 
pean habits,  I  shall  here  subjoin  an  extract  from  a  letter  which  he 
did  me  the  honor  of  addressing  to  myself,  from  Louisville,  Ky.. 
April  5th,  1846.*     I  am  immediately  prompted  to  this  step  by  the 

*  In  alluding  to  my  Defense  of  the  Medical  Profession  of  the  United  States, 
Professor  Caldwell  goes  on  to  remark  that, 

"  On  perhaps  every  part  of  your  unsparing  career  throughout  your  task,  from  begin 


PATHOLOGY. MORBID    ANATOMY.  461 

manner  in  which  the  Medical  Profession  of  the  United  States  has 
been  lately  presented  to  the  World  by  the  Medical  Society  of  the 
State  of  New  York,  in  the  hope  that  I  may  be  thus  instrumental  in 

ning  to  end,  my  sentiments  accompany  you,  and  probably  on  one,  at  least,  leave  j'ou  a 
little  in  the  rear.  I  allude  to  the  practical  superiority  -which  the  physicians  of  our  own 
country  hold,  in  general,  over  those  of  Europe,  and  I  presume  also,  of  course,  of  every 
other  portion  of  the  globe. 

"  Respecting  the  treatment  of  chronic  complaints  I  forbear  to  speak  ;  because  my  knowl- 
ede:e  on  that  point  is  less  full  and  thorough,  and  therefore  my  opinion  less  positive.  But, 
in  their  rational,  skillful,  bold,  and  successful  treatment  of  acute  diseases,  particularly  of 
the  classes  _/efrres  and  phlegmasia;,  the  physicians  of  the  United  States  are  incomparably 
superior  to  any  Europeans  whose  practice  I  have  either  witnessed  in  person,  or  read  of 
in  books.  That  this  is  true  in  relation  to  American  complaints  cannot  be  denied.  Nor, 
in  my  opinion,  is  it  less  true  in  respect  to  those  of  transatlantic  counti-ies. 

"  Of  all  the  physicians  in  Europe  of  whom  I  have  any  knowledge  to  be  relied  upon,  I 
am  most  partial  to  the  practice  of  certain  Dublin  gentlemen,  and  of  those  in  some  parts  of 
Italy.  In  their  treatment  of  disease  they  have  often  reminded  me  of  home.  And  of  all 
the  practice  I  have  ever  witnessed,  that  of  Paris  is  the  most  inefficient  and  miserable. 
Yet  is  it  this  Parisian  school  in  which  American  pupils  are  most  anxious  and  proud  to  be 
educated,  and  to  which  they  are  advised  to  repair ;  and  most  unwisely  and  inconsiderate- 
ly advised.  As  far  as  the  practice  of  medicine  is  concerned,  if  they  do  not  there  learn  how 
to  kill  the  sick  themselves,  they  learn,  or  may  learn,  to  perfection,  the  art  of  allowing 
their  complaints  to  kill  them.  Never  have  I  witnessed  in  Paris  a  single  well-directed 
Herculean  blow  attempted  in  a  case  of  fever.  The  battle  was  always  fought  in  a  Lillipu- 
tian manner.  Nor,  were  I  to  say  the  same  in  relation  to  Enghsh  and  Scotch  practice, 
would  it  be  easy  to  refute  the  assertion.  It  is  a  well-known  ti-uth,  that  European  phy- 
sicians of  every  nation,  who  migrate  to  America,  are,  on  their  first  removal,  incompetent 
to  the  successful  treatment  of  the  complaints  of  the  country ;  nor  can  any  thing  but  expe- 
lience  render  them  competent  to  it. 

"  It  is  undeniable,  that  the  physicians  of  Europe  are,  in  the  mass,  very  far  from  being 
an  able  and  elevated  body  of  men.  Strike  off  the  few,  I  might  say  the  comparatively 
very  few,  who  alone  give  lustre  and  standing  to  the  profession,  and  the  remaining  '  mill- 
ion' will  be  found  to  be  positively  and  strikingly  the  reverse ;  a  very  ordinary  body,  pos- 
sessing not  an  element  of  distinction  on  the  ground  of  either  talent  or  attainments.  And 
the  same  is  true  in  relation  to  the  pupils  whom  I  have  seen  in  attendance  on  the  Euro- 
pean schools.  A  majority  of  them,  which  may  be  called  vast,  are,  in  appearance,  far  infe- 
rior to  the  pupils  of  our  own  schools.  Nor  have  I  the  least  reason  to  believe  them  much 
if  any  less,  inferior  in  mind  than  they  are  in  person.  In  proof  of  this,  the  American  pu- 
pils, whom  I  have  seen  in  attendance  on  foreign  schools  of  medicine,  were,  in  no  ordinary 
degree,  the  finest  young  men  belonging  to  the  classes  ;  the  foremost,  I  mean,  in  everj'  es- 
sential attribute  of  standing.  Of  this  they  were  themselves  confident  and  proud  ;  and  so 
was  I. 

"  It  is  not  true,  then,  that  the  mass  of  physicians  in  Europe  are,  in  any  respect,  superior 
to  the  mass  in  the  United  States.  In  their  treatment  of  disease,  I  fearlessly  repeat  that 
they  are  decidedly  inferior.  On  each  side  of  the  Atlantic,  the  icest  not  less  than  the  east, 
there  exist  in  the  Faculty  the  eminent  feio,  who,  in  talents  and  knowledge,  are  nearly  on 
a  par;  the  Americans,  however,  being  at  once  the  most  efficient,  most  rational,  and  most 
successful  practitioners. 

"  Wliile  I  yield  to  no  one,  tlierefore,  in  the  estimate  I  place  on  the  leading  physicians 
of  Europe,  I  cannot  admit  that  those  of  the  United  States  are  in  any  respect  their  inferi- 
ors. And  I  should  deem  myself  unworthy  my  birth-right,  were  I  not  to  discountenance 
the  wordy  tirade  poured  out  so  superabundantly  in  certain  quarters,  in  disparagement  of 
the  education  and  standing  of  the  great  body  of  American  physicians. 

"For  the  inferiority  of  the  mass  of  European  physicians  a  plain  and  substantial  reason 
may  be  assigned :  they  are  enslaved  by  precedent  and  trammeled  in  mind,  and  are  not, 
therefore,  independent  thinkers.  And  I  need  hardly  add,  where  independecce  of  thought 
is  wanting,  so  are  vigor  and  efficacy  of  thought." 

"  An  overwhelming  majoritj'  of  the  physicians  of  Europe  reside  and  practice  in  country 
places,  villages,  and  small  towns.  And,  as  already  alleged,  they  ai-e,  ab  origine,  more  or 
less  of  an  interior  caste.  Their  education  is  also  mferior.  Hence,  conscious  of  their  inferior- 
\ty,  they  look  upward  for  fight  and  direction,  sni  follow  those  whom  they  acknowledge  as 
their  superiors.  In  tliis  they  but  conform  to  the  European /as/iion,  according  to  which  the 
lower  orders  of  society  do  a  sort  of  homage  to  the  higher,  and  walk  in  their  footsteps.  So 
ti-ue  is  all  this  that  there  are  few,  if  any,  medical  commoners  in  the  Old  "World,  who  venture 
to  think  in  any  other  way  than  by  authority  of  some  writer  or  teacher;  whom  they  obey 
and  adhere  to  as  retainers  do  to  their  feudal  lords.  I  need  hardly  subjoin,  that  in  a  con- 
dition so  humiliating,  it  is  impossible  for  physicians  to  rise  to  eminence. 

"  Much  of  this,  however,  you  have  yourself  stated  in  your  '  Defense  of  the  Profession,'  or 
elsewhere.  But  I  am  not  apprized  of  your  having  stated  that  the  American  youth  caa  be 
much  better  educated  in  their  own  countjy  than  in  any  foreign  one.  Yet  is  the  fact  un- 
questionably true.  I  mean  that  it  is  a  jact,  and  not  a  nan-ow-minded,  selfish  assertion, 
l^e  real  proximate  elements  of  medicine  are  more  thoroughly  taught  in  some  American 


462  INSTITUTES   OF   MEDICINE. 

obliterating  unmerited  reproach,  and  in  inspiring  ray  medical  couii 
rxymen  with  that  consciousness  of  worth,  and  self-respect,  and  self- 
dependence,  which  they  are  so  eminently  entitled  to  enjoy. 

schools,  than  in  any  European  ones  I  have  ever  visited.  This  is  especially  true  in  rela- 
tion to  the  Principles  or  Philosophy  of  medicine  ;  without  an  acquaintance  with  which 
the  practice  of  the  profession  is  rank  quackery." 

I  have  no  disposition  to  pursue  the  foregoing  subject  beyond  what  may  seem  expedient 
for  the  defensive  purposes  which  common  justice  urges  upon  an  injured  right.  The  scope 
of  rsmark  is  therefore  designed  to  extend  far  beyond  those  domestic  relations  which  might 
be  adjusted  without  foreign  aid.  But  our  own  self-reproach  was  not  the  offspring  of  con- 
scious degradation.  It  was  but  the  sequel  of  disdain  which  prospective  greatness  never 
fails  to  encounter  on  its  triumphant  march.  The  aspersions  of  the  mother-country  had 
been  received  in  the  dignity  of  silence,  and  they  who  midertook  the  game  at  home  calcu- 
lated to  win  through  an  imaginary  acquiescence  in  foreign  diplomacy  and  an  accustomed 
non-resistance.  All  that  was  noble  in  our  land  had  been  the  subject  of  unmitigated  scorn  ; 
and  so  it  progressed  under  the  blandishments  of  diplomatic  skill.  I  will  not  point,  in  tes- 
timony of  this,  to  the  "  London  Q,uarterly,"  or  political,  or  other  journals  of  inferior  note  ; 
but  that  which  has  reigned  supreme  in  the  world  of  letters  unfolds  an  amount  of  proof  at 
which  Honor  and  Humanity  hang  their  heads  in  shame.  The  blows  have  not  fallen  upon 
the  imbecile  and  weak.  That  is  the  coward's  work,  and  would  have  yielded  nothing  to 
the  final  cause.  A  nation  has  been  the  intended  victim,  and  therefore  a  nation's  pride 
has  been  the  target.  The  critique  upon  Channing  in  that  National  work,  the  Edinburgh 
Review,  for  April,  1839,  is  alone  enough  to  dishonor  any  country,  at  any  age. 

I  shall,  therefore,  briefly  sustain  the  foregoing  comparative  estimate  of  the  Medical  Pro- 
fession, in  a  limited  application  to  "the  Mother-Country."  I  complain  not  of  any  other; 
and  revere  the  ancestor  as  a  fading  luminary,  of  the  largest  macrnitude,  whose  resplen- 
dent light  has  only  passed  into  other  regions  to  advance  the  welfare  of  other  worlds.  I 
shall  sustain  the  comparison,  I  say,  by  a  quotation  of  one  of  many  analogous  comments 
that  have  lately  appeared  in  a  medical  work  which  may  be  regarded  as  the  oracle  of  the 
British  Profession, — the  London  Lancet. — Note  W  p.  1127. 

In  speaking  of  the  existing  state  of  medicine  in  Great  Britain,  and  after  representing 
British  '•  works  on  pathology  and  the  practice  of  medicine  as  deficient  in  originality  and 
richness  of  materials,"  the  veteran  editor  aims  his  Lancet  at  the  very  foundation.  "Look," 
he  saj-s,  "  at  the  state  of  British  pathology  !  Of  what  does  the  great  majority  of  our  books 
en  this  subject  consist  ?  Of  compilations  ;  of  old  views  cooked  up  as  new  discoveries  ;  of 
annotated  translations;  or,  at  best,  of  able  and  comprehensive  digests  of  materials  that  were 
already  before  the  public  in  other  forms." — London  Lancet,  May  6,  1843.  And  may  I  not 
adduce,  in  support  of  the  Lancet,  what  I  have  said  in  former  sections  of  the  reference 
and  suirender  of  British  medicine  to  the  laboratory  of  a  German  chemist  (§  349,  d,  376j, 
676,  878)?' 

ShaU  Americans,  therefore,  go  on  to  decry  the  efforts  of  their  own  medical  scholars, 
degrade  the  whole  profession  of  their  own  country,  and  sacrifice  their  own  medical  litera- 
tiu-e  for  what  is  conceded  to  be  the  present  medical  literature  of  Great  Britain?  It  is 
not  mine  to  complain  of  British  critics  for  promulgating  what  could  not  be  concealed  ;  and, 
doubtless,  it  is  the  only  remedy  for  professional  apathy,  the  only  stimulus  to  "  medical  re- 
form," the  only  motive  for  "  Parliamentary  action,"  and  the  only  means  of  extending  edu- 
cation and  of  rescuing  the  practice  of  medicine  from  the  hands  of  "  apothecaries." 

There  has  been  no  occasion  for  vindictive  motive ;  which  never  fails  to  tarnish  truth  or 
poUsh  error.  The  common  ends  of  life  are  known  to  all,  and  each  in  his  place,  in  the  scale 
of  conscience,  weighs,  to  the  weight  of  a  thought,  the  right  and  the  wrong.  What  was 
once  true  is  true  forever ;  and  nothing  has  stood  the  test  of  truth  hke  the  great  elements 
of  national  decline.  In  vain  do  we  point  to  our  former  greatness,  and  call  for  help  upon 
the  past.  The  very  power  of  example  is  gone.  What  was  noble,  was  virtuous,  was 
intellectual  has  passed  to  other  regions,  is  cherished  and  honored  in  other  chmes.  It  is 
lost  only  to  the  land  of  its  birth. 

While,  therefore,  we  adopt  whatever  is  valuable  from  abroad,  let  us  have  a  literature 
of  our  own,  based  upon  American  observation,  American  industry,  and  American  genius. 
But,  as  I  formerly  said,  let  us  remember  the  admonitions  of  history,  that,  when  nations 
have  begim  to  trample  upon  the  past,  to  reject  its  experience,  and  to  stiike  out  new  sys- 
tems of  observing  Nature,  it  has  been  the  most  certain  presage  of  approaching  imbecility, 
and  of  that  ultimate  fall  to  which  all  are  destined.  When  the  great  revolution  shall  have 
reached  the  Genius  of  Philosophy — "  to  Kpariarov  r?;f  (JtAoffo^iCf" — the  last  vial  of  wrath  is 
emptied,  and  that  nation  is  irretrievably  gone.  This  is  humiliating  to  pride,  and  may  have 
been  designed  as  one  of  its  correctives.  But  since  it  is  so  in  the  great  plan  of  Providence, 
it  must  be  sufficiently  obvious,  tiiat,  as  a  nation  approaches  its  chaotic  state,  those  who 
may  be  in  the  ascendant  are  bound  neither  to  counteract  the  order  of  nature,  nor  to  suf- 
fer their  own  prosperity  to  be  blighted  by  the  mildew.  Ambition  must  follow  the  beaten 
path  of  philosophy.  'The  denunciation  of  past  experience  is  the  ambition  of  egotism,  which 
erects  its  innovations  upon  error,  and  imbues  them  with  superstition  and  absurdities. 

I  say,  therefore,  let  us  have,  at  least,  a  medical  hterature  of  our  own.  There  is  noth- 
ing that  will  contribute  like  it  to  the  nationality  of  Americans,  nothing  that  will  inspire  so 
extensively  the  culture  of  other  sciences,  promote  the  advancement  and  refinement  of  tiie 

1  T/ie  Lo.NDON  Lancet  will  concede  that  alt  thins)  remain  in  statu  quo,  I860.— Firft  Note,  p.  617. 


PATHOLOGY. MOllBID    ANATOMY.  463 

Other,  and  perhaps  I  should  say  more  important  objects,  are  con- 
templated by  this  note,  and  which  form  no  small  part  of  the  interests 
of  medicine.  They  are  the  same  which  I  have  had  uninterruptedly 
in  view.  They  are  those  which  are  intended  to  designate  the  conse- 
quences of  spurious  systems.  Those  systems  and  their  results  must  be 
displayed;  and  that,  too,  in  connection  with  what  may  be  designed  as 
substitutes.  Nor  is  there  any  inquiry  in  which  this  method  is  so  in- 
dispensable as  in  the  philosophy  of  medicine.  Truth  would  never 
obtain,  till  the  "  lion  shall  lay  down  with  the  lamb,"  unless  the  In-, 
stitutes  of  Organic  Nature  are  presented  in  forcible  contrast  with  the 
devices  of  art.  It  has  been  tried  from  the  day  when  Hippocrates 
evolved  the  philosophy  of  medicine  from  Nature  herself,  and  dragged 
it  from  the  midst  of  error  and  superstition.  It  has  been  tried,  I  say, 
in  vain.  The  present  times  bear  me  witness  of  the  fact.  The  mind 
must  enjoy  ready  means  of  comparison.  Nay,  more,  the  compar- 
isons must  be  planned,  matured,  logical,  and  irresistible.  Such,  only, 
can  give  stability  to  medicine ;  can,  only,  illustrate  and  enforce  the 
truth.  I  have  made  the  attempt :  I  do  but  say  a  humble  attempt. 
I  design  it  as  an  example  for  more  able  pens ;  and  ever  consistent 
and  firm  in  the  views  which  I  have  now  expressed,  I  would  cheer- 
fully become,  upon  my  own  method,  the  victim  of  a  better  philosophy. 
I  would  have  corruptions,  speculations  of  all  kind,  swept  with  an  un- 
sparing hand  from  the  tablet  of  organic  nature ;  and  while,  therefore, 
whatever  I  may  have  attempted  shall  remain  unrefuted,  uninvalidated, 
or  however  it  may  receive  approval,  or  be  condemned  without  "  the 
ordinary  prerogative  of  being  presumed  to  be  true  until  the  contrary 
is  clearly  shown"  (§  376f ,  a),  I  shall  suffer  the  method  of  inquiry  to 
remain  undisturbed,  the  exposures  of  error  to  hold  firm  their  places, 
in  any  future  editions  of  this  work ;  that  they  may  unceasingly  con- 
tribute to  their  original  objects,  and  admonish  the  pretender,  that  some 
one  more  competent  to  the  task  may  fasten  upon  him  a  universal 
verdict  of  guilt.  They  will  therefore  remain,  as  a  safeguard  to  med- 
icine, till  the  corruptions  be  shown  to  bear  on  their  front  the  broad 
seal  of  Nature.* 

useful  and  ornamental  arts,  nothing  that  will  so  effectually  confirm  and  cany  forward  that 
elevated  rank  which  the  Medical  Profession  of  the  United  States  have  already  won  for 
themselves  in  the  hearts  of  their  countrymen.  We  have,  indeed,  already  the  foundation 
of  such  a  literature  in  the  multifarious  writin2:s  of  the  hard-thinking  men  of  America  ;  and 
it  is  this  very  literature,  and  the  general  dissemination  of  knowledge  in  the  American 
Medical  Profession,  their  indomitable  industry,  their  well-directed  skill,  and  their  discreet 
and  dignified  bearing,  which  give  them  higher  rank,  greater  influence  in  society,  than  any 
other  class.  Look  where  we  may,  we  shall  be  likely  to  find  the  medical  man  foremost  in 
enterprise,  turning  night  into  day,  leading  in  measures  for  the  public  health  and  for  its 
general  prosperity,  curbing  the  impetuosity  of  error  and  superstition,  rearing  and  conse- 
crating temples  to  the  Divinities  of  Health  wherever  a  dozen  worshipers  can  be  found, 
and  stretching  out  an  influence  which  awakens  all  the  elements  of  learning  and  industry. 
It  is  the  Profession  alone  which  is  not  true  to  itself 

In  all  tliat  I  have  now  said,  I  may  not  be  suspected  of  undue  partialit'.es,  for  I  am  un- 
der no  obligation  to  any  portion  of  my  profession  in  America,  or  of  the  American  Repub- 
lic ;  while  I  am  actuated  by  the  deepest  sense  of  gratitude  to  some  foreign  countries  that 
can  be  inspired  in  a  man  of  literary  habits.  To  those  countries  I  am  the  more  indebted 
as  they  are  always  just  to  my  native  land,  do  honor  to  her  scholars,  and  are  the  great' 
abodes  of  leanimg  and  philosophj'.  Nevertheless,  in  all  the  instances  I  have  endeavored 
to  speak  according  to  my  convictions  of  the  truth,  and  the  demands  of  my  subjects  ;  ever 
sacrificing  self  to  those  pi-imary  objects.  If  there  may  seem  to  have  been  asperity,  I 
trust  it  will  be  found  in  the  facts  themselves,  and  in  the  unavoidable  nature  of  the  coa- 
clusions  at  which  I  have  arrived. 

*  The  subject  of  Mkuical  Educatiox,  and  the  great  superiority  of  the  sj-stem  pur- 
sued in  the  United  States  over  that  of  Great  Britain,  was  resumed  in  a  series  of  seven- 
teen numbers,  which  I  contributed  (but  which  appeared  editorially)  to  the  New  York 
Medical  Press  (from  Jan.  29th  to  June  4th,  1859),  founded  upou  Parliamentary  doc'ls. 


464  INSTITUTES    OF    MEDICINE. 


INFLAMMATION  AND  FEVER. 

710,  a.  I  PROCEED  to  illustrate  the  most  important  principles  in  med- 
icine by  considering  those  which  are  especially  relative  to  inflarmna- 
tion  audi  fever ;  the  two  orders  of  disease,  indeed,  which  make  up  the 
.great  amount  of  human  maladies,  and  form  the  great  outlets  of  life. 
The  few  diseases  which  do  not  fall  under  one  or  the  other  of  the  fore- 
going denominations  are  least  important  in  a  practical  sense,  and  least 
understood  in  their  pathology.  Nevertheless,  a  knowledge  of  the 
principles  which  apply  to  the  pathology  of  inflammation  and  fever 
will  greatly  aid  our  interpretation  of  the  essential  changes  which  con- 
stitute the  pathological  conditions  of  other  affections. 

710.  b.  Inflammation  and  fever  have  been  generally  regarded  as 
one  disease,  and  they  who  have  considered  them  distinct  affections 
have  offered  no  analysis  by  which  their  individuality  may  be  estab- 
lished, and  by  which  each  complaint  may  be  readily  distinguished  in 
practice.  Important  evils  to  the  sick  are  therefore  in  constant  prog- 
ress from  this  source  alone ;  and  when  there  is  added  to  it  the  entire 
darkness  in  which  venous  congestion  has  been  shrouded,  both  in  its 
absolute  pathology  and  as  it  modifies  fever  and  the  recognized  forms 
of  inflammation,  it  may  be  safely  said  that  a  vast  opening  is  here  pre- 
sented for  the  improvement  of  medical  philosophy,  and  for  the  com- 
mon welfare  of  man  (§  787,  Rights  of  Authors,  p.  919,  nos.  27,  28). 

INFLAMMATION. 

711.  I  shall  first  state  the  outlines  of  inflammation,  and  its  essential 
pathological  characters ;  from  which  it  will  be  seen  that  it  takes  its 
rise  in  purely  physiological  conditions,  and  holds  its  progress  and  de- 
cline under  the  same  great  natural  laws  of  the  constitution  (§  137, 
149-152,  638). 

712.  Unlike  idiopathic  fever,  which  is  a  universal  disease  of  the 
body,  inflammation  is  always  local  (§  143,  148).  Fever,  however,  is 
often  complicated  with  inflammation  of  one  or  more  organs  at  or  near 
its  commencement,  and  the  local  disease  may  precede  the  constitu- 
tional one,  and  even  become  the  exciting,  though  not  \\~\e  predisposing, 
cause  of  it  (§  645,  650,  651,  653).  More  frequently,  however,  inflam- 
mations spi'ing  up  during  the  progress  of  idiopathic  fever,  and  often 
attack  and  disoi-ganize  many  important  parts  in  rapid  succession. 
Indeed,  it  is  rare  that  fever  exists  long  without  this  greater  foe 
making  its  appearance,  and  adding  seriously  to  the  difficulties  and 
dangers  of  the  case  (§  779). 

713.  Owing  to  the  foregoing  complications  the  capital  mistake  is 
often  made  of  regarding  the  local  affection  as  the  essential  or  predis- 
posing cause  of  the  constitutional  fever.  Such  pathologists  assume, 
of  course,  that  there  is  no  distinction  between  fever  and  inflammation, 
and  that  both,  therefore,  are  equally  and  always  local  diseases.  But 
this  is  not  the  doctrine  of  those  who  depend  less  on  morbid  anatomy, 
and  study  Nature  in  her  living  aspects  (§  699).  The  single  symptom 
which  has  given  to  fever  its  name  has  been  a  main  cause  of  the  con- 
fusion which  prevails  upon  this  subject  {§  657  h,  764,  &c.). 


PATHOLOGY. INFLAMMATION DESCraPTION.  465 

714.  Inflammations  of  much  activity  generally  disturb,  but  very  va- 
riously, the  functions  of  many  distant  organs ;  but  the  results  from 
their  reflected  nervous  actions  have  mostly  a  different  pathological 
condition  from  the  primary  disease,  and  such  as  are  truly  inflamma- 
tory are  limited  to  a  few  parts ;  while  all  parts  are  affected  in  fever, 
and  with  pathological  conditions  more  or  less  alike. 

In  chronic  inflammations  sympathies  are  more  slowly  and  less  ex- 
tensively produced,  or  not  at  all  where  more  acute  fonns  would  occa- 
sion great  constitutional  disturbance;  even  when  the  brain  or  other 
impor);ant  organs  may  be  the  seat  of  the  chronic  variety  (§  140). 

Acute  inflammation,  on  the  other  hand,  is  prone  to  give  rise,  at  its 
early  stage,  to  what  is  called  Jebrile  action,  or  Jever  (§  134,  139,  140, 
150).  But  this  kind  of  "  fever"  is  purely  sympathetic,  never  pre- 
cedes the  local  affection,  and  is  mostly  remarkable  for  a  simple  ex 
citement  of  the  heart  and  arteries ;  while  in  idiopathic  fever,  the 
most  violent  excitement  often  takes  place  without  any  appreciable 
antecedent  local  complaint,  but  simultaneously  with  the  general  ex- 
citement all  the  oi'gans  appear  to  have  become  involved  in  a  morbid 
process ;  and  now,  also,  inflammation  may  as  suddenly  supervene  (§ 
143  h,  148).  The  febrile  condition  proves  an  exciting  cause  of  the 
other  mode  of  disease  in  some  part  predisposed  to  the  inflammatory 
process  (§  4751-488^   500  m,  514/,  674   d,  903,  904  a,  990^). 

It  appears,  therefore,  that  great  confusion  has  prevailed  upon  this 
all-impoitant  subject,  and  that  causes  have  been  mistaken  for  effects, 
and  effects  for  causes.  The  excitement  of  the  heart  and  arteries  at- 
tendant on  inffamraation  appears  to  have  engrossed  attention,  inquiry 
to  have  stopped  short  as  to  all  other  organs,  and  a  comparison  to  have 
been  alone  made  between  the  general  arterial  excitement  of  inffam- 
mation  and  that  which  is  attendant  on  fever.  In  one  affection  the 
general  excitement  may  be  almost  the  only  element  of  disease  beyond 
the  local  cause ;  in  the  other  it  is  only  one  of  a  great  number  of 
elements  distributed  throughout  the  body  (§  487  h,  500  ?/?,  686,  694f). 

Again,  it  is  fundamental  with  inflammation  that  the  sympathetic 
development  of  general  arterial  excitement  will  subside  as  soon  as  the 
local  inflammation,  or  primary  cause,  is  removed  ;  but,  in  fever  the 
whole  disease  continues  after  the  original  cause  is  removed.  The  or- 
gans of  circulation  may  be  long  subject  to  very  high  degrees  of  ex- 
citement, as  often  witnessed  in  the  intermittent  fever,  without  a  shade 
of  inflammation  presenting  itself  during  the  progress  of  the  disease. 
And  how  clear  the  characteristic  distinction,  that  in  intermittent  fever 
the  excitement  disappears  not  only  periodically,  but  according,  also, 
to  the  type  of  the  fever,  while  in  inflammation  it  remains  till  the  local 
cause  is  removed ;  when,  also,  the  whole  disease  is  at  an  end.  But 
violent  inflammations  which  coexist  with  intermittent  fever  may  be 
entirely  subdued,  and  yet  the  fever  proceed  uninterruptedly.  Again, 
it  is  a  common  circumstance  that  all  idiopathic  fevers  are  introduced 
by  a  chill ;  while  such  is  rarely  the  case  with  inflammations.  The 
chill,  too,  and  of  great  severity,  may  attend  every  paroxysm  of  a  long- 
continued  intermittent.  Other  distinctions  in  §  720, 757, 759, 764  a,  e,  770. 

715.  When  inflammation  gives  rise  to  general  arterial  excitement  it 
is  in  part  by  continuous,  and  in  part  by  remote  sympathy  (§  498-500). 
The  latter  is  mostly  concerned  in  developing  the  general  results, 
The  nervous  power  being  excited  in  the  brain  and  spinal  cord    is  re- 

Gg 


466  INSTITUTES    OF    MEDICINE. 

fleeted  upon  the  heart  and  capillaiy  blood-vessels  of  the  whole  system, 
That  power,  thus  reflected,  proves  a  stimulant  to  these  organs,  by 
which  their  action  is  increased,  and  otherwise  modified  (§  188,  205 
22G,  480-485).  Again,  the  same  primary  inflammation  which  thug 
calls  up  a  general  excitement  of  the  circulatory  system  .may  be  si- 
multaneously producing  inflammation  of  some  other  and  distant  part, 
through  the  same  process  of  reflex  nervous  action.  That  second  pari 
may  have  been  predisposed  to  inflammation  by  some  external  remote 
cause,  and  the  nervous  power  determined  upon  it  may  then  operate 
only  as  an  exciting  cause.  If  the  part  be  not  antecedently  predispos- 
ed, then  the  nervous  power  may  prove  the  predisposing  as  well  as  ex- 
citing cause,  or  there  may  be  other  predisposing  causes  co-operating 
with  it  (§  143-150,  226,  484  h,  no.  6,  645,  652).  This  second  part, 
thus  sympathetically  influenced,  then  becomes  the  source  of  other 
reflex  nervous  actions  ;  co-operating,  in  this  way,  with  the  primary 
inflammation,  and  increasing  more  and  more  the  action  of  the  heart 
and  arteries  at  large,  and  developing  inflammation  in  other  parts, 
while,  also,  the  general  arterial  excitement  is  a  supplementary  me- 
chanical cause.  The  circles  of  sympathy  now  become  very  complex, 
and  interwoven  with  each  other  (§  148) ;  and  yet,  through  the  same 
laws  of  reflex  nervous  action  a  blow  may  be  simultaneously  struck 
at  the  whole  by  one  decisive  impression  from  a  single  remedy. 
Bloodletting,  for  instance,  will  do  it ;  but  the  operation  of  this  remedy, 
although  involving  the  agency  of  the  nervous  power,  is  different,  in 
some  respects,  from  that  of  any  other  agent.  But,  suppose  it  may  be 
done  by  an  active  cathartic,  combined  with  a  nauseating  dose  of  tar- 
tarized  amtimony.  The  pathological  states  of  the  various  inflamed 
organs  are  every  where  nearly  or  considerably  alike.  A  single  rem- 
edy inay,  therefore,  overthrow  at  once  the  whole  complex  condition 
of  disease  (§  137  d,  143  c,  d,  476^  h,  479,  481  g,  484  b,  no.  5,  514. 
557  a,  929-934,  944  b,  970  c).— Note  D  p.  1114. 

715^.  So  also  the  foregoing  modus  operandi  of  the  nervous  influ- 
ence ininfl.ammation  is  applicable  to  the  predisposing  influences  of  the 
remote  causes  of  fever  (§  148),  of  hydrophobia,  of  the  constitutional 
effects  of  mercury,  antimony,  &c.,  and  of  all  agents,  indeed,  which 
transmit  their  influences  to  parts  remote  from  the  direct  seat  of  their 
operation  (§  500,  535,  &c.,  657).     It  is  all  by  reflex  nervous  action. 

716.  The  general  sympathetic  excitement  is  supposed  to  often  con- 
stitute a  state  o^  general  inflammation.  But  this  is  an  error;  since 
inflammation  is  always  confined  to  some  limited  part,  the  minute  ves- 
sels of  which,  and  not  the  larger  arteries  and  heart,  are  the  instru- 
ments of  the  disease  (§  407  b,  410,  411).  The  term  inflammatory  fe- 
ver'\s>  also  objectionable,  as  being  significant  of  what  has  no  existence. 
The  term  constitutional  derangement  is  commonly  employed  to  denote 
the  sympathetic  disturbances  which  inflammation  may  inflict  upon 
parts  remote  from  its  own  location.  It  is  the  same  condition  that  goes 
under  the  denomination  o? fever  when  owing  to  the  reflex  nervous  ac- 
tions of  inflammation.  But,  unlike  idiopathic  fever,  per  se,  it  embra- 
ces a  variety  of  morbid  conditions  in  different  parts  (694f ). 

717.  Inflammation  occurring  in  one  part  may  induce  the  same  dis- 
ease in  another,  and  this  last  in  a  third,  &c.,  independently  of  the  fore- 
going affection  of  the  heart  and  arteries.  It  often  happens,  also,  that 
Bome  sympathetic  derangement  will  disturb  the  system  far  more  ex 


PATHOLOGY. INFLAMMATION DESCRIPTION.  467 

tensively  than  the  primary  afFection.  The  heart  may  be  the  only  or- 
gan that  may  be  disposed  to  sympathize  with  an  inflammation  of  the 
skin ;  but,  when  the  action  of  the  former  important  organ  becomes 
disturbed,  though  only  its  irritability  be  increased  along  with  that  of 
the  general  arterial  system,  it  may  develop  sympathetically,  and  by  a 
mechanical  impulse  of  blood,  extensive  derangements,  perhaps  inflam- 
mations, in  other  parts.  And  so,  in  the  same  vital  sense,  of  the  stom- 
ach, brain,  &c.,  when  one  of  those  organs  may  sympathize  with  some 
distant  inflammation  (§  139,  140,  525  c),  by  reflex  nervous  action. 

718.  The  more  active  and  extensive  the  inflammation,  the  more 
important  the  part  affected,  and  the  more  irritable  and  disposed  to 
sympathy  the  individual,  the  more  readily,  in  a  general  sense,  will  con- 
stitutional effects  ensue,  and  vice  versa  (§  139,  140,  597  d,  600  b).  Ex- 
ceptions are  seen  in  the  pleura  and  the  mucous  tissue  of  the  fauces. 
But  only,  in  the  latter  case,  under  special  circumstances ;  probably  of 
primary  abdominal  disease,  when  the  secondary  affection,  which  is 
commonly  erysipelatous,  reacts,  in  its  turn,  sympathetically  (§  689,  I). 
Th'e  special  sympathies  of  tissues  and  compound  organs  have  been 
already  considered  in  a  general  sense  (§  525-529).  As  it  respects 
inflammation,  a  predominance  is  seen  among  certain  organs,  as  the 
skin  and  mucous  tissue  of  the  alimentary  canal.  But  the  principle  is 
more  readily  comprehended  by  observing  its  operation  among  parts 
whose  natural  physiological  connections  are  strongly  pronounced,  as 
in  the  principal  organs  subservient  to  the  process  of  digestion  (§ 
129,  i).  The  sympathetic  results  may  not  be  inflammatory,  or  of  the 
same  nature  as  the  primary  disease ;  but  the  organs  which  thus  co- 
operate in  a  special  function  are  readily  disturbed  when  any  one  part 
of  the  system  is  invaded  by  disease,  and  readily  excite  reflex  nerv- 
ous actions  among  each  other,  and  throughout  the  body  (§514  h,  &c.). 
The  general  constitutional  affection  is,  therefore,  often  more  or  less 
dependent  on  the  habitual  association  of  the  action  of  different  organs 
while  in  health,  as  well  as  upon  the  nature  of  their  vital  constitution 
and  their  special  relations  to  other  parts  of  the  body  (§  129).  Owing, 
also,  to  the  special  modifications  of  the  vital  states  of  associated  or- 
gans, some  of  them  sympathize  more  readily  than  others  with  each 
other,  and  extend  their  influences  more  readily  and  powerfully  abroad 
(§  133,  &c.).  Thus,  the  small  intestine  occasions  sympathies  more 
readily  and  forcibly  than  the  large,  and  the  stomach  more  readily  than 
the  liver,  with  each  other.  But  these  morbid  sympathies  are  not  mu- 
tual among  the  parts  where  they  occur  most  readily,  and  the  same  is 
true  of  tlieir  natural  sympathies.  Thus,  inflammation,  or  any  aflbc- 
tion,  of  the  small  intestine  commonly  produces  more  or  less  derange- 
ment of  the  stomach ;  but  the  same  affection  happening  to  the  stom- 
ach will  not  equally  disturb  the  small  intestine.  Gastric  disease  read- 
ily deranges  the  liver ;  but  hepatic  affections  do  not  as  readily  affect 
the  stomach.     Such  are  plain  cases  of  reflex  nervous  action. 

It  may  be  also  well  to  remark,  that  were  it  not  that  one  part  nat- 
urally sympathizes  with  others,  it  would  never  sympathize  with  them 
under  circumstances  of  disease  ;  no  more  than  in  plants  (§  113- 
117,  129,  183-185,  224,  226,  349,  456-461^,  475^,  493  cc,  578  d). 

719.  Violent  sympathetic  disturbances  which  are  especially  relative 
.to  the  nervous  system  often  spring  up  from  simple  irritation  of  the 

nerves   of  a   comparatively  unimportant  part,   as   convulsions  from 


468  INSTITUTES    OF    MEDICINE. 

teethino;,  &c.     These  conditions  have  been  confounded  with  absolute 

* 

inflammation  of  the  nerves  (§526  d). 

720.  We  may,  perhaps,  reckon  as  the  first  among  my  radical  dis- 
tinctions between  inflammation  and  fever  the  fact  that  the  constitution- 
al disturbances  of  the  former  grow  out  of  direct  or  reflex  nervous  influ- 
ences instituted  and  kept  up  by  local  disease,  while  in  pure  fever  they 
are  independent  of  local  diseases,  though  equally  brought  about  by  al- 
terative reflex  nervous  influences  (§  233|,  475|,  647-0-,  715^). 

721,  a.  Inflammation  is  a  very  comprehensive  genus  ;  or,  perhaps, 
it  should  be  rather  said,  it  is  a  species  of  disease  which  embraces  a  mul- 
titude of  varieties,  forming  a  truly  protean  malady. 

721,  b.  According  to  the  varieties,  it  is  divided  into  common  and  spe- 
cific, whose  details  distinguish  it  very  broadly  from  fever. 

In  its  most  simple  form,  as  arising  from  mechanical  injuries,  or  as 
manifested  in  pneumonia,  pleurisy,  catarrh,  &c.,  it  is  distinguished  as 
common  inflammation  (§  652,  c). 

When  the  disease  presents  certain  peculiarities  that  are  not  attend- 
ant on  the  common  form,  it  is  called  specific ;  as  in  small-pox,  scrof- 
ula, lues,  gout,  rheumatism,  &c.,  and  in  all  cases  of  animal  and  veg- 
etable poisons  (§  650). 

722,  a.  Between  the  foregoing  characteristic  examples  of  common 
and  specific  inflammation  there  is  a  vast  range  of  gradations,  which 
meet,  as  it  were,  together;  so  that  it  is  evident  no  definite  line  exists, 
and  that  all  the  individuals  belong  to  a  common  family.  The  very 
extremes  are  so  much  alike  that  they  may  be  compared  to  twins, 
which  we  may  mistake,  one  for  the  other,  at  a  superficial  glance,  or 
may  only  know  them  apart  by  some  ^peculiarities  of  mind  or  manner; 
but  which  peculiarities,  again,  have  so  many  points  of  resemblance 
that  the  same  general  system  of  moral  and  physical  discipline  is 
adapted  to  each  of  the  twins,  with  only  some  special  modifications  to 
suit  the  peculiarities  of  each. 

722,  b.  In  a  general  sense,  when  inflammation  is  produced  by  a 
single  cause  it  appears  under  the  same  modification  or  variety  (§ 
652).  But  when  two  or  more  predisposing  causes  concur  in  estab- 
lishino^  the  morbid  chans^e  the  modification  thus  induced  will  be  de- 
termined  more  or  less  according  to  their  combined  virtues  (§  652). 
Thus,  cold  applied  to  the  sui-face  generally  produces  what  is  called 
common  inflammation.  But  it  will  also  act  as  a  predisposing  cause 
of  acute  rheumatism,  which  is  a  specific  form  of  inflammation,  and 
therefore  possesses  peculiarities  which  distinguish  it  from  all  other 
forms.  Hence,  in  this  affection  other  predisposing  causes  are  con- 
cerned, the  principal  of  which  may  be  ingrafted  upon  the  constitu- 
tion, or  if  transitory,  may  have  begun  the  foundation  of  disease  in 
the  organs  of  digestion  (§  659,  661). 

722,  c.  Inflammation  is  also  modified  by  the  natural  peculiarities 
of  the  vital  properties  in  the  different  tissues,  and  the  sympathetic 
influences  it  may  exert  will  often  depend,  both  as  to  kind  and  inten- 
sity, upon  the  nature  of  the  tissue  inflamed,  and  the  general  nature 
of  the  compound  organ  of  which  the  tissue  may  form  a  component 
part.  As  to  the  modifications  of  the  disease  and  the  reflex  nervous 
actions  as  affected  by  the  nature  of  the  tissue,  good  examples  of  dif- 
ference occur  in  the  comparative  phenomena  and  sympathetic  effects 
of  pleurisy  and  phlebitis  (§  150,  160-162,  807,  809,  &c.). 


PATHOLOGY. INFLAMMATION DESCRIPTION.  469 

As  to  the  modifications  of  common  or  specific  inflammation  which 
grow  out  of  the  combined  peculiarities  of  the  vital  properties  of  par- 
ticular tissues  and  of  the  compound  organ  of  which  the  inflamed  tis- 
sue is  a  component  part,  we  have  numerous  and  striking  examples ; 
as  in  inflammations  of  the  brain,  stomach,  liver,  intestines,  &c. 

Again,  the  phenomena  will  be  varied  as  inflammation  may  affect 
different  parts  of  one  and  the  same  continuous  tissue,  according  to 
the  nature  of  the  compound  organs  into  which  the  different  parts 
may  enter.  Examples  of  this  occur  in  the  pulmonary  and  intestinal 
mucous  tissue  wherever  it  contributes  to  variations  of  the  general 
structure  (§  135-140). 

722,  d.  From  all  that  has  been  now  said,  it  is  evident  that  those 
lesions  which  have  been  rejected  fi'om  the  general  denomination  of  in- 
flammation by  Louis,  Andral,  Marshall  Hall,  &c.,  and  airanged  un- 
der the  designations  of  hyperEemia,  hypertrophy,  lesions  of  nutrition, 
iriitation  from  loss  of  blood,  contra-inflammatory  action,  &c.,  but  at- 
tended by  many  of  the  characteristic  marks  of  inflammation,  fall  nat- 
urally within  the  range  of  this  variable  affection,  (§  725.  Also,  Med. 
and  Phys.  Comm.,  vol.  ii.,  p.  317-331,  712-715,  760,  &c.). 

723,  a.  Inflammation  is  also  divided  into  acute  or  active  and  chronic  ; 
the  former  being  more  violent  than  the  latter,  comparatively  of  short 
duration,  and  commonly  distinguished  by  a  greater  variety  of  local 
results,  and  far  greater  constitutional  derangements. 

723,  h.  The  foregoing  pathological  states,  being  essentially  alike, 
run  into  each  other;  so  much  so,  indeed,  that  what  has  been  chronic 
may  suddenly  become  acute,  and  pass  with  great  rapidity  through  the 
different  stages.  There  is,  therefore,  no  other  foundation  for  this  di- 
vision than  such  as  is  here  indicated. 

724,  I  am  now  conducted  to  an  analysis  of  this  disease,  and  shall 
consider  it, 

1.  In  its  most  simple  condition,  as  affecting  different  tissues. 

2.  As  affecting  different  parts  of  different  structures. 

3.  The  varieties  of  inflammation  in  respect  to  its  general  attributes. 

4.  The  sympathies  to  which  it  may  give  rise. 

5.  The  remote  and  pathological  causes  of  inflammation. 
The  first  four  problems  will  be  considered  connectedly. 

725,  a.  In  a  general  sense,  inflammation  is  attended  by  redness,  tw- 
mor,  heat,  and  ^;aw.  They  were  once  supposed  to  be  essential  phe- 
nomena ;  but  either  may  be  absent,  particularly  exalted  heat  and 
pain.  Their  presence  or  absence,  intensity  or  mildness,  may  depend 
upon  the  nature  of  the  morbific  cause,  the  nature  of  the  tissue,  &c. 
(§  651,  722).  Thus,  there  is  no  redness  from  the  bite  of  a  musketoe, 
and  there  is  intense  itching  instead  of  the  exquisite  pain  occasioned 
by  the  sting  of  a  bee.  None  will  deny  that  the  affection  resulting 
from  the  latter  cause  is  exquisitely  inflammatory,  and  all  must  allow 
the  near  coincidence  between  the  two  affections.  By  this  analogy  we 
bring,  also,  the  white  nettle  rash,  the  white  gangrene,  scirrous  tu- 
mors, &c.,  under  one  general  pathological  condition  (§  722,  d). 

725,  b.  Again,  for  example,  in  respect  to  pain,  much  will  depend 
upon  the  nature  of  the  tissue  affected,  and  upon  the  force  and  kind 
of  inflammation.  Inflammation  of  the  serous  membranes  is  attended 
with  far  greater  pain  than  the  mucous ;  in  which  last  it  is  often  ab- 
sent.    Simple  pneumonia  may  exist  to  an  alarming  extent  with  littla 


470  INSTITUTES    OF    MEDICINE. 

or  no  paiij.  The  serous  tissue,  also,  possesses  only  colorless  blood- 
vessels in  its  healthy  state,  but  is  apt  to  become  more  florid  in  its  in- 
flammations than  the  mucous.  On  the  other  hand,  parts  which  have 
only  a  dormant  state  of  sensibility,  as  the  tendons,  bones,  ligaments, 
may  become  exquisitely  painful  when  inflamed,  and  more  so  when 
inflammation  is  produced  in  the  fibrous  tissues  by  a  lacerated  than 
an  incised  wound.  There  are  also  peculiarities  as  to  the  skin  (§ 
652,  c).  It  is  also  worth  observing,  as  contributing  to  a  knowledge 
of  the  properties  and  laws  of  life,  that  while  common  sensibility  is 
liable  to  be  exalted  in  inflammations,  specific  sensibility,  as  seeing 
tasting,  feeling,  is  apt  to  be  diminished,  or  impaired  in  a  different  way 
from  common  sensibihty  {^  133-137,  193-204). 

725,  c.  It  would  appear,  therefore,  that  increase  of  sensibility  is 
only  a  contingent  result  of  inflammation.  This  property,  too,  is  not 
directly  concerned  in  the  organic  functions;  and  a  part  is  quite  liable 
to  become  inflamed  when  all  its  principal  nervous  connections  with  the 
brain  and  spinal  cord  are  separated  (§  188,193,205,489,500  J, 746c). 

726.  There  is  generally  more  or  less  pulsation  in  the  inflamed  part, 
and  in  the  larger  arteries  leading  to  it  (§  498,  516  d,  803).  In  all 
such  cases  the  extreme  capillary  arteries,  which  are  the  immediate 
instruments  of  the  disease,  and  which  naturally  carry  little  red  blood, 
have  become  enlarged,  and  admit  the  red  globules.  This  transmis- 
sion, however,  of  ^;he  red  globules  is  less  due  to  the  enlargement  than 
to  a  change  in  the  relation  of  the  vital  properties  of  the  vessels  to 
these  globules  (§  192,  384,  394,  396,  398,  399). 

728.  Like  the  arteries,  the  veins  of  an  inflamed  part  are  increased 
in  size ;  at  least  when  the  former  are  enlarged.  This  is  owing  to 
active  dilatation  of  the  veins,  and  to  the  increased  volume  of  blood 
transmitted  to  them  (^  387,  786,  &c.). 

729,  a.  Common  inflammation,  when  it  goes  on  to  a  natural  ter- 
mination, and  in  its  greatest  latitude  of  simple  results,  may  be  distin- 
guished into  four  stages;  namely,  the  formative,  suppurative,  ulcera- 
tive, and  restorative  or  granulating.  There  may  be  present,  there- 
fore, from  what  has  already  been  said,  only  the  formative  stage  (§  700, 
&c.).  When  the  disease  does  not  advance  beyond  that  stage,  it  is 
said  to  terminate  by  resolution.  The  suppurative  and  restorative 
stages  form  the  most  simple  natural  process  of  cure.  They  are  also 
subject  to  great  irregularities. 

Pathologists  have  generally  reckoned  the  adhesive  process  as  a  dis- 
tinct stage  of  inflammation.  It  will  be  seen,  however,  that  it  is  not 
founded  on  principle. 

729,  b.  The  curative  stages  of  inflammation,  whether  regular  or  ir- 
regular, are  also  called  terminations  of  inflammation.  The  term  is  sig- 
nificant of  what  has  not  truly  happened ;  and,  as  words  have  often 
more  force  than  facts,  it  should  be  abolished.  There  is  gi-eat  practi- 
cal philosophy  concerned  about  the  mutations  of  disease  at  the  sev- 
eral regular  stages  of  inflammation,  and  in  all  the  modifications  to 
which  those  stages  are  liable.  There  is  but  one  termination  of  dis- 
ease, excepting  death.  Disease  remains,  however  altered  from  the 
formative  stage  of  inflammation,  till  nature  is  completely  restored 
(§  672,  733  c). 

730.  The  formative  stage  is  distinguished  more  or  less  by  the  char- 
acteristics alx'eady  described. 


PATHOLOGY. INFLAMMATION DESCRIPTION.  471 

The  suppurative  stage  is  introduced  by  a  decline  of  all  the  symp- 
toms of  the  formative  stage,  and  when  most  regular  there  is  a  pro- 
duction of  purulent  matter,  which  constantly  tends  to  a  more  com- 
plete removal  of  the  formative  stage. 

The  ulcerative  stage  is  more  or  less  attendant  on  the  suppurative ; 
generally  attends  the  formation  of  pus  excepting  on  exposed  sur- 
faces, when  it  may  be  present  or  absent  (^  733,  b).  Whenever  pres- 
ent it  is  immediately  antecedent  to  the  restorative  or  granulating 
stage,  although  a  destructive  process. 

The  restorative  or  granulating  stage  is  promoted  by  the  suppura- 
tive, and  is  marked  by  a  continued  decline  and  ultimate  disappear- 
ance of  all  the  symptoms. 

731.  The  foregoing  stages  are  generally  more  distinctly  marked  in 
the  cellular  than  in  other  tissues.  With  the  exception  of  the  ulcera- 
tive, they  may  be  often  well  observed  upon  the  mucous  tissue  of  the 
eye.     The  ulcerative  is  seen  in  the  intestinal  mucous  membrane. 

732,  a.  Deviations  occur  in  the  suppurative  stage  in  the  production 
of  coagulable  lymph,  or  of  serum,  or  redundant  mucus,  or  effusions  of 
blood,  instead  of  purulent  matter.  But  these  results,  or  however 
they  may  deviate  from  their  proper  standard,  are  all  analogous  to  the 
formation  of  pus,  being  exactly  equivalent  in  principle,  constitute 
equally  the  second  stage,  and,  in  the  same  way,  contribute  to  the 
restorative  stage,  or  that  of  perfect  cure  (§  12,2  f,  740  h,  764  e,  863  a). 

732,  h.  The  fluids  effused  operate  as  depleting  means ;  and  it  is 
especially  for  this  reason  that  morbid  anatomists,  not  finding  the  vas- 
cularity they  had  anticipated,  declare  that  its  absence  in  many  drop- 
gical  affections  denotes  an  exactly  opposite  pathology  from  that  where 
the  same  affections  are  attended  by  a  preternatural  fullness  of  the  ves- 
sels (§  699  c,  700  li).  Nature,  however,  has  no  such  inconsistencies 
{Med.  and,  Phys.  Covim.,  vol.  i.,  p.  180-182;  vol.  ii.,  p.  187,  199,  556, 
557,  note).  At  the  first  reference  here  made  I  have  quoted  the  vic- 
chanical  rationale  as  propounded  by  Andral,  and  have  endeavored  to 
prove,  by  his  own  showing,  that  what  are  denominated  "  passive 
dropsies"  depend  on  a  vital,  inflammatory  action  (§  740  J,  805,  863  a). 

732,  c.  When  the  second  stage  of  inflammation  is  attended  by  an 
effusion  of  coagulable  lymph  it  is  called  the  adhesive,  instead  of  the 
suppurative  stage.  This  variety  appears  mostly  in  the  serous  and 
cellular  tissues,  though  it  is  often  presented  by  particular  parts  of  the 
mucous  system,  as  that  of  the  trachea  in  croup,  and  of  the  intestines 
(§  133-135). 

732,  d.  When  wounds  heal  from  the  effusion  of  coagulable  lymph, 
it  is  by  the  "  first  intention ;"  though  the  process  is  the  same  as  when 
the  pleurae  unite,  or  the  lungs  become  hepatized  in  pneumonia.  In 
either  case  the  new  formations  are  a  part  of  the  natural  process  of 
cure  (§  732  a,  i,  863  a).  However  momentous  the  evil  in  pneumo- 
nia, or  other  disorganizations,  it  is  still  the  result  of  the  great  recu- 
perative law;  just  as  effusions  of  blood  within  the  head  in  cases  of 
cerebral  congestion  are  on  a  par  with  haemoptysis,  haematamesis,  &c., 
or  all  dropsical  effusions  with  each  other,  and  with  the  preceding  re- 
sults. Nature  makes  no  digression  from  great  principles  for  minor 
purposes.  But,  in  the  apparent  contradictions  now  stated  Nature 
has  duly  provided  for  the  removal  of  extraneous  matter  from  shut  cav- 
ities, and  from  the  recesses  of  organization    by  the  function  of  ab- 


•172  INSTITUTES   OF    MEDICINE. 

sorption  (Med.  and  Phys.  Comm.,  vol.  i.,  p.  371-384 ;  vol.  ii.,  p.  546- 
666,  733). 

732,  e.  It  is  also  a  peculiarity  of  lymph  not  appertaining  to  pus  that 
it  is  readily  susceptible  of  organization,  whereby  Nature  accomplishes 
other  purposes ;  though  such  ox-ganization  occurring  in  pneumonia  is, 
as  in  §  732,  d,  an  apparent  though  not  a  real  departure  from  the  great 
law  cf  recuperation.  Being  a  law  of  Nature  for  reparation  in  other 
parts,  it  must,  under  equal  circumstances,  prevail  in  all  parts. 

732,  y.  It  appears,  therefore,  that  the  adhesive  process  consists  of 
two  stages  ;  that  by  which  lymph  is  effused,  and  the  strictly  adhesive. 
And,  although  the  effusion  of  lymph  be  equivalent'to  the  suppurative 
process,  there  is  superadded  to  the  former  a  distinct  final  cause,  since 
Nature  contemplates  in  this  modification  not  only  the  curative  effect, 
but,  also,  the  reparation  of  injured  parts  (§  732,  a). 

733,  a.  When  suppuration  occurs  upon  surfaces,  as  on  the  mucous 
tissue,  the  process  happens  in  its  most  simple  form.  But,  in  other  in- 
stances, as  when  pus  is  generated  by  the  cellular  or  serous  tissue,  the 
matter  cannot  escape  as  when  it  is  produced  by  the  mucous  tissue. 
In  these  cases,  therefore,  an  obstacle  intervenes  between  Nature  and 
the  cure,  as  when  the  formation  of  lymph  or  of  serum  takes  the  place 
of  purulent  matter  (§  732,  d).  But  here,  as  there,  Nature  has  provi- 
ded for  the  removal  of  the  secondary  evil,  through  a  principle  com- 
mon to  all  the  cases,  and  which  appertains  to  the  absorbent  vessels, 
This  happens  after  the  following  manner,  wliich  must  be  briefly  sta- 
ted as  characterizing  an  important  law,  and  the  third  stage  of  inflam- 
mation. 

733,  b.  The  process  is  called  ulceration  (§  730).  It  consists  in  the 
absorption  of  all  the  tissues  intervening  between  the  accumulated 
matter  and  some  external  surface.  It  is  so  significant  of  a  sc^eat  final 
cause,  so  replete  with  evidences  of  Design,  especially  in  connection 
with  the  other  attendant  processes,  that  some  authors,  even  Hunter, 
have  metaphorically  ascribed  it  to  something  like  intelligence.  It  is 
to  be  observed,  also,  that  in  this  complex  condition  there  is  in  simul- 
taneous progress  both  the  formation  of  pus  and  of  lymph.  The  pus 
occupies  the  central  parts  of  the  abscess,  while  the  lymph  is  effusea 
at  the  circumference,  agglutinates  the  cellular  tissue,  and  thus,  by 
forming  a  sac,  prevents  the  spread  of  the  purulent  matter.  It  is  yet 
another  part  of  the  complex  law  under  consideration,  that  while  the 
substance  between  the  abscess  and  external  surface  is  constantly  yield- 
ing to  the  ulcerative  process,  rej^aration  or  the  graiiulatijig  process  is 
going  on  posteriorly  to  the  abscess,  and  the  redundant  lymph  under- 
going absorption,  or  what  is  equivalent  to  the  ulcerative  process  in 
the  anterior  part  of  the  abscess.  There  is,  however,  a  certain  differ- 
ence between  the  processes  ;  but  it  is  less  than  between  the  absorption 
of  lymph  in  the  present  example  and  the  function  which  is  in  univer- 
sal operation  in  health.  In  the  case  before  us,  like  ulceration,  the  ab- 
sorption of  lymph  is  an  emanation  from  inflammation,  though  more 
remote  than  ulceration.  Both,  therefore,  may  be  regarded,  though 
not  equally,  as  pathological  conditions  of  absorption  (§  672). 

733,  c.  When  the  surface  is  reached,  and  the  matter  discharged^ 
the  cavity  is  no  longer  circumscribed.  Nature  now  puts  an  end  to 
the  destructive  process,  and  completes  the  work  of  reparation  which 
had  been  in  progress  in  the  posterior  part  of  the  abscess.     This  is  ac- 


PATHOLOGY. INFLAMMATION DESCRIPTION.  473 

complished  by  the  formation  of  a  substance  analogous  to  that  which 
had  been  removed.  Coagulable  lymph,  along  with  more  or  less  pu- 
rulent matter,  is  secreted  by  the  surface  of  the  ulcer,  upon  which  it  is 
arranged  in  little  fleshy  heaps,  or  knobs,  of  a  florid  color,  and  forms 
the  granulations.  These  knobs  contract  and  spring  from  the  top  of 
each  other  till  the  cavity  is  filled. 

Among  the  various  and  striking  results  which  are  involved  in  this 
process  of  reparation  none  is  more  remarkable,  or  more  strongly  ex- 
emplifies its  dependence  on  laws  that  are  unknown  in  the  inorganic 
world,  than  one  which  is  least  appreciated,  the  substitution  for  the 
granulations  of  an  organized  substance  similar  to  that  which  had  been 
removed.  The  granulations  have,  originally,  the  same  apparent  phys- 
ical characteristics,  from  whatever  part  of  the  body  they  may  spring. 
But  they  are  so  endowed  with  the  special  vital  characteristics  of  the 
parts  by  which  they  are  generated  that  in  each  part  they  secrete  a 
substance  which  is  similar  to  the  part  removed,  while  the  granulations 
themselves  are  progressively  absorbed  (^  135,  b).  Doubtless,  also, 
the  granulations  are  specifically  different,  in  a  physical  sense,  in  all  the 
cases,  differently  organized,  and  therefore,  as  in  all  other  cases  of  or- 
ganized lymph,  derive  their  vessels  from  the  parts  by  which  they  are 
generated  (Med.  and  Physiolog.  Comm.^  vol.  ii.,  p.  354-362).* 

The  cavity  being  filled,  the  granulating  process  ceases,  as  if  inetinct- 
ively,  and  a  new  one  sets  in,  by  which  the  granulations  are  covered 
with  a  substance  analogous  to  skin,  and  which  is  called  the  cicatrix. 
This  completes  the  series  of  Designs  attendant  on  the  different  stages 
of  an  abscess,  and  which  exemplifies  all  the  regular  stages  of  inflam- 
mation (§  729,  h). 

733,  d.  Who  shall  resolve  the  foi'egoing  wonderful  processes  and 
results,  their  exact  concurrence,  their  obvious  design,  their  great  final 
cause,  by  any  process  or  laws  of  the  inorganic  world  %  Yet  is  even 
this  now  almost  universally  attempted  !  Such  is  ever  materialism ! 
But,  when  it  will  not  listen  to  the  voice  of  Nature  as  it  proclaims  her 
Author,  we  may  hope  in  vain  for  any  interpretation  of  her  phenome- 
na that  may  recognize  dignity  or  design  in  her  minor  aspect^*,  and 
least  of  all  as  it  may  conflict  with  the  fundamental  principle  of  mate- 
rialism. When  error  is  bold  in  its  demonstrations  it  is  reckless  of 
consistency,  and  therefore  regardless  of  facts  (§  5i,  5|,  40,  80,  117, 
137,  143,  155,  156,  169/,  172  h,  226,  303i  a,  306,  310,  311,  350^  g-o, 
376i,  384,  385,  387,  399,  409/,  422,  500  n,  514  h,  524  d,  525,  526  d, 
528  c,  638,  649  d,  733  h,  764  h,  811,  847  c,  848,  902/  905,  943  c,  980, 
1019/  1085). 

733,  e.  As  we  have  now  and  before  seen.  Nature  often  contem- 
plates a  variety  of  useful  purposes  in  the  individual  processes  she 
adopts  for  the  benefit  of  organic  beings.  The  healthy  state  of  the 
body  is  full  of  examples.  Every  action  of  every  part  has  commonly 
more  than  one  definite  object;  often  many.  So  is  it,  also,  with  those 
morbid  processes  which  are  instituted  for  the  restoration  of  health. 
As  soon  as  the  tendency  in  diseased  actions  is  set  up  toward  the  nat- 
ural condition,  the  subsequent  changes  have  a  specific  reference  to 
the  ultimate  cure ;  the  completion  of  which,  however,  may  be  very 
remote  from  the  initiatory  step.  The  vital  properties  and  actions  may 
pass  through  a  variety  of  changes  before  they  attain  the  natural  phys- 
iological condition  (§  672,  676).     But  each  change,  each  step  in  the 

*  OUier's  production  of  bone  by  tlie  transplantation  of  periosteum  is  a  good  illustration  of  thi 

subject.— 1800 


474  INSTITUTES    OF    MEDICINE. 

process,  may  be  necessary  to  the  next  succeeding,  till  Nature  attains 
her  normal  condition.  This,  however,  is  only  one  part  of  Nature's 
plan  in  her  salutary  efforts  to  escape  from  disease.  She  renders  vari- 
ous results,  as  she  goes  along,  instrumental  in  bringing  about  the  sub- 
sequent steps  in  the  process  of  cure,  and  even  associates  with  these 
other  useful  objects.  In  the  case  but  just  before  us,  while  ulceration 
is  making  its  way  to  the  surface  for  the  discharge  of  matter,  the  puru- 
lent formation  is  constantly  subduing  the  inflammation,  and  the  secre- 
tion of  lymph,  which  is  designed  for  agglutination  and  granulation,  has 
the  same  salutary  influence  upon  the  morbid  process  on  which  its  pro- 
duction depends  (§  764,  e). 

The  properties  of  life  are  thus  constituted  in  such  a  manner  as  not 
only  enables  them  to  undergo  changes  from  their  diseased  to  healthy 
states,  but,  through  their  instruments  of  action,  to  result  in  the  forma- 
tion of  products  which  shall  contribute  to  this  great  ultimate  end  (§ 
672,  733  d,  761).     This  is  the  philosophy  of  the  vis  medicatrix  natures. 
733,  y.  The  foregoing  law  of  reparation  prevails  universally  in  or- 
ganic beings  ;  extending,  therefore,  to  the  vegetable  kingdom.     It  ap- 
pears, however,  under  various  modifications,  even  among  the  animal 
tribes.     It  is  presented  in  its  most  simple  form  in  the  growth  of  divi- 
ded polypi,  the  reproduction  of  the  claws  of  lobsters,  of  the  lizard's 
tail,  &c.,  when  it  takes  the  name  of  regeneration.     But,  it  is  equally 
an  act  of  regeneration  when  ulcerated  parts  are  restored  in  their  for- 
mer organization  by  the  granulating  process.     The  difference  consists 
alone  in  partial  modifications  of  a  common  action  (§  733,  Z»).     In  the 
regenerative  and  reparative  processes  of  plants  the  difference  is  still 
greater ;  and  such  as  reject  analogy,  or  cannot  discern  its  light,  have 
argued  that  the  differences  depend  upon  essentially  different  laws.    A 
previous  inflammatory  action,  it  is  true,  is  necessary  to  reparation  in 
the  higher  order  of  animals,  but  is  not  necessary  to  the  fundamental 
law  as  it  is  concerned  in  the  regenei'ation  of  entire  parts  in  the  lower 
animals,  nor  in  the  reparative  process  of  plants.     The  properties  of 
life  are  differently  modified  in  each,  and  consequently  the  processes 
differ,  though  as  intimately  connected  by  analogies  as  the  modifica- 
tions of  the  simple  physiological  states  (§  185,  672,  688  ee,  733  e). 
Nor  is  the  granulating  process  an  inflammatory  one,  but  only  conse- 
quent on  that  pathological  condition  ;  while  the  simple  production  of 
lymph  may  be  a  direct  emanation  from  inflammation,  or  only  conse- 
quent on  its  decline,  or  on  a  near  approximation  to  that  mode  of  ac- 
tion.    All  the  modifications,  however,  give  rise  to  con-esponding  va- 
rieties in*  the  nature  of  the  lymph,  just  as  they  do  in  that  of  purulent 
matter.    They  may  offer  to  our  inadequate  vision  the  sameness  of  ap- 
pearance that  is  presented  by  the  pus  of  an  abscess,  or  of  a  chancre, 
or  of  small-pox,  or  appear  as  identical  as  the  granulations  of  every 
part.     The  last,  indeed,  are  the  things  in  question ;  and  although  their 
ultimate  results  supply  an  unening  test,  it  is  only  coincident  with  all 
the  others,  and  even  with  that  which  is  offered  by  the  natural  states 
of  the  different  tissues  (§  22,  42,  48,  53  h,  133,  135  a,  409  e,  411,  739, 
740). 

By  thus  pursuing  the  inquiry,  the  various  results  will  be  found  con- 
nected by  close  analogies,  though  the  extremes  may  be  stumbling 
blocks  to  the  careless.  The  periodical  regeneration  of  the  stag's 
horn,  where  some  of  the  most  characteristic  marks  of  inflammation 


PATHOLOGY. INFLAMMATION DESCEIPTION.  475 

are  present,  forms  an  intermediate  example.  But  the  deer,  in  other 
respects,  is  as  limited  as  man,  or  other  animals  of  the  same  complex 
organization,  as  to  the  principle  of  reparation.  In  all  such  animals, 
the  amputation  of  a  limb,  or  the  removal  of  any  important  organ,  is 
never  followed  by  a  regeneration  of  the  part.  Such  parts  do  not  em- 
brace, like  the  parts  of  a  polypus,  or  of  a  plant,  the  organization  that 
is  necessary  to  constitute  a  whole.  Nevertheless,  the  law  obtains, 
even  here,  to  a  remarkable  extent.  If  the  middle  of  a  bone  be  re- 
moved,* it  is  regenerated.  But  there  must  be  opposite  surfaces,  and 
the  right  action  must  be  instituted  in  each  surface,  as  when  the  oppo- 
site pleurae  unite.  In  the  same  way  central  portions  of  the  muscles 
and  nerves  may  be  removed  and  regenerated  ;  and  the  process  by 
which  this  is  accomplished  is  the  granulating. —  See  p.  473,  note. 

733,  g.  This  leads  me  to  notice  a  fallacy  of  the  physical  philoso- 
phers, who  have  been  led  into  the  error,  as  in  most  other  cases,  from 
neglecting,  if  not  altogether  the  vital  properties,  at  least  their  natural 
modifications  as  they  exist  in  vegetables,  and  in  the  different  races  of 
animals  (§  133-163,  185).  With  this  neglect  of  fundamental  princi- 
ples, and  a  substitution  of  chemical  and  physical  laws  (§  5\,  h),  they 
have  endeavored  to  array  an  argument  against  the  Hunterian  doctrine 
of  the  dependence  of  the  union  of  wounds,  by  \hejirst  inf.e?ition,  mpoji 
inflammatory  action,  by  identifying  the  process  of  reparation  in  veg- 
etables with  the  union  of  incised  wounds.  Reparation  in  plants,  say 
they,  is  not  an  inflammatory  process,  and,  therefore,  the  eff'usion  of 
lymph  in  the  incised  wounds  of  animals  is  not  connected  with  inflam- 
matory action ;  and  they  endeavor  to  fortify  this  reasoning  by  an  ap- 
peal to  the  regenerating  power  of  the  polypus,  the  lobster,  &c.  As 
well  might  we  argue  that  vegetables,  and  polypi,  should  be  subject  to 
the  same  diseases  as  man  or  quadrupeds,  or  that  all  animals  should  live 
alike  upon  the  same  kinds  of  food  [Med.  and  P/ii/sioIog.  Comm.,  vol. 
1.,  p.  696-698). 

733,  li.  The  same  objectors,  however,  set  aside,  on  other  occasions, 
some  of  the  plainest  and  most  important  analogies  of  nature.  They 
maintain,  for  example,  that  the  functions  of  nutrition,  secretion,  &c., 
are  carried  on  in  all  animals  mostly  through  the  nervous  system,  but 
are  compelled  to  take  a  very  different  ground  for  the  same  functions 
in  plants  (§  350,  no.  18-20,  62,  63,  &c.). 

The  nervous  system,  however,  being  superadded  to  animals,  modi- 
fies greatly  their  common  properties  and  functions  of  life,  expounds, 
in  part,  the  differences  and  special  analogies  in  the  foregoing  pro- 
cesses of  reparation,  regeneration,  &c. ;  and  being  a  superaddition  to 
animals,  and  a  large,  however  unintelligible  element  in  the  doctrines  of 
the  physical  philosophers  of  life,  I  formerly  employed  it  as  the  ground 
of  an  analogical  argument  that  the  principle  of  life  was  originally  su- 
peradded to  animals  after  the  creation  of  their  structure. 

733,  i.  Consider,  also,  the  parallel  which  holds  between  the  mor- 
bid growths  that  are  induced  by  special  injuries  of  the  animal  and  veg- 
etable organization.  Take  an  example  of  the  latter  in  the  nest  of 
the  Cynips  quercus  folii ;  and  how  evident  is  it,  from  this  simple  fact 
alone,  that  both  departments  of  the  organic  kingdom  are  endowed 
with  the  same  organic  properties  and  functions,  alike  liable  to  dis- 
ease, and  governed  by  analogous  laws  (§  185,  191  a,  409). 

All  the  foregoing  may  be  farther  illustrated  by  what  I  have  said  in 


476  INSTITUTES    OF    MEDICINE. 

a  former  section  of  inflammation   in   its   connection  with  child-bed 
women,  &c.  (§  688,  ee). 

733,  k.  It  is  certainly  remarkable  that  such  obvious  analogies  should 
strike  different  minds  under  such  different  aspects,  and  doubtless  many 
will  think  it  superfluous  that  misapprehensions  of  the  foregoing  nature 
should  receive  a  formal  refutation.  But  they  are  sustained  by  minds 
that  have  a  powerful  influence,  and  must  be  respected.  It  is  so,  in- 
deed, with  the  delusions  of  imagination  itself;  and  were  not  a  cer- 
tain degree  of  resistance  opposed  to  animal  magnetism,  its  votaries 
would  trespass  far  upon  the  domain  of  physiology,  and  trample  with- 
out remorse  upon  universal  knowledge. 

Irregularities  of  Inflammation. 

734,  The  regular  stages  and  results  of  common  inflammation  which 
have  been  now  described  are  subject  to  various  irregularities,  which 
spring  from  innumerable  causes,  but  especially  from  morbific  influ- 
ences propagated  from  the  organs  of  digestion.  A  great  variety  of 
modifications  are  also  attendant  on  the  specific  forms  of  the  disease ; 
when  the  special  results  are  apt  to  be  mostly  due  to  the  nature  of  the 
predisposing  cause.  At  other  times,  and  in  numerous  cases  of  com- 
mon inflammation,  certain  effusions,  such  as  coagulable  lymph  and 
serum,  which  are  equivalent  in  principle  to  the  suppurative  stage,  ap« 
pear  to  be  regular  stages.  But  they  so  often  run  into  each  other,  that 
it  is  more  philosophical  to  regard  suppuration  as  the  elementary  pro- 
cess. 

735,  a.  Instead  of  the  progressive  stages  of  inflammation,  the  dis- 
ease may  terminate  in  resolution.  This  result  is  generally  intended 
to  embrace  one  of  the  common  products,  coagulable  lymph  ;  the  name 
and  mode  of  termination  coming  to  us  from  the  humoral  pathology. 
But,  according  to  the  philosophy  which  I  have  endeavored  to  set 
forth,  I  reject  both  the  "  concoction  of  humors"  and  the  eftusion  of 
lymph,  and  mean  by  the  term  resolution  a  simple  restoration  of  the 
morbid  properties  and  functions  of  an  inflamed  part  to  their  natural 
state,  without  any  other  supervening  result  beyond  the  formative 
stage  (§  729,  h). 

it  is  a  primary  object  of  art  to  anticipate  nature  in  her  depletive 
course,  and  thus  prevent  inflammation  from  passing  beyond  its  incip- 
ient stage.  It  is  here  that  the  advantages  of  art  are  strikingly  illus- 
trated ;  since  unaided  nature  proceeds  to  the  cure  by  effusions  of 
lymph,  pus,  serum,  &c.  (§  732  d,  863). 

735,  b.  Inflammation  frequently  advances  in  its  fonnative  stage 
without  being  circumscribed  either  by  effusions  of  lymph,  or  by  other 
causes,  and  it  is  then  diffuse.  This  irregularity  is  apt  to  attend  upon 
some  tissues  more  than  others,  especially  the  venous,  lymphatic,  cu- 
taneous, and  serous.  There  are  also  certain  striking  facts  relative  to 
diffuse  inflammation  which  go  to  illustrate  important  physiological 
laws.  Thus,  in  erysipelas,  it  is  apt  to  be  symmetrical  upon  both  sides 
of  the  face.  In  phlebitis,  the  inflammation  is  often  limited  to  the  di- 
vero-ence  of  a  vein  (§  741,  c).  In  small-pox  and  kine-pox,  the  inflam- 
mation extends  only  a  certain  distance  around  the  pustules,  though 
not  limited  by  the  adhesive  process.  And  here  we  may  notice  one  of 
ihe  various  demonstrations  of  a  law  expressed  in  §  149,  in  the  manner 
in  which  the  sinapis,  cochlearia,  rhus  vernix,  &c.,  produce  diffuse  in« 


PATHOLOGY. INFLAMMATION DESCRIPTION.  477 

flammation  of  the  skin  (§  649,  c).  Each  of  all  the  cases,  and  thousands 
of  parallel  examples,  each  as  a  whole,  or  in  its  details,  supply  so 
many  problems  for  the  pi'ofound  inquirer,  reveal  the  apparent  myste- 
ries of  life,  and  stamp  their  seal  upon  the  doctrines  I  have  taught  (§ 
133-163,  177-184,  188-192,  651-657,  &c.).— Note  T  p.  1125. 

736,  a.  Opposed  to  the  termination  of  inflammation  in  resolution 
is  that  of  mortification^  which  is  the  greatest  irx'egularity  of  the  dis- 
ease. Mortification,  also,  like  resolution,  commonly  happens  in  the 
formative  stage.  This  result  also  takes  place,  in  most  instances, 
when  that  stage  has  reached  a  very  high  intensity.  Exceptions,  how- 
ever, as  to  tlie  force  of  the  disease,  occur  in  dry  gangrene,  in  the  gan- 
grene of  old  men,  and  in  white  gangrene  [Med.  and  Physiolog.  Comm., 
vol.  ii.,  p.  319,  &c.).  Irregular  eftusions  are  more  or  less  attendant 
on  this  mode  of  termination. 

736,  h.  What  is  the  cause  of  mortification  %  It  can  be  only  said  of 
it,  that  there  happens  a  profound  alteration  of  the  properties  and  ac- 
tions of  life  which  results  in  their  extinction,  and  that  this  change  is 
of  a  vital  nature  and  not  dependent  on  mechanical  causes,  as  supposed 
by  the  physical  theorists,  unless  the  circulation  be  artificially  inter- 
rupted, and  as  practiced  by  these  theorists  with  a  view  to  an  interpre- 
tation of  a  natural  process.  But  this  mode  of  death  is  as  easily  com- 
prehended as  that  from  fever,  or  hydrocyanic  acid,  &c.  (§  54-56.  Also,. 
Med.  and  Physiolog.  Comm.,  vol.  ii.,  p.  171-173). 

736.  c.  By  what  process  is  the  dead  removed  from  the  living  parts] 
Here,  again,  we  have,  from  most  physiologists,  a  mechanical  rationale 
which  shall  be  consistent  with  the  more  important  steps  in  their  phi- 
losophy of  inflammation.  The  dead  parts,  say  they,  ai'e  removed  by 
the  impulse  of  the  vis  a  tergo.  But  I  apprehend  the  process  to  be  ex- 
actly the  same  as  that  by  which  a  thorn  is  removed  from  a  living  mus- 
cle, or  a  scab  from  an  ulcer.  Each  is,  in  the  same  relative  sense,  a 
foreign  body,  and  each  brings  into  operation,  for  its  own  removal,  the 
laws  which  are  represented  in  section  733.  The  dead  part,  like  the 
thorn,  excites  inflammation  in  the  surrounding  tissues,  suppuration  and 
ulceration  set  in,  the  absorbents  carry  off  the  portion  of  the  living 
matter  contiguous  to  the  foreign  bodies,  and  thus  is  their  separation 
effected.  The  process  of  granulation  completes  the  cure  {Med.  and 
PJiysiolog.  Comm.,  vol.  ii.,  p.  167-172).  Or,  turning  to  the  analogy 
supplied  by  the  vegetable  kingdom,  will  it  be  surmised  that  the  re- 
moval of  the  dead  parts  of  plants  depends  upon  the  mechanical  action 
of  di  vis  a  tergo  1 

737.  Another  irregularity  of  inflammation  respects  the  period  of  its 
different  stages,  one  or  more  of  which  may  be  accelerated  or  protract- 
ed beyond  the  ordinary  time.  This  is  often  true  of  \hQ  formative  and 
restorative  ;  and  since  the  formative  may  be  long  continued,  and  then 
result  in  resolution,  we  see  the  importance  of  holding  morbid  anatomy 
subordinate  to  the  vital  signs  of  disease. 

The  restorative  process  varies,  also,  as  to  its  course.  Granulations 
sometimes  fail  of  approximating  a  level  with  the  skin,  when  the  true 
cicatrix  may  fail  of  being  formed,  and  in  the  place  of  it  appears  a 
scabby  substance,  or  some  other  imperfect  formation,  and  often  read- 
ily liable  to  absorption.  At  other  times  the  true  cicatrix  is  suddenly 
removed,  the  granulations  absorbed,  and  the  ulcer  reproduced. 

738.  Scirrus  is  another  distinct  irregularity  of  inflammation.     Here 


478  INSTITUTES    OF    MEDICINE. 

the  action  is  modified  in  a  very  remarkable  manner,  and  is  obstinate- 
ly retentive  of  that  peculiar  modification.  It  is  so  far  analogous,  how- 
ever, to  common  inflammation,  that  some  of  its  worst  results  are  an 
effusion  of  coagulable  lymph,  and  destructive  ulceration.  It  has  been 
lately  denied  by  the  physical  theorists  that  scirrus  is  an  imflamma- 
tory  affection  [3Ied.  and  Physiolog.  Comm.,  vol.  ii.,  p.  321-330). 

739.  The  products  of  the  second  stage  of  inflammation,  pus,  lymph, 
or  serum,  are  liable  to  deviations;  denoting  special  modifications  of 
the  pathological  conditions  upon  which  they  depend  (§  733, y).  Be- 
sides the  obvious  and  well-known  variations  from  the  proper  pus  of 
common  inflammation,  there  are  other  varieties  which  neither  sense 
nor  chemical  analysis  can  detect ;  as  in  small-pox,  and  lues.  It  pre- 
sents, also,  certain  obscure  peculiarities  according  to  the  nature  of  the 
tissue  by  which  it  is  generated  (§  133-137) ;  and  this  is  also  true  of 
the  morbid  production  of  serum  [Med.  and  Physiolog.  Comm.,  vol.  ii., 
p.  197,  198). 

740,  a.  Every  variety  of  product  has  its  special  pathological  cause, 
which  it  is  the  great  end  of  art  to  comprehend.  It  is  the  best  obser- 
vation ever  made  by  Andral,  that, 

"  We  are  not  to  suppose  that  the  qualities  of  the  purulent  secretion 
are  affected  by  causes  which  operate  locally.  The  qualities  are  like- 
wise modified  by  every  alteration,  whether  physiological  or  patholog- 
ical, which  takes  place  in  any  other  organ,  no  matter  how  far  removed 
from  the  seat  of  the  suppuration,  even  though  it  have  no  particular  con- 
nection either  of  function  or  tissue.  Thus,  we  have  all  seen  instances 
of  the  pus  secreted  by  the  surface  of  a  sore  becoming  suddenly  altered 
in  quantity  and  quality,  under  the  influence  of  a  simple  moral  emotion, 
of  the  process  of  digestion,  of  the  diminution  or  increase,  whether 
natural  or  artificial,  of  any  of  the  secretions,  or,  in  short,  of  any  super- 
vening disease.  Nay,  farther,  there  are  certain  constitutions,  certain 
idiosyncrasies,  which  modify  the  qualities  of  pus,  and  in  which  it  con- 
stantly assumes  a  peculiar  and  determinate  character.  There  are 
some  persons,  for  example,  whose  organs,  when  irritated,  never  fur- 
nish any  other  than  a  thin  serous  fluid ;  in  others  it  is  always  blood 
more  or  less  pure  which  is  secreted  ;  while  in  a  third  class  of  persons 
the  place  of  pus  is  supplied  by  a  grumous  fluid,"  &c.  (§  134,  135,  222- 
232,  500,  585,  &c.,  593,  732,  733/,  830,  847  d). 

Thus  have  I  quoted  from  Andral  a  luminous  confirmation  of  my 
doctrines  of  vital  action,  of  alterative  nervous  influence,  direct  and 
reflex  ;  and  I  have  adopted  it  on  account  of  the  force  which  it  de- 
rives from  emanating  from  a  physical  theorist  of  disease,  and  the  dis- 
tinguished restorer  of  the  humoral  pathology. 

740,  b.  Nor  have  I  yet  quoted  all  from  Andral  that  is  expedient, 
in  this  place,  on  a  subject  where  vitalism  and  solidism  may  establish 
their  firm  foundation  ;  and  this,  too,  by  the  most  absolute,  unguarded 
concessions  from  the  opposite  school. 

Let  us  hear,  then,  once  more,  the  great  modern  humoralist.    Thus  : 

"  All  attempts  to  modify  the  qualities  of  the  suppuration  by  local 
treatment,  in  scorbutic  and  scrofulous  subjects,  are  utterly  ineffectual ; 
for  it  is  the  system  at  large,  and  not  merely  the  suppurating  surface, 
which  is  deranged  in  nutrition  and  secretion.  We  must  commence 
the  treatment  by  endeavoring  to  modify  the  whole  process  of  nutrition, 
innervation,  and  haematosis." — And  again:  ''We  do  not  know  what 


PATHOLOGY. I\FLA.MMATIO\ DESCRIPTION.  479 

the  peculiar  modification  is  which  the  texture  of  an  organ  undergoes, 
60  that  in  one  case  it  allows  the  blood  determined  toward  it  to  escape 
from  its  vessels ;  in  another  it  fonns  pus,  or  exhales  only  a  thin  se- 
rum ;  while  in  a  thii-d,  it  becomes  indurated,  softened,  and  ulcerated  ; 
but  there  is  a  common  link  which  unites  these  different  alterations  ;  and 
hence  it  is,  under  the  influence  of  apparently  the  same  cause,  we  often 
see  them  produced  indifferently,  and  not  unfrequcntly  replaced  one  by 
the  other  (§  732,  a).  But,  in  all  this  series  of  phenomena,  we  can  per- 
ceive, throughout  the  whole  course  of  the  disease,  one  constant  lesion^ 
namely,  the  hyperemia,  and  a  succession  of  morbid  alterations  in  the 
organic  action  of  the  tissue  affected,  producing,  alternately,  the  results 
already  mentioned"  (§  672,  733  e,f). 

Here,  then,  are  pure  vitalism  and  solidism,  because  the  writer  was 
specifically  concerned  about  matters  of  fact.  The  same  principles, 
exactly,  ajjply  to  all  other  actions  and  results  which  deviate  from  the 
natural  condition  of  the  body  (§  64,  345-350,  350f  «,  699  c). 

741,  a.  Again,  here  is  another  important  practical  and  philosophi- 
cal fact,  which  distinctly  evinces  the  dependence  of  all  the  foregoing 
conditions,  changes,  &c.,  upon  purely  vital  actions.  A  suppurating 
surface  may  be  so  affected  by  constitutional  influences,  by  disordered 
digestion,  that  the  same  results  may  follow  as  when  the  change  is  pro- 
duced by  some  local  imtant.  This  proves  that  the  modifications  of 
pus,  and  therefore  pus  itself,  are  not  owing,  as  commonly  maintained, 
either  to  a  degeneration  of  the  blood,  or  of  the  tissues,  or  even  to 
changes  of  organization,  but  to  certain  modifications  of  the  vital  prop- 
erties by  which  organization  is  animated  ;  since  it  would  be  absurd 
to  suppose  that  indigestion,  and  some  caustic  or  other  imtant  applied 
to  the  ulcer,  would  determine  the  same  physical  changes. 

741,  h.  From  what  has  been  now  and  before  seen,  we  may  insist 
upon  one  of  the  most  important  conclusions  in  medical  philosophy, 
which  strikes  at  the  whole  foundation  of  humoralism,  and  is  unsur- 
passed in  its  practical  bearings.  We  may  conclude,  I  say,  that  when 
serum,  or  lymph,  or  mucus,  are  diverted  from  their  natural  condition 
by  disease,  that  the  modification  depends,  in  each  instance,  as  much 
upon  certain  special  physiological  changes  as  do  their  natural  states 
upon  the  natural  condition  of  the  solids.  This  analogy  prevails 
throughout  all  other  natural  products  of  an  organic  nature,  when 
turned  from  their  common  standard ;  and  were  .there  no  other  facts, 
the  analogy  would  establish  the  same  principle  in  relation  to  all  new 
formations,  as  pus,  &c.  But,  such  facts  I  have  multiplied  abundantly 
in  another  work.  All  the  varieties,  every  shade  of  difference,  arise 
from  modifications  of  action  which  are  always  necessary  to  the  sev- 
eral varieties,  respectively.  The  vital  properties  must  be  so  modi- 
fied in  the  several  cases  that  the  capillaries,  acting  in  obedience 
to  these  properties,  shall  decompound,  and  recombine,  the  particular 
elements  and  constituents  of  each  product,  and  in  their  proper  ratio, 
and  modes  ;  rejecting  all  the  rest.  Otherwise,  indeed,  there  could  be 
no  resemblances  among  the  natural  or  morbid  products,  no  gradations 
from  one  to  the  other,  no  obvious  coincidence  between  certain  mor- 
bid lesions  of  the  solids  and  the  resulting  products.  Every  thing 
would  be  confused ;  there  would  be  nothing  but  the  riot  of  the  chem- 
ical forces  ;  and  even  empyricism  would  look  on  in  dismay.  The 
physical  theorists,  therefore,  are  forever  involved  in  inconsistencies 


480  INSTITUTES    OF    MEDICINE. 

excepting  their  universal  collision  with  facts,  and  suiting  hypotheses 
to  each  particular  occasion  (§  42-52,  409  d,  694f ). 

But  the  properties  of  life  can  never  undergo  any  change  of  their 
essential  nature  till  they  are  verging  toward  a  state  of  extinction. 
Hence  the  analogies  among  diseases,  according  to  the  nature  of  the 
remote  causes.  It  is  a  great  foundation  of  the  healing  art ;  and  were 
it  otherwise,  medicine  would  be  utterly  fruitless,  a  mere  creature  of 
circumstance,  one  perpetual  experiment  (§  638,  780j. 

The  considerations  which  I  have  now  made  enforce,  particularly,  a 
critical  reference  to  the  pathological  conditions  in  all  our  prescrip- 
tions, their  seat,  the  influences  which  surround  them,  the  precise 
adaptation  of  remedies  as  to  their  nature,  dose,  time  and  order  of 
their  exhibition,  &c.  They  demonstrate,  also,  the  distinction  among 
remote  causes  of  disease,  especially  such  as  have  their  origin  in  mor- 
bid or  healthy  processes  of  living  beings,  and  establish  the  fact  that 
the  same  disease  cannot  be  produced  by  the  products  of  organization 
and  of  chemical  decomposition  (§  653). 

741.  c.  We  may  now  glance  at  one  or  two  important  facts  connect- 
ed with  the  foregoing  subjects.  Thus,  it  is  important  to  bear  in 
mind  that  it  is  the  tendency  of  inflammation  to  confine  itself  to  that 
tissue  in  which  it  springs  up,  along  which  it  is  propagated  especially 
by  continuous  sympathy;  though  exceptions  often  occur  (§  133,  141, 
&c.,  498,  500).  What  is  true  of  inflammation  in  this  respect  is  prob- 
ably, also,  of  other  morbid  states.  The  reason  is  to  be  found  in  the 
natural  modifications  of  the  vital  properties  of  the  different  tissues. 
This  modification  existing  in  different  parts  of  one  and  the  same  con- 
tinuous tissue  commonly  limits  the  continuity  of  inflammation  to  a 
particular  part  of  the  tissue,  though  it  often  spring  up  in  other  parts 
of  the  tissue  by  reflected  nervous  actions  (§  134,  &c.,  500,  674  d). 

The  foregoing  general  limitation  of  any  given  foiTn  of  disease  to 
the  tissue  first  invaded  (excepting  as  other  tissues  of  the  same  com- 
pound organ  are  more  or  less  disturbed  in  function)  is  especially  re- 
markable of  the  common  form  of  inflammation,  and  of  diseases  that 
are  not  distinguished  by  obstinate  conditions,  such  as  specific  inflam- 
mations with  strongly-marked  characteristics ;  as  scrofulous,  venereal, 
carcinomatous,  &c.  (§  149-151,  525-531). 

REMOTE    CAUSES    OF    INFLAMMATION. 

742.  The  remote  causes  of  inflammation  fall  under  the  general 
considerations  already  made  (§  644-606).  As  all  the  agents  which 
contribute  to  its  production  must  be  included  in  the  category,  such  as 
are  naturally  salubrious,  or  necessary  to  the  purposes  of  life,  as  food, 
&c.,  sometimes  fall  within  the  comprehensive  class.  It  is  mostly, 
however,  the  abuse  of  such  agents  which  renders  them  predisposing 
causes ;  but  they  may  readily  prove  exciting  when  other  causes  have 
laid  the  foundation  of  predisposition. 

743.  It  only  remains  to  be  added  ujion  this  subject,  that  I  cannot 
agree  with  distinguished  vitalists  that  stimuli  are  alone  the  predis- 
posing causes  of  inflammation  and  fever ;  but  there  can  be  no  doubt 
that  a  right  decision  of  the  question  is  of  practical  importance. 
Upon  it  may  depend,  for  example,  the  proper  treatment  of  cerebral 
aflfections  arising  from  excessive  doses  of  opium.  In  excessive  doses, 
it  is  generally  conceded  to  be  directly  sedative ;  and  yet  is  profound 


PATHOLOGY. INFLAMMATION REMOTE    CAUSES.  481 

cerebral  congestion  one  of  its  morbific  effects,  for  which  bloodletting  is 
the  most  efficient  remedy.  Hydrocyanic  acid  will  do  the  same  thing, 
which,  in  like  manner,  is  best  relieved  by  loss  of  blood  (§  483,  484, 
494  dd,  827  d,  828).  And  so  of  extreme  cold,  the  philosophy  of 
which  is  set  forth  in  the  Commentaries  (vol.  ii.,  p.  478-493.)  Tartar- 
ized  antimony  is  powerfully  sedative  in  all  its  doses,  and  the  larger 
the  more  so.  Yet  in  its  over-doses  it  j)roduce3  a  serious  form  of  in- 
flammation. Even  excessive  bloodletting  may  lead  to  inflammation, 
for  which  the  farther  abstraction  of  blood  by  means  of  leeches  may 
be  useful,  or  at  least  so  it  is  said  (^  1024  a,  1057). 

Concentrated  miasmata,  when  followed  immediately  by  an  attack  of 
fever,  evidently  depress  the  powers  of  life,  as  one  of  the  first  changes 
which  they  establish  [Commentaries,  vol.  i.,  p.  471-474).  We  must 
take  the  facts  as  we  find  them,  and  build  our  theories  accordingly. 
And  here  we  see  the  importance  of  looking  well  to  the  characteristics 
of  the  properties  of  life,  at  their  wonderful  mutability,  observe  how 
they  may  be  profoundly  altered  at  the  moment  when  certain  morbific 
causes  begin  to  operate,  how  they  may  go  down  in  an  instant  to  a 
state  of  extinction ;  and  how,  on  the  other  hand,  every  restoration 
from  disease  is  the  result  of  their  own  constitutional  tendency  to  return, 
through  a  series  of  changes,  suddenly  or  gradually,  to  their  natural 
state  (§  175,  177-185,  672,  733  e). 

These  considerations  enable  us  to  understand  how  the  properties 
of  life  may  be  as  readily  aflected  by  depressing  agents  or  sedatives 
as  by  stimulants,  and  how,  when  affected  by  the  former,  they  may 
speedily  react  and  constitute  the  absolute  conditions  of  inflammation 
and  fever  (§  666),  or  return  at  once  to  their  natural  state  (§  150,  151, 
227).  When  either  of  these  morbid  conditions  actually  ensues,  there 
can  be  no  doubt  that  the  organic  properties  have  undergone  an  exal- 
tation as  well  as  another  modification  in  kind.  The  physical  philoso- 
phers will  allow  nothing  but  absolute  prostration,  and  a  passive  relax- 
ation of  the  vessels,  when  high  arterial  action  sets  in ;  but  they  look 
upon  the  cold  stage  of  fever  as  being  best  explained  by  something 
like  the  "  glacier  theory."  And  yet,  if  we  go  to  the  simple  facts  at- 
tendant on  the  very  invasion  of  fever,  we  shall  find  in  the  universal 
contraction  of  the  capillary  vessels,  during  the  cold  stage  of  fever, 
abundant  proof  of  the  exaltation  of  mobility  and  irritability  ;  and  this 
is  farther  confirmed  by  the  salutary  effects  of  two  most  depressing 
agents,  bloodletting  and  emetics.  See,  too,  how  local  inflammations 
are  becoming  generated  duiing  this  stage ;  and  when  the  hot  stage 
supervenes,  and  when,  also,  in  progi'essive  order,  the  secretions  break 
forth,  we  have  the  most  unequivocal  demonstrations  of  exalted  pow- 
ers ;  though  here,  as  in  inflammations,  this  change  is  only  an  incon- 
siderable part  of  the  alteration  which  the  properties  of  life  sustain  (§ 
188i,  487  h,  569,  675,  764,  964). 

Still,  however,  in  respect  to  inflammation,  its  most  common  causes 
are  directly  stimulant,  and  exalt  the  vital  properties  and  actions  by 
their  direct  operation;  but  this  appears  not  to  be  equally  true  of  idio- 
pathic fever  {Med.  and  Fhys.  Comm.,  vol.  ii.,  p.  213,  241-248,  277- 
280,^  288,  &c.). 

Finally,  we  may  not  lose  sight  of  the  fact  that  the  nervous  influence, 
either  reflex  or  direct,  is  the  immediate  remote  cause  of  effects  beyond 
the  seat  of  the  direct  action  of  the  primary  causes  (§  647|^,  G66). 

H  H 


482  INSTITUTES    OF    MEDICINE. 


PATHOLOGICAL    OR    PROXIMATE    CAUSE    OF    INFLAMMATION. 

744.  "The  act  of  inflammation,"  says  Hunter,  "appears  to  be  an 
increased  action  of  the  small  vessels.  It  is  commonly  supposed  to  ha 
contraction  of  the  vessels ;  but  I  have  show^n  that  their  elastic  power 
also  dilates  them,  and  I  have  also  reason  to  believe  that  their  muscu- 
lar power  has  a  similar  effect." — Hunter,  on  the  Blood,  &c. 

"The  blood,"  says  Magendie,  "traverses  with  ease  the  infinitely 
more  minute  tubes  that  abound  in  our  tissues.  There  must  be  soma 
particular  conditions  to  facilitate  its  passage.  What  proves  their  ex- 
istence is,  that  if  certain  alterations  are  effected  in  the  composition  of 
the  blood,  it  stops,  undergoes  morbid  changes,  becomes  extravasated 
and  decomposed,  and  produces  the  various  disorders  which  patholo- 
gists have  vainly  attempted  to  explain  by  the  words  inflammation 
and  irritation.  What  sense,  in  truth,  is  there  in  applying  the  word 
inflammation  to  our  organs  ]  Do  our  tissues  actually  takeJireV'  [So 
says  Vacca,  and  Magendie  is  of  his  school.] — Magendie,  in  London 
Medico- Chirurgical  Review,  January,  1839,  p.  208. 

"  For  my  part,  I  declare  boldly,  that  I  look  upon  these  ideas  about 
VITALITY  and  the  rest  of  it,  as  nothing  more  than  a  cloak  for  ignorance 
and  laziness."  "  All  the  physician  can  do  is  to  order  remedies,  which, 
if  necessary,  the  nurse  could  prescribe  equally  well."  "You  saw  me 
give  rise,  at  my  pleasure,  to  pneumonia,  scurvy,  yellow  fever,  typhoid 
fever,  &c.,  not  to  mention  a  number  of  other  affections  lohich  I  called 
into  being  before  you." — Magendie's  Lectures. — And  that,  too,  upon 
animals. 

"  Pythagoras,"  says  an  ancient  philosopher,  "  looks  at  the  sun  verj 
differently  from  Anaxagoras.  The  former  carries  his  eyes  into  it  like 
a  god,  while  the  latter  looks  up  to  it  as  unfeelingly  as  a  stone"  (§  699, 
709,  810,  838. — Also,  Medical  and  Physiological  Commentaries,  vol. 
i.,  p.  510-515,  text  and  notes,  518,  note,  526,  539,  567,  note,  584,  611, 
650,  notes,  697,  698,  as  to  Magendie.     Also,  Lehmann,  ^  1034). 

745.  No  subject  has  excited  more  discussion,  or  more  deservedly, 
than  the  pathological  cause  of  inflammation,  since  this  affection  and 
idiopathic  fever  comprise  most  of  the  diseases  of  man,  and  since,  also, 
the  treatment  of  disease  turns  mainly  upon  our  conceptions  of  its  path- 
ological character  (§  4,  667-677). 

The  example  of  inflammation  involves  the  whole  philosophy  of  all 
other  diseases ;  and,  if  our  views  be  right  in  respect  to  this  affection, 
we  shall  have  little  difliculty  with  any  other.  This  I  shall  endeavor 
to  show  by  a  special  consideration  of  fever  and  venous  congestion. 
The  general  laws  are  the  same  in  all  the  cases ;  though  the  results 
are  variously  modified.  There  may  be,  for  instance,  in  one  form  of 
disease  increased  action  of  the  extreme  vessels,  an  exaltation  of  the 
vital  properties,  &c.,  while  in  another  foim  an  opposite  condition  may 
obtain.  Yet  these  opposite  states  shall  depend  upon  the  same  great 
general  laws.  In  either  case,  for  instance,  it  is  a  general  law  that  an 
altered  condition  of  the  organic  properties  constitutes  the  essential 
pathology ;  and,  it  is  another  general  truth  that  this  altered  condition 
has  been  instituted  by  deleterious  agents.  The  changes  in  function 
will  also  correspond  with  the  particular  changes  of  the  organic  prop- 
erties. But,  coming  to  the  details  in  respect  to  the  exact  nature  of 
the  changes,  we  find  them  different  in  the  diflerent  cases ;  and  they 


PATHOLOGY. INFLAMMATION PATHOLOGICAL    CAUSE.         483 

depend  mainly  upon  the  specific  nature  of  the  remote  causes,  which 
have  altered  the  properties  of  life  in  one  series  of  cases  in  a  different 
manner  from  the  other  series  (§  652).  These,  therefore,  are  only  con- 
tingent results,  and  do  not  affect  the  great  laws  which  are  concerned 
about  the  essential  pathology  of  disease. 

746,  a.  The  extreme  terminating  series  of  the  arterial  system  of 
vessels  are  the  immediate  instruments  of  inflammation.  They  are  en- 
dowed with  muscular  fibres,  and  perform,  naturally,  the  function  of 
active  contraction  and  dilatation  (§  384-387,  397-399).  That  such 
are  the  essential  instruments  is  evident  from  a  variety  of  facts,  of 
which,  however,  it  is  only  necessary  to  state  one,  namely,  the  analogy 
which  subsists  between  the  process  of  nutrition  and  the  reparative 
process  of  inferior  animals  and  the  formative  and  adhesive  stages  of 
inflammation;  while  the  true  suppurative,  and  all  its  modifications, 
are  analogous  to  the  general  function  of  secretion  (§  729,  732  a). 
The  effect  of  cantharides,  &c.,  applied  to  the  skin,  is  an  example  in 
illustration.  All  this,  too,  corresponds  exactly  with  what  is  kno^vn 
of  the  greater  development  of  the  properties  of  life  in  the  exlremo 
vessels ;  which,  it  may  be  now  said,  supplies  an  important  proof  of 
their  increased  action  in  inflammation  (§  407  h,  410,  411). 

Such,  too,  are  some  of  the  numerous  instances  in  which  we  reason 
with  certainty  from  analogy,  especially  in  relation  to  organic  life; 
while  the  conclusions  are  corroborated  by  all  the  relative  facts. 

I  have  thus  thought  it  impoitant  to  indicate  with  precision  the  in- 
struments of  inflammatory  action,  that  they  may  not  be  confounded 
with  that  series  of  capillary  vessels  which  serve  mainly  as  reservoirs 
to  the  extreme  vessels,  and  between  which  there  is  also  a  broad  dis- 
tinction in  their  vital  states.  We  shall  have  accomplished  much  in 
establishing  the  vital  character  of  inflammation,  and  in  exposing  the 
errors  of  the  physical  hypothesis,  by  the  plain  fact  whose  statement  is 
made  as  a  point  of  departure  and  for  the  government  of  the  whole  in- 
quiry. Those  vessels,  as  I  have  endeavored  to  prove,  are  eminently 
characterized  by  the  attributes  of  life,  and  I  hold  it  to  be  fundamen- 
tal, and  cannot  be  denied,  that  what  is  physiologically  true  is  true, 
also,  of  those  morbid  states  which  coincide  in  their  genei'al  results 
with  the  physiological  (§  41-44,  48,  52,  134,  135,  136,  409  c-411,  &c., 
516  d,  no.  6,  524  a,  no.  1,  526  a,  1039,  1040,  1056). 

If  such,  therefore,  be  founded  in  nature,  the  essential  philosophy  of 
inflammation  is  to  be  found  in  modified  states  of  the  natural  proper- 
ties and  functions  of  the  extreme  series  of  the  arterial  system. 

746,  h.  The  absorbents,  also,  are  interested  in  the  ulcerative  pro- 
cess, and  are,  therefore,  modified  in  their  action. 

746,  c.  The  nerves,  from  constituting  a  part  of  all  the  tissues,  and 
from  the  liability  of  every  part  to  be  affected  by  preternatural  deter- 
minations of  the  nervous  power  upon  them,  and  being,  also,  the  organs 
of  sensibility,  are  so  far  liable  to  a  participation  in  the  pathological 
states  of  inflammation,  and  in  affecting  the  secreted  products  (§  456  a). 

From  all  that  has  been  said,  it  is  evident  that  the  nervous  power 
can  act  only  as  a  remote  cause  of  morbid  changes,  and  that  the  con- 
clusion is  unavoidable  that  all  the  remote  causes  of  inflammation,  as 
of  every  other  disease,  produce  their  morbific  effects  upon  the  oi'ganic 
properties,  that  the  morbid  processes  are  carried  on  by  these  proper- 
ties, as  in  the  vegetable  kingdom,  and  that  the  nervous  system  is  not 


464  INSTITUTES   OF    MEDICfN  E 

necessary  to  the  disease,  however  it  may  exert  a  profound  influence 
both  upon  the  actions  and  products  (§  227,  233|,  475^,  507,  647^). 

The  nervous  power,  it  is  true,  is  the  immediate  remote  cause  of  all 
inflammations  which  spring  up  sympatheticafly,  but  it  forms  no  part 
of  the  essential  pathological  cause  ;  nor  are  the  nerves  in  any  other 
way  the  medium  through  which  inflammations  are  excited  (§  201-204, 
226,  233,405,  446  a,  500,  647^,  715,  725  c,  902-905,  1039,  1040). 

On  the  other  hand,  the  physical  philosophers,  with  singular  incon- 
sistency, maintain  that  the  "nervous  influence"  has  an  important 
agency  in  the  inflammatory  process,  though  they  do  not  say  in  what 
that  agency  consists,  or  how  it  co-operates  either  with  mechani- 
cal or  chemical  agencies  (^638j). 

747.  Hunter  laid  the  foundation  of  the  true  theory  of  inflammation. 
He  supposes  that  the  vessels  are  in  a  state  of  increased  action,  both  as 
to  contraction  and  dilatation,  and  that,  in  a  general  sense,  they  carry 
an  increased  quantity  of  blood. 

Irritability  and  mobility,  the  two  great  properties  upon  which  oi 
ganic  actions  mostly  depend,  are  probably  always  increased  and 
otherwise  variously  modified  in  all  inflammations.  In  consequence, 
also,  of  the  increase  of  irritability  all  inflamed  parts  are  more  than 
naturally  susceptible  of  the  action  of  stimuli,  though  not  according  to 
their  ordinary  effects  in  health.  It  is  a  general  law,  indeed,  in  re- 
spect to  all  diseases,  that  the  natural  relations  of  the  affected  parts  to 
physical  and  mental  agents  are  more  or  less  altered ;  and  upon  this 
turns,  mostly,  the  curative  action  of  medicine,  (Sec.  (§  143,  149-152). 
It  was  a  radical  defect  in  Hunter's  doctrine  that  he  did  not  consider 
the  altered  condition,  in  their  very  nature,  of  the  vital  properties,  but 
imputed  the  essence  of  inflammation  to  a  simply  "  increased  action 
of  the  powers  of  the  part."  If  the  hand  be  plunged  into  warm  water, 
there  ensues  an  increased  action  of  the  vessels,  but  there  is  no  inflam- 
mation. 

748.  A  theory  opposed  to  the  foregoing,  and  now  universally  adopt- 
ed by  the  physical  school  of  medicine,  supposes, 

1.  That  the  vessels  concerned  in  the  process  of  inflammation  are 
passively  relaxed. 

2.  A  progressive  accumulation,  stagnation,  and  coagulation  of  blood 
within  the  vessels  (§  789). 

3.  An  enlargement  of  the  collateral  vessels  proportioned  to  the  re- 
dundancy of  blood  transmitted  to  the  part,  occasioned  by  the  force  of 
the  vis  a  tergo. 

4.  That  the  blood  is  propelled  through  the  collateral  vessels  by  the 
action  of  the  heart  (§  392). 

5.  That  the  vessels,  being  paralyzed,  relaxed,  and  mechanically  ob- 
etructed,  can  perform  no  part  in  generating  the  products,  or  in  those 
processes  already  described  as  the  results  or  "  terminations"  of  in- 
flammation ;  but,  on  the  contrary,  that  all  the  fluids  are  mechanically 
strained  off"  from  morbid  blood,  notwithstanding  the  mechanical  ob- 
struction occasioned  by  the  coagulation,  and  that  ulceration  is  only  a 
mechanical  softening  of  the  living  solids.  (See  "Report  of  the  recent 
State  of  Knowledge  of  tlie  Nature  of  Inflammation,'''  by  Mr.  Wharton 
Jones,  in  British  and  Foreign  Medical  Review,  April,  1844.) 

749.  Such  is  the  prevailing  mechanical  doctrine  of  inflammation, 
vvhich,  in  conformity  with  the  plan  of  this  work,  I  have  here  intro- 


PATHOLOGY. INFLAMMATION PATHOLOGICAL  CAUSE.  485 

duced  as  appearing  to  me  the  most  adverse  to  facts  and  philosophy, 
but  sustained  by  a  powerful  school.  I  shall  not  enter  upon  its  farther 
refutation,  nor  upon  the  proof  of  the  vital  theory,  beyond  the  state- 
ment of  a  few  prominent  facts.  Both  of  these  objects  I  have  endeav- 
ored to  accomplish  in  the  Medical  and  Physiological  Commentaries, 
nor  have  I  seen  any  fact  whose  import  is  not  there  considered  (vol.  ii., 
p.  141-214,  224-397.  Also,  my  "  Introductory  Discourse,"  p.  22,  &c., 
1842,  in  vol.  iii.). 

The  mechanical  doctrine  of  inflammation  has  grown  out  of  experi- 
ments by  which  Nature  is  misrepresented.  I  mean  that  such  is  my 
opinion ;  but  not  without  its  attendant  reasons.  One  experimental 
fallacy,  however,  lies  mainly  at  the  foundation  of  all  the  foregoing 
conclusions,  which  consists  in  the  means  by  which  inflammations  are 
artificially  produced  for  the  purpose  of  amving  at  a  knowledge  of 
their  pathology.  Irritants  of  a  chemical  nature  have  been  applied  to 
delicate  membranes,  by  which  their  organization  is  impaired  or  de- 
stroyed, and  the  blood  also  coagulated  by  direct  chemical  influences. 
The  part  has  been  then  subjected  to  the  microscope,  under  the  direct 
rays  of  the  sun,  whose  heat  has  the  effect  of  drying  the  disorganized 
tissues,  and  consolidating  the  blood.     Let  rubefacients  be  a  test. 

From  such  most  unnatural  results  the  whole  organic  process  of  in- 
flammation, its  formative  stage,  the  stages  of  suppuration,  ulceration, 
and  the  secretion  of  lymph,  of  serum,  &c.,  are  interpreted  upon 
purely  mechanical  principles  (§  396,  410). 

But,  if  this  were  true  of  inflammation,  it  should  be,  equally  so  of 
the  analogous  results  in  the  healthy  state  of  the  body  ;  and  growth 
itself,  and  all  the  secreted  products,  should  be  equally  determined  by 
mechanical  laws.  Were  the  doctrine,  therefore,  founded  in  nature,  it 
'would  completely  overthrow  the  whole  science  of  physiology,  and  re- 
duce the  living  being  to  a  mere  automaton  (§  639  a,  746  a). 

750,  a.  We  have  already  variously  seen  what  analogy  prompts. 
We  have  seen,  too,  that  it  has  been  demonstrated  that  the  blood  is  ac- 
celerated in  the  capillary  and  larger  vessels  when  stimulants  are  ap- 
plied to  them,  or  to  the  brain  or  spinal  cord,  and  that  they  give  rise 
to  alternate  actions  of  contraction  and  dilatation,  even  in  the  veins 
(§  384,  387,  392,  399,  408-411,  480-485,  498  e).  We  have  seen 
how  the  extreme  vessels  become  enlarged  and  admit  the  red  globules 
(§  192).  We  have  seen,  physiologically,  that  all  the  vessels  must 
have  an  independent  vital  action  (§  382,  &c.,  407,  410,  &c.).  And 
now  I  ask  the  physical  philosopher,  upon  his  own  ground,  how  the 
extreme  vessels  in  dense  structures,  such  as  ligament,  cartilage,  and 
bone,  acquire  their  great  enlargements  in  their  inflammations  1  It  is 
evident  that  the  physical  philosopher  has  limited  his  views,  as  he  has 
his  experiments,  to  soft,  delicate  membranes.  He  has  reasoned  from 
an  isolated  fact,  and  that  fact  evidently  of  a  spurious  nature  (^  5^,6,  c). 

That  there  is  generally,  though  not  invariably,  an  increased  volume 
of  blood  circulating  in  the  instruments  of  inflammation,  is  shown  by 
the  increased  quantity  of  blood  which  flows  from  the  veins  of  an  in- 
flamed part ;  by  the  high  florid  color  of  the  part,  and  of  the  blood  ; 
by  the  profusion  of  blood  which  follows  scarifications  and  leech-bites  ; 
by  the  rapidity  with  which  the  blood  returns  when  expelled,  by  rub- 
bing, from  an  inflamed  surface ;  by  the  actually  increased  fluidity  of 
the  blood  proceeding  directly  from  the  seat  of  inflammation,  as  show» 


486  INSTITUTES    OF    MEDICINE. 

by  its  slower  coagulation  than  in  health  ;  by  the  preternatural  gener- 
ation  of  heat,  which  even  no  chemical  theory  can  explain  without 
admitting  an  increased  circulation  of  the  blood ;  by  the  profuse  se- 
cretion of  certain  fluids,  and  their  specific  nature ;  by  the  frequently 
increased  pulsation  of  an  artery  leading  to  an  inflamed  part,  and  es- 
pecially as  the  pulsation  is  often  strongest  when  the  general  circula- 
tion is  prostrate,  and' again,  on  the  other  hand,  as  the  throbbing  of  the 
vessel  often  subsides  when  the  force  of  the  general  circulation  rises 
under  the  influence  of  the  lancet ;  while  the  local  inflammation  may 
go  on  increasing,  &c.  (§  1056). 

750.  h.  Coincident  with  the  numerous  physical  and  pathological 
facts  which  lie  at  the  foundation  of  the  vital  doctrine  of  inflammation 
are  the  effects  of  remedial  agents ;  since  bloodletting,  cathartics,  an- 
timonials,  and  other  depressing  agents,  should  increase  the  supposed 
relaxation  of  the  vessels,  and  stagnation  of  blood,  both  by  their  direct 
action  and  by  diminishing  the  force  of  the  vis  a  tergo  ;  while,  on  the 
other  hand,  tonics  and  stimulants  should  be  the  prevailing  means  of 
cure.  Nor  can  the  curative  effect  of  the  former  agents,  nor  the  mor- 
bific of  the  latter,  be  interpreted  on  any  other  than  physiological  prin- 
ciples. How,  again,  will  the  physical  philosopher  explain  the  instan- 
taneousness  with  which  moderate  bloodletting,  nay,  even  syncope 
without  the  loss  of  blood,  will  sometimes  overcome  pneumonia,  in- 
flammation of  the  brain,  &c.  (§  951)  ?  How  explain  the  rapidity 
with  which  croup  will  yield  to  the  prostrating  effect  of  antimonials ; 
or  how  deep-seated  inflammations  take  their  departure  as  soon  as  the 
same  condition  is  produced  in  the  skin  by  cantharides,  or  yield  more 
gradually  to  the  silent  influences  of  antimony,  ipecacuanha,  mercu- 
rials, iodine,  colchicum,  guaiacura,  veratria,  quinia,  &c.,  according  to 
the  special  modifications  of  the  disease  by  its  various  remote  causes 
(§  150,  650-653,  662  h,  668,  669,  672,  674,  742,  935  d,  e)  ? 

751.  I  have  just  intimated  that,  if  vital  action  do  not  exist,  there 
should  be  no  varieties  of  inflammation.  It  should  be  all  small-pox, 
or  lues,  or  rheumatism,  or,  at  least,  all  of  the  common  variety.  The 
vital  phenomena  and  physical  products  should  be  always  the  same; 
the  same  in  all  tissues  and  in  all  constitutions  (§  409,  c-i).  Nor 
should  we  have  any  remarkable  and  diversified  sympathetic  influences 
of  inflamed  parts  upon  the  system  at  large  (§  500,  512-530).  The 
vitalist  supplies  the  only  intelligible  solution  of  the  facts  which  are 
presented  in  real  life.  He  points  to  the  various  modifications  of  the 
organic  properties,  according  to  the  peculiarities  of  every  tissue,  the 
diversities  of  the  remote  causes,  constitution,  age,  sex,  &c.,  which  he 
believes,  also,  to  be  the  foundation  of  all  rational  pathology  ;  and  upon 
the  same  principles  he  interprets  the  curative  effects  of  remedies. 

Active  and  Passive  Inflammation. 

752.  I  endeavored,  originally,  in  the  Medical  and  Physiological  Coni' 
mentaries,  to  show  the  fallacy  of  the  distinction  of  inflammation  into 
active  and  passive,  and  to  prove  the  dependence  of  all  forms  of  the 
disease  upon  one  general  pathological  cause ;  and  I  shall  now  briefly 
advert  to  the  manner  in  which  the  principles  set  forth  in  the  present 
work  establish  that  conclusion. 

753.  In  the  active  fosm  of  inflammation  there  appears  to  be  a  vague 
recognition,  so  far  as  the  verbal  distinction  gcos,  of  the  morbidly-in- 


PATHOJ,OGY. INFLAMMATION PATHOLOGICAL    CAUSE.        487 

creased  action  of  the  part,  while  in  the  passive  form  all  is  "  relaxa- 
tion" and  "  stagnation"  (§  748).  These  exactly  opposite  states  of 
verbal  pathology  are  especially  characteristic  of  the  school  who  main- 
tain that  inflammation  is  always  constituted  by  a  passive  relaxation  of 
the  vessels  and  coagulation  of  blood.  With  the  same  consistency  they 
also  affirm  that  the  two  nominal  conditions  require  opposite  modes  of 
treatment ;  though,  in  justice  to  the  real  hypothesis,  it  should  be  said 
that  the  stimulant  plan  is  apt  to  prevail.  There  are  many  authors 

who  speak  of  an  active  and  passive  state  of  inflammation  as  things  in 
absolute  opposition,  but  they  attempt  no  explanation  of  the  supposed 
distinction. 

Andral  perceived  that  the  term  active  is  not  in  harmony  with  the 
mechanical  philosophy  of  the  disease,  nor  with  his  own  views  as  to  the 
abolition  of  the  general  term  ;  and  he  therefore  substitutes  sthenic  and 
asthenic  to  express  the  opposite  conditions,  and  hypercemia  in  the  place 
of  inflammation.  But  the  epithets  are  as  much  in  direct  opposition 
as  active  ■axidi  passive  (§  699,  c). 

754.  But  it  requires  only  a  right  exercise  of  judgment  to  under- 
stand that  the  same  disease  cannot  be  constituted  by  opposite  patho- 
logical conditions  (§  741,  h).  The  supposition  contradicts  itself.  The 
varieties  depend  simply  upon  partial  modifications  of  a  common  path- 
ological cause  ;  and  this  conclusion,  as  abundantly  exemplified,  is  of  no 
little  practical  importance  (§  766).  The  term  passive  can  only  be  in- 
tended, by  those  who  use  it,  to  inculcate  a  stimlant  treatment,  and  that 
mechanical  condition  of  the  blood-vessels  whose  refutation  I  have  at- 
tempted extensively  in  the  Commentaries. 

755.  Again,  in  the  supposed  opposite  conditions,  the  vital  signs,  and 
the  morbid  products,  are  nearly  identical ;  which  evinces,  sufficiently, 
a  close  affinity  in  the  pathological  states,  while  the  analogy  between 
those  products  and  such  as  depend  on  the  natural  processes  places 
both  modifications  of  the  disease  on  a  common  physiological  founda- 
tion (§  137  e,  150-153,  639,  746  a,  694f ). 

756.  a.  The  occasional  success  of  tonics  and  stimulants  in  the  treat- 
ment of  inflammation,  whether  applied  internally  or  externally,  or 
with  or  without  antiphlogistic  remedies,  is  no  evidence,  as  supposed, 
of  a  pathological  state  manifestly  different  from  that  which  is  most 
readily  surmounted  by  loss  of  blood,  cathartics,  &c.,  alone.  This  will 
be  obvious  when  the  true  modus  operandi  of  remedial  agents  is  duly 
considered  (§  150-152,  638,  893,  &c.).  It  is  also  well  known  that  a 
sudden  and  powerful  impression  even  from  alcoholic  stimulants  will 
sometimes  subvert  an  inflammation  or  a  fever  of  great  activity,  which, 
under  apparently  the  same  circumstances,  would  be  aggravated  by 
such  treatment  in  the  hundred  next  following  cases,  but  where  loss  of 
blood,  &c.,  would  be  speedily  curative  in  nearly  all  (§  900,  904  d'). 
The  disciples  of  Brown  have  been  thus  enabled  to  sustain  themselves 
in  the  midst  of  general  failure. — Note  Ee  p.  1133. 

Take  a  clear  example,  which  illustrates  the  only  distinction,  so  far 
as  principle  is  concerned,  between  the  supposed  opposite  conditions 
of  inflammation.  Such  a  one  occurs  in  this  disease  when  modified  by 
the  predisposing  cause  of  intermittent  fever.  Here  the  Peruvian  bark 
may  be  as  necessary  to  its  cure  as  the  loss  of  blood,  though  the  latter 
is  commonly,  also,  more  important.  And  there  occurs  to  me  a  proof 
from  analogy  which  demonstrates  the  vital  doctrine  of  inflammation ; 


488  INSTITUTES    OF    MEDICINE. 

which  consists  in  the  fact  that  the  Peruvian  bark  is  also  a  specific  for 
intermittent  fever,  w^hile,  as  with  inflammations,  it  wiJl  aggravate  other 
forms  of  fever.  If,  therefore,  it  be  admitted  that  there  is  no  "  stagna- 
tion of  blood"  in  the  intermittent  and  other  fevers,  it  clearly  follows 
from  this  analogy  that  there  is  none  in  inflammations. 

The  intense  inflammations  attendant  on  scurvy  often  yield  only  to 
such  remedies  alone  as  improve  the  digestive  organs,  of  which  tonics 
may  be  one ;  and  here  we  witness  impressive  demonstrations  of  the 
laws  of  sympathy  (§  500,  512,  &c.).  And  yet  in  the  same  conditions 
bloodletting  may  be  simultaneously  appropriate  or  necessary.  Op- 
posite modes  of  local  treatment  succeed  in  burns  and  scalds ;  catarrh 
is  often  cured  by  "  gin  sling;"  erysipelas  has  apparently  yielded  to  the 
tonic  and  stimulant  practice,  though  at  the  hazard  of  life ;  and  typhus 
fever,  with  its  train  of  local  inflammations  and  congestions,  divides  the 
medical  world  into  the  two  opposite  systems  of  treatment. 

Again,  the  most  feeble  subjects  are  quite  as  likely  to  require  the 
depletive  treatment,  in  grave  inflammations,  as  the  robust ;  and  long- 
continued  chronic  inflammations  have  often  yielded  to  a  repeated  loss 
of  blood  where  tonics  had  been  employed  under  the  illusive  doctrine 
of  passive  inflammation  (§  1007  h-d,  1008,  1019).— Note  Ii  p.  1139. 

The  differences  in  small-pox,  varioloid,  and  cow-pox,  which  are 
essentially  one  disease,  illustrate  the  principles  before  us.  So,  too, 
do  all  the  varieties  attendant  on  specific  forms  of  inflammation,  as 
measles,  scarlatina,  lues,  rheumatism,  &c.  Lues  yields  especially  to 
mercury ;  rheumatism  to  colchicum  and  guaiacum ;  scrofula  to  io- 
dine, &c. ;  and  yet  the  simultaneous  loss  of  blood  may  be  more  or 
less  useful  or  indispensable.  The  example  of  tuberculous  phthisis  is 
illustrative  of  our  whole  subject.  A  mixed,  or  even  a  stimulant,  treat- 
ment is  slow  in  its  destructive  effects ;  and  its  evils  have  been,  there- 
fore, overlooked  in  the  speculative  views  which  morbid  anatomy  has 
suggested  as  to  the  nature  of  the  pathological  change  in  which  tuber- 
cle originates  (§  695,  &c.),  and  in  the  brown  chicken-meat  which 
chemistry  has  contradistinguished  from  the  white.  This  morbid  con- 
dition has  been  recently  and  extensively  considered  non-inflammatory, 
and  as  supposed  by  Louis  when  the  most  extensive  inflammatory  le- 
sions and  products  have  supervened  :  and  it  supplies  us  with  another 
exemplification  of  the  irresistible  tendency  of  theory,  true  or  false,  to 
determine  the  treatment  of  disease  (§  4).  The  antiphlogistic  prac- 
tice has  been  abandoned.  But  what  are  its  results  %  Has  the  mor- 
tality from  phthisis  diminished  ]  On  the  contrary,  it  has  most  fear- 
fully increased  [Medical  and  Physiological  Commentaries,  vol.  ii.,  p. 
622-633,  743-752).— Notes  F  p.  1114,  Mm  p.  1141. 

756,  b.  However  varied  may  be  some  of  the  remedies  in  the  differ- 
ent modifications  of  inflammation,  the  general  principles  of  treatment 
are  substantially  the  same.  The  incidentally  favorable  effect  of  local 
or  constitutional  stimulants  is  no  proof  that  the  pathological  conditions 
of  inflammation  are  not  closely  allied.  It  only  proves  their  effect  in 
altering  the  vital  properties  in  such  a  way  as  will  enable  Nature  to 
take  on  the  restorative  process.  Least  of  all  can  opposite  principles 
prevail  at  different  times  and  in  different  climates.  It  has  been  so 
from  the  earliest  records  of  disease.  Otherwise,  medicine  would 
consist  only  of  an  unconnected  series  of  observations.  There  would 
bo  no  principles,  and  of  course  no  science.     Medical  learning  would 


PATHOLOGY. FEVER DESCRIPTION.  489 

be  useless,  and  experience  would  suit  only  the  present  occasion.  A 
new  system  of  treatment  would  have  to  be  devised  for  every  climate, 
every  constitution,  and  every  reappearance  of  the  same  disease. 

But  Nature  is  not  thus  the  creature  of  accident.  It  is  not  Nature 
who  is  inconsistent,  or  who  operates  by  conflicting  laws.  Art  may 
give  her  this  appearance ;  but  still  I  say,  that  "  Nature  can  never 
deceive."  It  is  owing  to  this  consistency  of  Nature  that  medicine 
had  long  since  become  a  noble  science;  difficult  and  concerned  about 
all  other  sciences,  and  therefore  taking  the  lead  of  all  others.  A 
6cience  of  principles  deduced  from  the  phenomena  of  Nature,  and 
which,  with  the  facts  that  are  known,  conduct  us  with  remarkable 
certainty  to  facts  that  are  unknown.  It  is  here  that  well-founded 
principles  enable  us  to  see  farther  than  the  senses,  and  to  learn  from 
a  single  vital  phenomenon,  from  the  expression  of  the  eye,  the  ex- 
istence and  nature  of  those  latent  changes  which  too  many  can  see 
only  when  seeing  is  useless,  and  bring  upon  art  and  philosophy  the 
derision  of  the  crowd  (§  704,  1005^,  1006/-1007  d,  1068  a-d). 

A  sound  pi'inciple  in  medicine  is  like  the  calculus  in  mathematics ; 
and  what  are  falsely  called  "exceptions  to  general  principles"  are 
nothing  more  than  variations  in  phenomena,  which  arise  from  the  in- 
stability of  the  properties  of  life,  and  the  vast  variety  of  influences  to 
which  they  are  exposed  (§  177-179,  237).  These  variations  may  de- 
note only  partial  modifications  of  a  common  morbid  action,  arising 
especially  from  differences  in  the  remote  causes  (§  644,  &c.) ;  or, 
they  may  depend  upon  the  same  action  affecting  different  tissues ;  or 
upon  the  morbid  condition  of  particular  organs  affecting  certain  other 
organs,  or  all  others  (§  117,  129,  134,  137,  529,  &c.) ;  or,  upon  age, 
sex,  constitutional  peculiarities,  and  other  accidents  (§  335,  &c.,  570, 
&c.).  And,  although  there  be  one  leading  principle  in  the  treatment 
of  such  cases,  there  are  other  subordinate  ones  founded  u^Don  the 
modifications.  These  are  to  be  nicely  balanced,  that  the  governing 
principle  may  be  properly  directed  (§  675).  But,  it  is  only  men  of 
correct  thinking  and  close  observation  that  can  apply  these  principles. 
All  others  will  look  upon  the  variations  of  symptoms  from  their  usual 
state  in  any  one  disease,  or  upon  the  differences  in  the  results  of  an 
exact  methodical  practice,  as  denoting  very  different  pathological  con- 
ditions, or  as  constituting  "  exceptions  to  general  principles ;"  and 
*'  bark  and  wine"  will  therefore  obtain  in  numerous  cases  where 
bloodletting  is  the  only  efficient  remedy. 

FEVER. 

757,  a.  Important  distinctions  between  the  two  great  classes  of  dis- 
ease. Inflammation  and  Fever,  have  been  already  sufiiciently  indica- 
ted. The  former,  as  we  have  seen,  is  limited  to  certain  parts,  while 
the  latter  invades  the  body  universally  from  its  beginning.  I  have 
reserved  for  this  place,  however,  a  fundamental  distinction,  which,  as 
a  characteristic  of  inflammation,  has  been  described.  This  consists 
of  the  morbid  products,  new  formations,  and  lesions  of  structure,  to 
which  inflammation  gives  rise.  It  is  otherwise  with  fever,  whose  dis- 
tinguishing phenomena  are  mostly  of  a  vital  nature,  and  whose  mor- 
bid physical  products  consist  only  of  modifications  of  the  natural  se- 
creted fluids  (§  764,  e).  Morbid  anatomy,  therefore,  reflects  no  light 
whatever  upon  the  pathology  of  fever.     And  yet  is  its  treatment,  all 


490  INSTITUTES    OF    MEDICINE. 

its  varieties,  as  well  ascertained  as  that  of  inflammation  and  its  vari- 
eties. Indeed,  of  most  of  the  varieties  of  inflammation  morbid  anato- 
my does  not  afford  the  least  information ;  and  yet  is  the  specific  treat- 
ment of  the  most  common  and  important,  such  as  rheumatism,  gout, 
intermittent,  scrofulous,  &c.,  as  well  known  as  the  general  remedies 
for  inflammation.  And  so  with  the  varieties  of  fever.  I  say  ao^ain, 
therefore,  that  the  morbid  anatomist  may  not  appropriate  what-  so  em- 
inently belongs  to  the  acumen  of  genius  in  its  philosophical  observa- 
tion of  the  phenomena  of  nature  (§  695,  &c.). 

It  is  plain,  therefore,  that  all  those  who  would  render  morbid  anat- 
omy the  principal  basis  of  pathology  can  have  no  definite  views  of 
disease.  The  effects  are  mistaken  for  the  cause  ;  and  if  the  former 
be  not  present,  the  case  is  regarded  as  inscrutable  in  respect  to  its 
pathology.  Every  disease  is,  of  course,  to  the  morbid  anatomist  cir- 
cumscribed to  the  organs  which  tell  upon  his  senses ;  the  varieties  in 
inflammation  are  overlooked  from  their  want  of  tangible  distinctions ; 
and  as  ulceration,  and  some  other  lesions  of  inflammation,  may  happen 
to  appear  red  or  white,  they  ai'e  denominated,  as  by  Louis,  inflam- 
matory or  contra-inflammatory. 

757,  b.  Many  of  the  ordinary  and  most  characteristic  symptoms  of 
inflamrft«.tion  are  wanting  in  fever ;  such  as  hardness  and  incompress- 
ibility  of  pulse,  buffing  and  cupping  of  the  blood,  local  pain,  &c.  This 
is  very  obvious  in  intermittent  fever.  Exalted  heat  probably  takes 
place  in  all  inflamed  parts ;  but  a  sunken  temperature  is  common  in 
fever  (§  712-722).    Reflex  nervous  actions  supply  a  test  (§  720,  893). 

758*  Fever,  like  inflammation,  has  numerous  modifications,  as  a  ne- 
cessary result  of  the  constitution  of  the  vital  properties,  the  variety  of 
morbific  causes,  the  unequal  distribution  of  the  disease,  &c.  These 
modifications  have  given  rise  to  the  distinctions  of  continued,  intermit- 
tent, remittent,  typhus,  nervous,  hilious,  yellow  fever,  plague,  &c.  But 
strong  analogies  prevail  among  the  whole;  the  general  pathological 
cause,  as  in  inflammations,  being  essentially  the  same.  Most  of  the 
varieties  in  fever  depend,  indeed,  more  or  less,  upon  the  modifying 
influences  of  coexisting  inflammations  and  venous  congestions,  though 
more  so  upon  the  predisposing  causes,  while,  also,  the  modifications 
which  grow  out  of  these  local  affections  will  depend  much  upon  their 
particular  seat.  Some  organs,  also,  sustain  a  greater  burden  of  the 
febrile  disease  than  others  ;  and  this,  of  course,  will  give  to  every 
case  certain  peculiar  modifications  (§  134,  &c.,  644,  &c.). 

759.  Fever,  in  its  most  simple  form,  is  of  short  duration,  never  con- 
tinues three  days,  rarely  longer  than  twenty-four  hours,  and  some- 
times terminates  within  four  hours.  This  is  the  ephemera,  which  may 
be  taken  as  the  type  of  the  complex  forms  that  consist  of  a  series  or 
repetition  of  paroxysms. 

The  foregoing  may  be  also  noticed  as  a  broad  fundamental  distinc- 
tion between  fever  and  inflammation  ;  since  the  ephemera,  a  perfect 
representation  of  fever,  may  sweep  through  its  course,  and  terminate 
as  suddenly  as  it  invades  the  body,  and  in  less  than  twelve  hours,  and 
leave  scarce  a  vestige  of  its  former  presence  behind. 

760.  If  fever,  therefore,  be  continued  beyond  a  single  paroxysm  it 
is  made  up  of  a  succession  of  paroxysms.  Many  have  supposed  that 
every  compound  case  consists  of  as  many  fevers  following  each  other 
as  there  are  paroxysms.     This,  however,  is  not  pathologically  true; 


PATHOLOGY. FEVER DESCRIPTION.  491 

Bince  the  same  moi~bid  predisposition  in  which  the  first  paroxysm 
originated  remains,  and  is  the  cause  of  each  succeeding  paroxysm, 
and,  therefore,  a  connecting  hnk  among  the  whole.  The  supposed 
distinction  consists  only  of  periodical  abatements  of  one  continuous 
disease  (§  514  g,  516  d,  no.  6,  665,  666). 

761,  a.  The  foregoing  abatements  of  fever  are  the  results  of  salu- 
tary efforts  of  nature,  and  are  variously  pronounced  as  to  their  degree 
and  duration  (§  733).  They  are  most  perfect  in  intermittent  fever, 
in  which  they  vary  from  a  few  hours'  duration  to  one  or  more  days  (§ 
675). 

761,  b.  These  abatements  of  fever,  often  amounting  to  an  apparent 
termination  of  the  disease,  supply  a  fine  illustration  of  the  recupera- 
tive nature  of  the  properties  of  life,  and  of  their  inherent  tendency  to 
maintain  themselves  in  a  state  of  integrity.  We  see,  too,  the  modus 
operandi  of  art  in  its  use  of  physiological  Iravs,  when,  by  the  interposi- 
tion of  remedies  the  natural  abatement  of  fever  is  confirmed  by  new 
influences  that  are  different  from  the  original  morbific  ones  (§  675, 
897,  898,  901,  237,  239,  447  h.  639,  839,  854,  856,  900,  905). 

762,  a.  Each  paroxysm  of  fever  consists,  in  a  general  sense,  of  a 
certain  succession  of  symptoms,  which,  however,  are  liable  to  great 
variations  ;  and  new  ones  that  may  spring  up  in  the  progress  of  dis- 
ease, from  accidental  influences,  may  present  a  general  aspect  more 
widely  different  from  the  preceding  than  the  near  identity  of  the  path- 
ological cause  would  lead  us  to  suppose.  These  differences  spring 
from  the  very  susceptible  nature  of  the  properties  of  life,  especially  in 
their  morbid  state,  and  the  various  new  influences  which  may  operate 
upon  them ;  and  the  manifestations  are  liable  to  exceed  the  ratio  of 
any  change  that  may  be  wrought  in  the  vital  conditions.  A  slight 
change  only,  some  error  in  diet,  by  instituting  morbific  reflex  nerv- 
ous actions,  may  give  rise  to  new  and  striking  phenomena,  or  they 
may  be  forcibly  presented  by  the  transient  effect  alone  of  some  mo- 
mentary cause,  as  an  emotion  of  the  mind  {^  740,  1067). 

762,  b.  In  presenting  a  summary  analysis  of  fever,  I  shall  first  con- 
sider the  Ephemera.  Secondly,  fever  as  constituted  by  a  repetition 
of  the  "same  paroxysm,  and  in  different  modes.  Thirdly,  the  remote 
causes  of  fever,  the  coexisting  inflammations,  &c.  Fourthly,  the  path- 
ological cause. 

763,  The  ephemera,  as  I  have  said,  may  be  taken  as  the  general 
type  of  the  entire  family  of  fevers.  It  generally  commences  between 
six  or  seven  o'clock  in  the  morning,  or  five  or  six  in  the  evening;  a 
coincidence  of  difficult  explanation,  but  manifestly  connected  with 
some  natural  periodical  mutations  in  the  vital  states'  of  the  system 
(§  768).  It  has  three  distinct  stages,  which  are  commonly  present; 
namely,  the  cold  stage  or  cold  Jit,  the  hot  stage,  and  the  crisis. 

764,  a.  The  first,  or  cold  stage,  is  the  period  of  the  most  intense 
morbid  action.  Its  invasion  is  marked  by  a  sudden  contraction  .of  all 
the  capillary  blood-vessels,  and  consequent  determination  of  blood 
about  the  right  cavities  of  the  heart,  by  a  diminution  of  the  fluid  prod- 
ucts, by  reduction  of  temperature,  and  by  a  loss,  in  various  degrees, 
of  the  voluntary  control  over  the  muscles.  These  are  the  most  obvi- 
ous changes ;  and  such  as  relate  to  organic  life  evince  a  universality 
of  the  disease  at  its  invasion.  Here  we  may  stop  to  observe  another 
Droad  distinction  between  fever  and  inflammation  ;  since  the  latter 


492  INSTITUTES    OF    MEDICINE. 

does  not  begin  in  the  foregoing  manner,  but  with  an  enlargement  of 
the  capillary  blood-vessels  (§  712,  &c.,  757,  759,  770). 

In  idiopathic  fever,  many  of  the  prominent,  but  less  important,  vital 
symptoms,  so  far,  at  least,  as  sensation  is  concerned,  appertain  to  the 
organs  of  animal  life.  Those  of  the  organic  system  are  less  remark- 
able at  first,  as  natural  sensibility  is  here  inferior  to  its  condition  in 
animal  life.  The  eye,  for  instance,  is  naturally  more  sensible  than 
the  intestines,  and  hence  an  affection  of  the  former  is  more  conspicu- 
ous than  of  the  latter,  till  disease,  at  least,  may  develop  the  property 
in  the  intestine.  The  same  rule,  in  a  general  sense,  will  hold  as  to 
the  individual  organs  in  either  division  of  life,  at  this  early  stage  of  fe- 
ver, and  is  applicable  to  all  other  diseases.  There  may  be  more  dis- 
ease in  one  organ  than  in  another,  yet  the  symptoms  of  that  which  is 
most  affected  may  be  less  strongly  pronounced  on  account  of  its  nat- 
ural inferiority  in  sensibility^  and  often,  also,  oi  irritahility  (§  133-139, 
188,  194). 

A  preliminary  condition,  subsequent  to  the  formation  of  the  predis- 
position, and  immediately  antecedent  to  the  cold  stage,  may  be  rec- 
ognized under  the  denomination  of  access ;  a  term  which  has  been 
employed  to  denote  the  cold  stage,  or  the  most  intense  degree  of  mor- 
bid action,  and  which,  being  already  formed,  cannot  be  regarded  as 
the  access  of  disease.  Prior  to  the  absolute  seizure,  however,  there  is 
commonly  a  more  or  less  obvious  failure  of  the  living  powers  to  per- 
form any  of  their  functions  in  their  perfect  manner ;  and  that  consti- 
tutes the  true  access  of  the  complaint.  The  distinction  and  the  term 
are  practically  useful  as  leading  to  sound  pathological  views,  and  to 
correct  treatment. 

The  development,  or  attack  of  fever,  is  always  sudden,  whatever 
the  duration  of  the  pi'edisposition ;  and  this  is  one  of  distinguishing 
marks  between  fever  and  inflammation. 

764,  b.  After  the  cold  stage  has  continued  for  an  indefinite  time, 
the  diseased  conditions  begin  to  assume  a  tendency  toward  their  natural 
state,  or  to  obey  the  great  restorative  law,  the  vis  medicatrix  naturce. 
This  recuperative  effort  introduces  the  hot  stage,  which  is  the  first 
part  of  the  natural  cure.  The  prominent  characteristics  of  this  stage 
are  an  expansion  of  the  capillaries,  an  increased  volume  of  blood  at 
the  circumference,  greater  force  of  the  general  circulation,  and  an  ex- 
altation of  temperature  above  its  natural  standard. 

A  spontaneous  change  has  happened  in  the  vital  conditions  of  the 
whole  body.  The  small  vessels  expand  in  consequence.  Irritability 
has  become  more  susceptible,  but  less  profoundly  altered,  and  the 
blood  accumulated  about  the  heart  in  the  cold  stage  now  rouses  that 
organ  to  greater  action,  while  it  receives  concurrent  reflex  nervous 
influences  from  the  changes  which  are  going  forward  in  all  parts  of 
the  capillary  system.  An  increased  volume  of  blood  is  thus  sent  out, 
and  this  is  harmoniously  met  by  the  active  expansion  which  is  taking 
place  in  all  the  small  vessels  {§  384-387).  But  this  is  only  a  part  of 
the  involutions  of  reflex  nervous  actions  which  are  now  in  progress. 

Notwithstanding,  however,  the  hot  stage  is  the  beginning  of  the 
natural  cure,  the  symptoms  would  often  denote  an  increase  of  the 
morbid  condition,  and  frequently  call  for  the  intervention  of  art. 
Nature  may  be  excessive  in  her  aims  at  reparation.  She  may  over- 
step her  ordinary  limit,  and  push  the  organs  of  circulation  with  a  ve- 


PATHOLOGY. FEVER DESCRIPTION.  493 

hemence  that  shall  light  up  inflammations,  and  call  for  an  outlet  of 
blood  as  an  indispensable  means  of  prevention  (§  674,  d).  But  we 
know,  from  the  general  progress  of  symptoms,  and  the  final  result, 
that  a  succession  of  favorable  changes  has  been  instituted  from  the 
beginning  of  the  hot  stage. 

764,  c.  The  crisis  follows  next.  This  constitutes  the  greatest  de- 
cline of  the  disease.  The  phenomena  of  health  are  now  more  or  less 
pronounced.  The  secretions  break  forth,  morbid  at  first,  but  rapidly 
assuming  their  natural  character.  Among  these  perspiration  is  the 
most  obvious ;  and  hence  this  stage  of  the  disease  is  universally 
known  as  the  sweating.  The  designation  is  too  partial  and  hypothet- 
ical, since  the  volume  of  bile,  or  of  urine,  may  be  quite  as  redundant, 
or  more  so.  Crisis  is  more  comprehensive,  and  implies  exactly  the 
things  which  are  in  progress.  The  hot  stage  is  better  named ;  for 
exalted  temperature  is  the  beginning  of  the  elaboration  of  redundant 
products,  and,  for  a  while,  it  stands  alone.  And  here  I  may  refer  to 
this  connected  series  of  physical  products,  during  the  curative  stage, 
as  showing  analogically  the  dependence  of  sweat,  bile,  urine,  and  the 
elevated  temperature,  upon  common  physiological  principles,  and 
in  which.  alteratiA'^e  reflex  nervous  actions  take  an  important  part  (^ 
224,  226,  446-447,  461;  475-491,  503,  512,  902  g). 

764,  d.  The  secreted  products,  although  the  result  of  improving 
pathological  changes,  contribute,  as  in  inflammations,  to  the  ultimate 
design  of  nature  as  depletory  remedies  (§  732,  733  e,  151  a). 

764,  e.  In  consequence  of  the  foregoing  remarks  it  may  occur  to 
some  that  there  is  a  greater  affinity  between  fever  and  inflammation 
than  I  have  admitted  (§  712,  &c.).  But  that  conclusion  does  not  fol- 
low from  the  course  of  nature  in  her  restorative  movements.  The 
cold  stage  of  fever  may  be  the  period  of  the  most  profound  disease, 
and  nature  may  be  emerging  toward  her  healthy  standard  during 
the  stage  of  reaction,  and  yet  the  apparently  analogous  excitement 
of  the  general  organs  of  circulation,  and  of  the  immediate  instru- 
ments of  the  morbid  process  in  inflammation,  may  be  the  stage  of 
most  profound  disease;  and  this  is  known  by  the  various  attendant 
facts.*  The  pathological  conditions,  indeed,  are  so  widely  different, 
that  the  general  arterial  excitement  attendant  on  inflammation  is  not, 
as  in  fever,  followed  by  augmented  perspiration,  bile,  &c.  The  in- 
creased products  are  relative  to  some  particular  part,  and  are  not  of 
the  nature  of  those  which  attend  the  restorative  process  of  fever.  In 
one  disease  they  proceed  from  a  tissue,  in  the  other  from  compound 
organs.  One  affection  besets  the  tissues  in  their  individual  sense,  the 
other  in  their  compounded  sense.  These  are,  therefore,  other  broad 
fundamental  distinctions  between  fever  and  inflammation  (§  141  b, 
148,  675,  712-722,  757,  759,  764  a,  110). 

765.  If  a  repetition  of  the  paroxysm  take  place,  the  crisis  is  al- 
ways imperfect.  Their  repeated  occurrence  is  said  to  form  a  com- 
pound fever ;  but,  as  we  have  seen,  the  disease  is  as  much  an  entire 
whole  as  the  ephemera  (§  759,  760). 

When  the  paroxysms  apparently  go  off  entirely  the  fever  is  called 
an  intermittent.  When  the  interval  is  less  perfect,  or  a  new  pai'oxysm 
takes  place  in  the  middle  of  a  crisis,  the  disease  is  called  a  remittent. 
Wlien  the  disease  continues  without  much  abatement  of  symptoms, 
or,  rather,  if  a  new  paroxysm  set  in  during  the  hot  stage  of  a  prece- 

*  Inflammation,  as  a  general  fact,  is  not  introduced  by  a  chill,  but  chills  often  precede 
suppuration,  when  disease  is  subsiding. 


494  INSTITUTES    OF    MEDICINE. 

ding  paroxysm,  it  receives  the  name  of  continued  fever.  Between  the 
remittent  and  continued  fevers,  however,  there  is  no  well-defined  line 
of  distinction,  as  it  respects  the  succession  of  paroxysms.  Again,  the 
remittent  and  intermittent  interchange  with  each  other ;  and  it  is  even 
common  for  one  attacked  with  a  remittent  to  have  the  intermittent 
form  before  his  recovery.  When,  also,  intermittents  are  badly  treat- 
ed, they  are  often  converted  into  a  remittent ;  which  is  commonly  a 
more  intractable  form  (§  557). 

766.  We  have  thus  a  series  of  analogies  which  connect  the  contin- 
ued fever  with  the  intermittent ;  and  when  we  regard  the  distinct  na- 
ture of  the  paroxysms  of  an  intermittent,  we  see  that  the  ephemera  is 
a  representation  of  each  one.  The  symptoms  also  confirm  these  con- 
clusions ;  from  which  we  learn,  more  and  more,  that  the  essential  ele- 
ments are  the  same  in  all  the  preceding  forms,  and  other  minor  varie- 
ties of  the  disease  (§  557,  650,  652,  670,  741  b,  754,  756  b).  The  ex- 
istence of  this  coincidence  corresponds  with  the  like  attribute  of  in- 
flammations ;  the  varieties  of  which,  respectively,  are  not  more  re- 
markable in  their  vital  manifestations  and  results  than  are  the  natural 
modifications  of  the  vital  properties  in  different  tissues  (§  133-137). 

767,  a.  Notwithstanding,  however,  the  foregoing  analogies  (§  765, 
766),  the  causes  of  continued  fever  are  so  far  different  from  those  of 
the  remittent  and  intermittent,  that  the  first  of  these  varieties  does  not 
interchange  with  the  last,  as  do  the  last  two  with  each  other,  although 
the  quotidian  and  tertian  types  are  sometimes  manifested  with  consid- 
erable distinctness  during  the  pi'ogress  of  continued  fever.  Remit- 
tents and  intermittents  are,  also,  rare  in  climates  where  the  continued 
fever  occurs,  while  the  former  go  togethei',  and  have  close  affinities 
in  their  predisposing  causes  (§  652,  &c.). 

767,  b.  We  see,  therefore,  more  and  more,  the  fallacy  of  the  doc 
trine  which  regards  disease  as  a  unit,  and  especially  as  propounded 
by  one  to  whom  medicine  is  under  the  deepest  obligations.  Thei'e 
are,  indeed,  no  two  cases  precisely  alike  in  their  pathological  condi- 
tions ;  and  there  is  scarcely  a  principle  of  greater  importance  (§  673, 
S57).  It  is  true  of  diseases  which  are  most  allied,  and  even  true  of 
the  same  case  during  its  advances  or  its  decline ;  and  coming  to  the 
specific  forms  of  inflammation,  and  paesing  from  those  to  idiopathic 
fever  and  the  various  modifications  of  this  disease,  and  regarding  in 
connection,  also,  the  more  obscure  pathology  of  the  various  conditions 
of  the  stomach  which  are  grouped  under  the  general  denomination  of 
indigestion,  and  all  those  states  which  go  to  make  up  the  "  nervous 
disorders,"  we  can  scarcely  fail  of  escaping  from  the  illusions  which 
have  grown  out  of  the  physical  views  of  disease,  or  of  turning  our- 
selves to  that  philosophy  which  concerns  the  mutability  of  the  prop- 
erties of  life  (§  177-184,  &c.,  780). 

768,  a.  In  a  vast  proportion  of  all  the  cases  of  fever  the  paroxysms 
take  place  in  the  afternoon  ;  generally  beginning  about  five  or  six 
o'clock,  and  going  off  about  five  o'clock  in  the  morning.  This  is  com- 
mon to  all  constitutions  ;  nor  is  it  much  regulated  by  the  force  of  mor- 
bid habit,  but  rather  by  its  association  with  a  natural  evening  parox- 
ysm, to  which  all  individuals  in  health  are  liable,  and  which  happens 
and  subsides  about  the  foregoing  hours,  even  when  traveling  to  the 
eastward  or  westward  (§  772,  b).  This  natural  paroxysm  is  marked 
clearly  by  its  phenomena ;    and   the  foregoing  coincidence   shows, 


PATHOLOGY. FEVER DESCRIPTION.  495 

again,  how  the  physiological  laws  hold  their  control  in  disease  (§  133- 
152,  638).  A  coincidence  is  farther  seen  in  a  diminution  of  the  se- 
cretions attendant  on  the  natural  and  morbid  paroxysm.  A  purgative 
given  now,  whether  in  health  or  disease,  irritates  the  system  more 
than  at  any  other  time,  and  produces  smaller  evacuations  than  in  the 
morning,  especially  if  rapid  in  its  operation.  On  the  contrary,  in  ei- 
ther case,  if  the  cathartic  do  not  operate  till  morning,  the  discharge 
will  be  far  more  abundant.  Toward  morning  the  natural  paroxysm 
subsides,  sweating  often  comes  on,  and  all  the  functions  of  the  body 
and  mind  are  then  manifestly  improved.  And  so,  more  or  less,  with 
the  morbid  paroxysm.  The  former  is  not  connected  with  the  fatigue 
of  the  day,  since  it  is  common  to  mankind  under  every  condition  of 
repose,  employment,  and  habits. 

Again,  the  first  paroxysm  of  a  fever  may  take  place  at  any  period 
of  the  day ;  the  time  of  the  invasion  often  depending  upon  some  im- 
mediate exciting  cause.  But,  the  succeeding  ones  generally  coincide 
with  the  natural  evening  paroxysm ;  especially  in  continued  and  re- 
mittent forms  of  fever.  I  speak,  however,  of  the  disease  as  manifest- 
ed by  unembarrassed  Nature,  or  when  she  may  be  duly  assisted  by 
art.  Misapplied  remedies,  and  various  other  exciting  causes,  will  be 
apt  to  affect  the  periodical  law,  especially  where  Nature  is  least  re- 
cuperative, as  in  continued  and  remittent  fevers.  The  regularity  of 
the  paroxysm  is  also  influenced  by  local  congestions  and  inflamma- 
tions, and  this,  particulai'ly,  when  exciting  causes  are  in  operation  (§ 
773).  These  considerations,  independent  of  their  practical  bearing, 
refer  to  important  problems  in  the  philosophy  of  life  and  of  disease. 

The  paroxysms  of  fever,  therefore,  observe  a  diurnal  period  ;  rare- 
ly taking  place  in  the  night. 

768.  b.  The  foregoing  natural  paroxysm  extends  its  influences  to 
all  diseases,  and  influences,  also,  the  operation  of  remedial  agents. 

769.  If  a  paroxysm  return  two  or  three  times,  or  two  or  three  re- 
lapses take  place  at  short  intervals  (as  a  few  days,  or  perhaps  weeks), 
the  force  of  morbid  habit  is  manifested ;  since  in  one  case  the  parox- 
ysms continue  to  return  with  greater  obstinacy,  and  in  the  other  re- 
lapses are  more  likely  to  follow,  and  this,  often,  for  a  threat  length  of 
time  (§  535,  &c.,  768  a).  Much,  howevei",  may  be  frequently  due  to 
supervening  local  congestions,  which  keep  up  the  predisposition  to  fe- 
ver, and  operate,  also,  as  exciting  causes  (§  645,  665,  666,  870).  Where 
the  intervals  are  long,  the  return  of  the  fever  is  not  a  relapse,  but  a 
new  attack ;  though  this  is  truer  of  continued  than  of  intermittent  or 
remittent  fever.  And  this  leads  me  to  say,  that  any  remote  cause  of 
fever  is  less  apt  to  produce  a  relapse  than  to  excite  the  disease  in  one 
who  has  not  been  before  affected  (§  544,  550,  560,  &c.). 

770.  It  would  be  difficult  to  say  why  the  paroxysms  of  fever  are 
separated  by  definite  intervals,  and  these  intervals,  too,  remarkable 
for  their  variety  as  well  as  precision  in  the  same  form  of  fever.  They 
show  us  at  least,  however,  the  absurdity  of  expounding  disease  by 
any  of  the  laws  or  agencies  that  are  known  in  the  inorganic  world. 
These  definite  intervals  have  given  rise  to  several  designations  of  the 
same  form  of  fever;  and  according  to  the  interval  so  is  the  ty2)e.  We 
have  nothing  like  this  in  inflammations  (§  712-722,  764  e). 

771.  In  the  continued  form  of  fever,  and  in  remittents,  the  parox- 
ysms (or  exacerbations,  as  they  are  then  called)  recur  about  once  in 


496  INSTITUTES    OF    MEDICINE. 

twenty-four  hours ;  but  the  interval  is  more  indefinite  than  with  inter- 
raittents.  In  a  majority  of  the  cases  of  intermittent  fever  the  parox- 
ysms are  repeated  at  the  end  of  forty-eight  hours,  and  hence  the  name 
oi  tertian,  or  tertian  type.  The  next  most  common  are  quotidians,  or 
fever  with  daily  paroxysms  ;  each  one  taking  place  at  the  end  of  twen- 
ty-four hours.  A  third,  and  most  fixed  variety,  is  called  the  quartan, 
having  a  return  of  its  paroxysms  in  seventy-two  hours. 

772,  a.  Sometimes  there  is  a  periodical  difference  in  all  the  varie- 
ties, or  types,  of  the  intermittent,  of  four  hours ;  and  if,  as  now  and 
then  happens,  the  difference  be  greater,  the  fever  is  said  to  be  irregu- 
lar. These  irregularities  are  commonly  owing  to  local  congestions, 
or  other  accidental  influences,  the  removal  of  which  will  generally  es- 
tablish the  more  definite  interval. 

772,  b.  When  the  foregoing  deviations  occur,  the  paroxysms  may 
either  anticipate  the  usual  hour,  or  be  delayed  beyond  it ;  and  it  is  a 
remarkable  fact,  and  strikingly  illustrates  the  law  of  vital  habit  (since 
it  is  inobedient  to  the  influence  of  the  natural  paroxysm  of  health), 
that  in  such  cases  the  paroxysms  are  apt  to  go  on  with  the  particular 
irregularity  with  which  they  began  (§  544,  &c.,  768  a). 

772.  c.  Another  remarkable  fact  connected  with  the  intrinsic  nature 
of  the  vital  properties,  and  illustrative  of  the  special  institutions  of 
organic  life,  relates  also  to  the  inequality  of  the  foregoing  intervals. 
That  is  to  say,  if  the  interval  of  tertian  paroxysms,  for  example,  de- 
viate from  forty-eight  to  forty-six  hours,  or,  on  the  other  hand,  from 
forty-eight  to  fifty  hours,  the  occurrence  of  the  paroxysms  will  be 
growing  earlier  in  the  former  case,  and  later  in  the  latter.  But  this 
is  not  the  most  striking  phenomenon  attending  these  cases ;  for  when 
the  paroxysms,  by  their  regular  anticipation  of  the  period  of  each  last 
preceding  paroxysm,  approach  the  night,  one  paroxysm  is  often  lost. 
This  phenomenon,  however,  has  its  more  obvious  foundation,  as  the 
others  have  more  obscurely,  in  the  natural  law  of  the  body  already 
mentioned  (§  768,  o),  since  there  is  no  inherent  tendency  in  the  sys- 
tem to  induce  a  paroxysm  during  the  night  (§  137  b,  149-152,  638). 

773.  The  intermittent  and  remittent  fever  are  often  so  nearly  allied 
in  pathology,  that  it  is  sometimes  difficult  to  decide  upon  the  type. 
Here  the  deviation  from  the  regular  form  of  the  intermittent  is  clearly 
owing  to  the  presence  of  venous  congestions,  or  to  inflammation ; 
since  the  intermissions  will  become  well  defined  as  soon  as  those  com- 
plications are  removed  (§  758,  762,  768  a). 

774.  The  natural  duration  of  continued  fever  is  about  three  weeks, 
rarely  six.  It  varies  with  intermittents  according  to  the  particular 
type.  Such  is  the  power  of  vital  habit  (§  544,  &c.),  that  a  tertian  nat- 
urally occupies  from  three  to  four  months ;  and  this  is  one  of  the  nu- 
merous instances  in  which  the  advantages  of  medicine  are  illustrated, 
and  the  philosophy  of  solidism  established ;  since,  as  it  respects  the 
pathology,  an  emetic,  or  a  dose  of  quinine  (of  no  analogous  virtues), 
may  so  alter  the  morbid  properties  as  to  place  them  at  once  in  a  con- 
dition to  recover  their  natural  state  (§  557  a,  904  d). 

Much,  however,  of  the  prolongation  of  fever  is  often  due  to  the  lo- 
cal forms  of  disease  which  supervene  on  its  progress,  to  errors  in  diet, 
fatigue,  &c. 

775.  Opposed,  also,  to  the  humoral  pathology,  and  all  the  physical 
hypotheses,  is  the  occasional  sudden  termination  of  continued  and  in- 


PATHOLOGY. FEVER REMOTE  CAUSES.  497 

termittent  fevers,  in  a  state  of  health.  This  is  generally  preceded  by 
a  severe  paroxysm,  and  the  disease  is  ended  at  once  (§  557,  a).  The 
very  violence  of  morbid  action  is  attended  by  an  alteration  of  the  or- 
ganic properties  vi^hich  enables  them  to  take  on  the  recuperative  pro- 
cess; just  as  w^e  sometimes  see  alcoholic  stimulants  overthrow  acute 
inflammation,  or  the  same  conditions  of  fever  (§  756).  Will  the 
chemist  or  humoralist  explain  1  Fothergill,  Falconer,  and  others,  sup- 
posed that  the  full  and  tense  pulse  which  often  supervenes  on  apo- 
plexy depends  upon  a  struggle  which  arises  from  an  action  of  the 
vires  vitce.  to  restore  health.  "  I  believe,"  says  Fothergill,  "  it  hap- 
pens in  most  cases  where  there  has  been  a  temporary,  or  even  mo- 
mentary cessation  of  the  animal  powers." 

Remote  Causes  of  Fever. 

776.  I  come  next  to  the  remote  causes  of  fever,  and  to  consider, 
also,  yet  farther,  how  the  general  pathological  condition,  as  in  inflam- 
mation, is  liable  to  modifications  by  differences  in  the  nature  of  the  re- 
mote causes,  and  how,  also,  fever  is  influenced  by  coexisting  inflam- 
mations and  venous  congestions ;  with  a  view  to  farther  illustration 
of  principles  of  various  import. 

777.  The  predisposing  causes  of  idiopathic  fever  probably  consist, 
in  all  cases,  of  the  results  of  vegetable  decay  (§  652,  653).  The  spe- 
cial type  and  modification  of  the  fever  are  determined  very  greatly 
by  the  nature  of  the  new  combinations  ;  though  other  influences  may 
contribute  (§  650,  651,  758,  762,  773).  The  essential  causes  make 
their  impression  so  profoundly,  that  the  incubation  goes  on  althouo-h 
the  causes  may  have  long  ceased  to  operate ;  which  is  commonly  dif- 
ferent with  inflammations  (§  711,  &c.).  The  causes  of  fever  are  also 
distinguished  by  the  peculiarity  of  so  modifying  the  organic  properties 
of  certain  parts  by  their  direct  action,  that  the  entire  system  is  sympa- 
thetically brought  into  a  corresponding  morbid  state  (§  148,  657  h). 

778.  The  predisposing  causes  of  fever  have  been  considered  in  all 
their  other  relations  to  the  disease  under  that  general  division  of  pa- 
thology ;  their  modus  operandi,  the  nature  of  predisposition,  the  in- 
tervening periods,  &c.  (^  148,  644,  &c.). 

779.  The  predisposing  causes  of  fever  are  also  causes  of  inflamma- 
tion and  venous  congestion ;  and  hence  it  is,  in  part,  that  fever  rarely 
continues  long  without  the  appearance  of  one,  or  the  other,  or  both 
conjointly,  of  these  local  affections.  Or,  the  local  may  precede  the 
constitutional  disease,  and  become  its  exciting  cause  ;  or  the  former 
may  exist  without  developing  an  attack  of  the  latter,  although  the 
system  be  predisposed  to  the  constitutional  affection.  Or,  again,  the 
explosion  of  the  general  malady  is  very  apt  to  occasion  a  full  develop- 
ment of  the  local  conditions  of  disease  in  organs  so  predisposed.  But, 
independently  of  this  predisposition  to  local  disease,  it  is  the  great 
tendency  of  febrile  action  to  lay  its  foundation.  The  occurrence  of 
these  local  affections  modifies  very  variously  the  constitutional  disease, 
and  increases  its  force  and  obstinacy.  The  treatment,  therefore,  must 
turn  greatly  upon  the  local  complications,  and  remain  strictly  anti- 
phlogistic till  they  are  removed  or  greatly  subdued. 

780.  It  may  seem  remarkable  that  diseases  which  are  so  consider- 
ably diverse  in  theii-  pathological  conditions  as  fever  and  inflammation 
should  be  produced  by  the  same  predisposing  causes.     But  this  only 

I  r 


498  INSTITUTES    OF    MEDICINE.  * 

shows  that  there  are  analogies  among  all  diseases.  All  depend  upon 
certain  states  of  the  properties  of  lite  ;  and  as  these  propeities  can 
never  be  greatly  diverted  from  their  natural  conditions  till  life  is  at  its 
ebb,  there  must  be  affinities  among  all  morbid  states.  By  consider- 
ing, also,  that  the  vital  properties  have  various  natural  modifications 
in  different  parts  we  come  to  understand  how  the  predisposing  causes 
of  fever  may  simultaneously  predispose  particular  organs  to  inflamma- 
tion, or  venous  congestions  (§  133-152,  741  h,  767  a,  786,  &c.).  What 
I  have  said,  also,  in  former  sections  (§  662,  670,  675)  as  to  the  fluctu- 
ating state  of  the  vital  properties  and  functions  during  the  progress 
of  a  febrile  paroxysm  may  reflect  light  upon  this  subject  of  analogies. 

Pathological  Cause  of  Fever. 

781.  Coming  to  the  pathology  of  fever,  morbid  anatomy  yields  nu 
assistance,  and  proves  that  our  conclusions  as  to  the  essential  nature 
of  disease  must  be  mainly  derived  from  its  phenomena  during  life 
(§  695,  &c.).  It  is  therefore  not  remarkable  that  they  who  look  for 
the  philosophy  of  disease  to  its  direct  manifestations  should  alone  dis- 
tinguish idiopathic  fever  from  inflammation  (§  695,  &c.,  712-722,  757, 
759,  764,  770). 

782.  Next  to  the  proximate  cause  of  inflammation  no  question  in 
medicine  has  occasioned  more  speculation  than  that  of  fever.  The 
humoral  pathology  has  been  at  the  foundation  of  many  hypotheses, 
and  others  have  risen  upon  some  supposed  change  in  the  organiza- 
tion of  the  solids.  These  were  the  ancient  and  are  now  the  prevail- 
ing doctrines. 

783.  In  no  form  of  fever  do  the  symptoms  denote  an  absolute  un- 
varying affection  of  any  organ ;  but,  on  the  contrary,  the  greatest  va- 
riety occurs  as  to  the  force  of  the  disease  in  different  parts.  These 
contingencies  have  suggested  the  minor  designations  as  stated  in  sec- 
tion 758  (§  134,  138,  142,  143,  &c.). 

784.  a.  Fever  being  a  disease  of  the  whole  body,  and  constantly 
liable  to  complications  with  local  inflammations  and  venous  conges- 
tions, it  is  particularly  important  that  all  the  attendant  symptoms 
should  become  elements  in  forming  our  conclusions  as  to  the  nature 
and  force  of  the  disease,  both  in  a  general  and  local  sense,  and  that 
our  prescriptions  should  be  determined  by  the  aggregate  weight  of  the 
phenomena  (§  675).  Vicissitudes  may  be  also  hourly  occurring  in 
different  parts,  embarrassing  to  the  judgment  of  the  practitioner,  and 
demanding  its  highest  exercise  (§  675,  685,  686,  857), 

784,  b.  Owing  to  the  universality  of  the  disease,  and  the  general 
coincidence  in  its  pathological  character,  remedial  agents,  when  ap- 
plied before  morbid  habit  has  taken  possession,  or  local  inflammations 
have  supervened,  will  stretch  their  influence  over  the  universal  body, 
and  may  institute  every  where  those  pathological  changes  which  are 
capable  of  a  progressive  march  to  their  ultimate  termination  in  health 
(§  148-152,  487,  535,  &c.,  557,  672,  854,  893,  &c.). 

785.  It  is  the  triumph  of  morbid  anatomy  that  it  lays  open  to  the 
senses  the  tangible  products  of  inflammation ;  while  it  seizes  upon 
what  an  observation  of  Nature  had  already  determined  as  to  the  pa- 
thology of  the  disease.  The  great  family  of  fevers  shall  sustain  this 
position  of  the  vitalist,  since  here  nothing  is  seen,  in  numerous  cases, 
after  life  has  become  extinct.     The  knife  of  the  anatomist  goes  down 


PATHOLOGY. FEVER PATHOLOGICAL  CAUSE.        499 

to  tne  smallest  fibre,  and  the  aid  of  the  eye-glass  is  summoned  in  vain. 
And  yet  do  we  know  about  as  much  of  the  pathology  of  fever,  for 
pi'actical  purposes,  as  of  inflammation,  and  the  treatment  of  one  is  as 
well  determined  as  of  the  other  (§  705).  This  has  been  inferred  from 
the  vital  phenomena  of  both  diseases,  and  from  an  observation  of  the 
effects  of  remedies.  These  phenomena  are  not  less  multifarious  in 
fever  than  in  inflammation  ;  and  so  far  as  sensible  changes  attend  the 
immediate  instruments  of  disease  there  is  more  to  be  seen  in  febrile 
than  in  inflammatory  diseases.  In  both  there  is  commonly  an  in- 
creased volume  of  blood  circulating  in  the  capillaries ;  but  there  is 
also,  as  a  common  element  of  fever,  a  primary  contraction  of  those 
vessels.  What  I  have  now  said  is  the  test  between  organic  philoso- 
phy and  morbid  anatomy  (^  1056). 

And  how  is  it  with  the  signs  which  denote  the  essential  pathology  1 
We  have  seen  that  the  facts  are  equally  clear  in  both  diseases,  that 
there  is  an  exaltation  of  irritability  and  mobility  from  the  time  of  their 
invasion  (§  743,  744,  &c.).  But  that  is  all  we  can  leaiTi  of  the  partic- 
ular changes  which  they  undergo  in  either  affection,  and  that  is  only 
a  minor  part  of  the  disease.  The  organic  properties  and  functions 
have  also  sustained  a  change  in  kind,  which  is  likewise  known  by  the 
phenomena.  It  is  that  change  which  constitutes,  essentially,  the  dis- 
eases, respectively,  and  which  distinguishes  one  from  the  other  (§  177- 
181).  The  phenomena,  however,  do  not  indicate  the  nature  of  this 
essential*change  ;  but  what  they  disclose  as  to  the  exaltation  of  irrita- 
bility and  mobility,  in  connection  with  their  more  indefinite  sugges- 
tions, and  with  experimental  obsen^ation,  enables  us  to  institute  all  the 
pathological  and  therapeutical  principles  that  are  necessary  or  useful 
in  practice.  The  rest  is  concealed,  because  it  would  be  useless  for 
man  to  know  it.* 

The  cold  stage,  or  invasion  of  fever,  when  morbid  action  is  most 
profound,  is  marked,  it  is  true,  by  an  apparent  debility  of  the  living 
powers  ;  so  much  so,  indeed,  that  it  may  be  difficult  to  show  that  this 
universal  opinion  is  erroneous.  In  a  former  section,  however,  I  have 
attemj:)ted  it  (§  743).  Its  practical  importance  cannot  be  too  highly 
appreciated,  since  it  deters  the  practitioner  from  the  use  of  the  lan- 
cet, or  leads  him  to  that  of  stimulants  ;  especially  in  congestive  fevers 
(§  961,  &c.).  The  error  has  proceeded,  in  part,  from  the  very  fact 
which  evinces  an  exalted  state  of  irritability  and  mobility, — the  tonic 
contraction  of  the  capillary  vessels  during  the  cold  stage.  The  em- 
barrassed action  of  the  heart,  diminished  circulation,  sympathetic  in- 
fluences of  venous  congestions,  the  partial  loss  of  control  over  the  vol- 
untary muscles,  or  indisposition  of  the  will  to  act,  and  the  want  of  a 
proper  estimate  of  the  j^roperties  of  life,  and  of  the  morbid  changes 
to  which  they  are  liable,  have  contributed  their  share  to  this  mistaken 
view  of  the  pathology  of  fever.  Nothing,  however,  has  done  so  much 
toward  the  doctrine  of  "  debility,"  and  the  stimulant  treatment,  as  the 
impaired  energy  of  the  will  over  the  voluntary  muscles,  which  arises 
from  the  venous  congestions  that  are  associated  with  fever  (§  569,  487, 
488^).     I  shall  therefore  proceed  next  to  the  subject  of  Congestion. 

*  I  had  a  patient  whose  head  of  dense  black  hair  changed  in  the  course  of  one  night 
to  a  bright  bluish  turkey-ffreen,  as  the  result  of  remittent  fever.  He  recovered,  and  his 
hair  returned  gradually  to  its  former  black.  I  had  been  before  skeptical  as  to  the  re- 
puted effect  of  the  nervous  influence  when  excited  bj-  fear  in  changing  the  hair  sud- 
denly from  dark  to  white. 


500  /NSTITUTES    OF    MEDICINE. 


VENOUS  CONGESTION. 


78G.  The  pathology  of  venous  congestion,  its  treatment,  &c.,  form 
an  extensive  Essay  in  the  Medical  and  Physiological  Commentaries. 

For  all  that  relates  to  the  pathology  of  that  disease,  as  well  as  ol 
varix,  and  for  an  exposure  of  the  errors  of  former  doctrines,  and,  in- 
deed, for  most  that  is  essentially  important  in  that  Essay,  I  claim  the 
merit  of  an  exclusive  originality  (Rights  of  Authors,  p.  919,  no.  28.) 

787.  The  conclusions  at  which  I  have  arrived,  if  founded  in  nature, 
are  among  the  most  important  in  practical  and  theoretical  medicine ; 
since  the  conditions  which  obtain  in  venous  congestion  often  demand 
an  energetic  practice,  reveal  the  true  cause  of  the  extensive  mortality 
v/hich  has  resulted  from  the  stimulant  treatment  of  fevers,  and  enforce 
the  admission  of  some  of  the  most  important  doctrines  in  physiology 
(§  710,  b).  The  relation,  for  example,  of  the  pathology  of  venous 
congestion  to  the  philosophy  of  the  circulation  of  the  blood,  &c.,  illus- 
trates the  vital  character,  and  establishes  the  elements  of  that  com 
plex  function  (§  384-391). 

788.  During  the  last  century,  the  enlarged  state  of  the  veins,  which 
forms  the  prominent  characteristic  of  venous  congestion,  attracted  the 
attention  of  several  writers,  who  ascribed  a  malign  influence  to  the 
enlargement,  though  they  regarded  it  merely  as  a  mechanical  phe- 
nomenon. From  that  time,  till  a  recent  period,  this  state  of  the  veina 
was  lost  sight  of  entirely,  notwithstanding  it  contributes,  more  than 
the  recognized  forms  of  inflammation,  to  the  mortality  of  the  human 
race.  The  neglect  of  this  disease  in  our  own  times  probably  arises 
from  the  prevailing  disposition  to  interpret  organic  phenomena,  wheth- 
er healthy  or  morbid,  upon  chemical  and  mechanical  principles. 

789.  The  foregoing  enlargement  of  the  veins  is  an  essential  condi- 
tion of  the  disease,  though  of  minor  importance.  This  enlargement 
has  been  universally  referred  to  an  obstruction  of  the  current  of  ve- 
nous blood,  or  to  a  partial  relaxation  of  the  coats  of  the  veins  and  a 
stagnation  of  blood  within  them.  It  has  been  also  as  universally  sup- 
posed that  all  the  evil  results  of  this  disease  are  owing  to  the  accu 
mulated  or  stagnated  blood,  while  it  is  in  the  highest  degree  probable 
that  neither  the  enlargement  of  the  veins,  nor  the  increased  volume 
of  blood  within  them,  is  productive  of  a  single  morbid  phenomenon 
(§  748). 

790.  a.  The  enlargements  of  veins  which  are  produced  by  ligatures, 
hanging,  reflux  of  blood,  and  as  presented  in  the  "  circuitous  circula- 
tion" occasioned  by  the  pressure  of  tumors  or  obliteration  of  the  trunk 
of  a  vein,  are  in  no  respect  instances  of  venous  congestion,  although 
they  are  generally  adduced  as  the  most  palpable  examples  of  that  dis- 
ease. Nevertheless,  the  stimulus  of  distension  arising  from  pressure 
on  a  vein  may  give  rise  to  the  sub-acute  disease  which  constitutes  es- 
sentially congestion,  varix,  and  venous  hypertrophy ;  as  set  forth  in 
my  former  Essay. 

Four  mechanical  hypotheses  have  been  surmised,  to  meet  the  exi- 
gencies of  all  cases.  One  of  them  supposes,  that,  during  the  cold 
stage  of  fever,  the  blood  being  determined  from  the  centre  to  the 


PATHOLOGY. VENOUS  CONGESTION.  501 

circumference,  accumulates  about  the  heart,  and  then  regurgitates 
throughout  the  venous  system  of  the  internal  organs.  A  second  is 
similar  in  pi-inciple.  It  supposes  that,  at  other  times,  the  accumula- 
tion results  from  a  simply  diminished  energy  of  the  vis  a  tergo,  which 
is  inadequate  to  the  maintenance  of  a  free  circulation,  and  that  an  ac- 
cumulation of  blood  takes  place  in  the  veins  as  a  consequence.  A 
third  hypothesis  assumes  that  an  embarrassed  circulation  takes  place 
in  the  lungs,  by  which  an  obstruction  is  constituted  to  a  return  of 
blood  to  the  heart,  when,  also,  as  a  farther  consequence,  the  blood 
accumulates  in  the  veins  of  other  parts,  particularly  the  head.  The 
fourth  hypothesis  has  a  similar  mechanical  cause.  It  imagines  that 
venous  congestions  in  all  parts  are  owing  to  obstructions  occasioned 
by  hepatic  disease. 

I  have  shown  that  the  objections  to  all  the  foregoing  suppositions 
are  numerous  and  conclusive.  In  respect  to  those  of  a  general  na- 
ture, which  are  mostly  applicable,  I  may  now  say  that  it  is  obvious 
that  the  blood  would  accumulate  principally  about  the  right  cavities 
of  the  heart  alone,  and  not  in  the  veins  of  distant  organs.  Or,  should 
a  reflux  happen,  it  should  be  coextensive  and  equal  in  the  veins  of 
all  parts  at  equal  distances  from  the  heart.  On  the  contrary,  how- 
ever, venous  congestion  is  limited  to  particular  parts,  often  to  one  or- 
gan, which  may  be,  also,  distant  from  the  heart  or  supposed  centre  of 
obstruction.  It  is  often,  for  example,  the  brain  only  that  is  congested  ; 
where,  too,  accumulations  of  blood,  unless  from  disease  of  the  ve- 
nous parietes,  would  be  prevented  by  gravitation  alone.  Again,  also, 
were  there  any  foundation  for  these  hypotheses,  the  liver,  stomach, 
kidneys,  lungs,  &c.,  should  always  be  congested  whenever  the  brain 
is  the  seat  of  the  supposed  reflux  of  blood.  It  is  also  obvious  that, 
the  moment  an  equilibrium  is  restored  to  the  general  circulation,  as 
in  bloodletting,  the  volume  of  blood  should  be  equally  reduced  in  the 
veins  of  all  parts.  Contrary  to  this,  however,  the  veins  of  some  par- 
ticular organ  or  organs  often  continue  in  a  state  of  great  enlargement, 
as  in  the  brain,  &c. ;  while  the  central  accumulation  of  blood,  the 
supposed  cause,  is  now  completely  removed. 

790.  b.  So  indefinite  has  been  the  pathology  of  venous  congestion, 
that  injuries  attendant  on  falls,  and  those  prostrated  states  that  are  in- 
duced by  the  shock  of  surgical  operations,  have  been  regarded  as 
identical  with  profound  congestion ;  and  this  even  by  so  distinguished 
and  able  an  observer  as  Dr.  Armstrong.  This  great  error  in  theory 
may  explain  his  commendation  of  stimulants  in  aggravated  forms  of 
congestive  fever,  and  is  probably  one  of  the  causes  which  have  led  to 
their  more  indiscriminate  use  in  less  prostrating  conditions  of  the  dis- 
ease (§  970). 

791.  To  aiTive  at  the  true  pathology  of  venous  congestion,  as  well 
as  to  ascertain  the  powers  which  circulate  the  blood,  it  was  one  of 
my  primary  objects  to  show  that  the  state  of  the  circulation  in  con- 
gested veins  is  exactly  the  reverse  of  the  foregoing  supposition  (§ 
790) ;  that  is  to  say,  that  the  veins  are  in  a  state  of  active  dilatation, 
and  that  the  blood  circulates  freely  within  them.  (See  Comm.,  vol.  ii. 
Also,  §  382-394.) 

792.  I  have  shown,  also,  that  the  veins  are  susceptible  of  active  di- 
latation in  their  natural  state  from  the  local  irritation  of  stimulants; 
and  that  it  is  owing,  primarily,  to  this  action  of  the  veins  that  the^ 


502  INSTITUTES    OF    MEDICINE. 

swell  when  the  hand  is  immersed  in  warm  water  or  exposed  to  a  fire 
From  these  premises,  I  passed  on  to  a  demonstration  that  the  veins 
possess  an  exquisite  relation  to  the  communicating  arteries,  of  a  sym- 
pathetic nature,  and  by  which  they  dilate  actively  in  obedience  to  the 
action  which  exists  in  the  communicating  arteries,  and  the  quantities 
of  blood  which  may  be  transmitted. — See,  also,  ^  387. 

I  endeavored  to  show,  also,  that  when  the  veins  become  inflamed, 
as  in  acute  phlebitis,  or  in  the  sub-acute  state  of  venous  congestion, 
the  inflammation  of  their  coats  acts  as  a  stimulant,  and  thus  occasions 
an  active  dilatation. 

793.  Whatever,  therefore,  will  produce  any  degi'ee  of  inflammation 
in  the  venous  parietes,  will  be  a  remote  cause  of  dilatation ;  and,  al- 
though the  phenomenon  depend  upon  that  physiological  constitution 
of  the  veins  which  occasions  their  active  dilatation  when  increased 
quantities  of  blood  are  transmitted  from  the  arteries,  or  when  they 
are  irritated  by  simple  stimuli  (§  387),  there  is  a  wide  difference  in 
the  proximate  cause  of  the  morbid  and  the  natural  phenomenon.  In 
the  latter  case  there  is  simply  an  obedience  to  natural  influences, 
and  the  phenomenon  is  therefore  transient ;  in  the  former,  the  influ- 
ences are  morbid,  and  the  organic  properties  altei'ed  from  their  healthy 
standard,  and  the  dilatation,  therefore,  is  also  cotemporaneous  with 
the  disease,  or  until  the  vein  becomes  disorganized,  as  in  acute  phle- 
bitis. In  the  natural  state  there  is  also  an  increased  volume  of  blood 
constantly  transmitted  to  the  veins ;  in  the  morbid  the  increased  vol- 
ume depends  upon  the  enlargement  of  the  veins.  And  yet  the  mor- 
bid dilatation  has  the  physiological  constitution  for  its  foundation. 

The  following  example  shows  the  operation  of  the  natural  princi- 
ple. "  Cooks,"  says  Sir  B.  Brodie,  "  are  subject  to  varicose  veins. 
Wiiy  1  If  you  put  one  hand  into  warm  water,  and  the  other  into 
cold,  you  know  that  the  veins  of  the  former  become  dilated,  and  that 
those  of  the  latter  will  contract." 

This  is  a  clear  illustration  of  the  physiological  constitution  of  the 
veins,  both  as  to  active  dilatation  and  contraction.  But  it  goes  no  far- 
ther. The  dilatation  is  the  result  of  the  operation  of  a  healthy  vital 
stimulus,  and  depends,  in  part,  upon  a  constantly-increased  volume 
of  blood  which  is  transmitted  from  the  arteries,  as  set  forth  in  section 
387.  In  varix  there  is  no  such  increased  volume  transmitted,  nor  in 
phlebitis,  nor  in  venous  congestion.  The  dilatation  is  also  permanent 
in  the  latter  cases,  while  in  that  of  the  cook  it  subsides  as  soon  as  the 
stimulus  of  heat  is  withdrawn.  The  illustration  is,  indeed,  a  con- 
tradiction of  the  intended  philosophy,  since  cooks  are  not  subject  to 
varicose  affections  in  their  arms,  which  are  alone,  though  constantly, 
exposed  to  hot  water.  And  so  of  the  glass-blower.  It  is  nothing 
more  than  the  phenomenon  which  proceeds  from  exercise,  or  febrile 
action,  or  even  from  the  common  forms  of  inflammation ;  though 
slightly  modified  in  these  morbid  states  of  action.  The  example 
serves  to  confirm,  also,  what  I  have  taught  as  to  the  physiological  re- 
lations between  the  arteries  and  veins,  and  the  instrumentality  of  a 
great  principle  in  the  circulation  of  the  blood  (§  387). 

The  assumed  analogy  to  varix  in  the  foregoing  example  is  a  part 
of  the  common  mistake  of  confounding  the  physical  with  the  vital 
laws,  and  shows  the  untenable  nature  of  all  such  positions.  We  re- 
lax dry,  dead  matter  by  soaking  it  in  warm  water.     The  water  pen- 


PATIIOLOiiY. VENOUS    CONGESTION.  503 

etrales  the  substance ;  and  this  whether  wai'm  or  cold.  But  what 
would  be  the  effect  upon  the  cook  if  she  take  the  hand  from  the 
warm  water  and  place  it  with  the  other  in  the  cold  water  ] 

794.  The  venous  tissue  is  composed  of  three  coats  ;  the  inner, 
which  resembles  considerably  a  serous  membi'ane,  the  middle,  which 
possesses  longitudinal  fibres,  and  the  external  or  cellular  coat. 

The  inflammation  is  seated  mostly  in  the  inner  coat.  Contraction 
and  dilatation  are  effected  by  the  fibres  of  the  middle  coat ;  which,  be- 
ing longitudinal,  are  capable  of  producing  contraction  or  dilatation 
with  rapidity  and  uniformity  over  a  great  extent.  This  natural  pro- 
vision was  necessary  to  the  purposes  of  venous  circulation,  and  to  ac- 
commodate the  diameters  or  capacity  of  the  veins  to  the  suddenly 
and  constantly  varying  proportions  of  blood  transmitted  to  them  from 
the  arteries.  Circulation  could  not  be  performed  without  it ;  since, 
if  the  dilatation  of  the  veins  were  effected  by  the  supposed  mechan- 
ical distension  of  the  blood  when  increased  volumes  are  deteiTnined 
upon  them  by  the  arteries,  the  physical  resistance  of  the  veins  would 
impede  the  transmission,  and  the  subsequent  progress  of  the  blood. 
There  would  then  be  a  want  of  harmony  between  the  arteries  and 
veins,  which  would  constitute  a  fundamental  defect  in  organization. 
Nay,  more ;  this  harmony  reaches,  also,  to  special  modifications  of  the 
organic  properties  of  the  venous  tissue,  by  which  the  veins  are  ren- 
dered sensitive  to  the  varying  states  of  the  capillary  arteries,  and  to 
impressions  arising  from  the  varying  quantities  of  transmitted  blood 
(§  133,  &c.,  385). 

795,  a.  Now,  it  is  in  the  foregoing  peculiar  organization  of  the 
veins,  and  the  special  modifications  of  their  vital  properties,  that  all 
the  remarkable  phenomena  of  acute  phlebitis  and  venous  congestion 
have  their  foundation.  The  veins  dilate  actively  when  inflamed,  be- 
cause such  is  their  natural  function  when  impressed  by  stimuli,  espe- 
cially their  natural  stimulus,  the  blood.  Their  dilatation  is  permanent 
in  inflammation,  as  that  affection  operates  as  a  permanent  stimulus ; 
and  irritability  is  permanently  increased,  by  Avhich  the  blood  has. 
also,  a  preternatural  effect  (§  143,  &c.). 

795,  h.  From  the  exquisite  development  of  their  organic  properties, 
the  veins  are  extremely  liable  to  inflammation ;  especially  that  sub- 
acute form  which  constitutes  venous  congestion.  And  whether  their 
inflammations  exist  in  the  form  of  acute  phlebitis,  varix,  or  venous 
congestion,  it  is  always  diffuse,  extending  rapidly  over  the  venous  tis 
sue,  and  liable,  in  all  its  forms,  especially  of  phlebitis  and  congestion, 
to  give  rise  to  great  constitutional  disturbances.  The  diffuse  nature  of 
inflammation  is  partly  owing  to  the  natural  principle  by  which  the 
venous  tissue  has  an  associated  action  over  an  extensive  surface ;  and 
all  the  local  and  constitutional  phenomena  may  be  traced  to  the  pecu- 
liar vital  constitution  of  the  veins  (§  151,  &c.). 

Turning,  however,  to  the  arterial  system,  we  find  all  things  quite 
the  reverse,  and  referable  to  the  natural  vital  constitution  of  those 
vessels  (§  149,  &c.).  The  arterial  tissue  is  very  little  liable  to  inflam- 
mation, the  disease  is  always  very  circumscribed,  and  produces  but 
little,  or  no  constitutional  effect  (§  140,  526  a). 

796.  It  was  an  important  object  in  my  Essay  on  Venous  Conges- 
tion to  establish  satisfactory  analogies  between  acute  phlebitis  and  ve- 
nous congestion,  and  I  extended  the  analogies  to  varix  and  venous 


504  INSTITUTES    OF    MEDICINE. 

hypertrophy ;  and  in  so  doing,  as  well  as  by  the  specific  facts,  demon- 
strated the  inflammatory  nature  of  these  last  affections.  The  several 
conditions  were  thus  brought  to  illustrate  and  confirm  the  common 
nature  of  their  pathological  cause.  Nor  was  the  necessity  overlooked 
of  showing  the  fallacy  of  the  universal  doctrine  of  the  dependence  of 
varix  upon  local  obstructions  to  the  venous  circulation  and  stagnation 
of  blood,  nor  of  applying  to  practical  uses  the  true  pathology  of  varix 
(§  350|).  It  was  thus  shown  how  it  happens  that  tying,  or  dividing, 
varicose  veins,  is  so  often  followed  by  active  phlebitis. 

Besides  its  never  having  been  shown  that  any  obstructing  cause  ex- 
ists either  in  venous  congestion,  or  in  the  early  stages  of  varix,  if  any 
stagnation  of  blood  arose  from  other  causes,  the  valves  of  the  veins 
should  be  closed,  and  a  knotted  appearance  presented  at  the  several 
points.  Such,  indeed,  had  always  been  the  supposition  in  relation  to 
the  valves,  till  I  proved  it  otherwise.  While  the  blood  circulates,  the 
valves  are  necessarily  open  (§  391). — Rights  of  Authors,  p.  919. 

797.  Taking  the  most  simple  and  subdued  form  of  venous  inflam- 
mation, and  in  its  most  local  sense,  we  have  a  type  of  the  whole  by 
which  we  may  ascend  progressively  upward  till  we  reach  the  strong- 
ly-marked conditions  of  phlebitis,  without  losing  a  hold  upon  many 
striking  analogies  which  assure  us  that  the  common  feature  is  imparted 
by  venous  inflammation.  When  constitutional  influences  may  not  ob- 
tain, as  in  the  ordinary  conditions  of  varix,  there  are  still  present  the 
dilatation  of  the  veins,  their  long-continued,  unembai-rassed  circulation, 
their  ultimate  disorganization,  pain,  soi-eness,  liability  to  active  phle- 
bitis, &c.,  to  establish  the  intimate  relationship  of  varix  to  the  high- 
est grades  of  venous  inflammation,  and  to  throw  a  broad  light  over  the 
common  family,  however  they  may  be  removed  in  degrees  of  con- 
sanguinity. 

798.  It  is  also  an  important  practical  fact,  as  well  as  proof  of  the 
physiological  doctrine  of  venous  congestion,  that  this  affection  often 
springs  up  in  quick  succession  in  different  organs,  and  often  manifest- 
ly as  sympathetic  results  of  each  other  (§  525,  a).  The  same  is  also 
partially  true  of  active  phlebitis.  Apoplexies  are  often  remotely 
owing  either  to  irritation  of  the  stomach,  or  to  venous  congestions  of 
the  liver.  On  dissection,  we  find  in  most  of  the  cases  a  state  of  ve- 
nous engorgement  in  the  brain,  which  has  been  excited  sympatheti- 
cally by  one  of  the  foregoing  causes.  It  is  especially  to  hepatic  con- 
gestion, connected  with  peculiar  influences  of  external  predisposing 
causes,  and  the  law  of  sympathy  which  predominates  in  the  venous 
tissue  (§  387),  that  we  must  ascribe  the  epidemic  apoplexies  which 
have  been  described  by  numerous  writers  from  Hippocrates  to  our 
own  times.  And  how  absurd  would  be  the  conjecture  that  in  such 
apoplexies  there  happens  an  epidemic  mechanical  obstruction  to  the 
venous  circulation  of  the  brain,  and  where,  too,  gravitation  would  pre- 
vent all  accumulations  of  venous  blood,  were  it  not  for  the  active,  mor- 
bid dilatation  of  the  veins! 

799.  My  demonstration,  also,  of  the  essential  contribution  of  the 
derivative  or  suction  power  of  the  heart  to  venous  circulation  brings 
into  view  another  principle  which  must  tend  powerfully  to  prevent  all 
accumulations  of  blood  in  the  veins. — {Essay  in  Comm.  Also,  §  388- 
390.) 

800.  Passing  over  a  multitude  of  facts  which  I  formerly  embra 


PATHOLOGY. VKNOUS  CONGESTION.  505 

ced  in  the  foregoing  illustrative  proof  of  the  inflammatory  nature 
of  venous  congestion,  and  varix,  I  may  now  appeal  to  morbid  anato- 
my for  a  tangible  demonstration  of  my  conclusions.  But  this  ground 
is  too  extensive  and  circumstantial  for  the  objects  of  the  present  work  ; 
and  it  has  been  most  amply  explored  in  my  former  Essay.  It  is  wor- 
thy of  remark,  however,  that  the  blood  often  gravitates  from  congest- 
ed veins  of  the  liver  after  death  (p.  725,  note). 

801,  a.  Let  us,  therefore,  attend  next  to  a  more  practical  demon- 
stration, which  will  be  again  resumed  under  the  Philosophy  of  the 
operation  of  loss  of  blood  ;  namely,  the  appropriate  treatment  of  ve- 
nous congestion,  in  its  simple  forms,  and  as  complicated  with  idio- 
pathic fever.  There  is  no  practical  question  of  greater  moment,  none 
more  likely  to  be  decided  by  theoi'etical  principles,  and  none  where 
the  therapeutical  facts  settle  more  conclusively  the  nature  of  the  dis- 
ease, and  the  piinciples  which  should  guide  the  treatment. 

801,  b.  The  method  of  cui'e  had  been  either  empyrical,  or  Avithout 
a  sound  principle  to  guide  it,  till  my  Essay  was  published.  So  far  as 
the  mechanical  hypothesis  has  had  its  sway,  it  has  led  to  nothing  but 
error,  suffering,  and  death ;  since,  upon  that  ground,  stimulants  have 
been  the  remedies. — Notes  F  p.  1114,  S  p.  1124. 

Nevertheless,  experience  has  led  some  of  the  soundest  minds,  as  it 
has  many  in  regard  to  the  humoral  pathology  in  its  broad  application, 
to  disregard  the  dictates  of  hypothesis,  and  to  depend  upon  bloodlet- 
ting and  other  antiphlogistic  means  ;  and  the  result  has  proved  that 
they  are  the  only  successful  means.  But  there  was  little  of  this  prac- 
tice till  the  time  of  Armstrong,  and  even  this  philosopher  yielded  to 
the  mechanical  doctrine  in  those  intense  fOrms  of  the  disease  where 
loss  of  blood  was  most  imperatively  demanded  (§  4,  960,  961,  964 
1005).    Bloodletting  was  inculcated  by  the  ancient  masters. 

Now,  therefore,  antiphlogistic  means  being  the  remedies  for  inflam- 
mation of  other  tissues,  and  stimulants,  as  in  such  inflammations,  be- 
ing pernicious  in  venous  congestions,  they  concur  with  all  other  facts 
in  establishing  the  inflammatory  nature  of  this  disease. 

801,  c.  By  the  guide  of  the  pathology  and  principles  which  I  have 
indicated,  and  as  shown  by  the  results  of  the  best  and  the  worst  expe- 
rience, we  apply  ourselves  to  the  work  of  cure  with  an  intelligible 
object  before  us ;  nor  are  we  harassed  by  doubts,  nor  fluctuate  from 
experiment  to  experiment  (§  960,  1005).  There  is  a  specific  object 
in  contemplation,  the  only  principal  one  to  which  our  treatment  should 
ever  refer  (§  667,  &c.),  and  we  pursue  it  with  steadiness  of  purpose, 
and  without  the  alarm  or  those  imputations  of  imbecility  to  a  noble 
art  which  flow  from  the  mechanical  doctrine,  with  its  associated 
visions  of  debiliti/.  We  regard  the  sluggish  mood  of  the  will  as 
constituting  much  of  what  otherwise  seems  a  state  of  universal  weak- 
ness (§  487  h,  569,  743),  and  look,  as  in  all  other  cases,  with  the  calm- 
ness of  an  enlightened  understanding,  upon  an  insidious  and  powerful 
foe,  since  we  know  his  ambush  and  his  strength,  and  our  own  means 
of  circumvention  and  defeat. 

802.  As  to  the  incipient  seat  of  venous  congestion,  I  shall  only  now 
say,  that  farther  observation  has  sustained  the  opinion  which  I  ex- 
pressed, and  endeavored  to  enforce,  in  the  Co?)imeniaries,  that  there  is 
"  much  ground  for  believing  that  the  inflammatory  action  begins  in  the 
capillary  veins,  and  that  it  is  subsequently  propagated  to  their  trunks." 


506  INSTITUTES    OF    MEDICINE. 

Many  grounds  are  set  forth  for  the  conclusion,  some  of  which  were 
of  the  nature  of  principles  ;  such  as  the  extent  in  which  the  venous 
system  of  organs  is  generally  and  simultaneously  involved,  &c.  This 
also  corresponds  with  what  I  have  said  of  the  natural  function  of  these 
vessels  in  relation  to  the  varying  proportion  of  transmitted  blood. 

When  the  larger  veins  are  the  seat  alone  of  accumulated  blood, 
they  are  commonly  isolated,  as  in  varix.  Nor  does  venous  conges- 
tion affect  the  largest  series;  but  it  is  commonly  limited  to  some  com- 
plex vital  organ,  where  we  are  certain  that  the  capillary  veins  are 
more  highly  endowed  with  the  properties  of  life  than  in  parts  which 
are  less  instrumental  in  the  great  organic  piocesses,  and  where  re- 
mote causes,  external  and  internal,  may  therefore  operate  with  great- 
er intensity,  or  any  general  derangement  of  the  organ  may  develop  in 
the  venous  capillaries  the  supposed  morbid  condition.  The  termina- 
ting series  of  the  arterial  system  are  the  instruments  of  all  the  great 
vital  actions,  and  of  all  diseases, — of  venous  congestion  itself.  Anal- 
ogy, therefore,  as  well  as  the  general  office  of  the  veins,  and  their  an- 
atomical and  functional  alliance  to  the  terminating  series  of  arterial 
vessels,  show  us  that  the  organic  properties  of  veins  are  more  strong- 
ly pronounced  in  the  venous  capillaries  than  in  the  venous  trunks. 
And  yet  they  may  be  so  modified  that  inflammation  may  run  higher 
In  the  trunks  than  in  the  capillaries  (§  134,  387,  526  a). 

803.  Venous  congestion  often  passes  rapidly  into  inflammation  of 
other  tissues  with  which  the  congested  veins  may  be  associated ;  and 
both  forms  of  the  disease  frequently  exist  together  in  the  same  organ. 
This  remarkable  fact  of  the  ready  passage  of  venous  congestion  into 
inflammation  of  other  associate  tissues  grows  out  of  the  vital  relations 
between  the  veins  and  arteries  (§  387).  The  mode  of  propagation, 
therefore,  is  by  continuous  sympathy*  or  by  reflex  nervous  action.  The 
presence  of  inflammation  in  the  coats  of  the  veins  operates  either  di- 
rectly or  indirectly  as  a  stimulus  upon  the  communicating  arteries, 
through  the  foregoing  natural  relations  (§  802),  and  thus  becomes  a 
sympathetic  cause  of  inflammation  in  some  other  associate  tissue. 
The  nature  of  the  irritation  is  strongly  manifested  in  the  violent  pul- 
sations of  the  abdominal  aorta,  and  of  the  coeliac  and  carotid  arteries, 
in  hepatic  and  cerebral  congestion  ;  and,  I  may  add,  that  this  phenom- 
enon alone  would  establish  the  vital  nature  of  the  whole  assemblage 
of  movements  and  results.     It  is  the  result  of  continuous  sympathy.* 

804.  But,  while  the  foregoing  morbid  action  is  taking  place  in  tis- 
sues associated  with  the  congested  veins,  an  abatement  of  the  conges- 
tion or  venous  inflammation  is  simultaneously  going  forward.  This 
harmonious  process  involves,  also,  another  beautiful  exemplification 
of  reflex  nervous  action.  As  soon  as  the  supposed  influence  is  estab- 
lished upon  the  capillary  arteries  of  the  surrounding  tissues,  a  reaction 
of  sympathy  takes  place  in  the  veins,  by  which  the  morbid  state  is 
overcome  (§  143  c,  152,  524  c,  528,  657,  660,  905).  Their  contraction 
then  follows,  as  a  consequence,  and  "  the  balance  of  the  circulation," 
as  it  is  called  by  the  mechanical  theorists,  is  more  or  less  restored. 
This  salutary  reacting  sympathy  which  arises  from  the  supervening 
diseases  is  a  common  phenomenon.  Pulmonary  affections,  for  exam- 
ple, will  supervene  by  reflex  action  upon  gastric  disease,  and  simul- 
taneously operate  as  a  relief  to  the  stomach.  A  part  of  this  great  and 
universal  law  is  manifested  by  the  operation  of  blisters,  and  sometimes, 

•  Contimcovs  injluence  of  these  Institutes  (5 129  c,  /,  498  a). 


PATHOLOGY. VENOUS    CONGESTION.  507 

when  the  artificial  disease  subsides,  its  abatement  accelerates  the  decline 
of  the  natural  affection,  and  thus  exemplifies  the  law  of  reflex  nervous 
influence  in  its  compound  aspect  (§  733  e,  893,  90<5). 

Inflammation  of  other  tissues  is  also  an  exciting  cause  of  venous 
congestion,  and  here,  too,  the  primary  affection  is  apt  to  subside  when 
the  sympathetic  one  has  taken  place;  the  philosophy  being  the  same 
as  in  the  preceding  case  (§  638 J). 

Again,  active  phlebitis  of  the  liver  is  not  infrequent,  preceded  by 
symptoms  of  venous  congestion,  which  has  simply  passed  into  the  more 
active  state,  just  as  irritation  of  varicose  veins  will  excite  acute  phlebitis. 

805.  With  the  farther  object  of  illustrating  the  pathology  of  venous 
congestion,  as,  also,  to  ascertain  the  pathology  of  spontaneous  hemor- 
rhage, I  have  gone  into  a  critical  inquiry  relative  to  the  latter  subject 
in  two  Essays  embraced  in  the  Commentaries,  one  of  which  is  devoted, 
to  that  investigation  (vol.  i.,  p.  371-384  ;  vol.  ii.,  p.  546-566).  The 
subject  involves  some  physiological  and  therapeutical  principles  of 
great  moment ;  and  so  far  as  I  have  shown  the  general  dependence  of 
hemorrhage  upon  venous  congestion,  it  goes  with  my  other  facts  in 
establishing  the  inflammatory  nature  of  the  disease.  As  a  prelimina- 
ry step,  I  demonstrated  by  the  observations  of  mechanical  theorists, 
that  the  prevailing  physical  rationale  is  contradicted  by  their  owr. 
facts ;  that  it  is  very  rare  that  ruptured  vessels  have  been  detected  by 
the  microscope,  and  tliat  no  vessels  admit  the  transudation  of  their 
fluids  till  putrefaction  has  opened  the  way.  I  shall  now  only  add,  that 
I  have  variously  sho\vu  that  capillary  hemorrhage  is  not  only  the  re- 
sult of  a  vital  process,  but  is  analogous,  as  had  been  supposed  by 
Hunter,  to  that  of  secretion.  Prominent  examples  occur  in  purpura 
hemorrhagica,  in  petechial  fevers,  in  sanguineous  apoplexy,  haemop- 
tysis, &c.  (§  1002).— Note  Bbb  p.  1148. 

The  effusion  of  blood  is  the  result  of  a  salutary  effort  of  nature  to 
relieve  the  venous  inflammation  (§  732).  The  quantities  of  blood 
which  are  often  poured  out  in  this  condition  of  disease,  not  only  with 
safety  but  with  relief,  are  perfectly  astonishing,  and  such  as  would  be 
fatal  if  imitated  by  art.  We  may,  however,  well  take  a  lesson  from 
nature  as  to  this  her  antiphlogistic  treatment  of  venous  congestions, 
and  pause  over  the  administration  of  stimulants  to  revive  the  energies 
of  powers  when  prostrated  by  an  overwhelming  load  of  venous  inflam- 
mation, for  the  relief  of  which  nature  often  snatches  the  cure  from  the 
hand  of  art,  and  astonishes  the  stimulant  practitioner  by  a  stupendous 
and  successful  discharge  of  blood  (§  812,  1018,  1019).* 

806.  The  influences  of  venous  inflammation,  in  all  its  degrees,  are 
very  different  from  inflammation  of  other  tissues  (§  140).  The  gen- 
eral circulation,  for  instance,  is  apt  to  be  much  excited  in  common  in- 
flammations ;  but  in  acute  phlebitis,  and  in  venous  congestion,  the 
influences  are  quite  liable  to  be  of  a  depressing  nature,  especially  upon 
the  general  circulation.  This  is  generally  true  when  either  form  of 
the  disease  exists  in  its  greatest  intensity ;  and  the  phenomena  of  ex- 
citement obtain,  more  or  less,  when  these  forms  of  venous  inflamma- 
tion are  less  violent,  or  when  on  the  decline. 

Its  morbific  reflected  nervous  influences,  whether  it  be  acute  or  sub- 
acute, are  of  a  compound  nature ;    partly  the  exciting  influences  of 
inflammation  when  affecting  other  tissues,  and  partly  the  depressing 
effects  which  are  peculiar  to    morbid  changes  in    the  venous    tissue. 
*  See  Notes  F  p.  1114,  Ff  p.  1135,  Gg  p.  1138,  Ii  p.  1139. 


508  INSTITUTES    OF    MEDICINE. 

These  are  the  most  visible  results,  though  more  profound  changes  tako 
place.  The  predominance  of  these  two  manifest  influences  is  gener- 
ally on  the  side  of  the  depressing  effect,  in  the  stages  of  full  develop- 
ment ;  but,  in  what  may  be  called  the  chronic  state  of  venous  conges- 
tion, the  exciting  and  depressing  tendencies  seem  more  nearly  bal- 
anced. An  exception,  however,  should  be  made  in  respect  to  venous 
congestion  of  the  brain,  where  the  usual  exciting  influences  of  inflam- 
mation are  commonly  in  the  ascendant  (§  686  h,  974  c,  975).  It  fre- 
quently happens  that  a  very  decided  hardness,  incompressibility,  and 
considerable  fullness  of  pulse  attend  the  chronic  forms  of  hepatic  con- 
gestion, and  that  there  will  be  little  other  apparent  constitutional  dis- 
turbance, excepting  as  the  stomach  performs  its  ofiice  imperfectly,  the 
bowels  more  or  less  torpid,  &;c.,  and  that  these  cases  may  suddenly 
eventuate  in  a  very  aggravated  form ;  especially  if  miasmatic  fever 
happen  to  supervene.  The  character  of  the  pulse  then  undergoes  a 
very  striking  change ;  becomes  small,  accelerated,  loses  much  of  its 
hardness  and  incompressibility  (§  686  I,  688  d,  e).  A  chronic  state 
of  hepatic  congestion  is  often  the  forerunner  of  miasmatic  fever,  and 
one  of  its  exciting  causes  ;  the  local  predisposition  having  been  form- 
ed by  the  predisposing  cause  of  the  general  malady  (§  665,  813). 

807.  The  local  phenomena,  also,  are  apt  to  be  obscure  in  all  grada- 
tions of  venous  inflammation  ;  and  it  is  no  unusual  event  for  uterine 
phlebitis  to  terminate  fatally  without  its  presence  having  been  sus- 
pected ;  till  a  post-mortem  examination  has  revealed  a  disorganized 
state  of  the  uterine  and  iliac  veins,  attended  with  purulent  matter 
within  the  vessels.  And,  although  it  is  not  my  purpose  to  enter  into 
a  detail  of  symptoms  beyond  what  may  be  necessary  to  illustrate  the 
patholoo-y  of  venous  congestion,  and  the  general  principles  which  1 
have  in  view  (§  800,  b),  it  is  still  worthy  of  the  practical  remark,  and 
as  showing,  also,  the  special  constitution  of  the  venous  tissue,  that  it3 
inflammations  of  every  degree  are  apt  to  be  unattended  with  much  pain, 
or  tenderness  on  pressure  ;  excepting  when  in  the  form  of  varix,  which 
is  sometimes  very  painful,  and  often  tender  (§  725,  b).  An  absence  of 
those  common  phenomena  of  inflammation  of  other  tissues,  and  per- 
haps only  a  subdued  state  of  some  other  of  its  striking  symptoms,  iiot 
unfrequently  betray  the  unwary  into  a  false  security,  or  beguile  him 
into  the  fatal  belief  that  "  debihty"  is  the  worst  attendant. 

808.  Upon  my  theory,  therefore,  of  the  pathology  of  venous  conges- 
tion, we  see  more  and  more  an  admirable  concurrence  between  the 
morbid  phenomena  of  that  aflectiou  and  the  natural  physiological 
manifestations  of  the  venous  system  ;  and  we  arrive  through  the  phys- 
iological data  at  a  ready  interpretation  of  the  most  difficult  problems 
in  venous  congestion.  By  these  data  we  are  enabled  to  discover,  also, 
why  the  veins  of  the  external  parts  of  the  body  are  not,  like  those  of 
the  internal  organs,  subject  to  congestion,  but  rather  to  varix;  and 
why,  again,  an  acute  inflammation  of  a  large  internal  vein  is  often  lim- 
ited to  a  point  of  divergence  (§  133-152,  526,  576  d,  578  d,  579  b, 
721,  722,  794,  795). 

809.  It  is  owing  especially  to  the  foregoing  peculiarities  of  venous 
inflammation,  that  when  complicated,  either  in  its  form  of  acute  phle- 
bitis or  venous  congestion,  with  idiopathic  fever,  it  greatly  modifies 
the  phenomena  of  that  disease  ;  rendering  it  insidious,  obstinate,  and 
fatal  (§  651,  652,  722  c).     It  is  always  an  attendant  of  the  plague 


PATHOLOGY. VENOUS   CONGESTION.  509 

yellow  fever,  typhus,  cholera  asphyxia,  "  black  death,"  &c.,  and  im- 
parts to  them  much  of  their  peculiarities,  severity,  and  danger. 

810.  Venous  congestion  and  acute  phlebitis  not  only  steal  their 
march  in  ambush  (§  807),  but  often  throw  a  mask  over  constitutional 
fever,  or  present  their  own  characteristics  as  the  prominent  phenome 
na.  Hence  it  is  that  when  venous  inflammation  is  artificially  excited 
by  mechanical  injuries  of  the  veins,  or  by  irritating  injections,  the  re- 
sults are  said  to  resemble  those  of  typhus,  or  yellow  fever.  It  was 
this  illusion,  as  well  as  a  radical  defect  in  his  physiological  views,  and 
practical  obsers'ations,  which  betrayed  Magendie  into  the  experiment- 
al fallacies  recorded  in  a  foregoing  section  (§  744). — Note  S  p.  1124. 

It  will  be  also  observed  that  the  experiments  go  to  prove  the  de- 
pendence of  many  of  the  phenomena  of  typhus  and  yellow  fever  upon 
the  attending  venous  congestions. 

811.  The  foregoing  modifying  influence  of  venous  congestion  upon 
idiopathic  fever  (§  688  dd,  806,  810,  961,  &c.)  is  one  of  the  many 
clear  demonstrations  of  the  modifying  effects  of  local  disease  upon  the 
vital  states  of  the  whole  system,  illustrative  of  the  manner  in  which 
it  may  bring  all  parts  into  harmonious  relation  with  any  changes  which 
such  local  disease  may  effect  in  the  blood,  and  which  would  other- 
wise prove  morbific  (§  847,  g).  It  shows,  also,  how  the  entire  body 
may  be  rendered  susceptible,  through  morbific  influences,  to  the  ac- 
tion of  remedial  agents  which  might  be  otherwise  inert,  and  how,  when 
those  agents  exert  salutaiy  effects  upon  the  various  parts  that  may  be 
partially  influenced  by  some  local  malady,  the  morbidly  sympathizing 
parts  may  then  become  reacting  sources  of  salutary  impressions  upon 
the  more  absolute  seat  of  disease  (§  143,  149-152,  514  h,  638,  804. 
Also,  Med.  and  Phys.  Comm.,  vol.  i.,  p.  649,  653-655,  &c.). 

The  reflex  nervous  influences  of  venous  inflammation  being  of  a 
mixed  character  (§  806),  are  extended,  also,  over  the  phenomena  of 
any  coexisting  membranous  inflammation,  as  well  as  of  idiopathic  fe- 
ver ;  thus  presenting  still  farther,  in  their  delicate  shades  as  well  as 
prominent  characteristics,  the  complex  results  of  diff'erent  forms  of 
disease,  whether  existing  independently  or  in  connection  with  each 
other,  or  offering  a  striking  illustration  of  the  natural  modification  of 
the  properties  of  life  in  the  different  tissues  and  organs,  of  the  man- 
ner in  which  morbid  changes  in  any  common  disease  correspond  in 
peculiarities  with  the  natural  peculiarities  of  the  vital  properties  of 
the  tissue,  and  showing  how  reflex  nervous  influences  exerted  on 
remote  parts  correspond  with  the  peculiar  conditions  now  stated  (§ 
133-151,  191,  577,  578).  It  is  also  worthy  of  remark,  that  where  ve- 
nous congestion  is  complicated  with  inflammation  of  other  tissues,  it 
is  apt  to  lessen  the  hardness  and  force  of  the  pulse,  and  to  modify  the 
other  symptoms  which  are  usually  attendant  on  the  recognized  foiTn 
of  inflammation.  In  congestive  pneumonia,  and  epidemic  erysipelas, 
for  example,  it  so  far  disguises  the  usual  phenomena  of  the  associated 
inflammation,  that  practitioners  are  constantly  betrayed  into  the  fatal 
use  of  tonics  and  stimulants.  These  associated  conditions  supply, 
also,  a  good  exemplification  of  the  tendency  of  venous  inflammation 
to  maintain  the  pulse  within  a  limited  degree  of  that  hardness  and  in- 
compressibility  which  are  often  very  strongly  pronounced  in  inflam- 
mations of  other  tissues  (§  638i,  814,  1005  h). 

812.  Examples  of  independent,  isolated  forms  of  venous  conges- 


510  INSTITUTES    OF    MEDICINE. 

tion  are  constantly  seen  in  the  brain,  especially  of  children  and  ap* 
oplectic  subjects,  in  the  liver,  &c.  (§  790,  a).  But  the  most  prom- 
inent instance  occurs  in  purpura  hemorrhagica,  where  all  its  phe- 
nomena may  be  studied,  and  where  its  inflammatory  nature  may  be 
fully  ascertained,  particularly  if  not  complicated  with  fever,  or  with 
inflammation  of  other  tissues,  but  depending,  immediately,  upon  ex- 
tensive congestion  of  the  veins  (805,  1002  d). 

813,  a.  Venous  inflammation  in  the  form  of  congestion  is  occa- 
sioned more  frequently  than  inflammation  of  other  tissues  by  the 
predisposing  causes  of  .idiopathic  fever  (§  644,  &c.,  742,  &c.,  776, 
&c.).  Congestive  fevers  and  local  congestions  pi'evail,  therefore,  at 
the  same  time  and  places.  Both  may  also  prove  exciting  causes  of 
each  other  (§  712,  777,  &c.).  The  local  affection  may  exist  many 
weeks,  grow  into  a  state  of  intensity  without  being  suspected  (§  807), 
and  finally  give  rise  to  an  explosion  of  fever,  which,  from  the  mild 
ness  of  the  predisposition,  may  not  have  happened  but  for  the  exci- 
ting influences  of  the  local  disease.  The  fever  which  ensues,  though 
not  a  sympathetic,  but  an  independent  disease,  aggravates  the  local 
congestion,  and  gives  greater  intensity  to  its  symptoms ;  though  both 
conditions  may  coexist  for  some  time  in  great  force  and  obstinacy 
without  any  prominent  or  alarming  symptom.  These  Cases  are  not 
uncommon,  nor  is  it  a  rare  circumstance,  in  such  instances,  for  prac- 
titioners in  good  repute  to  stand  appalled  over  a  lifeless  body  where 
they  had  only  a  few  hours  before  predicted  an  early  convalescence ; 
and  if  the  morbid  anatomist  be  summoned  to  the  scene  of  disappoint- 
ment, chagrin,  and  distress,  he  seeks  in  vain  for  his  post-mortem  pa- 
thology, and  pronounces  a  malediction  upon  Nature,  or  upon  the  im- 
perfections of  science,  or  upon  the  imbecilities  of  art  (§  695,  &c.). 
"  Medical  philosophy  is  a  metaphysical  subtlety,  and  it  were  a  thousand 
times  better  to  confess  our  ignorance  than  to  give  up  our  senses." 

813,  h.  Since,  therefore,  miasmata  are  so  extensively  the  cause  of 
venous  congestion,  it  is  important  to  consider  that  its  exact  patholog- 
ical character  will  depend,  caeteris  paribus,  like  that  of  fever,  upon 
the  exact  nature  of  the  miasma  (§  653).  Hence,  also,  the  constitu- 
tional modifications  of  fever  by  venous  congestions  will  be  more  or 
less  determined  by  the  exact  pathology  of  the  venous  disease,  as  well 
as  by  the  general  effect  upon  the  system  of  the  miasmatic  agent  (§  644, 
&c.,  722  c). 

814.  The  considerations  which  have  been  now  made  enable  us  to 
understand  the  sources  of  those  numerous  modifications  which  distin- 
guish the  different  species  of  fever,  and  aid,  especially,  our  compre- 
hension of  their  connections  with  venous  congestion,  and  the  various 
modifying  influences  of  this  disease  upon  the  constitutional  affection. 
Depending  greatly  on  the  specific  nature  of  their  predisposing  causes, 
the  local,  as  well  as  the  constitutional  changes,  being  imbued  in  the 
several  cases  with  the  specific  influence  of  these  causes,  and  the 
general  characteristics  being  determined,  for  the  most  part,  by  the 
constitutional  affection,  the  incidental  venous  congestions  impart  yet 
another  general  resemblance  among  the  congestive  fevers ;  varying 
the  whole  from  their  simple  type,  and  often  more  or  less  confounding 
the  specific  phenomena  under  a  common  aspect  (§  638^,  811). 

It  is  upon  principles  which  I  have  now,  and  at  other  times  stated, 
that  we  may  understand  why  the  typhus  of  one  country,  or  of  one 


PATHOLOGY. VENOUS    CONGESTION.  511 

season,  lias  been,  under  equal  circumstances  of  treatment,  varied  in 
its  phenomena  from  that  of  another  ;  why  epidemic  scarlatina  and 
measles  are  more  fatal  than  the  simply  contagious ;  epidemic  erysip- 
elas more  so  than  sporadic;  why  the  inttjrmittents  of  Africa  are  more 
pernicious  than  those    of  other  countries  (§  630  e). — Note  Oo. 

815.  When  venous  congestion  so  far  disguises  the  attributes  of  idio- 
pathic fever  as  to  present  the  constitutional  phenomena  of  venous  in- 
flammation, there  is  no  condition  of  disease  which  demands  more  im- 
peratively enlarged  views  in  pathology,  a  deeper  scrutiny  of  symptoms, 
or  greater  moral  firmness  for  its  appropriate  treatment.  If  danger  be 
seen,  it  appals  the  timid,  and  prostrated  voluntary  power  urges  him 
to  the  fatal  use  of  stimulants  (§  487,  488^,  569).  Under  these  fearful, 
but  common  conditions,  the  presence  of  well-marked  inflammation  of 
other  tissues  contributes  to  the  safety  of  the  patient.  Such  inflamma- 
tions, however  undesirable  in  other  aspects,  tend  to  counteract,  for 
awhile,  the  depressing  influence  of  venous  inflammation,  to  lull  the 
imagination,  which  sees  nothing  but  "  debility,"  or  "  putrefaction,"  in 
the  prostrated  state  of  the  circulation  and  of  voluntary  motion,  and  in 
itself  sustains  the  powers  of  life  under  the  influence  of  depletive  rem- 
edies, which  alone  can  cure  ;  and  gives  the  last  remaining  hope  which 
may  be  inspired  by  the  unaided  vis  medicatrix,  but  which  may  be 
speedily  extinguished  by  tonics  and  stimulants  (§  662  h,  675,  686).* 

816,  a.  Venous  congestion,  being  mostly  occasioned  by  miasmata, 
prevails  in  its  local  form  simultaneously  with  congestive  fevers,  and 
independently  of  any  apparent  predisposition  to  the  latter.  In  this 
simple  condition  the  disease  is  most  apt  to  affect  the  abdominal  or- 
gans. Nevertheless,  it  is  evident  in  many  of  these  cases,  that  the  sys- 
tem is  also  imbued  with  a  predisposition  to  fever  (§  666).  In  a  still 
more  simple  form  it  is  common  in  cities  ;  particulai'ly  south  of  the  lat- 
itude of  forty  degrees.  It  seems  then  dependent,  also,  upon  malari- 
ous causes.  And  when  it  is  considered  that  the  liver  is  especially  the 
seat  of  venous  congestion  in  the  different  forms  of  congestive  fever,  and 
that  the  veins  of  this  oi'gan  are  quite  liable  to  acute  phlebitis,  and  that 
the  phenomena  of  each  are  often  analogous,  a  very  special  proof  is  thus 
supplied  of  the  correspondence  of  the  pathological  states  (§  390  b,  526  b, 
803,  809). 

816,  h.  Other  causes  of  malign  influence  may  be  transiently  no- 
ticed. The  disease,  for  example,  is  generally  an  accompaniment  of 
severe  forms  of  scarlet  fever,  appearing  then  mostly  in  the  liver  and 
intestinal  canal ;  when  it  is  also  badly  modified  by  the  predisjDoshig 
cause  of  the  more  specific  affection.  Again,  it  often  springs  up  as  a 
sequel  of  scarlet  fever;  when  it  is  also  imbued  with  the  lingering  in- 
fluences of  that  complaint,  and  presents  obstinate  and  difficult  prob- 
lems for  the  practitioner.  It  is  still  the  digestive  organs  that  suffer 
its  invasion ;  and  now  it  not  unfrequently  leads  to  inflammatory  afl^ec- 
tions  of  the  peritoneum,  or  of  the  cellular  tissue  of  the  surface,  which 
ends  in  dropsical  eff"usions  ;  or,  as  when  coexisting  with  scarlatina, 
glandular  swellings  may  suddenly  supervene  about  the  neck.  This 
is  especially  true  if  the  intestinal  canal  be  often  subjected  to  the  irri- 
tation of  mercurials,  which  are  apt  to  be  of  a  peculiarly  morbific  na- 
ture in  scarlatina  (§  689,  I),  Gastric  irritations  in  childhood  are  com- 
mon causes  of  hepatic  and  cerebral  congestions  ;  and  in  many  adults 
there  is  a  constitutional  predisposition  to  cerebral  congestion  which  is 
*  See  Note  S  p.  1124. 


512  INSTITUTES    OF    MEDICINE. 

apt  to  terminate  in  sanguineous  apoplexy.  Various  kinds  of  poisons, 
animal  and  vegetable,  healthy  and  morbid,  give  rise  to  venous  con- 
gestions ;  each  one  imparting  some  peculiar  shade  of  difference  to  the 
affection  (§  721,  722).  Such  is  the  case  with  the  narcotic  poisons, 
alcohol  (in  delirium  tremens),  hydrocyanic  acid,  the  poison  of  dissec- 
tion wounds,  the  wourari,  &c.  {§  662,  c). 

All  the  foregoing  causes,  excepting  miasmata,  produce  the  local 
forms  of  venous  congestion;  which  is  therefore  never  complicated 
with  idiopathic  fever  when  proceeding  from  those  causes  (§  653). 

817.  Looking  back  upon  the  attributes,  the  causes,  the  constitu- 
tional effects,  and  the  morbid  anatomy,  of  venous  congestion,  and  con- 
sidering what  is  yet  to  be  said  of  its  treatment  (§  961,  &c.),  we  find 
a  great  amount  of  proof  in  favor  of  the  vital  doctrine  which  I  have 
propounded  as  to  the  pathology  of  this  disease.  As  in  inflammations 
of  other  tissues,  the  causes  are  such  as  make  their  impressions  upon 
the  properties  of  life.  We  see,  also,  in  like  manner,  even  a  greater 
variety  of  modifications  of  the  phenomena,  corresponding,  also,  with 
the  special  nature  of  the  predisposing  causes.  We  see  the  disease 
influenced  by  peculiarities  of  climate,  habits,  constitution,  age,  &c., 
and  constantly  arising  with  or  without  fever  in  some  places,  while  it 
is  rare  in  others.  It  affects  the  robust  far  more  frequently  than  the 
weak ;  high  livers,  the  sanguine,  and  especially  tipplers,  more  than 
the  temperate  and  other  constitutions.  We  see  it  slaying  the  morbid 
anatomist,  while  its  remote  cause  has  been  concealed  in  a  wound 
which  no  microscope  can  discover.  We  see  it  springing  up  in  the 
brain  in  obedience  to  the  specific  relations  of  many  agents  to  that  or- 
gan ;  narcotic  poisons,  alcohol,  prussic  acid,  carbonic  acid  gas,  &c. 
We  see  it  coexisting  with  affections  of  a  distinctly  inflammatory  char- 
acter, as  measles,  small-jDox,  scarlatina,  &c.,  always  increasing  their 
violence,  and  adding,  according  to  the  nature  of  the  principal  disease, 
to  their  fatality,  as  when  complicated  with  idiopathic  fever.  Or,  if  it 
supervene  on  common  derangements  of  other  parts,  those  maladies 
are  such  as  predispose  to  inflammation  of  other  tissues.  Nor  has 
morbid  anatomy  detected  a  cause  of  obstruction,  nor  can  reason  sur- 
mise a  cause  for  a  single  instance  in  the  midst  of  the  variety ;  but' 
where,  on  the  contrary,  the  variety  alone  of  predisposing  causes  de- 
molishes the  whole  fabric  of  the  mechanical  pathologists. 

If  we  turn  to  active  phlebitis,  or  admitted  inflammation  of  the  veins, 
we  find  it  equally  depending  upon  the  predisposing  causes  of  venous 
congestion,  and  both  diseases  often  associated  in  the  same  organ,  or 
presenting  themselves  together  as  complications  of  idiopathic  fever, 
and  often  making  demonstrations  of  the  same  phenomena.  Shall  we, 
therefore,  in  one  case,  impute  the  phenomena  to  a  simple  mechanical 
fullness  of  a  limited  portion  of  the  veins,  while  in  the  other,  we  refer 
the  analogous  symptoms,  and  the  venous  enlargement,  to  a  local  dis- 
ease whose  pathology  is  settled  upon  the  broad  basis  of  organic  ac- 
tion 1 

The  treatment  is  yet  in  resen^e  as  contributing  largely  to  the  com- 
prehensive philrsophy  of  bloodletting,  and  as  demanding,  more  than 
any  other  disease,  that  summary  remedy.  Let  us,  therefore,  study 
the  pathology  of  venous  congestion,  as  of  inflammation,  through  the 
philosophy  of  the  operation  of  loss  of  blood,  and  the  analogies  which 
are  supplied  by  its  effects  upon  all  other  inflammatory  conditions ; 


PATHOLOGY. VENOUS    CONGESTION.  513 

nor,  when  deliberating  upon  these  profound  and  important  topics,  let  us 
neglect  the  coincidences  in  the  adverse  effects  of  tonics  and  stimulant?. 
818.  I  now  dismiss  the  great  subject  of  venous  congestion  ;  than  which 
none  greater  can  undergo  the  attention  of  the  philanthropist  or  the  med- 
ical philosopher.  But  he  may  not  bring  to  its  investigation  any  fancied 
analogies,  nor  any  of  the  laws,  or  other  conditions  of  the  inorganic  world. 
He  must  start  with  all  the  philosophy  of  organic  life,  carry  it  all  into  the 
depths  of  the  subject,  and  finally  try  the  grand  result  by  the  test  of  thera- 
peutical principles.  He  will  then  have  found  that  he  has  accomplished 
a  study  of  the  most  elaborate  character,  and  where  medical  philosophy 
is  presented  in  its  most  difficult  but  elevated  aspects.  He  will  have 
cleared  up  the  way  to  all  other  obscurities  in  medicine,  and  have  obtained 
a  key  by  which  he  will  acquire  a  ready  access  to  most  of  the  arcana  of 
organic  beings. 

REVIEW  OP  THE  PHILOSOPHY  INVOLVED  IN  THE  FOREGOING  DISCUSSION 
OP  THE  REMOTE  AND  PATHOLOGICAL  CAUSES  OF  DISEASE,  AND  OF  THE 
SPECIAL  CONDITIONS  KNOWN  AS  INFLAMMATION,  FEVER,  AND  VENOUS 
CONGESTION,   AS  IT  RESPECTS^THE  NERVOUS  SYSTEM. 

818 1.  Throughout  the  foregoing  field  I  have  endeavored  to  expound 
the  operation  of  the  remote  causes  of  disease,  whether  of  an  external  or 
internal  nature,  and  of  all  remedial  agents,  which,  in  either  case,  exert 
their  effects  upon  parts  remote  from  the  seat  of  their  direct  action,  through 
the  natural  laws  of  reflex  actions  of  the  nervous  system,  and  have  endeav- 
ored to  demonstrate  variously  modifying  influences  of  those  causes,  and 
according  to  their  special  characteiistics,  upon  the  nervous  power  which 
is  thus  brought  into  a  preternatural  and  alterative  condition  (§  222-233|, 
498-514,  894-905,  etc).  Every  distinct  external  cause  we  have  seen 
to  possess  certain  peculiarities,  or  as  two  or  more  may  operate,  and  ac- 
cording to  their  individual  or  combined  properties  the  nervous  power 
will  be  modified  and  thus  governed  in  its  production  or  removal  of  dis- 
ease, so  far  as  this  agent  is  concerned  ;  and  the  same  philosophy  applies 
to  those  internal  remote  causes  which  consist  of  the  various  forms  of 
local  disease,  or  any  other  internal  cause,  such  as  the  passions,  when 
they  exert  morbific  effects.  In  the  former  cases  the  effects  depend  upon 
reflex  actions  of  the  nervous  system,  by  which  the  modified  nervous 
power  is  brought  into  alterative  action ;  in  the  other  series  of  cases,  or 
that  of  the  passions,  and  diseases  of  the  nervous  centres,  the  development 
of  the  modified  nervous  power  is  not  reflex  but  direct.  The  philoso- 
phy is,  however,  as  I  have  sho^^^l,  precisely  the  same  in  both  cases,  the 
only  difference  being  that  in  the  one,  or  that  o^  reflex  action,  the  sensi- 
tive nerves  participate,  while  they  do  not  in  the  other.  The  latter, 
therefore,  I  designate  as  direct  action,  or  direct  sympathy,  the  former  as 
remote  and  contiguous  sympathy,  or,  simply,  sympathy.  These  terms,  and 
sympathetic  influences  also,  are  wanted  to  express  the  functional  influences 
of  the  foregoing  processes,  especially  their  morbific  and  therapeutical, 
and  as  being  brief  and  comprehensive.  The  terms  remote  and  contiguous 
sympathy  were  introduced  by  John  Hunter,  and  predicated  of  the  phe- 
nomena, and  their  import  is  perfectly  understood,  even  by  the  communi- 
ty, and  sympathy  as  far  back  as  Hippocrates,  and  are  exactly  adapted  to 
all  that  has  been  recently  ascertained  as  to  the  nervous  mechanism  through 
which  the  function  is  performed,  whether  reflex  or  direct  (§  222-233f, 
495-500  I,  500  o-514  m,  6381,  894-905,  etc.). 

K  K 


514 


INSTITUTES    OF    MEDICINE. 


THE  HUMORAL  PATHOLOGY. 


819,  a.  "  To  what  errors  have  not  mankind  been  led  in  the  employment  and  denominar 
tion  of  medicines  ?  They  created  deobstruents  when  the  theory  of  obstruction  was  in 
fasliion ;  and  incisives  when  that  of  the  thickenings  of  the  humors  prevailed  (§  748,  7S9). 
The  expressions  of  diluents  and  attemiants  were  common  before  this  period.  When  it 
was  necessary  to  blunt  the  acrid  particles,  they  created  inviscants,  i7icrassants,  &c. 
Those  who  saw  in  diseases  only  a  relaxation  and  tension  of  the  fibres,  the  laxum  and* 
slrictwn  as  they  called  it,  employed  astringents  and  relaxants  (§  569,  b).  Refrigerants 
and  heating  remedies  were  brotight  into  use  by  those  who  had  a  special  regard  in  dis- 
eases to  an  excess  or  deficiency  of  caloric  (§  433,  &c.).  The  same  identical  remedies  have 
been  employed  under  different  names,  according  to  the  manner  in  which  they  were  sup- 
posed to  act.  Deobstruent  in  one  case,  relaxant  in  another,  refrigerant  in  another,  the 
same  medicines  have  been  employed  with  all  these  opposite  views  ;  so  true  is  it  that  the 
mind  of  man  gropes  in  the  dark,  when  it  is  guided  only  by  the  wildness  of  opinion"  (§  4) 
— BiCHAT's  General  Anatomy  applied  to  Physiology  and  Medicine,  vol.  i.,  p.  17. 

"  Among  physical  people,''  says  Hunter,  "  we  find  such  expressions  in  common  use  as, 
the  humors  are  affected  in  the  blood ;  sharp  humors  in  the  blood ;  the  whole  humors  being 
ill  a  bad  state  ;  the  whole  blood  7iiust  be  alteredi  or  corrected ;  and  a  vaiiety  of  such  expres- 
sions without  meaning.  They  ev(!n  go  so  far  as  to  have  hereditary  humors,  as  gout,  scrof- 
ula, &c. ;  and  make  us  the  parents  of  our  own  humors,  saying  that  we  breed  bad  humors. 
Humors  are  even  supposed  to  gravitate  to  the  legs  slowly ;  and,  in  short,  the  whole  theory 
of  disease  has  been  built  upon  tlie  supposition  of  humors  in  the  blood,  or  the  blood  itself  be- 
ing changed.  I  cannot  conceive  what  is  meant,  unless  it  be  that  a  strong  susceptibility 
to  a  specific  disease  exists;  as  small-pox  may  bring  on  scrofula,  or  a  strain  the  gout."— 
Hunter's  Lectures  on  the  Principles  of  Surgery,  11th. 


Affirmative. 

1.  "  Various  animal  poisons,  such  as  those 
of  the  snake  tribe,  and  different  mineral  poi- 
sons, as  mercuiy,  for  instance,  act  upon  the 
blood.  Those  derangements  of  functions  and 
organs  produced  by  the  experimenter,  when 
he  introduces  different  deleterious  substan- 
ces directly  into  the  blood,  are  likewise  those 
that  are  produced  by  the  sting  or  bite  of  cer- 
tain animals  ;  they  are  also  those  that  take 
place  in  small-pox,  measles,  and  scarlatina, 
of  a  malignant  nature,  as  it  is  called.  They 
are  the  same  derangements  that  appear  in 
persons  exposed  to  putrid  emanations,  vege- 
table or  animal,  and  to  miasmata  from  the 
bodies  of  other  persons  that  are  themselves 
diseased  and  crowded  in  confined  places, 
iVc.  Lastly,  they  show  themselves,  also,  in 
individuals  whose  blood  is  only  imperfectly 
or  badly  repaired  by  insufficient  or  unwhole- 
some diet." 

2.  "There  takes  place  a  vitiation  o{  the 
blood  by  the  commixture  of  deleterious  sub- 
stances ;  next,  in  consequence  of  such  vitia- 
tion, an  alteration  of  the  functions  of  the 
nervous  system  ;  and,  lastly,  the  blood  that 
supports  the  organs,  and  the  nei-vous  sys- 
tem that  animates  them,  having  suffered  a 
geneial  injury,  a  constant,  though  not  al- 
ways appreciable,  modification  of  these  or- 
gans in  their  functions,  or  in  their  texture." 

3.  "  Diseases,  resembling  many  of  the 
preceding  (no.  1)  in  their  s3Tnptoms,  or  in 
the  appearances  discovered  after  death,  are 
not  unfrequently  occurring  where  no  delete- 
rious  substance  has  been  introduced  into  the 
blood,  and  in  which  there  is  no  direct  proof 
that  any  alteration  of  that  fluid  has  been  the 
primary  cause  of  the  morbid  phenomena. 
Here,  as  in  the  preceding  case  (no.  1),  it  ap- 
pears tliat  the  primary  cause  of  the  disease 
thould  be  referred  to  the  blood,  whicli.  in  this 


Negative. 

A.  "  The  VITAL  FORCES  appear  to  be  af- 
fected primarily  by  a  gi'eat  many  poisons, 
by  the  vegetable  or  animal  emanations, 
known  by  the  name  of  miasmata,  and  by 
various  modifications  of  the  external  agents 
which  are  incessantly  acting  upon  us,  such 
as  a  want  of  due  exposure  to  the  sun,  too 
damp  an  atmosphere,  and  an  unwholesome 
diet." 

5.  "  In  every  disease  not  immediately  pro- 
duced by  external  violence,  the  symptoms 
that  occur  depend  either  on  a  lesion  of  the 
forces  that  animate  every  living  part,  or  on 
a  lesion  of  organization  (§  177,  189  b).  The 
former  is  primary  and  constant ;  the  latter 
is  secondary,  variable  in  its  nature,  and  in- 
constant in  its  existence." 

6.  "  No  one  solid  can  undergo  the  slight- 
est modification  without  producing  some  de- 
rangement in  the  nature  or  quantity  of  the 
materials  destined  to  fonn  the  blood,  or  to 
be  secreted  from  it." 

7.  "  Until  it  is  proved  that  the  forces 
which,  in  a  living  body,  interrupt  the  play 
of  the  natural  chemical  affinities,  main- 
tain a  proper  temperature,  and  preside 
OVER  the  various  actions  of  organic  and  ani- 
mal life,  are  analogous  to  those  admitted  by 
natm-al  philosophy,  we  shall  act  consist- 
ently with  the  principles  of  that  science, 
by  giving  distinct  names  to  those  two  kinds 
OF  FORCES,  and  employing  ourselves  in  cal- 
culating the  DIFFERENT  LAWS  they  obey." 

"  The  qualities  of  pus  are  modified  by 
every  alteration,  whether  physiological  or 
pathological,  which  takes  place  in  any  other 
organ,  even  though  it  have  no  particular  con- 
nection either  of  function  or  tissue.  Thus 
we  have  all  seen  instances  of  the  pus  se- 
creted by  the  surface  of  a  sore  becoming 
suddenly  altered  in  quantity   and  quality 


PATHOLOGY. HUMORALISM.  .        515 

Affirmative.  Negative. 

case,  lias  altered  its  nature  under  the  influ-  under  the  inflaence  of  a  simple  moral  emo- 
ence  of  unknown  catisen,  as  it  has  in  the  otli-  tion,  of  the  process  of  digestion,  or,  in  short, 
ers,  in  consequence  of  the  commixture  of  of  any  supei-veuing  disease.  Nay,  farther, 
various  substances." — Andral's  Pathologi-  there  are  certain  constitutions,  certain  idio 
cal  Anatomy.  syncrasies,  which  modify  the   qualities  of 

pus,  and  in  which  it  constantly  assumes  a 
peculiar  aud  detenninate  character." — An- 
deal's  Pathological  Anatomy. 

yi9,  h.  I  HAVE  thus  brought  into  contrast  the  prominent  doctrines 
of  the  distinguished  individual  w^ho  enjoys  the  honor  of  having  re- 
stored the  humoral  pathology,  with  the  same  intentions  that  led  me  to 
a  similar  display  of  the  chemical  philosophy  in  its  applications  to 
physiology,  pathology,  and  therapeutics,  according  to  the  exact  quan- 
titive  method  of  the  laboratory  (§  350,  350i,  350^,  350|,  350f  a-gg, 
438-442,  447y^448y).  I  have  done  this,  I  say,  because  of  the  gen- 
eral alliance  of  the  whole  philosophy,  and  its  almost  universal  sway 
in  Great  Britain  and  France,  urged  on  by  the  powerful  influence  of 
the  Parisian  School,  of  the  British  Association  for  the  Advancement 
of  Science,  of  the  British  and  Foreign  Medical  Review,  the  Med- 
ico-Chirurgical  Review,  the  London  Lancet,  and  other  periodicals  of 
less  importance  (§  5|  a,  349  d,  350;^  k,  JcJc,  709,  note).  In  consider- 
ing the  causes  which  have  led  to  the  subversion  of  medical  philos- 
ophy, we  should  steadily  distinguish  the  projectors  from  those  who 
give  the  impulse  and  who  govern  public  sentiment.  It  will  be  read- 
ily seen  by  every  discerning  mind,  from  my  analysis  of  doctrines, 
and  from  what  I  have  shown  of  the  absence  of  all  method,  of  all 
consistency,  and  the  manifest  want  of  any  definite  conceptions,  in  the 
chemical  and  physical  doctrines,  from  the  intermixture  of  vitalism, 
solidism,  chemistry,  humoralism,  mechanical  philosophy,  &c.,  as  the 
basis,  individually  and  collectively,  of  exactly  the  same  laws,  that  if 
the  systems  which  are  thus  projected  had  been  permitted  to  address 
themselves  to  the  reason  of  mankind  truth  would  have  enjoyed,  at 
least,  an  equal  chance  with  error.  But,  the  opposing  school  decided 
that  it  should  be  otherwise ;  and  nothing  remains,  therefore,  to  the 
few  who  have  been  thus  overlooked  in  the  haste,  but  to  disarm,  if 
possible,  the  adversary,  and  turn  his  own  weapons  against  him.  These 
weapons,  in  the  phraseology  of  science,  are  facts,  and  upon  his  own 
"  facts"  the  great  questions  at  issue  might  be  safely  rested.  The 
whole  matter,  indeed,  must  ultimately  turn  upon  this  species  of  ev- 
idence. The  theories  naturally  follow.  As  the  mind  becomes  en- 
lightened about  the  nature  of  the  premises,  there  will  be  no  diflSculty 
in  distinguishing  between  the  fair  and  the  false  in  theory.  In  all 
medical  philosophy,  where  so  much  is  controverted,  truth  cannot  be 
attained  without  a  simultaneous  survey  of  the  ground-work  of  error 
as  well  as  of  truth ;  or  if  the  latter  take  its  chance  upon  its  Heaven- 
born  rights,  it  is  sufficiently  known  that  it  cannot  remain  long  in  the 
ascendant  (§  1  h,  5\  c). 

820,  a.  I  thought  it  an  object  of  importance  to  examine  the  whole 
ground  of  the  humoral  pathology  in  the  former  work,  which  I  had 
devoted  to  the  high  branches  of  medicine,  according  to  the  best  of 
my  humble  efforts.  I  shall  now  rather  invite  an  attention  to  what 
I  have  there  presented,  than  enter  again  upon  any  circumstantial 
view  of  the  subject.  But,  independently  of  the  important  objects 
set  forth  in  the  preceding  section,  the  present  work  would  be  defec- 


516  •  INSTITUTES    OF    MEDICINE. 

live  in  its  plan,  should  all  regard  be  neglected  for  a  doctrine  sc 
widely  embraced  by  the  educated  physician  in  common  with  the  ig- 
norant pretender,  and  so  broadly  opposed  to  the  solidism  which  lies 
at  the  foundation  of  these  Institutes  (§  1  h,  3501). 

Moreover,  there  was  not  extant,  till  the  appearance  of  the  Com- 
mentaries^ any  representation  of  the  doctrines  of  Humoralism,  ex- 
cepting such  as  might  be  gathered  from  the  writings  of  its  masters, 
or  from  disquisitions  of  a  desultory  nature  by  its  opponents. 

820,  h.  The  restoration  of  humoralism  is  an  impi'essive  exemplifi- 
cation of  the  popularity  of  simple  views  when  brought  into  contrast 
with  systems  of  philosophy  that  concern  profound  institutions  of  Na- 
ture, since  it  unavoidably  associates  itself  with  that  identical  ratioci- 
nation which  is  the  pai'ent  of  empyricism,  but  which  the  more  enlight 
ened  party  can  only  recognize  as  the  offspring  of  ignorance. 

The  essential  facts,  however,  which  are  relative  to  the  great  foun- 
dations of  Nature,  especially  in  her  organic  department,  have  been 
too  familiarly  known,  and  their  laws  too  well  comprehended,  to  ad- 
mit of  any  important  innovations  in  medicine  that  shall  long  retard 
its  progress,  or  rescue  the  projector  from  a  certain  oblivion.  The 
beaten  path  is  the  only  road  to  usefulness  and  enduring  fame ;  but  to 
achieve  the  latter  requires  the  patient  toil  of  the  botanist  who  looks 
for  eclat  in  the  discovery  of  an  unknown  plant  within  the  environs  of 
London.  Enlightened  genius  attempts  no  other  route.  It  is  alone 
the  ambition  of  narrow  mind,  or  the  conceit  of  genius  in  its  limited 
observation,  that  aspires  at  revolutions  in  philosophy.  Hence  the  de- 
sertion, by  the  former,  of  that  path  for  the  old  by-ways  which  lie 
obscured  in  the  mists  of  antiquity ;  while  the  latter  strikes  out  sys- 
tems of  such  eccentricity  as  command,  for  awhile,  universal  admira- 
tion (§  350,  3501,  350i). 

820,  c.  Without,  however,  attempting  now,  as  on  a  former  occasion, 
to  assign  more  extensively  the  ground  of  the  foregoing  conclusions,  I 
si.all  briefly  add  that  I  know  of  no  recent  attempted  innovation  upon 
the  philosophy  of  organic  nature,  whether  under  its  healthy  or  moi'- 
bid  aspects,  and  as  that  philosophy  recognizes  the  principles  of  vital- 
ism and  solidism,  but  has  prevailed  more  or  less  at  former  eras,  and 
has  been  so  abandoned  and  eradicated  that  it  now  comes  up  again 
with  the  interest  and  power  of  novelty.  And  it  comes  to  us  again 
without  having  changed  in  one  essential  aspect  its  old  thread-bare 
livery.  That  this  should  be  so  is  owing  to  the  absence  of  all  efforts 
to  refute  the  erroi's,  excepting  as  transiently  made  in  the  form  of 
opinions,  and  imbodied  in  the  perishable  journals  of  the  day, 

821,  a.  The  humoral  pathology  having  higher  pretensions,  from  its 
dignified  relations  to  the  past,  than  its  kindred  hypotheses,  should  al- 
ways secure  for  itself  a  patient  hearing,  and  a  full  refutation  (§  1  h. 
3501,  and  Rights  of  Authors,  p.  919,  no.  21). 

821,  h.  In  the  brief  review  which  I  now  propose  the  question 
should  be  first  settled  as  to  the  main  doctrine  of  the  present  humor- 
al ists.  This  was  so  accurately  done  in  my  Essay  on  the  Humoral 
Pathology  that  the  Medico-Chirurgical  Review,  which  was  addicted 
to  that  Pathology,  quoted  my  exposition  of  the  main  principle,  and 
allowed  that  it  was  "  fairly  stated."     The  following  is  the  passage  : 

"  The  question  at  issue  is  not,  whether  the  blood  becomes  diseased 
by  a  morbid  action  of  the  solids ;  and  the  solidist  is  sui-prised  that  the 


PATHOLOGY. HUMORALISM.  517 

defense  of  humoralism  should  often  turn  upon  labored  attempts  to 
prove  what  every  body  admits.  Nor  is  it,  whether  vitiated  blood,  or 
putrid  matter,  will  excite  disease  when  injected  into  the  veins.  The 
question  at  issue  is,  whether  foreign  viorhijic  causes,  and  remedial 
agents,  in  their  ordinary  modes  of  operation,  produce  their  primary  ef- 
fect upon  the  solids  or  upon  the  blood,  and  the  latter  become  the  cause 
of  disease  in  the  former ;  whether  we  '  have  hereditary  humors,  as  gout, 
scrofula,^  Sfc,  and  whether  we  are  '  the  parents  of  our  own  humors,  and 
that  we  breed  bad  humors,^  "  &c. — M.ed.  and  Physiolog.  Comm.,  vol. 
i.,  p.  636. 

In  the  same  Essay  I  have  quoted  many  recent  authors,  as  setting 
forth  the  doctrine  in  exact  conformity  with  its  ancient  impurities,  and 
as  promulgated  in  the  newspapers  of  the  day.  A  paragraph  em- 
braces all  that  is  essential  in  the  science  of  medicine ;  or,  should  the 
facts,  the  basis  of  the  science,  form  an  accompanying  part,  the  whole 
is  comprised  within  a  moderate  pamphlet  entitled  "  Organic  Chemis- 
try in  its  Application  to  Physiology,  Pathology,  and    Therapeutics^ 

821,  c.  It  may  be  interesting  to  some  should  I  annex  the  precise 
tnodus  operandi  of  morbific  agents,  as  expressed  in  almost  every  work, 
ancient  and  recent,  which  recognizes  the  humoral  pathology.  The 
learned  and  distinguished  Dr.  Hosack  shall  speak  for  the  school  and 
its  imitators.     Thus : 

"  That  '  a  little  leaven  leaveneth  the  whole  lump'  is  as  true  in  fevers 
as  in  making  bread,  or  in  the  conversion  of  acescent  fluids  into  acetic 
acid  ;  and  that  upon  the  same  principle  of  assimilation.  That  one 
spoiled  herring  will  taint  the  whole  cask,  is  well  known  to  every 
housewife  or  fish-monger.  Hence  the  gi-eat  care  of  the  Dutch  in  theii 
herring  fisheries  to  salt  down  their  fish  as  soon  as  they  are  taken. 
They  never  permit  the  sun  to  rise  upon  them"  (§  830,  b).  And  so, 
also,  the  chemists  (§  350,  nos.  44,  45). 

Although,  as  will  be  seen  by  the  references,  the  exact  chemical 
school  differ  from  the  foregoing  in  respect  to  the  modus  operandi  of 
the  mind  and  passions,  they  agree  as  to  the  physical  agents  ;  even  to 
the  Dutch  herring  (§  349  e,  350,  no.  44,  &c.).  So  far  as  these  illus- 
trations go,  it  must  be  in  justice  admitted  that  they  are  peculiar  to  the 
walks  of  science,  and  are  the  rightful  trophies  of  "  experimental  phi- 
losophy."    "  Qui  meruit  palmam"  &c. 

In  connection  with  what  I  have  now  said  should  be  taken  the  details 
of  the  philosophy  as  expounded  by  its  late  restorer,  which  may  be 
seen  in  the  introductory  matter,  and  in  subsequent  sections. 

Such,  then,  by  universal  admission,  is  the  philosophy  of  humoralism; 
and  that  it  has  no  better  foundation  I  have  endeavored  to  demonstrate 
in  my  former  Essay  (§  4,  Z»).* 

822.  On  the  other  hand,  what  says  the  solidist?  He  tells  us  that, 
however  simple  the  foundation  (§  638),  disease  and  its  cure  depend 
upon  the  most  intricate  system  of  laws ;  far  beyond  any  thing  in  the 
inorganic  world  :  That  these  laws  are  associated  with  properties 
which  are  peculiar  to  organic  beings,  and  determine  all  their  natu- 
ral processes  :  That  all  morbid  conditions  consist  essentially  in  alter- 
ations of  the  properties  and  functions  of  the  solid  parts  :  That  altera- 
tions of  the  blood  are  only  consequences  of  these  essential  changes  ; 
That  all  practical  medicine  consists  in  restoring  these  solids  to  their  nat- 

*  The  philosophy  and  illustrations  (including  "the  stimulating  plan")  remain  un- 
changed, 1860. —  Vide  the  late  and  standard  British  works  of  F.  W.  Headland,  R.  B. 
Todd,  and  J.  H.  Bennett.    Also,  notes  p.  462,  872. 


518  INSTITUTES    OF    MEDICINE. 

ural  state,  witliout  leference  to  the  existing  condition  of  the  blood,  ex- 
cepting in  the  aspect  of  symptoms  :  That  it  is  only  through  the  agency 
of  the  renovated  solids,  whose  morbid  state  had  affected  the  condition 
of  the  blood,  that  this  fluid  can  be  in  any  respect  diverted  from  its 
modified  conditions,  or  restored  to  its  integrity. 

Finally,  we  are  told  by  the  solidist  that  medicine,  in  any  one  of  ita 
branches,  cannot  be  taught  in  the  compass  of  a  pamphlet. 

823.  There  are  some  eight  or  nine  principal  positions  taken  by  the 
present  humoralists  in  the  way  of  tangible  proof.  With  the  exception 
of  the  second  following,  they  are  the  same  as  are  disseminated  in  the 
books  of  the  older  writers.  They  are  now,  for  the  first  time,  con- 
densed into  a  methodical  order  from  extended  disquisitions  in  the 
Commentaries ;  namely : 

1.  That  substances  deleterious  to  life  have  been  known  to  be  taken 
into  the  circulation  through  the  lacteals  (§  826). 

2.  That  gaseous  and  fluid  substances,  having  an  affinity  for  each 
other,  permeate  and  unite  through  a  dead  animal  membrane  (^  827).* 

3.  That  morbific  agents,  when  inserted  in  wounds,  give  rise  to  dis- 
eases in  various  parts  (§  828). 

4.  That  injections  of  various  substances,  and  morbid  blood,  into  the 
circulation,  produce  disease  in  the  solids,  and  occasion  death  (§  830). 

5.  That  when  many  substances,  as  salt  and  acids,  are  mixed  with 
the  blood  out  of  the  body,  they  affect  its  sensible  character  apparently 
like  the  changes  which  happen  to  the  blood  when  circulating  in  the 
living  organism  (§  832). 

6.  That  when  certain  substances,  such  as  yeast,  are  added  to  dead 
organic  compounds,  like  vegetable  infusions  and  dough,  they  create 
an  intestine  commotion.  The  example  of  a  putrid  fish,  which  is  of 
the  same  nature  as  the  preceding,  contaminating  a  barrel  of  sound 
ones,  has  been  lately,  as  formerly,  adduced  in  high  quarters  to  prove 
the  soundness  of  humoralism  (§  833). 

7.  That  the  blood,  in  certain  conditions  of  disease,  undergoes  changes 
in  its  appearance  ;  especially  in  refusing  to  coagulate,  and  in  being  of 
a  dark  color ;  and  that  chemists,  also,  have  sometimes  detected  a  va- 
riable composition  (§  834,  p.  780,  ^  1029). 

8.  That  morbid  changes  occur  in  the  secreted  and  excreted  prod- 
ucts (§  835). 

9.  That  diseases  are  transmitted  from  parent  to  child  (§  836). 

10.  That  remedial  agents,  when  injected  into  the  circulation,  some- 
times produce  the  same  effects  upon  particular  organs  as  when  ad- 
ministered by  the  stomach  (§  837). 

11.  That  certain  vegetable  tonics,  containing  an  astringent  princi- 
ple, will  increase  the  physical  strength  of  dead  muscles,  vessels,  mem- 
branes, &c.  (§  842). 

824,  a.  So  far  as  my  knowledge  extends,  the  foregoing  admitted 
facts  constitute  the  entire  foundation  of  humoralism ;  and  it  will  be 
seen  that  not  a  single  one  of  them  has  any  sound  relation  to  physiol 
ogy  !  But  what  do  they  prove  1  Nothing  whatever  beyond  the  sim 
pie  fact  affirmed  by  each  proposition  (§  5\).  No  one  of  them  has  the 
least  bearing  upon  the  questions  relative  to  the  natural  operation  of 
morbific  causes,  nor  of  remedial  agents  when  employed  according  to 
the  only  methods  that  are  sanctioned  by  nature  or  by  art.  We  have 
also  before  us  a  remarkable  display  of  the  general  habits  of  mankind 

*  By  a  violent  process  it  may  be  done  throu-ili  -  living  one. 


PATHOLOGY. HUMORALISM.  519 

in  respect  to  the  value  of  evidence  in  that  sense  which  Nature  has  or- 
dained as  the  basis  of  her  institutions.  Here  we  see  nothing  but  a 
factitious  assemblage  of  analogies  for  the  foundation  of  great  princi- 
ples in  medicine,  devised  by  those  very  philosophers  who  condemn  all 
conclusions  in  this  science  that  are  predicated,  in  other  systems  of  phi- 
losophy, of  those  analogies  which  are  impressed  upon  the  face  of  Na- 
ture. Nor  is  it  less  worthy  of  remark,  that  the  school  in  chemistry, 
who  aspire  at  more  exact  applications  of  analogy  to  the  healthy  and 
morbid  processes  of  the  living  being,  borrow  the  whole  from  the  in- 
organic world,  and,  for  its  better  success,  condemn  this  method  of  in- 
duction as  employed  by  the  vitalists  in  their  study  of  organic  phe- 
nomena. 

824,  b.  Most  of  the  foregoing  premises  in  humoralism  are  brought 
into  view  in  various  parts  of  this  work  in  their  appropriate  relations  to 
special  principles  in  physiology,  pathology,  and  therapeutics  ;  and 
the  subjects  are  too  extensive  for  elaborate  consideration.  In  the  Es- 
say embraced  in  the  Commentaries  they  have  been  subjected  to  all 
the  examination  which  farther  experience  and  reflection  would  enable 
me  to  bestow. 

825,  Humoralism,  however,  has  now  become  so  generally  preva- 
lent, and.  is  sustained  by  so  powerful  an  array  of  "  authorities,"  and 
as  my  own  writings  afford  the  only  systematic  view  of  the  subject,  I 
shall,  for  the  advantage  of  the  young  inquirer,  present  such  a  condens- 
ed and.  connected  statement  of  my  grounds  of  objection  as  will  enable 
him  to  comprehend  the  misapplication  of  facts,  and  to  apply  them  in 
the  manner  which  appears  to  have  been  ordained  by  nature  (§  5^). 
I  shall,  however,  introduce  other  facts  and  arguments,  that  they  may 
be  taken  in  connection  with  the  former,  and  shall  simplify  the  subject 
by  adopting  a  method  in  conformity  with  the  foregoing  propositions 
(§  823).  But  it  will  be  my  object  to  bring  into  view  the  great  jmn- 
ciples  which  bear  upon  the  several  specific  statements,  either  directly, 
or  by  reference  to  other  sections.  These  references,  therefore,  will 
form  an  important  part  of  the  investigation,  as  they  connect  it  with 
various  principles  and  facts  in  physiology  (§  639,  a). 

826,  a.  As  to  the  first  proposition,  that  substances  deleterious  to 
life  have  been  taken  into  the  circulation  through  the  lacteals,  I  ob- 
ject, that  the  phenomenon  is  rare,  that  it  has  been  mainly  ascertained 
of  certain  mineral  substances,  and  that  these,  as  allowed  by  the  chem- 
ists, are  eliminated  by  the  kidneys  in  from  five  to  fifteen  minutes  after 
their  absorption  (§  280).  The  lacteals,  on  the  contrary,  elect,  with 
astonishing  precision,  the  nutritive  chyle,  and.  reject  the  rest.  This  is 
due  to  the  exquisitely-modified  irritability  of  these  vessels ;  just  as 
has  been  seen  of  a  like  provision  in  the  glottis,  the  pyloric  orifice,  and 
vessels  which  exclude  the  red  globules  of  blood  (§  191,  192).  Nor 
can  we  too  much  admire  the  Wisdom  which  embraced  in  one  univer- 
sal Design  the  general  good  of  the  organism  by  so  endowing  the  lac- 
teals that  they  shall  exclude  all  things  which  are  not  in  harmonious 
relation  to  the  special  vital  states  of  every  other  part  (§  274-295). 

When  such  substances  effect  their  entrance  through  absorbing  ves- 
sels, it  is,  as  we  have  seen,  by  modifying  their  irritability,  and  thus 
establishing  relations  with  them ;  just  as  undigested  food  escapes  a 
morbid  pylorus,  or  the  red  globules  of  blood  enter  the  serous  vessels 
in  inffammations.     Bile,  &c.,  are  incapable  of  producing  such  modifi- 


520  INSTITUTES    OF    MEDICINE. 

cations  of  the  lacteals,  and  are,  therefore,  forever  excluded.  Here, 
too,  morbific  or  remedial  agents  act  in  their  concentrated  state,  and 
supply  a  ground  for  interpretation,  through  reflex  nervous  action,  of 
the  remote  phenomena  ;  while  the  little  that  may  gain  the  general  cir- 
culation is  so  diluted,  and  so  soon  excreted,  as  to  be  worthless  in  our 
estimate  of  causes  (§  1089). 

826,  h.  It  should  be  also  considered,  that,  notwithstanding  the  ra- 
pidity with  which  foreign  matter  at  all  offensive  to  the  organism  is 
eliminated  by  the  excretory  organs  (§  280),  the  blood  and  entire  body 
may  have  undergone  many  renewals  between  the  application  of  the 
predisposing  cause  and  the  explosion  of  disease ;  that  hydrophobia 
may  not  supervene  for  months  or  for  years,  fever  for  a  year  or  more, 
and  may  then  return  at  annual  periods ;  that  salivation  may  follow  a 
very  minute  quantity  of  mercury,  and  may  be  continued  long  after  the 
saliva  and  other  secretions  have  flowed  in  great  redundancy,  &c. ; 
while,  on  the  other  hand,  the  interpretation  of  their  modus  operandi, 
accoi'ding  to  the  philosophy  which  I  have  propounded,  is  in  perfect 
harmony  with  every  principle  advanced  in  these  Institutes,  and  in- 
vites the  severest  scrutiny.  In  connection,  also,  with  these  topics 
should  be  considered  all  that  I  have  expounded  of  the  laws  of  sympa- 
thy, vital  habit,  constitution,  acclimation,  temperament,  &c.  As  to  the 
oft-alleged  smell  of  garlic  in  the  excretions,  of  the  coloring  matter  of 
madder  in  the  bones,  or  of  the  bile  in  all  parts  of  the  body,  they  are 
among  the  most  attenuated  of  material  substances,  and  are  inoffensive 
to  the  lacteals  and  the  general  organism.  (See,  also,  il^e<i.  «wcZ  PA?/5- 
iolog.  Comm.,  vol.  i.,  p.  523-557,  576-581,  589-594,  599-608,  &c.) 

826,  c.  Nor  should  it  be  neglected,  that  there  is  no  agreement  among 
chemists  as  to  some  of  the  most  important  morbific  and  remedial  agenta 
which  have  been  said  to  gain  a  ready  admittance  to  the  circulation. 

826,  cc.  Why  is  the  pulse  always  consulted  in  all  forms  of  disease 
and  after  all  remedies  %  Is  it  to  find  out  how  far  the  blood  is  affected, 
or  whether  the  remedies  be  duly  absorbed,  or  whether  the  heart  or  ar- 
teries be  the  seats  of  disease  ?  Consider  the  unceasing  modifications 
of  the  heart's  action,  and  of  the  arteries  too,  as  brought  about  by  dis- 
eases of  all  parts,  and  by  medicines,  and  by  mental  emotions,  and  mark 
the  coincidences,  and  you  will  allow  that  you  "  feel  the  pulse"  simply 
to  learn  the  nature  of  the  reflex  nervous  influences  which  remote  dis- 
eases inflict  upon  the  circulatory  organs,  and  to  thus  find  out  the  na- 
ture and  force  of  those  diseases,  or  equally  in  the  case  of  medicine  what 
reflex  nervous  influences  they  institute  either  mediately  or  immediately. 
If  such,  then,  be  our  objects  in  feeling  the  pulse,  why  is  not  the  same 
philosophy  applicable  when  diseases  spring  up  consecutively,  or  when 
morbific  causes,  acting  upon  surfaces,  light  up  diseases  in  the  internal 
organs?  In  the  former  cases  you  "feel  the  pulse"  for  the  purpose 
alone  of  ascertaining  the  nature  and  extent  of  the  disturbing  or  mod- 
erated reflex  nervous  actions,  whether  you  know  it  or  not,  and  in  the 
latter  cases  the  analogy  is  supported  by  all  the  pathological  and  thera- 
peutical facts,  and  especially  so  by  the  staring  fact  that  powerful  irri- 
tants, like  tartarized  antimony,  which  occasion  violent  disturbances 
when  conveyed  into  the  circulation,  break  down  inflammations  and 
high  arterial  excitements  Avhen  applied  to  the  intestinal  mucous  mem- 
brane (§  829,  902  g,  904  hh)*  Why  is  the  tongue,  like  the  pulse,  always 
expected  to  supply  information  as  to  the  diseases  of  other  parts  and  the 

*  The  universal  custona  of  "  feeling  the  pulse"  is  a  remarkable  example  of  an  equall 
universal  unconsciousness  of  the  philosophy  which  relates  to  the  subject. 


PATHOLOGY. HUMORALISM.  521 

salutary  or  injurious  effects  of  remedies  ?  Can  any  other  rational  solu- 
tion be  offered  than  that  which  I  have  presented  in  relation  to  the  heart 
and  arteries  (§  500  m,  687^-688,  G94f,  840,  891^-,  892|,  893)?* 

826,  d.  We  should  not  be  led  into  the  error  of  confounding  the  re- 
sults of  agents  applied  to  the  trunks  of  a  nerve  and  to  its  extremities. 
The  physical  philosophers  have  taken  advantage  of  the  comparative 
failure  of  the  former  to  show  that  morbific  and  remedial  agents  do  not 
produce  their  remote  effects  through  the  medium  of  the  nervous  sys- 
tem, and  have  adopted  this  view  from  Miiller's  misapprehension  of 
the  subject.  "  The  narcotic  action  of  opium,"  says  Miiller,  "  does  not 
react  from  a  particular  point  of  a  nerve  on  the  brain."  Therefore, 
argue  the  materialists,  when  applied  to  the  surface  of  tissues,  its  nar- 
cotic effect  is  due  to  absorption.  But  the  great  Physiologist  has 
shown,  himself,  the  error,  while,  at  the  same  time,  he  proves  the  un- 
tenable nature  of  humoralism.     Thus  : 

"  The  spirituous  extract  of  nux  vomica,  introduced  in  a  small  quan 
tity  into  the  mouth  of  a  young  rabbit,  produces  immediate  death  (in  a 
second  of  time) ;  whereas,  when  applied  to  a  nerve  at  some  distance 
from  the  brain,  for  instance,  to  the  ischiadic  nerve,  it  produces  no 
general  symptoms"  (§  494  dd,  498  c,  514  d). 

There  is  the  broadest  distinction  between  the  trunk  of  a  nerve  and 
its  expanded  extremities  in  connection  with  organic  tissues ;  while, 
also,  the  organic  properties  of  the  terminal  fibres,  and  especially  sym- 
pathetic sensibility  (§  201,  451  d),  are  incomparably  more  strongly 
pronounced  than  in  the  nervous  trunks.  The  important  consideration 
has  been  also  neglected  that  two  orders  of  nerves  are  concerned  in 
.the  function  of  remote  sympathy  as  it  occurs  naturally,  and  that  the 
points  of  departure  and  of  incidence  are  the  expanded  portions  of  the 
nervous  system.  This  is  also  undoubtedly  true  even  of  the  sympa- 
thies of  the  nervous  system  itself,  which  embraces  all  the  elementary 
parts  of  other  organs  (§  472,  no.  4,  514  d,  516  d,  526  d.  Also,  Med. 
and  Phys.  Comm.,  vol.  i.,  p.  507,  563-566). 

Moreover,  when  irritating,  or  other  agents,  produce  strong  im- 
pressions upon  the  surfaces  of  organs,  it  is  not,  as  supposed  by  Miil- 
ler and  others,  mainly  upon  the  ramifications  of  the  nerves,  but  may 
be  equally,  at  least,  upon  the  organic  properties  of  the  other  tissues 
of  the  part  (§  184,  188).  Hence,  particularly,  the  wide  difference  in 
the  effects  of  irritants,  &c.,  when  applied  to  the  trunk  of  a  nerve  and 
to  an  organ  of  a  different  vital  constitution  ;  as  shown,  for  example,  in 
the  action  of  vesicants  (§  133,  &c.).  The  insusceptibility  of  nervous 
trunks  is  also  farther  shown  by  their  remarkable  exemption  from  the 
action  of  morbific  causes  (§  526,  d). 

827,  a.  The  second  fundamental  proposition  of  humoralism  is  in 
part  that  gaseous  and  fluid  substances,  having  an  affinity  for  each  oth- 
er, permeate  and  unite  through  a  dead  animal  membrane. 

That  fact  is  undeniable.  But  what  is  its  physiological  aspect  1  Is 
it  worthy,  in  any  other  than  its  naked  relations  to  chemistry,  of  grave 
consideration  ]  And  so  of  the  entire  amplitude  of  endosmosis  and 
exosinosis.  There  must  first  be  shown  a  correspondence  between  a 
dead,  permeable  tissue,  and  a  living,  impermeable  one,  before  we 
can  proceed  to  apply  the  foregoing  fact  in  any  physiological  bearing. 
But  its  utmost  latitude  would  only  show  that  foreign  substances  unite 
chemically  with  the  blood  through  the  living  tissues.  It  is  true  that, 
*  See  Notes  I  p.  1118,  Ll  p.  1140. 


522  INSTITUTES    OF   MEDICINE. 

more  recently,  active  chemical  agents  have  been  brought  to  bear  in  a 
corresponding  manner  upon  living  tissues ;  but  the  violent  influences 
which  have  been  thus  set  in  operation  render  these  experiments  as  worth- 
less as  the  original  ones.     It  is  equally  a  perversion  of  nature. 

827,  h.  Of  all  the  agents  which  surround  us  oxygen  gas  is  the  only 
one  which  has  been  shown,  with  any  degree  of  plausibility,  to  pene- 
trate a  living  animal  tissue,  or  to  unite  chemically  with  the  blood,  or 
with  any  supposed  constituent  of  that  fluid.  If  it  be  allowed,  also, 
that  this  has  been  demonstrated,  nothing  can  be  predicated  of  it  ana- 
logically in  respect  to  other  extraneous  matters,  since  it  is  an  ordain- 
ed function  of  organic  life,  under  the  c-ontrol  of  specific  laws  in  the 
animal  and  vegetable  kingdoms,  and  conducted  through  special  parts 
of  the  organism.  The  philosophy  is  the  same  as  we  recognize  in  all 
other  parts.  It  is  the  office,  for  example,  of  the  chylopoietic  and 
sanguiferous  organs  to  rearrange  the  elements  of  food,  and  endow  the 
new  compounds  with  the  properties  of  life ;  while  it  is  that  of  the 
glandular  organs,  the  membranes,  &c.,  to  select  certain  constituents 
from  the  common  homogeneous  mass  by  virtue  of  these  vital  proper 
ties,  and  to  impress  upon  them  various  peculiarities,  according  to  the 
mechanism  of  each  tissue,  and  as  the  vital  constitution  of  each  part 
may  happen  to  be  modified  (§  18,  42-44,  133,  &c.). 

Coming  again  to  the  specific  uses  of  oxygen  in  the  organic  king- 
dom, the  relative  laws,  the  organs,  the  final  causes,  &c.,  are  also  dif- 
ferent in  the  two  organic  departments,  and  even  varied  as  to  oi'gani- 
zation  in  animals ;  yet  in  all  according  to  other  variations  in  the  gen- 
eral physiological  constitution  (§  133-151,  185,  259-295,  409,  410). 

But,  I  think  it  must  be  conceded  that  I  have  shown  that  there  is  no  • 
physical  penetration  of  the  pulmonary  mucous  tissue  even  by  oxygen 
gas,  and  that  the  formation  of  carbonic  acid  within  the  lungs  is  pri- 
marily due  to  a  strictly  physiological  process  (§  135,  419,  433,  &c., 
447i  a^).— Notes  N  p.  1121,  R  p.  1123. 

I  am  now  conducted  to  a  fact  which  illustrates  the  principle  on 
which  miasmatic  poisons  operate. 

It  is  well  known  that  adult  dogs,  &c.,  will  bear  without  injury  a 
suspension  of  respiration  for  the  space,  at  least,  of  five  minutes.  But 
they  perish  immediately  if  plunged  into  carbonic  acid  gas.  There- 
fore, say  the  humoralists,  the  gas  is  absorbed  in  the  latter  case,  which 
makes  the  difference  in  results.  This,  however,  is  contradicted,  in 
the  first  place,  by  the  ordination  of  nature  that  carbon  shall  be  evolv- 
ed from  the  lungs,  and  by  an  organization  of  the  mucous  tissue  of  the 
lungs  coiTesponding  to  that  fundamental  law ;  whether  the  process 
be  the  result  of  chemical  or  vital  actions,  or  both  united  (§  447|,jr). 
Organization  is  thus  specifically  opposed  to  the  absorption  of  carbon- 
ic acid.  As  well  might  it  be  assumed  that  gastric  juice  is  resorbed 
by  the  mucous  tissue  of  the  stomach.  Carbonic  acid,  therefore,  does 
not  destroy  by  absorption  and  union  with  the  blood  (§  419,  420). 

But  this  incontrovertible  philosophy  is  sustained  by  direct  experi- 
ment ;  since  it  was  found  by  Nysten  that  "  carbonic  acid  gas  may  be 
injected  into  the  venous  system  in  large  quantities,  without  stopping 
the  circulation,  and  without  acting  primitively  on  the  brain  ;  but  when 
more  is  injected  than  the  blood  will  absorb,  it  produces  death  by  dis- 
tending the  heart,  as  when  air  is  injected  into  the  veins." — Nysten, 
RecJterchcs,  &c.,  p.  88.     This,  however,  is  not  the  modus  operandi. 


PATHOLOGY. HUMORALISM.  523 

Here,  then,  we  have  the  pnnciple  demonstrated,  which  is  of  uni- 
versal appHcation  to  mephitic  gases,  upon  whatever  surface  their  ac- 
tion may  be  exerted.  The  poisonous  action  of  carbonic  acid  is  ex- 
erted upon  the  pulmonary  mucous  tissue,  and  then  only  upon  the 
brain,  as  a  consequence  of  that  primary  effect,  and  through  the  phys- 
iological relations  of  the  mucous  tissue  of  the  lungs  to  the  great  ner- 
vous centre  (§  129,  137,  222,  &c.,  666.  Also,  Med.  and  Physiolog. 
Gomm.,  vol.  i.,  p.  443,  &c.).  This  lets  us  into  the  secret  why  certain 
poisons,  as  that  of  the  viper,  of  the  mad  dog,  and  some  others,  have 
no  action  upon  the  stomach,  or  when  applied  to  the  surface  of  the 
brain,  but  operate  with  violence  when  inserted  within  the  organiza- 
tion of  the  skin,  and  why  that  of  the  rhus  vemix,  &c.,  will  affect  the 
skin  when  applied  only  superficially  (§  135-137,  140,  150,  904  h). 

Again,  in  connection  with  the  foregoing  illustration,  it  is  an  im- 
portant fact  that  animals  may  be  destroyed  by  the  application,  for  a 
considerable  time,  of  carbonic  acid  to  the  skin,  although  free  respira- 
tion of  atmospheric  air  be  permitted.  This  shows  that  it  may  also  ex- 
ert a  deleterious  action  upon  the  organic  constitution  of  the  skin;  and 
by  analogy,  therefore,  such  may  be  more  or  less  the  case  with  mala- 
ria. And  it  should  be  farther  stated,  that  the  action  of  carbonic  acid 
agrees,  also,  with  that  of  concentrated  forms  of  malaria  in  the  instan- 
taneousness  of  its  effects  (§  654,  a). 

827,  c.  An  almost  endless  series  of  examples  of  clear,  definite  char- 
acter illustrate  the  philosophy  of  more  obscure  but  analogous  problems. 
Another,  for  instance,  may  be  found  in  the  effects  of  the  nitrous  oxide 
gas,  when  respired.  Here,  the  immediate  production  of  the  phenome- 
na, and  more  especially  the  abruptness  with  which  they  subside,  prove 
that  the  whole  action  of  the  gas  is  upon  the  pulmonary  mucous  tissue, 
and  that  the  general  phenomena  can  be  in  no  respect  owing  to  a  mod- 
ified state  of  the  blood,  however  the  gas  may  be  absorbed.  And  just 
so  with  the  respiration  of  ammonia,  which  brings  on  coughing,  rouses 
the  circulation,  &c.,  instantly,  and  which  cease  as  instantly  on  remov- 
ing the  exciting  cause.  The  example  of  cold  in  producing  pneumonia, 
or  rheumatism,  &c.  (§  649  c,  d,  657,  666),  the  fatal  action  of  hydrocy- 
anic acid,  aconitina,  strychnia,  «fec.,  the  remedial  influences  of  tartarized 
antimony,  of  the  mercurials,  and  of  numerous  other  alterative  agents, 
concur  in  one  general  illustration  of  this  subject  (§  494  cZd,  550-563). 
The  philosophy  relative  to  reflex  nervous  action  conducts  us  through 
all  the  labyrinth  of  the  wide-spi'ead  influences  that  radiate  from  a  given 
point  which  may  seem  almost  alone  exempt  from  the  general  invasion 
of  disease  (§  222,  &c.,  500,  904  h,  1066  a).— Note  M  p.  1120. 

827,  d.  The  present  place  supplies  a  good  opportunity  for  intro- 
ducing a  case  of  death  from  hydrocyanic  acid ;  partly  with  a  view  to 
our  present  subject,  and  to  serve,  in  part,  as  a  reference  to  illustrate 
other  topics.     Thus  : 

A  medical  gentleman  had  swallowed  a  fatal  dose  of  Scheele's  hydro- 
cyanic acid,  from  which  he  died  in  about  ten  minutes.  "  On  cutting 
into  the  right  lung,  a  frothy,  dirty-brown  semi-mucous  fluid  exuded, 
tinged  with  blood.  There  was  no  odor  of  prussic  acid  fi'om  it.  In 
the  cavity  of  the  right  pleura  were  about  eight  ounces  of  thin  serum. 
The  left  lung  was  firmly  adherent  in  its  whole  extent  to  the  costal 
pleura.  Heart  firmly  contracted.  It  exhaled  no  smell  of  prussic  acid 
Liver  healthy.     Spleen  soft  and  easily  broken  down,  resembling  mul- 


524  INSTITUTES    OP    MEDICINE. 

berry  jam.  Kidneys  natural.  The  stomach  contained  about  fifteen 
ounces  of  half-digested  food,  that  gave  out  the  well-known  odor  of  bit- 
ter almonds.  The  mucous  coat  of  the  stomach  healthy,  and  smelled 
strongly  ofprussic  acid  after  the  stomach  had  been  emptied  of  its  con- 
tents (§  657).  Intestines  healthy.  Vessels  and  sinuses  of  the  hrain 
filled  with  a  dark-colored  fluid  hlood.  No  smell  of  prussic  acid. 
Blood  every  where  fluid"  (§  494,  904  h). — Mr.  PooLEy,  in  London 
Medical  Gazette,  1845.— See  notes,  p.  172,  863.-§  1066,  1088  a,  h. 

827,  e.  The  foregoing  philosophy  enables  us  to  understand  why  the 
morbific  action  of  miasmata  is  promoted  by  various  causes  which  in- 
crease the  susceptibility  of  the  system  (§  663),  and  which  has  its  par- 
allel in  numerous  examples  of  daily  occurrence  ;  as  the  greater  liability 
of  mercurial  agents  to  produce  salivation  if  we  increase  irritability  by 
cathartics,  blood-letting,  &c.  (§  556  c,  030  e) ;  while,  on  the  contrary, 
had  humoralism-any  foundation,  cathartics  and  blood-letting  should  di- 
minish the  chances  of  mercurial  action,  nor  should  that  action  increase 
long  after  profuse  ptyalism  has  been  established.  The  warm  bath  pro- 
motes the  constitutional  action  of  mercurial  ointment  by  increasing  the 
susceptibility  of  the  skin  and  system  at  large  (§  1088  b,  c). 

It  should  be  observed,  also,  that  upon  the  hypothesis  of  humoralism 
there  should  be  no  exemption  of  individuals  from  epidemic  diseases, 
since  the  blood  of  all  should  be  equally  liable  to  contamination.  Hu- 
moralism may  not,  consistently,  assign  as  the  ground  of  exemption  a 
difference  in  the  susceptibilities  of  the  solids  which  have  been  in- 
duced by  other  causes  (§  651  b,  657  a,  837  Z») ;  and  since,  therefore, 
the  blood  is  the  2^(ibulum  vitce,  and  convertible  into  the  solids,  it 
should,  upon  the  humoral  doctrine,  when  itself  diseased,  occasion 
universal  disease  of  the  solids  (§  663).  The  same  is  also  true  of  the 
poisons,  of  the  prick  of  a  pin,  &c. ;  but  always  affecting  some  severe- 
ly, and  others  slightly, — the  former  sometimes  striking  at  one  organ, 
and  again  at  another,  while  the  latter  induces  in  one  man  erysipela- 
tous inflammation,  in  another  always  phlegmonous,  and  in  a  third 
none  at  all  (§  652  c,  828  c,  494,  740,  741).— Note  Oo  p.  1141. 

827,  f.  If,  however,  it  be  admitted  that  offensive  substances  when 
absorbed  operate  through  the  medium  of  the  circulation,  solidism  and 
vitalism  can  alone  interpret  the  phenomena.  There  is  abundant  proof 
that  the  results  are  not  due  to  any  affection  of  the  blood,  but  must  be 
referred  to  the  direct  action  of  the  agents  themselves  upon  the  vital 
constitution  of  the  solids  to  which  they  are  distributed.  This  con- 
struction of  the  subject,  therefore,  is  directly  within  the  pale  of  solid- 
ism ;  though  it  be  foreign  from  the  truth  (§  284,  904  c). 

827,  g.  Again,  however,  most  of  the  substances  whose  presence  in 
the  blood  or  secretions  can  be  detected  (a)  are  either  innoxious,  or 
undei'go  chemical  decomposition  as  soon  as  they  come  in  contact  with 
the  cii'culating  mass,  and  would  therefore  either  be  rendered  inert, 
or  would  certainly  give  rise  to  different  phenomena  from  those  of  the 
agents  in  their  original  shape  (§  52,  149,  650). 

827,  h.  But  this  part  of  the  doctrine  of  absorption  does  not  end 
with  gaseous  substances;  since  there  are  some  distinguished  philoso- 
phers who  maintain  that  seeing  is  produced  by  the  penetration  of  light 
to  the  recesses  of  the  brain,  where  it  gives  rise  to  certain  cerebral 
changes  that  result  in  vision  ;  just  as  Liebig  and  his  school  suppose 
that  all  the  operations  of  the  mind  are  determined  by  chemical  chan- 


PATHOLOGY. HUMORALISM.  525 

ges  of  the  brain  (§  349  e,  350|  'n-g)-  By  the  analogies  of  Nature, 
therefore,  we  must  conclude  that,  whatever  gives  rise  to  other  sensa- 
tions must  be  equally  absorbed  and  conveyed  to  the  sensorium  com- 
mune,— the  odor  of  plants,  the  undulations  of  air,  the  prick  of  a  pin, 
&c.  (§  837,  b).     If  this  be  frivolous  it  is  not  the  fault  of  the  logic. 

828,  a.  The  third  proposition  of  humoralism  sets  forth,  that  when 
morbific  agents  are  inserted  in  wounds  they  give  rise  to  diseases  in 
various  parts. 

Here,  then,  we  have  something  besides  ordinary  surfaces.  The 
■'  facts"  which  I  have  considered  in  the  preceding  propositions  were 
evidently  unsatisfactory  to  "  experimental  philosophy,"  and,  therefore, 
a  start  has  been  given  to  absorption  by  inserting  the  noxious  agents 
within  the  vascular  systems.  But,  I  have  gone  extensively,  in  the 
Commentaries,  into  the  proof  that  in  all  the  cases  of  this  nature  the 
agents  have  been  either  violently  forced  into  the  torrent  of  blood,  or 
that  their  direct  effect  is  exclusively  upon  the  injured  part,  and  thence 
by  reflected  nervous  actions  over  the  system.  It  will  be  also  observed 
that  in  these  experiments  the  agents  are  brought  into  dii'ect  contact 
with  parts  where  the  organic  properties  are  most  exquisitely  develop- 
ed and  susceptible.  The  time  of  incubation  (§  666)  may  be  from  an 
instant,  as  with  hydrocyanic  acid  and  strychnia  (§  SSO^^,  494,  743, 
826  h-d,  827  d,  904  Z>),  to  a  year  or  more,  as  with  the  cause  of  inter- 
mittent fever  (§  561,  657),  or  even  to  years,  as  with  the  hydrophobic 
virus  (§  547,  559,  560,  654-659,  500  o,  503,  506,  &c.  Also,  Comm., 
vol.  i.,  p.  496-506).  As  to  the  last,  the  virus  can  neither  remain  in 
the  wound,  nor  circulate  in  the  changeable  body  for  months,  or  for 
weeks.  It  is  either  washed  away  from  the  former,  or  carried  off  by 
the  latter. — Note  Aaa  p.  1146. 

Now  all  these  cases  are  exactly  upon  a  par  so  far  as  principle  is 
concerned.  The  same  influences  obtain  in  respect  to  the  hydropho- 
bic virus  as  with  those  agents  which  destroy  life  as  soon  as  they  como 
in  contact  with  the  body.  This  is  the  work  of  the  nervous  power ; 
just  as  it  is  when  joy,  or  anger,  or  a  surgical  operation,  or  blows  on 
the  stomach,  &c.,  kill  in  an  instant  of  time  (§  227,  230,  234  e,  476  /*, 
509-511).  The  principle  is  the  same  as  when  the  division  of  a  nerve 
excites  inflammation  in  the  part  to  which  it  is  distributed.  And  all 
this  conducts  us,  at  once,  to  a  knowledge  of  the  modus  operandi  of 
the  poison  of  venomous  animals  in  the  following  comprehensive  case. 

828,  h.  "  I  have  seen,"  says  Dr.  Johnson,  the  late  distinguished  ed- 
itor of  the  Medico-Chirurgical*  Review,  "  the  ear  of  a  rabbit  exposed 
to  the  bite  of  a  cobro  de  capella,  with  a  pair  of  scissors  kept  across 
the  ear,  ready  to  cut  it  off  the  moment  the  bite  was  inflicted ;  yet  the 
animal  died  quickly  in  convulsions"  (§  234  e,  507,  827  d). 

The  foregoing  fact  corresponds  exactly  with  experiments  of  a  very 
different  nature  by  Van  Deen,  Stilling,  Budge,  &c.  (§  494),  and  forms, 
with  those,  substantial  grounds  for  analogical  inductions.  They  may 
be  safely  considered  of  universal  application,  whatever  the  morbific 
cause,  whatever  the  interval  of  predisposition. 

828,  c.  It  is  astonishing,  too,  with  what  rapidity  certain  morbific 
causes  will  establish  inflammation,  and  thus  lead  to  an  almost  instan- 
taneous disorganization.  Take  another  example  from  the  venomous 
serpent,  as  related  by  Sir  E.  Home.  He  caused  a  rat  to  be  bitten 
by  a  snake.     It  died  in  one  viinute.     The  cellular  membrane  beneath 


526  INSTITUTES    OF    MEDICINE. 

the  wound  was  wholly  destroyed,  the  muscles  separated  from  the  ribs 
and  from  a  small  extent  of  the  scapula.  The  bitten  part  was  greatly 
inflamed. — Note  Aaa  p.  1146. 

Here  the  inflammation  must  have  commenced  in  the  region  of  the 
thorax  at  the  moment  the  bite  was  inflicted.  Absorption  and  distribu- 
tion were,  of  coui'se,  impossible,  and  there  is  nothing  but  the  philoso- 
phy which  I  have  propounded  of  the  nervous  power  that  will  in  the 
least  explain  the  phenomena  in  this  and  all  analogous  cases  (§  222, 
&c.,  234  e,  503,  509).  By  the  foregoing  case  we  are  also  prepared 
to  understand  that  hydrocyanic  acid  may  light  up  venous  congestion 
in  the  brain,  although  it  destroy  with  equal  rapidity  (§  827,  d). 

828,  d.  Finally,  an  elementary  example  of  universal  application  to 
morbific  agents,  and  illustrative  of  the  nature  of  life,  will  supei'sede 
the  necessity  of  farther  comment  upon  the  three  fundamental  proposi- 
tions of  humoralism  as  it  respects  absorption  (§  823).  This  example 
is  of  the  same  nature  as  that  of  the  seton,  farther  on  ;  but  more  open 
to  the  understanding  of  all  (§  905). 

It  will  be  admitted  that  when  inflammation  is  excited  by  the  punc- 
ture of  a  lancet,  it  is  not  by  irritating,  or  otherwise  affecting  the  blood ; 
but  that  all  the  attendant  phenomena  are  due  to  an  impression  made 
upon  the  solids,  and  to  their  consequent  morbid  action.  The  inflam- 
mation, thus  excited,  may  be  extensively  and  violently  propagated 
along  the  part,  as  in  phlebitis,  &c.  (I  specify  a  vein,  as  it  is  here  the 
acrid  injections  are  made,  §  830) ;  and  it  is  but  reasonable  to  suppose 
that  the  same  condition  is  owing  to  a  similar  cause  at  one  or  six  inches 
from  the  Avound,  as  at  the  eighth  of  an  inch.*  No  sooner,  also,  does 
the  inflammation  begin  than  reflex  nervous  actions  may  ensue  ; 
but  as  we  have  no  morbific  blood  in  these  cases,  we  must  look  for 
some  principle,  analogous  to  that  in  which  the  local  changes  began,  to 
explain  the  general  derangement  (§  500,  711,  &c.).  All  this  will 
help  us  to  the  philosophy  of  analogous  developments  in  diseases  of  re- 
putedly humoral  origin.  But,  besides  the  common  effects  of  inflam- 
mation the  prick  of  the  lancet  may  convulse  the  whole  nervous  and 
muscular  systems  (§  222,  &c.).  Nay,  more,  and  greatly  to  our  pur- 
pose, the  inflammation  arising  from  a  wound  will  be  variously  modifi- 
ed in  its  character  by  the  exact  nature  of  the  wound  itself,  and  the 
kind  of  instrument  or  violence  with  which  it  is  inflicted  (§  652,  c). 

If  there  be  now  added  to  the  point  of  the  lancet  sulphuric  acid,  or 
the  virus  of  putrid  animal  matter,  of  the  small,  or  cow-pox,  or  the 
poison  of  the  viper,  of  the  wourari,  &c.',  there  will  be  many  diversities 
in  the  general  results  of  the  several  causes  thus  superadded  to  the 
mechanical,  but  strong  resemblances  in  the  local  phenomena,  and  in 
the  progress  of  symptoms.  The  specific  products,  also,  as  well  as 
other  circumstances,  denote  specific  modifications  of  a  common  path- 
ological state  (§  722,  &c.).  If,  then,  the  mechanical  irritation  in  one 
instance  have  acted  directly  upon  the  solids,  is  it  not  a  proper  conclu- 
sion from  the  progress  and  analogy  of  symptoms,  that  the  several  va- 
rieties of  poison  have  done  so  in  the  others  ]  It  cannot  be  said  that 
certain  differences  in  the  results  imply  a  difference  in  the  principle, 
since  all  these  results,  where  life  is  sufficiently  prolonged,  are  purely 
secondary,  and  will  be  admitted  to  be  consequent  on  the  morbid  affec- 
tion of  the  solids.  But  all  the  primary  phenomena  in  such  instances 
coincide  with  each  other,  and  have  the  same   order  of  development. 

*  By  continuous  sympatliy,  or  continuous  influence  of  these  Institutes  (sec.  129  c,  /  498  a). 


PATHOLOGY. HUMORALISM.  527 

• 

If  the  poison  of  the  viper  destroy  life  with  great  instantaneousness, 
this  is  conclusive  against  absorption,  and  is  exactly  allied  in  principle 
to  the  fatal  operation  of  a  blow  upon  the  region  of  the  stomach,  or  of 
surgical  operations  which  produce  instant  death,  or  of  the  prick  of  a 
pin  which  is  followed  by  tetanus  (§  494  h,  509,  &c.). 

828,  e.  There  is  an  endless  variety  of  analogies  where  disease  is 
excited  by  agents  of  a  mechanical,  or  even  of  a  more  negative  nature; 
such  as  cold,  heat,  wakefulness,  fatigue,  &c.,  which,  like  the  opera- 
tions of  the  mind  or  its  passions,  in  producing  or  removing  disease, 
killing  or  curing,  according  to  the  exact  nature  of  the  intellectual  pro- 
cess, that  are  applicable  with  all  the  force  of  the  strongest  analogies 
to  show  that  in  all  other  cases  the  same  laws  prevail  (§  188^  d,  527  h, 
902  m,  905).     The  laws  of  reflex  nervous  action  explain  the  whole. 

829.  "  When  we  consider,"  says  Pei-eira,  "  the  peculiarities  attend- 
ing the  hepatic  circulation,  and  that  all  the  remedial  agents,  whose 
particles  are  absorbed,  have  to  pass  through  the  portal  vein, — the  vein 
by  whose  branches  the  bile  is  secreted, — our  astonishment  is  great  that 
this  secretion  is  not  more  frequently  affected  hy  the  various  medicinal 
agents  put  into  the  stomach^ — Pereira's  Mat.  Med.,  p.  92. 

May  we  not,  however,  rather  be  astonished  that  the  frequent  exemp- 
tion of  the  liver  itself  from  all  morbid  effects,  as  well  as  the  condition 
of  the  bile,  did  not  satisfy  our  able  author  that  the  doctrine  of  reme- 
dial and  morbific  action  by  absorption  is  contradicted  by  the  plainest 
facts  (§  889,  a)  1 

Our  author,  however,  has  been  led  into  an  important  physiological 
error  by  Magendie's  assumption  that  the  veins,  and  not  the  lymphat- 
ics, perform  the  office  of  absorption ;  while  in  respect  to  any  ingress 
of  deleterious  agents,  it  is  mostly  by  way  of  the  lacteals  (§  277).     Ad- 
mitting, therefore,  that  the  violent  agents  of  the  Materia  Medica  oper- 
ate by  absorption,  they  are  first  conveyed  directly  to  the  heart  through 
the  thoracic  duct;  and  if  "astonishment"  be  great  in  the  mistaken 
case  of  the  liver,  how  much  greater  should  it  be  when  we  consider  the 
realities  of  nature,  and  observe  how  often  the  exquisitely  irritable 
heart  remains  unaffected  when  the  niost  powerful  irritants  would  be 
emptied  into  its  cavities.     Or  taking  the  construction  of  our  author, 
the  effect  upon  the  heart  would  be  equally  the  same,  since  a  large 
proportion  of  the  portal  blood  is  delivered  at  the  same  cavities.     In 
either  case,  the  irritants  would  exist  in  a  state  of  concentration  in  tho 
most  in-itable  organ  of  the  body  compared  with  their  dilution  in  other 
parts,  except  the  lungs,  as  1  to  50,  or  more.     And  yet  the  henrt  often 
remains  undisturbed  in  its  regular  action  after  the  administration  of 
violent  agents,  while  they  are  simultaneously  healing,  or  inflicting 
disease  on  other  parts.     I  present,  therefore,  this  isolated  fact  as  ade- 
quate in  itself  to  a  full  refutation  not  only  of  the  doctrine  of  morbific 
and  remedial  action  by  absorption,  but,  by  the  force  of  analogy,  to 
that  of  the  entire  system  of  the  humoral  pathology.     If  embarrassing 
to  the  humoralists  in  the  case  of  the  inirritable  liver,  it  is  conclusive 
in  that  of  the  heart  (^  500  m,  638J,  826  cc,  840,  1089,  487  a,  904  c).* 

8.30,  a.  Tho  fourth  grand  assumption  of  humoralism,  as  a,  part  of  its 
basis,  is  the  production  of  disease  and  death  by  the  injection  of  va- 
rious substances  into  the  circulation  (§  823).  These  injections  are 
made  upon  ani?nals,  and  their  effects  carried  up  to  the  natural  morbific 
causes  which  operate  on  man. 

*   Diseases  have  their  predisposing  and  exciting  causes  (§  645),  and  no  one  supposes 
thai  the  latter  are  absorbed.     Why,  then,  the  former? 


528  INSTITUTES    or    MEDICINE. 

Strange  as  is  this  analogical  ground  of  induction,  it  is,  neverthelesg, 
the  great  bulwark  of  humoralism.  The  doctrine  is  thus  set  forth  by 
its  restorer,  M.  Andral : 

"Various  animal  poisons,  such  as  those  of  the  snake  tribe,  and  dif- 
ferent mineral  poisons,  as  mercury,  for  instance,  act  upon  the  blood 
in  the  same  manner  as  deleterious  substances  injected  into  the  circu- 
lation." "  Those  derangements  of  functions  and  organs  produced  by 
the  experimenter,  when  he  introduces  different  deleterious  substances 
directly  into  the  blood,  are  likewise  those  that  are  produced  by  the 
sting  or  bite  of  certain  animals ;  they  are  also  those  that  take  place  in 
small-pox,  measles,  and  scarlatina  of  a  malignant  nature,  as  it  is  call- 
ed. They  are  the  sai7ie  derangements  that  appear  in  persons  exposed 
to  putrid  emanations,  vegetable  or  animal,  and  to  miasmata  from  the 
bodies  of  other  persons  that  are  themselves  diseased  and  crowded  in 
confined  places,  &c.  (§  653).  Lastly,  they  sJioio  themselves,  also,  in 
individuals  whose  blood  is  only  imperfectly  or  badly  repaired  by  in- 
sufficient or  tmwliolesome  dief"  (§  744,  819  b). 

830.  Z».  The  order  of  results  as  stated  by  Andral,  and  as  adopted  by 
all  humoralists,  is  the  following  : 

"  A  vitiation  of  the  blood  by  the  commixture  of  deleterious  sub- 
stances. Next,  in  consequence  of  such  vitiation,  an  alteration  of  the 
functions  of  the  nervous  system.  Lastly,  the  blood  that  supports  the 
organs,  and  the  nervous  system  that  animates  them,  having  suffered  a 
general  injury,  there  takes  place  a  constant,  though  not  always  appre- 
ciable, modification  of  these  organs  in  their  functions,  or  in  their  tex- 
ture" (§  709,  740,  744,  821,  847  d).      ^ 

831.  Injections  of  noxious  agents  into  the  circulation  of  animals 
were  made  to  an  almost  incredible  extent  centuries  ago ;  and  millions, 
I  may  safely  say,  have  been  repeated  in  later  times.  But  they  prove 
only  two  things, — their  short-sightedness  and  inhumanity.  They  cer- 
tainly do  not  show,  in  the  least,  that  the  ordinary  causes  of  disease  are 
taken  into  the  circulation,  nor  do  they  produce  those  constitutional 
affections  which  are  generated  by  the  natural  operation  of  morbific 
causes,  especially  on  the  human  species.  Their  action  is  commonly 
upon  the  venous  system ;  and  if  the  reader  will  refer  to  my  remarks 
upon  phlebitis,  he  will  perceive  the  reason  for  the  conclusion  of  many 
experimenters  that  they  have  given  rise  to  yellow  fevei-,  typhus,  &c.,  in 
the  brute  race  (§  744,  810,  &c.,  1088  d). 

These  devices  of  art  are  very  extensively  considered  in  my  Essay 
on  the  Humoral  Pathology,  where  1  have  endeavored  to  show  that  they 
all  go  to  the  proof  of  solidism  (§  827,/"). — In  Med.  and  Phys.  Comm. 

832.  For  an  examination  of  what  I  have  designated  as  the  Jifik  prop- 
osition in  humoralism  (§  823),  I  must  refer  the  curious  reader  to  the 
Co?nmentarics,  vol.  i.,  p.  401-408,  431-451). 

833.  The  sixtJi  foundation  is  relative  to  the  yeast  and  herrings  ;  and 
the  reader  will  probably  be  satisfied  with  the  references  to  this  sub- 
ject which  occur  in  §  821,  c  ;  otherwise,  he  may  consult  section  350, 
nos.  44,  45  ;  and  the  Comfnentaries,  vol.  i.,  p.  417,  &c. 

834.  The  seventh  fundamental  assumption  goes  with  ihejifth,  and 
the  I'eader,  by  the  references  there,  may  satisfy  himself  of  their  degree 
of  importance. 

835.  The  eighth  bulwark  of  the  doctrine  is  the  important  fact, — im- 
portant to  the  solidist, — that  morbid  changes  occur  in  the  secreted 


PATHOLOGY. HUMORALISM.  520 

and  excreted  products.  Nor  is  it  less  important  in  its  philosophical 
and  practical  bearings  upon  the  humoral  pathology  ;  since  it  is  unde- 
niable that  it  places  the  learned  and  the  unlearned  practitioner  on 
common  ground.  Their  pathology  is  the  same  ;  and  what  is  affirmed 
in  the  following  extract  of  the  educated,  in  respect  to  their  practical 
habits,  every  newspaper  in  the  land  assures  us  is  equally  true  of  the 
pretender  in  medicine.     Thus  the  extract : 

"  The  humoral  pathologist  neglects  the  study  of  visceral  lesions , 
and  when  he  turns  his  attention  to  the  digestive  system,  he  only  con- 
siders its  secretions,  and  not  its  actual  condition,  or  the  state  of  its 
sympathies.  His  sole  purpose  is  to  evacuate  sordes,  or  to  produce  a 
flow  of  healthy  bile,  and  to  eliminate  depraved  secretions  ;  and  this  he 
attempts  without  possessing  any  knowledge  of  the  effects  of  disease 
of  the  digestive  system  on  other  organs"  (Stokes'  Theor.  Prac.  Med.). 

Professional  humoralism  assumes  that  these  "  vitiated  secretions" 
are  due  to  a  morbid  state  of  the  blood,  and  not  to  perverted  actions 
of  the  solids,  which,  in  their  ordinary  state,  give  rise  to  the  various 
natural  products.  And  so  the  newspapers.  Perhaps,  however,  the 
student  may  obtain  some  ideas  to  the  contrary  by  consulting  the  fol- 
lowing references  (§  42,  44,  53,  135,  220,  222-233f,  284-292,  307, 
314,  322-326,  327-331,  407-432,  452,  &c.,  500,  &c.,  512,  &c.,  674, 
675,  686,  8911  ^^  893  a,  c,  e,  896,  900,  902  g,  904  bh,  905,  905|,  1088. 

836.  The  ninth  ground  of  induction  goes  back  to  ancestral  dis- 
eases ;  and  assumes  their  transmission,  by  hereditary  impurities  of  the 
blood,  to  succeeding  generations.  I  have  referred  sufficiently  to  the 
philosophy  of  this  subject  in  the  present  work  (§  75-80,  143-147, 
220,  327-331,  559,  561-563,  591,  659,  666  b,  674),  and  more  exten- 
sively, and  in  other  aspects,  in  the  Commentaries  (vol.  i.,  p.  464,  &c.). 
I  shall  not,  therefore,  again  encounter  this  part  of  the  foundation  ;  but 
cannot  refrain  from  adverting  to  its  pernicious  eff"ects  in  practice. 
One  of  its  vague  attendants  is  the  doctrine  of  "  poverty  of  the  blood," 
and  this,  as  practically  applied  to  active  conditions  of  scrofula,  is  a 
fearful  scourge  to  the  human  family.  The  "  enriching  black  meats," 
and  the  "  sustaining  cordials,"  which  are  every  where  commended  to 
the  subjects  of  phthisis,  in  its  early  stages,  are  the  occasion  of  a  great- 
er mortality  in  one  day  than  ever  proceeded  from  the  abstraction  of 
blood  in  all  diseases  since  medicine  became  an  art  (§  620,  note.  Also, 
Comm.,  vol.  ii.,  p.  608-634,  "  PatJiology  of  Tuhercle  and  Scrofula").'^ 

837,  a.  Humoralism  assumes,  as  its  tenth  fundamental  basis  which 
I  have  indicated,  that  remedial  agents  when  injected  into  the  circu- 
lation sometimes  produce  the  same  effects  upon  particular  organs  as 
when  administered  by  the  stomach  (§  823). 

Rarely  has  this  experiment  been  tried  on  man,  in  recent  times ; 
probably  in  consequence  of  the  mere  transfusion  of  blood  having  been 
fatal,  and  interdicted  by  law,  in  former  times.  It  is  almost  entirely 
limited  to  animals ;  when,  as  might  be  expected,  the  agents  exert 
their  effects  mostly  upon  the  venous  system  ;  "  giving  rise  to  scurvy, 
yelloiv  fever,  typhoid  fever,  &c.,  not  to  mention  a  number  o^  other  affec- 
tions which  I  called  into  being  before  you'^  (§  744,  709,  810). 

The  case  in  which  Dr.  Hale,  of  Boston,  injected  castor  oil  into  his 

own  circulation  is  a  standing  reference  ;    but  loses  force  from  want 

of  confirmation.      What  though,  however,  it  rewarded  the  gentleman 

\vith  a  few  moderate  evacuations,  I  have  never  yet  seen  it  affirmed  by 

*  See  Notes  F  p.  1114,  Mm  p.  1141. 

L  L 


530  INSTITUTES    OF    MEDICINIC. 

the  advocates  of  operation  by  absorption  that  castor  oil  has  been 
detected  within  the  organism  after  its  exhibition  by  the  stomach  ;  and 
we  need  not  doubt  that  the  experiment  has  been  satisfactorily  tried. 

837,  h.  That  certain  articles  of  the  materia  medica  which  manifest 
specific  relations  to  particular  parts  when  administered  by  the  stom- 
ach will  exert  specific  effects  according  to  those  relations  when  in- 
jected into  the  circulation  is  clearly  inferable  from  the  first  princi- 
ples in  physiology.  If  vomiting  result  from  the  mere  action  of  tar- 
tarized  antimony  upon  the  mucous  surface  of  the  stomach,  and  purg- 
ing from  that  of  castor  oil  on  the  intestine,  it  should  probably  follow 
that  the  same  results  will  happen  when  either  of  these,  or  analogous 
agents,  are  injected  into  the  veins,  and  are  circulating  within  the  very 
organization  of  parts  possessing  superficially  those  relations  to  the 
same  agents  (§  150).  Each  series  of  observations,  however,  stands 
independently  by  itself.  The  injections  prove  nothing  beyond  their 
own  results.  They  can  have  no  bearing  upon  the  question  of  super- 
ficial action  ;  and  we  may  as  well  deny  that  croton  oil,  hellebore,  ela- 
terium,  &c.,  act  upon  the  skin  when  they  produce  inflammation  of  that 
organ  as  to  deny  the  same  local  action  upon  the  intestines  when  they 
increase  their  motion,  augment  their  secretion,  or  inflict  inflammation 
upon  them ;  we  may  as  well  deny,  I  say,  that  we  feel  with  the  ends 
of  our  fingers,  or  assume  that  offensive  odors,  tickling  the  throat,  warm 
water,  and  mental  emotions,  produce  vomiting  through  the  medium  of 
the  circulation.  Humoralism  must  group  the  whole  under  one  cate- 
gory, and  must  include  all  those  varying  susceptibilities  which  arise 
from  habits  and  analogous  causes  as  exerting  their  morbific  effects  upon 
the  blood  ;  for  the  moment  it  regards  the  solids  as  taking  an  initiatory 
step   it  opens  a  door  for  its  own  expulsion  (§  651  h,  827  e,  1088  c?). 

837,  c.  A  great  variety  of  examples  might  be  adduced  in  proof  of 
the  repugnance  of  nature  to  the  doctrine  of  humoral  absorption  as 
commended  to  our  confidence  by  the  experimentalist,  and  which 
equally  confirm  the  vital  theories  of  morbific  and  remedial  action, 
whether  the  agents  be  applied  to  the  raucous  tissue  or  to  the  skin. 
What,  for  example,  would  bg*the  condition  of  the  acetate  of  lead,  or 
the  nitrate  of  silver,  or  sulphuric  acid,  were  they  absorbed  from  the 
stomach  %  Utterly  changed,  perfectly  inert,  on  their  contact  with  the 
blood.  How,  then,  does  sulphuric  acid,  or  the  acetate  of  lead,  ar- 
rest the  night-sweats  of  phthisical  subjects  1  What  disposition,  I  say, 
will  you  make  of  the  universal  effects  of  certain  familiar  substances 
applied  to  the  skin;  as  the  numerous  preparations  of  mercury  ?  How 
will  you  account  for  the  well-known  action  of  nitric  acid  upon  the 
liver,  when  applied  in  the  form  of  pediluvium  ?  Interrogate  the 
chemist  as  to  the  condition  of  all  these  things,  and  many  other  analo 
gous  Bemedial  agents,  when  he  mingles  them  with  the  blood  (^  1088) 

The  experiments,  therefore,  have  no  tendency  to  prove  the  doc 
trine  of  absorption.  On  the  contrary,  they  go  to  substantiate  what  1 
have  said  of  the  nervous  power  as  the  immediate  cause  of  the  remote 
effects,  and  the  importance  of  duly  considering  the  special  modifica- 
tion of  the  properties  of  life  in  the  different  tissues  and  organs  {§  133- 
152,  227,  &c.).— Note  R  p.  1123. 

837,  cc.  But,  after  all,  the  foregoing  experiments  are  worthless  in  a 
practical  sense,  since  they  have  been  made  (unless  in  rare  and  unsuc- 
cfiKsful  instances)  upon  a  very  few  individuals  in  health;  and  there- 


PATHOLOCy. HUMORALISM.  531 

fore  prove  nothing  as  to  their  action  upon  diseased  conditions  (§  137, 
143,  149,  150,  152  h,  156,  163,  &c.).  And,  coming  to  the  multifari- 
ous examples  in  which  animals  have  been  the  subjects,  they  serve  only 
to  raise  our  astonishment  that  educated  men  can  have  imagined  their 
applicability,  in  any  sense  whatever,  to  the  profound  problems  of  hu- 
man maladies.  The  difference  in  constitution  alone  is  conclusive 
against  the  supposed  analogies.  It  is  conclusive,  indeed,  against  all 
such  reasoning  from  one  species  of  animal  to  another  species,  how- 
ever apparently  allied  ;  since,  in  respect  to  the  critical  relations  even 
of  food,  there  is  scarcely  any  certainty  attending  this  inductive  process, 
while  the  distinction  in  respect  to  the  influences  of  morbific  and  reme- 
dial agents  upon  different  animals  is  marked  by  every  agent  which  is 
capable  of  making  any  positive  demonstration.  Some  vegetable  poi- 
sons, indeed,  which  are  most  destructive  to  man,  and  to  many  species 
of  animals,  are  to  others  of  the  brute  tribe  wholesome  articles  of  food 
(§  IS,  150,  191,  366,  447,  854  bb). 

838.  The  natural  adaptation  of  the  various  fluids  of  the  body  to  the 
several  parts  with  which  they  come  in  contact,  and  the  certainty  with 
which  most  of  them  produce  disease  in  parts  to  which  they  are  not 
naturally  related,  is  conclusive  that  the  blood  cannot  be  medicated  by 
any  agents  of  sufficient  power  to  act  upon  parts  that  are  morbidly  ir- 
ritable, without  often  endangering  every  part  of  the  body.  The  prin- 
ciple is  of  course  the  same  as  with  the  truly  morbific  agents ;  and,  to 
be  fully  comprehended,  the  following  references  should  be  consulted 
(§  133,  136,  137,  2333,  277,  494,  526,  826  cc,  829,  847  a,  889). 

839.  As  with  morbific,  so  with  remedial  agents.  The  philosophy 
is  essentially  the  same  (§  151).  May  we  not,  therefore,  take  from 
Nature  an  important  hint  as  to  the  mode  in  which  remedies  operate, 
and  apply  it  analogically  to  the  modus  operandi  of  morbific  causes  1 
Does  unaided  Nature  medicate  the  blood  ]  Does  she  ever  effect  a 
change  in  that  fluid  without  an  antecedent  change  in  the  solids? 
Never.  Does  she  not  always  restore  the  blood  from  its  morbid 
states  through  the  agency  of  the  solids  alone  %  How  is  it  with  small- 
pox, and  measles,  and  other  self-limited  diseases  %  Art  can  do  noth- 
ing to  shorten  their  established  time,  or  affect  their  regular  progress. 
Nature  accomplishes  the  whole.  But  I  say,  again,  does  she  first  ren- 
ovate the  blood  (§  858,  861)?  We  may  imagine  primary  changes  in 
this  fluid  as  the  cause  of  the  morbid  changes  which  befall  the  solids  ; 
but  if  this  were  true,  then,  ex  necessitate  rei,  the  restorative  powers 
must  commence  and  advance  with  the  blood.  In  the  natural  cure, 
however,  there  is  no  agent  excepting  the  solids  to  exert  the  slightest 
impression  upon  that  substance;  by  which  I  thus  demonstrate  the  de- 
pendence of  the  morbid  changes  of  the  blood  upon  those  solids  by 
which  their  subsequent  removal  is  brought  about. 

840.  Try  the  question  by  an  infallible  experiment.  Apply  the 
medicine  to  the  organ  affected  ;  tartarized  antimony,  for  example,  to 
the  brain  in  phrenitis,  to  the  lungs  in  pneumonia.  How  absurd  the 
proposition  !  Even  in  the  primary  action  of  remedies  upon  the  stom- 
ach, and  when  disease  of  that  organ  yields  to  their  operation,  it  is 
not  alone  from  the  direct  action  of  the  agents,  but  greatly  so  from  in- 
fluences of  the  nervous  power  reflected  upon  the  mucous  tissue  of  the 
organ  (§  514  b,  516  d,  nos.  6,  12,  657,  658). 

Circulating  within  the  organization,  remedial  agents  of  an  imtating 


532  INSTITUTES    OF    MEDICINE. 

nature  exasperate  disease  far  more  certainly  and  violently  than  do 
cathartics  when  acting  upon  a  highly-inflamed  intestinal  mucous 
membrane.  This  will  be  readily  appreciated  by  all  who  have  wit- 
nessed the  stimulant  effects  of  muriate  of  soda  when  injected  into  the 
veins  of  the  dying  subject  of  the  cholera  asphyxia.  Simple  as  the 
substance,  the  scarce  audible  heart  bounded  under  its  influence  be- 
yond its  natural  vigor,  and  the  whole  vascular  system  instantly  emer- 
ged from  its  sunken  state  into  one  of  preternatural  excitement,  and 
long  after  the  most  powerful  stimulants  administered  by  the  stomach 
would  not  awaken,  in  the  least,  the  expiring  sympathies  of  the  heart, 
nor  violent  irritants  applied  to  the  skin  rouse  its  circulation  (§  829). 

Can  it  be  entertained  that  pneumonia,  or  ophthalmia,  or  erysipelas, 
or  fuininculus,  &c.,  are  relieved  by  the  transmission  of  the  various 
substances,  which  may  yield  relief,  to  the  very  organization  of  the 
parts  affected  1  And  when  vesication,  and  bloodletting,  and  mental 
emotions,  are  added  to  those,  a  medley  is  presented  which  defies  as- 
sumption, but  which  is  interpreted  with  consistency  through  the  agen- 
cy of  the  nervous  power  (§  222-233|,  686  b,  872,  904  bb,  905). 

841.  In  former  sections  I  had  occasion  to  illustrate  the  law  of  vi- 
tal habit  by  certain  effects  of  morbific  and  remedial  agents  ;  and 
what  is  there  considered  would  appear  to  cover  the  whole  ground  of 
solidism  and  vitalism.  Among  the  many  illustrations  is  the  complex 
example  of  the  influences  of  tartarized  antimony  (§  549-554,  556), 
which  may  now  be  continued  with  a  more  specific  reference  to  the 
humoral  pathology,  as  it  will  be  in  a  future  section  to  that  of  its  mo- 
dus operandi  (§  902,  904  bb).  But  now,  as  hereafter,  I  shall  show  its 
operation  through  reflex  action  of  the  nervous  system  (^  904  bb). 

I  may  say,  then,  that  it  is  especially  to  my  present  purpose  that  the 
humoralist,  as  well  as  the  solidist,  is  guided,  in  his  repeated  adminis- 
tration of  the  antimonial  alterative,  by  its  effects  upon  the  stomach ; 
since  nothing  can  be  more  obvious  to  either  than  that  all  the  remote 
effects  depend  upon  the  amount  of  impression  which  the  remedy  pro- 
duces upon  the  stomach.  It  is  not,  therefore,  quantity,  but  effect, 
gastric  effect,  which  is  regarded  in  the  administration  of  this  distin- 
guished humoral  agent  (§  826,  c).  The  intense  excitement  of  fever, 
or  the  violence  of  pneumonia,  yields  to  the  first  nauseating  dose  of 
the  antimonial,  or  if  it  only  approximate  that  point  of  gastric  irritation. 
The  next,  and  the  next,  in  unaltered  doses,  may  fail  of  an  equal  as- 
cendancy, while  the  fourth  makes  no  resistance  to  the  returning  phe- 
nomena. But,  if  there  be  now  added  to  the  original  twentieth  or 
eighth  of  a  grain  only  a  fiftieth  or  thirtieth  part,  the  phenomena  are 
again  subdued  the  moment  that  gastric  influence  begins.  And  in 
this  way  may  we  proceed,  experimentally,  by  continuing  the  same,  or 
increasing  the  dose,  and  find  at  each  repetition  that  the  general  re- 
sults will  conform  to  the  impression  which  is  made  upon  the  stomach, 
at  its  nearest  approximation  to  a  state  of  nausea ;  whatever  the  re- 
quisite dose, — however  small,  or  however  large  (§  556,  873,  904  bb). 

Again,  antimonials  are  more  salutary  when  they  can  be  borne  in 
gradually-increased  doses  than  where  it  is  necessary  to  lessen  a  small 
dose  from  the  beginning.  The  reason  is  this.  In  the  first,  or  most 
advantageous  case,  the  irritability  of  the  stomach  is  not  morbidly  sus- 
ceptible to  the  action  of  the  remedy,  but,  on  the  contrary,  obeys 
the  law  of  vital  habit  in  its  diminishing  influences  upon  the  suscepti 


PATHOLOGY. HUMOR  ALISM.  533 

bility  of  the  vital  states  (§  551,  &c.),  so  that  the  stomach  is  not  inju- 
riously irritated ;  while,  in  the  opposite  case,  the  law  of  habit  has  its 
exactly  opposite  effect  (§  556),  and  the  susceptibility  of  the  stomach 
being  morbidly  great,  and  farther  aggravated  by  the  antimony,  dis- 
ease of  this  organ  is  more  or  less  liable  to  set  in  as  a  consequence,  and 
the  object  of  the  remedy  to  be  thus  defeated.  In  the  mean  time,  it 
may  be  shedding  abroad  pernicious  reflex  nervous  influences  in 
doses  of  extreme  minuteness.  In  a  general  sense,  the  best  dose  is  just 
short  of  that  which  produces  nausea;  but,  at  other  times,  occasional 
nausea  may  be  very  salutary,  and  again,  at  others,  a  full  emetic  dose 
may  overthrow,  at  once,  a  formidable  condition  of  disease  (§  476|^  h). 
The  principle,  though  not  the  details,  is  universal.  Its  practical 
application  is  of  the  highest  importance,  and,  unlike  the  hypothesis  of 
absorption,  may  be  in  the  hands  of  all  (§  481,  494,  828  h,  1088). 

842.  The  eleventh  foundation  of  humoralism,  and  the  last  in  the  or- 
der of  arrangement  (§  823),  is  derived  from  the  tan-yard.  Thus, — 
animal  tissues  have  their  strength  increased  by  immersion  in  astrin- 
gent vegetable  infusions ;  therefore,  as  many  tonics  are  also  astrin- 
gent, they  are  taken  into  the  circulation  and  give  strength  to  the  stom- 
ach and  the  system  at  large  by  the  same  process  (§  569  h,  904  d). 

So  much  has  been  said  upon  the  foregoing  philosophy  in  the  course 
of  this  work,  that  I  should  have  avoided  the  present  subject  but  for 
its  incorporation  into  the  basis  of  humoralism,  and  as  I  was  desirous 
of  presenting  the  whole  system  in  a  methodical  manner. 

My  own  construction  of  the  modus  operandi  of  astringents  is  briefly 
set  forth  in  ray  Arrangement  of  the  Materia  Medica,  and  will  be  ex- 
tended in  subsequent  sections  of  the  present  work.  But  I  would  now 
propound  for  the  consideration  of  the  humoralist  the  modus  operandi 
oicoM,  of  ipecacuanha,  of  muriate  nf  soda,  and  analogous  agents  devoid 
of  true  astringency,  in  arresting  hemorrhage ;  or  how  vesicants  and 
ipecacuanha  often  relieve  redundant  effusions  from  the  pulmonary 
and  intestinal  raucous  membrane,  or  how  opium  restrains  all  secre- 
tions (§  890  V)  ?  The  force  of  necessity  which  applies  to  the  an- 
swers will  be  very  likely  to  extend  its  sway  throughout  the  classes 
of  astringents  and  tonics,  and  yield  to  the  laws  of  reflex  nervous 
action. — Note  Bbb  p.  1148. 

843.  That  nothing  may  be  omitted  which  may  serve  to  complete 
my  analysis  of  humoralism,  I  may  state  what  may  be  regarded  by 
many  as  a  twelfth  fundamental  ground ;  though  it  is  only  an  induction 
from  the  general  assumption  that  the  blood  is  radically  vitiated,  &c., 
and  the  efficient  cause  of  the  morbid  state  of  the  solids.  Its  "  black" 
color,  as  it  is  called,  which  appears  in  congestive  fevers,  scurvy,  &c., 
is  taken  as  one  of  the  important  evidences  of  its  corrupted  state ;  and 
when  it  refuses  to  coagulate,  humoralism  assumes  that  "  putridity" 
has  taken  place.  It  will  be  thus  seen  that  "  putrescency"  is  only  a 
corollary  of  the  seventh  proposition  in  my  analysis,  and  sustained  by 
the  fifth  (§  823,  834).  Liebig  has  gone  scientifically  into  the  subject 
(§  350) ;  and  in  the  Commentaries  I  have  endeavored  to  do  justice  to 
its  merits  (vol.  i.,  p.  403-410,  418,  430-440,  442-460,  663-673).  But, 
what  is  more  remarkable  than  the  rest,  it  is  argued,  that,  because  the 
blood  ultimately  becomes  "black"  or  "putrid,"  it  therefore  takes  the 
initiatory  step  in  the  morbid  processes.  It  is  also  an  important  "  fact" 
in  the  "  experimental  philosophy"  of  humoralism,  that  the  color  of  this 
elood  is  changed  to  a  vermilion  hue  by  adding  saline  cathartics  to 


534  INSTITUTES    OF    MEDICINE. 

that  whicli  is  abstracted  ;  from  which  the  conclusion,  is  drawn  that  vhe 
same  substances  are  taken  into  the  circulation  when  administered  by 
the  stomach,  and  that  they  then  and  there  change  the  color  of  the 
blood  in  like  manner ;  which  proves  that  the  remedial  effect  is  exert- 
ed upon  that  fluid.  There  is  no  doctrine  in  humoralism  more  sti-enu- 
ously  maintained,  and  none  in  which  the  conclusions  are  considered 
more  logical.  It  goes  with  the  rest  in  representing  the  nature  of  the 
"  experimental  philosophy"  which  now  lies  at  the  basis  of  theoretical 
and  practical  medicine.  Next  to  this  are  ancBmia,  chlorosis  and  iron.'''' 
844,  Finally,  an  author  of  the  olden  times,  writing  in  the  palmi- 
est days  of  humoralism,  but  not  of  the  professional  corps,  in  one  of 
his  sallies  upon  the  vagaries  of  philosophy,  let  slip  a  bolt  which  de- 
molishes every  material  fabric  in  medicine. 

"  All  the  world  knows,"  he  says,  "  there  is  no  virtue  in  charms  ;  but 
a  strong  conceit  and  opinion  alone,  which  forceth  the  humors  {moral 
ones),  spirits,  and  blood,  which  takes  away  the  cause  of  the  malady 
from  the  parts  affected.  The  like  we  may  say  of  our  magical  effects, 
superstitious  cures,  such  as  are  done  by  mountebanks  and  wizzards 
(§  167y,  note).  An  empiric  oftentimes,  and  a  silly  chirurgeon,  doeth 
more  strange  cures  than  a  rational  physician.  Nymannus  gives'  a 
reason :  because  the  patient  puts  his  confidence  in  him,  which  Avi- 
cenna  prefers  before  art,  and  all  remedies  whatsoever.  'Tis  opinion 
alone,  saith  Cardan,  that  makes  or  mars  physicians ;  and  he  doeth  the 
best  cures,  according  to  Hippocrates,  in  whom  most  trust.  So  di- 
versely doth  this  phantasie  of  ours  affect,  turn,  and  wind,  so  imperi- 
ously command  our  bodies,  which,  as  another  Proteus,  or  a  chame- 
leon, can  take  all  shapes,  and  is  of  such  force,  as  Facius  adds,  that  it 
can  work  upon  others  as  well  as  ourselves.  How  can  otherwise  blear- 
eyes  in  one  man  cause  tlie  like  affection  in  another  ]  How  does  one 
man's  yawning  make  another  yawn  1 — one  man's  p — ing  provoke  a 
second  many  times  to  p  ]  Why  does  scraping  of  trenchers  offend  a 
third,  or  hacking  of  files  1  Why  do  witches  and  old  women  fascinate 
and  bewitch  children,  but,  as  AVierus,  Paracelsus,  Cardan,  Mizaldus, 
Valleriola,  Vannius,  Campanella,  and  many  philosophers  think,  the 
forcible  imagination  of  the  one  party  nerves  and  alters  the  spirits  of 
the  other  %  Nay,  more,  they  can  cause  and  cure  not  only  diseases, 
maladies,  and  several  infirmities,  by  this  means,  as  Avicenna  suppo- 
seth,  in  parties  remote,  but  move  bodies  from  their  places,  cause 
thunder,  lightning,  tempests ;  which  opinion  Alkiadus,  Paracelsus, 
and  some  others  approve  of;  so  that  I  may  certainly  conclude,  this 
strong  conceit  or  imagination  is  astrum  Jiominis,  and  the  rudder  of 
this  our  ship,  which  reason  should  steer,  but  overborne  by  phantasie, 
cannot  manage,  and  so  suffers  itself  and  this  whole  vessel  of  ours  to 
be  overruled,  and  often  overturned"  (§  167/,  note,  227,  234  e,  500/,  o, 
509,892|,  1072).  What  a  display  is  here  of  our  direct  nervous  action  ! 
845.  Having  now  considered  the  grounds  upon  which  the  humoral 
pathology  reposes,  and  how  estranged  from  the  institutions  of  organic 
nature,  I  shall  proceed  to  offer  the  reader  a  condensed  view  of  my  ar- 
gument predicated  alone  of  the  fundamental  laws  of  physiology. 

I  propose  showing  by  this  argument,  that  the  blood  is  neither  a^;n- 
ynuftj  cause  of  disease  in  the  solids,  in  virtue  of  its  own  morbid  con- 
dition, nor  an  aggravating  cause  of  disease  when  altered  in  its  char 
acter  l)y  the  morbid  action  of  the  solids. 

*  See  NoTK.  R  p.  1123. 


PATHOLOGY. HUMORALISM  535 

b46.  No  one  will  deny  what  is  affirmed  by  Andral,  tliAt  every  mor- 
bid change  in  the  action  of  the  solids  is  probably  followed  by  some 
change  in  the  blood.  The  influences  from  bloodletting  often  give  rise 
to  very  remarkable  and  instantaneous  changes  in  the  circulating  mass 
(§  952,  a-h). — See  Kriemer's  expriments  ^  485. 

I  also  agree  with  Andral,  that  ^xiy  primary  alteration  of  ihe  blood, 
of  a  morbid  nature,  must,  with  greater  certainty,  produce  disease  of 
the  solids  (§  827,  e). 

The  latter  proposition  is  the  basis  of  humoralism,  and  it  is  this 
which  I  now  address. 

847,  a.  There  is  a  specious  parallelism  about  the  two  foregoing 
propositions,  of  which  humoralism  has  taken  no  little  advantage.  Both 
are  conceded  by  the  solidists,  and  humoralism  draws  its  conclusions 
from  both,  just  as  has  been  seen  of  its  principal  data  (§  823,  &c.).  Its 
inferences  involve  the  assumption  that  the  blood  and  the  solids  sus- 
tain, reciprocally,  the  same  relations  to  each  other;  when,  in  truth, 
the  distinction  is  nearly  as  great  as  between  an  agent  and  the  object 
acted  upon.  There  is  this  difference,  however.  In  the  present  case, 
in  their  natural  state,  the  blood  is  the  object,  while  it  contributes  to 
the  support  of  the  agent,  and  to  maintain  its  action. 

Were  the  blood,  therefore,  to  become  primarily  diseased,  it  would 
then  assume  the  same  relation  to  the  solids  as  any  other  morbific 
cause,  and  this  the  more  so  on  account  of  its  incorporation  with  them. 

Now,  observe  the  humoral  premises,  as  laid  down  by  Andral,  and 
considered  impregnable  by  all  humoralists.  It  will  be  seen  that  the 
first  is  the  very  thing  which  is  most  denied  in  humoralism, — the  ground 
of  solidism  itself;  yet  is  it  put  forth  for  an  unreflecting  world.     Thus  : 

Ist.  Every  morbid  change  in  the  action  of  the  solids  is  followed  by 
some  change  in  the  blood. 

2d.  'EiV ery  pri7nary  alteration  of  the  blood,  of  a  morbid  nature,  pro- 
duces disease  of  the  solids  (§  846). 

Therefore,  say  Andral,  and  other  humoralists,  every  morbid  change 
in  the  action  of  the  solids  is  occasioned  by  a  primary  change  in  the 
blood.  That  is  the  logic  (§  843).  But,  we  have  seen  that  the  two 
propositions  are  not  convertible  in  a  physiological  sense,  while  they 
stand  as  independent  statements,  and  in  exact  opposition  to  each  other. 

But  let  us  reverse  the  logic,  and  then  see  how  the  case  will  stand. 
By  the  first  of  the  premises,  the  solidist  argues  that  all  morbid  lesions 
of  the  blood  are  dependent  on  primary  changes  of  the  solids.  And 
this  conclusion  is  justified  by  the  strongest  force  of  analogy.  From 
the  germ  to  the  adult,  all  the  results  of  organic  life  have  their  origin 
in  organic  actions.  The  nutritive  fluid  itself,  from  the  time  that  or- 
ganic actions  begin,  is  universally  conceded  to  be  either  directly  or 
indirectly  the  product  of  these  actions ;  and  the  only  sense  in  which 
the  blood  can  be  regarded  as  an  agent,  is  that  of  stimulating  the  solids 
so  that  they  shall  carry  on  the  work  of  life  and  appropriate  the  blood 
to  their  own  uses  (§  1087). 

Here,  then,  we  must  steadily  regard  the  true  relation  of  one  to  the 
other,  in  the  farther  progress  of  this  inquiry. 

Now,  it  is  said  that  the  solids,  which  give  being  and  vitality  to  the 
blood,  become,  in  their  noi*mal  state,  the  subject  of  its  morbific  ac- 
tion ;  and,  according  to  the  premises  of  humoralists  and  solidists,  whec 
the  solids  are  diseased,  the  blood  undergoes  disease  in  consequence. 


536  INSTITUTES  OF    MEDICINE. 

If,  therefore,  diseased  blood  be  originally  the  cause  of  disease  in  the 
solids,  it  must  certainly  maintain  an  ascendency  over  them.  Moreover, 
the  solids,  in  their  turn,  react  upon  the  blood  and  increase  the  dis- 
eased state  of  that  fluid,  or  the  primary  morbific  cause ;  and,  accord- 
ing to  the  admitted  premises,  every  increasing  degree  of  disease  in  the 
hlood  must  he  a  cause  of  increasing  disease  in  the  solids.  Thus  would 
the  blood  and  solids  perpetually  act  and  react  upon  each  other;  and 
since  a  morbid  state  of  the  blood,  according  to  humoralism,  is  the  pri- 
mary cause  of  disease  in  the  solids,  and  constantly  becomes  more  and 
more  diseased  and  morbific  in  virtue  of  the  morbid  state  which  it  sets 
up  in  the  solids,  it  is  plain,  if  the  doctrine  of  humoralism  were  true, 
there  could  never  he  a  recovery  from  disease. — Note  Aaa  p.  1146. 

It  follows,  therefore,  I  say,  that  the  solids  having  been  brought  int » 
a  morbid  condition  by  their  own  natural  stimulus,  and  their  own 
means  of  sustenance,  and  the  morbific  state  of  the  blood  continually 
advancing,  according  to  the  admitted  pi-emises,  every  disease  so  be- 
ginning must  necessarily  terminate  in  death.  For,  again,  in  the  first 
place,  I  have  shown  the  absurdity  of  attempting  the  restoration  of  the 
blood  to  its  natural  state  by  any  direct  action  upon  it  by  foreign  agents; 
and  secondly,  what  I  have  thus  shown  an  absurdity  is  a  matter  of  uni- 
versal admission,  since  it  is  conceded  by  all  that  the  natural  state  of 
the  blood  is  entirely  dependent  on  a  natural  or  healthy  state  of  the 
solids.  Nor  can  Nature,  in  her  spontaneous  cures,  begin  to  restore 
the  blood  but  through  a  primary  recuperative  act  on  the  part  of  the 
solids.  Nothing,  therefore,  can  make  healthy  blood  but  the 
HEALTHY  ACTION  OF  THE  SOLIDS.  It  is  exactly  with  morbid  blood  as 
with  morbid  bile,  mucus,  &c.  The  restoration  of  one  depends  as 
much  as  the  other  upon  an  antecedent  improvement  of  the  solids.  No 
humoralist  medicates  the  blood  to  change  the  bile  or  mucus,  per  se. 

847,  b.  As  the  foregoing  doctrine  is  based  upon  fundamental  laws 
in  physiology,  which  admit  of  no  "  exception"  (§  284-288),  it  is  man- 
ifest that,  when  the  constitution  of  the  blood  is  altered,  or  becomes  dis- 
eased, in  virtue  of  a  diseased  state  of  the  solids,  the  blood  thus  alter- 
ed is  not  an  aggravating  cause  of  disease  in  the  solids.  Indeed, 
should  it  become,  under  these  circumstances,  a  direct  morbific  agent 
to  the  solids,  the  same  philosophy  would  hold,  the  same  effect  obtain, 
as  were  the  blood  primarily  diseased ;  since,  as  the  blood  is  entirely 
dependent  upon  the  solids  for  its  healthy  constitution,  the  moment  it 
becomes  a  morbific  agent  to  the  solids,  the  latter  will  have  lost  a  con- 
trol which  they  can  never  regain. 

847,  c.  The  fundamental  principles  now  stated  might  have  been  in- 
ferred from  the  final  cause  of  the  blood  ;  since  it  would  have  been  a 
radical  defect  in  the  animal  economy,  that  a  fluid  which  pervades  so 
universally  every  part,  which  is  intended  for  the  growth  and  nutrition 
(ff  the  whole,  which  depends  upon  those  parts  for  its  being,  and  those, 
in  their  turn,  upon  the  blood  for  their  nutrition,  and  is  at  all  times  in 
subordination  to  the  state  of  the  solids  in  the  natural  condition,  should 
receive  a  morbid  impress  fiom  a  part  or  the  whole,  which  would  not 
only  defeat  its  great  final  purpose,  but  give  to  it  an  ascendency  over 
those  poweys  and  actions  to  which  it  is  entirely  submissive,  for  the 
great  end  of  life,  in  their  natural  state  (§  43,  277,  27S,  3031,  303^, 
322-326,  385,  i09  f-i,  411,  422,  424,  449  a,  464,  638,  733  d). 

There  is  an  ever-varying  adaptation  of  the  state  of  the  blood  •'C 


PATHOLOGY. HUMORALISM.  537 

the  vaiying  condition  of  the  solids,  and  this  is  brought  about  by  the 
Bolids  themselves.  It  proceeds,  in  equal  pace,  with  the  changes  of 
the  latter ;  as  clearly  and  forcibly  exemplified  dui-ing  the  operation  of 
general  bloodletting  (§  136,  970  c).  The  properties  and  universal 
condition  of  the  blood,  therefore,  undergo  changes  corresponding  with 
any  alterations  of  the  vital  condition  of  the  solids.  What  is  phys- 
iologically true  in  this  respect  must  be  equally  so  in  a  pathological 
sense  (§  639,  a).  A  morbid  state  of  the  blood  is  an  exact  product  of 
an  antecedent  change  in  the  solids,  by  which  they  move  on  in  harmo- 
ny (§  653,  733  d,  740,  741). 

847,  d.  Just  so  is  it  with  the  morbid  product  of  an  ulcerated  sur- 
face. The  exact  condition  of  the  product  will  depend  upon  the  exact 
state  of  the  solids  by  which  it  is  generated  (§  653),  nor  does  the  prod- 
uct, however  morbid,  increase  the  diseased  state  of  the  solids,  unless 
it  undergo  some  chemical  change  after  its  elaboration.  "Were  it  oth- 
erwise, the  natural  and  immediate  result  would  be  a  perpetual  in- 
crease of  the  morbid  condition  of  the  ulcer  and  of  its  secreted  product. 
The  same,  again,  is  exactly  true  of  the  blood  and  the  organs  upon 
which  it  depends  (§  133  c,  136,  137,  150-152,  740,  741). 

The  analogy  of  which  I  am  now  speaking  is  still  more  forcible  in 
its  connections  with  the  humoral  philosophy  of  morbid  blood,  when 
it  is  considered  that,  with  whatever  violence  morbid  secretions  may 
act  upon  sound  parts,  they  bear  a  common  relation  to  all  other  mor- 
bific causes,  and  that,  therefore,  as  soon  as  the  parts  are  brought  into 
a  morbid  state  and  generate  other  or  the  same  morbid  products  them- 
selves, they  cease  to  be  offended  by  either.  The  surface  upon  which 
the  syphilitic  virus,  or  that  of  small-pox,  excites  suppurative  inflamma- 
tion, ceases  to  be  offended  by  the  virus  as  soon  as  it  becomes  the 
product  of  the  part.  Now  it  is,  indeed,  that  not  only  is  this  resistance 
made,  but  Nature  may  set  in  with  her  recuperative  process. 

It  is  hai-dly  necessary  to  add,  that  there  is  no  physiological  coinci- 
dence between  the  foregoing  morbific  causes  and  morbific  blood  in 
the  humoral  acceptation.  The  blood,  in  the  humoral  pathology,  is 
converted  into  a  morbific  cause  by  agents  foreign  to  the  organic  prop- 
erties and  actions.  These  properties  and  actions,  I  say,  therefore,  will 
have  lost  their  control  over  the  blood  thus  affected,  since  the  blood  is 
their  natural  stimulus,  the  pabulum  vitce,  and  depends  upon  a  healthy 
state  of  the  solids  for  its  integrity. 

847,  e.  The  correspondence  of  which  I  have  now  spoken  between 
the  modified  vital  properties  of  a  part  and  its  morbid  products,  and 
between  a  diseased  state  of  the  solids  and  blood  rendered  morbid 
thereby,  has  its  deep  foundation  in  physiological  laws.  The  princi- 
ple is  seen,  naturally,  in  the  adaptation  of  the  veins  to  venous  blood, 
the  ureters  and  bladder  to  the  urine,  of  the  gall-bladder  and  mucous 
tract  of  the  bowels  to  the  bile,  while  venous  blood  is  fatal  in  the  arte- 
rial system,  and  these  natural  products  excite  inflammation  in  other 
parts  (§  133,  &c.,  385,  733  d).  Mark,  however,  that  such  inflamma- 
tion cannot  be  overcome  while  a  fresh  supply  of  urine  or  bile  is 
brought  into  contact  with  the  parts  which  they  had  thus  offended. 
It  is  not  now,  as  was  just  seen  of  the  syphihtic  and  small-pox  virus 
(§  847,  d),  since  no  part  is  ca|lb.ble  of  having  its  constitution  so  alter- 
ed as  to  generate  urine  or  bile,  and  therefore  there  can  be  no  preter- 
natural adaptation  of  the  vital  state  of  any  part  to  the  morbific  proper 
ties  of  those  natural  secretions. 


53S  INSTITUTES    OF    MEDICINE. 

And  just  so  with  the  ordinary  forms  of  disease,  if  excited  in  the  sol« 
ids  by  a  primary  diseased  state  of  the  blood.  There  will  be  nothing, 
then,  to  make  healthy  blood,  and  disease  must  go  on  to  the  death. 
The  humoralist  seems  to  have  had  some  vague  conception  of  this, 
since  he  applies  himself  to  drugging  the  blood. 

847/".  Again,  as  to  the  morbid  secretions  and  the  blood,  in  the  for- 
mer case  the  general  powers  of  the  body  may  contribute  their  restora- 
tive influence  (§  848),  but  not  in  the  latter,  according  to  humoralism. 
l>ut,  in  the  sense  of  solidism,  if  the  alterations  of  the  blood  depend  on 
un  antecedent  morbid  state  of  the  solids  the  changes  of  the  blood  will 
be  always  suited  to  the  existing  condition  of  the  organic  properties  and 
actions,  of  which  the  morbid  state  of  the  blood  has  been  only  a  conse- 
quence, as  in  the  foregoing  analogous  cases  (§  847  e).  And  since  the 
changes  are  thus  exerted,  the  same  organic  properties  and  actions, 
whatever  their  condition,  can,  either  unassisted  or  by  the  aid  of  reme- 
dies, replace,  by  their  own  improvement,  the  morbid  changes  of  the 
blood  by  others  of  any  degree  of  approximation  to  the  healthy  standard  ; 
as  was  seen  of  a  part  in  relation  to  the  syphilitic  or  small-pox  virus. 

847,  g.  Is  it  asked  why  the  blood,  when  essentially  altered  by  any 
local  inflammation,  is  not,  according  to  my  principles,  detrimental  to 
the  system  at  large  %  The  solidist  can  reply  upon  sound  physiological 
laws,  while  the  humoralist  can  make  no  answer. 

I  say,  then,  that  all  other  parts  are  now  modified  in  their  powers 
and  functions  by  reflex  nervous  influences  of  the  local  disease  (§222, 
'&c.,  452,  &c.,  500,  &c.,  512,  &c.,  733  d,  811).  In  proportion  as  that 
affection  is  capable  of  modifying  the  blood,  so  does  it  exert  a  reflex 
nervous  action  upon  all  parts  of  the  organization  (§  674,  d).  The  mod- 
ifications of  the  blood  and  the  constitutional  derangement  being  pro- 
duced by  a  common  cause,  the  blood  and  the  solids  are  universally 
adapted  to  each  other ;  the  blood  being  thus  inoffensive  to  the  gener- 
al organization,  just  as  the  virus  of  the  small-pox  is  harmless  to  the 
skin  by  which  it  is  generated  (^  858). 

This  law  of  adaptation  meets  us  every  where,  both  in  the  natural 
and  morbid  states  of  the  animal  kingdom.  It  is  the  same  great  work 
of  Design  under  all  the  circumstances  of  life.  In  disease  it  is  coin- 
cident with  what  is  seen  in  health  of  the  modified  irritability  of  the 
larynx,  adapting  it  to  atmospheric  air,  of  the  pylorus  to  chyme,  &c. 
The  same  as  the  adaptation  of  natural  bile  to  the  natural  state  of  the 
intestine,  or  of  morbid,  acrid  bile  to  the  diseased  or  disordered  intes- 
tine. It  is  analogous  to  the  expedient  by  which  a  deep-seated  ab- 
scess reaches  the  surface,  and,  finally,  to  all  the  pi'ocesses  of  recu- 
peration (§  156  b,  733  d,  references).  Through  the  same  law  of 
adaptation,  also,  the  solids  are  brought  into  such  relationship  with 
each  other  by  the  reciprocal  influences  of  disease  as  it  may  affect  va- 
lious  parts,  and  whatever  the  variety  in  the  coexisting  conditions,  that 
a  single  remedy,  as  bloodletting,  a  cathartic,  an  emetic,  &c.,  may  be 
universally  suited  to  the  several  pathological  states.  These  cases  are 
perpetually  before  us ;  and  were  not  my  philosophy  true,  all  our  effi- 
cient remedies  would  forever  aggravate  some  part  of  a  compound  dis- 
ease. The  principle  is  the  same  in  both  the  cases,  and  our  experi- 
mental knowledge  of  its  truth  in  the  latter  confirms  what  I  have  stated 
as  to  the  blood  in  the  former  (§  143,  c). 

847,  7i.  Were  not  the  foregoing  all-wise  provisions  established  in 


PATHOLOGY. HUMORALISM.  539 

the  constitution  jf  animals,  all  the  diseases  which  it  may  now  throw 
off  would  require  for  their  removal  the  interposition  of  Supernatural 
Power  (§  133  c,  151,  152).  The  morbific  blood  would  not  develop 
disease  in  one  part  alone,  as  overlooked  by  the  humoralists,  but  through- 
out the  universal  organism;  and  the  blood  itself,  becoming  progress- 
ively diseased  in  the  ratio  of  its  morbific  influence  upon  the  solids, 
would  hasten  the  general  catastrophe  in  an  increasing  ratio.  The 
blood  of  the  victim  of  small-pox  would  poison  more  and  more  pro- 
foundly, while  the  purulent  matter  would  erode  the  body  and  lend  its 
powerful  aid  in  the  universal  work  of  destruction.  Nature,  however, 
comes  out  triumphantly,  and  in  an  allotted  time.  We  must  look  U) 
the  philosophy  which  I  have  taught  for  the  only  possible  interpreta- 
tion ;  while  it  opens  a  door  to  a  stupendous,  harmonious  system  of 
fundamental  laws  (^  233f,  500  k,  m,  841,  893  a,  n,  904  bb,  905). 

848.  It  will  now  be  apparent  from  what  has  been  said  in  the  pre- 
ceding section,  how  it  is  that  remedial  agents  will  call  into  salutary 
reflex  nervous  actions  various  parts  of  the  body  not  affected  by  disease, 
but  whose  susceptibilities  are  increased  by  morbific  reflex  nervouB 
actions  excited  by  absolute  desease,  and  upon  which  parts  the 
remedial  agents  might  otherwise  be  inoperative.  In  this  way,  there- 
fore, various  parts  may  be  rendered  instrumental  in  establishing  those 
influences  upon  the  seat  of  disease  which  enables  Nature  to  take 
on  the  recuperative  process  (§  137  d,  e,  143  c,  149-151,  152  b,  163, 
514  7i,  674  d).  Wh.irever,  too,  may  be  the  complexities  of  disease, 
the  right  remedy  will  be  at  least  compatible  with  the  whole  condition 
(§  870  aa,  891  g,  891^  e,f,  892  c,  d,  892i  c,  d). 

849.  Upon  the  foregoing  fundamental  ground  (§  847),  it  appears,  a 
fortiori,  that  if  perfectly  healthy  human  blood  be  allowed  to  flow  into 
the  veins  of  a  subject  affected  with  fever,  or  scurvy,  or  inflammation 
of  any  important  organ,  in  quantities  sufficient  to  produce  an  eflfect, 
while,  also,  a  corresponding  quantity  of  morbid  blood  flows  out  of  the 
veins,  such  healthy  blood  would  aggravate  the  disease  (§  136,  137  h, 
c,  e,  149,  152).  This  induction  from  principles  has  been  practically 
demonstrated,  even  to  the  death  of  human  subjects,  although  the  quan- 
tity of  healthy  blood  transmitted  was  small.  There  was  no  natural 
relation  between  the  healthy  blood  and  the  diseased  solids,  and  the 
former,  therefore,  became  morbific  (§  152,  b). 

850.  It  follows,  also,  from  the  foregoing  physiological  principles, 
that  morbid  blood  may  excite  disease  in  a  healthy  subject,  if  trans- 
ferred in  certain  quantities  into  the  circulation.  It  may  be  necessary, 
however,  that  the  quantity  should  be  large  ;  when,  as  soon  as  morbid 
action  follows,  the  whole  mass  of  blood  will  become  affected,  and  thus 
brought  into  harmonious  relation  with  the  diseased  state  of  the  solids 
(§  847,  e-g).  Hence,  the  great  mass  of  blood  is  altered  from  its  natu- 
ral state  by  the  solids,  and  convalescence  may,  therefore,  begin  spon- 
taneously, or  through  the  intervention  of  art. 

It  is  scarcely  necessary  to  add,  that  the  pi-esent  case  is  entirely  dif- 
ferent from  those  in  which  it  is  assumed  by  the  humoralists  that  the 
whole  mass  of  blood  is  primarily  morbific.  The  injected  portion  is 
like  any  other  morbific  agent  circulating  with  the  blood  ;  nor  does  it 
assimilate  to  itself,  any  more  than  wine,  or  bile,  when  so  injected,  the 
circulating  mass.  The  general  mass  remains  under  the  control  of  the 
solids,  and  receives  from  them  its  deterioration  should  disease  ensue. 


540  INSTITUTES    OF    MEDICINE. 

Nor  doss  it  follow  that  the  injected  blood  will  produce  the  same  con- 
dition of  disease  as  that  by  which  it  was  altered  (§  350,  nos.  44,  45, 
97,  744,  810),  or  be  fatal  either  in  this  or  the  other  case  (§  849). 

851,  a.  Finally,  the  humoral  pathology  chains  the  mind  in  igno- 
rance, and.  whether  with  the  learned  man,  or  the  bolder  empyric,  leads 
equally,  in  its  application,  to  the  most  unhappy  practical  errors.  The 
violent  assumption  is  equally  made  by  either,  that  the  blood  must  be 
purified  or  otherwise  changed  by  the  direct  action  of  remedial  agents  ; 
that  its  impurities  must  be  purged  away ;  that  the  means  are  taken 
into  the  circulation,  even  calomel,  blue  pill,  and  other  less  soluble  sub- 
stances ;  that  they  are  then  conveyed  into  the  torrent  of  the  circula- 
tion, cleanse,  neutralize,  purify  the  blood,  and  reinstate  its  natural 
condition,  as  necessary  to  the  subsidence  of  disease  in  the  solids.  It 
is  all  the  work  of  the  hlood-mdking  faculty  of  calomel,  opium,  and  nux 
vomica.  The  treatment,  therefore,  is  ajDt  to  be  governed  by  this  in- 
dication (^  1087). 

Or,  does  the  humoralist  resort  to  bloodletting;  he  professes  to 
carry  off  the  poison,  the  "  peccant  humors,"  &c.,  by  abstracting  some 
dozen  ounces  of  blood  from  the  circulating  mass.  But  this  is  neither 
conformable  with  fact,  nor  with  the  hypothesis ;  since  the  great  bulk 
of  the  poison  remains  behind,  and  since,  also,  at  the  beginning  of  the 
disease,  the  infected  mass  must  be  greatly  less  morbific  than  when 
remedies  are  applied  at  its  advanced  stages.  The  humoralist  affirms, 
indeed,  that  an  inappreciable  quantity  of  miasma,  or  of  the  virus  of  the 
dissection  wound,  &c.,  enters  the  circulation  and  throws  the  whole 
mass  into  a  ferment,  and  that  this  goes  on  progressively  increasing  ; 
nay,  that  one  drop  of  blood  thus  affected  is  sufficient  to  contaminate 
the  whole  mass,  "  as  a  little  leaven  leaveneth  the  whole  lump,"  or 
"  as  one  spoiled  herring  will  taint  the  whole  cask"  (§  350,  nos.  44,  45, 
821  c).  And  yet  may  a  severe  grade  of  disease  be  suddenly  overcome 
by  a  single  bloodletting,  or  by  a  cathartic,  or  by  an  emetic,  or  by  a 
full  dose  of  quinine  (^  284,  330,  892  I,  900,  902,  905  c,  970  c). 

But  the  humoralist,  learned  or  unlearned,  is  little  prone  to  abstrac- 
tions of  blood  in  recent  times,  and.  now,  more  than  ever,  proceeds 
upon  the  broad  basis  of  his  pathology.  Cathartics  are  his  special  fa- 
vorites, for  they  purge  off  the  humors,  and  cleanse  the  blood  ;  or  if  it 
be  quinia  for  an  intermittent,  it  is  administered  with  a  view  to  neu- 
tralize a  poison.  To  him  the  vis  mcdicatrix  NaturcB  is  like  the  mid- 
night darkness  to  a  blind  man  (§  240,  839,  853). 

851,  h.  How  different  the  practice  of  the  solidist ;  how  enlarged  his 
philosophy  ;  how  various  his  remedies  ;  how  consistent  his  doctrines  ; 
how  important  to  humanity  !  Let  a  single  example  illustrate  and  con- 
firm his  theories.  According  to-the  nature  of  the  predisposing  causes, 
and  the  exact  pathological  conditions,  he  cures  ophthalmia  by  an  emet- 
ic, or  cathartic,  or  by  bark,  or  arsenic,  or  iodine,  or  mercury,  or  blood- 
letting,  or  leeches,  or  blisters,  or  electricity,  or  local  sedatives  or  stim- 
ulants, and  by  light  or  darkness  (§  675,  686,  904  a). 

851,  c.  I  reoret  the  necessity  of  the  parallel  and  the  contrast.  But 
r  speak  of  facts  and  philosophy  ;  nor  should  I  be  true  to  my  duty  did 
[  not  speak  with  honesty  and  frankness.  If  wrong,  refutation  will  be 
easy  and  gladly  accepted  (^  1  a} 


THERAPEUTICS.  541 


THERAPEUTICS. 


852,  a.  Therapeutics  is  the  great  ultimate  object  of  all  medical 
inquiries.  It  refers  back  to  the  natural  physiological  states  of  the 
body,  and  to  the  laws  which  govern  organic  beings  in  their  healthy 
condition.  It  takes  in  the  whole  range  of  pathology,  since  there  could 
be  no  rational  treatment  of  disease  without  a  previous  investigation 
of  its  causes  and  nature,  and  a  proper  knowledge  of  their  relative  laws 
and  principles.  Having,  also,  for  its  specific  objects  the  means  of 
cure,  and  their  just  application  to  disease,  therapeutics  comprehends 
all  the  vital  relations  of  the  Materia  Medica. 

Notwithstanding,  however,  the  vast  range  of  principles  which  it  em- 
braces, and  the  immensity  and  complexity  of  its  details,  it  has,  essen- 
tially, but  one  fundamental  object ;  namely,  that  of  inducing  such 
changes  in  the  morbid  organic  properties  and  functions  as  will  enable 
them  to  return  spontaneously  to  their  natural  state  (§  177). 

852,  h.  We  thus  find  that  all  parts  of  our  inquiry  are  intimately 
bound  together ;  that  together  they  form  a  perfectly  consistent  whole  ; 
and  that  as  a  whole  each  part  is  necessary  to  all  the  rest  (§  137  a, 
639  a). 

Wonderful,  indeed,  that  so  vast  a  subject  should  be  so  simple  in  its 
elementary  principle  ;  but  more  wonderful  still  that  a  principle  so 
simple  should  be  more  complex  in  its  attributes  than  all  other  princi- 
ples in  nature  (§  133-153,  177-182,  222-233). 

853,  It  is  an  attribute  of  the  properties  of  the  Vital  Principle  that 
they  possess  an  inherent  tendency  to  return  from  their  morbid  to  their 
natural  states.  This  endowment  has  given  rise  to  Thei'apeutics,  and  is 
indispensable  to  the  perpetuation  of  organic  beings.  It  belongs, 
therefore,  to  plants  as  well  as  to  animals  (§  133  c,  185).  The  object 
of  art,  in  the  treatment  of  disease,  is  to  place  those  properties  in  a 
condition  which  will  enable  them  most  readily  to  obey  this  natural 
tendency  (§  189).    This  is  what  I  mean  by  Nature,  and  the  vis  rncdicatrix. 

854,  a.  Remedial  agents  operate  upon  the  same  principle  as  the 
remote  causes  of  disease  (§  150-152).  They  can  never  transmute  the 
morbid  into  healthy  conditions.  That  is  alone  the  work  of  Nature 
(§  524,  d,  862).     Art  can  only  make  the  best  use  of  her  laws  (§  237). 

854,  h.  The  most  violent  poisons  are  among  our  best  remedies. 
"  Ubi  virus,  ihi  virtus."  In  a  medical  sense,  however,  we  do  not  know 
them  as  poisons,  but  as  among  the  choicest  blessings  bestowed  upon 
man.  Poisons,  however,  they  may  all  become  when  not  employed  in 
their  proper  relations  to  disease  (§  150,  673,  674).  That  it  may  be 
properly  known  in  what  respects  they  are  remedial,  they  should  be 
studied  in  their  morbific  aspects  ;  studied  in  their  morbific  effects  upon 
diseased,  not  upon  healthy,  conditions  (§  137,  d,  &c.).  Thus,  also, 
shall  we  employ  them  with  a  more  solemn  reference  to  their  morbific 
capabilities,  and  under  the  deep  conviction  that  when  injudiciously 
administered  they  cannot  fail  to  exasperate  disease. 

854,  hh.  The  foregoing  consideration  demonstrates  an  important 
fallacy  at  the  very  foundation  of  homoeopathy.  It  affects  very  seri- 
ously its  main  principle  as  founded  upon  experiments  with  remedial 


542  INSTITUTES   OP   MEDICINE. 

agents  upon  the  healthy  subject.  But  the  fact  that  this  objection  has 
not  been  advanced  is  an  evidence  of  the  little  consideration  which  is 
bestowed  upon  the  vast  differences  between  the  operation  of  reme- 
dies upon  healthy  and  diseased  organs  ;  and  if  such  palpable  distinc- 
tions be  not  observed,  what  must  be  the  amount  of  knowledge  in  re- 
spect to  the  immense  variety  in  the  degrees  and  kinds  of  susceptibility 
in  different  forms  of  disease  and  in  the  variable  pathological  states  of 
a  common  form  (§  137  d,  150,  191,  &c.,  S92i  h,  855,  856)  ]  There 
is  nothing,  however,  more  important  in  medicine  than  the  principle 
which  I  am  now  considering.  But,  there  can  be  little  hope  of  its  gen- 
eral recognition  till  experiments  upon  animals  with  a  view  to  elicit 
the  causes  and  the  philosophy  of  disease  as  manifested  in  the  human 
race  shall  have  been  abandoned.  Not  till  all  indications  as  to  the 
curative  virtues  of  remedial  agents  shall  become  limited  to  observa- 
tions upon  man  alone,  and  man  in  a  state  of  disease.  Not  till  all 
others  shall  have  ceased.  Not  till  principles  in  medicine  are  wrested 
from  the  hands  of  the  chemical  and  mechanical  philosophers  (^  676,  h). 
Not  till  a  proper  decision  can  be  obtained  between  the  two  methods 
of  considering  disease  as  propounded  in  sections  5^  a,  675,  6S6  h. 
Should  the  last  of  these  references  prevail,  then  must  fall,  as  an  indis- 
pensable prerequisite,  all  the  principles  and  suggestions  which  have 
been  derived  from  the  philosophy  which  concerns  the  external  world, 
and  yield  to  that  system  which  I  have  set  forth  as  the  foundation  of 
the  method  of  interrogating  disease  according  to  that  section  to  which 
this  special  reference  is  made  (§  686,  h,  1058  b,  note,  1059). 

854,  c.  In  respect  to  the  absolute  influences  of  all  remedial  agents 
of  positive  virtues,  they  are  essentially  morbific  in  their  remedial 
action ;  as  will  have  been  duly  explained  (§  893,  902).  They  are 
alterative  in  disease,  as  in  health,  in  respect  to  the  vital  properties 
and  actions.  There  is  no  difference  in  principle  as  to  their  absolute 
action.  In  certain  remedial  quantities  many  may  induce,  in  the 
healthy  organism,  various  degrees  of  disease  with  as  much  certainty 
as  those  agents  which  are  called  morbific.  It  is  upon  this  alterative 
nature  of  remedial  agents  that  I  have  founded,  in  part,  my  Therapeu- 
tical Arra?igement  of  the  Materia  Medica  (§  893,  897-901,  1059). 

854,  d.  The  difference,  in  effects,  between  the  truly  morbific  and 
remedial  agents  is  two-fold.  Morbific  causes  make  their  deleterious 
impression,  in  a  general  sense,  more  profoundly  and  more  perma- 
nently. Positive  remedial  agents,  in  certain  quantities,  exert  such 
morbid  changes  as  are  not  profound,  and  from  which  the  properties 
of  life  may  recover,  by  their  inherent  tendency,  their  normal  state. 
But,  there  is  also  another  difference  which  is  fundamental.  The  two 
classes  of  agents  not  only  affect  the  vital  states  in  different  modes,  ac- 
cording- to  the  special  virtues  of  each,  but  each  establishes  changes  ac- 
cordino-  to  the  existing  condition  of  the  vital  states  (§  137^^,149, 150, 
S54  hb).  The  Materia  Medica  is  necessarily  founded  upon  the  fore- 
goincr  principles,  however  it  may  have  been  hitherto  unexplained,  or 
however  it  may  not  be  now  admitted  (^  2  b,  143c,  895,  902/). 

854,  e.  In  the  treatment  of  disease,  therefore,  we  do  but  substitute 
one  morbid  action  for  another.     Physiological  processes  do  the  rest. 

854, y.  In  consequence  of  the  laws  of  organization,  the  approxima- 
tions of  morbid  conditions  are  such  as  to  enable  us  to  estaljlish  upon 
a  conain  combination  of  phenomena  certain  general  priaciplep  of 


THERAPEUTICS.  643 

treatment,  corresponding  harmoniously  with  the  principles  through 
which  the  morbific  agents  have  induced  the  adverse  changes.  The 
curative  principles,  therefore,  will  be  liable,  in  all  cdses  which  are  not 
exactly  alike,  to  certain  modifications  according  to  the  modifications 
of  disease  ;  and  these  are  to  be  learned,  especially,  from  the  vital 
manifestations  (§  150-152,  177-179,  182  b,  638,  650,  670,  672,  676, 
677,  680,  733  e-i,  741  b,  745,  756  b,  758,  766,  854  bb). 

855.  Many  of  the  remedies  for  disease,  especially  when  Nature  is 
engaged  in  the  recuperative  process,  consist  of  the  ordinary  means 
of  maintaining  health,  such  as  the  various  modes  of  exercise,  change 
of  climate,  &c.  These  means  now  operate  with  greater  power  than 
under  ciixumstances  of  health,  and  must  therefore  be  carefully  adapt- 
ed to  the  existing  state  of  the  patient,  since,  when  unduly  applied, 
they  aggravate  or  reproduce  disease  like  agents  of  absolute  virtues 
(§  137  b,  143,  147,  149,  150,  854  bb,  872  a,  902  m).  When  produc- 
tive of  useful  eifects  they  co-operate  in  a  direct  manner  with  the  ten- 
dency to  restoration  which  had  already  begun  (§  672,  733  e-i). 

Of  the  same  nature,  also,  are  the  agreeable  excitements  of  imagi- 
nation, of  society,  of  rural  scenery,  of  joy,  hope,  amulets,  charms,  &c. 
While,  also,  some  of  these  means  may  be  powerfully  morbific  they 
may  be  equally  curative  of  disease  (§  226,  227,  &c.,  844,  1067). 

856,  a.  There  are  yet  other  remedial  means  which  may  be  called 
negative,  or  such  as  merely  allow  Nature  the  fullest  opportunity  to  go 
on  with  her  recuperative  "efforts.  They  make  no  impression  upon 
the  vital  conditions  ;  and  all  the  changes  to  which  they  administer 
grow  exclusively  out  of  the  constitutional  tendency  of  the  properties 
and  actions  of  life  to  return  to  a  state  of  health  ;  which  is  the  import 
I  give  to  the  convenient  term  Nature  when  employed  therapeutically. 

856,  h.  Now  the  means  of  cure  embraced  in  this  and  the  preceding 
sections  are  of  the  highest  moment  in  every  case  of  disease ;  and  yet 
are  they  the  most  neglected  except  by  those  who  depend  on  Nature 
alone.(§  854,  bb).  In  a  large  proportion  of  chronic  forms  of  disease,  and 
whei'e  they  are  acute  but  not  profound,  little  else  is  needed  than  a 
modified  system  of  hygiene  adapted  to  the  individual  cases.  Com- 
ing to  graver  modes  of  disease,  and  where  active  remedial  agents  are 
required,  the  negative  means  are  more  important  than  in  the  former 
cases,  and  nothing  more  so  than  a  rigorously  low  diet. 

Here,  then,  is  opened  a  wide  door  for  the  contemplative  and  prac- 
tical inquirer.  Here  recuperative  nature  is  displayed  according  to 
the  Ordination  of  Providence  throughout  brute  creation.  The  animal 
sickens,  "  starves,"  and  thus  nature  works  the  cure.  Man  alone  vio- 
lates her  law  (§239,  240). 

857.  It  has  been  seen  that  morbific  and  remedial  agents,  even  the 
natural  agents  of  life,  acting  with  certain  intensities,  and  under  given 
circumstances,  may  be  entirely  on  a  par ;  each  leading  with  certainty 
to  morbid  changes  which  may  transcend  the  restorative  disposition  of 
the  organic  functions. 

This  fact  involves  a  principle  which  is  fundamental  in  the  Materia 
Medica  ;  that  of  limiting  the  quantity  of  remedial  agents,  and  the 
duration  through  which  they  operate,  so  that  they  shall  only  establish 
such  changes  in  the  vital  conditions  as  will  enable  them  to  exert  their 
fullest  tendency  to  return  to  a  state  of  health.  Beyond  that  point  pos- 
it We  remedies  determine  morbid  changes  that  are  emban'assing  to 


o44  INSTITUTES    OF    MEDICINE. 

Nature,  and  may  be  far  more  so  than  the  conditions  which  had  been 
instituted  by  the  primary  cause  of  disease.  This  is  a  matter  of  constant 
demonstration ;  and  if  we  connect  with  it  the  more  general  abuse  of 
food,  their  common  mode  of  action  becomes  so  obvious,  that  he  who 
may  pause  in  his  excessive  medication  should  take  the  hint  and  unite 
the  advantages  of  the  negative  treatment  (§  856). 

I  am  now  upon  ground  of  the  first  importance  in  practical  medi- 
cine. I  have  endeavored  to  enforce  and  to  illustrate  that  importance 
by  calling  up,  in  a  variety  of  shapes,  those  fundamental  physiological 
laws  which  give  the  greatest  determination  to  the  effects  of  remedial 
agents,  in  respect  to  their  amount,  and  the  frequency  of  their  repeti- 
tion (§  889, 1).  I  leave  out  of  consideration,  for  the  moment,  the  vast 
questions  which  relate  to  the  right  adaptation  of  remedies  as  concerns 
their  nature,  and  the  order  of  their  application  (§  150).  I  would  dwell 
abstractedly  upon  the  dose  and  the  frequency  of  its  repetition.  Too 
little  reference  to  the  natural  constitution  of  the  pi'operties  of  life  and 
the  laws  which  they  obey  in  their  natural  states,  and  too  little  depend- 
ence upon  recuperative  nature — ay,  I  may  safely  affirm,  too  general 
an  abandonment  of  that  foundation,  and  even  a  universal  ignorance  of 
the  practical  bearings  of  some  of  its  most  important  elements  (§  516  d, 
no.  6,  524  d),  have  mainly  led  to  an  abuse  of  remedies  in  respect  to 
doses  and  their  repetition  which  has  been  more  pernicious  than  er- 
rors in  their  appropriate  nature,  and  their  order  of  application.  That 
abuse,  indeed,  in  connection  with  the  stimulant  and  feeding  practice, 
is  the  whole  secret  of  the  origin  of  homoeopathy,  and  of  its  extensive 
prevalence  (^  621,  a,  1068). 

It  must  be  conceded,  however,  that  there  is  no  attainment  in  medi- 
cine so  difficult  as  that  which  relates  to  quantity  or  dose,  or  which  re- 
quires so  much  critical  observation  of  disease ;  and  next  to  that  is  the 
time  when  the  dose  should  be  repeated,  or  varied,  or  some  substitute 
made.  The  most  delicate  points  are  relative  to  dose  and  repetition, 
and  these  can  never  be  attained  with  any  accuracy  without  a  full  ap- 
preciation of  certain  physiological  laws  which  I  have  endeavored  to 
expound  as  far  as  my  own  apprehension  of  their  nature  will  admit  (§ 
5J  a,  516  d,  no.  6,  &c.,  686).  It  should  be  kept  steadily  in  view  that 
all  efficient  remedies  are  morbific  in  excessive  doses,  that  what  would 
be  pei-fectly  inert  in  one  condition  of  the  same  disease  may  be  fatal  in 
another  modification,  and  that  the  impressions  produced  are  continued 
beyond  the  time  of  their  direct  operation,  according  to  the  nature  of 
the  remedy,  its  dose,  the  precise  pathological  conditions,  &c.  (§  149, 
150,  163,  191,  514  g,  516  c,  516  J,  no.  6,  550,  552,  556  h,  558  a, 
673).  A  repetition  of  the  means  before  the  influences  already  estab- 
lished shall  have  ceased,  or  have  duly  lessened,  or  have  fallen  short  of 
the  intended  amount,  either  prolongs  the  cure,  or  exasperates  and 
multiplies  disease  (§  872). 

858.  The  foregoing  principle  is  strikingly  shown,  and  a  large  reli- 
ance upon  Natui'e  as  strongly  enforced,  by  the  impracticability  of  art 
in  arresting  the  progress  of  the  self-limited  diseases,  and  by  their 
spontaneous  termination  in  health.  We  cannot,  by  any  active  treat- 
ment of  small-pox,  &c.,  place  the  morbid  properties  and  functions  in 
a  more  advantageous  slate  to  exert  their  recuperative  principle  than 
had  been  already  done  by  the  very  causes  of  the  disease.  On  the  con- 
trary, all  active  treatment  embarrasses  Nature,  and  is  generally  mor- 


THERAPEUTICS.  545 

bific.  Accidental  conditions,  such  as  inflammation  of  important  or- 
gans, may  spring  up  in  the  truly  self-limited  diseases,  which  may  re- 
quire a  decisive  impression  from  remedial  agents ;  and  it  is  an  ad- 
mirable law  of  nature  that,  in  proportion  as  these  special  exigencies 
may  arise,  the  influences  of  their  pathological  conditions  will  enable 
the  more  general  affection  to  bear  the  treatment  that  may  be  demand- 
ed by  the  contingent  derangements  (§  150,  156  b).  But  we  must  be 
careful  to  avoid  such  agents  as  may  interfere  with  the  established  ten- 
dency of  the  general  affection  to  subside  spontaneously  (^  847  g). 

Nowhere,  however,  is  the  recuperative  tendency  of  nature,  the  vis 
medicatrix  natures,  so  forcibly  displayed  as  in  the  brute  creation,  where 
instinct  alone  obtains,  and  where  organic  life  moves  on  unshackled  by 
artificial  habits  (§  856,  V).    All  is  the  work  of  physiological  processes. 

859,  a.  We  see,  therefore,  more  and  more,  that,  in  therapeutics,  we 
should  cautiously  avoid  those  fallacious  inductions  which  have  been 
drawn  from  the  actiun  of  remedial  agents  upon  man  in  health,  and 
even  upon  animals  and  plants,  and  which  constitute  a  part  of  the  "  ex- 
perimental philosophy"  of  the  age  (§  854).  It  is,  however,  one  of  the 
worst  corruptions  that  has  crept  into  medicine.  I  have  variously  in- 
dicated its  want  of  philosophy,  and  the  evils  of  its  practical  applica- 
tion. They  are  summarily  comprehended  in  principles  set  forth  in 
sections  149-152.  These  principles  I  regard  as  among  the  foremost 
in  therapeutics  ;  and  here,  but  for  other  reasons,  they  would  have 
been  first  announced. 

859,  h.  To  arrive  at  any  just  knowledge  of  the  physiological  rela- 
tions of  any  remedy  to  a  given  form  of  disease,  it  must  be  considered 
in  the  opportuneness  of  its  application,  its  appropriate  degrees,  and 
according  to  the  varieties  of  constitution,  age,  habits,  sex,  &c.,  and 
according,  also,  to  the  nature  of  the  affected  organ,  to  the  variations 
of  any  given  disease,  its  reflex  nervous  influences,  and  as  those  influ- 
ences may  be  modified  by  the  remedy,  and  the  connection  of  the  par- 
ticular remedy  with  other  agents  that  may  precede,  or  follow,  or  be 
simultaneously  employed,  and  all  other  circumstances  that  may  favor 
or  embarrass  its  most  salutary  effects  (§  133-163,  535,  &c.,  574,  &c., 
585,  &c.,  622,  650,  651,  659-662,  671-673,  675,  685,  686,  &c.). 

859.  c.  Nevertheless,  the  salutary  action  of  remedies,  or  rather  the 
aid  which  they  may  contribute  to  the  recuperative  process,  is  common- 
ly in  the  ratio  of  the  intensity  of  disease.  This  grows  out  of  the  con- 
stitutional nature  of  the  organic  properties,  as  already  variously  con- 
sidered, and  Medicine  simply  administers  their  laws  (^  235,  237). 

860.  All  remedial  agents  of  positive  virtues,  like  all  morbific  ones, 
alter  the  properties  and  actions  of  life,  ctxteris  paribus,  according  to 
the  nature  of  each  agent  (§  652).  Each  one  affects  them  in  Tiind,  and 
in  a  way  more  or  less  peculiar  to  itself.  Hence,  mainly,  the  varieties 
in  any  common  genus  of  disease,  as  in  inflammation  and  fever  ;  hence, 
also,  the  modifications  of  a  common  mode  of  treatment,  and  hence  the 
importance  of  selecting  the  cathartic,  the  emetic,  &c.,  whose  virtues 
may  be  most  appropriate  to  the  precise  pathological  condition  of  tlie 
case  before  us,  and  introduce  the  right  pathological  change. 

861.  There  are  but  a  few  diseases  which  have  a  determinate  ten- 
dency to  a  state  of  health,  and  these  are,  in  consequence,  denominated 
self-limited.  Sooner  or  later,  however,  there  is  apt  to  arise  in  a  large 
proportion  of  diseases  a  spontaneous  subsidence      This  may  not  be 

M  M 


546  INSTITUTES   OF   MEDICINE. 

true  of  a  great  proportion  of  cases ;  but  the  restorative  disposition  is 
often  manifested  in  a  gi'eat  number  of  instances  of  any  given  disease, 
vsrhile  a  gi-eater  number  of  the  same  disease  may  run  on  to  a  fatal  ter- 
mination. Their  morbific  causes  are  not  such,  as  in  small-pox,  &c., 
as  to  establish  modifications  of  the  vital  states  which  go  on  through 
regular  changes  till  they  terminate  in  health  (§  858) ;  though  there 
may  be  a  strong  tendency  of  this  nature  existing,  as  seen  in  intermit- 
tent fevers.  Nevv^  agents  (called  remedial,  but  in  reality  morbific 
(§  901))  may,  therefore,  be  made  to  operate  so  as  to  develop  the 
restorative  principle  where  it  might  otherwise  fail,  or  introduce  it 
sooner  than  it  would  occur  spontaneously  ;  and  thus  place  the  disease 
on  a  par  with  the  self-limited,  whose  predisposing  causes  surpass  all 
remedies,  in  a  fundamental  sense,  in  developing  a  tendency  to  the  re- 
storative process. 

It  is  also  important  to  consider  that  the  restorative  process,  in  a 
general  sense,  is  most  readily  established  near  the  invasion  of  disease, 
whatever  its  violence  (§  557  a,  868,  869,  &c.). 

862.  Nature  resorts  to  a  variety  of  expedients  in  caiTying  out  her 
process  of  cure.  The  principle  is  the  same  in  all  the  cases,  and  its 
details  illustrate  what  has  been  hitherto  so  obscurely  meant  by  the  vis 
medicatrix.  It  is  the  same,  through  all  the  intermediate  conditions  and 
complications,  from  those  diseases  which  are  marked  by  a  definite  or- 
der of  results,  as  in  the  self-limited,  to  the  most  intractable  maladies. 
A  clear  and  impressive  example  of  the  nature  of  the  principle  is  seen 
in  the  progress  of  an  abscess  toward  the  surface,  to  its  termination  in 
health  (§  733).  Whenever  inflammation  passes  its  formative  stage, 
there  is  always  some  sensible  demonstration  of  the  modus  operandi  of 
the  vis  medicatrix.  These  visible  results  are  of  a  depletory  nature, 
like  redundancies  of  bile,  and  consist  of  lymph,  serum,  pus,  &c. ;  and, 
although  the  results  of  salutary  changes  in  the  morbid  states,  and  con- 
ducive to  the  farther  subsidence  of  disease,  they  are  apt  to  constitute 
as  great  or  greater  evils  than  the  disease  whose  decline  had  led  to 
their  formation  (§  732  d,  733  a).  It  is  the  business  of  art  to  prevent 
these  intangible  consequences,  although  they  grow  out  of  a  law  by 
which  Nature  aims  at  preservation  and  cui-e  (§  733,  c). 

863,  a.  In  the  treatment  of  disease  we  endeavor  to  imitate  Nature 
in  her  spontaneous  efforts  at  relief,  so  far  as  principle  is  concerned. 
If  these  efforts  result  in  the  formation  of  new  products,  or  an  increase 
of  the  natural  ones,  in  certain  modes  of  disease,  our  remedies  should 
be  such,  in  the  same,  or  analogous  affections,  as  will  be  likely  to  de- 
termine an  increase  of  the  natural  secretions  (§  732  a,  h,  756  h,  785, 
801,  805).  And,  although  these  effusions  do  not  relate  directly  to  the 
parts  that  may  be  mainly  diseased  (as  is  generally,  though  not  always, 
true  of  Nature),  they  are  significant  that  favorable  impressions  are 
made  upon  these  parts.  In  the  natural  cure,  also,  it  is  these  vital 
changes,  far  more  than  the  physical  products  to  which  they  give  rise, 
that  determine  the  cure.  This  is  artificially  exemplified  in  the  influ- 
ence of  vesicants,  rubefacients,  issues,  moxa,  &c.,  upon  deep-seated 
inflammations,  and  proving  my  doctrine  of  reflex  nervous  action. 

863,  b.  Nevertheless,  these  redundant  products,  whether  of  Na- 
ture or  of  art,  contribute  more  or  less,  as  means  of  depletion,  to  the 
restorative  process.  The  part,  however,  which  they  perform  will  de 
pend  upon  a  variety  of  circumstances,  upon  the  nature  and  seat  of  the 


THERAPEUTICS.  547 

disease,  upon  the  means  employed  by  art,  upon  the  organ  from  which 
the  effusion  takes  place,  and  whether  from  that  which  is  diseased  or 
from  another  which  may  only  sustain  a  moderate  sympathetic  derange- 
ment, upon  the  nature  of  the  product,  and  whether  it  be  the  conse- 
quence of  disease  or  induced  artificially. 

S63,  c.  If  Nature  institute  the  effusion,  it  is  commonly  far  more 
curative  than  when  flowing  from  remedial  agents.  The  latter  operate 
mostly  by  changing  the  morbid  states  ;  and  although  they  are  design- 
ed to  imitate  nature  in  their  general  results,  they  may  be  yet  intend- 
ed to  prevent  many  of  the  consequences  of  spontaneous  cure,  such  as 
effusions  of  lymph,  serum,  and  blood,  and  the  formation  of  pus.  But, 
in  accomplishing  this,  they  institute  an  increase  of  those  natural  prod- 
ucts which  issue  upon  open  surfaces  (§  862). 

863,  d.  The  increased  product  is  most  curative  when  it  proceeds 
directly  from  the  affected  organ.  This  is  true  both  of  Nature  and  of 
art.  If  produced  artificially  from  other  organs,  the  curative  effect  will 
be  generally  the  greatest  in  proportion  to  the  importance  of  the  organ ; 
and  will  so  far  depend  upon  reflex  nervous  actions  set  up  by  the  vi- 
tal changes  which  give  rise  to  the  increased  product ;  as  when  cathar- 
tics augment  the  bile,  the  intestinal  mucus,  &c.,  or  antimonials  the 
perspirable  matter.  Hence,  it  will  be  seen  that  the  vital  changes  in- 
duced will  depend,  in  any  given  form  of  disease,  upon  the  nature  of 
the  cathartic  by  which  the  bile  or  intestinal  mucus  is  augmented.  Calo- 
mel, or  jalap,  or  castor  oil,  &c.,  may  be  speedily  curative,  when  aloes, 
or  elaterium,  or  croton  oil,  &c.,  may  be  as  speedily  fatal.  So,  again, 
as  to  "  sudorifics,"  as  they  are  called.  Antimonials  or  ipecacuanha, 
for  example,  though  they  but  soften  the  skin,  may  overthrow  the  most 
profound  inflammations,  when  hot  water,  or  herb  teas,  would  be  per- 
fectly ineflicient,  though  they  bathe  the  skin  in  perspiration.  "  Sialo- 
gogues"  fall  under  the  same  philosophy.  Horseradish  is  one  of  them; 
but  though  its  mastication  may  keep  up  a  flow  of  saliva,  it  will  only 
aggravate  an  inflammation  which  mercury,  without  salivation,  may 
soon  subdue.  We  come  thus  to  understand  how  all  remedial  and 
morbific  agents  affect  the  vital  states  in  conformity  with  the  exact  vir- 
tues of  each  agent  and  the  existing  condition  of  parts  upon  which  their 
effects  may  be  exerted  (§  150).  We  are  thus  enabled  to  understand 
why  the  vomiting  which  is  produced  by  an  offensive  odor,  or  by  tick- 
ling the  fauces,  or  by  disgusting  objects,  or  any  other  mental  emotion, 
or  by  warm  water,  is  less  effective  in  breaking  up  disease  than  when 
produced  by  an  infusion  of  mustard  seed  ;  and  less  from  the  last  than 
from  the  sulphate  of  zinc,  and  less  from  this  than  from  ipecacuanha, 
and  often,  perhaps,  still  less  from  ipecacuanha  than  from  tartarized  an- 
timony, and  perhaps  often  still  less  from  either  than  from  ipecacuanha 
and  tartarized  antimony  combined.  One  agent  impresses  the  organic 
properties  of  the  stomach  more  profoundly  and  in  a  different  way  from 
another,  and  therefore  excites  and  modifies  the  nervous  power  in  a 
way  peculiar  to  itself,  which,  when  reflected  upon  the  diseased  parts, 
will  affect  their  condition  in  modes  corresponding  with  the  peculiar 
impression  that  had  been  made  by  the  nauseating  influence  exerted 
on  the  mucous  tissue  of  the  stomach  (§  226,  &c.).  And  so  of  every 
other  remedial  agent  which  produces  its  effects  upon  reinote  parts 
by  primary  impressions  upon  the  gastro-intestinal  mucous  membrane, 
or  the  skin,  or  any  other  organ.     The  same  is  also  equally  true  of  mor- 


649  INSTITUTES    OF    flIEDICINE. 

bific  agents  (§  650,  653).  And  here,  through  the  foregoing  philoso- 
phy, we  may  understand  the  reason  for  the  differences  in  results  be- 
tween the  action  of  cathartics  and  the  analogous  effects  of  emetics 
upon  the  intestine.  We  may  regard  it,  for  example,  as  manifested  by 
tartarized  antimony  in  the  double  aspect  of  a  curative  and  morbific 
agent  as  it  may  happen  to  prove  emetic  or  cathartic.  If  it  fail  of  the 
former  effect,  it  will,  nevertheless,  have  produced  more  or  less  of  that 
profound  impression  upon  the  stomach  which  is  peculiar  to  its  own 
virtues  in  their  relation  to  the  gastric  mucous  tissue,  and  when  it  passes 
on  to  the  intestine  it  exerts  not  only  a  more  depressing  effect  upon  the 
whole  organism,  but  may  act  upon  the  intestine  as  a  profoundly  mor- 
bific cause,  and  develop  reflex  nervous  influences  that  light  up  inflam- 
mation in  the  lungs,  or  extinguish  life,  as  is  often  the  case,  ere  its 
purgative  effect  has  ceased  (§  150,  226,  228).  The  fundamental  prin- 
ciples are  the  same  thx-oughout,  and  rest  mainly  on  reflex  action  of  the 
nervous  system.  No  chemical,  physical,  or  humoral  hypothesis  can 
withstand  its  force,  for  a  single  moment,  with  the  enlightened  prac- 
titioner. In  a  practical  sense,  it  should  be  the  perpetual  study  of  phy- 
sicians ;  the  touch-stone,  as  it  were,  by  which  all  remedies  are  selected 
(§  149-154,  222-2334,  475^,  500  k-nn,  514/  647^,  891^  k,  893  a,  c). 
A  great  variety  of  other  practical  conclusions  follow  in  the  train  of 
the  foregoing  principles.  We  see,  for  example,  from  what  is  known 
of  the  rapidity  with  which  emetics  produce  vomiting,  and  the  reaction 
which  speedily  follows,  that  they  exert  their  alterative  effects  upon 
diseased  parts  with  great  suddenness,  and  that  the  influence  of  mere- 
ly nauseating  doses  of  the  same  agents  may  be  exerted  more 
gradually,  and  may  therefore,  according  to  the  nature  of  their  virtues, 
be  more  profoundly  alterative.  The  depressing  nausea  which  pre- 
cedes the  emetic  effect  of  tartarized  antimony  may  be  remarkably  pro- 
ductive of  an  alterative  influence  upon  all  the  organs  of  the  body  (§ 
514,  h-m) ;  prostrating  the  circulation,  and,  when  prolonged,  removing 
croup,  or  pneumonia,  more  effectually,  perhaps,  than  by  the  speedy 
operation  of  an  emetic.  Hence,  also,  it  is  obvious  that  emetics  are 
mostly  useful,  in  their  therapeutical  aspect,  soon  after  the  invasion  of 
disease,  when  unembarrassed  by  the  force  of  vital  habit  (§  535,  &c.), 
or  during  the  intermission-s  of  fever  when  nature  is  inclined  to  the 
restorative  process,  and  when,  as  in  either  case,  she  may  require  only 
a  sudden  and  temporary  shock  to  place  her  permanently  in  the  right 
way.*  The  philosophy  of  their  success  in  these  cases  appears  to  be  per- 
fectly simple.  The  morbid  change,  in  one  case,  having  but  just  be- 
gun, and  Nature,  in  the  othei',  being  inclined  to  restoration,  reflex 
nervous  influences  which  radiate  from  the  stomach  during  the  action 
of  an  emetic  easily  establish  new  changes  in  the  diseased  conditions, 
when  the  properties  of  life  are  enabled  to  obey,  at  once,  their  natural 
tendency  to  return  to  a  state  of  health.  This  simple  principle,  there- 
fore, leads  us  to  understand  that  the  most  auspicious  time  for  admin- 
istering an  emetic  in  intermittent  fever  is  when  the  stage  of  intermis- 
sion is  fully  formed.  There  is  now  the  greatest  suspension  of  morbid 
action,  and  the  organic  states  are  going  the  right  way.  We  critically 
seize  this  moment  to  prevent  Nature  passing  again  into  a  state  of  in- 
cubation ;  or,  perhaps,  a  better  time  is  not  long  before  the  expected 
access  of  a  paroxysm,  since  the  artificial  change  being  made  about  the 
time  of  the  access,  the  predisposition  is  so  crippled  at  this  partic  ila. 

*  See  p.  298,  d  470J  h. 


THERAPEUTICS.  549 

juncture  that  the  artificial  change  breaks  up,  most  effectually,  the  suc- 
cession. This  interruption  of  the  access  of"  a  paroxysm  destroys  the 
paroxysmal  habit,  and.  the  disease  is  at  an  end.*  The  same  philosophy 
is  here  concerned  as  that  which  respects  the  influences  of  bloodlet- 
ting just  before  the  access  of  the  cold  stage,  and  goes  to  illustrate  the 
modus  operandi  of  that  remedy  (§  986,  &c.).  But  the  most  advanta- 
geous time  for  bleeding,  if  not  demanded  by  some  inflammation,  or 
by  high  arterial  action  during  the  rise  of  the  hot  stage,  is  soon  after 
that  stage  begins  to  subside  ;  and  this,  next  to  the  time  just  antece- 
dently to  the  expected  access  of  the  cold  stage,  is  the  best  period  for 
administering  an  emetic ;  and  this,  also,  is  the  best  period  for  the  ex- 
hibition of  a  cathartic,  unless  given  along  w^ith  the  emetic  before  the 
access  of  the  cold  stage.  The  same  philosoj^hy  applies  whether  Na- 
ture be  engaged  in  a  restorative  movement  or  be  about  to  enter  upon 
a  state  of  incubation.  The  expediency  as  to  time  depends  upon  the 
kind  of  remedy.  In  either  case  Nature  may  be  readily  turned  into 
her  favorite  course.  Conditions  are  instituted  which  correspond  with 
those  through  which  the  morbid  properties  take  on  spontaneously  the 
progressive  changes  that  result  in  health ;  as  shown  by  the  coincidence 
in  the  immediate  results  of  the  remedies,  and  those  which  ensue  at 
more  distant  times  when  no  remedies  have  been  applied.  In  either 
case,  whether  the  artificial  or  the  natural,  sweating  breaks  forth,  the 
secretions  of  the  liver,  of  the  intestinal  mucous  tissue,  of  the  kidneys, 
&c.,  are  poured  out.  By  anticipating  nature  we  aid  her  in  consum- 
mating her  efforts  at  relief;  while  the  artificial  change  so  far  tran- 
scends the  spontaneous  improvement  that  Nature  is  gi'eatly  started 
along  in  her  recuperative  process,  and  often  obtains  an  impulse  by 
which  she  passes  on  triumphantly  through  an  uninterrupted  series  ot 
salutary  changes  till  the  properties  and  actions  of  life  become  restored 
to  their  natural  state  (§  672,  675).*  And  here  we  may  look  at  one  of 
the  reasons  why  cathartics  are  more  remedial  than  emetics  after  dis- 
ease becomes  established ;  for,  although  very  profound  reflex  ner- 
vous actions  may  be  determined  by  emetics  through  the  mucous  tis- 
sue of  the  stomach,  the  impression  upon  that  organ,  as  exerted  by  the 
most  curative,  is  much  more  transient  than  that  upon  the  intestine 
by  the  best  of  the  cathartics  (§  514  g,  516  d,  no.  6).  This,  however, 
is  only  a  principal  one  among  other  reasons,  of  which  the  difference 
in,  virtue  is  the  greatest.  Hence,  an  important  corollary,  that  the 
therapeutical  effects  of  cathartics  and  emetics,  and,  indeed,  of  all  other 
remedies,  will  depend,  other  things  being  equal,  upon  the  particular 
virtues  of  the  agent,  and  the  time,  within  certain  limits,  during  which 
it  may  act  upon  the  gastro-intestinal  mucous  tissue  (^  516  d,  no.  6). 

We  may  remark,  also,  as  intimately  related  to  the  principles  and 
practice  now  under  consideration,  and  as  farther  illustrative  of  the 
importance  of  adapting  our  remedies  to  the  precise  pathological  con- 
dition of  any  given  form  of  disease  (§  675,  870  aa),  that  cathartics,  un- 
less united  with  an  emetic,  are  apt  to  be  detrimental  if  exhibited  just 
before  the  access  of  a  paroxysm  of  intermittent  fever^  and  to  bring  on 
the  attack.  But  this  is  less  the  case  with  an  appropriate  cathartic, 
such  as  calomel  and  jalap,  if  associated  with  an  emetic  ;  since  the  op- 
eration of  the  cathartic  is  then  more  immediate,  less  prolonged,  and 
its  general  irritation  more  or  less  counteracted  by  the  prostrating  ef- 
fect of  the  emetic  It  is  the  same  principle  which  is  concerned  wher 
*  See  Notes  K  L  pp.  1119,  1120. 


J50  INSTITUTES    OF    MEDICINE. 

antecedent  loss  of  blood  lessens  the  constitutional  irritation  of  cathar- 
tics, or  when  the  prostrating  effect  of  an  emetic  prevents  the  abstrac- 
tion of  blood,  however  apparently  different  in  the  two  cases.  The 
principle  reaches  very  far  into  the  philosophy  of  medicine,  and  con- 
cerns, especially,  the  order  in  which  remedies  should  be  applied.  As 
one  of  its  more  obscure  details,  I  may  say  that  the  union  of  opium  with 
a  cathartic,  for  the  purpose  of  moderating  the  irritation  of  the  latter,  is 
exactly  equivalent  to  either  of  the  immediately  preceding  examples. 

From  what  has  been  just  said,  we  readily  see  one  of  the  princi- 
pal distinctions  between  cathartics  and  emetics.  The  non-stimulant 
emetics  reflect  a  nervous  influence  which  depresses  the  circulation 
throughout  their  widest  range  but  excites  perspiration  as  a  conse- 
quence of  salutary  changes,  while,  on  the  contrary,  cathartics  are  more 
or  less  apt  to  stimulate  and  excite  the  circulation  at  first,  and  do  not 
often  affect,  in  a  sensible  manner,  the  functions  of  the  skin.  A  knowl- 
edge of  these  differences,  as  well  as  of  the  analogies  which  prevail 
among  the  influences  and  results  of  different  remedies,  and  also  of  their 
modus  operandi,  is  indispensable  to  a  successful  application  of  those 
suggestions  which  are  afforded  by  Nature  in  her  unaided  efforts  at 
restoration. — Note  Ee  p.  1133. 

863,  e.  In  respect  to  the  curative  influence  of  increased  effusions, 
much  will  depend  upon  the  intrinsic  nature  of  the  product  which  arti- 
ficial or  natural  changes  may  bring  about  {b).  By  the  natural  process, 
in  local  inflammations,  lymph,  and  serum,  and  pus  are  a  good  deal  alike 
in  the  amount  of  effect  (§  732,  ti),  and  redundancies  of  bile  are  next  in 
the  relief  of  hepatic  derangements.  Least  of  all,  in  respect  to  organic 
products,  is  increased  mucus.  But  this  will  depend  much  upon  the 
nature  of  the  part.  It  is  most  cui-ative  in  inflammations  of  the  lungs, 
far  less  in  intestinal  inflammation,  and  still  less  so  in  inflammation  of  the 
bladder  (§  133,  &c.).  The  inorganic  products  contribute  very  little, 
by  their  augmentation,  to  the  curative  process,  whether  naturally  or 
artificially  induced.  Perspiration  is  more  so  than  urine.  When  these 
products,  however,  flow  abundantly,  the  salutary  effects  depend  most- 
ly upon  the  vital  changes  from  which  the  redundancies  emanate.  Hu- 
moralism,  on  the  other  hand,  imputes  all  to  the  augmented  product  (§ 
514,  h).  That  is  the  difference  between  solidism  and  philosophical 
humoralism.  The  former  detects  the  cause  and  renders  it  his  polar 
star  in  his  philosophical  and  practical  movements ;  the  latter  mistakes 
the  effect  for  the  cause,  analyzes  the  blood,  or  the  saliva,  or  the  urine, 
and  according  to  the  real,  or  artificial,  or  imaginary  developments  of 
the  test  glass  and  crucible,  he  neutralizes  an  acid  or  an  alkali,  purges 
off"  ozmazome,  or  picromel,  or  cholesterine,  and  taps  the  abdomen  to 
cure  the  dropsy ;  while  the  charlatan  "  holds  up  the  mirror,"  and  all 
the  world  believes  the  shadow  reflected  "  Nature"  (§  5  j,  349  d,  851). 

863,  y.  But  Natui'e  has  one  means  of  depletion  which  stands  for  all 
the  rest.  And  so  it  does  in  the  hands  of  art.  This,  I  need  not  add, 
is  loss  of  blood.  Here  Nature  and  art  meet  upon  common  ground. 
Both  interpose  the  remedy  for  the  direct  subversion  of  disease,  and 
Doth  equally  prevent  thereby  the  formation  of  other  products  (§  805, 
890  d-g,  1019).  Indeed,  such  is  the  magnitude  of  this  remedy,  and 
such  its  direct  effect  in  changing  pathological  conditions,  that  I  shall 
enter  largely  upon  the  philosophy  of  its  operation,  and  its  applicabil- 
ity to  disease.— Notes  Fj'.  11 14,  Ff  p.  1135,  Go  p.  1138,  Ii,  p.  1139. 


THERAPEUTICS.  5&1 

863,  g.  What  we  have  now  seen  of  Nature  and  of  art,  in  respect  to 
inflammatory  diseases,  is  equally  true  of  fever.  The  eff"usions,  how- 
ever, which  Nature  institutes  in  fever  are  less  various  than  in  inflam- 
mation, and  proceed  from  organs  connected  with  the  external  world. 
But  here  they  are  more  universal,  and  it  is  here  as  fever  is  complicated 
with  venous  congestions  that  Nature  makes  the  same  demonstration 
with  the  remedium  principale  as  she  does  in  obstinate  affections  of  the 
lungs,  or  the  stomach  (§  805). 

863.  7i.  It  is  a  common  event  for  disease  to  persist  until  great  ema- 
ciation, and  other  signs,  denote  approaching  death,  but,  notwithstand- 
ing, for  the  restorative  process  to  set  in,  and  where  no  secreted  prod- 
ucts had  apparently  contributed  to  the  change.  In  these  cases,  how- 
ever, the  emaciation  has  been  moi'e  or  less  an  equivalent.  And  here, 
again,  a  lesson  may  be  taken  from  Nature,  on  the  subject  of  diet,  by 
those  who  will  not  listen  to  her  law  as  proclaimed  by  the  instinct  of 
animals.  But  even  where  disease  is  maintained  by  eiTors  in  food,  there 
may  be  yet  remaining  hope  from  emaciation  (^  1007  K). 

864.  It  appears,  therefore,  that  the  salutary  changes  which  occur 
spontaneously  in  all  inflammatory  and  febrile  affections  lead  to  a  va- 
riety of  evacuations  from  the  secretory  and  excretory  apparatus,  and 
within  the  organization,  of  which  eff"usions  of  blood  are  the  most  effi- 
cient. Art,  in  its  imitation  of  Nature,  has  proved  that  she  is  the  only 
guide  ;  and  since  fever  and  inflammation  comprise  all  the  severe  forms 
of  disease,  and  as  there  is  nothing  in  the  results  of  spontaneous  chan- 
ges which  correspond  with  those  induced  by  tonics  and  stimulants,  we 
may  safely  conclude  that  those  practitioners  who  often  resort  to  that 
class  of  agents  have  but  very  imperfect  views  in  physiology  and  pathol- 
ogy, and  are  astray  from  the  path  of  Nature. — Note  Ee  p.  1133. 

865.  No  remedial  agents  are  truly  specifics ;  though,  for  conven- 
tional purposes,  the  designation  is  useful.  Mercurials  will  often  fail 
of  curing  syphilis,  where  a  non-stimulant  diet  may  succeed  alone. 
Cinchona  may  exasperate  an  intermittent,  when  arsenic  or  cobweb 
would  readily  succeed.  There  is  no  remedy,  indeed,  however  adapt- 
ed to  the  cure  of  any  given  disease,  which  will  not  sometimes  fail,  and 
admit  of  a  substitute  apparently  quite  different.  Bloodletting,  cathar- 
tics, &c.,  will  generally  remove  intermittent  inflammation  ;  but  cases 
occur  in  which  the  s^peci^X  febrifuge  virtue  of  cinchona  is  necessary. 

866.  All  remedies,  therefore,  are  only  so  in  relation  to  diseases  upon 
which  they  may  exert  salutary  effects  (§  149,  150).  Cinchona,  for 
example,  is  a  remedy  for  intermittent  fever  if  no  local  diseases  of  se- 
verity exist ;  but  if  so,  it  will  commonly  exasperate  the  fever,  and  is 
then  a  morbific  agent  (§  854,  857).  Its  tonic  virtues  then  transcend 
iisfehrfuge,  of  the  first  of  which  arsenic  and  cobweb  are  destitute. 

The  former  of  this  remarkable  combination  of  virtues  may  be  the 
best  for  enfeebled  states  of  the  system,  or  of  the  stomach,  if  no  inflam- 
mation be  present ;  otherwise,  it  is  morbific  It  should  be  constantly 
before  us,  that  a  tonic,  an  antiphlogistic,  &c.,  are  only  such  when  ap- 
propriate to  the  case  before  us.  With  this  understanding,  we  are  led 
to  investigate  the  exact  pathology  of  the  case,  and  its  various  attend- 
ing circumstances  (§  673,  675,  685,  686). 

867.  The  curative  effect  of  remedies  is  more  or  less  progi'essive. 
When  the  primary  state  begins  to  give  way,  a  new  pathological  con- 
dition  is  introduced,  and  so  on  in  regular  progress  where  there  is  an 


552  INSTITUTES    OF    MEDICINE. 

uninten-upted  decline  of  disease  (§  672).  But  it  rarely  happens  that 
diseases  are  diverted  from  the  essential  pathological  character  with 
which  they  begin. 

The  curative  effect  commences  at  the  first  moment  a  favorable  im- 
pression is  made  upon  the  seat  of  disease  or  upon  any  part  capable  of 
participating  sympathetically  in  the  restorative  process,  and  terminates 
when  that  exact  change  is  made  in  the  diseased  properties  and  func- 
tions which  is  most  conducive  to  their  spontaneous  recovery.  When 
remedies  are  carried  beyond  that  point,  they  are  apt  to  become  mor- 
bific. Hence  it  is  one  of  the  most  important,  but  difficult  acquisitions, 
to  determine  when  our  remedies  should  be  discontinued,  or  moderated. 

868,  a.  It  should  be  a  great  object  of  art  to  render  the  associated 
train  of  pathological  states  as  short,  and  make  it  consist  of  as  few 
changes,  as  possible.  In  a  general  sense,  therefore,  where  disease  is 
intense,  the  first  remedial  impressions  should  be  strongly  made  ;  but, 
in  doing  this,  the  right  agents  should  be  selected.  It  would  answer, 
for  instance,  to  exhibit  a  decisive  dose  of  calomel  and  jalap,  at  the  on- 
set of  pneumonia  ;  but  it  would  be  sad  practice  in  inflammation  of  the 
intestine.  Bloodletting,  however,  is  adapted  to  either  case,  and  is 
the  right  initiatory  remedy  for  both. 

As  the  favorable  changes  advance,  our  remedies  should  become 
milder  and  milder,  till  that  critical  point  is  attained  where  Nature  re- 
quires only  the  occasional  interposition  of  art  to  accomplish  the  remo- 
val of  some  slight  obstacles  that  are  more  or  less  liable  to  spring  up 
during  convalescence ;  such  as  constipation,  deficient  secretion  of 
bile,  &c. 

868,  h.  Our  remedies  may  be  perfectly  right,  and  yet  disease  shall 
increase  by  the  force  of  its  intensity  (§  685,  no.  9).  In  such  a  case, 
however,  we  may  have  fallen  short  of  the  due  amount  of  the  remedial 
agent ;  and  this  we  shall  see  to  be  often  true  of  bloodletting.  But  it 
is  rarely  so  of  any  internal  agent ;  there  being  a  prevailing  disposition 
to  medicate  largely.  We  have  thus  a  positive  abuse  of  drugs  and  a 
nesrative  abuse  of  bloodlettino:.  Beino;  sure  of  the  riofht,  we  should 
steadily  pursue  it ;  repeating  the  remedy,  or  associating,  or  substitu- 
ting, others  of  analogous  virtues  in  relation  to  the  case  before  us,  till 
their  effects  are  pronounced  by  a  manifest  decline  of  the  symptoms. 

869,  The  rapidity  with  which  the  full  salutary  changes  will  be  ef- 
fected will  depend  upon  a  vai"iety  of  circumstances ;  but  mainly  upon 
the  period  of  the  disease.  All  diseases  being  most  easily  and  speedily 
arrested  near  the  time  of  their  beginning  (§  557,  a),  the  difficulties  in- 
crease in  proportion  to  their  unmitigated  duration,  or  any  increase 
they  may  sustain.  They  soon  begin  to  acquire  the  obstinacy  of  a  mor- 
bid habit  (§  535,  &c.),  to  involve  sympathetically  other  organs,  and  to 
result. in  disorganization,  effusions  of  serum,  &c.  (§  660,  712-718. 
732  d). 

870,  a.  Some  remedies,  in  their  greatest  proper  latitude,  make  a 
decisive  impression  much  sooner  and  more  effectually  than  others,  un- 
der the  same  circumstances  of  disease,  and  where  either  may  be  ap- 
propriate. Bloodletting,  in  inflammations  and  fevers,  operates  far 
more  immediately  and  decisively  than  any  other  remedy,  and  cathar- 
tics are  generally  next.  And  so  of  many  individual  cathartics  which 
may  be  appropriate  to  a  given  condition  of  disease.  The  saline  may 
be  slowly  and  moderately  useful,  and  some  of  them  better  than  olh- 


THERAPEUTICS.  553 

ere  /  castor  oil  more  speedy  and  effectual ;  jalap  more  so;  calomel  far 
more  so  ;  and  the  united  force  of  calomel  and  jalap  may  greatly  tran- 
scend either.  Sometimes,  however,  as  we  have  seen,  a  fever  at  its 
onset  may  be  completely  subdued  by  the  alterative  action  of  an  appro- 
priate emetic.  Tartarized  antimony  will  do  it  with  the  gi'eatest  certain- 
ty ;  ipecacuanha  comes  next ;  but  most  of  the  other  emetics  would  be 
perfectly  useless  or  detrimental.  The  union,  however,  of  antimony 
and  ijjecacuanha  improves  the  useful  alterative  virtue  of  each,  and 
lessens  the  chance  of  morbific  action  from  the  antimonial  (§  150). 

870,  aa.  Remedies  sometimes  operate  with  gi-eat  and  rapid  effect 
upon  one  part  of  a  compound  disease,  but  may  fail  in  respect  to  other 
parts  ;  or,  if  not  justly  applied,  they  may  assuage  a  part  of  the  disease, 
but,  from  theirtiwant  of  proper  relation  to  other  parts,  they  may  prove 
morbific  to  these  conditions,  and  thus  indirectly  reproduce  that  part  of 
the  malady  which  they  had  been  instrumental  in  subduing.  But  this 
will  not  happen  with  the  right  remedy  (§  150,  552  b,  665,  848).  Blood- 
letting, for  example,  may  quickly  subvert  pneumonia  when  complicated 
with  small-pox,  but  will  not  shorten  the  natural  progress  of  the  more 
general  malady  (§  858).  But  the  remedy  will  now  be  perfectly  com- 
patible with  the  whole  condition  of  disease  ;  since  the  local  inflamma- 
tion has  brought  the  specific  form  under  its  influence,  and  bloodletting 
now  operates  in  conformity  with  the  law  of  adaptation  (§  137  c,  143  c, 
847,  &c.).  Through  the  same  law  quinine  may  be  peculiarly  salutary 
in  some  cases  where  pleurisy  is  complicated  with  small-pox,  if  the  for- 
mer affection  be  owing  to  the  remote  causes  which  generate  intermit- 
tent fever ;  but  will  exasperate  the  whole  condition  of  disease  if  the 
pleuritic  affection  be  owing  to  any  other  cause.  Much,  also,  may  de- 
pend upon  a  coexistence  of  different  virtues  in  a  remedial  agent,  espe- 
cially in  connection  with  the  amount  of  its  doses.  Thus,  quinia,  in  the 
dose  of  five  or  ten  gi-ains,  may  speedily  arrest  an  intermittent  fever  by  its 
febrifuge  virtue.  But  that  is  bad  practice  ;  since,  by  its  associate  tonic 
virtue,  it  is  likely  to  increase  or  to  induce  local  congestions  ;  thus  leav- 
ing the  patient  imperfectly  cured  and  subject  to  relapses  (§  769).  But, 
in  these  cases,  the  local  inflammation  and  venous  congestion  are  so  apt 
to  be  modified  by  the  predisposing  cause  of  the  febrile  affection,  that 
repetitions  of  a  small  dose  of  quinine  may  be  curative  as  to  the  whole 
condition  of  disease.  I  have  twice  seen,  in  my  own  family,  the  most 
formidable  grade  of  remittent  fever,  of  long  duration  and  attended  by 
the  foregoing  complications,  ardent  heat,  thread-like  pulse,  loss  of 
raind,  &c.,  and  where  hope  of  recovery  had  been  abandoned,  yield  to 
less  than  a  grain  of  quinine,  divided  into  sixteen  doses  (§  137  d,  662  b, 
756,  811,  813  b,  857).    There  had  been  repeated  bloodlettings  &c* 

870,  b.  This  leads  me  to  say,  that  the  best  experience  sustains  what 
is  enforced  by  my  interpretation  of  the  modus  operandi  of  remedial 
agents,  that  simplicity  of  treatment  should  distinguish  the  course  ol 
the  practitioner.  Where  diseases  are  circumscribed,  he  will  have 
little  need  of  variety ;  while,  on  the  other  hand,  the  more  compound- 
ed the  affection  the  more  likely  will  it  be  necessary  to  bring  several 
agents  into  operation.  In  simple  pleurisy  an  appropriate  loss  of 
blood  may  be  the  only  requisite  means,  and  an  emetic  at  the  invasion 
of  croup.  But  if  pleurisy  be  complicated  with  congestion  of  the  liv- 
er, or  with  idiopathic  fever,  &c.,  several  other  agents  may  be  neces- 
sary to  meet  these  complications.  Much,  however,  will  depend  upon 
*  See  Notes  K  L  pp.  1110,  1120. 


554  INSTITUTES    OF    MEDICINE 

the  stao-e  of  the  disease  when  the  treatment  is  begun.  There  must 
be  harmony,  however,  among  the  virtues  of  the  several  agents,  con- 
forming- to  the  general  modifications  of  disease,  and  the  existing  sus- 
ceptibilities to  their  influence  (§  150,  870  aa,  871,  888  b). 

871.  We  have  variously  seen  how  the  susceptibility  of  organs  to 
the  influence  of  remedial,  as  well  as  morbific,  agents  may  be  increas- 
ed by  antecedent  impressions  from  other  causes  (143,  145,  149,  150, 
556,  &c.).  This  is  fundamental  in  therapeutics,  and  carries  us  back 
to  preceding  statements  (§  672,  867,  868).  The  administration  of 
remedies  proceeds  greatly  upon  this  principle.  One  prepares  the 
way  for  the  favorable  operation  of  another,  or  which  last  might  be 
otherwise  injurious.  A  remedy  which  is  curative  under  one  combi- 
nation of  circumstances  may  aggravate  disease  when  ^at  combination 
is  a  little  varied.  The  cathartic  which  would  not  irritate  intestinal 
inflammation  immediately  after  bloodletting  might  gi-eatly  exasperate 
the  disease  if  exhibited  without  the  antecedent  loss  of  blood.  And 
so  of  vesicants,  &c.  Indeed,  so  profoundly  and  rapidly  curative  is 
bloodletting  of  inflammatory  affections,  and  so  greatly  does  it  promote 
the  useful  effects  of  other  remedies,  or  prevent  their  morbific  action, 
that,  whenever  it  is  indicated,  it  should  precede  all  others  ;  and  then 
it  will  be  often  found  that  it  has  taken  the  place  of  all  others. 

Hence  a  great  doctrine  in  therapeutics,  that  the  order  in  which 
remedial  agents  are  applied  should  be  in  their  best  individual  rela- 
tions to  the  existing  pathological  state,  whether  that  state  may  depend 
exclusively  upon  the  primary  causes,  or  as  modified  by  the  subsequent 
treatment  (§  137,  d,  &c.). 

This  principle,  however  manifest,  enforces  a  thorough  knowledge, 
not  only  of  physiology  and  pathology,  but  of  the  exact  capabilities  of 
remedial  agents,  of  their  various  doses,  and  of  their  modus  operandi, 
in  any  given  pathological  state.  Its  highest  practical  attainment  is  the 
highest  consummation  of  medical  skill  and  science.  It  is  the  ne plus 
ultra  of  medicine  (§  857). 

872,  a.  The  last  section  involves  the  principle  which  is  concerned 
in  the  combination  of  medicines.  By  the  union  of  two  or  more,  and 
according  to  the  exact  virtues  of  each  substance,  and  according,  also, 
to  the  proportion  of  each,  we  create,  as  it  were,  a  new  remedy, — add 
a  new  one  to  the  Materia  Medica.  It  is  thus  seen  that  art  may  mul- 
tiply remedial  agents  to  an  almost  endless  extent ;  and  this  explains 
the  reason,  in  part,  why  the  most  enlightened  practitioners  do  not  oft- 
en seek  for  desirable  virtues  in  the  inferior  medicines.  By  variously 
combining  two  or  more  of  a  limited  number  new  virtues  are  evolved, 
however  analogous,  in  almost  every  prescription  for  disease. 

By  this  process,  what  might  be  otherwise  highly  morbific  may  bo 
rendered  curative.  The  cathartic,  which  given  alone  might  aggra- 
vate intestinal  inflammation,  may  be  often  rendered  safe  and  useful 
by  the  addition  of  a  little  opium  or  hyoscyamus  ;  and  thus,  too,  the  ne- 
cessity of  antecedent  bloodletting  may  be  sometimes  avoided.  The 
narcotic  so  lessens  irritability  that  the  cathartic  is  innoxious,  and  is 
thus  enabled  to  establish  a  favorable  pathological  change.  How  ad- 
verse to  humoralism  this  single  example,  how  confirmatory  of  the  doc- 
trine which  I  have  taught  of  the  action  of  remedies  upon  the  proper- 
ties of  life  (^  188  a,  189,  &c.) !  Add  to  the  cathartic,  guarded  by  the 
narcotic,  a  grain,  or  more  or  less,  of  ipecacuanha,  and  new  alterative 


THERAPEUTICS.  555 

hiflueiices  may  spring  up,  of  great  power  and  extent ;  each  ingredi- 
ent, and  according  to  the  proportion  of  each,  modifying,  increasing, 
and  extending  the  reflex  nervous  actions,  hut  in  such  a  combined 
manner  that  the  compound  acts  as  a  whole,  and  not  by  its  individual 
parts  (§  188i  d,  224,  500  k-nn,  514  A,  889  k,  8911  k,  896,  902). 

Take  another  example ;  for  these  examples  not  only  illustrate  im- 
portant principles,  but  are,  in  themselves,  practically  important.  In 
a  case  of  common  remittent  fever,  near  its  invasion,  we  may  proceed 
with  decision,  employ  bloodletting,  calomel  and  jalap,  and  speedily 
pretty  well  overcome  the  disease.  The  most  that  the  patient  will  im- 
mediately afterward  require  will  be  rest,  low  diet,  and  mild  influences 
by  certain  cathartics.  The  best  of  these,  till  the  bile  begins  to  assume 
a  good  yellow  color,  will  be  small  doses  of  castor  oil ;  for  this  cathar- 
tic exerts  a  peculiarly  alterative  influence  upon  the  livei'.  When  the 
dejections  shall  have  put  on  a  natural  aspect,  castor  oil  begins  to  irri- 
tate the  intestine  rather  injuriously,  and  this  effect  increases  as  its  rep- 
etition goes  on  ;  although  given,  perhaps,  in  the  dose  of  a  tea-spoonful, 
or  a  half  tea-spoonful  only,  to  an  adult.  It  is  also  then  apt  to  nauseate 
the  stomach  and  prostrate  the  strength.  Convalescence  has  now  ad- 
vanced too  far  for  this  active  agent,  and  some  other  should  be  substi- 
tuted to  maintain  a  free  secretion  of  bile,  and  to  procure  one  evac- 
uation, at  least,  daily.  But  I  know  of  no  mild  cathartic  which  is 
exactly  suited  to  this  state  of  things.  If  we  employ  moderate  doses 
of  Rochelle  salts,  they  operate  too  superficially  ;  mainly  upon  the  mu- 
cous tract  of  the  intestine,  and  ai'e  also  apt,  in  this  condition,  to  irritate 
that  membrane  injuriously.  Magnesia  is  liable  to  the  same  objection 
as  it  respects  the  superficial  effect ;  and  rhubarb  alone  is  too  stimula- 
ting to  the  whole  system,  and  to  the  mucous  tract.  But  it  has  the  ad- 
vantage of  extending  its  influences  to  the  liver,  and  of  promoting  the 
tone  of  the  stomach  and  of  the  whole  system,  when  this  part  of  its 
tonic  and  stimulating  effect  can  be  properly  restrained. 

Now,  the  foregoing  three  agents  in  combination,  and  in  proportions 
adapted  to  the  state  of  the  case,  are  exactly  suited  to  the  convalescent 
from  fever  who  has  passed  the  stage  when  castor  oil  ceases  to  be  use- 
ful. The  magnesia  corrects  the  irritating  effects  of  the  Rochelle  salts, 
and  neutralizes  any  acid  that  may  exist  in  the  primee  viae,  while  each 
counteracts  any  injurious  stimulant  action  of  the  rhubarb,  so  only  the 
proportion  of  rhubarb  be  not  too  large.  The  rhubarb,  also,  in  its  turn, 
gives  tone  to  the  digestive  organs,  counteracts  the  prostrating  effect 
of  the  saline  substance,  and  imparts  to  the  whole  compound  a  reflex 
nervous  action  over  the  liver,  by  which  a  free  secretion  of  bile  is 
maintained  till  health  is  established. — See  Note  Ee  p.  1133. 

Nature  has  carried  out  this  principle  of  combination  very  extensively, 
and  has  thus  supplied,  in  numerous  substances,  a  variety  of  virtues 
in  each  one,  which  are  exactly  adapted  to  the  varying  exigencies  of 
disease.  We  see  it  strongly  pronounced  in  the  cathartic,  tonic,  and 
astringent  properties  of  rhubarb  ;  in  the  febrifuge  and  tonic  virtues  of 
cinchona;  in  the  soporific,  anodyne,  and  relatively  astringent  proper- 
ties of  opium  ;  in  the  narcotic  and  laxative  virtues  of  hyoscyamus,  &c. 
Indeed,  so  manifold  is  this  union  of  virtues,  that  art  has  availed  it- 
self of  the  opportunity,  and  elaborated  many  in  the  form  of  the  alka- 
loids, &c.,  by  which  greater  simplicity  is  obtained. 

It  is  not  unusual  to  meet  with  prescriptions  in  systematic,  labor- 


556  INSTITUTES    OF    MEDICINE. 

savino-  works,  embracing  several  articles,  with  definite  proportions  of 
each,  which  are  said  to  be  adapted  to  certain  forms  of  disease.  This 
practice  is  not  only  wanting  in  philosophy,  but  is  clearly  empyrical; 
since  the  adaptation  of  remedies,  both  as  to  the  ingredients  of  the 
compound,  and  their  relative  proportions,  should  be  adjusted  by  the 
united  circumstances  of  every  case,  as  they  may  exist  at  the  moment ; 
especially  in  all  the  forms  of  acute  disease.  It  is  manifest,  therefore, 
that  this  great  object  of  medical  science  can  be  fulfilled  only  by  a 
careful  investigation  of  every  case  whenever  a  prescription  is  made. 
It  implies  a  great  range  of  inquiry,  an  accurate  discrimination  of  the 
pathological  conditions,  and  an  intimate  knowledge  of  the  virtues  of 
each  remedial  agent  (§  686,  d).  Hence,  also,  the  voluminous  reports 
of  cases,  with  or  without  the  "  numerical  method,"  are  only  useful  for 
the  institution  of  principles  in  medicine  (§  672,  867).  It  is  so  with 
every  thing,  with  food  itself  in  every  case  of  disease.  The  principle 
extends  even  to  light  in  the  treatment  of  ophthalmia  ;  which  also  sup- 
plies another  proof  of  the  coincidence  in  the  philosophy  that  relates 
to  the  operation  of  light  and  other  vital  agents  (§  74,  ISSh.d).  And 
so  with  the  agreeable  emotions  of  the  mind  (§  500,  539  c,  855,  1067). 
If  the  reader  will  now  attend,  in  connection  with  the  foregoing 
principle,  to  what  has  been  said  of  the  nervous  power  (§  222,  &c.), 
of  its  laws  of  reflex  action  (§  500,  512,  &c.),  and  to  other  special  cir- 
cumstances which  favor  the  operation  of  remedies  (§  143  c,  &;c.,  &c.), 
he  will  readily  perceive  the  extent  of  his  power  in  tlie  judicious  com- 
bination of  a  few  only  of  the  best  remedies.  But,  to  accomplish  this 
art  of  combining  remedies,  in  connection  with  the  requirements  in  the 
preceding  section  (§  871),  demands  an  acquaintance  with  the  whole 
ground  which  forms  the  basis  of  therapeutics.' — Note  Ee  p.  1133. 

872,  b.  And  yet  I  would  not  abandon  any  part  of  the  materia  med- 
ica.  I  would  hold  it  all,  and  all  in  connection  ;  that  what  is  good  may 
be  compared  with  what  is  indifferent  or  bad,  and  our  knowledge  of 
remedial  virtues  and  remedial  action  be  thus  extended.  There  is 
also  scarcely  a  recognized  means  of  cure  but  is  hallowed  by  the  ser- 
vice it  has  done,  and  which  it  may  do  again,  in  enlightened  hands, 
where  the  better  means  are  wanting.  It  was  with  such  intentions, 
and  to  promote  the  habit  of  a  critical  investigation  of  each  member 
^f  the  materia  medica,  that  I  was  prompted  to  an  attempt  of  arrang- 
ing the  whole  according  to  their  physiological  aspects  and  therapeu- 
tical capabilities. 

873,  a.  It  is  an  important  circumstance  to  be  recollected,  that  many 
remedies  are  cumulative  in  their  effects  when  employed  in  small 
doses ;  while  the  effects  of  others,  on  the  contrary,  lessen  by  use  (§ 
549-559).  The  action  of  the  former,  therefore,  should  be  carefully 
observed  during  their  progressive  administration,  that  they  may  be 
promptly  diminished  or  discontinued.  The  latter  are  not  obnoxious 
to  the  equal  objection  of  becoming  morbific,  as  they  must  be  often 
increased  to  obtain  progressively  their  original  effects;  but  much  may 
be  lost  by  neglecting  the  ascendency  of  habit  in  its  aspect  of  dimin- 
ished susceptibility  (§  535,  &c.,  841,  889  b). 

These  two  important  gi'oups,  however,  are  liable  to  some  essential 
modifications.  Mercurials,  for  example,  in  their  constitutional  altera- 
tive sense,  are  cumulative  in  respect  to  most  adults,  but  very  little  si 
in  regard  to  children,  who  are  generally  insusceptible  of  salivatioo 


THERAPEUTICS.  557 

Again,  in  respect  to  agents  which  become  inoperative  from  habit,  this 
is  often  true  of  them  only  in  certain  small  doses,  and  when  frequent- 
ly repeated.  Tartarized  antimony,  in  its  minimum  doses,  generally 
diminishes  the  irritability  of  the  stomach.  But,  if  carried  to  the  point 
of  nausea,  its  effects  will  then  be  often  cumulative,  and  the  dose  must 
be  diminished,  or  incessant  and  aggravated  vomiting  may  follow  (§ 
556,  841).  Opium,  hyoscyamus,  &c.,  lose  their,  effects,  more  or  less, 
from  habit,  when  continued  at  certain  intervals,  as  twelve  hours,  and 
the  dose,  if  expedient,  may  be  increased  ;  but  if  repeated  as  fre- 
quently, perhaps,  as  once  in  six  hours,  or  less,  they  are  cumulative, 
and  the  dose  must  often  be  diminished.  By-and-by,  however,  under 
this  frequency  of  exhibition,  irritability  becomes  obtuse  in  relation 
to  the  agent  employed,  the  opposite  influence  of  habit  obtains,  and  the 
dose  must  be  increased  to  procure  the  original  effect. 

Many  agents  continue  to  produce  about  the  same  effects  in  the  same 
doses,  administered  at  certain  intervals,  however  long  continued.  Such 
is  true  of  ipecacuanha,  and  those  vegetable  substances  which  are  alli- 
ed to  it.  So,  generally,  of  iodine,  and  many  of  its  combinations. 
Much,  however,  depends  upon  the  intervals  between  the  doses.  Un- 
like tartarized  antimony,  which  it  resembles  in  so  many  respects,  ipe- 
cacuanha is  cumulative  as  the  intervals  shorten  below  four  hours, 
when  the  dose  is  a  grain.  The  ipecacuanha  will  then  often  produce 
nausea  and  vomiting,  while  the  antimonial,  though  repeated  at  far 
shorter  intervals,  is  apt  to  lose  its  effect  unless  progressively  increased 
to  an  extent  which  would  prove  emetic  at  the  first  dose. 

873.  h.  In  larger  doses,  or  in  their  greatest  admissible  extent,  all 
the  foregoing  agents  are  apt  to  be  cumulative.  This  is  true  of  the  fre- 
quent exhibition  of  cathartics  and  emetics,  though  more  so  of  some 
than  of  others.  The  dose  of  aloes  which  purges  from  the  beginning 
must  be  often  greatly  lessened  at  the  subsequent  doses  ;  or  what  was 
originally  only  a  mild  effect  may  soon  become  a  violent  one.  This  is 
also  remarkably  true  of  castor  oil.  All  the  cathartics,  also,  when  ad- 
ministered daily  in  small  doses,  commonly  raise  the  irritability  of  the 
intestine,  and  operate  with  increasing  energy,  though  in  some  of  the 
cases  a  part  of  the  result  may  be  due  to  an  increased  production  of 
bile  (§  516  d,  no.  6,  556  h,  841,  889  m,  mm,  902-904,  1057  T). 

874.  It  is  an  important  circumstance,  philosophical  and  practical, 
that  the  operation  of  narcotics  is  remarkably  influenced  by  pain,  and 
by  certain  states  of  the  great  centre  of  sympathies,  as  in  delirium  a 
2)otu.  It  is  fatally  opposed  to  the  physical  hypotheses,  and  to  thera- 
peutical conclusions  from  experiments  on  animals  or  on  man  in  a  state 
of  health. 

It  is  also  interesting  to  the  medical  philosopher  that  pain  has  no 
remarkable  modifying  influence  upon  any  remedial  agents  excepting 
the  narcotics ;  and  of  those,  such  only  as  have  a  special  relation  to 
sensibility  (§  194,  &c.,  891). 

875.  We  have  now  seen,  in  a  general  manner,  that  the  susceptibili- 
ty of  the  vital  properties  to  salutary  impressions,  and  their  inherent 
tendency  to  a  state  of  restoration  when  driven  by  disease  from  their 
natural  standard,  has  given  rise  to  two  general  modes  of  treatment, 
which  are  familiarly  known  as  the  active  and  the  ^catching  or  expect- 
ant (§  853). 

876.  The  active  method  consist?  in  the  application  of  such  remedies 


558  INSTITUTES    OF    MEDICINE. 

as  produce  artificial  impressions.  It  comprises  all  that  is  attempted 
by  art,  in  a  direct  manner,  to  promote  the  natural  curative  process. 
By  this  method,  therefore,  we  forcibly  institute  those  new  patholofj- 
ical  conditions  which  are  most  conducive  to  a  return  of  the  natural 
physiological  states  (^  150,  854  h,  855,  856,  901,  &c.). 

877.  The  system  of  watching,  or  the  expectant  plan,  leaves  Nature 
mostly  to  herself;  only  keeping  obstacles  out  of  her  way.  In  its 
greatest  latitude  its  advantages  are  exemplified  in  the  self-limited  dis- 
eases ;  but  there  is  a  period  in  all  dieases,  terminating  favorably,  when 
art  should  surrender  the  case  to  Nature  (§  858,  861,  867,  868  a). 

878.  So  many  evils  have  resulted  from  abuses  of  the  active  method, 
that  great  numbers,  not  considering  that  Nature  is  embarrassed  in 
these  cases  by  ignorance  or  carelessness,  and,  withal,  having  errone- 
ous views  in  physiology  themselves,  do  little  else  than  loatch.  This 
is  remarkably  true  of  the  homoeopath,  whose  lessons  from  Nature 
have  taught  physicians  that  all  the  virtue  does  not  lie  in  the  amount  of 
doses,  and  that  a  foe  has  arisen  who  can  be  exterminated  only  by  con- 
sulting the  philosophy  of  disease,  and  the  modus  operandi  of  remedies. 

Nevertheless,  although  medical  philosophy  and  a  knowledge  of  the 
mode  in  which  remedies  operate  be  indispensable  to  the  right  treat- 
ment of  disease,  the  community  look  only  at  the  results  ;  and  while 
the  homoeopath  cultivates  his  mind,  there  will  be  no  inquiries,  no  in- 
terest, as  to  his  theories.  In  America  these  innovations  cannot  pre- 
vail extensively,  since  the  contrast  will  be  vastly  on  the  side  of  our 
Hippocratic  practice  (§  709).  But,  in  every  section  of  the  country 
there  are  some  who  are  prone  to  a  large  and  indiscriminate  medica- 
tion ;  and  while  this  evil  exists,  homoeopathy,  in  its  original  practical 
sense,  will  make  its  more  successful  demonstrations.  Nor  can  it  be 
doubtful  that  the  tonic  and  stimulant  practice  which  has  risen  in  our 
cities,  and  which  still  sways  the  British  profession  (§  621,  a),  would 
yield  a  harvest  to  those  who  suffer  Nature  to  take  an  unmolested,  how- 
ever unaided  way.* 

It  is  due,  however,  to  truth  {Jlat  justitia  mat  ccelum),  that  the  physiol- 
ogist concede  to  the  homoeopath  that  his  hypothetical  views  may  be  di- 
rected by  an  enlightened  understanding  of  the  properties  and  laws  of 
healthy  beings.  Upon  that  ground,  indeed,  his  hopes  can  alone  re- 
pose ;  and  even  his  doctrines  in  pathology  and  therapeutics  are  a  thou- 
sand-fold better,  more  rational,  more  consistent,  more  conducive  to 
liealth  and  to  life,  than  any  or  all  the  tenets  of  the  chemical  and  phys- 
ical schools.  With  the  one  there  may  be  a  great  deal  of  misapplied 
philosophy ;  with  the  other  there  is  certainly  none  at  all  (§  892,  i). 

879.  It  appears,  therefore,  that  the  active  and  expectant  modes  of 
treatment  should  be  more  or  less  associated  ;  either  taking  the  lead  ac- 
cording to  the  general  character  of  the  disease,  and  the  particular  cir- 
cumstances of  individual  cases.  Having  made  the  requisite  impression 
by  the  active  method,  we  should  watch  till  another  remedial  change 
may  be  advantageously  produced.  When  all  is  steadily  in  the  right 
way,  we  should  do  nothing  but  watch.  Another  impression  by  an  ac- 
tive agent  would  disturb  the  restorative  process,  and  might  so  derange 
the  vital  states  as  to  establish  a  condition  of  disease  which  art  and  na- 
ture together  might  not  be  able  to  surmount  (§  137  d,  150,  151,  854). 

*  See  Dr.  Torbes's  "Young  Physic.;"  also,  Prof.  Lawsos's,  and  Medico  Chirurg* 
oal's  Reviews  of  tlie  same,  1846. 


THERAPEUTICS.  55'J 

880.  Having,  I  say,  placed  the  morbid  conditions  in  the  right  way 
for  their  subsidence  into  health,  but  little  else  remains  than  to  with- 
draw, in  good  time,  the  active  interference  of  art.  Much,  however, 
as  I  have  said,  may  remain  to  be  accomplished  by  what  may  be  call- 
ed restorative  means ;  such  as  a  well-regulated  diet,  exercise,  expos- 
ure to  the  air,  &c.  (§  855).  In  protracted  diseases  Nature  may  also 
require  the  aid  of  tonics  and  stimulants ;  and  this  is  mainly  the  ad- 
vantage which  they  bestow.  They  are  rather,  therefore,  adjuncts  to 
medicines  that  are  curative,  than  positively  curative  themselves.  The 
same  is  also  true  of  those  narcotics  which  address  themselves  to  exalt- 
ed sensibility  or  irritability. — See  Note  Ee  p.  1133.     Also  Note  F. 

881.  Though  by  the  system  of  watching  we  intrust  Nature  with 
the  cure,  the  active  interference  of  art  may  be  demanded  by  super- 
vening obstacles.  Such  is  the  case,  as  we  have  seen,  when  visceral 
inflammations  spring  up  in  the  self-limited  diseases  (§  858).  In  these 
affections,  also,  in  their  simple  states,  general  arterial  excitement  may 
become  so  excessive  as  to  require  the  loss  of  blood,  or  alterative  do- 
ses of  tartarized  antimony,  &c.  The  remedies  are  designed  for  these 
specific  objects,  and  not  with  any  expectation  of  arresting  diseases 
which  have  a  strictly  natural  course  and  termination.  The  same  prin- 
ciple is  applicable  to  all  other  forms  of  disease  ;  according  to  the  na 
ture  of  the  contingencies  that  may  arise  after  the  restorative  process 
shall  have  been  introduced.     It  is  alike  employing  constitutional  laws 

882.  It  is  no  uncommon  prejudice  that  certain  local,  and  even  con 
stitutional  forms  of  disease  should  be  allowed  to  continue  for  the  pre- 
vention of  some  apprehended  greater  evil.  This  practice  is  founded 
upon  the  humoral  hypothesis,  and  is  one  of  the  strong  exemplifications 
of  the  fallacy  of  that  doctrine.  The  intermittent  fever  is  thus  allowed 
to  persist,  that  some  peccant  matter  may  be  concocted  and  expelled ; 
ulcers  are  cherished  as  outlets  to  vicious  humors,  &c.  But,  we  are 
never  benefited  by  the  continuance  of  natural  diseases.  The  sooner 
we  get  rid  of  them,  the  more  shall  we  insure  the  chances  of  pi'o- 
longed  life,  enjoy  an  exemption  from  corporeal  and  mental  suffering, 
and  manifest  our  common  sense. 

883.  a.  In  considering  what  is  to  be  done  in  the  treatment  of  dis- 
ease, we  speak  of  the  Indications.  These  consist  of  the  suggestions 
that  may  be  afforded  by  all  that  relates  to  the  state  of  the  patient. 
They  refer  to  the  symptoms,  the  seat  of  the  disease,  its  remote  and 
pathological  causes,  its  duration,  the  habits,  occupation,  temperament, 
constitution,  age,  and  sex  (§  686,  b). 

883,  b.  And  here  we  may  go  back  to  the  origin  of  our  Science  for 
one  of  those  summary  statements  which  can  flow  only  from  an  en- 
lightened and  comprehensive  view  of  organic  philosophy,  and  which 
no  subsequent  observation  has  improved. 

"  Consider  well,"  says  Hippocrates,  "  the  nature  of  causes,  the  na- 
ture and  seat  of  the  disease,  what  is  most  suitable  to-day,  and  what 
to-morrow,  what  the  vigor  and  what  the  mildness  of  treatment.  A 
neglect  of  either  may  be  fatal  to  the  sick.  Reason  as  a  practitioner, 
and  practice  with  reason."  "  Again,  an  important  thing  to  be  done  is 
to  consider  the  seasons  of  the  year,  the  various  changes,  and  the  dif- 
ferences of  their  effects.  Next,  the  winds,  particularly  such  as  are 
common  to  all  nations,  and  such  as  are  peculiar  to  certain  countries." 
"  The  knowledge  of  disease  is  to  be  obtained  from  the  common  na- 


560  INSTITUTES    OP    MEDICINE. 

lure  of  all  things,  and  from  the  nature  of  every  individual ;  from  the 
disease,  the  patient,  the  things  that  are  administered,  and  the  peison 
that  administers  them,  for  the  case  becomes  easier  or  more  difficult 
accordingly.  We  are,  also,  to  consider  the  whole  season  in  general, 
and  the  particular  state  of  the  weather,  and  of  every  country ;  the 
customs,  the  diet,  the  employment,  the  age,  of  every  one,  the  conver- 
sations, the  manners,  the  taciturnity,  the  imaginings,  the  sleep,  the 
watchings,  and  the  dreams ;  and  how  far  vellications,  itchings,  and 
tears,  are  concerned ;  and  what  the  paroxysms  are ;  what  the  evacu- 
ations by  stool,  or  spitting,  or  vomiting  may  be ;  and  what  changes 
may  happen  from  one  disease  to  another,  and  their  various  conse- 
quences. Sweat,  cold,  shivering,  cough,  sneezings,  sighing,  breath- 
ing, belchings,  flatus  (secret  and  audible),  hemorrhages,  and  hemor- 
rhoids, are  also  to  be  considered,  together  with  the  consequences  of 
each"  (§  5i  a,  350f,  821  c-823).— Note  Oo  p.  1141. 

884.  When  the  foi'egoing  indications  are  subjects  of  attention  we 
pursue  the  rational  system,  which  is  so  called  in  contradistinction  to 
the  e)7ipirical. 

The  rational  treatment  looks,  also,  at  the  physiological  states  of  the 
body,  and  considers  disease  in  its  relations  to  those  states.  It  is 
constantly  concerned  about  the  laws  of  vital  actions,  and  regards  dis- 
ease as  consisting  in  their  modifications.  In  short,  it  proceeds  upon 
the  broad  ground  of  inductive  philosophy,  and,  therefore,  takes  in  its 
scope  all  the  principles  of  medicine  (§  639,  a). 

The  empirical  practice,  on  the  contrary,  discards  evei'y  thing  but  a 
few  prominent  symptoms,  and  would  as  soon  relieve  the  pain  of  pleu- 
risy by  opium  as  that  which  attends  a  spasm  of  the  stomach.  Such, 
rather,  is  the  common  acceptation  of  empiricism.  But,  it  is  more  a 
prevailing  usage  with  the  ignorant,  and  with  those  who  discard  the 
rational  treatment,  to  be  regardless  even  of  abstract  symptoms,  and  to 
be  mostly  swayed  by  the  humoral  hypotheses  (§  4  h,  744,  821,  824, 
830,  835). 

885.  Symptoms,  however,  are  the  most  essential,  in  their  relative 
beai'ing,  in  the  series  of  indications.  They  inform  us  of  the  organs 
affected,  conduct  us  to  a  knowledge  of  the  pathological  cause,  and  fre- 
quently conti'ibute  their  aid  in  detecting  the  nature  of  the  remote 
causes,  by  which  the  pathological  is  determined  (§  644,  667,  678). 

A  few  diseases  have  a  particular  symptom  which  is  pathognomonic ; 
as  the  eruption  in  small-pox,  measles,  &c.  But  signs  of  this  nature 
are  very  rare,  and  still  rarer  the  strictly  vital  phenomena  (§  682,  h). 

In  the  great  class  of  inflammations  there  are  certain  symptoms  com- 
mon to  the  whole,  which,  being  more  or  less  present,  denote  the  pres- 
ence of  this  disease,  and  thus  become  a  general  guide  to  the  treat- 
ment through  the  light  which  they  shed  upon  the  general  pathology. 
That  treatment  is  the  antiphlogistic  ;  but  whether  it  shall  consist  of 
bloodletting,  cathartics,  alteratives,  blisters,  &c.,  individually  or  col- 
lectively, and  to  what  extent,  will  depend  not  only  upon  the  amount 
and  severity  of  the  general  symptoms,  but  often,  also,  upon  many 
others  less  uniform  that  may  relate  to  each  individual  case,  and  which 
frequently  mark  some  special  modification  of  the  common  form  of  in- 
flammation (§  721,  722), 

886.  Next  in  importance  to  the  immediate  symptoms,  and  as  often 
indispensable  to  a  correct  apprehension  of  the  pathological  cause,  is 


THERAPEUTICS.  561 

a  knowledge  of  the  predisposing  causes.  This,  also,  has  been  amply 
shown  in  its  appropriate  places  (§  644,  742,  776,  813,  &c.).  To  these 
causes,  besides  the  more  immediate,  belong  the  innate  tendencies  to 
particular  forms  of  disease,  and,  more  or  less,  all  the  natural  and  ac- 
quired temperaments,  and  all  the  habitual  deviations  from  the  natural 
standard  of  a  sound  constitution  (§  143—147,  561,  661,  &c.).  It  is  evi- 
dent, therefore,  vi^here  there  are  many  remote  causes  concerned  in  the 
production  of  any  given  case  of  disease,  that  a  few  only,  perhaps  but 
one,  have  an  important  agency.  Those  few,  or  this  one,  are  most  im- 
portant to  be  known  ;  and  so  of  the  others  in  proportion  to  their  mod- 
ifying influence.  In  the  great  families  of  fever  and  inflammation 
there  is  generally  but  one  principal  cause  for  each  modification,  which 
is  generally  transient,  or  may  appertain  to  the  constitution.  In  the 
latter  case,  as  where  phthisis  pulmonalis  arises  from  the  combined 
influences  of  cold,  moisture,  errors  in  food,  &c.,  I  regard  these  appa- 
rently predisposing  causes  as  simply  exciting,  and  assume  the  natural 
predisposition  as  the  predisposing  cause  (§  661).  ^ 

887.  The  great  value,  then,  of  a  knowledge  of  symptoms  and  of  the 
•"emote  causes  of  disease  is  that  of  conducting  us  to  a  right  under- 
standing of  the  pathological  cause.  In  forming  our  indications  of 
treatment  from  the  symptoms  alone  we  may  effect  the  removal  of 
many,  but  in  so  doing  we  may  aggravate  the  disease,  and  perhaps 
destroy  the  patient.  This  is  conspicuously  seen  in  the  bark  and  wine 
treatment  of  those  congestive  fevers  which  destroy  so  many  of  the 
human  family ;  one  symptom  only  being  the  guide  of  practice  in  such 
cases.  "  Debility,"  indeed,  is  practically  rendered  the  disease  itself 
by  philosophers  of  the  tonic  and  stimulant  school  (§  476  c,  487  h,  488^, 
569,  621  a),  though  it  be  a  mere  failure  of  voluntary  power. 

888,  a.  It  is  commonly  a  simple  problem  for  the  enlightened  and 
observing  practitioner  to  resolve  the  general  character  of  any  patho- 
logical condition.  With  this  knowledge  we  are  ready  to  act  in  a  cer- 
tain general  manner,  or,  as  it  is  called,  upon  general  principles.  But, 
there  is  something  far  more  diflScult,  though  often  scarcely  less  im- 
portant to  be  known,  in  many  cases  of  disease;  namely,  the  particu- 
lar species,  or  rather  variety,  of  inflammation,  of  fever,  &c.,  which 
any  given  case  may  present.  Having  found  this  last  important  point 
in  the  cases  supposed,  and  settled  the  modifying  influences  of  contin- 
gent causes,  we  are  fully  prepared  for  all  the  details  of  treatment. 

888,  h.  Owing  to  variations  in  the  pathological  state  of  many  cases 
of  a  common  form  of  disease,  but  where  no  fundamental  change  in 
the  general  character  of  the  affection  has  happened,  it  may  be  neces- 
sary to  employ  remedies  in  apparent  opposition  to  each  other.  But, 
in  these  cases,  there  is  no  violation  of  principle,  no  inconsistency  of 
Nature.  A  different  conclusion  only  proves  that  we  do  not  interpret 
Nature  correctly.  To  reconcile  the  seeming  inconsistency  it  is  only 
necessary  to  recollect  the  explanation  which  I  have,  given,  that  our 
remedies  cure  by  instituting  new  pathological  states,  and  that  a  cer- 
tain variation  of  disease  from  that  condition  to  which  loss  of  blood  is 
generally  most  appropriate  may  render  stimulants,  along  with  anti- 
phlogistics,  the  best  means  for  instituting  the  pathological  change  that 
shall  be  most  r.oy^y'.ive  to  the  restorative  process  (§  752-756,  870- 
872).  W^ 

888,  c.  There  are  a  few  fundamental  points  to  be  carefully  consid- 

N   N 


6B2  INSTITUTES    OF    MEDICINE. 

ered  in  all  cases  in  relation  to  the  effects  of  lemedies.     They  refer  to 
the  j)rinciples  and  details  already  propounded. 

1.  The  direct  local  effect  of  remedies  upon  the  part  to  which  they 
may  be  applied. 

2.  Their  effects  upon  remote  parts  through  reflex  nervous  action. 

3.  Their  ultimate  effects  after  their  direct  action  i«  over. 

4.  The  general  influence  each  remedy  may  exert  upon  the  course 
and  termination  of  disease. 

888,  d.  It  is  one  of  the  most  remarkable  facts  connected  with  con- 
stitutional principles,  that  those  organs  which  are  most  important  to 
life  ai'e  either  within  the  direct  reach  of  medicine,  or  they  sympathize 
with  such  more  powerfully  and  more  readily  than  do  the  less  impor- 
tant (§  129,  cScc.) 

It  is  also  to  be  observed  that  the  parts  through  which  we  operate 
artificially,  and  with  which  those  vast  and  important  sympathetic  rela- 
tions subsist,  are  of  an  external  nature,  and  admit  the  application  of 
powerful  remedies  to  their  surfaces. 

And  yet,  again,  observe  that  whenever  no  useful  results  would  fol- 
low the  direct  application  of  remedies  to  other  organs,  such  organs 
will  not  admit  their  application  without  injury  to  themselves  and  to 
others  remotely  situated.  Nature  has  therefore  kindly  given  to  us 
two  surfaces  through  which  we  may  act  upon  all  diseases ;  while  she 
has  placed  a  barrier  against  the  entrance  of  all  morbific  agents  into 
those  parts  where  the  direct  action  of  remedies  would  be  useless  or 
detrimental  (^  278  and  references  there). 

888,  e.  I  now  leave  the  subject  of  therapeutics  in  its  general  as- 
pects, to  illustrate  the  doctrines  which  I  have  propounded,  and  to  ad- 
vance the  rational  treatment  of  disease,  by  investigating  still  farther 
the  modus  operandi  of  remedial  agents,  and  as  that  philosophy  is  mod- 
ified in  its  connection  with  the  operation  of  loss  of  blood.  At  a  future 
time  it  will  be  my  purpose  to  carry  the  same  philosophy  through  all 
the  details  of  the  Materia  Medica. 

Before  proceeding,  however,  to  the  summary  consideration  of  the 
modus  opei'andi  of  remedies,  I  shall  make  a  more  practical  analysis 
of  the  therapeutical,  effects  of  certain  agents  which  are  capable  of  a 
wide  range  of  influences,  but  between  which  the  resemblances  are  so 
obscure  as  to  have  contributed  not  a  little  to  the  errors  which  prevail 
in  respect  to  the  impressions  they  produce,  or  discourage  others  from 
all  expectation  of  ever  attaining  any  knowledge  of  their  operation  be- 
yond their  direct  manifestations.  I  shall  select  such  agents  for  this 
purpose  as  will  be  most  conducive  to  a  ready  apprehension  of  the  mo- 
dus operandi  of  all  others,  especially  the  most  impoitant  and  most 
neglected  of  all — neglected  practically  as  well  as  philosophically — loss 
of  blood.  Those  agents  may  consist  of  catliartics,  astringents,  tonics, 
Thircotics,  antispasmodics,  arsenic,  Peruvian  hark,  or,  rather,  the  alkaloid 
q^iinia,  iodine,  and  ergot.  The  last  four  will  illustrate  what  is  known 
as  specific  action.  In  the  Peruvian  bark  I  shall  also  bring  into  view  an 
agent  possessing  two  prominent  and  rather  opposite  virtues,  and  thus  at- 
tempt the  just  application  of  a  compound  agent  to  important  problems 
in  disease.     So,  also,  with  rhubarb,  &c.,  when  speaking  of  astringents. 

While  considering  the  therapeutical  uses  of  the  foregoing  agents,  I 
shall  also  indicate  their  morbific  capabilities  ;  and,  as  an  important 
means  of  engaging  attention,  I  shall  dwell  upon  their  abuses. 


THERAPEUTICS. CATHARTICS.  563 

The  advantages  of  irritants,  applied  externally,  especially  vesicants, 
will  follow  in  the  train ;  and  bloodletting,  the  first  in  importance,  will 
be  reserved  for  the  last,  that  it  may  have  the  united  testimony  in  its 
behalf  of  all  that  precedes. 

I  am  also  prompted  to  these  inquiries  by  a  desire  to  introduce  the 
treatment  of  inflammation,  fever,  and  venous  congestion,  along  with 
my  investigation  of  their  pathology,  &c. 

CATHARTICS. 

889,  a.  What  I  may  now  say  of  cathartics  is  a  continuation  of  what 
has  been  set  forth  in  section  863,  d.  Their  definition  as  founded  upon 
their  most  sensible  and  uniform  effect  is — agents  which  increase  intes- 
tinal evacuations.  But  this  acceptation  scarcely  refers  to  any  of  their 
important  physiological  and  therapeutical  influences;  which  are  just 
as  intelligible,  through  the  various  resulting  phenomena,  and  the  laws 
of  reflected  nervous  actions,  as  the  evacuations  they  produce. 

The  increase  of  peristaltic  motion,  and  the  augmented  product  of 
the  intestinal  mucous  tissue,  spring  from  the  irritation  which  is  exerted 
upon  that  tissue  by  the  action  of  cathartics ;  and  the  whole  group  of 
these  agents  are  more  or  less  capable  of  producing  those  results.  It 
is  through  this  irritation,  which  is  variable  in  its  kind  according  to  the 
nature  of  the  cathartic,  that  all  the  remote  influences  which  they  exert 
arise ;  and  as  these  remote  effects  depend  upon  modifications  of  the 
nervous  power  corresponding  with  the  nature  of  the  primary  impres- 
sion, it  is  obvious  that  one  cathartic  may  be  speedily  curative,  while 
others  may  be  profoundly  morbific,  in  certain  given  conditions  of  dis- 
ease (§  52,  150,  227,  228,  500,  638^,  1088  d). 

But  cathartics  exert,  also,  important  effects  upon  remote  organs  by 
continuous  sympathy  ;*  as  upon  the  stomach,  and  especially  upon  the 
liver  (§  498).  It  is  extremely  common,  for  instance,  when  a  cathai'tic 
is  about  operating,  for  nausea  or  vomiting  to  take  place  ;  which,  how- 
ever, may  result  from  remote  as  well  as  from  continuous  sympathy. 
And  here  I  bring  the  analogous  influences  of  leeching  into  connection 
with  the  illustration  to  which  I  formerly  adverted  (§  498, y,  g).  By 
the  foregoing  manifest  irritation  of  the  stomach  we  see,  also,  how  the 
vital  condition  of  that  organ  may  be  at  the  same  time  profoundly  af- 
fected, either  for  better  or  for  worse,  by  the  mere  action  of  cathartics 
upon  the  intestine.  And  that  this  is  truly  so  is  evident  from  the  man- 
ner in  which  we  often  see  gastric  disease  subside,  or  produced,  or  in- 
creased, immediately  after  the  nauseating  effect  of  a  cathartic.  But, 
should  the  same  results  happen  without  nausea,  we  know  from  the 
connection  of  phenomena  now  stated,  that  they  have  pi'oceeded  in  the 
more  obscure  instance  from  exactly  the  same  influence,  though  the 
prominent  symptom  of  nausea  happen  to  be  absent.  We  thus  arrive 
at  the  farther  knowledge  not  only  that  cathartics  throw  their  powerful 
influence,  by  reflex  nervous  action, upon  distant  organs,  in  virtue  of  their 
intestinal  action,  and  in  the  same  manner  as  the  stomach  is  affected 
by  the  remote  process,  but  how,  also,  this  organ  is  simultaneously  ren- 
dered the  point  of  departure  of  other  profound  influences  upon  distant 
organs  ; — their  main  efi^ects  depending  on  reflex  nervous  actions. 

If  we  now  look  at  what  is  going  forward  in  the  liver,  at  the  same 
time,  we  shall  see  that  here,  also,  are  phenomena  which  denote  the 
same  principles,  and  the  same  chain  of  causation.     Take,  in  the  first 

*  Continuous  inf.wcnce  of  these  Institutes  (§  129  c,f,  498  a). 


564  INSTITUTES    OF    MEDICINE. 

place,  what  is  most  obvious  to  the  senses,  the  bile ;  and  we  find  it 
often  greatly  increased  during  the  operation  of  cathartics.  Now  it 
would  be  clearly  wrong  to  explain  this  phenomenon  upon  any  other 
principle  than  that  which  I  have  assigned  for  the  nausea  and  vomiting; 
that  is  to  say,  by  remote  and  continuous  sympathy,*  just  as  muco-in- 
testinal  inflammation  is  extended  by  reflex  and  continuous  sympathy 
into  the  ducts  of  the  liver  (see  §  829).  Here,  also,  as  in  the  case  of 
the  stomach,  we  find  that  disease  simultaneously  subsides,  or  is  produ- 
ced, in  the  liver,  and  we  know  that  it  depends  upon  the  same  causes  that 
had  given  rise  to  the  production  of  bile.  But  this  is  not  all.  The 
liver,  from  its  important  connections  with  other  parts,  now  occasions,  as 
in  the  case  of  the  stomach,  reflex  nervous  influences  upon  distant 
parts,  while,  moreover,  it  may  yield  important  relief  to  the  brain,  or 
the  stomach,  or  intestine,  &c.,  through  an  increased  secretion  of  bile 
(§  863).  The  irritation  of  the  intestinal  mucous  tissue  which  determines 
the  nervous  action  upon  the  muscular  coat  (§  514/)  is  the  occasion  of 
extensive  alterative  reflex  actions  upon  other  structures,  and  the  former 
phenomenon  is  a  key  to  the  latter,  and  of  the  modifications  which  result 
in  increased  secretions,  the  abatement  or  increase  of  disease,  etc.  Organic 
actions  alone  manifest  change  under  such  influences,  never  the  muscular, 
and  hence  the  difficulty  of  reasoning  from  the  latter  to  the  former  (§  893  J). 

889,  b.  But,  cathartics  often  produce  their  full  curative  effects  upon 
remote  organs  without  determining  any  alvine  evacuation ;  and  this 
proves  to  us  that  the  great  curative  operation  of  cathartics  is  of  a  phys- 
iological nature.  Nothing,  indeed,  is  more  common  than  to  exhibit 
cathartics  when  the  intestine  is  empty ;  and  all  the  good  we  then  ob- 
tain from  them  (and  it  is  often  great)  arises  from  those  vital  influences 
of  which  I  have  been  speaking.  If  much  bile,  mucus,  &c.,  happen  to 
be  discharged  in  these  cases,  they  are  mainly  generated  during  the 
action  of  the  cathartic  (§  694^-).  In  almost  every  acute  disease  of 
much  importance  cathartics  are  administered,  and  if  not  with  the  in- 
tention of  which  I  am  speaking,  they  are  employed  empyrically. 
When  no  such  specific  object  is  contemjolated,  they  are  given  mere- 
ly because  it  is  customary  to  do  so ;  always  excepting  the  humoral 
interpretation  (§  456  a,  46U,  473  c,  478  b,  483  c,  1058  d). 

889,  c.  In  my  Arrangement  of  the  Materia  Medica,  I  have  placed 
the  chloride  of  mercury  and  blue  pill  as  the  first  in  importance  among 
cathartics  ;  and  yet  their  purgative  effect  is  comparatively  very  little 
with  many  of  those  which  I  have  arranged  as  the  most  infeiior.  This 
was  plainly  done  for  the  reason  that  the  curative  influences  of  these 
mercurial  preparations  are  far  greater,  in  a  general  sense,  than  those 
of  any  other  cathartic.  Experience  assures  us  that  the  arrangement 
is  right ;  while  philosophy,  as  also  founded  on  observation,  enforces 
the  truth  that  the  most  drastic  cathartics  inflict  their  injuries  through 
exactly  the  same  principles  that  the  less  purgative  exert  their  good 
effects,  differing  only  in  the  irritations  and  reflex  nervous  actions. 

We  thus  see  how  liable  definitions  are  to  lead  us  astray ;  and  this 
is  true  of  most  of  the  designations  which  I  have  retained  in  my  Phys- 
iological Arrangement,  and  more  })articularly  so  of  those  general  de- 
nominations, such  as  demulcents,  revulsives,  deobstruents,  &c.,  which 
I  have  excluded  (§  729  h,  819  a). 

889,  d.  We  mny  make  up  our  minds,  therefore,  that  the  mere  pur- 
gative effect,  or  the  evacuation  of  the  fecal  matter,  abstractedly  con- 

*  The  case  is  the  same  here  as  when  stimulants  or  mechanical  irritants  applied  to 
the  conjunctiva  instantlj'  excite  the  lachrymal  gland  to  the  production  of  tears. 


THERAPEUTICS. CATHARTICS.  565 

sidered,  is  one  of  the  least  that  is  exerted  by  cathartics ;  and  nothing 
can  be  said  in  behalf  of  their  supposed  action  upon  the  blood. 

889,  e.  Nevertheless,  it  should  be  steadily  considered  that  fecal 
accumulations  are  a  source  of  mechanical  imtation,  at  least ;  or,  if 
they  consist  more  or  less  of  fermented  food  they  also  irritate  in  virtue 
of  their  specific  properties,  and,  in  both  the  cases,  exasperate  remote 
diseases  through  the  same  physiological  laws  that  are  relative  to  the 
good  or  bad  effects  of  cathartics.  It  is  then  an  object  to  remove  these 
exciting  causes.  But,  if  none  of  the  important  vital  influences  of  ca- 
thartics be  then  contemplated,  we  should  employ  such  only  as  are 
mild,  and  whose  action  does  not  extend  much  beyond  the  intestinal 
canal.  Precisely  the  same  rule  should  also  obtain  in  the  administra* 
tion  of  emetics.  Tartarized  antimony  and  ipecacuanha  are  all  we 
want  for  profound  curative  virtues  ;  and  sulphate  of  zinc  for  superficial 
action,  or,  at  most,  associated  with  one  of  the  others  where  gastric  ir- 
ritability is  rendered  obtuse  by  narcotic  poisons. 

889, y!  Does  the  reader  now  inquire  why  it  so  frequently  happens 
that  the  best  effects  of  cathartics,  in  diseases  remote  from  the  intes- 
tines, are  obtained  only  when  they  operate  decisively,  and  perhaps 
powerfully  1  The  answer  is  important ;  for  it  goes  far  to  illustrate  the 
modus  operandi  not  only  of  cathartics,  but  of  all  remedial  agents.  It 
is,  then,  because  this  strong  impression  upon  the  vital  condition  of  the 
intestinal  mucous  tissue  is  necessary  to  establish  those  reflex  nerv 
ous  actions  on  remote  parts  that  may  be  the  seat  of  disease  which  re- 
sult in  such  a  change  as  brings  about  their  own  natural  curative  ten- 
dency. The  repeated  evacuations  are  a  necessary  consequence  of 
that  requisite  impression  upon  the  intestinal  mucous  tissue,  and  serve 
as  an  evidence  that  such  necessary  impression  has  been  produced.* 

889,  g.  It  appears,  therefore,  that  the  results  which  follow  the  ac- 
tion of  cathartics  may  affect  powerfully  all  organs,  however  remote 
they  may  be  from  the  intestine,  without  resorting  to  the  common  as- 
sumption of  absorption,  or  to  any  doctrine  in  the  humoral  pathology. 
In  al]  this,  too,  we  are  aided  not  only  by  our  knowledge  of  the  phys- 
iological relations  of  the  intestinal  mucous  tissue  to  all  other  parts 
through  the  sympathetic  nerve,  but  by  its  anatomical  connections  with 
the  liver  and  skin,  and  by  its  vast  extent.  It  is  also  the  seat  of  some 
of  the  most  important  vital  functions,  and  it  is  here  that  the  whole  lac- 
teal system  takes  its  rise,  and  here  is  the  great  concentration  of  the 
sympathetic  nerve  in  the  semi-lunar  ganglion  and  solar  plexus,  with 
the  contributions  from  the  pneumogastric  nerve  and  spinal  cord. 

It  is  owing  to  these  vast  and  important  anatomical  and  physiolog- 
ical connections,  that,  when  disease  springs  up  in  the  intestinal  mu- 
cous membrane,  it  sheds  its  morbific  influence  abroad  over  the  whole 
system;  now  developing,  by  reflex  actions,  cerebral  inflammation  or 
congestion;  now  of  the  liver;  again,  inflammation  of  the  skin;  at  an- 
other time,  of  the  bladder;  in  this  subject  rheumatism;  in  that,  scrof- 
ula ;  in  another,  croup ;  in  others,  inflammation  of  the  fauces ;  here, 
of  the  eyes  ;  there,  of  the  nose ;  here,  an  attack  of  the  gout ;  there, 
abortion  ;  and  so  on,  through  every  part  of  the  organization. 

Considering,  therefore,  I  say,  the  foregoing  anatomical  and  phys- 
iological characteristics  of  the  mucous  tissue  of  the  alimentary  canal, 
and  how  diseases  of  this  membrane  may  give  rise  to  disease  in  every 
other  part,  we  may  readily  comprehend  how  it  is  that  cathartics  exeil 
*  See  Note  G  p.  1116. 


566  INSTITUTES    OF    MEDICINE. 

powerful  sympathetic  eifects  upon  distant  organs  when  rendered  un- 
usually susceptible  by  disease.  And  so  of  all  other  remedial  agents, 
internally  applied,  according  to  the  nature  of  their  virtues,  their 
doses,  &c.     The  philosophy  lies  mostly  in  reflex  nervous  actions. 

889,  h.  From  all  which  it  follows,  that  three  principal  advantages 
are  contemplated  from  the  operation  of  cathartics  ;  namely, 
1st.  Their  sympathetic  influences,  remote  and  continuous. 
2d.  The  increased  secretions  to  which  they  give  rise ;  especially 
from  the  intestinal  mucous  tissue,  and  from  the  liver. 

3d.  The  evacuation  of  the  fecal  matter,  which,  in  a  general  sense, 
is  the  least  of  all. 

889,  i.  Certain  cathartics  affect  certain  portions  of  the  intestinal  mu- 
cous tissue  more  than  other  portions ;  and  this  is  owing  to  the  pecu- 
liar modifications  of  the  organic  properties  in  different  parts  of  that 
tissue,  and  the  peculiar  vital  relations  of  particular  cathartics  to  one 
or  another  of  those  different  parts  (§  134-137,  150.)  These  special 
relationships  should  become  the  subjects  of  critical  investigation,  since 
it  often  happens  that  cathartics  may  be  advantageously  selected  with 
a  view  to  these  exact  physiological  conditions.  The  fact  is  more  or 
less  understood,  but  not  so  the  philosophy.  Thei'e  are  some  great 
errors,  howevei-,  as  to  the  facts.  Aloes,  for  example,  is  supposed, 
universally,  to  exert  its  effect  especially  upon  the  large  intestine,  while, 
in  truth,  its  influence  is  vastly  more  upon  the  jejunum  and  ilium,  as 
abundantly  manifested  in  irritable  states  of  the  small  intestine,  and  by 
the  manner  in  which  it  aggravates  the  general  arterial  excitement  of 
fever  and  inflammation.  The  irritation  of  the  highly-sensitive  anus 
which  has  given  rise  to  the  prejudice  depends  mostly  upon  the  sudden 
provluction  of  morbid  bile  which  aloes  elicits  by  its  special  influence 
up  )n  the  liver;  and  this,  also,  is  a  proof  of  its  direct  and  main  effect 
upon  the  superior  portion  of  the  alimentary  canal  (§  718).  But  again, 
we  have  an  opposite  demonstration  of  the  same  philosophy  in  the 
failure  of  aloes  to  be  attended  by  this  irritation  of  the  anus  in  the  ab- 
sence of  hepatic  derangements  ;  and  then,  also,  there  is  comparatively 
little  bile  evacuated  (^1063  h). 

The  gi"eat  governing  principle,  however,  in  the  selection  of  cathar- 
tics, should  be  their  known  effect  upon  disease,  according  to  its  seat 
and  pathology.  If  applied  with  a  view  to  their  special  action  upon 
one  part  or  another  of  the  intestinal  canal,  they  will  be  often  liable  to 
the  worst  practical  consequences  unless  the  philosophy  which  I  have 
Bet  forth  upon  this  subject  be  considered  accurately  along  with  exper- 
imental observation  of  the  relative  virtues  of  the  different  cathartics ; 
and,  I  may  add,  that  the  more  these  relations  are  studied,  the  more 
apparent  will  that  philosophy  become  in  its  truth  and  importance  (§ 
52,  134-137,  150,  1058  h,  and  references  there,  1063  i,  1065  h). 

889,  li.  From  what  has  been  hitherto  said  of  the  philosophy  of  life, 
and  as  modified  by  disease,  we  readily  understand  how  cathartics 
may  be  greatly  varied  in  their  action  by  associating  two  or  more  to- 
gether, or  by  uniting  with  them  agents  from  other  groups.  Each  com- 
bination is  a  new  remedy,  and  a  new  one,  too,  according  to  the  exact 
proportions  of  each  ingredient.  How  important,  therefore,  a  critical 
regard  to  all  the  details  involved  in  these  suggestions  !  But,  there  is 
no  problem,  I  say  again,  more  difficult  in  practical  medicine  ;  and 
next  to  that  is  the  right  dose  of  the  whole,  or  of  any  single  agent,  and 


THERAPEUTICS. CATHARTICS,  567 

next  in  order  the  time  for  its  repetition,  or  for  the  substitution  of  some 
other  remedy.  Such  combinations  act  as  a  ivhole,  and  not  only  upon 
the  intestinal  mucous  tissue  according  to  their  collective  virtues,  but 
develop  and  reflect  upon  other  parts  an  alterative  nervous  influence  in 
a  corresponding  manner.  Thus  the  nervous  influence  is  on  common 
ground  with  those  agents  as  an  exciting  and  modifying  cause,  since  the 
latter  increase  and  modify  the  raucous  product  by  their  direct  action, 
while  the  increase  of  bile,  urine,  sweat,  &g.,  depends  upon  reflected 
nervous  action  as  the  exciting  cause  (§  222-233|,  461,  512,  647^). 

If  we  now  take  an  example,  familiar  as  it  may  be  in  practice,  it  may 
help  our  philosophy  as  to  all  other  combinations  of  remedies,  and 
guide  the  practical  hand  in  regulating  the  proportion  of  ingredients, 
the  doses,  &c.  Thus,  cathartics  may  become  completely  inoperative, 
as  such,  by  the  addition  of  opium.  This  is  done  by  rendering  the  ir- 
ritability of  the  intestinal  mucous  tissue  so  obtuse  that  it  cannot  be 
roused  by  the  irritating  virtue  of  the  cathartic.  Diminish  the  propor- 
tion of  opium,  and  the  cathartic  irritates  moderately  and  purges 
slightly.  Reduce  the  narcotic  still  more,  and  the  cathartic  irritates 
more  and  purges  more.  Omit  the  opium,  and  the  purgative  effect 
may  be  violent  and  attended  by  great  pain.  And,  in  doing  all  this,  we 
also  variously  modify  the  reflected  nervous  influences  of  all  the 
agents  which  are  thus  employed  (§  227»  228,  500,  &c.,  872  a)* 

This  is  an  example  for  all  other  combinations  of  remedies  ;  for  the 
same  philosophy  is  concerned  throughout.  We  see,  too,  in  this  ex- 
ample, how  the  combination  acts  as  a  whole.  The  cathaitic  and  nar- 
cotic simultaneously  impress  irritability  and  sensibility  ;  each  exerting 
its  force  upon  those  properties  of  life  in  the  ratio  of  their  proportions, 
and  according,  also,  to  the  existing  state  of  the  properties  (§  137  d, 
150,  189,  191, 872  a),  and  so  will  be  the  modified  reflex  nervous  actions. 

889,  I.  Cathartics  are  often  cumulative  in  their  effects  ;  but  this  will 
depend  much,  as  with  numerous  other  remedies  to  which  this  princi- 
ple applies,  upon  the  frequency  with  which  they  are  administered 
(§  556-558).  If  the  interval  be  short,  as  about  four  or  six  hours,  and 
the  same  dose  be  continued,  the  last  may  operate  with  violence,  al- 
thouo'h  the  preceding  had  manifested  no  effect.  But  this  is  far  from 
being  always  true.  Indeed,  it  is  often  necessary  to  increase  the  dose, 
even  when  exhibited  at  these  short  intervals ;  and  we  arrive  at  a 
knowledge  of  all  this,  and  sufficient  for  the  exigencies  of  the  case, 
whether  as  to  dose,  the  nature  of  the  cathartic,  or  time  for  repetition,  by 
considering  the  existing  condition  of  the  intestinal  canal,  or  other  con- 
tingent influences,  such  as  jaundice,  &'c.  But  here,  embarrassments 
frequently  grow  out  of  constitutional  peculiarities  of  patients.  These 
natural  peculiarities,  in  relation  to  cathartics  especially,  are  often  re- 
markably great ;  one  patient  bearing  far  larger  doses,  and  more  ac- 
tive cathartics,  than  another  under  apparently  the  same  circumstances 
of  disease  ;  just  as  in  the  case  of  bloodletting  (§  912).  I  am  therefore 
always  in  the  habit  of  interrogating  patients  with  whose  susceptibili- 
ties in  this  respect  I  am  unacquainted,  as  to  the  quantity  of  salts,  or 
of  castor  oil,  they  may  be  in  the  habit  of  using,  with  a  view  to  their 
action  upon  the  bowels.  This  enlightens  us  greatly  as  to  their  pTob- 
able  susceptibility  to  the  action  of  other  cathartics  ;  and,  with  the  ob- 
ject of  extending  the  philosophy  which  concerns  this  subject,  I  will 
add  that  this  knowledge,  as  to  cathartics  will  not  help  us  with  any  oth- 
er agent.  Every  other  must  be  subjected  to  the  same  analysis. 
*  See  NoiK  Ek  p.  1133. 


568  INSTITUTES    OF    MEDIC [NE. 

There  is  another  and  important  modification  of  the  cumulative  effect 
of  cathartics,  according  to  the  frequency  of  their  repetition,  and  which 
may  be  said  to  apply,  more  or  less,  to  most  other  remedies  whose  ef- 
fects are  cumulative  {^  555-558).  We  have  just  seen,  that  if  cathar- 
tics be  administered  once  in  four  or  six  hours,  that  effect  is  variously 
manifested.  But,  if  the  interval  be  much  shorter,  the  cumulative  in- 
fluence will  be  more  strongly  pronounced.  This  is  owing  to  the  per- 
sistence of  the  modified  state  of  intestinal  irritability  after  each  suc- 
cessive dose.  Each  dose,  if  soon  repeated,  raises  irritability  more 
and  more,  so  that  each,  in  succession,  operates  more  and  more.  But, 
if  the  intervals  be  long,  irritability  returns  to  its  natural  state,  and  a 
larger  dose  will  be  necessary  to  make  an  impression  (§  137  d,  514^, 
516  d,  no.  6,  549-558,  857).  The  principle  now  concerned  explains 
the  reason  why  tartarized  antimony  or  ipecacuanha  when  united  with 
the  sulphate  of  zinc  will  take  effect  as  soon  as  the  latter.  It  is  the 
same,  too,  which  brings  the  permanent  tonics  into  speedy  operation 
when  associated  with  the  analogous  diffusible  stimulants  (§  890|-,  g). 

Now,  therefore,  if  the  interval  be  quite  short  between  the  doses  of 
a  cathartic,  their  cumulative  effect  will  be  more  and  more  strongly 
pronounced.  Thus :  if  an  infusion  of  senna,  or  a  solution  of  salts, 
forming,  respectively,  one  full  dose,  be  taken  in  divided  quantities  ev- 
ery half  hour,  the  entire  quanxity  of  either  will  often  purge  more  act- 
ively than  if  the  whole  of  either  were  taken  at  once.  So,  if  a  grain 
of  ipecacuanha  be  administered  once  in  four  hours,  it  will  generally 
fail  of  producing  nausea;  but  if  half  a  grain  be  exhibited  once  in  two 
hours,  it  will  be  more  apt  to  nauseate.  There  are  peculiarities  about 
tartarized  antimony  and  other  agents,  in  this  respect,  which  have  been 
considered  under  the  designation  of  vital  habit  (§  535,  &c.,  873). 

A  common  principle  applies  to  all  the  foregoing  cases,  is  extensive- 
ly ingrafted  upon  morbific  and  remedial  agents,  and  of  vast  import- 
ance to  the  hand  of  art.  In  the  cases  recited,  by  the  frequent  repeti- 
tion of  the  remedies  we  increase  progressively  the  susceptibility  of  one 
part  or  another  to  their  peculiar  influences,  either  directly  or  by  reflex 
nervous  action.  We  bring  the  virtues  of  the  different  agents  more 
and  more  into  relation  with  the  organic  properties ;  and,  when  that 
relation  is  fully  established,  the  last  dose  appears  to  exert,  and  may 
exert,  a  greater  power  than  all  that  had  preceded  it. 

889,  m.  We  may  now,  perhaps,  more  readily  comprehend  a  part 
of  the  philosophy  which  should  govern  us  where  it  is  mainly  an  ob- 
ject to  remove  habitual  constipation,  and  to  which  a  brief  reference 
was  made  in  a  former  section  (§  556,  b).  In  cases  of  this  nature,  there 
are  two  primary  objects  to  be  kept  in  view  :  1st.  To  avail  ourselves 
of  the  cumulative  effect  of  cathartic  remedies  ;  2d.  To  establish  a  free 
secretion  of  bile,  through  alterative  reflex  nervous  actions.  To  ob- 
tain these  objects,  it  is  obvious  that  the  cathartic  should  be  adminis- 
tered with,  a  certain  frequency,  and  that  it  should  be  of  a  certain  kind. 
The  cathartic  should  be  of  the  best  alterative  nature,  that  it  may  reach 
the  liver,  and  establish  the  most  favorable  change  in  the  intestinal  ca- 
nal ;  the  last  of  which  has  been  already  stated  (§  556,  h).  Castor  oil 
is  also  valuable  for  this  purpose  (Paine's  Materia  Medica,  p.  37).  It 
is  plain,  also,  that  the  doses  should  be  so  small  as  not  to  produce  irri- 
tation ;  for  this  would  soon  result  in  positive  disease.  The  most  vio- 
lent agent  may  be  rendered  mild  by  a  proper  regulation  of  the  dose 


THERAPEUTICS. CATHARTICS.  569 

It  is  therefore  less  the  energy  of  the  remedy,  than  its  salutary  altera- 
tive virtues,  that  is  to  be  considered.  In  pursuing  the  treatment,  our 
object  should  be  to  imitate  Nature  as  nearly  as  possible  :  that  is  to 
say,  to  produce  one  free  movement,  daily,  in  the  adult,  and  one  or  two 
in  infants.  The  remedy,  therefore,  should  be  administered  at  least 
once  in  a  day;  or,  if  it  can  be  rightly  adjusted,  evening  and  morning 
would  be  still  better,  at  the  beginning  of  the  treatment.  By  this  pro- 
cess we  gradually  alter  the  irritability  of  the  intestine  and  bring  it  fully 
into  relation  with  the  virtues  of  the  agent ;  and,  as  the  bile  possesses, 
also,  cathartic  endowments,  we  shall  have  thus  adapted  intestinal 
irritability  to  the  action  of  that  natural  and  now  augmented  stimulus. 
The  case  is  parallel,  in  its  philosophy,  with  that  of  the  emetics  and 
tonics,  as  stated  in  the  preceding  section  889,  /.     Also,  §  516  d,  no.  6. 

It  hence  becomes  manifest,  that,  by  pursuing  this  course  we  shall 
soon  be  under  the  necessity  of  diminishing  the  dose  with  which  the 
treatment  was  commenced ;  till,  at  last,  the  quantity  dwindles  away 
to  such  minute  doses  that  the  stimulus  of  the  bile  and  the  mechanical 
irritation  of  the  alimentary  matter  supersede  the  faither  use  of  the 
medicine ;  or,  the  minute  doses  may  now  become  morbific. 

It  not  unfrequently  happens,  that,  at  the  beginning  of  the  foregoing 
treatment  the  doses  fail  of  their  intended  effect ;  when  some  other 
cathartic,  as  a  little  castor  oil,  or  Rochelle  salt,  should  be  exhibited,  but 
not  enough  to  operate  actively.  Their  active  effect  would  interfere 
with  the  process  of  bringing  the  organic  properties  into  a  fixed  rela- 
tion with  the  small  doses  of  the  more  alterative  remedy,  and  subse- 
quently to  their  natural  stimulus,  the  bile. 

In  all  this  series  of  influences  it  is  clear  enouarh  that  a  change  is 
established  in  the  condition  of  the  liver ;  but  a  not  less  important  one 
occurs  in  the  vital  state  of  the  intestine  (^  1057  c). 

889,  m7n.  If  we  now  regard,  for  a  moment,  the  universal  system 
which  is  pursued  of  administering  active  doses  of  cathartics,  in  the 
foregoing  cases  (§  889,  m),  at  intervals  of  two,  three,  or  more  days, 
we  shall  readily  see  that  different  results  must  follow;  while  experi- 
ence teaches  that  constipation  is  not  often  surmounted  in  this  manner. 
Too  much  violence  is  thus  inflicted,  nature  is  embarrassed,  and  is  in- 
capable of  instituting  those  salutary  changes  which  we  have  seen  to 
arise  in  the  former  case. — See  ^  516  d,  no.  6,  857. 

Nor  is  it  alone  the  intestine  which  fails  of  being  diveited  from  its 
torpid  state.  A  shock  is  propagated  to  the  stomach  ;  the  liver  vio- 
lently impressed,  and  natural  changes  are  not  instituted  in  its  action, 
and  a  continuous  flow  of  increased  bile  is  not  established  (§  889,  a). 

It  is  readily  seen  that  rhubarb,  for  the  sake  of  its  tonic  virtue,  may 
be  often  substituted  for  the  aloetic  and  mercurial  compound  (§556,Z>), 
or  associated  with  them,  or  ipecacuanha  sometimes  intermingled.  Or, 
at  other  times,  it  may  be  greatly  best  to  substitute  mild  enemas,  whose 
action  is  explained  in  section  498,  or  again  to  depend  upon  diet,  ex- 
ercise, running  especially,  &c.  But,  a  very  common  error  is  commit- 
ted in  these  cases,  as  it  respects  food.  It  is  not  considered  that  the 
stomach  often  suffers  as  well  as  the  intestine  ;  and  all  the  laxative  food, 
as  it  is  called,  which  is  employed  with  a  view  of  increasing  the  residuary 
matter,  is  apt  to  inflict  a  greater  injury  upon  the  stomach  than  any 
advantage  that  may  arise  from  its  mechanical  irritation  of  the  intes- 
tine.    These  are  cases,  therefore,  for  a  very  limited  diet  of  those 


570  INSTITUTES    OF    MEDICINE. 

things  which  are  easy  of  digestion,  and  for  the  alterative  treatment 
by  medicine,  exercise,  &c. 

889,  n.  And  now  as  to  the  time,  in  a  general  sense,  most  appropri- 
ate for  the  exhibition  of  cathartics,  and  the  philosophy  which  concerns 
it  (§  863,  (Z).  There  is  a  certain  attendant  of  the  human  constitution, 
as  already  seen  (§  768),  which  disposes  the  system  to  daily  periodical 
excitement.  This  natural  phenomenon  takes  place  late  in  the  after 
noon,  in  all  parts  of  the  globe.  I  have  considered  its  application  in 
a  pathological  sense,  and  it  is  of  great  importance  in  that  double  ac- 
ceptation as  it  regards  the  operation  of  cathartics. 

It  is  obvious,  I  say,  that  the  system  is  in  its  most  irritable  and  sus- 
ceptible state  toward  the  decline  of  the  day,  and  that  this  period  must  be 
the  worst  for  the  operation  of  so  powerful  an  irritant  as  cathartics,  and 
more  especially  so  if  fever  or  inflammation  be  present  (§  137,  d) ; 
though  there  is  a  great  difference,  in  this  respect,  among  different  ca- 
thartics. The  most  appropriate  time  for  their  administration,  in  a  gen- 
eral sense,  is  toward  the  decline  of  the  natui-al  evening  paroxysm,  or 
between  ten  o'clock  at  night,  and  eight  o'clock  in  the  morning.  This 
will  also  generally  bring  their  exhibition  in  febrile  affections  at  an 
early  stage  of  the  remission  of  fever,  so  that  their  operation  may  be 
over  before  the  access  of  another  paroxysm.  The  same  principle  ap- 
plies to  inflammation ;  for,  although  there  be  no  manifest  exacerba- 
tion in  the  afternoon,  the  disease  is  under  the  natural  tendency  of  the 
system  to  a  sate  of  excitement  at  this  period  of  the  day. 

At  a  late  hour  in  the  evening,  the  natural  paroxysm  is  fast  on  the 
decline,  and  this  is  the  most  suitable  hour  for  those  cathartics  whose 
operation  is  slow ;  as  calomel,  blue  pill,  aloes,  &c. ;  and  if  other  pur- 
gatives be  afterward  necessary,  they  may  follow  in  the  morning  with 
a  speedy  effect.  In  this  manner,  the  repose  of  the  patient  is  not  dis- 
turbed, and  is  conducive  to  the  salutary  influence  of  the  highly-al- 
terative cathartics.  These  cathartics  exert  powerful  influences  upon 
organs  that  may  not  be  the  seat  of  disease  ;  which  is  particularly  true 
of  the  skin.  Now  this  action  which  is  thus  instituted  in  the  surface 
transmits  a  curative  reflex  nervous  influence  to  parts  that  are  diseased, 
and  both  the  impression  upon  the  skin  and  its  salutary  reflex  nerv- 
ous actions  will  be  much  promoted  by  the  warmth  of  the  bed,  by  the 
horizontal  posture,  and  by  sleep.  For  the  same  reason,  if  cold  should 
arrest  the  action  in  the  skin  which  the  cathartic  institutes,  that  organ, 
suffering  this  violence,  may  reflect  morbific  sympathies  upon  other 
parts,  and  may  thus,  more  or  less,  defeat  the  useful  effects  of  the  ca- 
thartic (§  514,  li)*  It  is  the  work,  throughout,  of  reflex  nervous  action. 

But,  all  cathartics  whose  operation  is  speedy  should  be  exhibited 
at  an  early  hour  in  the  morning,  when  the  irritability  of  the  system  ia 
least,  and  sleep  has  had  its  balmy  influences. 

ASTRINGENTS. 

890,  a.  Astringents  are  commonly  supposed  to  act  upon  physical 
principles  more  than  any  other  remedial  agents,  and  that  their  special 
operation  is  analogous  to  the  tanning  process  (§  569,  h).  I  shall  en- 
deavor, however,  to  show  that  Nature  is  so  far  consistent  with  herself, 
and  that  all  the  facts  in  the  case  enforce  the  conclusion,  that  astrin- 
gents operate  like  all  other  remedial  agents  upon  vital  principles, 
whether  thoy  be  administered  internally,  or  applied  to  the  external 
*  See  Note  D  p.  1114 


THj!,ivAPEUTICS. ASTRINGENTS.  571 

siuiace ;  that  they  operate  by  so  modifying  the  living  properties  and 
actions  of  the  secerning  vessels,  that  redundant  secretions  of  blood,  or 
of  other  fluids,  are  arrested  in  virtue  of  that  change  of  vital  action. 

890,  h.  Let  us  wow  look  for  an  illustration  of  the  foregoing  to  some 
agent  which  embraces  other  virtues  in  connection  with  that  which  is 
reputedly  astringent.  There  are  many  of  these  ;  such  as  the  sul- 
phate of  zinc,  the  sulphate  of  copper,  rhubarb,  &c.  We  will  take 
the  last  mentioned,  for  the  sake  of  indicating,  also,  its  uses  in  prac- 
tice. This  substance  is  positively  cathartic  in  certain  therapeutical 
doses,  but  so  stimulating  to  the  system  in  such  doses  as  to  render 
great  caution  necessary  in  its  administration  in  acute  inflammatory 
diseases ;  while,  on  the  other  hand,  in  much  smaller  doses  it  is  adapt- 
ed to  many  chronic  inflammations.  Again,  in  certain  other  small  do- 
ses it  is  a  valuable  tonic,  but  still  contra-indicated  by  active  inflamma- 
tion. Lastly,  it  may  act  as  an  astringent  in  various  doses,  from  its 
smallest  alterative,  to  its  full  cathartic  dose ;  operating  under  partic- 
ular circumstances  of  disease  as  a  direct  astringent  in  its  small  doses, 
as  in  diarrhcea,  yet,  in  an  opposite  state  of  the  bowels,  as  in  constipa- 
tion, proving  an  admirable  laxative  in  the  same  small  and  repeated 
doses  (§  889,  m,  min) ;  while  its  wonders  cease  not  even  in  its  full  ca- 
thartic dose — for  now  in  diarrhoea  it  first  operates  as  a  cathartic,  and 
then  shuts  up  the  bowels  as  an  astringent. 

Now,  to  what  causes  are  all  these  diversified  and  apparently  con 
tradictoi'y  effects  owing?  They  depend  upon  the  natural  susceptibil- 
ity of  the  organic  properties  to  changes  according  to  the  virtues  of  the 
agents  which  may  act  upon  them,  and  their  existing  state  when  the 
agents  are  brought  into  operation  ;  and,  secondly,  as  well,  also,  upon 
the  doses  in  which  they  are  administered.  When  the  vital  conditions 
are  affected  in  a  peculiar  way,  and  under  a  given  combination  of  cir 
cumstances,  if  a  vital  agent  possessing  particular  virtues  be  applied,  it 
will  so  modify  or  alter  the  existing  morbid  state,  that  new  and  definite 
results  will  follow.  Thus,  when  the  intestinal  mucous  tissue  is  affect- 
ed with  that  condition  of  disease  which  results  in  a  preternatural  wa- 
tery secretion,  and  consequent  evacuations,  which  is  called  diarrhoea, 
and  rhubarb  is  administered  in  a  certain  dose,  this  substance  first  im- 
presses the  membrane  in  such  a  way  as  to  determine  an  increase  of 
the  peristaltic  movement ;  but  it  simultaneously  alters  the  morbid 
state  of  the  intestinal  mucous  tissue  in  such  manner  that  the  unnatural 
secretion  is  arrested ;  while  the  change  which  is  thus  established  in 
the  tissue  removes  the  morbid  reflex  nervous  action  from  the  muscu- 
lar tissue  of  the  intestine,  upon  which  the  diarrhoeal  evacuation  in 
part  depended.  The  diarrhoea  thus  ceases  after  the  rhubarb  has  act- 
ed moderately  as  a  cathartic.  The  same  causation  which  determined 
the  action  of  the  rhubarb  as  a  cathartic  changed  the  morbid  state  in 
such  wise  as  to  arrest  the  farther  production  of  the  intestinal  fluid, 
and  the  preternatural  determination  of  the  nervous  power  upon  the 
muscular  coat  of  the  bowels  (^  1062). — See  Note  Ee  p.  1133. 

Whether,  therefore,  the  rhubarb  purge,  or  prove  astringent,  or 
tonic,  a  common  principle  and  common  laws  are  concerned  through- 
out; and  all  the  sensible  results  depend  upon  certain  alterations 
which  the  agent  effects  in  the  vital  properties  and  actions  of  the  ves- 
sels, or  tissues,  which  are  the  seat  of  the  morbid  conditions,  or  in 
which  the  various  phenomena  may  take  place. 


572  INSTITUTES    OP    MEDICINE. 

Just  SO  it  is,  also,  with  the  sulphate  of  zinc,  or  of  copper,  or  ipe- 
cacuanha, when  they  restrain  haemoptysis  by  their  emetic  effect,  or 
when  in  smaller  doses  they  arrest  other  hemorrhages,  or  diarrhoea,  or 
at  other  times  bring  about  the  results  of  ordinary  tonics.     Consider, 
too,  the  special,  but  analogous,  effects  of  opium ;  which,  in  arresting 
intestinal  secretions,  or  those  of  the  liver  and  kidneys,  surpasses  ev- 
ery astringent.     And  yet  opium  has  no  astringent  principle,  nor  has 
it  ever  been  supposed  that  this  remedy  checks  those  products  by  as- 
tringing  the  vessels  or  condensing  the  tissues.     It  arrests  them,  espe- 
cially, by  so  modifying  irritability  and  sensibility  that  the  natural  and 
other  stimuli  become  less  operative.     And  what  lets  us  particularly  into 
the  philosophy  of  this  subject  is  the  coincidence  in  the  effects  of  opium 
as  it  respects  the  simultaneous  diminution  of  the  various  other  products 
of  the  abdominal  organs ;  the  cause  of  the  diminution  of  the  bile,  and 
of  the  urine,  being  the  same  as  that  of  the  diminution  of  the  diarrhoeal 
product  of  the  intestine  (§  889  k,  891  (/,  891^  k). 

890,  bb.  What  I  have  now  explained  comprehends  the  whole  philos- 
ophy of  the  operation  of  astringents.    When  they  arrest  the  discharge 
of  ulcers,  or  of  blood  from  the  stomach,  or  of  any  part  with  which 
they  come  in  direct  contact,  it  is  mostly  by  their  direct  action  upon 
the  vital  condition  of  the  parts.     In  other  cases  it  is  through  reflex  ac- 
tion of  the  nervous  system.       And  here  we  may  look  at  the  coinci- 
dence in  results  between  the  application  of  an  astringent  to  a  suppu- 
rating surface  and  as  the  same  discharge  is  arrested  by  a  tonic,  or  by 
exercise,  or  change  of  air,  &c.  (§  227,  740,  902  m).     It  is  the  change 
of  action  upon  which  the  cessation  of  the  various  products  depends,  and 
this  change  may  or  may  not  be  attended  by  a  vital  contraction  of  the 
secerning  vessels,  or  of  the  vessels  of  any  tissues  upon  which  the  agents 
may  exert  their  direct  effects. 

Other  remedies,  such  as  loss  of  blood,  and  that  one  of  a  negative  na- 
ture, cold,  which  often  surpass  the  pure  astringents  in  arresting  effusions 
of  blood,  &c.,  may  be  brought  to  the  same  interpretation  of  the  modus 
operandi  of  those  astringents.     And  so  the  mind  itself  (§  740  a). 

890,  c.  When  astringents  are  applied  to  outward  surfaces,  as  to 
leech-bites,  wounds,  &c.,  they  are  called  styptics  ;  and  in  relation  to 
those  agents  which  are  designed  for  the  purpose  of  arresting  external 
hemorrhages  only,  there  are  many  which  act  mostly  upon  mechanical 
principles  ;  either  by  pressure  upon  the  bleeding  vessels,  as  with  lint, 
agaric,  cobweb,  &c.,  or  by  coagulating  the  blood  which  exudes  from 
the  part;  while  they  also  stimulate  the  bleeding  vessels  to  contract. 

890,  d.  Astringents  are  one  of  the  classes  of  remedies  which  have 
been  greatly  abused,  as  well  as  applied  with  little  reference  to  the 
pathological  states  they  are  designed  to  correct.  Hemorrhage  from 
every  part,  frequent  discharges  from  the  intestine,  whether  watery, 
bilious,  or  mucous,  the  discharge  in  gonorrhoea,  leucorrhoea,  &c.,  are 
treated  by  vast  numbers  according,  alone,  to  the  physical  conceptions 
of  the  action  of  astringents  ;  and  those  agents,  thei-efore,  are  indiscrim- 
inately applied  to  all  the  foregoing  conditions.  Beyond  this  consid- 
eration, the  discharge  alone  is  an  object  of  attention ;  the  disease  ap 
pearing  to  consist  in  this  particular  symptom.  Many  of  the  preter- 
natural effusions  depend  upon  inflammation  or  congestion,  which  as- 
tringents rarely  fail  to  aggravate.  And  yet  nothing  is  more  common 
than  the  exhibition  of  those  agents  in  these  pathological  conditions 


THERAPEUTICS. — ^ASTKINGEKTS.  573 

without  any  antecedent  treatment  by  other  remedies.  It  is  a  common 
practice,  for  example,  to  exhibit  the  acetate  of  lead,  or  some  other 
pm"e  astringent,  for  a  moderate  hsemoptysis.  The  effusion,  being  in- 
stituted by  nature  for  the  relief  of  the  congestive  state  of  the  lungs 
in  which  it  originates  (805,  1019),  and  violently  arrested  by  the  astrin- 
gent, is  counteracted  in  its  great  final  cause.  But  astringents  not  only 
inflict  that  evil,  but  are  also  apt  to  increase  the  pulmonary  affec- 
tion by  a  direct  morbific  action  ;  just  as  they  increase  dysenteric  in- 
flammation when  they  establish  the  change  by  which  the  redundant 
secretion  of  mucus  is  arrested.  A  very  frequent  ultimate  consequence 
of  the  former  untoward  treatment  is  tuberculous  phthisis.  This  prac- 
tice has  received  a  great  impulse  in  recent  times  from  morbid  anato- 
my, especially  as  promulgated  by  Louis  and  Andral,  and  carried  for- 
ward by  British  pathologists ;  who  deny  the  dependence  of  tubercle 
upon  inflammation.  Nor  can  we  desii'e  a  better  proof  of  the  import- 
ance of  i-endering  all  such  pursuits  entirely  subservient  to  the  demon- 
strations of  living  Nature  (§  756.  Also,  Med.  and  Physiolog.  Comm., 
vol.  ii.,  p.  608-634,  743,  744,  748,  780-782,  799).— Note  F  p.  1114. 

Instead,therefore,of  the  foregoing  mal-practice,  along  with  the  simul- 
taneous use  of  a  stimulating  diet,  these  patients,  if  the  hemorrhage  be 
small,  should  be  treated  by  bloodletting,  or  small  doses  of  tartarized 
antimony  or  ipecacuanha,  blisters,  &c.  These  agents  an-est  the  effu- 
sion, and  so  far  they  exert  the  effect  of  astringents.  But  they  do  more. 
They  alter  the  morbid  states  in  a  mode  which  Nature  was  attempt- 
ing; while  the  real  astringents  alter  them  for  the  worse;  though  a 
cessation  of  the  hemorrhage  may  be  equally  the  result  of  either  meth- 
od of  treatment  (§  150,  151,  732  h,  733  e,  862-864,  892|  d,  g)  * 

There  can  be  no  sound  practice  till  hemorrhagic  effusions  are  rec- 
ognized as  the  result  of  a  secreting  process,  instituted  by  morbid 
states.  The  proof  is  abundant;  but  it  is  enough  that  we  witness  the 
consequent  relief  of  disease,  and  apply  ourselves  to  the  analogy  in 
this  respect  with  what  is  known  of  redundant  effusions  of  bile,  of  se- 
rum, &c.,  and  which  none  can  fail  to  recognize  as  salutary  means  em- 
ployed by  Nature.  These  hemorrhages,  too,  are  analogous  to  men- 
struation, and  here,  as  there,  a  great  final  cause  lies  at  the  foundation 
There  is,  therefore,  no  more  propriety  in  arresting  hemorrhage,  unless 
excessive,  than  in  attempting  to  interfere  with  the  natural  function. 

890,  e.  In  the  advanced  stages  of  fever,  and  of  other  severe  forms 
of  disease,  hemorrhages  have  been  often  followed  by  death.  And 
here  it  is  that  hemorrhages  have  raised  the  greatest  apprehension  of 
their  fatal  tendency.  But,  it  is  very  rare  that  it  is  the  hemorrhage 
which  destroys  (§  1019).  It  is  only  a  symptom,  at  this  advanced 
stage  of  the  malady,  significant  of  a  fearful  condition  of  disease, 
which,  in  itself,  in  a  vast  proportion  of  cases,  is  the  true  cause  of 
death  (§  805,863).  The  cause,  therefore,  is  too  apt  to  be  mistaken, 
the  blame  too  often  attributed  to  a  kind  effort  of  Nature  to  throw  off 
the  deadly  weight;  and  Nature  would  much  oftener  succeed  by  this 
depletory  process  were  it  not  for  the  interference  of  art  with  its  mis- 
chievous astringents.  It  is,  however,  always  a  fearful  symptom  in 
the  advanced  stages  of  acute  disease.  But,  bad  as  it  is,  it  should  be 
hailed  as  the  best  possible  event  that  can  happen.  The  effusion 
comes  directly  from  the  congested  parts,  and  if  any  thing  can  relieve 
them,  it  must  be  this  spontaneous  effort.  Art  cannot  now  interfere 
*  The  record  should  be  made  that  tonics  and  stimulants  are  now  generally  applied  to 
this  as  to  most  other  maladies. — Notes  F,  Ee,  Ff,  Gg,  Ii,  Mm. — lb65. 


574  INSTITUTES    OP    MEDICINE. 

with  bloodletting.  The  golden  opportunity  may  have  been  allowed 
to  pass,  either  from  ignorance,  or  fear,  or  from  the  difficulties  of  the 
case  (§  569,  960,  964  c).  Nature,  alone,  can  now  institute  the  great 
remedy;  and  hei'e  it  is  that  we  so  often  witness  the  safety  with  which 
she  makes  her  wonderful  demonstrations  of  cure,  and  rebukes  the 
timid  practitioner.  But  she  has  now  her  own  way  of  operating.  She 
has  taken  the  business  of  rational  treatment  upon  herself,  and  out  of 
the  hand  of  art ;  for  now  it  is  that  quarts  of  blood  may  flow  away 
from  the  intestine,  and  triumph  over  disease,  when  bloodletting  would 
be  perfectly  useless,  and  the  abstraction  of  a  dozen  ounces  of  blood 
would  probably  be  fatal.  These  are  lessons  from  Nature  of  every- 
day occurrence,  and  should  not  be  lost  even  to  such  as  are  incapable 
of  appreciating  disease,  or  who  may  be  imbued  with  prejudice,  or 
haunted  by  fear,  in  respect  to  the  great  remedy  whose  timely  appli- 
cation would  save  them  from  the  consternation  of  witnessing  a  natural 
(jutpouring  of  blood,  and  from  the  mortification  of  discovering  that 
there  may  have  been  an  important  error  in  treatment. 

These  are  cases  which  require,  in  all  respects,  a  great  precision  of 
treatment.  Where  Nature  may  have  laid  the  foundation  of  cure  by 
hemorrhagic  eff'usions,  a  slight  error  in  practice  may  be  fatal.  And 
here,  again,  the  fault  is  apt  to  be  laid  at  the  door  of  Nature,  and  thus 
the  disposition  to  interfere  with  astringents  is  more  and  more  increas- 
ed. Nevertheless,  we  should  watch  these  effusions  with  vigilance ; 
and,  whenever  they  appear  to  be  transcending  the  exigencies  of  the 
case,  or  the  ability  of  the  system  to  bear  them,  we  should  endeavor 
to  restrain  them  by  appropriate  astringents  (§  805).* 

890,  ee.  Those  philosophers  who  justly  refer  capillary  hemorrhage 
to  a  secretory  process  have  distinguished  the  condition  into  active  and 
passive ;  of  which  haemoptysis  is  an  example  of  the  former,  and  that 
which  was  considered  in  the  last  preceding  section,  of  the  latter. 
But,  this  distinction  is  as  clearly  unfounded  as  that  of  active  and 
passive  inflammation  (§  752,  &c.).  Here,  as  there,  the  varieties  are 
nearly  on  a  par  in  respect  to  the  pathological  cause.  Tlie  differences 
which  exist  among  them  are  owing  to  only  slight  modifications  of  that 
essential  cause.  The  modifications,  however,  are  such  as  may  require 
variations  of  treatment ;  one  of  them  the  antiphlogistic,  another  the 
antiphlogistic  and  astringent  combined,  and  another  the  astringent 
alone.  They  are  thus  seen  to  run  into  each  other,  and  they  offer 
problems  where  it  is  the  nicest  point  to  determine  whether  we  shall 
bleed  and  purge,  or  administer  an  astringent. 

890, y!  When  hemorrhage  supervenes  upon  chronic  forms  of  dis- 
ease, it  commonly  happens  that  it  must  be  great  to  overthrow  the  ob- 
stinacy of  habit ;  and  the  triumph  of  Nature  is  often  thus  displayed 
in  the  haematamesis  which  is  set  up  by  aggravated  indigestion. 

The  hemorrhage  attendant  on  tuberculous  phthisis  is  a  relief  to  the 
sufferer ;  but  not  often  more  than  temporary.  Nor  can  we  now  hope 
to  do  much  by  co-operating  with  Nature,  any  farther  than  to  moder- 
ate the  activity  of  disease  by  a  non-stimulant  diet,  and  blisters  to  the 
chest,  or  by  general  or  local  abstractions  of  blood  where  the  quantity 
expectorated  may  be  small.  Astringents  are  always  pernicious  in 
these  cases,  unless  the  hemorrhage  be  excessive ;  and  even  then  we 
shall  generally  fail  to  arrest  the  eff'usion  on  account  of  its  connection 
with  a  serious  lesion  of  organization.  These,  therefore,  are  case/» 
*  Notes  Ff  p.  1135,  Go  r-  H-'^S.  I'  F>-  1139.    Also,  §  1019. 


THERAPEUTICS. ASTRINGENTS.  575 

which  sometimes  prove  suddenly  fatal  by  the  quantity  of  blood  ef- 
fused, or  by  its  choking  up  the  air-cells. — Note  F  p.  1114. 

890,  g.  Cases  of  the  foregoing  nature  (§  890, y)  appear  now  and 
then  as  consequences  of  badly-treated  pneumonias,  especially  the  con- 
gestive variety,  or  what  is  called  typhoid  pneumonia.  But,  we  rarely 
witness  any  thing  more  than  an  expectoration  of  bloody  mucus  in  the 
common  form  of  the  disease,  or  even  in  the  congestive,  if  the  treat- 
ment have  been  of  the  proper  antiphlogistic  nature. 

890,  h.  Again,  nothing  is  more  extensively  employed  in  the  treat- 
ment of  dysentery  than  rhubarb,  and  nothing  more  injuriously  (§  150). 
Its  administration  proceeds  upon  the  erroneous  views  of  the  modus 
operandi  of  astringents  and  the  want  of  a  proper  reference  to  the  pa- 
thology of  the  disease.  As  that  pathology  consists  in  active  inflam- 
mation, it  should  be  manifest  that  rhubarb  is  one  of  the  worst  agents 
that  can  be  devised  ;  since  it  possesses  not  only  the  virtue  of  a  true 
astringent,  but  is  stimulant  to  the  whole  circulation,  irritant  to  the 
whole  mucous  tract  of  the  intestine,  now  morbidly  susceptible  through- 
out its  length  from  the  severe  and  specific  inflammation  of  its  inferior 
portion  (§  137  d,  398),  and  if  the  agent  arrest  the  discharge,  it  is  com- 
monly by  increasing  and  otherwise  unfavorably  modifying  the  inflam- 
matory condition  (^  1062). — Note  Bbb  p.  1148. 

As  in  the  foregoing  case  of  haemoptysis,  therefore,  we  should  have 
recourse  to  dii-ect  antiphlogistic  means ;  and  the  cathartics  employed 
should  be  of  the  least  irritating  nature,  and  then,  only  in  cautious 
doses.  But,  they  should  be  also  of  an  alterative  nature,  and  such  as 
will  reach  the  liver  as  well  as  the  intestine.  In  a  general  sense,  cas 
tor  oil  is  the  best  (Paine's  Materia  Medica,  p.  45).     Also,  ^  1057  I. 

If  we  now  consider  that  ipecacuanha  is  the  best  internal  remedy 
for  dysentery,  and  the  best  for  haemoptysis,  and  that  common  table 
salt  is  one  of  the  best  for  the  latter  affection,  it  will  help  us  greatly 
to  the  knowledge  we  are  seeking  as  to  astringents,  and  lead  to  many 
practical  advantages. — See  Ergot  §  892f  o ;  Note  Gg  p.  1138. 

890,  i.  Rhubarb,  opium,  and  other  agents  which  arrest  redundant 
secretions,  are  often  highly  useful  in  some  forms  of  diarrhoea,  and  some- 
times in  chronic  discharges  of  mucus  ;  but  these  products  depend  upon 
various  pathological  states,  and  whether  astringent  remedies  will  be 
useful  or  injurious  will  depend  upon  the  precise  nature  of  the  disease 
(§  150,  670-674,  733y).  In  the  simplest  forms  of  diarrhoea  they  are 
more  or  less  useful ;  particularly  rhubarb,  and  that  agent,  chalk,  which 
possesses  no  astringent  virtue,  but  brings  about  the  prominent  result 
of  an  astringent  merely  by  neutralizing  some  irritating  acid.  But 
soda  or  potass  would  not  answer,  since  these  irritate  by  their  own  vir- 
tues, and  still  more  so  by  forming  purgative  salts  within  the  alimenta- 
ry canal.  Saline  cathartics  are,  therefore,  also  improper,  and,  more- 
over, scarcely  extend  their  salutary  permanent  effects  beyond  the  in- 
testinal canal  in  cases  where  they  are  admissible  (^  1061). 

390,  k.  But,  even  in  the  simple  forms  of  diarrhoea,  there  is  variety 
as  to  the  exact  nature  of  the  morbid  condition,  which  demands,  in  dif- 
ferent cases,  a  choice  of  astringent  remedies  (§  150,  672-674,  733/, 
863  d).  One  variety  will  be  greatly  benefited  by  rhubarb  and  chalk, 
but  aggravated  by  opium.  To  another  opium  is  exactly  suited,  as  in 
pulmonary  phthisis ;  and  in  such  rhubarb  may  be  detrimental,  and 
pure  astringents  useless.     To  another  variety,  as  in  some  old  chronic 


576  INSTITUTES    OP    MEDICINE. 

cases,  the  acetate  of  lead  may  be  best  adapted  ;  and  to  others  the  pure 
astringents,  such  as  kino,  catechu,  geranium,  &c.,  when  all  other  means 
which  I  have  indicated  would  be  either  useless  or  injurious. 

890,  I.  The  foregoing  examples  illustrate  variously  the  general  prin- 
ciples which  are  propounded  in  this  work.  But,  the  variety  of  illus- 
tration may  be  greatly  extended  in  respect  to  the  remedies  now  be- 
fore us.  It  often  happens,  for  example,  that  frequent  watery  dis- 
charges are  owing  either  to  inflammation  of  the  intestinal  mucous  tis- 
sue, or  to  a  state  approaching  inflammation  ;  as  in  cholera  infantum. 
Here,  all  astringents  are  inadmissible  ;  and,  if  the  case  be  cholera  in- 
fantum, such  is  the  peculiar  nature  of  its  predisposing  causes  (§  650- 
653),  that  there  is  nothing  comparable  with  the  mild  chloride  of  mer- 
cury in  doses  varying  from  the  twentieth  to  the  eighth  of  a  grain,  once 
in  four  to  twelve  hours ;  perhaps,  also,  with  a  little  chalk  and  the 
camphorated  tincture  of  opium  along,  to  neutralize  an  acid  and  to  al- 
lay intestinal  irritability.  But  it  is  the  mercurial  agent  which  does 
the  work,  by  breaking  up  the  morbid  condition.  Calomel,  therefore, 
in  such  cases,  is  just  as  much  an  astringent  as  alum,  or  the  acetate  of 
lead,  or  catechu,  in  other  cases  of  a  modified  pathology  (§  150,  151, 
863  d).     Will  Chemistry  explain  (^  892  h)  1 

890,  m.  Gonorrhoea  is  another  example,  and  another  form  of  in- 
flammatory disease,  where  great  suffering,  and  prolonged  sickness,  are 
induced  by  the  want  of  a  proper  knowledge  of  the  operation  of  as- 
tringents, and  a  proper  discrimination  as  to  the  particular  state  of  the 
pathological  condition  when  the  remedies  are  applied  (§  672).  The 
preternatural  discharge  is  apt,  indeed,  to  be  regarded  as  the  disease ; 
or  whether  so  or  not,  it  is  a  common  practice  to  resort,  at  once,  to  as- 
tringent remedies,  internally  and  by  injections.  Such,  however,  is 
the  force  of  inflammation,  and  morbid  iiTitability  so  strongly  pro- 
nounced, that  a  direct  antiphlogistic  treatment  should  be  at  least  pre- 
mised ;  when,  also,  it  will  be  commonly  found  that  it  has  superseded 
the  necessity  of  astringents.  And  here,  again,  we  may  remark  how 
the  coincidence  in  effects  between  the  internal  use  of  copaiba,  or  cu- 
bebs,  and  injections  of  an  astringent  nature,  denotes  a  common  mode 
of  action,  and  places  the  whole  upon  vital  ground.  The  frequent  sal- 
utary effect  of  the  nitrate  of  silver  when  employed  as  an  injection  in 
the  early  stage  of  gonorrhoea,  and  its  pre-eminent  advantages  in  leucor- 
rhoea,  go  to  confirm  the  same  philosophy  (§  150,  151).  This  sub- 
stance lias  no  astringency,  in  the  proper  acceptation,  but  operates  in 
its  own  wonderful  way  in  breaking  up  the  inflammatory  state  upon 
which  the  discharge  depends. 

890,  71.  And  then  as  to  leucorrhoea.  How  badly  is  this  affection 
often  treated  by  astringents,  internally  and  externally,  and  also  by 
tonics!  And  all  this,  mainly,  because  the  disease  happens  to  have, 
for  one  of  its  symptoms,  a  discharge  from  the  vagina,  and  is  supposed 
to  depend  upon  debility  of  the  general  system,  and  relaxation  of  the 
mucous  tissue ;  a  sort  of  mechanical  exudation  from  a  flabby  mem- 
brane that  tonics  and  astringents  may  condense  and  sti-engthen  (§  409  i, 
410,  509).  But,  if  we  look  at  the  inflammatory  nature  of  this  afl'ec- 
tion,  there  will  be  no  difficulty  in  understanding  how  these  agents, 
and  the  usual  stimulating  diet,  inflict  their  injuries.  And  now,  if  we 
consider  that  cantharides  is  the  best  internal  remedy  for  leucorrhoea, 
another  luminous  guide  will  be  obtained  to  a  right  appi'ehension  of 


THERAPEUTICS. ASTRINGENTS.  577 

the  mode  in  which  astringents  may  check,  for  awhile,  those  discharges 
which  they  may  ultimately  increase,  or  others,  in  other  cases,  success- 
fully and  permanently. 

890,  0.  Let  us  now  consider  the  remarkable  manner  in  which  cer- 
tain agents  will  arrest  a  copious  excretion  of  sweat,  and  we  shall 
learn  still  more  distinctly  that  astringents  operate  through  reflex  nerv- 
ous actions  ;  and  thus  be  guided  to  the  only  intelligible  purposes  fiu 
which  they  should  be  employed,  and  carry  this  knowledge  throughout 
the  breadth  of  the  Materia  Medica. 

Thus,  then  ;  here  is  a  patient  affected  with  pulmonary  phthisis,  who 
rises  in  the  night  to  shift  his  wet  for  dry  linen.  But  this  inconveni- 
ence may  be  stopped  at  once  by  a  few  drops  of  sulphuric  acid  ;  and 
opium  will  often  do  the  same.  The  acid  and  the  opium,  however, 
produce  very  different  impressions  ;  though  each  arrests  the  sweating 
by  certain  vital  influences.  One  may  be  beneficial,  while  the  other  is 
injurious,  and  vice  versa,  according  to  the  exact  combination  of  path- 
ological circumstances  when  the  agents  are  administered.  In  other 
diseases,  and  where  the  skin  is  dry,  opium  will  induce  perspiration ; 
and  it  accomplishes  this  through  the  same  laws  as  when  it  arrests  the 
excretion.  And,  if  we  now  observe  the  apparently  contradictory  phi- 
losophy when  opium  simultaneously  checks  the  products  of  the  liver 
and  kidneys  and  increases  that  of  the  skin,  we  gain  yet  farther  light 
as  to  astringents,  penetrate  to  the  common  laws  which  are  distinguish- 
ed by  opposite  results,  and  go  to  the  work  of  cure  as  the  mechanic 
when  he  elicits  countervailing  movements  from  a  common  principle, 
or  a  common  power,  whose  attributes  are  known  (§  863,  d). 

The  vegetable  kingdom  supplies  many  astringents  from  which  a 
substance  is  derived  under  the  name  of  tannin;  and  hence,  in  part, 
the  physical  rationale  of  their  modus  operandi  upon  living  beings.  It 
is  supposed  that  their  astringent  virtue  resides  in  this  tannin  ;  and  this 
may  be  so  where  the  principle  may  be  elaborated.  But,  there  are 
numerous  substances  of  active  astringent  virtues  from  which  nothing 
analogous  to  tannin  can  be  derived ;  such  as  the  acetate  of  lead,  and, 
indeed,  all  the  mineral  substances  belonging  to  the  group  of  astrin- 
gents. We  see,  therefore,  that  the  effect  of  the  astringents  them- 
selves is  not  due  to  any  coincidence  in  the  constitution  of  these  sub- 
stances ;  and  yet,  notwithstanding  the  great  differences  among  them, 
they  may  all  bring  about  a  common  result  (§  150,  892  h,  892^  v). 

It  is  not  alone  to  certain  pathological  states  that  result  in  redundant 
effusion  that  astringents  are  applicable.  Certain  conditions  of  inflam- 
mation, especially  of  external  surfaces,  are  often  greatly  relieved  by 
their  local  action.  Acetate  of  lead  is  one  of  the  best  remedies,  exter- 
nally applied,  for  inflammation  of  the  skin,  of  the  eyes,  &c.  Sulphate 
of  zinc,  also,  for  conjunctivitis,  the  mineral  acids  or  vegetable  astrin- 
gents for  inflammation  of  the  tonsils.  These  are  active  astringents, 
and  the  variety  in  their  effects,  according  to  the  nature  of  the  patho- 
logical conditions,  whether  employed  internally  or  externally,  declare 
their  physiological  action,  and  call  upon  the  practitioner  to  study  well 
the  capabilities  of  each  one.  Nay,  more  ;  their  variety  of  action  when 
applied  externally  is  not  less  than  what  we  have  seen  from  their  inter- 
nal administration.  The  acetate  of  lead,  for  example,  may  speedily 
relieve  certain  conjunctival  inflammations,  when  such  modifications  of 
inflammation  would  be  greatly  aggravated  by  the  sulphate  of  zinc ; 

Go 


578  INSTITUTES    OP    MEDICINE, 

but,  in  another  case  apparently  alike,  the  sulphate  of  zinc  will  answen 
a  better  purpose.  The  nitrate  of  silver,  however,  or  blisters,  or  leech- 
es, may  be  well  adapted  to  all  the  modifications.  But  hei'e  is  a  case,  ap- 
parently the  same,  in  which  all  the  foregoing  means  have  failed  en- 
tirely. On  pushing  inquiry,  however,  we  learn  that  in  the  generation 
preceding  the  last  there  prevailed  the  scrofulous  diathesis.  We  ac- 
cordingly resort  to  iodine,  and  the  inflammation  yields  as  under  the 
influence  of  some  magic  power  (§  137  e,  150,  151,  851  b,  863  d). 

Now,  it  is  of  vast  practical  importance  to  consider  that  the  forego 
ing  differences  in  results  depend  mostly  upon  slight  shades  of  differ- 
ence in  the  inflammatory  states  in  the  several  cases  (§  150,  662,  673). 
And  who  can  mistake  the  common  nature  of  the  modus  operandi  of 
all  the  agents  employed  (§  137,  e)  1 

890,^:?.  It  is  important,  therefore,  to  understand  that  no  two  astrin- 
gents are  exactly  alike  in  their  effects,  and  that  the  property  which  is 
recognized  as  such  may  be  associated  with  other  active  virtues  in  the 
same  substance,  by  which  the  astringent  is  variously  modified  ;  while, 
as  in  compound  medicines,  the  several  virtues  act  as  a  whole,  that 
which  is  most  predominant  giving  the  gi-eatest  determination  to  the  na- 
ture of  the  impressions  that  may  be  produced  (§  lS8i  d,  889  k,  892). 
This  variety,  it  appears,  adapts  thdse  agents  very  variously  to  differ- 
ent forms  of  disease.  When,  therefore,  a  pure  astringent  is  only  re 
quired,  sucli  as  may  possess  tonic  or  stimulant  virtues  should,  obviously, 
be  avoided.  Remarkable  examples  of  this  nature,  associated  also  with 
other  virtues,  occur  in  rhubarb,  cinchona,  the  muriated  tincture  of  iron, 
&c.  Hence  there  is  a  great  range  of  choice  among  remedies  which 
may  be  selected  to  answer  the  intention  of  an  astringent,  in  its  strict 
acceptation.  This  has  been  already  variously  illustrated,  as  in  the  ex- 
ample of  rhubarb.  But  we  will  have  an  exemplification  in  the  Peru- 
vian bark,  an  infusion  of  which,  on  account  of  its  specific  febrifuge 
virtue,  would  be  exactly  adapted  to  diarrhoea  attendant  on  intermit- 
tent fever ;  or  quinine,  perhaps,  would  be  preferable  if  the  disease 
be  recent.  In  such  cases  a  pure  astringent  would  be  useless  ;  which 
farther  illustrates  the  operation  of  astringents,  as  it  does,  also,  the  dis- 
tinctions between  tonic,  astringent,  and  febrifuge  virtues. 

But,  the  foregoing  are  broad  shades  of  difference  in  pathological 
conditions.  In  very  many  cases  where  there  is  a  great  approximation 
in  the  pathological  states,  in  many  modifications  of  inflammation,  it  is 
often  important  to  apply  a  certain  remedy  of  astringent  virtue  in  pref- 
erence to  others. 

890,  q.  We  may  now  see  that  certain  astringents  may  be  best  suited 
to  certain  organs  to  which  they  are  addressed  than  to  other  parts  (§ 
133,  &c.,  140,  150). 

But  these  agents  are  so  much  circumscribed  in  their  uses,  that  it  is 
no  longer  an  object  to  pursue  the  inquiry.  What  has  been  said  is 
more  with  a  reference  to  bring  these  remedies  within  the  pale  of  med- 
ical philosophy,  and  to  illustrate  that  philosophy  ;  and,  in  so  doing,  to 
prevent  their  misapplication.  Those  which  are  associated  with  other 
virtues  are  mostly  wanted ;  such  as  rhubarb,  cinchona,  the  sulphates 
of  zinc  and  copper,  &c.,  and  these,  mainly,  for  the  sake  of  those  vir- 
tues. 


THERAPEUTICS. TONICS STIMULANTS.  579 


PERMANENT    TONICS,   AND    DIFFUSIBLE    STIMULANTS. 

890^,  a.  Tonics  raay  be  regarded  as  a  counterpart  of  the  antiphlo- 
gistics.  Froin  the  circumstance,  therefore,  of  the  latter  occupying  the 
high  places  in  the  materia  medica  we  may  come,  at  once,  to  the  con- 
clusion that  the  former  are  comparatively  of  very  limited  importance. 
Indeed,  it  is  only  in  the  advanced,  or  in  the  declining  stages,  of  acute 
diseases,  or  in  certain  states  of  chronic  affections,  that  tonics  can  ren- 
der much  service. — Note  Ee  p.  1133. 

No  remedial  agents,  however,  have  been  more  extensively  employed, 
and  therefore  none  which  have  been  so  extensively  injurious  (§  569,  e). 
This  misapplication  of  the  Materia  Medica  has  arisen,  as  in  other  ca 
ses,  from  erroneous  theoretical  views  of  disease,  and  mistaken  notions 
of  the  modus  operandi  of  remedies  (§  854  hh,  863  d,  892  b,  904  d). 

8901,  b.  In  considering  the  uses  of  tonics  it  should  be  borne  in 
mind  that  they  have  but  a  very  limited  range  of  curative  influences  ; 
and  that,  in  a  general  sense,  they  do  but  invigorate  organic  actions 
which  have  been  reduced  by  prolonged  disease,  and  where  there  is 
either  no  great  amount  of  absolute  disease,  or  where  nature  is  already 
in  the  way  of  the  restorative  process,  or  where  that  process  may  only 
require  an  invigorating  impulse  to  start  it  into  existence.  Such  are 
the  uses  of  tonics. — Note  F  p.  1114. 

By  now  regarding  the  true  mode  in  which  these  intentions  are  ac 
complished,  and  the  absolute  influences  which  are  exerted  by  tonics, 
we  shall  come  to  a  just  apprehension  of  their  relations  to  morbid  states, 
and  be  better  qualified  to  avoid  them  where  they  may  be  injurious. 

890^^,  c.  Tonics  are  commonly  supposed  to  act  upon  mechanical  prin- 
ciples, by  bringing  into  close  apposition  the  molecules  of  which  the 
living  tissues  are  composed,  and  attempts  have  been  lately  made,  as 
at  former  times,  to  demonstrate  the  truth  of  this  conjecture  by  exper- 
iments upon  dead  tissues  (§  569,  b).  This  has  led  many  to  con- 
found the  virtues  of  tonics  with  those  of  astringents.  But,  we  shall 
find  that  here,  as  in  all  other  cases.  Nature  is  consistent,  and  that  ton- 
ics bring  about  their  results  like  other  remedial  agents ;  that  here,  as 
in  all  analogous  instances,  there  is  no  departure  from  Unity  of  De- 
sign (§  137,  e).  A  few  plain  illustrations  will  place  the  opei'ation  of 
tonics  in  its  proper  aspect. 

8901,  d.  Thus  :  on  leferring  to  an  example  already  stated  for  anoth- 
er purpose,  we  cannot  fail  to  observe  that  the  increased  warmth  of 
the  skin,  and  muscular  vigor  produced  by  animal  food  as  soon  as  it 
enters  the  stomach,  are  due  to  the  same  causation  as  the  analogous  ef- 
fect of  alcoholic  stimulants,  and  that  both  must  be  expounded  upon  vital 
principles  (§  512,  b).  Those  speedy  effects  manifestly  depend  upon 
vital  impressions  exerted  upon  the  mucous  tissue  of  the  stomach,  and 
their  transmission  by  reflex  nervous  action  to  other  parts.  They  are  va- 
riously pronounced  according  to  the  exact  combination  of  circumstan- 
ces. The  food  will  display  itself  most  distinctly  in  such  as  have  .suf- 
fered its  privation,  and  where  the  surface  is  chilled  ;  the  wine  where 
it  is  least  employed  (§  535,  &c.).  By  varying  these  incidental  influ- 
ences a  corresponding  variety  will  obtain  in  the  results.  Employ  the 
food  or  the  wine  in  febrile  and  inflammatory  states  and  the  same  man- 
ifestations take  their  rank  among  the  violent  phenomena  of  diseasa 
Now,  here  is  the  whole  principle  which  is  relative  to  the  action  of 


580  INSTITUTES   OF    MEDICINE. 

tonic*.  These  agents  produce  the  same  effects  as  the  foregoing  causes, 
They  are  the  same,  or  sufficiently  so  for  my  present  purpose,  in  the 
natural  state  of  the  body,  and  are  modified  in  the  same  manner  when 
employed  in  fever  and  inflammation.  The  fatigue  incident  to  hard 
labor  is  instantly  relieved  by  nourishment  or  by  wine.  The  influence3 
here  are  exactly  analogous  to  the  vigor  which  is  imparted  to  the  vol- 
untary muscles  by  tonics  in  cases  of  indigestion.  In  the  former  case 
the  powers  of  the  stomach  and  the  animal  frame  have  sunk  under  fa- 
tigue (§  855)  ;  in  the  latter  from  disease.  The  food  and  the  wine  in 
one  case  exalt  those  conditions ;  and,  from  the  analogy  in  the  influen- 
ces which  are  established  by  tonics  in  the  other,  we  know  that  a  com- 
mon mode  of  action  has  obtained  throughout  (§  137  e,  151).  But,  the 
tonic  goes  yet  farther,  and  brings  about  a  change  in  the  organic  state 
of  the  stomach,  since  food  will  not  remove  the  condition  upon  which 
its  indigestion  depends.  The  tonic,  therefore,  is  an  alterative  stimu- 
lant. In  all  the  cases  the  voluntary  muscles  are  suddenly  or  grad- 
ually invigorated  by  reflex  nervous  actions  propagated  from  the  stom- 
ach. It  is  the  same  with  the  tonic  as  with  the  food  or  the  wine.  No 
sooner  has  the  dyspeptic  swallowed  the  first  dose  of  bark  than  he  tells 
us  that  his  strength  is  coming  as  by  enchantment.  The  tonic,  also, 
like  the  wine,  increases  the  desire  for  food ;  and  if  this  effect  can  be 
no  more  interpreted  by  the  physical  doctrine  than  the  former  results, 
it  may  be  safely  concluded  that  every  other  problem  oflTered  by  tonics 
falls  within  the  philosophy  of  vitalism  (§  500,  516  d,  no.  6,  350,  no.  94). 

It  is  now  an  easy  matter  to  institute  analogical  demonstrations  of 
the  physiological  operation  of  tonics,  as  in  former  cases,  that  of  astrin- 
gents, for  example  (§  890).  For  this  pui'pose  ipecacuanha  and  the 
nitrate  of  silver  may  be  taken  ;  neither  of  which  has  any  tonic  virtue, 
while  the  former  is  contra- stimulant.  But  these  agents  are  appropri- 
ate to  the  same  states  of  indigestion  as  the  tonics,  and  bring  about  the 
same  results  (§  904,  d).  Or,  take  a  mental  cause  for  an  exactly  simi- 
lar parallel,  which  may  be  seen  in  the  effects  of  some  agreeable  intel- 
ligence, which,  no  one  can  mistake,  has  imparted,  on  the  instant,  a 
keenness  of  appetite,  a  vigor  of  digestion,  and  an  exaltation  of  mus- 
cular strength,  which  had  not  been  enjoyed  for  a  month  or  a  year  (§ 
137  e,  227,  512,  514  k).  Or,  place  the  same  individual  on  board  a 
vessel,  or  give  him  an  airing  by  land,  and  the  first  hour,  perhaps,  will 
have  brought  with  it  far  greater  improvement  of  digestion  and  of  mus- 
cular strength,  than  would  have  been  imparted  by  cinchona,  or  any 
other  tonic,  in  a  month  (§  150,  657  a,  847  g,  856  a). 

890j,  e.  As  to  the  extent  in  which  tonics  may  act  as  alteratives 
that,  as  in  respect  to  all  other  remedial  agents,  will  depend  upon  the 
departure  of  the  organic  properties  and  actions  from  their  natural 
type.  As  in  all  other  cases,  also,  the  useful  effects  will  depend  upon 
the  nature  of  the  morbid  changes.  But  these  conditions,  in  their  re- 
lation to  tonics,  are  not  often  constituted  by  any  great  deviations  from 
the-natural  states.  In  most  other  instances  tonics  are  morbific  (§  137,  e). 
If  they  happen  to  be  useful  in  active  foi-ms  of  disease,  it  is  a  random 
hit  (§  756).  Their  operation,  however,  even  then,  comes  under  the 
same  principle  as  when  they  produce  favorable  results  upon  chronic 
derangements  (§  901).  Sometimes,  therefore,  when  active  disease 
becomes  prolonged,  and  the  susceptibilities  of  the  parts  affected  turn- 
ed a  little  from  the  incipient  pathological  state   and  under  the  influ- 


THERAPEUTICS. TONICS STIMULANTS.  581 

ence  of  vital  habit,  tonics  will  prove  less  frequently  detrimental,  or 
may  be  so  far  curative  that  w^e  venture  to  associate  them  now  and 
then  with  the  direct  antiphlogistics,  to  obtain  their  mixed  influence. 
It  is  often  useful  to  combine  them,  especially  the  vegetable,  in  the 
form  of  infusion,  or,  perhaps,  of  tincture,  with  the  mild  cathartics  that 
are  adapted  to  the  advanced  stages  of  disease,  just  as  we  have  seen 
of  the  union  of  rhubarb  with  saline  purgatives  (§  872,  a).  In  such 
cases,  they  not  only  prevent  any  prostrating  effects  of  the  cathartic,  but 
are  positively  remedial  by  going  to  the  vital  condition  of  organs  (§ 
137  d,  150,  569  c).  And  here,  as  in  the  case  of  rhubarb  (§  872,  a), 
we  may  reverse  the  order  of  indications,  and  suppose  that  a  tonic  may 
be  useful  if  it  can  be  prevented  from  stimulating  injuriously.  This 
object  may  be  often  attained  by  uniting  a  mild,  saline  cathartic,  or, 
administering  small  alterative  doses  of  tartarized  antimiony.  This 
practice,  in  respect  to  antimony,  is  often  highly  useful  in  the  treat- 
ment of  intermittent  fever,  where  the  tonic  virtue  of  cinchona,  or  quin- 
ia,  interferes  with  the  febrifuge  virtue  ;  while,  at  the  same  time,  the 
antimony  does  its  important  work  as  an  antiphlogistic  alterative. 
Both  of  the  agents,  in  these  cases,  are  principal  remedies.  But  it  is 
the  febrifuge,  not  the  tonic  virtue,  which  makes  the  salutary  impres- 
sion. The  former  is  positively  morbific,  and  may  not  only  defeat  the 
febrifuge  action  without  the  counteracting  influence  of  antimony,  but 
aggravate  greatly  the  whole  condition  of  disease.  And  this,  by  the 
way,  is  a  distinct  exemplification  of  the  existence  of  those  two  oppo- 
sing virtues  in  cinchona  ;  while  in  the  other  forms  of  disease  it  shows 
itself  in  the  aspect  only  of  one  of  the  best  tonics  (§  137  d,  150,  535, 
&c.,  672,  673,  675,  756,  847  g,  848,  854,  863  d,  867,  889  k,  890  i). 

890 J,  y!  But  I  say,  again,  that  these  agents  are  never  wanted,  in 
their  relation  to  diseased  states  as  tonics,  in  the  early  stages  of  any 
disease  whatever ;  and,  however  they  may  now  and  then  succeed  (§ 
756),  they  are  generally  prejudicial.  If  employed  in  certain  forms 
of  fever  or  inflammation  in  which  tonics  possessing  febrifuge  virtues, 
like  cinchona,  are  not  indicated,  they  endanger  life  (§  150,  569  e,  621  a, 
652  c,  662,  847  g,  848,  863  d).  I  think  I  shall  have  justified  this  as- 
sertion throughout  the  extent  of  these  Institutes.  But,  in  failure  of 
this  I  have  only  to  point  out  the  results  of  the  Brunonian  doctrine 
of  disease,  which  prompted  the  tonic  and  stimulant  treatment  to  so 
oreat  an  extent  that  it  has  been  computed  to  have  destroyed  a  great- 
er number  of  the  inhabitants  of  Europe,  in  the  first  forty  years  of  its 
prevalence,  than  all  the  wars  of  that  sanguinary  period  (§  621,  a,  1068). 

890^,  g.  There  are  great  resemblances  between  the  virtues  of  ton- 
ics and  diffusible  stimulants,  in  their  common  acceptation ;  but  there 
are  also  important  distinctions.  In  instituting  comparisons,  therefore, 
between  them,  or  of  all  other  remedies,  they  should  be  regarded  in 
their  just  relations  to  morbid  states ;  for  in  this  adaptation  alone  can 
they  be  remedial.  We  shall  thus  find  that  both  classes  of  remedies 
are  more  or  less  applicable  to  the  same  conditions  of  disease,  and  that, 
on  account  of  the  differences  that  exist  in  their  remedial  virtues,  it 
will  be  often  useful  to  combine  them  together  (§  863  d,  889  k,  I).  In 
their  proper  therapeutical  acceptation,  tonics  make  their  impression 
much  more  gradually,  and  more  permanently,  than  diff'usible  stimu- 
lants ;  observing,  in  this  respect,  the  same  distinction  that  subsists  be- 
tween animal  and  vegetable  food  (§  441  c,  890 J  d).     When,  also, 


582  INSTITUTES    OF    MEDICINE. 

tonics  are  useful,  their  effects  are  far  more  profound  than  those  of  dif- 
fusible stimulants.  But  this  is  not  true  of  their  morbific  effects  under 
circumstances  of  existing  disease  ;  since  wine,  and  especially  more 
ardent  spirits,  taken  in  any  acute  inflammation  or  fever,  not  only  pro- 
duce their  usual  more  rapid  impressions,  but  exasperate  the  morbid 
states  to  far  greater  degrees  of  intensity  than  any  of  the  permanent 
tonics.  The  principle  holds,  also,  in  chi'onic  diseases  when  tonics  or 
stimulants  prove  moi'bific  (§  137,  d). 

The  foregoing  peculiarity  of  tonics  fits  them  admirably  to  certain 
chrouic  forms  of  disease  where  the  strong  influence  of  a  long-pro- 
tracted morbid  habit  is  to  be  surmounted  (§  535,  &c.).  Stimulants 
will  not  reach  these  conditions  with  sufficient  alterative  effect,  or  they 
may  act  with  too  much  rapidity  where  a  diseased  habit  is  obstinately 
established,  and  where  long-continued  organic  actions  of  a  morbid  na- 
ture can  be  surmounted  only  by  the  slow  operation  of  favorable 
causes.  But,  in  these  obstinate  conditions  the  permanent  tonics  may 
not  act  with  all  the  rapidity  that  may  be  useful ;  and  then  we  associ- 
ate some  of  the  transient  stimulants  with  them,  by  which  the  morbid 
states  are  rendered  more  susceptible  of  the  effect  of  the  tonic  remedy, 
just  as  by  uniting  the  sulphate  of  zinc  with  ipecacuanha  the  latter  will 
exert  its  emetic  effect  simultaneously  with  the  former ;  all  of  which 
contradicts  the  doctrine  of  absorption  (§  137  d,  889  k,  I,  904  bl). 

Again,  however,  some  of  the  tonics  possess,  also,  the  virtues  of 
ti'ansient  stimulants,  such  as  the  cinchonas;  and  these  compound  at- 
tributes suit  them  well  for  those  conditions  of  which  I  was  last  speak- 
ing, or  for  irritable  states  of  the  stomach  when  tonics  are  wanted,  but 
are  apt^to  nauseate  (§  150,  889  k,  890  b).  In  these  conditions,  a  cold 
infusion  of  cinchona,  whether  as  a  febrifuge  or  as  a  tonic,  surpasses 
its  alkaloids  on  account  of  the  presence  of  a  volatile  oil  by  which  the 
stomach  is  promptly  and  gently  stimulated,  and  thus  enabled  to  bear 
the  tonic  influence  of  the  bark. 

890|,  Ji.  The  suggestions  which  have  been  now  made  let  us  at 
once  into  the  reason  why  all  the  tonics  and  stimulants  may  be  con- 
verted to  useful  purposes  in  disease,  and  why  it  is  greatly  otherwise 
with  cathartics  and  emetics.  In  the  last  instances  there  are  far  great- 
er diversities  in  their  curative  and  morbific  virtues,  and  they  ai'e  far 
more  of  an  alterative  nature  than  such  as  appertain  to  tonics  and 
stimulants.  There  exist,  indeed,  among  cathartics  and  emetics  many 
agents  that  can  rarely  be  applied  to  any  morbid  conditions  without 
increasing  the  existing  evil  or  engendering  new  ones.  In  this  re- 
spect, all  the  tonics  and  stimulants,  when  employed  in  active  febrile 
or  inflammatory  states,  are  on  a  par  with  the  most  irritating  cathartics 
and  emetics.  Their  effect  then  goes  deep ;  which  admonishes  us, 
more  and  more,  to  study  well  the  relations  of  remedies  to  diseased 
conditions,  and  to  discard  all  the  conclusions  which  have  been  drawn 
from  an  observation  of  their  effects  upon  man  in  health  (§  137  d,  150, 
662  a,  675,  854  bh). 

Nevertheless,  the  same  principle  of  diversity  applies  to  the  sevei-al 
members  of  the  classes  of  tonics  and  stimulants ;  but  it  reaches  them 
in  a  vei-y  inferior  degree  (§  52,  650).  Since,  therefore,  there  are  nc 
groups  of  remedies  so  closely  allied  in  their  virtues  throughout  as 
tonics  and  stimulants,  there  are  none  which,  throughout,  bring  about 
results  in  the  treatment  of  disease  that  so  closelv  resemble  each  othpr 
(§  863,  r^).— Is^oTK  Ee  p.  113?.  ■ 


THERAPEUTICS. NARCOTICS.  bHii 

We  thus  come  to  understand  why  all  the  substances  which  compose 
the  classes  of  tonics  and  stimulants  may  be  more  or  less  useful,  and 
that  no  one  of  them  is  an  excrescence  upon  the  Materia  Medica ; 
notwithstanding  the  vast  abuses  to  which  they  have  been  subjected, 
and  the  immense  mortality  of  which  they  have  been  the  conspicuous 
causes  (§  569  e,  621  a).  We  are  also  thus  led  to  the  knowledge  that 
one  tonic,  or  stimulant,  will  often  answer  a  better  purpose  than  an- 
other; and  we  find,  on  applying  ourselves  to  an  observation  of  Na 
ture,  that  experience  confirms  all  the  other  premises.  We  have  just 
seen  an  example  of  this  in  cinchona,  and  it  is  a  striking  general  dis- 
tinction, that  the  vegetable  tonics  are  best  adapted  to  the  prostrate 
conditions  which  follow  long-protracted  acute  diseases,  while  the  min- 
eral, especially  the  preparations  of  iron,  are  suited  to  chronic  mala- 
dies, such  as  indigestion.  Here,  however,  the  vegetable  tonics  may 
be  equally  appropriate,  while  the  mineral  ones  are  not  so  to  the  direct 
sequelae  of  acute  maladies. 

NARCOTICS. 

891,  a.  Narcotics  are  agents  which  affect,  especially,  the  nen'ous 
centres,  and  are,  therefore,  also  denominated  cerehro-spinants.* 

In  my  Arrangement  of  the  ^lateria  Medica  I  have  divided  them 
into  six  groups  or  orders,  according  to  their  special  influences  upon 
the  nervous  system.  Narcotics  stand  in  a  group  by  themselves  ;  and 
the  remaining  five  consist  of  antispasmodics,  tetanies  or  cerebro-spino- 
excitants,  moto-paralysants,  senso-paralysants,  and  cerehro-spino-de- 
pressants.     These  distinctions  are  more  or  less  observed  by  others. 

Some  of  the  narcotics,  however,  possess  also  the  vii-tues  of  other 
groups,  and  vice  versa ;  and,  therefore,  in  conformity  with  this  com- 
pound endowment,  the  same  agents  appear  under  the  several  appro- 
priate denominations. — Note  Nn  p.  1141. 

891,  b.  The  most  useful  of  the  narcotics  are  the  great  agents  by 
which  pain  is  immediately  assuaged,  restlessness  subdued  into  tran- 
quillity, and  wakefulness  converted  into  refreshing  sleep.  Such, 
therefore,  may  be  taken  as  the  definition  which  I  apply  to  narcotics, 
and  without  special  reference  to  the  profound  influences  which  they 
may  exert  upon  organic  functions,  or  to  other  useful  effects. 

But,  all  narcotics  do  not  equally  produce  their  several  effects. 
Some  of  them  are  more  remarkable  for  diminishing  and  relieving 
pain,  and  are  called  anodynes  (§  194,  &c.).  Others  produce  sleep 
more  particularly,  and  are  known  as  soporifics.  Others  allay  irrita- 
bility and  diminish  vascular  action,  local  and  general,  in  a  more  deci- 
ded manner  than  the  rest,  and  are  called  sedatives  (§  IBS,  &c.). 

Such  are  the  denominations  in  common  use ;  but  they  are  some- 
what defective.  All  the  soporifics,  for  instance,  are  also  anodynes, 
and  most,  though  not  all  of  the  anodynes,  are  more  or  less  soporific. 
There  are,  also,  many  sedatives  which  do  not  rank  at  all  among  the 
narcotics  ;  to  which,  indeed,  the  most  powerful  do  not  belong,  such  as 
bloodletting,  hydrocyanic  acid,  tobacco,  &c.,  and  of  which  bloodletting 
is  the  only  one  of  much  value  in  the  treatment  of  disease,  but  that  one 
emphatically  and  justly  denominated  the  reviedium  pn'incijmle.  The 
sedatives,  therefore,  which  fall  under  the  denomination  of  narcotics, 
possess,  also,  anodyne  or  soporific  virtues. 

891,  c.  We  have  seen  how  extensively  large  classes  of  remedies 

*  This  term  is  deficient  in  not  embracing  tlie  sympathetic  nerve,  which  is  mainly 
interested  in  the  nervous  influences  upon  organic  functions  and  products  (§  113,  46H). 


584  INSTITUTES    OF    MEDICINii. 

have  been  perverted  in  their  uses,  and  have  yet  to  consider  the  no  less 
common  neglect  or  misapplication  of  bloodletting.  There  is  no  other 
way  of  enforcing  their  claims  to  a  just  consideration.  In  respect  to 
the  agents  now  before  us,  there  is  a  yet  smaller  class  who  are  equally 
unhappy  in  their  estimate  of  their  virtues  ;  and,  while  the  stimulating 
school  exhaust  the  energies  of  Nature  by  adding  to  the  intensity  of 
disease  in  their  peculiar  way,  the  narcotizing  school  do  the  same 
mischief  by  a  similar  neglect  of  the  pathology  of  disease  ;  and  what  in 
either  case  should  be  attacked  by  the  lancet,  cathartics,  antiphlogistic 
alteratives,  &c.,  is  roused  into  greater  immediate  violence  by  tonics 
and  stimulants,  or  indirectly  by  other  morbific  influences  which  apper- 
tain to  the  narcotics  (§  150,  151).  Take,  for  example,  the  opinion  of 
the  able  and  distinguished  London  physician.  Dr.  Sigmond,  who  says 
that, 

"  Of  all  the  different  classes  of  ?nedicine  we  possess,  we  may  fairly 
consider  the  narcotics,  slcillfully,  judiciously,  and  watchfully  adminis- 
tered, the  most  important.'"' — Sigmond's  Lectures  in  hondon  Lancet, 
183G-7,  p.  216.— And  so,  also,  Pereira,  ^  960,  a,  p.  718. 

The  foregoing  affirmation  shuts  out,  of  course,  bloodletting,  cathar- 
tics, all  the  important  and  numerous  agents  which  I  have  grouped  un- 
der the  denomination  of  alteratives,  as  inferior,  in  therapeutics,  to  opi- 
um, hyoscyamus,  &c.  {§  854  hb,  S57). — Note  H  p.  1117. 

On  the  contrary,  I  shall  have  endeavored  to  show,  in  various  parts 
of  this  work,  that  narcotics  are  but  little  more  than  humble  auxiliaries 
to  more  important  remedies,  and  then  only  in  a  comparatively  small 
number  of  the  cases  of  disease  ;  or,  that  they  are  mere  palliatives,  giv- 
ing a  temporary  ease  by  blunting  sensibility,  where  death  is  probably 
inevitable,  and  thus  easing  the  sufferer  out  of  existence. 

891,  d.  That  narcotics  are  extremely  deficient  in  curative  virtues 
should  be  sufficiently  apparent  from  what  has  been  already  said  of  the 
uses  to  which  they  are  constantly  applied.  But,  even  these  inten- 
tions can  be  rarely  well  fulfilled  by  narcotics  where  much  disease  is 
present.  We  must  then  resort  to  the  class  of  antiphlogistics  for  our 
great  curative  means  ;  and,  if  the  narcotics  be  summoned  to  their  aid, 
it  should  be  done  with  the  greatest  caution,  or  they  may  prove  fatally 
morbific.  We  may  exhibit  opium,  &c.,  for  the  relief  of  mere  spasm 
of  the  stomach,  to  procure  rest,  &c.,  where  no  important  acute  dis- 
ease is  present.  But  he  who  should  employ  them  to  assuage  the  pain 
of  pleuritis,  enteritis,  or  any  other  active  form  of  inflammation,  and, 
in  a  general  sense,  of  chronic  forms,  would  either  most  seriously  ag- 
gravate the  disease,  or  destroy  the  patient  (§  150,  151).*  Whenever, 
also,  there  is  any  affection  of  the  head,  or  any  tendency  to  cerebral 
disease,  so  great  is  the  liability  of  narcotics  to  induce  congestion  of 
the  brain,  that  they  are  totally  inadmissible  where  that  organ  is  in- 
creased in  its  susceptibilities  (§  137,  d).  And  then  let  us  consider 
their  never-failing  effect,  in  their  ordinaiy  doses  of  so  injuriously 
modifying  the  action  of  the  glandular  organs,  that  the  secretions  of  the 
whole,  especially  of  that  most  important  organ  the  liver,  are  more  or 
less  diminished  ;  whereby  Nature  is  obstructed  in  one  of  her  greatest 
processes,  natural  and  curative,  and  morbific  nervous  actions  reflected 
upon  all  diseased  parts,  and  upon  the  whole  organism  (§  862,  863). 
Should  this  nervous  influence  excite  in  the  skin  a  perspirable  action, 
it  is  not  of  a    salubrious  nature;    and   here,  again,  we   see  demon- 

*  There  would  be  as  much  propriety  in  treating  pleuritis  as  peritonitis  by  the  enor- 
mous doses  of  morphia  now  in  vogue  for  the  latter  affection. — 1860. — Note  H  p.  1117. 


THERAPEUTICS. NARCOTICS.  585 

strated  the  evils  that  arise  from  regarding  the  product  and  not  the  na- 
ture of  the  action  upon  which  it  depends  (§  512  b,  863  d,  902  g). 
Hence  has  arisen  the  pernicious  custom  of  depending  upon  the  com 
pound  powder  of  ipecacuanha  as  a  principal  curative  means  in  the 
treatment  of  fever.  The  opium  determines  morhific  nervous  actions  upon 
the  glandular  organs  and  nervous  system;  being  scarcely  modified 
for  the  better  through  its  union  with  ipecacuanha,  even  in  its  greater 
diaphoretic  influence  upon  the  nervous  power. 

891,  e.  In  respect  to  the  modus  operandi  of  narcotics,  I  shall  now 
only  lay  down  the  proposition  that  these  agents  produce  their  saluta- 
ry or  their  morbific  effects  like  all  other  remedies,  or  all  other  causes 
of  disease,  and  set  forth  the  proof  in  other  appropriate  places  (§  891^  k, 
904,  &c.).  The  principle  involved  is  so  perfectly  in  harmony  with 
all  physiological  facts  relative  to  the  healthy  state  of  the  body,  and 
supported  by  all  the  well-ascertained  facts  in  medicine,  that  it  ena- 
bles us  to  comprehend  how  it  is  that  ten  drops  of  the  tincture  of  opi- 
um administered  by  the  stomach  will  afford  more  relief  to  one  man 
than  fifty  drops  will  to  another,  or  how  the  ten.  drops  of  laudanum  may 
do  more  injury  in  the  former  case,  than  fifty  will  in  the  latter,  where 
the  conditions  of  disease  are  exactly  alike,  but  where  the  doctrine 
which  I  have  advanced  expounds  the  difference  in  effects  upon  natu- 
ral physiological  differences  and  other  attendant  peculiarities,  and,  as 
for  the  rest,  by  the  production  of  a  sedative  reflex  nervous  action  corre- 
sponding with  the  existing  susceptibiHties  (§  227,  447,  891^  ^,  k,  904). 
The  failure  of  narcotics  to  produce  the  same  effects  when  applied 
to  the  trunk  of  a  nerve  as  upon  its  expanded  extremities  is  a  promi- 
nent fact  in  humoi'alism,  and  has  contributed  largely  to  the  doctrine 
of  remedial  effect  by  absorption.  The  fallacy  of  the  whole  philoso- 
phy is  indicated  in  other  places  (§  826,  d,  &c.). 

891,  yi  The  effects  of  narcotics  generally  decrease,  respectively, 
when  frequently  repeated,  or  when  habitually  employed  at  more  dis- 
tant intervals  (§  558,  a).  But  the  organic  properties,  as  in  their  rela- 
tion to  all  vital  stimuli,  whether  remedial  or  morbific,  maintain  about 
their  usual  susceptibility  to  all  narcotics  except  the  one  in  use ;  and 
it  is  therefore  often  advantageous  to  change  from  one  to  another,  or 
to  employ  two  or  more  in  combination  (§  150,  151,  650,  889  k).  And 
here  I  may  remark  how  a  single  fact  proves  that  remedies  operate 
upon  the  system  at  large  by  reflex  actions  of  the  nervous  system. 

We  have  hitherto  seen  that  an  admirable  variety  of  virtues  apper- 
tains to  many  of  the  different  members  of  each  group  of  remedies,  by 
which  they  are  extensively  adapted  to  various  pathological  conditions 
that  approximate  each  other,  but  which  are  marked  by  such  differen- 
ces that,  were  each  group  composed  of  only  one  or  two  agents,  we 
should  be  constantly  baffled  in  the  treatment  of  disease  (§  889,  k). 
And,  how  vastly,  in  this  respect,  has  the  Materia  Medica  been  im- 
proved in  recent  times  by  simplifying  certain  substances  of  compound 
virtues,  attended,  also,  with  much  excrementitious  matter  ;  as  in  the 
examples  of  many  alkaloids,  iodine,  &c. !  Opium,  for  instance,  is  gen- 
erally inadmissible  in  inflammations,  unless  to  moderate  irritability 
of  the  intestine  in  muco-enteritis,  or  of  the  lungs  in  pneumonia,  oi 
after  the  disease  as  affecting  some  other  parts  shall  have  been  subdu 
ed  by  bloodletting,  cathartics,  &c.  But  morphia  may  be  very  appro- 
priate when  opium  itself  would  be  detrimental  (§  863,  d).     If  nei 


586  INSTITUTES    OF    MEDICINE. 

ther,  however,  be  admissible,  we  possess  in  hyoscyaraus,  or  coniunij 
or  lactucariura,  or  lupulin,  or  cliurrus,  &c.,  substitutes  which  may  be 
often  employed  with  advantage.  So,  again,  belladonna,  aconite,  stra- 
monium, render,  each  one,  their  peculiar  services  in  certain  painful 
affections,  or  other  conditions  of  disease,  or  subserve  some  purpose 
in  surgery.  As  these  last  three,  however,  possess  no  soporific  virtue, 
but  lead  to  sleep  by  assuaging  pain  and  irritability,  they  are  included 
in  my  arrangement  under  the  denomination  oi  se^iso-paralysants. 

891,  g.  The  most  extensively  useful  effect  of  narcotics  is  that  of 
procuring  sleep ;  so  great  is  the  tendency  to  wakefulness  in  diseases, 
and  so  pei"nicious  is  its  presence.  This,  too,  depends  greatly  upon 
age ;  children  requiring  a  great  amount  of  sleep,  while  four  or  six 
hours  will  commonly  answer  for  manhood  and  more  advanced  age. 
This  is  for  disease.  Rather  more  than  the  maximum  is  wanted  in 
health.  The  law  of  adaptation  comes,  here,  into  operation,  in  morbid 
states,  as  with  all  things  else  (§  137,  847  g,  848,  859,  863  d,  870  aa). 

But,  before  the  administration  of  narcotics  for  the  purpose  of  pro- 
curing sleep,  we  should  look  well  to  the  cause  of  the  wakefulness; 
for  the  loss  of  blood,  or  a  cathartic,  or  an  emetic,  or  greater  abstinence 
from  food,  &c.,  may  be  the  appropriate  means.  When,  however,  nar- 
cotics are  adapted  their  effect  is  peculiarly  happy,  not  only  in  reliev- 
ing and  aiding  Nature,  but  in  promoting  the  operation  of  other  reme- 
dies (§  137  d,  150). 

891,  h.  We  are  often  required  to  witness  an  obstinate  wakefulness 
arising  more  from  anxiety,  or  other  affections  of  the  mind,  than  from 
the  disease  itself;  and  when  the  day  comes,  the  first  glance  of  the  eye 
upon  the  sunken  or  ghastly  features  of  the  patient  may  awaken  ap- 
prehensions for  which  there  is  no  just  foundation.  Now  let  the  win- 
dow-shutters be  closed,  exclude  all  unnecessary  attendants,  let  the 
nurse  be  seated  quietly  in  a  chair,  lay  aside  medicine  and  even  food, 
take  down  the  bed-curtains,  ventilate  the  room,  but  not  from  a  win- 
dow that  may  throw  a  blast  upon  the  patient,  graduate  the  bed-clothes 
to  his  sensations,  moderate  or  put  out  the  fire,  and  if  the  patient  have 
not  rested  when  night  comes  on  again,  give  him  a  suitable  narcotic, 
keep  all  things  quiet,  and,  at  our  morning  call,  we  shall  be  likely  to 
understand  the  reason  why  narcotics  are  so  improperly  administered 
when  wakefulness  arises  from  profound  disease,  perhaps  of  the  brain, 
or  when  sleep  is  ample,  but  pain  and  suffering  call  for  a  relief  that 
narcotics  may  not  yield.  It  is  the  delightful  effect  of  these  agents,  in 
the  case  which  I  have  just  supposed,  and  where  pi'eliminary  means 
for  tranquilizing  the  system  have  been  adopted,  that  often  leads  the 
inattentive  observer  of  the  pathology  of  disease  to  their  indiscriminate 
use  ;  and  his  blindness  is  frequently  such,  and  so  great  may  be  the 
quiet  and  insensibility  which  the  narcotics  produce,  that  the  patient 
may  drop  into  the  grave  without  raising  the  suspicion  that  he  was 
doomed  by  the  treacherous  remedy. 

What  1  have  just  said  of  quiet,  darkness,  &c.,  are  exceedingly  im- 
portant auxiliaries  to  soporifics,  and  should  be  carefully  directed. 
They  are  causes,  too,  which  should  awaken  attention  to  the  modus 
operandi  of  active  remedies,  whereby  the  necessity  of  the  latter  will 
be  greatly  diminished.  Choose,  also,  the  night,  when  possible,  for 
the  exhibition  of  soporifics  ;  not  only  on  account  of  its  greater  stillness 
than  the  day,  but  because  this  is  the  natural  time  for  sleep  (§  137,  e). 


THERAPEUTICS. NARCOTICS.  SS"? 

891,  i.  The  next  great  use  of  narcotics,  in  an  absolute  remedial 
Bense,  relates  to  their  power  of  diminishing  the  irritahility  of  disease  ; 
whether  local  or  general,  and  thus  aiding  nature  (^  188,  905  b). 

Ii'ritability  is  augmented  in  inflammations,  and  it  may  be  important 
to  allay  it  by  narcotics  ;  not  only  to  enable  Natui'e  to  take  on  the  cure, 
but  to  prevent  the  undue  action  of  exciting  causes  (§  137  d,  150, 
645  c,  855).  Thus,  it  may  be  very  useful  to  exhibit  morphia  in  pneu- 
monia, after  bloodletting ;  by  which  the  cough  may  be  more  immedi- 
ately assuaged  than  by  the  loss  of  blood.  But  narcotic  means  arc 
more  admissible,  and  far  more  useful  in  inflammations  of  the  intesti- 
nal mucous  tissue  than  of  any  other  organ.  Here,  too,  in  various  states 
of  the  alimentary  canal,  narcotics  may  often  precede  advantageously 
the  administration  of  cathartics,  or  be  associated  with  them ;  and,  in 
a  general  sense,  hyoscyamus  is  by  far  the  best.  In  this  case  we  lessen 
the  irritability  of  the  intestinal  mucous  tissue,  and  thus  prevent  the 
cathartic  from  doing  mischief  to  the  part  (§  889,  h).  So,  also,  in  dys- 
entery opiates  are  often  given  to  allay  the  irritability  of  the  part  in- 
flamed ;  even  when  no  other  internal  remedy  may  be  employed.  Or, 
it  may  be  to  prevent  any  irritation  from  small  doses  of  ipecacuanha, 
or  calomel,  &c.  But  when  opiates  are  employed  in  such  affections, 
the  doses  should  be  small,  and  repeated  if  necessary.  Larger  ones 
prove  morbific.  In  serous  inflammation  of  the  bowels,  on  the  other 
hand,  they  are  entirely  inadmissible  (§  137,  b,  &c.).  But,  it  not  un- 
frequently  happens,  that  active  inflammation  seated  in  some  circum- 
scribed part  of  the  intestinal  mucous  tissue  induces  spasmodic  action 
in  the  contiguous  muscular  portion,  which  cathartics  never  fail  to  ag- 
e:ravate.  In  these  cases  a  moderate  dose  of  opium  may  relieve  the 
spasm,  and  result  in  free  dejections,  by  imparting  a  sedative  influence 
to  that  reflex  nervous  action  which  occasions  the  spasm  (§  89 ^  k). 

Nevertheless,  opium  should  be  always  cautiously  exhibited  in  all 
cases  of  the  foregoing  nature  ;  but,  with  this  reservation,  they  are  like- 
ly to  prove  highly  salutary  in  very  many  instances.  But  it  is  in  all 
such  instances  only  a  subordinate  agent ;  and  it  will  be  often  far  bet- 
ter to  accomplish  our  purpose  of  obviating  the  apprehended  bad  ef- 
fects of  a  cathartic,  or  any  other  remedy  that  may  be  likely  to  irritate 
the  intestinal  mucous  tissue,  by  the  general  or  local  abstraction  of 
blood,  or  by  vesicating  the  abdomen  (^  890  b,  1058/). — Note  Gg. 

It  should  be  now  said  that  puerperal  peritonitis  is  sometimes  treated 
successfully  by  opium  given  to  full  narcotization,  though  recovery  is 
then  as  slow  as  seldom.  The  same  has  been  more  doubtfully  aflarmed 
of  intestinal  peritonitis.  Irritability  is  so  thoroughly  subdued  in  the 
successful  cases  that  it  ceases  to  be  morbidly  excited  by  the  blood,  and 
the  inflammation  yields  in  consequence.  Gi'eater  exceptions  may  be 
seen  in  §  756.  The  practice  is  empyrical  (§  1005  a-g). — Notes  E  H. 
891,  Ti.  Next  in  order  come?,  pain,  depending  on  exalted  or  moibid 
sensibility.  This  might  appear  to  call  more  frequently  and  imperious- 
ly for  narcotics  than  wakefulness  or  the  irritability  of  disease.  But  it 
is  otherwise ;  though  it  is  for  the  relief  of  pain  that  narcotics  are  most 
abused,  and  where  they  do  their  greatest  injury.  Whether  they  will 
be  now  beneficial  will  depend  upon  the  cause  of  the  pain,  its  seat,  and 
other  circumstances.  If  owing  to  active  inflammation,  they  will  be 
likely  to  aggravate  the  disease  in  most  parts,  but  not  in  all.  And  here 
we  learn  the  vast  importance  of  a  critical  knowledge  of  the  special 
vital  endowments  of  the  different  tissues,  and  of  a  studious  reference 


588  INSTITUTES    OF    MEDICINE. 

to  the  seat  of  disease,  as  well  as  a  critical  examination  of  the  attend 
ant  symptoms,  since  the  pain  of  mucous  and  serous  inflammation  of 
the  intestine  may  be  exactly  the  same,  and  opiates  curative  in  the 
former,  but  certainly  fatal  in  the  latter  (§  133,  &c.,  150,  685,  686). 
Here,  too,  in  the  mucous  tissue,  they  accomplish  the  double  purpose 
of  reducing  irritability  as  well  as  sensibility  (§  150,  188,  194).  In  the 
other  case,  or  that  of  serous  inflammation  of  all  parts,  if  they  render 
sensibility  obtuse,  they  do  not  often  fail  to  injuriously  modify  the 
irritability  of  the  part,  and  thus  aggravate  the  disease.  In  the  same 
general  sense,  also,  opiates  are  more  or  less  suited  to  inflammatory 
states  of  the  whole  mucous  system. 

891,  I.  But,  the  great  agent  for  the  relief  of  pain  attendant  on  active 
inflammation  of  any  tissue  is  bloodletting ;  and  this,  particularly,  when 
the  disease  affects  any  gieat  vital  organ.  In  a  general  sense,  also,  the 
less  important  the  part  the  safer  will  narcotics  be  in  inflammatory  af- 
fections, whether  acute  or  chronic  ;  though,  in  these  cases,  care  should 
be  taken  that  they  are  not  contra-indicated  by  obscure  conditions  of 
disease  in  the  complex  and  great  organs  of  life  (§  150,  689  I,  863  d). 
And  here  it  is  well  to  remark,  that  the  organs  most  important  to  life 
are  far  from  being  most  liable  to  pain.  This  is  true  of  the  lungs  in 
pneumonia;  and  the  liver,  also,  is  but  little  subject  to  pain  in  any  of 
its  diseases,  while  the  pleura,  or  peritoneum,  or  thecal  membranes, 
the  ligaments,  &c.,  are  never  much  inflamed  without  great  attendant 
suffering.  The  urinary  and  generative  organs  are  liable  to  very  pain- 
ful affections  ;  and  here,  most  happily,  narcotics  are  very  often  admis- 
sible in  their  acute  inflammatory  diseases.  So,  also,  they  afford  im- 
mense temporary  relief  in  pain  of  the  stone.  They  operate  like  a 
charm  in  cramp  of  the  stomach,  and  in  the  suffering  attendant  on  the 
passage  of  a  gall-stone  along  the  ductus  choledocus.  In  these  last 
cases  the  narcotic  is  directly  curative  by  relieving  spasm. 

When  pain  attends  chronic  affections  narcotics  may  be  adminis- 
tered with  less  hesitation  ;  but  still  with  a  careful  reference  to  the  seat 
and  nature  of  the  disease.  They  are  of  the  greatest  value,  as  pallia- 
tives, in  the  pain  of  cancerous  affections,  and  genei-ally  for  the  suffer- 
ing attendant  on  the  chronic  maladies  of  most  parts  that  have  not  strong 
sympathetic  relations  to  important  organs  (§  725,  859  h). 

891,  m.  It  may  be  said,  in  connection  with  the  foregoing  subject, 
that  pain  is  very  rarely  a  cause  of  disease,  but  may  increase  the  force 
of  such  as  may  be  present.  But,  even  in  these  cases  the  aggravation 
of  disease  is  owing  more  to  the  general  disturbance  inflicted,  and  to 
privation  of  sleep,  than  to  any  direct  influences  upon  the  part  affected. 
Great  suffering  may  exist  without  disturbing  even  the  action  of  the 
heart,  if  the  subject  be  firm  of  endurance.  If  the  general  circulation 
be  disturbed  as  the  apparent  consequence  of  pain,  it  is  mental  emotion, 
not  the  pain,  which  produces  the  phenomenon  (§  167y,  note).  Indeed, 
the  true  philosophy  of  life  conducts  us  to  the  above  conclusion,  since 
the  property  upon  which  pain  depends  is  not  interested  in  the  organ- 
ic functions  (§  194,  &c.).  In  the  foregoing  manner,  or  through  the 
medium  of  the  vai'ious  mental  emotions  it  produces,  pain  may  aggra- 
vate or  develop  an  attack  of  disease  ;  and  it  is  through  the  medium  of 
the  cerebro-spinal  axis  that  it  increases  disease  without  the  interven- 
tion of  the  passions,  that  is,  by  alterative  reflex  nervous  action. 

The  power  of  endurance,  and,  therefore,  the  degi'ees  of  injury  which 


THERAPEUTICS. NARCOTICS.  589 

pain  may  inflict,  depend  greatly  upon  temperament,  and  the  general 
condition  of  the  constitution  as  arising  from  disease,  habits,  culture  of 
mind,  &c.,  and  these  contingencies  affect,  also,  the  susceptibility  of  the 
vital  states.  Much,  too,  will  depend  upon  the  kind  of  pain  ;  and  the 
kind,  also,  has  its  important  influence  in  dii'ecting  the  treatment. 

891,  71.  Owing  to  the  prevalence  of  sympathies,  the  patient  is  often 
liable  to  be  deceived  as  to  the  true  seat  of  pain  ;  and  an  inattentive  or 
ignorant  physician  may  be  thus  led  into  the  greatest  mistakes  (§  526  d, 
891^  b).  Diseases  of  the  liver,  for  example,  give  rise  to  pain  in  the 
right  shoulder,  which  opium  may  relieve,  while  it  would  aggravate  the 
hepatic  affection.  Or,  if  he  apply  a  blister,  or  other  agents,  to  the  shoul- 
der, they  will  be  useless.  But,  if  placed  over  the  seat  of  the  liver, 
they  will  be  moi"e  or  less  likely  to  relieve  the  remote  sympathetic  af- 
fection. This,  also,  enlightens  us  as  to  the  importance  of  addressing 
our  remedies,  in  all  cases,  mainly  to  the  organs  upon  which  sympa- 
thetic developments  depend,  and  where  they  may  remain  under  the  in 
fluence  of  the  primary  affection  (§  689  I,  905). 

891,  o.  We  see,  therefore,  that  blisters  are  among  the  great  means 
of  assuaging  pain  ;  but,  like  bloodletting,  they  operate  in  a  very  diffei'- 
ent  manner  from  narcotics,  though  by  reflex  nervous  actions. 

There  are,  also,  other  agents  not  of  the  class  of  narcotics,  which  are 
remarkable  for  their  control  over  the  pain  of  particular  modifications 
of  inflammation,  such  as  colchicum,  guaiacum,  &c.  (^  892  b,  c,). 

Hence  we  see,  more  and  more,  the  uncertainty  of  pain  as  a  guide 
to  treatment,  and  that  our  remedies  should  be  mainly  determined  by 
other  considerations.  Nor  will  I  neglect  the  opportunity  of  saying 
how  deeply  all  this  subject  relative  to  pain,  wakefulness,  &c.,  and  the 
counteracting  influences  of  the  narcotics,  should  impress  us  with  the 
futility  of  the  chemical  and  physical  philosophy  of  natural  and  morbid 
processes.  From  what  we  have  seen,  too,  of  the  great  variety  of 
means  by  which  pain  may  be  assuaged,  we  come  to  an  unhesitating 
conclusion  as  to  the  modus  operandi  of  narcotics. 

891,  p.  There  is  one  agent  not  yet  mentioned,  which  is  often  very 
remarkable  for  the  relief  which  it  affords  in  tranquilizing  restlessness, 
allaying  pain,  and  in  procuring  sleep  ;  while  it  has  also  the  great  ad- 
vantage of  being  generally  free  from  objection.  This  is  the  warm 
bath  ;  or  analogous  means  in  the  form  of  warm  fomentations  and  poul- 
tices. By  these  means  intestinal  pains,  strangury,  the  intense  suffering 
from  sprains,  painful  menstruation,  &c.,  are  frequently  dissipated  at 
once.  Again,  refreshing  sleep  may  be  often  induced  by  the  warm 
bath  when  narcotics  fail,  or  would  be  injurious  (§  150,  863  d).  These 
agents  are  also  curative  in  a  direct  manner ;  but  variously  so,  accord- 
ing to  the  nature  of  the  affection  and  the  degree  of  heat  employed. 
The  bath  at  105°  or  110°  F.  frequently,  perhaps  daily  applied,  es- 
tablishes such  impressions  upon  the  skin  that  highly  salutary  influen- 
ces are  often  reflected  upon  some  chronic  forms  of  hepatic  and  intes- 
tinal disease,  through  the  communicating  sensitive  and  motor  nerves. 

As  farther  illustrative  of  the  remedial  nature  of  narcotics  in  reliev- 
ing pain,  and  as  contributing  to  many  general  objects  in  the  philos- 
ophy of  life,  I  may  advert  to  the  manner  in  which  certain  affections 
of  the  mind  aiTest  intense  suffering,  remove  wakefulness,  &c.  This 
is  strikingly  shown  in  the  sudden  subsidence  of  toothache  when  the 
dentist  is  expected,  and  in  the  relief  which  follows  the  exercise  of 


590  INSTITUTES    OF    MEDICINE. 

charms,  &c.  Certain  sounds,  also,  by  awakening  agreeable  emo« 
tions,  produce  similar  results ;  as  variously  observed,  in  the  effects  of 
music,  the  monotonous  bubbling  of  the  brook,  &c. ;  and  here  the  di- 
rect nervous  influence  illustrates  the  reflex  of  narcotics  {^  844). 

891,  q.  Narcotics  are  generally  directly  sedative,  though  there  is 
sometimes  a  temporary  excitement  of  the  general  circulation.  But, 
their  great  effect,  and  which  is  positively  conclusive  of  their  sedative 
action,  consists  in  lessening  irritability  and  sensibility  in  a  direct  man- 
ner. Nevertheless,  opium  is  considered  by  many  as  the  most  power- 
ful stimulant ;  which  shows  the  importance  of  correct  views  in  the 
philosophy  of  life  (§  1057). 

891,  r.  Narcotics  generally  produce  their  effects  with  rapidity,  so 
that  when  their  repetition  is  indicated  for  immediate  purposes,  the 
inteiTening  time  need  not  be  long.  And  this  leads  me  to  advert  to 
the  remarkable  manner  in  which  pain  often  counteracts  the  sedative 
effect  of  narcotics,  and  enables  the  patient  to  bear  a  quantity  that 
would  be  fatal  in  health.  The  solution  of  this  problem  is  even  be- 
yond the  compass  of  the  physiologist ;  nearly  as  much  so  as  that  of 
sleep  (§  137  e,  150,  151,  175  c,  500  n). 

Certain  special  affections  of  the  nervous  system  also  counteract  the 
usual  effects  of  narcotics  in  an  astonishing  manner ;  as  seen  in  deliri- 
um of  drunkenness,  which  excites  an  irritating  nervous  action. 

891,  s.  Finally,  habit,  in  respect  to  the  use  of  narcotics,  is  very  re- 
markable. Instances  are  authenticated,  in  which  the  habitual  use  of 
opium  has  enabled  individuals  to  carry  it  to  the  extent,  daily,  of  more 
than  three  hundred  grains.  Solidism  and  vitalism  point  to  coito- 
epondence  between  the  general  results  and  the  amount  of  impression 
upon  the  stomach  for  an  interpretation  of  the  jDhilosophy  (^  841).* 

ANTISPASMODICS. 

891^,  a.  Two  principal  objects  are  contemplated  in  rendering  the 
antispasmodics  a  subject  of  consideration.  First,  to  aid  in  illustrating 
the  philosophy  which  concerns  the  nervous  power ;  and,  secondly,  to 
indicate  their  misapplication  in  many  conditions  of  disease. 

891|,  b.  The  group  of  antispasmodics  embraces  all  the  narcotics, 
and  regards  them  in  the  special  acceptation  which  it  is  my  present 
purpose  to  consider.  As  the  term  implies,  they  are  employed  for  the 
relief  of  spasm,  and,  mostly,  of  the  voluntary  muscles.  Now  these 
agents  are  very  commonly  applied  for  the  relief  of  the  symptom,  and 
with  too  little  reference  to  the  fundamental  cause.  Thus,  Dr.  Paris 
says  that  "  Spasin  may  arise  from  excessive  irritability,  as  from  teeth- 
ing, wounds,  ivorms,  &fc.,  in  which  case  a  narcotic  would  prove  benefciaV* 
(§  526  d,  676  b,  891  n).  I  have  taken  this  illustration  because  it  is 
quoted  by  others  as  a  good  example  of  spasm  where  the  narcotic  anti- 
spasmodics maybe  properly  employed.  But,  to  my  mind,  all  the  con- 
ditions which  ai'e  here  stated  very  rarely  admit  of  relief  from  narcot- 
ics, and  are  often  aggravated  by  them.  The  spasm  imputed  to  teeth- 
ing may  depend  upon  a  variety  of  pathological  causes,  however  the 
irritation  of  the  gums  be  a  concumng  cause.  If  it  be  due  alone  to 
dentition,  lancing  the  gums  is  the  remedy.  If  to  intestinal  disease 
which  is  maintained  by  teething,  the  remedies  are  then  the  foregoing 
and  others  of  greater  importance  relative  to  the  abdominal  affection, 
such  as  calomel,  castor  oil,  warm  fomentations  to  the  abdomen,  &c. 
*  See  Note  H  p.  1117. 


THERAPEUTICS. ANTISPASMODICS.  591 

If  narcotics  be  now  employed,  it  is  for  the  purpose  of  allaying  intes- 
tinal irritability,  and  not  at  all  with  a  view  to  their  direct  action  on 
the  cerebro-spinal  system.  As  to  spasm  from  wounds,  the  narcotics 
have  been  most  extensively  tried  and  abandoned  as  useless,  excepting 
where  they  are  slight ;  and  then,  more  relief  may  be  procured  by  a 
warm  poultice  applied  to  the  wound.  If  worms  be  the  cause,  we 
ought  surely  to  look  for  the  remedies  among  the  anthelmintics  (§  150, 
526  d,  891  n,  859  b,  863  d). 

89 1|^,  c.  Antispasmodics  have  been  largely  employed  in  hysteria. 
But  here  they  have  been  almost  as  fruitless  as  in  the  spasms  of  chil- 
dren ;  though,  perhaps,  not  so  detrimental.  Hysteria,  in  numerous  in- 
stances, is  so  dependent  on  some  uterine  derangement,  and  this  con- 
dition so  often  consequent  on  visceral  disease  of  the  abdomen,  that  the 
treatment  should  be,  in  such  cases,  of  quite  a  compound  nature,  but  in 
which  antispasmodics  can  take  no  useful  part.  An  emetic,  however, 
in  a  general  sense,  will  afford  temporary  relief,  which  it  accomplishes 
in  part  by  modifying  the  several  conditions  of  disease,  and  in  part 
through  influences  which  are  called  into  operation  in  suspending  a 
paroxysm  of  spasmodic  asthma,  and  hiccough,  as  explained  in  section 
514,  c,  where  the  philosophy  rests  upon  reflex  nervous  action.* 

891|,  d.  Chorea  is  another  complaint  in  which  antispasmodics  have 
been  extensively  employed,  and  with  as  little  reference  to  the  cause 
of  the  symptom.  They  have,  therefore,  failed,  or  have  left  the  patient 
for  the  worse.  Abdominal  disease  being  at  the  foundation,  the  rem- 
edies should  consist  of  cathartics,  a  well-regulated  diet,  exercise,  and 
change  of  air  (§  150,  863  d). 

891^,  c.  But,  worse  than  all,  antispasmodics  have  been  in  high  re- 
pute for  epilepsy ;  notwithstanding  their  universal  failure  to  afford 
any  relief.  The  disease,  however,  is  attended  by  spasm,  and  the 
symptom,  as  in  the  other  aff*ections,  has  been  taken  for  the  disease, 
and  no  small  amount  of  suffering  and  death  have  been  accordingly  in- 
flicted by  antispasmodics.  In  many  cases  this  affection  depends,  im- 
mediately, upon  cerebral  congestion  ;  and  then  bloodletting,  mostly, 
is  the  proper  remedy.  At  other  times  it  is  owing  to  a  transient  sym- 
pathy of  the  brain  with  an  overloaded  stomach;  when  a  mild  emetic 
is  the  sure  antispasmodic.  In  other  cases  the  sympathetic  disturb- 
ance of  the  brain  depends  upon  profound  disease  of  the  liver  and  oth- 
er abdominal  organs  ;  and  here,  cathartics  of  calomel,  &c.,  and  doubt- 
less bloodletting  also,  are  the  appropriate  means.  Again,  it  depends 
upon  organic  disease  of  the  brain,  or  on  a  spicula  of  bone  projecting 
from  the  dura  mater,  or  on  depression  of  some  part  of  the  cranium. 

The  foregoing  are  almost  all  the  causes  of  epilepsy  ;  from  which  it 
results  that  antispasmodics  should  have  no  place  among  the  remedies 
for  this  affection  (§  150,  847  g  848,  859,  863  d,  870  aa,  1058  v). 

891|,y!  Congestive  asthma,  the  usual  form  of  the  disease,  has  had 
its  full  share  of  the  antispasmodics,  and,  of  course,  with  as  little  bene 
fit  as  they  have  yielded  to  the  preceding  affections.  They  are  more 
or  less  appropriate,  however,  to  the  rare  form  of  spasmodic  asthma; 
but  here  an  emetic  is  often  better,  or  a  pipe  of  stramonium  leaves 
may  answer  (§  514,  c).  But  congestive  asthma  depends  upon  some- 
thing more  than  simple  irritation  of  the  nervous  centres,  There  is  a 
highly-injected  state  of  the  venous  system  of  the  lungs,  consequent  on 
disease  of  the  abdominal  viscera,  involves  many  important  organs,  and 
*  See  Note  Cc  p.  1132. 


592  INSTITUTES    OF   MEDICINE. 

calls  imperatively  for  blood-letting,  and  cathartics  (§  150,  786,  &c., 
847^,  848,  859  b,  863  d,  870  aa). 

891^,  g.  We  have  thus  seen  various  examples  in  vi^hich  reflex  actions 
originate  either  in  sensitive  fibres  of  cerebro-spinal  nerves  and  terminate 
in  motor  sympathetic  fibres  or  vice  versa,  and  direct  nervous  action  orig- 
inating in  the  brain  or  spinal  cord  and  terminating  in  motor  fibres  of 
the  sympathetic  system  (§  111-113,  and  references  there,  488 J,  893  a). 

891^,  A.  It  appears,  also,  that  the  true  narcotics  must  be  commonly 
injurious  in  most  of  the  affections  w^hich  give  rise  to  spasms. 

89 li,  i.  But  there  are  some  agents  which  are  mostly  antispasmodic, 
in  their  relation  to  the  nervous  system,  such  as  asafoetida,  musk,  valeri- 
an, &c.  These  agents  are  know^n  as  the  true  antispasmodics,  although 
opium  greatly  transcends  the  whole  in  its  virtue  of  arresting  spasm. 
But  those  of  simpler  virtues  are  very  circumscribed  in  their  morbific 
relations  to  the  brain  and  to  other  organs,  and  exert  but  little  effect 
as  therapeutical  agents  (§  150).  This  leads  me  to  consider  the  re- 
maining object  of  the  present  inquiry  (§  891i,  a). 

89 li,  k.  No  one  can  mistake  the  immediate  bearing  of  the  whole 
of  this  subject  upon  the  general  philosophy  which  concerns  the  modus 
operandi  of  remedial  and  morbific  agents,  while  the  function  of  res- 
piration, and  other  natural  processes,  display  the  physiological  laws 
under  which  the  former  are  directed  (§  462-475,  495-534,  639  a). 
Although,  therefore,  the  phenomena  of  spasm  form  so  luminous  a  guide 
through  the  whole  labyrinth  of  sympathy,  and  impart  a  peculiar  in- 
terest to  the  discovery  of  Sir  C.  Bell  in  relation  to  the  different  orders 
of  nerves  (§  462-470,  476  b),  we  need  not  be  long  detained  in  making 
the  contemplated  exposition. 

In  the  first  place,  then,  we  observe  that  the  irritation  of  the  nervous 
centres  may  be  either  direct,  as  in  severe  forms  of  epilepsy  (§  891^,  e), 
or  indirect,  as  in  the  more  compound  and  ordinary  reflex  nervous  in- 
fluences (§  227,  230,  500).  In  the  former  case  the  nervous  power 
is  developed,  in  a  direct  manner,  either  in  virtue  of  some  disease  af- 
fecting the  nervous  centres,  or  by  some  direct  mechanical  irritation, 
as  in  depressions  of  the  skull-bone,  projecting  spiculae  of  bone,  and 
extravasated  blood  (§  476-494).  In  the  latter  case  the  primary  irri- 
tation is  in  a  remote  part,  as  in  the  gums,  or  intestinal  canal,  &c 
(§  8911,  a).  In  this  instance  the  impression  is  transmitted  through 
sensitive  nerves  to  the  nervous  centres,  where  it  operates  as  an  ex- 
citing cause  of  the  nervous  power,  and  is  exactly  equivalent  to  the  di- 
rect irritation  of  those  centres  ;  as  observed  in  the  former  case.  The 
residue  of  the  process  then  becomes  alike  in  both  the  cases.  That  ia 
to  say,  the  nervous  power  is  reflected  through  motor  nerves,  or  motor 
fibres  of  compound  nerves,  upon  the  affected  muscles,  and  thus  ai*e  they 
thrown  into  spasmodic  action  (§  230,  233,  500,  893^.) 

Such,  again,  are  all  the  elements ;  and  since  they  are  now  in  oper- 
ation in  their  morbid  aspect,  we  have  the  plainest  demonstration  that 
the  whole  process  depends  upon  natural  physiological  laws. 

And  now,  briefly,  for  the  opposing  or  curative  influences.  We 
have  seen  that  when  the  simple  antispasmodics  arrest  the  movements, 
they  institute  only  mild  impressions  upon  the  nervous  centres ;  but 
they  must  necessarily  modify  the  nervous  power  in  its  very  nature, 
or  they  could  not  arrest  the  movements  of  the  muscles ;  since  it  is  the 
nervous  power  which  now  operates,  and  upon  exactly  the  same  mua- 


THERAPEUTICS. CINCHONA.  r>U3 

des  ill  wbicli  it  liad  developed  tlie  spasmodic  action.*  In  one  case, 
therefore,  it  acts  as  a  stimulant,  in  the  other  as  a  sedative.  Moi'e  or 
less,  however,  is  due  to  a  mere  suppression  of  the  exciting  nervous 
iuliuence.  The  same  results  obtain,  also,  when  the  narcotics  operate 
ill  simply  removing  spasm.  But  these  are  agents  which  embrace  oth- 
er virtues  that  are  very  apt  to  prove  moi-bific  (§  891,  d),  and  their  mor- 
bific impression  may  be  transmitted  from  the  stomach  to  the  nervous 
centres,  especially  on  account  of  their  specific  relation  to  the  nervous 
system  (§  137,  c),  without  first  engendering  or  increasing  disease  in 
the  stomach  or  other  parts  (§  502,  c),  or,  there  may  happen  along  with 
this  a  direct  morbid  change  in  the  condition  of  the  stomach  (§  502,  c), 
or  indirectly,  through  the  increased  morbid  change  in  the  nervous 
power,  in  other  parts.  These  new  conditions  of  disease  may  aggra- 
vate the  spasmodic  affection ;  since  the  nervous  power  is  not  render- 
ed sedative  to  the  affected  muscles  (§  150,  228  b-2o2,  233|) ;  or,  on 
the  other  hand,  the  morbid  change  may  be  of  such  a  nature  as  to  break 
up  the  special  condition  of  the  nervous  power  which  gives  rise  to  the 
spasm,  and  thus  put  an  end  to  that  part  of  the  malady,  although  there 
ensue  a  very  aggravated  state  of  disease  (§  890,  900,  901,  &c.).  Thus 
we  see  presented  the  compound  aspect  of  a  remedial  agent  bringing 
about  relief  to  one  part  of  disease,  or  removing  one  symptom,  and 
simultaneously  aggravating  or  inducing  disease  in  other  parts,  and  in- 
creasing all  other  symptoms.  The  principle  is  distinctly  the  same, 
throughout,  as  when  the  narcotics,  or  simple  antispasmodics,  establish 
that  change  which  results  only  in  the  removal  of  spasm.  There  is, 
therefore,  presented  in  the  examples  before  us,  as  a  general  gi'ound 
for  the  interpretation  of  morbific  and  remedial  agents,  the  union  of 
the  physiological,  morbific,  and  remedial  processes  (^  903,  984  b). 

From  the  foregoing  facts  and  philosophy  we  might  reason  safely  to 
the  modus  operandi  of  all  other  remedial  and  morbific  agents,  espe- 
cially in  connection  with  the  natural  processes  of  sympathy  (§  500), 
had  we  not  about  the  same  amount  of  concurring  proof  in  the  mani 
festations  of  every  other  cause, 

CINCHONA,  AND   ITS   ALKALOIDS. 

T7(to,  cito,  et  jucunde. 
892,  a.  As  an  interesting  incident  in  the  history  of  this  extraordi- 
nary agent,  it  may  be  said  that  the  Peruvian  bark  was  not  introduced 
into  Europe  till  the  year  1640,  or  more  than  one  hundred  years  after 
the  full  conquest  of  Peru  ;  which  is  abundantly  conclusive  that  all  the 
alleged  connections  of  the  savages,  lions,  and  vultures,  which  continue 
to  appear  in  works  on  the  Materia  Medica,  are  wholly  fabulous.  It 
was  not,  however,  till  a  century  afterward,  or  in  1738,  that  the  plant 
became  known  to  naturalists,  through  Condamine,  the  French  savant. 
His  account  of  the  tree  appeared  in  the  Memoirs  of  the  French  Acad- 
emy, along  with  the  story  about  the  lions.  Condamine  says  that  the 
Countess  del  Cinchon,  wife  of  the  Viceroy  of  Peru,  earned  the  bark 
to  Europe  in  1640  ;  from  which  circumstance,  and  from  her  previous 
connection  with  the  introduction  of  the  bark  into  use,  as  stated  by 
Condamine,  Linnaeus  immortalized  her  name.  The  countess  brought 
the  bark  into  use  in  Peru  by  a  first  experiment  upon  herself,  at  the 
suggestion  of  the  Corregidor  of  Loxa.  She  then  transferred  its  patron- 
age to  the  Jesuits;  when  the  bark  dropped  the  name  of  the  "  Count- 

*  Shown  also  b}'  certain  external  applications,  as  when  camphor  or  ice  applied  to 
the  skin  relieves  instantly  the  spasms  in  malignant  cholera  (p.  838,  §  1057^). 

P  V 


594  INSTITUTES    OF    MEDICINE. 

ess'  powder,"  and  became  known  as  the  "Jesuits'  bark."  It  would 
be  an  entertaining  inquiry  to  follow  the  history  of  cinchona  after  its 
introduction  into  Europe.  No  article  of  the  Materia  Medica  has  em- 
ployed so  extensively  the  pens  of  medical  philosophers,  and  under  ev- 
ery aspect  of  praise  and  condemnation,  and  of  angry  controversy ; 
and  next  to  this,  that  now  universal  luxury  of  man,  the  nicotiana  ta- 
bacum.  Before  the  time  of  the  alkaloids,  Von  Bergen  published  the 
names  of  more  than  six  hundred  authors  whose  writings  he  had  con- 
sulted on  the  subject  of  the  Peruvian  bark,  and  refers  to  eight  hun- 
dred distinct  treatises  upon  this  remedy.  Subsequently  to  that  peri- 
od, the  discovery  of  the  cinchona  alkaloids,  and  their  application  as 
therapeutical  agents,  have  given  rise  to  so  vast  an  accumulation  of 
books,  pamphlets,  and  memoirs,  that  the  writings  upon  this  single  ar- 
ticle of  the  Materia  Medica  would,  alone,  form  a  library  of  very  impos- 
ing dimensions.  And  yet  do  I  find  myself  at  the  threshold  of  another 
paragraph  upon  what  should  seem  so  completely  exhausted.  I  shall 
therefore  endeavor  to  turn  myself  upon  that  track  which  has  been 
least  pursued,  and  which,  as  in  many  other  cases,  is  too  often  aban- 
doned,— the  path  of  Nature. 

The  bark,  having  been  early  carried  from  Spain  into  Italy,  it  may 
be  well  supposed  that  a  country  so  liable  to  intermittents,  and  those, 
too,  of  the  most  formidable  character,  would  soon  illustrate  the  virtues 
of  this  extraordinary  febrifuge,  and  enlist  in  its  favor  the  most  power- 
ful patronage.  About  this  time,  however,  it  was  called  to  encounter 
one  of  those  checks  which  it  repeatedly  afterward  underwent  with 
less  disaster,  and  which  will  remind  us  of  what  has  befallen  the  phi- 
losophy of  medicine  in  the  laboratory  of  a  German  chemist.  I  shall 
therefore  state  it,  in  the  hope,  at  least,  that  it  may  go  with  the  rest  in 
promoting  independent  habits  of  observation  (§  349  d,  350,  350^-). 

The  commendations  which  the  bark  received  from  the  priesthood, 
and  the  popular  appellation  of  the  "  Jesuits'  bark,"  were  not  suffi- 
cient to  establish  its  success  in  countries  less  scourged  by  malaria 
than  the  Peninsula ;  for  even  in  Spain  the  physicians  were  either  dis- 
posed to  reject  the  remedy,  or  to  meet  it  with  opposition.  But,  its 
demonstrations  were  such  in  the  Italian  climate,  that  Pope  Innocent 
the  Tenth  made  it  the  subject  of  a  papal  communication  to  the  Church, 
and  co-operated  with  the  Italian  physicians  by  directing  the  publica- 
tion of  their  report ;  in  which  the  curative  virtues  of  the  bark  were 
set  forth  with  all  the  confidence  that  has  been  wairanted  by  subse- 
quent experience. 

The  medical  document  which  was  thus  promulgated  was  called  the 
"  Schedula  Romana,"  and  contained  directions  for  administering  the 
bark  as  to  time,  quantity,  &c. ;  the  established  dose  being  two  drachms 
of  the  powder. 

This  Schedula  soon  became  a  target  for  those  who  had  been  hos- 
tile to  the  bark  ;  and  the  warfare  was  begun  by  one  who  had  profess- 
ed to  have  entertained  prepossessions  in  its  favor.  This  individual, 
whose  name  was  Chifletus,  was  prompted  in  his  opposition  to  the 
bark  by  its  partial  failure  in  a  case  where  it  was  important  for  the 
physician  to  have  obtained  moi'e  complete  success.  A  relapse,  how- 
ever, ensuing  at  the  end  of  a  month,  the  chagrin  of  the  physician  led 
him  to  denounce  the  remedy  in  such  violent  terms,  that  it  lost,  at  once, 
many  of  its  firm  friends,  and  rekindled  the  animosity  of  its  opponent.« 


THERAPEUTICS. CINCHONA.  •  595 

Chifletus  boldly  assumed  that  all  the  Roman  and  other  encomiums 
were  mere  pretense,  and  that  the  bark  was  not  only  useless  as  a  rem- 
edy for  fever,  but  absolutely  pernicious,  and  should  be  utterly  pro- 
ecribed  by  the  profession.  He  challenged  any  well-authenticated 
cases  of  cure ;  and  by  this  arrogant  style  he  attracted  the  attention 
of  no  small  part  of  Europe.  The  credulous  came  to  believe  his  as- 
sertions, and  the  evil-disposed  united  in  a  crusade  against  the  tenant 
of  the  Andes.  Chifletus  was  hailed  as  a  great  public  benefactor,  as 
"  the  Reformer"  of  the  day,  in  having  relieved  the  world  of  a  scourge. 
His  publication  w^as  reprinted  in  the  languages  of  different  European 
countries  ;  and,  for  awhile,  the  whole  profession  appeared  to  acqui- 
esce in  the  justice  of  the  decision. 

Nor  was  this  condemned  article  ultimately  rescued  from  the  tram- 
mels of  ignorance  and  prejudice  by  its  proper  guardians ;  but  by  a 
learned  Jesuit,  who  once  more  bore  it  aloft  by  unequivocal  proof  of 
its  extraordinary  control  over  the  great  bane  of  Italy.  From  that 
time,  opposition  became  more  and  more  feeble,  and  the  merits  of  the 
remedy  gradually  established. 

But,  this  is  only  a  passage  in  the  early  history  of  the  Peruvian  bark. 
It  was  not,  like  the  tobacco,  required  to  encounter  the  edicts  of  des- 
pots, though  it  equally  underwent  the  ordeal  of  a  fierce  disputation ; 
and  it  is  scarcely  possible  for  us,  who  now  contemplate  these  two  re- 
markable members  of  the  vegetable  kingdom  with  the  calm  indiffer- 
ence of  long  and  universal  experience,  to  appreciate  the  uncertainty 
in  which  their  virtues  were  held,  or  the  angry  and  vindictive  reproach 
to  which  that  uncertainty  gave  rise. 

We  see,  also,  in  the  nature  of  the  hostility  v.'hich  was  for  awhile 
waged  by  a  great  part  of  the  profession  against  this  invaluable  reme- 
dial agent,  and  in  the  very  face  of  its  triumphant  success,  a  disposition 
to  trample  upon  the  best  interests  of  society,  where  it  may  seem  ex- 
pedient to  bow  to  the  dictates  of  a  despotic  writer,  or  where  profes- 
sional pride,  or  cunning  jealousy,  or  malevolent  envy,  may  hope  fox 
gain.  Nor  can  we  fail  to  observe  in  this  extraordinary  and  almost 
universal  denunciation  of  the  Peruvian  bark,  as  a  curse  which  was 
scarcely  exceeded  by  pestilence,  a  striking  parallel  with  the  furious 
opposition  which  bloodletting  has  been  required  to  encounter. 

It  is  also  an  interesting,  as  well  as  instructive,  coincidence,  that 
while  Sydenham  was  storming  the  prejudices  against  the  remedium 
princ.ipale  in  the  treatment  of  inflammations  and  fevers,  he  was  also 
emploj^ed  in  combating  the  opposition  to  the  bark,  which  had  become 
very  general  in  England.  He  triumphantly  set  forth  the  advantages 
of  the  former,  and  compelled  his  obstinate  cotemporaries  to  acknowl- 
edge the  healing  virtues  of  the  Peruvian  febrifuge.  But,  to  the  Pon- 
tine marshes  of  Italy  we  may  refer  the  stability  which  was  first  be- 
stowed upon  the  bark.  Here  were  perpetually  emitted  the  seeds  of 
intermittents,  which  were  now,  for  the  first  time,  controlled  exten- 
sively by  the  all-potent  drug. — Notes  F  H  K  pp.  1114,  1117,  1119. 

892,  aa.  In  my  Arrangement  of  the  Materia  Medica,  I  have  group- 
ed together,  in  the  order  of  their  therapeutical  value,  many  agents 
which  are  peculiarly  appropriate  to  intermitting  forms  of  disease,  and, 
into  this  group  no  other  remedies  are  admitted.  They  possess,  there- 
fore, what  are  commonly  denominated  specific  virtues  in  relation  to 
the  diseases  to  which  the  group  refers.     This,  indeed,  may  be  more 


596  INSTITUTES    OF    MEDICINE. 

or  less  affirmed  of  all  the  other  groups,  excepting  those  of  a  common 
antiphlogistic  nature.  It  is  not,  therefore,  to  be  inferred,  when  the 
remedies  for  any  given  character  of  disease  are  specifically  indicated, 
that  there  may  not  be  others  that  are  more  or  less  appropriate,  but 
which  are  not  included  in  the  gi'oup  before  us  (§  137  d,  150).  Cathar- 
tics, even,  are  liable  to  this  qualification  ;  since,  without  previous  blood- 
letting they  will  often  aggravate  disease.  But,  after  applying  the  for- 
mer remedy  the  cathartic  may  cease  to  be  necessary.  The  loss  of 
blood  has  accomplished  all  that  Avas  contemplated  from  the  internal 
agent ;  but  blood-letting  cannot  be  arranged  among  the  cathartics.  In 
certain  conditions  of  amenorrhoea  it  may  be  evident  that  guaiacum  will 
establish  menstruation  after  blood-letting  or  a  purgative,  but  would  be 
injurious  without,  or  either  of  the  last  may  be  sufficient.  Now,  the? 
same  remarks  are  precisely  applicable  to  the  group  of  anti-periodics,  un- 
less it  be  that  the  virtues  of  these  remedies  have  a  remarkable  beai-ing 
upon  the  remote  causes  of  intermittents  (§  650,  652  c,  653,  662,  675). 
892,  b.  It  is  the  prevailing  doctrine  that  cinchona,  arsenic,  and  oth- 
er anti-periodics  operate  by  either  neutralizing  some  imaginary  poison, 
or  by  forming  chemical  combinations  with  the  tissues  of  the  body,  and 
thus  transmuting  them  into  their  normal  conditions ;  Avhile  there  are  a 
remaining  few  who  ascribe  the  results  to  molecular  changes  induced  by" 
a  tonic  or  astringent  pi'inciple,  as  in  tanning  (§  350,  nos.  41,  42,  487  /i, 
569,  851  a,  890  a,  892^  ^).  On  the  contrary,  I  endeavor  to  show  that 
these  remedies  in  subduing  special  forms  of  inflammation  and  fever  op- 
erate upon  the  same  principle  as  loss  of  blood,  cathartics,  and  antimo- 
nials,  in  the  common  forms,  and  therefore  as  antiphlogistics  (§  756  a,  b). 
Excepting  loss  of  blood  and  the  antimonials,  the  remedies  which  are  ap- 
propriate in  a  general  sense  to  inflammations  and  fevers  will  often  prove 
morbific  in  some  of  the  pathological  phases  of  the  common  forms  of  those 
diseases.  Cathartics  are  comparatively  of  little  use,  and  often  injurious, 
in  pneumonia,  plcuritis,  enteritis,  phrenitis,  &c.,  without  antecedent 
loss  of  blood  ;  and  this  is  still  truer  of  vesicants,  which  may  ultimately 
render  important  service  in  those  diseases.  But  there  is  a  large  class 
of  inflammations  which  deviate  from  the  common  form,  known  as  spe- 
cific (§  648,  653,  721-722).  Here,  howevei',  the  same  principle  ob- 
tains, and  is  corroborated  by  a  greater  variety  in  the  means  that  may 
be  suitable  to  the  special  pathological  conditions.  Intermitting  inflam- 
mation and  intermitting  fever  are  specific  forms  of  inflammation  and 
fever,  and  are  so  far  bent  from  the  common  forms  as  to  be  benefited, 
in  connection  with  tlie  general  antiphlogistics,  by  many  heterogene- 
ous remedies  of  special  virtues,  but  whicli  will  aggravate  the  common 
forms  of  those  diseases.  And  just  so  of  chronic  rheumatism,  for  which 
colchicum,  and  guaiacum,  and  veratria,  and  other  acrid  and  miscella- 
neous substances  are  special  remedies,  but  which  will  aggravate  not 
only  the  common  form  of  inflammation  but  even  acute  rheumatism. 
Blood-letting,  however,  and  tartarized  antimony,  are  the  main  remedies 
for  intermitting  inflammation  and  acute  rheumatism,  and  generally  the 
best  for  the  chronic  forms.  It  would  be,  therefore,  equally  necessary 
to  deny  that  loss  of  blood  and  antimonials  act  as  antiphlogistics,  in  the 
vital  acceptation,  as  the  foregoing  specific  remedies,  and  to  assume  that 
the  entire  medley,  indiscriminately  employed,  lead  to  a  common  result 
in  the  cases  supposed  by  some  common  neutralizing  or  chemical  process 
(§  350,  nos.  41,  42)!     As  well  might  it  be  assumed  that  any  of  the 


THERAPEUTICS. — CINCHONA,  597 

remedies  for  intermittents  will  unite  and  form  an  identical  compound. 
The  mercurials  will  oftener  overcome  syphilitic  inflammation  .than  any 
other  form,  and  oftener  than  any  thing  else.  But  iodine,  and  sarsapa- 
rilla,  and  a  non-stimulating  diet,  and  frequently  loss  of  blood,  are  very 
good  remedies.  And  so  of  scrofula,  in  which  the  general  antiphlogistics 
are  often  necessary,  but  mainly  sudsidiary  to  iodine  and  bromine,  while 
the  latter  never  fail  to  aggravate  the  common  form  of  inflammation  (§ 
851  a,  863  d,  892^  v,  892|^,  896-900,  904  c,  905|,  951  c,  1065). 

Having  thus  divested  this  plain  affair  of  the  mystery  which  has  been 
thrown  around  it,  and  seeing  clearly  the  simple  principles  through 
which  all  remedial  effects  are  produced,  we  may  bi-ing  the  philosophy 
with  no  little  aid  to  our  experience  in  the  treatment  not  only  of  inter- 
mittents, but  of  all  other  diseases. — Notes  K  L  pp.  1119,  1120.* 

892,  c.  The  considerations  to  which  1  have  now  referred,  along 
with  what  is  known  of  the  peculiarities  that  appertain  to  the  virtues 
of  every  remedy,  and  how  those  viitues  may  prove  morbific  as  well 
as  salutary,  enable  us  to  understand  the  favorable  and  unfavorable  re- 
lations which  cinchona,  or  arsenic,  may  bear  to  the  different  stages  of 
a  paroxysm  of  intermittent  fever,  when  to  apply  the  remedies  and 
when  to  withhold  them,  how  they  may  aggravate  any  coexisting  local 
congestion  or  inflammation,  or  how,  from  our  knowledge  also  of  the 
modifying  effects  of  the  remote  causes,  these  agents  may,  at  other 
times,  arrest  the  local  as  well  as  the  general  disease,  or  how  other 
agents,  like  bloodletting,  will  place  the  unfavorable  states  in  a  favora- 
ble way  for  the  action  of  the  tonic  febrifuge  (§  150,  675,  847  g,  848, 
857,  859,  863  d,  870  aa).  We  learn,  also,  from  the  same  considera- 
tions, and  from  what  is  set  forth  in  section  904,  d,  that  no  remedies 
can  be  properly  regarded  as  specifics,  neither  cinchona,  arsenic,  &c.  ; 
since,  from  the  vast  variety  and  contradictory  nature  of  the  means  by 
which  intermittents  may  be  arrested,  we  may  clearly  perceive  that  no 
one  of  these  causes  exerts  what  is  understood  by  specific  effect.  The 
several  means,  however,  arrest  the  disease ;  and  they  do  it  by  insti- 
tuting such  changes  in  the  diseased  conditions  as  place  them  in  the 
way  of  restorative  changes  (§  672).  Each  one,  however,  determines 
changes  according  to  its  own  special  virtues,  and  in  no  other  sense 
are  they  specifics.  So  far,  then,  they  are  exactly  on  a  par  with  any 
other  remedy,  and  with  every  cause  of  disease  (§  52,  150,  151,  650, 
892|  d).  But,  this  peculiarity  of  virtues  is  more  strongly  pronounced 
in  some  things  than  in  others,  and  is  seen  remarkably  in  cinchona ;  as 
in  its  profoundly  morbific  effect  during  the  hot  stage  of  the  febrile 
paroxysm,  and  its  equally  curative  demonstration  during  the  period  of 
intermission.  Here,  too,  I  may  again  say  that  its  mode  of  operating 
at  these  successive  stages  of  one  and  the  same  disease  is  distinctly 
seen  to  be  of  a  common  nature  (§  675,  891^  k).  Here  we  have  not 
only  a  consistent  philosophy  throughout,  but,  also,  in  that  philosophy 
and  the  attendant  facts  a  fountain  for  many  practical  conclusions; 
such,  for  instance,  as  the  importance  of  bringing  about,  in  a  general 
sense,  distinct  intermissions  before  resorting  to  what  are  emphatically 
denominated  remedies  for  intermittents  ;  and  that  it  would  be  improp- 
er, in  a  general  sense,  to  employ  the  agents  now  under  consideration, 
in  remittent  fever,  or,  at  most,  not  till  the  febrile  action  has  been  mod- 
ified by  direct  antiphlogistic  means  (§  150,  847  g,  848,  857,  859  L 
870  aa,  1059. — See  Modus  operandi  of  Cinchona,  p.  677,  §  904  d) 
=:- Also,  N-Tic  Ek  r- 1133 


598  INSTITUTES    OF    MEDICINE 

Nor  may  we  begin,  precipitately,  the  treatment  of  intei'mittents  by 
cinchona,  nor  by  any  agents  of  the  present  group,  simply  because  it  is 
an  intermittent,  and  there  happens  to  exist  that  suspension  of  febrile 
action  which  is  known  as  the  period  of  intermission  (§  675,  890,  d, 
891  k,  I).  There  may  be  present  some  local  congestion  or  inflamma- 
tion that  may  demand  the  abstraction  of  blood  ;  and  the  general  con- 
dition of  things  will  rarely  fail  of  requiring  a  cathartic,  at  least.  But, 
it  often  happens  before  any  preliminary  treatment  may  have  been 
adopted,  that  an  intermission  is  pretty  strongly  pronounced,  and  yet 
that  the  intensity  of  the  febrile  condition  is  such  as  to  raise  apprehen- 
sions that  the  patient  may  be  destroyed  by  the  violence  of  the  next 
paroxysm.  These  are  frequently  cases  for  grave  deliberation,  whethei 
we  shall  abstract  blood,  or  administer  a  purgative,  or  an  emetic,  or  pro- 
ceed at  once  to  the  employment  of  bark.  If  no  important  local  dis- 
ease be  present,  some  eight  to  fifteen  grains  of  calomel  should  be  giv 
en,  followed  soon  by  an  appropriate  dose  of  castor  oil,  and,  in  the 
mean  time,  the  sulphate  of  quinia  should  be  exhibited  till  the  next 
paroxysm  takes  place.  It  will  not  do  to  prostrate  the  system  in  these 
cases  by  an  emetic.  In  the  way  now  suggested,  however,  we  may 
stay  the  violence  of  the  approaching  shock.    Will  chemistry  explain  ? 

On  the  other  hand,  if  there  be  any  serious  amount  of  congestion  in 
the  liver,  or  inflammation  of  the  intestinal  mucous  tissue,  as  commonly 
happens  with  the  liver  especially,  we  shall  accomplish  nothing  by  this 
early  use  of  the  bark,  in  these  concentrated  forms  of  fever.  Either 
trust  alone  to  the  cathartic  till  after  the  next  paroxysm,  or  bleed  the 
patient  also.  There  is  no  "  debility"  in  the  case.  Keep  the  eye  on 
the  pathology.  Nature  may  rise  up  at  once  under  the  lancet,  when 
she  would  sink  under  an  emetic,  or  the  tonic  virtue  of  the  febrifuge 
(§  ].50,  569  c,  576  e,  847  g,  8US,  857,  859  b,  863  d,  870  aa,  961,  962). 

892,  d.  Having  brought  the  system  into  a  condition  for  the  admin- 
istration of  cinchona,  or  some  of  its  preparations,  we  are  next  to  ascer- 
tain which  of  the  two  methods  should  be  adopted ;  for  there  are  two 
modes  of  treatment  having  essential  differences. 

One  of  these  methods  consists  in  making  a  very  strong  impression, 
at  once,  by  a  single  blow,  as  it  were,  upon  the  diseased  conditions, 
during  the  intermission,  by  the  administration  of  a  large  dose  of  bark, 
or  of  quinia  (as  five  or  ten  grains  of  the  latter),  and  thus  endeavoring 
to  arrest  the  fever  at  once. 

The  other  method  is  one  of  greater  moderation ;  the  remedy  being 
exhibited  in  small  quantities  (as  that  of  a  gitiin  of  quinia),  at  intervals 
of  two  to  four  hours  throughout  the  intermission. 

By  the  latter  process  the  alterative  action  is  more  gradually  exert- 
ed ;  so  that  the  pai'oxysms  may  continue  to  recur  an  imcertain  num- 
ber of  times,  but  with  diminished  intensity,  till,  at  last,  they  disappear. 

And  now  as  to  the  relative  advantages  of  the  two  methods.  In  the 
first  place,  we  can  readily  understand,  theoretically,  that  the  precipi- 
tate course,  by  large  doses,  may  exasperate  any  coexisting  inflam- 
mation or  venous  congestion ;  and  yet,  from  the  difference  in  the 
pathology  of  fever  and  inflammation,  the  former  condition  may  be 
overthrown. 

We  know,  also,  that  it  will  not  answer  to  arrest  the  fever  suddenly 
by  arsenious  acid  ;  because  a  large  dose  of  that  remedy  may  inflict  a 
far  greater  evil  than  is  constituted  by  the  fever.     Such,  in  fact,  is  tha 


THERAPEUTICS  CINCHONA.  599 

ntjgative  reason  ;  for  an  excessive  dose  of  arsenic  may  arrest  the  com- 
plaint at  once.  It  is  only,  therefore,  its  liability  in  large  doses  to  in- 
flict other  mischief  that  prompts  its  administration  in  small  doses. 
And  just  so  it  may  be  with  cinchona,  or  its  alkaloids,  and  their  salts. 
In  the  former  case  the  morbific  effects  are  strongly  pronounced,  and 
the  agent  is  not  prescribed  at  random.  But,  it  is  quite  otherwise  with 
the  large  doses  of  quinia.  The  attending  venous  congestions,  which 
are  very  apt  to  be  present  (and  far  less  frequently  other  forms  of  in- 
flammation), may  be  increased  and  established  without  manifesting 
any  striking  phenomena  to  admonish  a  hasty  practitioner  of  the  mis- 
takes he  may  have  made  (§  790,  795  b,  798,  801,  806,  807,  811,  815, 
816,  961-964,  967). 

Now,  experience  shows  exactly  what  theory,  suggested  by  the  true 
operation  of  remedies,  rendered  moi'e  or  less  probable.  Experience, 
I  say,  shows  that,  though  bark,  and  its  alkaloids,  in  large  doses,  will 
often  arrest  intermittent  fever  suddenly,  such  doses  are  liable  either 
to  induce  some  congestion,  especially  of  the  liver  or  of  the  mucous 
tissue  of  the  stomach,  or  will  aggravate  and  establish  some  coexisting 
congestion  ;  and  thus,  while  the  patient  is,  for  the  present,  relieved  of 
the  fever  (§  904,  d),  he  is  dismissed  with  an  insidious  local  complaint 
that  not  only  renders  him  a  permanent  invalid  (resulting  often  in  in- 
durated enlargements,  §  803),  but  which  local  malady  may,  and  often 
does,  become,  in  a  process  of  time,  the  exciting  cause  of  another  at- 
tack of  fever ;  thus  showing,  also,  that  the  predisposition  to  the  con- 
stitutional disease  remains,  although  the  paroxysms,  and  therefore  its 
absolute  condition,  were  interrupted  (§  150,  560,  665,  666,  779,  904  d). 
In  other  words,  while  we  thus  inflict  a  useful  and  sudden  blow  upon 
the  fever,  or  general  malady,  through  one  virtue  of  the  bark,  we  lay 
the  foundation  of  a  local  disease,  through  the  tonic  virtue,  in  itself  per- 
petually harassing,  undermining  the  constitution,  and  not  unfrequent- 
ly  so  establishing  the  predisposition  to  fever,  that  the  patient  will  con- 
tinue to  suffer  returns  of  it  from  time  to  time  during  the  residue  of 
the  brief  period  of  life  which  an  indiscreet  practice  not  unfrequently 
allots  to  him.  He  is  but  "  imperfectly  cured,"  as  Celsus  has  it ;  and 
these  imperfect  cures  become  the  slow  cause  of  those  chronic  enlarge-^ 
ments  of  the  liver  and  spleen  for  which  iodine  is  especially  beneficial. 
In  respect  to  relapses,  it  is  not  infrequent  that,  when  intermittents  are 
suddenly  stopped  by  a  large  dose  of  quinine  the  paroxysms  return  as 
soon  as  the  patient  begins  to  exercise  much,  or  to  take  his  ordinary 
food, — certainly  with  far  greater  frequency  than  when  the  case  has 
been  treated  upon  the  moderate  system  (§  847  g,  848,  857,  859  b, 
870  aa,  878).— Notes  K  p.  1119,  L  p.  1120. 

It  is  now  interesting  to  remark  that  the  plan  of  large  medication  is 
apt  to  be  adopted  by  those  practitioners  who  are  least  inclined  to  rec- 
ognize bloodletting  as  of  much  importance  among  remedial  agents,  or 
do  not  see  in  the  philosophy  of  disease  any  other  elements  than  de- 
bility and  something  in  the  blood  to  be  expelled  or  neutralized  (§  569, 
960),  and  suppose  that  medicines  do  the  whole  work  of  cure  (§  853,  856). 
On  the  other  hand,  when  the  gradually  alterative  process  is  pursu- 
ed, the  patient  is  not  only  about  as  expeditiously  relieved  of  the  fever, 
but,  also,  of  his  local  congestions;  for,  Nature  has  now  a  chance  to 
throw  off"  these  more  obstinate  affections  (§  904,  d),  which  she  is  great- 
ly disposed  to  do  wiile  undergoing  the  gradual  removal  of  the  febrile 


600  INSTITUTES    OF    MEDICINE. 

action ;  so  only  we  do  nothing  to  interfere  with  these  local  salutary 
efforts  (§  662).  But,  there  is  also  the  more  important  advantage  re- 
sulting from  the  negative  fact  of  not  directly  increasing,  or  actually 
producing,  congestions  by  the  milder  system  of  treatment. 

According  to  this  plan,  certain  other  objects  of  the  highest  import- 
ance are  not  as  likely  to  be  overlooked  as  when  its  antagonist  is 
brought  into  action.  It  presupposes  a  tolerable  regard  for  the  exist- 
ing state  of  the  pathological  conditions  before  the  treatment  is  begun, 
that  care  is  taken  that  all  congestions  or  inflammations  of  important 
organs  are  so  far  mitigated  by  bloodletting  or  cathartics,  or  by  anti- 
monial  alteratives,  and  the  intensity  of  the  fever  so  far  subdued  by 
some  one  or  more  of  those  direct  antiphlogistics,  as  shall  render  the 
tonic  febrifuge  not  only  safe,  but  speedily  curative  (§  150,  151,  847^, 
848,  857,  859  b,  863  d,  870  aa)  ;  for  speedy  it  will  almost  always  be 
when  its  administration  is  proper,  and  the  case  continues  to  be  judi- 
ciously treated.  If  the  intermissions  be  not  well  marked,  there  proba- 
bly remains  some  special  burden  of  disease  upon  the  stomach,  or  liver 
or  other  important  organ,  which  should  be  yet  farther  mitigated  be 
fore  the  use  of  the  tonic  febrifuge  is  begun  ;  although,  as  already 
seen,  it  may  be  sometimes  employed  in  cautious  doses  where  the  local 
inflammations  and  venous  congestions  have  refused  to  yield  to  blood- 
letting, cathartics,  antimonials,  &c.,  and  even  now  and  then  at  rather 
advanced  stages  of  the  disease  where  the  paroxysms  run  into  each 
other  (§  662).  In  all  such  cases,  however,  we  should  move  on  with 
great  circumspection  ;  never  employing  the  agent  of  tonic  virtues  till 
it  become  apparent  that  this  form  of  fevei",  and  its  local  complications, 
are  not  likely  to  surrender  to  the  direct  antiphlogistic  means  (§  870  aa). 

Among  what  may  be  considered  the  subordinate  remedies,  but 
which  are  truly  among  the  most  important,  are  perfect  rest  in  bed, 
and  a  total  privation  of  stimulating  and  solid  food  during  the  exist- 
ence of  the  fever,  whatever  may  be  its  prolongation.  It  is  astonish- 
ing, I  say,  what  an  important  agency  these  two  negative  remedies  ex- 
ert. Animal  food,  although  it  be  fluid,  will  stimulate  injuriously,  or, 
if  the  food  be  in  a  solid  form,  it  will  irritate  the  stomach  mechanic- 
ally; while  the  erect  posture,  if  long  continued  at  least,  proves  in  oth- 
er ways  an  exciting  cause.  And  then,  as  to  all  those  things  which  so 
falsely  pass  under  the  denomination  of  refrigerants,  such  as  the  acid 
of  lemons,  oranges,  &c.,  they  never  fail  of  so  irritating  the  intestinal 
raucous  tissue  as  to  aggravate  the  symptoms  which  they  are  intended 
to  assuage.  A  cathartic,  or  bloodletting,  are  the  only  things  that  de- 
serve such  a  name,  unless  it  be  ice ;  and  even  in  regard  to  ice  itself, 
either  of  the  first  means  may  prove  far  more  refrigerant  to  the  organic 
being  (§  150,  151,  440  e,  no.  14,  441  c,  442  b-e,  443  c,  447  c,  d,  447  h, 
447i/,  863  d). 

A  proper  want  of  attention  to  food,  and  fatigue  from  exercise,  du- 
ring convalescence,  are  the  great  causes  of  the  relapses  which  take 
place  after  well-treated  cases  of  intermittent  fever.  Almost  any  thing 
will  arrest  the  paroxysms  when  applied  under  favorable  circumstan- 
ces. And  just  so  it  is  on  the  other  hand  ;  almost  any  thing  unduly  ap- 
plied will  reproduce  them  while  the  predisposition  is  strong,  as  it  com- 
monly is  for  some  time  after  their  subsidence.   Will  chemistry  explain  ? 

892,  e.  In  the  quotidian  form  I  commonly  exhibit  one  grain,  in  so- 
Vution,  of  the  sulphate  of  quinia  every  two  or  three  hours  during  the 


THERAPEUTICS. CINCHONA  GOl 

intermission.  In  many  of  the  cases  the  patient  does  not  suffer  anoth- 
er paroxysm  after  the  preliminary  treatment  and  beginning  the  use  of 
qiiinia;  but,  in  a  majority  of  instances  he  has  another  paroxysm,  but 
of  great  comparative  mildness.  This,  however,  is  almost  invariably 
the  last  of  the  fever. 

In  the  treatment  of  tertians,  the  intermission  being  longer,  more 
time  is  allowed  for  producing  the  requisite  impression  by  the  quinia, 
and  I  therefore  take  no  unnecessary  risk  of  aggravating,  or  of  produ 
cing  any  local  forms  of  disease,  but  administer  the  sulphate  of  quinia 
in  doses  of  one  grain  once  in  three  or  four  hours ;  and  ]  continue  this 
regular  exhibition  of  the  remedy  throughout  the  night.  In  a  vast  ma- 
jority of  these  cases  there  has  been  no  return  of  the  paroxysm  after 
beginning  the  use  of  the  quinia — so  only  the  fever  have  been  a  reg- 
ular tertian,  and  the  intermission  well  marked.  But  absolute  rest, 
and  a  fluid,  farinaceous  diet,  till  there  is  a  failure  of  the  periodical  re- 
turn, are  a  sine  qua  non. 

892, y!  The  various  means  which  I  have  now  stated  as  to  the  treat- 
ment of  regular  intermittents,  with -the  exception  of  cinchona,  are  still 
more  important  in  remittent  and  continued  fevers ;  and  their  im- 
portance increases  in  the  ratio  of  the  intensity  of  any  local  inflam- 
mations and  congestions  of  important  organs.  The  former  affection 
is  here  far  more  apt  to  spring  up  than  in  intermittent  fever,  espe- 
cially in  the  continued  form ;  while  venous  congestion  is  the  predom- 
inating condition  in  intermittents  and  remittents. 

892,  g.  When  the  hot  stage  of  an  intermittent  is  unusually  pro- 
longed I  have  found  it  most  useful  to  employ  not  more  than  iialf  a 
grain  of  quinine  at  a  dose;  and,  in  remittents,  of  the  most  formidable 
nature,  after  repeated  abstractions  of  blood,  and  the  exhibition  of  ca- 
thartics, especially  of  calomel,  and  alterative  doses  of  tartarized  anti- 
mony, 1  have  in  the  end  resorted  to  the  sulphate  of  quinia  in  the  minute 
doses  set  forth  in  section  870  aa,  and  patients  have  been  thus  rescued 
from  otherwise  inevitable  death. 

Here,  too,  as  in  numerous  other  gradations  of  febrile  action,  espe- 
cially where  the  constitutional  affection  is  not  subdued  into  a  distinctly 
intermitting  form,  or  where  it  remains  complicated  with  declining  in- 
flammations, quinine  may  be  brought  to  bear  advantageously  in  small 
doses,  by  associating  with  it  the  minimum  doses  of  tartarized  antimo- 
ny, when  the  former  agent  would  be  otherwise  morbific.  The  anti- 
mony lessens  irritability,  subdues  arterial  action,  and  thus  counteracts 
the  stimulant  virtue  of  the  tonic  febrifuge,  while  it  also  reaches  more 
profoundly  by  its  alterative  virtue.  For  an  opposite  rectifying  in- 
fluence tonics  may  be  sometimes  brought  usefully  to  the  aid  of  anti- 
mony; especially  where  unsubdued  chronic  inflammations  are  kept  up 
by  prolonged  indigestion.  So,  again,  cathartics,  especially  the  neu- 
tral salts,  may  be  added  to  tonics  with  the  same  double  intention ;  or, 
on  the  other  hand,  tonics  may  be  combined  with  cathartics  to  coun- 
teract the  prostrating  influence  of  the  latter. 

892,  h.  On  the  Continent  of  Europe,  and  in  many  parts  of  the  Uni- 
ted States,  ten  grains  of  the  sulphate  of  quinia  at  a  dose  is  common  ; 
ani  this  explains  the  reason  why  an  impression  has  obtained  that  this 
compound  is  apt  to  irritate  the  stomach,  or  to  produce  purging.  If  its 
full  effects  in  such  quantities  were  farther  analyzed  and  better  appre- 
tiated   we  should  also  hear  of  them  much  more  unfavorable  reports. 


602  INSTITUTES    OF    MEDICINE. 

892,  i.  The  celebrated  French  writer,  and  admirable  practitioner 
Tissot,  more  than  a  century  and  a  half  ago,  complained  that  the  bark 
had  suffered  much  in  reputation  from  being  employed  in  too  small 
a  quantity.  The  subject,  in  consequence,  was  submitted  to  the  test  of 
critical  observation.  The  dose  employed  by  himself,  and  which  was 
about  the  same  as  sanctioned  by  the  distinguished  men  of  that  age, 
was  one  drachm  of  the  powdered  bark.  If  the  fever  were  of  the  ter- 
tian type  he  administered  eight  of  these  doses  during  the  intermission, 
or  a  dose  every  three  hours.  For  a  quartan  he  prescribed  the  same 
dose,  and  at  the  same  interval,  so  that,  instead  of  an  ounce,  as  in  the 
tertian  form,  an  ounce  and  a  half  would  be  taken  during  the  period 
of  intermission.  "  These  doses,"  he  says,  "  frequently  prevent  a  rep- 
etition of  the  paroxysm."  And  this  it  would  have  done  with  greater 
success  had  it  not  been  the  usage  of  those  days  to  enjoin  exercise 
upon  these  patients,  and  even  to  allow  them  solid  food  during  the  in- 
termission. 

As  to  the  quantity  of  bark,  Tissot  gave  the  maximum  doso  that  was 
mostly  employed.  This  was  considered  abundantly  large.  Tissot, 
indeed,  observes  that,  "  The  frequent  failures  of  the  bark  are  owing  to 
small  doses.  On  such  occasions  the  medicine  is  cried  down  and  con- 
demned as  useless,  when  the  disappointment  is  solely  the  fault  of  those 
who  do  not  employ  it  properly." 

If  we  allow,  therefore,  the  large  pi'oportion  of  one  grain  and  a  half 
of  the  alkaloids  to  one  drachm  of  good  bark,  and  that  the  febrifuge 
virtue  of  cinchona  depends  mostly  upon  these  principles,  we  shall  not 
have  more  than  one  grain  at  a  dose  in  actual  operation,  on  account  of 
the  nature  of  the  compound.  But,  in  a  great  proportion  of  the  bai'ks 
in  common  use  there  is  not  the  quantity  of  one  grain  of  the  alkaloids 
in  a  drachm  of  the  bark.  The  crown  bark  of  Loxa  (C.  Condaminea), 
an  excellent  species,  and  mostly  in  use  in  Tissot's  day,  has  less  than 
half  a  grain  of  the  alkaloids  to  each  drachm.  These  facts  are  of  gi-eat 
practical  moment  as  it  respects  the  important  question  now  before  us  ; 
as  they  come  from  some  of  the  very  best  observers,  men  who  would 
venture  upon  bloodletting  whenever  necessary,  and  who  had  the  same 
question  under  consideration. — Notes  K  L  pp.  1119,  1120. 

In  Tissot's  time,  however,  there  were  many  who  employed  exces- 
sive doses  of  the  bark,  and  thus  injured  or  destroyed  their  patients. 
And  this,  of  course,  was  another  reason  why  the  bark  was  often  in  dis- 
repute. The  alkaloids,  it  is  true,  are  rather  less  morbific  ;  but  not  at 
all  so  in  the  ratio  of  the  moderate  and  immoderate  practice.  The 
consequences,  therefore,  are  the  same  now  as  represented  by  Tissot, 
Morton,  Torti,  Sydenham,  and  others,  in  their  times. 

Be  it  also  remembered,  that  they  who  are  thus  fearless  of  the  cin- 
chona alkaloids,  and  others  who  administer  calomel  by  the  table-spoon- 
ful in  congestive  fever,  and  tartar  emetic  in  five  to  ten  grain  doses, 
repeated  at  short  intervals,  in  the  treatment  of  pneumonia,  &c.,  are 
the  very  ones  who  most  condemn  the  greatest,  safest,  and  most  spee- 
dy of  all  means  for  the  cure  of  such  affections.  And  just  so,  too,  as 
in  former  times,  the  public,  seeing  the  failure  of  their  efforts  with 
quinia,  and  other  powerful  internal  agents,  as  is  very  natural  with  a 
class  so  entirely  uninformed  of  the  true  merits  of  the  case,  run  to  an 
opposite  extreme,  and  imbibe  a  belief  that  medicines  are  hazardous 
unless  in  such  small  doses  as  shall  exert  no  effect  whatever.     The 


THERAf  t^UTlCS. CINCHONA.  COS 

confidence  of  the  public  being  thus  more  or  less  impaired  in  the  whole 
profession,  there  will  not,  of  course,  be  wanting  those  who,  as  in  Tis- 
sot's  day,  will  take  advantage  of  this  false  conclusion,  and  will,  as  in 
former  times,  employ  cinchona,  and  other  remedies,  in  such  minute 
doses  as  will  render  no  aid  to  Nature  (§  854  bb,  878,  894,  mottoes). 

892,  /.;.  The  large  medication  by  quinia  may  be  traced  up,  in  part, 
to  the  analogous  use  of  tartarized  antimony  in  Europe.  But,  while 
the  treatment  of  intermittents  by  doses  of  five  and  ten  grains  of  quinia 
has  extended  from  Europe  to  America,  we  have  not  kept  pace  with 
its  progress  there.  How  far  this  practice  has  had  its  origin  in  physi- 
ological or  pathological  facts  may  appear  from  some  of  the  results 
which  have  been  affirmed  by  its  advocates.  Thus,  the  distinguished 
M.  Piorry,  having  embraced  the  opinion  of  M.  Louis  that  the  enlarged 
and  indurated  spleen,  a  condition  which  often  supervenes  on  neglected 
or  badly-treated  intermittents,  is  the  cause  of  the  fever,  applied  the 
treatment  upon  that  hypothesis.  Accordingly,  we  learn  from  M.  Pi- 
orry the  following  results.  In  a  patient,  for  example,  affected  with  a 
quotidian,  we  ai"e  gravely  told  that, 

"  All  the  oi'gans  were  healthy,  except  the  spleen,  the  length  of 
which  was  seven  inches  and  ten  lines,  breadth  five  inches  and  five 
lines." 

To  this  patient  thirty  grains  of  quinia  were  given  at  a  dose,  and  in 
twenty  minutes  afterward  the  hypertrophied  spleen  was  reduced  more 
than  one  inch  in  its  length  and  breadth,  as  asceitained  by  percussion  ; 
but  which  we  may  regard  as  physiologically  impossible.  Four  days 
afterward,  as  the  paroxysms  still  continued,  M.  Piorry  gave  this  pa- 
tient forty  grains  of  the  sulphate  of  quinia  at  a  dose  ;  and  measured  the 
spleen  by  percussion  in  twenty  minutes  afterward,  and  found  it  more 
than  four  inches  shorter  than  when  the  first  dose  was  exhibited  ! 
Other  cases  uf  the  same  nature  are  related,  in  which  he  administered 
sixty  grains  of  the  sulphate  at  a  dose ;  with  the  never-failing  effect  of 
reducing  the  spleen  at  least  an  inch  in  all  its  dimensions  within  the 
regular  time  (twenty  minutes)  after  the  exhibition  of  the  remedy  (§ 
854  bb,  857,  878). 

These  reports  of  cases  have  been  extensively  circulated,  and  in-, 
corporated  into  the  "experimental  philosophy"  of  the  day.  Sigmond 
has  a  salutary  remark  upon  this  subject,  which  may  not  be  without  its 
advantages  in  this  place.     Thus  : 

"  He  who  has  in  eauly  youth  sedulously  watched  the  practice  of 
hospital  physicians,  and  has  heard  from  them  the  mode  of  manage- 
ment which  was  formerly  pursued  ;  he  who  has  compared  what  he 
himself  saw  at  that  period,  with  what  he  gathers  from  the  most  emi- 
nent writers,  and  has  then  enjoyed  opportunities  of  drawing  his  con- 
clusions from  the  bed-side  of  patients,  both  in  public  establishments 
and  at  their  own  houses,  will  be  able  to  appreciate  tlie  difficulties 
which  occur  in  the  application  to  practice  of  the  rules  that  are  laid 
down  by  some  individuals  with  such  dogmatic  precision ;  he  can  also 
judge  of  the  inutility  of  those  theories  which  appear  based  upon 
plausible  foundations,  arid  which  are  often  promulgated  by  individu- 
als who  hastily  draw  conclusions  from  few  facts,  and  who  commence 
explanations  of  their  own  views,  ignorant  of  what  has  been  thought, 
said,  and  practiced  by  some  of  the  able  men  who  have  preceded 
them ;  who  are  again  reviving  doctrines  which  time  and  experience 


G04  INSTITUTES   OF    MEDICINE. 

have  already  demonstrated  to  be  erroneous.  The  disregard  ofjjJtysl- 
ology  and  pathology  has  been  one  of  the  great  fallacies  of  the  age  in 
ichicli  we  live.  The  devotion  to  morbid  anatomy,  however  praisewor- 
thy is  its  investigation,  has  absorbed  too  much  of  the  consideration  of 
some  of  our  most  eminent  medical  philosophers.  They  have  rather 
reasoned  from  the  ravages  which  disease  has  committed,  than  from 
the  signs  and  symptoms,  and  from  the  gradual  development  of  the 
morbid  functions  of  organs.  Hence  fever  has  been  imagined  to  be 
a  local  disease,  and  hence  the  various  theories  have  led  not  only  to 
unsound,  but,  in  my  opinion,  to  dangerous  practice."  "  The  enlarge- 
ment and  induration  of  the  spleen,  which  attend  upon  mismanaged 
intermittent  fever,  are  not  uncommonly  produced  by  the  neglect  of 
the  proper  means  previous  to  the  use  of  cinchona,  and  by  its  admin- 
istration in  the  wrong  stage." — Sigmond's  Lectures,     hondon,  1837. 

892,  kJc.  In  what  has  now  been  said  of  the  employment  of  cinchona 
with  a  special  reference  to  chronic  enlargements  of  the  spleen  (§ 
892,  h),  it  is  not  intended  to  be  implied  that  the  agent  is  not  more  or 
less  adapted  to  such  cases;  as  it  is,  also,  to  analogous  affections  of  the 
liver,  &c.,  which  supervene  upon  intermittent  and  remittent  fevers. 
But,  in  all  such  cases  there  are  other  means  not  less  important ;  such 
as  a  well-regulated  diet  of  mild  vegetable  food,  leeching  and  vesica- 
ting the  affected  region,  the  local  or  internal  use  of  iodine,  &c.  In 
all  such  cases,  however,  the  doses  of  quinia  should  not  exceed  one 
grain ;  and  the  practitioner  and  his  patient  must  yield  to  the  necessi- 
ties of  the  case,  and  be  content  with  advances  toward  a  state  of  cure 
that  shall  correspond,  in  some  degree,  with  the  gradual  progi-ess  of 
the  disease  from  its  incipient  to  its  aggravated  form  (§  150,  548  a, 
557  a,  855,  856,  926). 

892,  I.  Pereira  has  presented  a  good  summary  of  the  effects  of 
quinia  in  the  exclusive  practice,  as  inferred  from  general  experience. 
Thus: 

"  In  doses  of  ten  grains,  sulphate  of  quinia  has  produced  on  man 
three  classes  of  effects  : 

"  1.  Gastro-enteritic  irritation,  marked  by  pain  and  heat  of  the  gas- 
tric region,  nausea,  griping,  and  purging. 

"  2.  Excitement  of  the  vascular  system,  manifested  by  increased 
fullness  of  pulse  and  augmented  respiration.  Fm-red  tongue,  and 
other  symptoms  of  a  febrile  state,  are  observed. 

"  3.  Disorder  of  the  cerebi-o-spinal  functions,  indicated  by  head- 
ache, giddiness,  contracted,  and  in  some  cases  dilated,  pupils,  disor- 
der of  the  external  senses,  agitation,  difficulty  of  performing  various 
voluntary  acts,  somnolency,  in  some  cases  delirium,  in  others  stupor." 
— Pereira's  Materia  Medica. 

Here,  then,  are  a  great  vai'iety  of  symptoms  which  denote  the  per- 
nicious effects  of  quinia  as  having  followed  immediately  its  exhibition 
in  doses  of  ten  grains,  and  I  have  witnessed  many  of  them  fromj»?i'« 
grains  only.  But,  it  is  these  strong  demonstrations  only  which  are 
likely  to  engage  the  attention  of  a  large  class  of  practitioners,  while 
the  more  obscure,  but  analogous  effects  of  wliich  I  have  spoken,  pass 
unheeded,  or  are  imputed  to  other  causes. 

892,  m.  Let  us,  then,  look  well  to  the  px-eparatory  treatment.  Let 
us  scrutinize  the  varied  and  exact  pathology  of  the  individual  cases 
of  intermittent  fever;  and  clear  up,  at  least,  any  local  congestions 


THERAPEUTICS. CINCHONA.  605 

tlut  are  so  apt  to  stand  in  the  way  of"  the  tonic  febrifuge.  But,  let  us 
not  neglect  the  important  consideration  that  these  local  states  aie  im- 
bued with  the  special  influences  of  the  remote  causes  of  the  constitu- 
tional affection,  and  that  they  are  more  or  less  amenable  to  the  Peru- 
vian bark,  and  would,  doubtless,  be  far  more  so  but  for  the  tonic  vir- 
tue of  the  febrifuge  (§  650,  652  c,  662,  670,  814-816,  847  g,  848, 
857).  Where  they  are  marked  by  periodical  exacerbations  they  may 
refuse  to  yield  in  their  specific  nature  to  all  things  else  than  some 
agent  of  very  peculiar  virtues ;  and  here  it  is  that  cinchona,  or  arse- 
nic, manifest  their  effects  as  specifics.  But  it  is  far  from  being  cer- 
tain that  such  agents  are  indicated  because  the  local  conditions  of  dis- 
ease do  not  give  way  to  a  direct  antiphlogistic  treatment.  It  may  be 
that  this  treatment  has  been  imperfectly  applied,  that  too  little  blood, 
pei'haps,  may  have  been  abstracted,  that  leeching  or  blistering  have 
been  improperly  neglected,  or  out  of  their  relative  order  to  general 
bloodletting  and  cathartics,  or,  that  some  untoward  exciting  causes, 
such  as  eiTors  in  food,  or  fatigue,  &c.,  have  been  in  operation  to  de- 
feat the  right  influence  of  the  principal  remedies  for  inflammation 
These  are  considerations  of  great  moment,  and  should  duly  pass  un- 
der review  in  all  cases,  before  we  summon  to  our  aid  the  power  in 
reserve;  especially  if  the  local  symptoms  do  not  fluctuate  like  the 
paroxysms  of  fever  (§  151,  675,  686,  847  g,  848,  870  aa). 

Again,  however,  cases  arise  where  the  local  affections  put  on  a  dis- 
tinctly intermitting  character.  The  symptoms  of  cerebral  congestion 
rise  and  fall  with  the  febrile  paroxysms  and  the  intermissions,  or  those 
of  pleurisy  undergo  the  same  fluctuations.  Here,  therefore,  there  is 
little  or  no  room  for  doubt,  after  a  full  impression  has  been  made  by 
bloodletting,  cathartics,  &c.,  upon  the  general  pathological  condition. 
This  preparatory  treatment  adopted,  the  first  modei'ate  dose  of  qui- 
nine will  often  tell  us  that  it  has  reached  deeply  the  peculiar  modifi- 
cation which  had  been  impressed  upon  the  congested  or  inflammato- 
ry states  by  the  miasmatic  cause  ;  while,  on  the  other  haiid,  had  the 
remedies  for  common  inflammation  been  neglected,  and  no  impression 
had  been  thus  made  upon  the  universal  pathological  condition,  that 
grain,  or  less,  of  quinia  would  have  exasperated  the  whole  condition 
of  disease  (§  137  d,  150,  151,  650,  672,  673,  801,  814,  857,  870  aa). 

892,  n.  The  foregoing  peculiarly  modified  states  of  congestion  and 
inflammation,  in  their  supposed  intensity  (§  892,  m),  are  not,  however, 
common  in  America ;  but,  it  is  more  common  to  find  that  remittent 
fevers,  notwithstanding  any  remaining  congestions  with  which  they 
may  have  been  complicated,  will  be  ultimately  benefited  by  vei-y  small 
and  cautious  doses  of  the  cinchona  alkaloids  (§  150,  870  aa). 

892,  o.  It  should  be  added  that  it  has  occasionally  happened  within 
the  experience  of  the  best  observers,  that  acute  and  violent  inflamma- 
tions have  occuiTed  independently  of  intermittent  fever,  where  the  in- 
flammation has  refused  to  yield  to  bloodletting,  &c.,  but  has  subse- 
quently surrendered  speedily  to  the  bark.  It  can  scarcely  be  doubt- 
ed, however,  that  these  rare  conditions  are  under  the  modifying  influ- 
ence of  the  remote  causes  of  intermitteots  (§  150,  151,  813  a,  816). 

892,  p.  Besides  the  aflfections  which  I  have  considered  in  the  fore- 
going sections,  there  are  others  of  an  intermitting  character  to  which 
the  cinchonas,  and  their  allies,  are  especially  adapted.  These  are  the 
well-known  intermittent  head-aches,  intermittent  neuralgia,  intermit- 


606  INSTITUTES    OP    MEDICINE. 

tent  amaurosis,  intermittent  ophthalmia,  &c. ;  all  of  which  probably  de- 
pend, for  their  specific  character,  upon  the  vegetable  miasmata  that 
lay  the  foundation  of  intermittent  and  remittent  fever  (§  150,  650,  &c.). 
Such  has  been  the  opinion  of  those  who  have  lived  and  written  in  the 
midst  of  such  affections.  "  The  same  cause,"  says  Tissot,  "  which 
produces  the  intermittent  fever,  frequently  occasions  also  disorders 
that  return  periodically  at  the  same  hour,  without  shivering,  without 
heat,  and  often  without  any  quickness  of  the  pulse.  Such  disorders 
generally  observe  the  intermissions  of  the  quotidian  or  tertian  fevers, 
but  much  more  seldom  those  of  quartans.  I  have  seen  violent  vomit- 
ings, and  retchings  to  vomit,  with  inexpressible  anxiety,  the  severest 
oppressions,  the  most  racking  colics,  dreadful  palpitation  and  tooth- 
aches, pains  in  the  head,  and  very  often  unaccountable  pain  over  one 
eye,  the  eyelid,  eyebrow,  and  temple,  on  the  same  side  of  the  face, 
with  a  redness  of  that  eye,  and  a  continual  trickling  of  tears.  I  have 
also  seen  such  a  prodigious  swelling  of  the  affected  part,  that  the  eye 
projected,  or  stood  out,  above  an  inch  from  the  head,  covered  by  the 
eyelid,  which  was  also  extremely  inflated  or  puffed  up.  All  these 
maladies  begin  precisely  at  a  certain  hour,  last  about  the  usual  time 
of  a  fit,  and  terminate  without  any  sensible  evacuation,  return  exactly 
at  the  same  hour  the  next  day,  or  the  next  but  one." 

This  reminds  us  of  Hippocrates  ;  and  the  practitioner  in  the  mala- 
rious districts  of  the  United  States  will  not  fail  to  recognize  in  the 
graphic  portrait  the  same  things  in  his  almost  daily  walks,  as  he  does 
in  the  "epidemics"  of  the  venerated  father  of  medicine. 

The  treatment  of  the  foregoing  cases  is  very  embaiTassing,  unless 
we  are  prepared  by  a  knowledge  of  their  peculiar  pathological  chai'- 
acter ;  and,  having  quoted  the  experience  of  Tissot  as  to  their  occur- 
rence, I  cannot  do  better  than  to  state  the  treatment  which  was  pur- 
sued by  one  who  is  so  eminently  entitled  to  our  confidence ;  especial- 
ly as  that  treatment  has  not  been  impi'oved. 

If  the  affection  was  decidedly  inflammatory,  as  in  the  case  of  the 
eye,  he  abstracted  blood.  Then  he  goes  on  to  remark  tiiat,  "  Thei"e 
is  but  one  medicine  that  can  effectually  oppose  these  periodical  mal- 
adies, which  is  the  bark.  Nothing  affords  relief  in  the  fit,  and  no  other 
medicine  ever  suspends  or  puts  it  off.  But,  I  have  cured  some  of  these 
disorders  with  the  bark,  and  especially  those  affecting  the  eyes,  which 
happen  oftener  than  the  other  conditions,  after  their  duration  for  many 
weeks,  and  after  the  ineffectual  use  of  bleeding,  purging,  baths,  blis- 
ters, and  a  great  number  of  other  remedies.  If  a  proper  quantity  of 
it  be  given,  the  next  fit  is  very  mild ;  the  second  is  prevented,  and  1 
never  saw  a  relapse  in  these  cases,  as  often  happens  with  intermittent 
fevers."     But  Tissot  had,  also,  a  preliminary  treatment. 

Tissot  wrote  before  arsenic  had  come  into  use  as  a  remedy  for  in- 
termittent fever,  and  which  has  been  subsequently  employed  with 
great  success  for  the  intermitting  headache,  &c. 

892,  g'.  There  is  one  form  of  continued  fever  to  which  the  bark  is 
adapted  in  its  advanced  stages,  and,  what  is  remarkable,  the  tincture 
is  often  the  best,  and  that,  too,  where  stupor  has  come  on,  along  with 
subsultus  tendinum,  black  tongue,  sordes,  &c.  This  form  of  the  con- 
tinued fever  is  the  typhus,  and  belongs  to  climates  where  the  inter- 
mitting diseases  are  scarcely  known  to  occur.*  In  these  cases,  the 

*  I  have  shown  in  the  31ed.  and  Phys.  Comm.  (vol.  2,  pp.  449,  690)  that  typhus  or 
typhoid  fever  does  not  originate  in  the  U.  S.  south  of  Lat.  41°.  The  '■'■fatal  typhoid^^ 
of  our  civil  war  is  the  congestive  remittent  fever. — August. — 1862. — Note  S  p.  1124. 


THERAPEUTICS. ARSENIC.  607 

bark  appears  to  act  both  as  a  tonic  and  febrifuge.    But,  it  is  suited 
only  to  advanced  stages  of  the  disease. 

892,  r.  Whenever  cinchona,  or  its  alkaloids,  prove  beneficial  under 
other  circumstances  than  such  as  have  been  stated  in  the  foregoing 
sections  they  operate  in  virtue  of  their  tonic  property.  But,  like  all 
other  tonics  their  range  of  usefulness,  in  this  acceptation,  is  very  lim- 
ited ;  being  suited  only  to  advanced  stages  of  acute  disease,  or  to 
some  chronic  maladies  in  which  digestion  is  peculiarly  impaired,  or 
to  others  attended  by  profuse  mucous  discharges,  as  in  old  and  ex 
cessive  bronchial  secretion,  old  diarrhoeas,  &c.  Their  best  effects  as 
tonics  are  probably  manifested  in  feeble  scrofulous  habits,  when  di- 
gestion is  impaired ;  and  along,  perhaps,  with  iodine.  They  exert, 
also,  a  kindly  influence  upon  the  shattered  constitutions  of  old  vene- 
real subjects,  especially  when  mercury  fails  of  its  usual  office,  and 
then,  also,  iodine  should  often  go  with  it.  They  are  among  the  pres- 
ent helps  to  broken-down  debauchees. 

Notwithstanding,  however,  the  inconsiderable  advantages  that  arise 
from  cinchona  as  a  tonic,  it  stands  at  the  head  of  that  group  of  reme- 
dies, as  it  does  in  its  rank  among  the  special  alteratives  for  intermit- 
tent diseases.  The  contrast  in  effects  separates  very  widely  from 
each  other  these  coexistinsr  virtues,  while  the  limited  advantages  of 
one  or  its  more  frequent  peraicious  effects  tell  us,  forcibly,  to  beware 
of  the  whole  group  of  tonics. 

ARSEMOUS    ACID. 

892|,  a.  Arsenious  acid,  in  the  ti-eatment  of  intermittent  diseases, 
has  been  rapidly  passing  into  the  great  reservoir  of  forgotten  things ; 
whither  it  has  been  driven  by  the  power  of  novelty,  and  the  superior 
excellencies  of  the  cinchona  alkaloids.  But,  it  remains  as  ever  a  sure 
friend  of  man  whenever  his  necessities  may  oblige  him  to  call  it  from 
obscurity.  It  is  partly  from  these  considerations,  and  in  part  to  look 
at  its  peculiar  attributes  as  a  curative  agent,  and  thus  to  elicit  new 
rays  of  light  upon  organic  life  and  the  philosophy  of  medicine,  that  I 
shall  venture  to  disturb  the  repose  of  this  once  busy  member  of  the 
mineral  kingdom. 

But,  these  objects  need  not  detain  us  long,  as  I  contemplate  a  ref- 
erence mostly  to  its  relations  to  intermittent  diseases  ;  and  much  of 
what  was  said  of  cinchona  is  applicable  to  arsenic.  This  agent,  how- 
ever, is  not  complicated  by  any  tonic  virtue,  as  otherwise  supposed 
by  many,  which  divests  it  of  objections  that  are  relative  to  that  char- 
acteristic of  cinchona.*  Yet,  it  has  the  attribute  of  a  violent  poison, 
and  may,  therefore,  be  liable  to  disastrous  effects  from  its  incautious 
use.  But,  with  this  contingent  objection  the  amount  of  evil  which  it 
has  inflicted  is  insignificant  with  that  which  is  constantly  in  progress 
from  the  untimely  application  of  the  Peruvian  bark,  or  from  its  ex- 
cessive administration.  In  one  case  the  immediate  evils  are  less 
striking,  or  creep  slowly  on  ;  in  the  other  it  is  death  itself  who  stands 
before  us. 

8921,  h.  Arsenious  acid  appears  to  be  more  or  less  poisonous  to  all 
animals.  In  its  therapeutical  dose  it  produces  no  apparent  effect 
upon  man  in  health  ;  which  is  only  one  of  the  numerous  facts  that 
admonish  us  against  all  conclusions  as  to  remedial  agents  from  what 
may  be  witnessed  of  their  effects  upon  the  healthy  system,  and  to  give 

*  The  supposed  tonic  virtue  of  arsenic  is  predicated  mostly  of  Voght's  experiments  on  broken 
down  horses,  whi'-h  have  been  incorporated  into  medical  philosophy  (§  S54  66,  892i  j,  A). 


608  INSTITUTES    OF   MEDICINE. 

our  a.,teT)tIon  to  the  properties  of  life  as  their  susceptibilities  may  be 
affected  in  disease  (§  150,  854,  870  aa,  892^  a). 

In  respect  to  the  manifestations  of  arsenic  in  morbid  states  of  the 
body,  independently  of  its  curative  effects,  they  may  be  sufficiently 
learned  from  a  statement  by  Dr.  Fowler,  that,  "in  320  cases,  some- 
what more  than  one  third  was  attended  with  nausea;  nearly  one  third 
with  an  open  body ;  and  about  one  third  with  griping.  Vomiting, 
purgings,  swellings,  and  loss  of  appetite  were  but  rare  in  comparison 
with  the  preceding  effects,  and  their  less  frequent  occurrence  was  gen- 
erally found  in  the  order  in  which  they  are  here  enumerated.  About 
one  fifth  of  the  cases  attended  with  nausea,  and  one  fourth  of  those 
attended  by  an  open  body,  were  unconnected  with  any  other  effects. 
Griping  did  not  often  occur  alone.  Purging  and  loss  of  appetite  sel- 
dom or  never  alone,  and  vomiting  was  always  accompanied  with 
more  or  less  nausea." 

The  foregoing  observations  unfold  the  nature  of  the  general  influ- 
ences which  may  be  more  or  less  expected  from  the  therapeutical 
dose  of  arsenic,  and  illustrate  the  fluctuating  nature  of  the  organic 
properties.   Such  effects,  however,  may  he  generally  avoided  (§  857). 

892^,  c.  Fowler's  Report  upon  the  effects  of  arsenic  appeared  in 
1786,  and  subsequent  experience  has  amply  established  its  febrifuge 
virtue.  It  appears,  indeed,  to  have  succeeded  not  only  occasionally 
in  the  hands  of  most  practitioners  of  experience  where  the  bark  and 
its  alkaloids  have  failed,  but  even  upon  an  extensive  scale  in  certain 
epidemical  intermittents.  It  owes,  in  fact,  its  early  reputation  con- 
siderably to  its  success  in  an  intermittent  fever  which  infested  Great 
Britain  about  the  year  1780,  and  which  prevailed  for  more  than  two 
years.  But,  it  was  the  obstinacy,  more  than  the  great  prevalence  of 
this  epidemic,  which  renders  it  memorable ;  and  this  the  more  so 
from  its  resistance  of  the  bark,  and  its  submission  to  arsenic.  This 
was  one  of  the  occasions  in  which  the  bark  fell  into  considerable  dis- 
repute ;  and  we  now  comprehend  the  reason  of  its  frequent  failui'e 
during  the  epidemic  of  which  I  am  speaking.  Bloodletting  was  not 
then  the  fashion  in  Great  Britain,  and  this  fever  was  attended  by 
those  local  congestions  and  inflammations  which  either  demand  the 
loss  of  blood,  or,  at  least,  render  it  necessary  to  any  safety  in  the  eai'ly 
administration  of  bark.  But  this  tonic  febrifuge  was  administered 
without  the  requisite  advantages  of  a  preliminary  treatment,  and  tlie 
local  conditions  of  disease  were  accordingly  exasperated,  the  fever 
aggravated  and  prolonged,  and  often  rendered  fatal  by  the  very  rem- 
edy upon  which  there  was  the  sole  reliance  (§  847  g,  848,  854  hb, 
857,  863  d,  870  aa). 

However,  therefore,  the  bark  may  have  been  thus  baflled  in  its  ef- 
fects as  a  febrifuge,  and  inflicted  the  evils  of  a  tonic,  it  was  no  fault  of  # 
the  I'emedy,  but  of  the  practitioners,  who  neglected  the  true  pathology 
of  the  disease,  overlooked  the  local  developments,  and  permitted  their 
prejudices  against  bloodletting  and  cathartics  to  deprive  them  of  the 
benefits  which  might  have  accrued  from  the  Peruvian  febrifuge.  Be- 
ing thus  baffled  in  their  attempts  with  an  agent  of  tonic  virtues,  a  few 
practitioners  availed  themselves  of  the  reputation  which  arsenic  had 
obtained  in  Poland  as  a  febrifuge ;  and  this  substance  being  destitute 
of  the  tonic  and  stimulant  virtues  of  cinchona,  it  was  more  compatible 
with  the  local  condition  of  disease,  and  therefore  succeeded  in  the 


THERAPEUTICS. ARSENIC.  609 

hands  of  those  few  better  than  the  bark.  It  was  apt,  however,  to  oc- 
casion vomiting  and  purging ;  but  these  effects  were  mostly  the  con- 
sequence of  a  neglect  of  the  appropriate  means  for  subduing  the  force 
of  the  local  burdens  of  disease. 

Parallel  with  the  foregoing  is  an  opinion  which  is  thus  stated  by 
Dr.  Sigmond. 

"  The  effects  of  arsenic  are  much  more  striking  in  the  intermittent 
fever  occurring  during  the  autumnal  months,  than  during  that  which 
is  prevalent  in  the  spring ;  and  the  more  intensely  the  miasm  has  act- 
ed upon  the  system,  the  more  decided  are  its  good  effects,  while  cin- 
chona, and  the  barks  of  certain  trees,  produce  their  characteristic  ef- 
fects during  the  spring." — Sigmond's  Lectures,  1837. 

I  have  quoted  this  remark  for  the  purpose  of  carrying  out  the  views 
which  I  have  expressed  as  to  the  failure  of  the  bark  in  the  English 
epidemics,  and  as  it  is  its  tendency,  also,  to  encourage  the  use  of 
arsenic  in  the  autumnal  intermittents,  without  any  just  ground  for  the 
conclusion  as  to  its  superiority  over  the  bark  in  the  fevers  of  that  sea- 
son. The  greater  success  of  arsenic  as  here  stated  has  been  observed 
only  in  the  hands  of  those  who  administer  the  bark  indiscreetly,  and 
without  properly  subduing  the  local  congestions  and  inflammations 
which  are  every  where  more  common  and  severe  in  the  autumnal  than 
in  the  vernal  intermittents.  And,  as  one  of  the  evidences  that  the 
greater  success  of  arsenic,  under  the  circumstances  now  stated,  is 
due  to  the  absence  of  the  tonic  and  stimulant  virtues  of  cinchona  I 
may  quote  the  remark  from  Pereira  that,  "  It  is  not  necessary  to  in- 
termit the  use  of  arsenic  during  the  febrile  paroxysm.  In  agues,  ac- 
companied with  inflammatory  conditions,  where  cinchona  and  quinia 
disagree,  arsenic  may,  according  to  Dr.  Brown,  be  sometimes  admin 
istered  with  the  best  effects."     It  has,  he  says,  no  tonic  virtue. 

Immediately  after  the  events  of  the  British  epidemic  of  which  I  had 
been  speaking.  Dr.  Fowler  appeared  with  his  "  arsenical  solution," 
or  the  liquor  potassae  arsenitis ;  which  has  been  supposed  by  many 
to  surpass  the  arsenious  acid  in  its  remedial  virtues.  This  preparation 
became  the  means  of  establishing,  rapidly,  the  character  of  the  new 
agent  all  over  Europe. 

892^,  d.  The  question  arises,  next,  as  to  what  conditions  of  inter- 
mittent fever  arsenic  is  applicable  in  preference  to  cinchona.  Wc 
have  seen  that  the  bark  and  its  alkaloids  are  capable  of  surmounting 
the  disease  with  great  certainty  and  rapidity  under  its  ordinary  con- 
ditions when  properly  administered ;  and  this  qualification  supposes 
that  other  remedies,  such  as  bloodletting,  and  especially  cathartics 
and  antimonials,  shall  be  brought  into  operation  whenever  demanded 
by  the  general  or  local  symptoms.  The  disease,  being  thus  treated 
according  to  its  variable  pathological  conditions,  and  the  Peruvian 
febrifuge  withheld  till  its  application  is  compatible  with  the  patholog- 
ical states  as  meliorated  by  the  direct  antiphlogistics,  we  may,  un 
doubtedly,  in  almost  all  cases  which  are  seen  in  their  early  stages, 
succeed  completely  with  the  alkaloids,  and  thus  avoid  a  remedy,  which, 
like  arsenic,  is  liable  to  the  objections  of  being  fatal  in  the  dose  of  a 
single  grain,  or  of  inducing  violent  symptoms,  or  of  laying  the  founda- 
tion of  other  serious  and  even  fatal  affections,  in  its  usual  therapeu- 
tical doses,  if  administered  in  inauspicious  conditions  of  the  system, 
or  when  continued,  under  favorable  circumstances,  beyor.d  a  certain 

Q  a 


GIO  INSTITUTES    OF    MEDICINE. 

period.  These  considerations  leave  no  doubt,  therefore,  that  the  al- 
kaloids should  be  first  employed  in  every  case  of  intermittents,  whether 
they  be  of  fever,  or  of  those  other  local  diseases  having  periodical  par- 
oxysms, as  considered  in  sections  relative  to  the  bai'k.  Such,  indeed, 
were  the  conclusions  of  the  soundest  medical  experience  before  the 
introduction  of  the  cinchona  alkaloids  ;  and,  while  balancing  the  mer- 
its of  these  remedies  we  cannot  too  well  consider  the  safety  of  one 
when  employed  with  a  proper  reference  to  pathological  conditions, 
and  the  dangers  of  the  other,  under  all  conditions,  that  are  liable  to 
accrue  from  over-doses.  But  this  objection  applies  only  to  the  care- 
less, and  may  be  predicated  of  many  other  remedies  in  common  use. 
We  must  take  the  world,  however,  as  it  is,  and  not  as  it  should  be ; 
and  when,  therefore,  as  in  the  case  before  us,  a  choice  exists,  let  us 
banish  the  evil  as  far  as  the  choice  extends.  It  should  still,  however, 
be  recollected  that,  in  the  case  of  the  bark,  a  morbific  virtue  may  be 
in  operation  in  the  therapeutical  doses  of  that  agent,  while  the  same 
special  virtue  does  not  appertain  to  arsenic  (§  150,  847  g,  848,  859, 
863  d). 

It  appears,  therefore,  that  arsenic  will  be  wanted  mostly  in  neg- 
lected or  badly-treated  cases  of  intermittent  fever ;  and  the  former 
will  be  more  likely  to  yield  to  other  means  than  the  latter.  In  the 
neglected  cases,  disease  can,  at  most,  have  been  aggravated  only  by 
errors  on  the  part  of  the  patient,  while  art,  with  its  powerful  morbific 
ao-ents,  may  lay  the  foundation  of  very  intractable  local  maladies  that 
shall  impart  great  obstinacy  to  the  constitutional  disease,  as  uninter- 
mitting  exciting  causes  (§  659,  b).  Cases  undoubtedly  arise,  also,  at 
certain  seasons  of  the  year,  such  as  the  autumnal  (§  892^  c),  to  which 
arsenic  is  better  adapted  than  quinine,  or  where  the  latter  may  fail  on 
account  of  its  tonic  virtue.  Again,  other  cases  sometimes  present 
themselves  at  all  seasons  where  the  vegetable  remedy  fails  under  the 
most  judicious  treatment.  This  may  be  owing  to  very  peculiar  modi- 
fications of  the  pathological  states,  or  to  unusual  affections  of  certain 
parts,  or  to  some  idiosyncrasy.  In  short,  arsenic  is  the  next  remedy, 
appertaining  to  the  group  before  us,  which  should  be  tried  after  the 
failure  of  cinchona.  But,  it  by  no  means  follows  that  agents  from  other 
groups  may  not  be  equally  or  more  appropriate.  It  happens,  fre- 
quently, in  prolonged  or  badly-treated  cases  of  intermittent  fever 
where  the  liver  or  spleen  becomes  the  seat  of  enlargements  and  indu- 
rations, that  iodine  maybe  employed  very  successfully  in  conjunction 
with  quinine.  The  accession  of  these  two  agents  to  the  Materia  Med- 
ica  has  contributed,  largely,  in  this  as  in  other  respects,  to  the  facili 
ties  of  art. 

It  has  placed,  indeed,  the  foregoing  affections  greatly  under  the 
control  of  either;  and,  what  is  vei'y  important,  where  the  bark  was 
inadmissible  during  the  coexistence  of  fever  with  the  chronic  derange- 
ments, quinine  is  often  adapted  to  both  conditions  ;  so  only,  the  treat- 
ment be  properly  conducted  in  its  other  details.  Iodine,  however,  is 
only  appropriate  after  an  ascendency  is  obtained  by  other  remedies 
over  the  febrile  state,  and  where  the  force  of  the  local  affections  has 
so  yielded  that  they  inflict  no  exciting  reflex  nervous 'influences  upon 
the  oigans  of  circulation.  Otherwise,  that  intensity  should  be  first 
moderated  by  leeching,  blistering,  low  diet,  &c.  With  this  qualifica- 
tion, and  in  the  absence  of  fever,  iodine  has  contributed  not  a  little 
toward  the  exclusion  of  arsenic  froin  the  tieatment  of  agues. 


THERAPEUTICS. ARSENIC.  611 

In  some  of  the  conditions  of  which  I  have  just  spoken,  arsenic  in 
advantageously  associated  with  quinia,  or  administered  in  the  associ- 
ated form  of  a  salt. 

892i,  e.  We  finally  come  to  the  conclusion  that  arsenic  ranks  next 
to  cinchona  in  the  certainty  with  which  it  overcomes  intermittent 
fever.  But,  it  is  less  certain,  and  less  rapid  in  effect ;  and  the  objec- 
tion which  applies  to  it  as  an  energetic  poison  in  over-doses  should 
hold  it  in  reserve,  to  be  employed  only  where  cinchona,  or  quinine, 
properly  administered,  may  fail.  Such  as  may  study  disease  in  its 
philosophical  aspects,  taking  a  comprehensive  survey  of  its  varied 
pathological  conditions,  firmly  resisting  the  prejudices  which  timidity 
or  ignorance  have  heaped  upon  bloodletting,  and  who  prescribe  for 
the  absolute  conditions  rather  than  for  the  name  of  a  disease,  will 
rarely  find  it  necessary  to  have  recourse  to  arsenic  in  the  ordinary 
forms  of  intermittent  fever. 

892^,  J".  It  is  not  improbable,  however,  that  this  agent  may  be  found 
more  useful  in  the  distinctly  intermitting  inflammations  which  accom- 
pany marsh  fever.  It  is  always  difficult  to  adapt  even  a  cinchona  alka- 
loid to  these  inflammatory  states,  while  it  never  fails  to  exasperate  the 
inflammation  if  administered  before  a  strong  impression  has  been 
made  by  bloodletting  and  other  antiphlogistics. 

892^,  g.  Intermitting  headache  is  a  more  common  form  of  period- 
ical disease  than  inflammation,  in  which  arsenic  proves  often  useful, 
and  frequently  where  cinchona  has  failed.  And  so,  also,  of  periodic 
tic  douloureux. 

892i,  h.  Besides  the  intermitting  affections,  there  are  others  to 
which  arsenic  is  well  adapted,  and  which  strikingly  illustrate  the  pro- 
foundly alterative  and  comprehensive  remedial  virtues  of  this  agent. 
These  remaining  conditions  of  disease  are  so  evidently  different  from 
the  intermitting,  that  I  have  reproduced  the  arsenical  preparations  in 
two  other  groups  of  remedies,  in  my  Materia  Medica.  It  is  impor- 
tant, in  the  first  place,  to  regard  each  remedial  agent  of  two  or  more 
virtues  as  a  whole,  and  to  consider  its  operation  under  its  compound 
aspect.  But,  in  this  state  of  complexity  they  cannot  be  brought  into 
that  practical  use  which  is  promoted  by  the  method  which  I  have 
projected  of  considering  the  various  properties  of  remedies  in  an  in- 
dividual sense,  and  according  to  the  prominent  conditions  of  disease 
to  which  they  are  suited,  and  by  associating  under  the  several  denom- 
inations of  disease  the  various  remedies  adapted  to  them,  and  in  the 
relative  order  of  their  therapeutical  value,  and,  therefore,  presenting 
under  each  denomination  groups  of  remedies  having  certain  remedial 
virtues  analogous  to  each  other,  however  they  differ  in  other  proper- 
ties, or  however  different  may  be  the  s'pecial  influences  by  which  the 
various  agents  under  any  given  denomination  of  disease  establish 
those  changes  which  give  to  Nature  the  recuperative  start.  In  this 
manner  a  single  compound  remedy  comes  to  be  distributed  into  what 
is  equivalent  to  several  agents ;  each  remedial  adaptation  to  possess 
an  individuality  which  distinguishes  it  from  other  remedial  virtues  that 
qualify  the  agent  as  a  remedy  for  other  morbid  conditions.  In  this 
way,  I  say,  we  avoid  a  confusion  which  has  prevailed  so  extensively 
from  considering  a  remedy  of  compound  virtues  in  its  general  aspect 
alone.  We  are  led  to  an  attentive  examination  of  its  several  virtues, 
of  their  critical  relations  to  different  uathological  conditions  and  thus 


612  INSTITUTES    OF    MEDICINE. 

to  acquire  a  more  distinct  apprehension  of  the  propcities  of  life,  of  the 
modus  operandi  of  remedial  agents,  and  of  the  laws  which  govern  the 
organic  being  under  all  his  conditions  of  health  and  disease. 

8921,  i.  The  diseases  which  fall,  more  or  less,  under  the  power  of 
arsenic,  and  which  illustrate  the  extent  of  its  remedial  virtues  beyond 
those  which  have  been  hitherto  considered,  consist  of  certain  chronic 
eruptive  affections  of  the  skin,  cancel",  noli-me-tangere,  chronic  rheu- 
matism, diseases  of  the  bones,  chorea,  elephantiasis,  iScc.  In  some 
of  these  conditions,  especially  in  cancer,  it  is  applied  externally  as 
well  as  iuternally.  Iodine  has  been  also  advantageously  associated 
with  arsenic  in  the  treatment  of  some  of  these  affections. 

8925,  h.  The  variety  of  diseases  to  which  arsenic  is  adapted,  and  its 
inertness  upon  the  healthy  body  in  its  therapeutical  doses,  illustrate  my 
doctrines  of  operation  through  alterative  reflex  nervous  actions,  and  of 
the  increased  susceptibility  of  morbid  states  (§  143  c,  222-233^,  500  m, 
892  h,  892^  V,  900,  902,  1059).— Note  L  p.  1120. 

IODINE. 

892^,  a.  Considering  the  extensive  and  powerful  nature  of  the  al- 
terative action  of  iodine,  it  is  remarkable  that  in  its  small  therapeuti- 
cal doses  it  produces  no  well-marked  effects  upon  the  function  of  any 
organ  in  its  healthy  state.  In  this  respect,  therefore,  it  goes  with 
arsenic,  and  the  rest,  in  illustrating  the  nature  of  life,  and  in  enforcing 
a  limitation  of  inquiries  into  the  therapeutical  capabilities  of  remedial 
agents  to  morbid  states  of  the  body  (§  137  d,  150,  854  hh,  870  aa, 
892i  b).  When  its  use  is  long  continued,  emaciation  is  said  to  have 
sometimes  followed,  and  now  and  then  a  low  state  of  gastro-enteritis 
has  been  supposed  to  have  supervened  when  iodine  has  been  employ- 
ed in  large  doses.  This,  however,  is  considered  a  rare  effect,  and  to 
depend  upon  the  incautious  use  of  the  medicine.  It  has  doubtless 
happened  in  morbidly  irritable  states  of  the  alimentary  canal  (§  137 
d,  150).  Lugol,  who  had  great  experience  with  iodine,  says,  that  so 
far  from  even  occasioning  a  wasting  of  the  body  it  promotes  growth, 
and  increases  the  size  of  organs,  in  their  healthy  state.  The  nervous 
system  is  said,  also,  to  have  been  occasionally  disturbed,  in  natural 
states  of  the  body,  by  therapeutical  doses  of  iodine ;  attended  by 
headache,  giddiness,  &c.  But  here,  too,  there  had  probably  been  an 
antecedent  derangement  of  the  alimentary  canal,  &c.  It  has  been  also 
laid  to  iodine,  that  it  has  occasioned  a  state  of  the  system  which  merits 
a  name  significant  of  one  of  its  morbific  tendencies  ;  and  hence  that 
of  iodism  has  been  associated  with  the  remedy.  This  condition  is 
marked  by  vomiting,  purging,  cramps,  emaciation,  fever,  &c.  But,  I 
am  apt  to  think  that  the  fault,  in  these  cases,  is  chargeable  to  malad- 
ministration. Others  have  affirmed  that  iodine  has  occasioned  saliva- 
tion ;  but  this,  also,  is  denied  by  others.  In  any  event,  such  a  result 
is  exti-emely  rare.  Twelve  grains,  on  an  average,  have  been  given 
daily  for  eighty  days,  making  960  grains,  without  any  manifest  effect. 
In  excessive  doses,  however,  iodine  is  capable  of  acting  as  an  irritant 
poison ;  or,  should  disease  be  present,  the  whole  aspect  of  the  subject 
is  changed.     I  have  never  witnessed  any  of  these  alleged  eflTects. 

A  remedy,  therefore,  so  exempt  from  all  untoward  action  upon 
the  healthy  body,  and,  withal,  as  inoffensive  when  skilfully  used  in 
morbid  states,  yet  capable  of  a  vast  range  of  the  most  important  reme- 


THERAPEUTICS. IODINE.  iJlH 

dial  effects,  must  be  regarded  as  an  accession  to  the  Materia  Medica 
of  great  value. 

892^,  b.  I  have  been  thus  led  to  consider  the  failures  of  iodine  upon 
the  body  in  a  state  of  health,  in  its  ordinary  doses,  for  the  purpose  of 
contrasting  them  vv^ith  some  of  the  remarkaljle  therapeutical  influences 
of  which  iodine  is  capable,  and  to  show  how  the  vital  states  are  chan- 
ged hi  their  relation  to  remedial  agents  by  morbid  states.  This,  how- 
ever, may  be  equally  instituted  with  many  other  very  powerful  reme- 
dies, even  those  which  are  liable  to  act  upon  morbid  states,  in  their 
therapeutical  doses,  with  the  intensity  of  energetic  poisons,  or  strike 
at  other  alarming  maladies,  yet  manifest  no  sensible  effects  upon  the 
healthy  organism  (§  137  d,  150,  870  aa,  8921  5^  ^^  jv^q^e  L  p.  1120). 

892|^,  c.  Perhaps  the  most  remarkable  demonstration  of  which  io- 
dine is  capable  is  in  those  latent  forms  of  disease  where  nothing  is 
present  to  denote  the  morbid  state  but  some  gradual  change  of  organ- 
ization. This  is  seen  especially  in  bronchocele,  for  which  affection  it 
surpasses,  greatly,  any  other  remedy.  And  here  it  may  be  said,  as 
indicative,  in  every  aspect  of  the  subject,  of  the  vital  philosophy  of  the 
operation  of  iodine,  that  it  is  often  as  efficient  in  most  of  the  local 
forms  of  disease  for  which  it  is  employed  whether  it  be  administered 
internally,  or  applied  externally.  It  is  also  an  important  fact,  of  the 
same  import,  that  the»external  application  must  be  made  over  the  re- 
gion of  the  affected  part,  when  disease  is  seated  internally ;  in  which 
respect  its  mode  of  action  through  a  reflex  nervous  process  borrows 
light  from  the  modus  operandi  of  counter-irritants.  Its  control  over  the 
ordinary  form  of  bronchocele  is  thoroughly  established,  and  where  it 
has  failed  I  have  no  doubt  it  has  been  generally  owing  to  some  defect 
in  the  treatment  (§  893  a,  c,  e,  m,  905f,  1059,  1088  b). 

I  say,  the  common  form  of  bronchocele ;  for  there  are  some  condi- 
tions of  the  thyroid  gland  which  nothing  will  reach  ;  which  is  one  of 
the  endless  exemplifications  of  the  importance  of  addressing  our  rem- 
edies to  the  exact  pathological  condition.  Now  the  true  bronchocele 
is  constituted  by  a  low  indolent  action  of  an  inflammatory  nature,  that 
which  results  in  hypertrophy  ;  better  known  at  present  as  a  "  lesion 
of  nutrition."  To  these  lesions  iodine  is  adapted;  and,  although 
it  seek  out  the  obstinate  forms  of  disorganization,  there  are  some 
morbid  changes  of  the  thyroid  gland  which  have  been  mistaken  for 
bronchocele  where  this  agent  has  disappointed  expectation,  and  has 
suffered  the  blame  of  another's  fault.  Among  these  intractable  con- 
ditions are  formations  in  the  gland  of  o'ther  substances  than  deposits 
of  lymph,  such  as  stony  and  other  concretions.  Or,  again,  the  organ 
takes  on  a  scirrous  condition.  Or,  at  other  times,  it  enlarges  sudden- 
ly, and  shows  high  vascular  action,  which  ends  in  an  effusion  of  serum  ; 
the  gland  becoming  enlarged  in  consequence.  But  this  condition  is 
not  apt  to  remain  long ;  and,  although  it  subside  spontaneously,  it  is 
not  amenable  to  iodine.  The  remedies  consist  of  leeches,  vesicants, 
&c. ;  and,  if  such  treatment  be  applied  to  the  indurated  states  of 
bronchocele,  preliminary  to  the  use  of  iodine,  this  remedy  will  not 
often  fail  of  accomplishing  the  residue  of  the  cure.  It  is  also  indis- 
pensable to  subdue,  in  the  first  place,  any  attendant  excitement  of  the 
general  circulation,  or  functional  derangement  of  the  chylopoetic  vis- 
cera. These,  indeed,  are  important  objects  of  attention,  whatever  be 
tne  nature  of  the  disease  for  which  iodine  may  be  prescribed.     Th^ 


614  INSTITUTES    OF    MEDICINE, 

external  use  of  iodine,  in  the  treatment  of  goitre,  is  net  less  efficient 
than  the  internal ;  so  that  both  methods  may  be  associated.  Or,  where 
objections  apply  to  the  more  constitutional  mode,  the  local  application 
is  often  admissible.  But  iodine  will  not,  like  the  mercurials,  extend 
its  influence  over  the  system  through  the  medium  of  the  skin.  Its 
effect  is  then  by  local  reflex  nervous  actions  {^  497,  893  e,  1059, 1088  b). 

892^,  d.  Soon  after  the  discovery  of  iodine  Dr.  Coindet  applied  it 
successfully  to  the  cure  of  scrofula.  His  observations  were  soon  fol- 
lowed up  by  others;  so  that  the  claims  of  the  remedy  became  early 
established  in  respect  to  this  most  intractable  disease.  Numerous 
cases  and  memoins  were  published,  all  tending  to  advance  inquiry 
into  the  new  and  extraordinary  agent ;  extraordinary  as  well  in  its 
relations  to  the  inorganic  as  the  organic  world.  It  was  early  and  suc- 
cessfully tried  upon  an  extensive  scale  by  Dr.  Manson  in  various  con- 
ditions of  sci'ofula,  scrofulous  ophthalmia,  &:c. ;  employed  both  inter- 
nally and  externally.  Then  followed  Lugol,  attached  to  the  hospital 
of  St.  Louis,  who  published  three  memoirs  confirming  the  favorable 
report  of  his  predecessors.  This  naiTative  seems  to  be  due  to  the  early 
founders  of  a  remedy  which  has  already  bestowed  incalculable  bless- 
ings upon  man ;  approaching  even  cinchona,  since  we  had  in  arsenic, 
and  numerous  other  means,  pretty  good  substitutes  for  that.  And 
now,  when  we  pause  for  a  moment  over  the  ciluntless  numbers  who 
have  been  already  rescued  from  the  grave  by  iodine  alone,  and  when  we 
attempt  to  think  of  the  labyrinth  of  medical  philosophy  through  which 
the  enlightened  physician  directs,  with  so  much  relief  to  the  whole 
race  of  man,  the  most  potent,  as  well  as  the  milder  agents,  of  the  Ma- 
teria Medica, — ay,  the  rcmedium  j^^i'ncipale  itself,  what  shall  be  said 
of  that  credulity  of  the  public  which  reposes  its  confidence  in  the 
charlatan,  or  yields  the  Paean  triumph  to  an  Apollo  in  surgery  1 

Lugol's  authority  is  valuable.  His  experience  has  scarcely  been 
improved.  He  employed  the  remedy  internally  and  externally,  and 
treated  the  various  conditions  to  which  scrofula  is  liable,  from  the 
simple  glandular  swelling,  ulceration,  abscess,  &c.,  to  its  destructive 
effects  upon  the  cartilages  and  bones.  An  exception,  however,  must, 
and  probably  always  will,  be  made  in  respect  to  tuberculous  phthisis. 
He  prefers  a  solution  of  iodine  with  the  iodide  of  potassium,  in  water. 
This  he  administered  either  in  the  form  of  drops,  or  largely  diluted 
with  water  under  the  denomination  of  ioduretted  mineral  water.  It 
has  become,  indeed,  a  standing  formula  ;  but  to  which  there  is  the 
same  objection  as  applies  to  all  other  analogous  prescriptions.  They 
all  require  variations  in  the  relative  proportions  of  their  constituent 
parts,  and  lead  to  a  neglect  of  the  varying  pathological  states  of  a 
common  form  of  disease  (§  150,  672,  673,  857,  &c.).  It  is  doubtful, 
however,  whether  the  union  of  the  iodide  of  potassium  often  increas- 
es the  efficacy  of  the  simple  iodine  ;  although  the  salt,  being  less 
enei'getic,  is  often  better  adapted  to  irritable  states  of  the  alimentary 
canal,  or  where  the  circulatory  organs  are  liable  to  excitement.  It  is 
readily  seen,  therefore,  that  for  this  reason  the  iodide  of  potassium 
may  be  often  united  in  variable  proportions  to  the  more  active  and 
irritating  form  of  the  remedy. 

892^,  e.  It  should  be  considered,  however,  in  reviewing  the  favora- 
ble reports  which  have  been  made  of  a  new  remedy,  that  here,  as  in 
most  other  cases,  other  observers  have  been  less  successful  with  iodine; 


THERAPEUTICS. IODINE.  615 

though  a  general  admission  obtains  that  it  is  more  useful  in  scrofulous 
affections,  with  the  exception  of  phthisis,  than  any  other  agent.  This, 
therefore,  is  sufficient  to  place  it  upon  very  high  ground  as  it  respects 
the  most  Protaean  disease.  There  is  much  reason  to  think,  however, 
that  those  who  have  been  least  successful  have  often  failed  fi-om  not 
having  bestowed  the  same  attention  upon  those  general  means  of  im- 
proving health,  such  as  diet,  warm  clothing,  exercise,  &c.,  which  are, 
of  themselves,  not  unfrequently  curative  of  scrofulous  affections ;  as 
they  are  of  syphilitic.  When  remedies  are  employed  in  any  given 
disease  for  the  cure  of  which  they  have  acquired  the  reputation  of 
specifics,  we  are  often  apt  to  rely  too  exclusively  upon  the  supposed 
specific,  and  the  remedy,  in  consequence,  frequently  fails  when  it 
would  have  succeeded  under  a  proper  regard  for  the  subordinate 
means.  Failure  in  this  respect  may  turn  the  "  specific"  into  a  form- 
idable foe,  especially  in  active  forms  of  disease  (§  137  d,  150,  &c.). 

Again,  since  the  early  day,  recent  to  be  sure,  of  the  wonder-work- 
ing power  of  iodine,  the  reputed  pathology  of  scrofula  has  undergone 
a  revolution  ;  and  where  abstraction  of  blood,  general  or  local,  a  non- 
stimulating  diet,  &c.,  were  often  considered  necessary,  especially  in 
the  primary  .stages  of  phthisis  pulmonalis,  a  tonic  and  stimulant  treat- 
ment has  been  erected  upon  the  new  doctrine  (§  4,  5i.  Also,  Med. 
and  Phys.  Comm.,  vol.  ii.,  p.  608-634,  743-746,  780-782).  From  my 
own  observation,  I  can  entertain  no  doubt  that  iodine  is  yet  destined 
to  yield  a  subordinate  aid  in  the  treatment  of  tuberculous  phthisis ; 
while  it  will  rarely  fail  to  aggravate  the  disease  if  employed  before 
inflammation  is  brought  under  the  discipline  of  the  lancet,  low  diet, 
&;c.,  or  where  the  alimentary  canal,  or  the  system  at  large,  is  in  an  ir- 
ritable state. — Note  F  p.  1114,  Mm  p.  1141. 

S92i,  y.  Thirdly.  The  power  of  iodine,  and  of  its  combinations, 
reaches  yet  farther,  and  more  remarkably,  perhaps,  than  as  respects 
its  control  over  bronchocele.  It  has  often  accomplished  the  removal 
of  certain  chronic  affections  which  appeared  to  have  been  excluded 
from  the  reach  of  every  other  medical  agent.  This  has  been  especially 
true  of  many  cases  of  those  affections  which  have  run  on  to  induration. 
Here  it  is  that  iodine  illustrates  its  remarkable  virtues  as  an  alterative, 
in  breaking  up  the  most  obstinate  conditions  of  disease,  changing  en- 
tirely the  long-established  morbid  action  of  those  capillaries  from 
which  the  deposition  of  a  peculiarly  modified  condition  of  lymph 
arises,  and  which  forms  some  of  the  worst  enlargements  and  indura- 
tions short  of  carcinoma  (§  733y',  738,  740  a,  b) ;  while,  also,  its  san- 
itive  effect  must  extend  to  the  absorbent  system  of  the  part,  increas- 
ng  its  energy,  and  thus  reducing  the  volume  of  the  organ  and  restor- 
mg  it  to  its  natural  state.  Mercury,  it  is  true,  will  accomplish  this  in 
some  instances,  but  is  comparatively  inoperative,  and  they  are  beyond 
the  reach  of  quinine. 

So  also  in  those  chi-onic  enlargements  and  indurations  of  the  liv- 
er and  spleen  which  form  the  sequelae  of  intermittent  and  remittent 
fevers  the  Peruvian  alterative  finds  a  competitor  in  iodine,  though 
they  will  now  harmonize  together  (§  892,  kk).  Mercury,  too,  in  some 
of  its  forms,  is  also  more  or  less  applicable  to  these  conditions.  But, 
to  iodine  we  look  with  greater  confidence  in  the  intractable  shapes ; 
and  here  we  may  not  calculate  much  upon  the  cinchona  alkaloids. 
Nevertheless,  even  here  mercury  may  be  often  advantageously  asso- 


616  INSTITUTES    OF    MEDICINE. 

ciated  with  iodine ;  and  this  is  particularly  true  of  bad  forms  of  he- 
patic induration.  Iodine,  however,  is  more  apt  to  take  in  its  thera- 
peutical scope  those  enlargements  of  the  spleen  which  are  known  as 
ague  cakes.  They  have  often  yielded  to  its  influence  in  this  and  ir 
other  countries ;  and  sometimes,  indeed,  where  the  splenic  induration 
has  been  independent  of  fever,  and  where  quinia  is  powerless  (§  662  a, 
813  h,  814,  816  h,  892  hk).     Leeching  often  promotes  their  effect. 

The  uterus,  in  its  former  intractable  indurations  and  enlargements, 
has  frequently  yielded  of  late  to  the  alterative  action  of  iodine.  Even 
when  of  a  bony  hardness,  and  filling  nearly  the  cavity  of  the  pelvis, 
this  condition  of  the  uterus  has  given  way  to  iodine  in  the  space  of 
six  weeks,  the  volume  of  the  organ  reduced  to  the  natural  size,  and 
the  catamenia  restored.  Here  the  dependence  was  upon  iodine  alone; 
and  justly  so,  since  there  was  no  local  or  constitutional  inflammatory 
symptom  to  require  the  co-operation  of  a  depletory  treatment.  But, 
in  other  examples,  where  more  or  less  active  inflammation  has  at- 
tended the  uterine  enlargements,  local  and  general  bloodletting,  rest, 
low  diet,  &c.,  have  been  brought  advantageously  to  the  successful  use 
of  iodine  (§  855,  856).  It  is  astonishing,  too,  with  what  rapidity  these 
conditions  of  the  uterus  have  given  way ;  yielding  entirely,  in  the  most 
successful  cases,  within  periods  varying  from  six  weeks  to  four  months. 

These  uterine  cases,  like  the  ophthalmic,  illustrate  the  safety  and 
advantage  of  applying  iodine  directly  to  the  affected  part,  wherever 
accessible ;  it  being  rubbed,  in  the  fonn  of  an  ointment,  in  the  case  of 
the  uterus,  upon  the  neck  of  that  organ.  This  practice  has  succeed- 
ed especially  where  the  neck  of  the  uterus  has  been  the  special  seat 
of  induration,  and  of  those  hard  tumors  which  are  liable  to  run  into 
ulceration. 

Iodine  has  even  made  salutary  impressions  upon  ovarian  tumors; 
and  here,  also,  it  is  mainly  useful  in  the  indurated  enlargements  of  the 
ovaries,  and  probably  little,  if  at  all,  in  ovarian  dropsy. 

Leaving  the  uterine  system  for  its  associate  mammary  gland,  we 
have  many  accounts  of  its  partial  success,  at  least,  in  those  scin-ous 
affections  which  put  on  some  of  the  aspects  of  cancer,  but  without  its 
malignancy ;  relieving  the  distress,  and  holding  the  disease  in  check ; 
while  even  cancer  itself,  and  in  its  ulcerated  state,  is  said  to  have  de- 
rived mitigation  from  the  external  use  of  iodine. 

Few  affections  are  more  sad  than  enlargements  and  indurations  of 
the  prostate  gland  ;  and  here,  too,  the  sufferer  has  sometimes  obtained 
relief  from  this  remarkable  agent,  both  from  its  internal  and  external  use. 

The  parotid  glands  swell  up  and  remain  permanently  enlarged  and 
indurated  after  scarlatina,  and  from  other  transient  causes  ;  and  the 
lymphatic  glands  become  involved  in  the  same  way  from  sympathy 
with  diseased  states  of  the  stomach,  or  from  other  causes  not  connect- 
ed with  the  scrofulous  diathesis.  In  all  these  cases,  iodine  is  the  most 
efficient  agent ;  at  least,  in  a  general  sense.  But  these  are  cases,  also, 
for  leeching  ;  which  not  only  greatly  heips  the  restorative  change,  but 
imparts,  also,  greater  efficacy  to  the  iodine.  Indeed,  it  is  not  unusual 
that  repeated  applications  of  leeches  to  these  glandular  tumors,  al- 
though of  an  extremely  indolent  nature,  will  alone  overthrow  their 
morbid  states,  and  disperse  the  whole  affection.  It  is  a  common  mode 
of  treatment  in  my  practice,  and  has  often  revealed  an  alteiative  influ- 
ence of  the  remedy  of  which  cupping  -=  rncapable  (^  893  c,  c,  q,  926). 


THERAPEUTICS. lODINK.  617 

892 1,  g.  Iodine  has  been  employed  internally  and  externally,  with 
various  degrees  of  advantage,  in  chronic  affections  of  the  skin,  such  as 
lepra, ichthyosis,  psoriasis,  &c.,  audit  has  been  applied  in  the  same  vfa.y 
to  arrest  the  progress  of  phagedenic  and  other  destructive  ulcers, 
which  often  put  on  favorable  changes  under  the  local  as  well  as  con- 
stitutional effects  of  this  agent ;  which  is  also  equally  true  of  bromine. 

8921^,  7i.  Nor  has  secondary  syphilis  refused  to  yield  to  the  power 
of  iodine  ;  and  this,  too,  in  cases  where  mercury  has  either  failed,  or 
has  aggravated  the  affection.  But,  these  cases  are  not  .common,  and 
we  should  not  be  led  away  from  the  better  remedy  by  i-are  exam- 
ples of  greater  success  from  an  agent  which  will  commonly  fail. 
Where  iodine  has  succeeded  in  cases  of  this  nature,  without  the  co- 
operation of  mercury,  the  syphilitic  affection  may  have  been  under  the 
influence  of  the  scrofulous  diathesis  (§  659,  662  a).  Besides  the  in- 
ternal proof  concerned  in  these  cases,  the  foregoing  conclusion  is 
strengthened  by  the  emaciation,  ulcerations  of  the  skin  and  throat, 
and  the  inflammation  of  the  bones  and  periosteum,  which  often  attend 
cases  where  iodine  has  exerted  an  independent  sway. 

But  iodine  has  succeeded  most  happily  in  syphilitic  cases  when 
combined  with  mercury ;  especially  where  syphilis  has  affected  scrof- 
ulous subjects.  But  simple  iodine,  true  to  its  great  prerogative  of 
overthrowing  deep-seated  mischief  of  chronic  glandular  inflammations, 
has  been  successfully  applied  to  old  venereal  affections  of  the  testicles, 
and  to  indolent  buboes. 

892^,  i.  Gonorrhoea  and  leucorrhoea,  in  their  indolent  states,  have 
been  successfully  treated  by  iodine  ;  especially  so  in  scrofulous  habits, 
when  the  relief  it  yields  is  more  uniform  than  in  other  cases. 

892^,  Ic.  I  stated  just  now,  that  iodine  has  been  more  successful  in 
real  ovarian  tumors  than  in  simple  ovarian  dropsy  ;  but  other  drop- 
sical affections  have  not  escaped  the  far-reaching  virtues  of  this  new 
agent;  though  I  have  not  much  to  say  in  commendation  of  its  efficacy 
on  this  score.  As  in  many  other  affections,  it  is  evident  that  iodine 
delights  in  the  worst  forms  of  dropsy,  and  is  little  disposed  to  grapple 
with  those  simple  conditions  which  depend  upon  mere  inflammation 
of  the  serous  or  cellular  tissues.  It  makes  its  attack,  rather,  upon 
those  dropsies  which  nothing  else  will  reach ;  such  as  are  symptom- 
atic of  organic  affections  of  the  liver,  or  kidneys,  or  spleen,  or  heart, 
&c.,  and  where  a  low  inflammation  is  instituted,  sympathetically,  in 
the  serous  tissue  of  the  abdomen  or  thorax,  as  the  immediate  proxi- 
mate cause,  and  kept  up  by  the  organic  disease.  And  now  we  under- 
stand how  it  is  that  iodine  will  sometimes  reach  these  most  formidable 
dropsies,  since  it  is  the  pecuhar  province  of  this  agent  to  break  up  old 
organic  lesions  ;  and,  in  exerting  this  astonishing  office  in  regard  to 
the  liver,  &c.,  the  cause  which  maintains  the  serous  inflammation  is 
removed,  and  the  dropsical  affection  disappears  as  a  consequence. 
Hence,  again  and  again,  the  importance  of  looking  well  not  only  to 
the  nature  of  the  pathological  cause,  but  to  all  the  complications  with 
which  it  may  be  attended,  and  their  sympathetic  relations  to  each  oth- 
er (§  905). 

8921,  I.  Iodine  has  been  successfully  employed  as  an  emmenagogue 
by  most  of  the  physicians  who  have  illustrated  its  uses.  My  ovra  ob- 
servation leads  me  to  believe  that  it  is  mostly  useful  in  restoring  men- 
struation in  subjects  of  a  scrofulous  diathesis ;  and  here  it  will  be  sal- 


G18  INSTITUTES    OF    MEDICINE. 

utary,  if  not  contra-indicated  by  irritable  states  of  the  btomach  and  in- 
testines. But,  even  in  such  cases  the  iodide  of  starch,  or  the  milder 
sponge,  may  be  admissible  ;  and  this  remark,  it  will  be  readily  seen,  is 
more  or  less  applicable  to  other  affections  attended  by  morbid  irrita- 
bility of  the  gastro-intestinal  mucous  tissue. 

The  same  agent  is  also  entitled  to  much  consideration  as  an  indirect 
emmenagogue  in  all  cases  where  suspended  menstruation  is  complica- 
ted with  chronic  enlargements  or  indurations  of  any  of  the  great  in- 
ternal viscera.  In  these  instances  the  uterine  affection  is  only  symp- 
tomatic of  graver  disease,  as,  indeed,  it  may  be  said,  in  a  majority  of 
other  cases,  to  depend  upon  a  primary  though  only  simple  derange- 
ment of  some  other  part,  especially  of  the  alimentary  canal  (§  689  /, 
905),  the  uterus  being  disturbed  by  reflected  nervous  actions. 

892^,  VI.  Chronic  rheumatism  has  proved  itself  amenable,  in  some 
cases,  to  iodine.  We  shall  find,  however,  much  better  remedies  for 
rheumatism,  in  all  its  aspects.  But,  it  is  not  remarkable  that  a  power 
so  sovereign  in  many  other  intractable  maladies  should  sometimes 
succeed  in  whatever  less  difficult  and  somewhat  analogous  instances 
it  may  be  brought  to  bear.  It  must  be  considered,  also,  that  the 
scrofulous  diathesis  is  common,  and  that  here  iodine  is  at  home. 

892 '2,  n.  In  the  form  of  iodine  vapor  the  novelty  is  even  held  up  as 
a  remedy  for  pulmonary  consumption  by  Sir  C.  Scudamore,  Sir  James 
Murray,  and  others.  But,  it  is  scarcely  probable  that  this  condition 
can  be  affected  in  any  other  way  than  through  the  constitutional 
method,  and  it  may  be  expected  that  the  vapor  will  share  the  fate  of 
boiling  tar,  and  the  steam  of  the  horse-stable. 

8921,  o.  Gout  has  yielded  to  this  potent  but  quiet  remedy.  The 
swellings  of  the  joints  have  given  way  not  only  in  chronic,  but  in 
some  acute  forms  of  the  disease.  Those  practitioners  who  have  em- 
ployed it  in  the  latter  case  are  probably  of  them  who  cure  the  same 
disease  with  bark  and  wine,  and  it  has  been  overrated  in  the  former. 
With  the  same  experimental  views  iodine  has  been  administered  in 
diabetes  mellltus  ;  but,  whether  it  may  be  useful  or  detrimental  in  this 
disease  will  depend,  clearly,  upon  the  circumstances  of  each  individual 
case  ;  especially  upon  the  state  of  the  digestive  organs,  which  take  an 
important  part  in  the  pathology  of  diabetes  (^  1007  c). 

8921,  2^-  Iodine  is  employed  by  the  surgeon  for  various  local  pur- 
poses, among  which  many  forms  of  ill-conditioned  ulcers  are  the  most 
common.  Here  it  often  manifests  its  sanative  influence,  but  more  so 
when  the  cases  justify  its  internal  use.  It  were  well,  too,  if  these 
cases  were  oftener  treated  according  to  the  precepts  of  medical  phi 
losophy  and  the  experience  of  sound  physicians. 

8921,  q.  The  ioduretted  bath  has  been  overrated,  and  the  proof  is 
against  the  supposed  absorption  by  the  skin  (^  892^  c,  1088  h,  c). 

The  details  as  to  dose,  &c.,  must  be  sought  by  the  young  inquirer 
in  the  appropriate  books.  There,  too,  he  will  find  some  useful  com- 
binations of  this  with  other  substances,  which  have  been  brought  to- 
gether by  the  chemist,  who  is  always  laying  the  profession  under  these 
high  obligations.  We  shall  not  often  want,  however,  more  than  the 
simple  substance,  the  iodide  of  potassium,  the  iodide  of  mercury,  and 
the  iodide  of  starch.  It  is  not  improbable,  also,  that  we  may  some- 
times find  in  bromine,  or  some  of  its  combinations,  useful  substitutes 
for  iodine. 


THERAPEUTICS. IDDINE.  619 

892i,  r.  I  have  spoken  of  the  iodide  of  starch  as  suitable  in  many 
cases  where  the  intestinal  canal,  or  the  system  at  large,  is  too  irritable 
for  the  more  active  forms  of  iodine.  But,  I  am  apt  to  think  that,  in 
such  cases,  we  may  also  fall  back  advantageously  upon  the  vegetable 
a'thiops,  or  upon  the  burnt  sponge.  They  have  done  us  service  in 
former  times,  and  may  do  it  again. 

It  is  certainly  a  curious  fact,  in  the  history  of  the  Materia  Medica, 
that  the  fucus  vesiculosus  and  the  sponge,  one  an  unseemly  weed  of  the 
ocean,  and.  the  other  an  anomalous  organic  being  from  the  bottom  of 
the  Mediterranean,  should  have  been  applied  to  the  relief  of  broncho- 
cele  and  scrofula,  and  have  led  to  the  important  supplement  which 
the  Materia  Medica  has  enjoyed  in  the  iodides  and  bromides.  Nor 
is  it  less  curious  that  a  remedy  for  the  same  affections  had  been  de- 
tected in  the  liver  of  the  cod. 

Although  the  day  of  these  mysterious  agents  has  passed  away, — 
passed  in  their  uses  and  their  mystery, — it  may  be  that  exigencies . 
may  now  and  then  commend  to  our  notice  their  quiet  influences  ; 
when  we  may  depend  upon  it  we  shall  find  organic  nature  as  unde- 
viating  in  these  low  conditions  of  life  as  in  all  other  objects  within  its 
comprehensive  range.  We  shall  always  find  iodine  and  bromine 
among  these  humble  tenants  of  the  deep  ;  and,  in  doses  of  one  drachm 
to  four  of  the  calcined  preparations,  we  may  depend  upon  i-esults,  it 
not  as  certain  and  speedy  as  those  of  iodine  or  bromine,  at  least  such 
as  will  evince  an  efficient  remedial  power  (§  290,  350,  nos.  25,  26. 
26^,28). 

892|,  s.  It  sometimes  happens  when  iodine,  or  its  compounds,  ins- 
tate the  intestinal  canal,  or  the  system  at  large,  they  may  be  rendered 
compatible  by  small  quantities  of  morphia,  or  the  extract  of  hyoscya 
mus,  or  of  lettiice,  &c.  This  interposition  of  narcotics,  however,  tc 
promote  the  tolerance  of  iodine,  demands  great  care;  and  the  narcotic 
must  not  be  detrimental  if  the  iodine  were  not  employed.  But,  it 
commonly  happens,  when  iodine  produces  its  salutary  effects,  that  it 
improves  the  appetite,  if  it  have  been  deficient ;  or,  at  least,  does  not 
impair  it.  In  a  general  sense,  also,  if  the  subject  have  been  thin  ho 
gains  in  flesh  under  its  influence.  These  affirmations  can  be  made 
of  no  other  remedy,  excepting  bromine,  of  equal  curative  power.  It 
is  often,  indeed,  upon  the  digestive  organs  that  the  fii'st  salutary  effects 
of  iodine  are  manifested ;  as  seen  not  only  in  the  improvement  of  ap- 
petite and  digestion,  but  in  the  more  abundant  elaboration  of  bile,  and 
m  a  healthier  aspect  of  the  fecal  discharges.  Simultaneously,  also, 
the  bowels  act  more  freely ;  and,  when  purging  takes  place  during 
the  use  of  iodine,  it  is  probably  often  more  from  the  redundant  flow 
of  bile  which  it  has  promoted  than  from  the  direct  action  of  the  rem- 
edy upon  the  intestinal  canal. 

892^,  t.  Here,  then,  through  these  effects  upon  the  organs  of  diges- 
tion, we  arrive  at  an  interpretation  of  those  salutary  changes  which 
are  exerted  upon  parts  remotely  situated.  It  is  either  a  direct  sympa- 
thetic result,  or  the  sympathetic  consequence  of  the  removal  of  disease 
fi-om  the  abdominal  viscera,  by  which  the  remote  affections  had  been 
maintained,  as  expounded  in  §  226,  503,  524  c,  893  a,  c,  905. 

892|,  u.  In  a  o-eneral  sense,  it  has  been  found  that  a  non-stimulant 
diet  promotes  the  salutary  effects  of  iodine.  This  agent  is,  in  itself,  a 
stimulant  to  the  circulation  in  most  of  the  morbid  states  to  which  it  ia 


G20  INSTITUTES    OP    MEDICINE. 

applicable ;  and,  while  it  heals  by  other  virtues,  its  stimulant  proper- 
ties disqualify  it  for  all  active  conditions  of  inflammation  (§  137  d^ 
143  c,  150,  151).  It  is  therefore  an  object  in  the  lower  forms  of  in- 
flammation which  come  within  the  range  of  iodine  to  avoid  increas- 
ing the  susceptibility  to  its  stimulant  virtues  by  stimulating  food  (§ 
143  c,  55(i  c,  872  a).  In  such  conditions,  indeed,  abstemiousness,  in 
respect  to  food,  is  in  itself  directly  curative  (§  150,  856,  863,  1007  h-d, 
1008). 

But,  there  are  some  conditions  to  which  iodine  is  peculiarly  suited, 
[)articularly  bronchocele,  when  the  general  health  is  often  sound,  and 
when  the  ordinary  diet  may  be  pursued  (§  143  c,  150,  151,  8921^  a). 
In  most  other  affections  to  which  iodine  is  adapted  the  general  health 
is  apt  to  be  unsound,  and  the  local  affections  of  a  distinctly  inflamma- 
tory nature. 

892^^,  V.  When  speaking  of  cinchona  and  other  special  remedies  for 
specific  forms  of  disease  (§  892  b),  I  endeavored  to  demonstrate  not  only 
their  therapeutical  eff*ects  through  alterative  reflex  actions  of  the  nerv- 
ous system,  but,  by  the  variety  of  means  leading  to  a  common  result, 
the  absurdity  of  the  humoral  and  chemical  hypotheses,  and  I  would  now 
reproduce  that  section  in  connection  with  iodine ;  nor  would  it  be  less 
appropriate  to  the  article  upon  arsenious  acid  (§  892;^).  The  great  va- 
riety of  special  forms  of  disease  which  iodine  and  arsenic  will  remove 
contributes  to  the  demonstration  (§  892^  i,  892|^,  900,  902,  951  c). 


892|,  a.  The  origin  and  special  character  of  ergot  have  been  only 
recently  well  determined.  Many  have  supposed  it  to  be  a  morbid 
conversion  of  the  seed,  produced  by  some  insect.  Others  regard  it 
as  a  parasitical  fungus ;  and  it  is  incorporated  by  them  as  a  true 
plant  in  the  genus  selerotium.  It  has  been  shown,  however,  by  Tes- 
sier,  and  others,  that  a  part  only  of  the  grain  sometimes  becomes  er- 
gotized ;  which  proves  sufficiently  that  it  is  not  a  fungus.  The  stig- 
ma, too,  often  remains  at  the  top,  and  the  ergot,  like  the  rye,  is  inti- 
mately connected  with  the  receptacle.  Other  observations,  more  re- 
cently made,  prove  conclusively  that  the  microscope  has  been  at  fault, 
even  in  this  very  visible  and  hard  substance,  in  its  report  of  parasiti- 
cal fungi  as  constituting  the  ergotized  rye  {§  83  b,  131).  The  ergot 
is  now  sufficiently  shown  to  be  a  morbid  degeneration  of  the  rye. 

892  ry,  b.  Ergot  was  introduced  into  regular  practice,  as  a  powerful 
agent  for  exciting  uterine  contractions  during  the  process  of  labor,  by 
the  venerable  John  Stearns,  M.D.,  of  the  city  of  New  York,  in  a 
letter  to  Dr.  Ackerly,  in  1808 ;  though  it  had  been  a  popular  means 
of  expediting  labor  a  century  and  a  half  ago,  in  Germany,  Italy,  and 
France. 

This  letter  of  Dr.  Stearns  has  not  often  met  the  public  eye,  nor  has 
that  reward  attended  the  service  which  it  was  the  delight  of  darker 
ages  to  bestow  upon  the  great  benefactors  of  man.  The  letter,  too,  ia 
interesting  from  the  brevity  with  which  it  announces  a  most  impor- 
tant discovery  (new  at  least  to  the  profession),  for  the  perfect  accuracy 
with  which  the  effects  are  described,  and  for  the  precautions  which 
Dr.  Stearns  had  the  sagacity  to  suggest  as  to  the  circumstances  under 
fvhich  this  aerent  should  be  administered,  but  which  have  been  most 
strangely  violated  by  others. 


THERAPEUTICS. ERGOT.  621 

The  brief  statement,  which  has  now  gi'own  into  volumes,  of  the 
wonderful  properties  of  ergot,  and  of  the  only  known  substance  which 
is  capable  of  exciting  uterine  contractions,  contrasts  in  its  brevity  and 
modesty  not  less  remarkably  with  the  never-ending  and  inflated  ac- 
counts which  are  often  coming  to  us  of  worthless  specifics,  and  more 
worthless  speculations,  than  does  the  decisive  power  of  ergot  form  an 
imposing  contrast  with  the  whole  host  of  those  pretended  remedies 
which  have  fallen  into  oblivion,  one  after  another,  when  their  ineih- 
ciency  has  been  proved  by  an  adequate  sacrifice  of  human  life. 

But  let  us  once  more  call  into  light  the  original  announcement. 
Thus  the  letter  : 

"  In  compliance  with  your  request,  I  herewith  transmit  to  you  a 
sample  of  the  pulvis  parturicns,  which  I  have  been  in  the  habit  of 
using  for  several  years  with  the  most  complete  success.  It  expedites 
lingering  parturition,  and  saves  to  the  accoucheur  a  considerable  por- 
tion of  time,  without  producing  any  bad  effect  on  the  patient. 

"  The  cases  in  which  I  have  generally  found  this  powder  to  be  useful, 
are  when  the  pains  are  lingering,  or  have  wholly  subsided,  or  are  in  any 
way  incompetent  to  exclude  the  foetus.  Previous  to  its  exhibition,  it 
is  of  the  utmost  consequence  to  ascertain  the  presentation,  and  wheth- 
er any  preternatural  obstruction  prevent  the  delivery ;  as  the  violent 
and  almost  incessant  action  which  it  induces  in  the  uterus  precludes 
the  possibility  of  turning.  The  pains  induced  by  it  are  peculiarly 
forcing,  though  not  accompanied  by  that  distress  and  agony  of  which 
the  patients  frequently  complain  when  the  action  is  much  less.  My 
method  of  administering  it  is  either  in  decoction  or  powder.  Boil 
half  a  drachm  of  the  powder  in  half  a  pint  of  water ;  and  give  one 
third  every  twenty  minutes  till  the  pains  commence.  In  powder  1 
give  from  five  to  ten  grains.  Some  patients  require  larger  doses, 
though  I  have  generally  found  these  sufficient. 

"  If  the  dose  be  larger,  it  will  generally  produce  nausea  and  vomit- 
ino-.  In  most  cases  you  will  be  surprised  with  the  suddenness  of  its 
operation.  'It  is,  therefore,  necessary  to  be  completely  ready  before 
you  begin  the  medicine,  as  the  urgency  of  the  pains  will  allow  you 
but  a  short  time  afterward.  Other  physicians  who  have  administered 
it  concur  with  me  in  the  success  of  its  operation. 

"  The  modus  operandi  I  feel  incompetent  to  explain.  At  the  same 
time  that  it  augments  the  action  of  the  uterus,  it  appears  to  relax  the 
rigidity  of  the  contracted  muscular  fibres. 

"  It  is  a  vegetable,  and  appears  to  be  a  spurious  growth  of  rye.  On 
examining  a  granary  where  rye  is  stored,  you  will  be  able  to  procure 
a  sufficient  quantity  among  the  grain.  Rye  which  grows  in  low,  wet, 
ground  yields  it  in  greatest  abundance.  I  have  no  objection  to  youi 
giving  this  any  publicity  you  may  think  proper." — John  Stearns,  in 
Neiu  "York  Medical  Repository,  vol.  xi.,  p.  308,  1808. 

That  is  the  whole  ;  correct  in  every  aspect,  and  without  a  practical 
improvement  from  that  day  to  the  present;  unless  it  be  an  extension 
of  some  of  the  minor  points  which  are  embraced  in  the  comprehen- 
sive statement  of  the  discoverer.  It  may,  therefore,  stand  as  an  admi- 
rable concentration  of  all  the  leading  details  relative  to  this  great  ac- 
cession to  the  universal  cause  of  humanity  and  medical  science.  It  is 
the  best  general  guide  for  the  practitioner  that  can  be  devised,  and 
had  it  been  duly  posted  in  medical  journals  and  obstetrical  works,  in- 


622  INSTITUTES    OF    MEDICINE. 

Stead  of  some  of  its  violations  which  have  appeared  from  time  to  time 
it  w^ill  be  conceded,  I  catmot  doubt,  that  I  am  not  astray  from  the  ob 
jects  of  the  present  work  in  bestowing  an  ample  notice  of  the  origin 
of  an  important  remedy  which  stands  alone  in  the  natural  world. 

No  sooner  was  this  discovery  announced  than  its  value  was  pro- 
claimed in  different  quarters,  not  only  by  a  confirmation  of  the  impu- 
ted virtues  of  ergot,  but  by  an  opposition  to  its  use  on  account  of  those 
very  attributes  of  the  remedy.  It  was  said  to  be  dangerously  violent 
in  its  uterine  influences.  And  so  it  is,  like  all  things  else  in  their 
various  relations  to  disease  unless  employed  with  a  proper  reference 
to  "precaution"  (§  137  d,  143  c,  150,  151). 

With  others  there  was  not  a  ready  disposition  to  concede  the  merit 
of  originality,  and  records  were  hunted  up  for  the  purpose  of  showing 
that  ergot  had  been  long  before  in  the  hands  of  the  common  people, 
about  in  the  same  way  as  had  been  the  cow-pox  before  Jenner  confirm- 
ed its  protective  power.  But,  whether  the  former  was  of  any  greater 
use  than  motherwort  the  profession  had  not  troubled  themselves  to 
inquire. 

Frightful  accounts  were  also  quoted  of  wide-spread  and  fatal  epi- 
demics, which  had  been  commonly  charged  upon  rye,  of  which  ergot 
was  supposed  to  be  the  insidious  cause  (§  S92|,  I).  A  more  feebla 
conjecture  was  never  assigned  for  epidemics ;  unless  the  hypothesis 
be  excepted,  that  damaged  rice  was  the  cause  of  the  malignant  chol- 
era in  Asia  and  Europe,  because  the  patients  had  "  rice-water  evac- 
uations :"  and,  also,  that  the  milk  of  cows  in  some  of  our  Western 
States  is  the  cause  of  a  malignant  form  of  miasmatic  fever  [Med.  and 
Physiolog.  Cojnm.,  vol.  i.,  p.  537-539). 

Other  writers  entered  the  field  against  the  new  agent  in  other 
shapes  ;  some  of  them  denouncing  the  remedy  as  invariably  fatal  to 
mother  and  child,  while  others  affirmed  that  it  was  as  inert  as  rye  itself. 

But  time  puts  all  things  right,  though  it  may  come  too  late  for  him 
who  should  reap  the  reward.  Hai'vey  lost  all  his  practice  because  of 
the  envy  which  was  excited  by  his  discovery  of  the  ciPculation  of 
the  blood ;  and  nothing  but  demonsti'ation  upon  demonstration  to  the 
eyes  of  the  multitude  rescued  Jenner  from  the  execration  which  he 
received  because  he  had  been  so  unfortunate  as  to  render  a  great  ser- 
vice to  his  cotemporaries.  Newton,  too,  was  so  annoyed  by  opposi- 
tion that  he  regretted  his  pursuits,  and  has  left,  in  consequence,  his 
stamp  upon  the  very  front  of  Philosophy,  that  she  is  "  a  capricious 
maid."  But  there  is  this  consolation,  as  Bacon  has  it — "The  sweetest 
canticle  is,  '  Nunc  dimittis,^  when  a  man  hath  obtained  worthy  ends  and 
expectations.  Death  has  this  also,  that  it  openeth  the  gate  to  good 
fame  and  extinguisheth  envy  :   '  Extinctus  amahitur  idem.''  " 

It  was  not  so  in  the  early  ages  of  our  art ;  and  had  Har\'ey,  or  Jen- 
ner, or  Stearns,  have  lived  at  that  remote  period,  temples  would 
have  overspread  the  land  for  the  perpetuation  of  their  names,  and  aa 
grateful  memorials  for  their  services  to  the  universal  family  of  man- 
kind. 

892?-,  c.  Ergot  is  poisonous  to  flies,  leeches,  and  some  other  small 
animals.  In  very  large  quantities  it  is  said  to  be  destructive  to  dogs, 
cats,  pigs,  sheep,  rabbits,  fowls,  &c.  But  this  effect  has  been  evident- 
ly overrated,  since  it  appears  that  some  ounces  were  necessary  to 
affect  rabbits  and  pigeons.     Sheep  are  put  down  by  Pereira,  in  his 


THERAPEUTICS. ERGOT.  623 

Materia  Medica,  among  the  animals  that  are  liable  to  be  poisoned  by 
ergot.  But  a  little  farther  on  he  says  that,  "In  1811,  twenty  sheep 
ate  together  nine  pounds  of  it  daily  for  four  weeks,  without  any  ill  ef- 
fects. In  another  instance,  twenty  sheep  consumed  thirteen  pounds 
and  a  half  daily,  for  two  months,  without  injury."  And  then  as  to 
other  animals  :  "  Thirty  cows  took  together  twenty-seven  pounds  dai- 
ly, for  three  months,  with  impunity ;  and  two  fat  cows  took  in  addition 
nine  pounds  of  ergot  daily,"  with  no  ill  effect  whatever. 

The  same  conflicting  statements  are  made  as  to  the  effects  of  ergot 
on  man  in  health  ;  some  affirming  that  in  doses  of  half  a  drachm  to  two 
drachms  it  excites  nausea,  occasions  pain  in  the  head,  dilated  pupils, 
&c.;  while  other  experimenters  declare  that  it  produces  no  effects  what- 
ever. This  is  probably  the  fact;  since  we  have  heard  of  only  some  very 
rare  cases  in  which  it  has  had  any  other  effect  upon  the  susceptible  preg- 
nant, or  parturient  female,  than  that  of  exciting  uterine  contractions. 
We  may,  therefore,  conclude  that  the  fractional  number  of  some  fire 
or  six  cases  in  which  delirium  or  stupor  is  said  to  have  resulted  from 
doses  of  half  a  drachm  to  two  drachms  was  due  to  other  causes ; 
especially  when  it  is  considered  that  such  affections  of  the  head  are 
not  unusual  with  parturient  women  where  no  ergot  has  been  exhibited. 

Universal  and  large  experience  has  settled  the  fact  that  ergot  has 
no  special  influence  on  the  nervous  system,  and  that,  in  its  therapeu- 
tical doses,  at  least,  it  is  perfectly  inoffensive  when  administered  with 
the  proper  "  precautions"  that  are  relative  to  the  uterine  system.  This 
consideration,  therefore,  imparts  an  inestimable  value  to  the  uterme 
agent;  and  the  other  attending  circumstances  go  with  iodine,  arsenic, 
&c.,  in  reprobating  all  conclusions  as  to  the  therapeutical  virtues  of 
any  agent  which  are  associated,  as  inductions,  with  its  manifestations 
upon  man  in  health,  and  especially  upon  the  modified  constitution  of 
animals,  or  the  yet  greater  modifications  that  are  presented  by  vege- 
table life.  There  is  no  other  agent  known  to  possess  virtues  anal- 
ogous to  those  of  ergot,  while,  also,  its  only  manifest  influences  are 
pronounced  under  special  modified  states  of  the  uterus.  But,  perhaps 
you  say,  and  truly,  too,  that  other  things  will  excite  abortion,  or  some- 
times hasten  natural  labor.  But,  in  all  such  cases,  the  results  depend 
on  very  different  influences  ;  on  some  violence  inflicted  on  other  parts, 
or  some  uterine  or  other  malady  which  may  be  thus  removed.  Can- 
tharides  may  have  sometimes  excited  abortion ;  but,  if  this  be  true,  it 
is  practically  useless,  rare  in  the  effect,  and  obnoxious  to  other  palpa- 
ble objections.  The  highest  practical  as  well  as  philosophical  consid- 
erations r>re  every  where  involved  in  the  principles  now,  again,  under 
investigation  (§  137  d,  143  c,  150,  151,  650,  831,  836,  854  bb,  857. 
859  b,  892  c,  892i  b,  &c.). 

892^,  d.  The  next  question  which  comes  up  relates  to  the  circum- 
stances under  which  the  uterus  is  susceptible  of  the  influences  of  this 
specific  agent ;  for  this  one  may  be  so  regarded  till  others  may  appear 
which  will  accomplish  the  same  results. 

Such  is  the  remarkable  action  of  ergot  after  labor  has  been  institu- 
ted, especially  after  the  usual  period  of  gestation,  that  it  was  natural, 
perhaps,  to  suppose  that  the  agent  can  bring  on  the  process  by  its  own 
specific  virtues  (§  143  c,  150,  151,  652  c,  863).  Experiments  have 
been  accordingly  made  upon  animals  to  ascertain  whether  abortion 
would  be  thus  brought  about;  but  Villeneuve.  Warner,  ChatU'd,  and 


624  INSTITUTES    OF    MEDICINE. 

others,  have  failed  in  all  their  attempts,  whether  the  ergot  be  injected 
into  the  circulation,  or  administered  by  the  stomach  (§  150,  151), 
But  this  would  not  prove  that  abortion  may  not  be  thus  instituted  in 
the  human  subject  (§  892|,  c).  And  to  show  how  deeply  founded  in 
nature  are  some  of  the  important  laws  embraced  in  a  former  section 
(§  150),  it  is  worthy  of  remark  that  ergot  commonly  promotes  the  ute- 
rine contractions  in  dogs,  cats,  sheep,  cows,  deer,  and,  indeed,  of  all 
other  animals,  so  far  as  tried,  after  natural  labor  has  been  for  some 
time  in  progi'ess ;  even  where  the  uterus  has  become  exhausted  by 
its  long-continued  efforts. 

As  to  the  human  female,  there  is  probably  not  much  doubt  that  er- 
got is  capable  of  exciting  abortion.  The  vital  relations,  in  the  preg- 
nant state,  are  more  or  less  in  correspondence  with  the  virtues  of  the 
agent  (§  143  c,  150,  189  b,  892|  c).  The  question  is  stated  in  the 
following  manner  by  an  adequate  observer,  and  who  believes  in  this 
remarkable  virtue  of  the  great  uterine  agent : 

"  Given,"  he  says,  "  to  excite  abortion,  or  premature  labor,  ergot 
has  sometimes  failed  to  produce  the  desired  effect.  Hence  many  ex- 
perienced accoucheurs  have  concluded  that  for  this  medicine  to  have 
any  effect  on  the  uterus  it  was  necessaiy  that  the  process  of  labor 
should  have  actually  commenced.  But,  while  we  admit  that  it  some- 
times fails,  Ave  have  abundant  evidence  to  prove  that  it  frequently 
succeeds."  Other  able  observers  testify  to  this  fact;  Miiller,  Rams- 
botham,  and  other  familiar  names. 

It  is  evident,  too,  that  ergot  is  capable  of  acting  upon  the  uterus, 
and  of  exciting  contractions  of  the  organ,  in  its  unimpregnated  state, 
when  its  susceptibilities  are  increased  by  disease  (§  143  c,  150,  151, 
177,  189  h).  Uterine  polypi  have  been  thus  expelled,  and  menor 
rhagia  arrested. 

But,  this  ceases  to  be  remarkable  when  it  is  considered  how  great- 
ly changed  is  uterine  irritability  in  a  state  of  pregnancy ;  when  the 
most  trifling  causes,  such  as  lifting  a  chair,  putting  up  window-cur- 
tains, sudden  joy,  sudden  surprise,  or  grief,  will  rouse  the  muscular 
action  of  the  impregnated  uterus,  and  bring  on  abortion  (§  150,  151, 
189  b,  227,  233,  233f ,  904  d).  If  we  now  add  to  the  foregoing  con- 
siderations the  increasing  tendency  to  abortion  in  proportion  to  the 
frequency  of  its  occurrence,  it  may  aid  our  philosophy  of  life  in  its 
general  aspects,  and  concur  with  other  facts  in  a  specific  illustration 
of  what  I  have  propounded  as  to  the  laws  of  vital  habit  (§  535-567). 

Our  experimental  knowledge,  however,  as  to  the  ability  of  ergot  to 
institute  labor  must  be  always  limited  ;  for  opportunities  must  be 
rare  in  which  a  physician  of  any  moral  sense,  and  therefore  of  any 
reliable  truth,  would  administer  this,  or  any  other  agent,  with  a  view 
to  producing  abortion.  Even  in  the  very  limited  number  of  cases 
where  art  is  called  upon  for  this  solemn  duty  it  rather  seeks  the  me- 
chanical method. 

Connected  with  the  difficulty  of  attaining  an  adequate  knawledge 
of  the  power  of  ergot  of  inducing  abortion  (especially  the  extent  of 
its  power),  are  the  numerous  mistakes  that  have  been  made  in  respect 
to  other  supposed  effects  of  this  substance ;  particularly  those  which 
are  relative  to  the  epidemics,  and  which  continue  to  be  more  or  less 
ascribed  to  its  malign  influence.  But,  what  is  more  to  the  present 
pu  rpose   is  the  important  fact,  that,  although  now  as  in  the  "  epidemic  " 


TIIERAPKUTICS. ERGOT.  625 

times  (p,  622),  doubtless,  rye  largely  compounded  with  ergot  is  ha- 
bitually and  very  extensively  consumed,  we  have  never  heard,  as  one 
of  its  evil  consequences,  that  it  has  given  rise  to  abortion.  This  un- 
deniable truth,  therefore,  must  settle  the  question,  at  least,  as  to  any 
uniformity  in  this  imputed  effect  of  ergot,  and  turn  our  attention  to 
the  mechanical  means  when  the  interposition  of  art  is  required,  and 
our  scrutiny  to  other  expedients  in  detecting  the  criminality  of  oth- 
ers. A  right  decision  of  the  question  is  one  of  great  interest,  not  only 
in  a  philosophical  aspect,  but  on  account  of  its  practical  bearings, 
and,  also,  in  a  medico-legal  aspect. — Note  A  p.  1111. 

892|,  c.  It  may  now  be  said  to  the  young  practitioner,  that  he 
should  bear  in  mind  that  the  expulsive  efforts  are  made  by  the  uterus, 
that  all  the  devices  of  the  lying-in  chamber,  such  as  straining,  pulling, 
&c.,  are  worse  than  useless ,  that  the  uterine  contractions  are  in- 
creased in  violence  and  frequency  soon  after  the  administration  of  er- 
got, and  that  they  generally  go  on  increasing  till  the  birth  is  effected. 
Indeed,  the  parturient  process  sometimes  continues,  under  the  influ- 
ence of  the  agent,  for  several  minutes  after  the  expulsion  of  the  pla- 
centa ;  but  it  commonly  ceases,  so  far  as  the  ergot  is  concerned,  after 
delivery  is  consummated  (§  150,  151,  652  c). 

892|,  f.  The  rapid  and  energetic  action  of  the  uterus  led  Dr, 
Stearns  to  say,  that,  among  other  things,  it  is  "  of  the  utmost  conse- 
quence to  ascertain  whether  any  preternatural  obstruction  prevent 
the  delivery;"  and,  from  what  is  also  said  of  the  circumstances  which 
justify  the  use  of  ergot,  it  is  evident  that  the  discoverer  considered  a 
full  dilatation  of  the  os  uteri  of  indispensable  importance  to  any  thing 
like  a  safe  i"esult.  He  foresaw  that  the  uterus  might  otherwise  be 
ruptured,  or  the  external  parts  lacerated,  or  the  child  destroyed  by 
the  rapidity  with  which  its  head  would  be  forced  along  the  yet  rigid 
parts.  He  foresaw,  I  say,  a  violation  of  nature  if  the  foregoing  con- 
dition were  not  awaited.  And  how  fearfully  has  this  been  verified  in 
pi-actice ;  especially  as  it  regards  the  foetus !  Why  the  vast  differ- 
ence in  results  in  the  hands  of  different  accoucheurs  1  Why  the  nu- 
merous cases  of  cerebral  hemorrhage  in  still-born  ehildren,  that  have 
come  up,  of  late,  for  the  good  of  science  1  The  question  is  readily 
expounded  when  we  turn  to  those  Essays  in  which  it  is  affirmed  that 
ergot  may  be  administered  when  the  mouth  of  the  uterus  has  attained 
the  diameter  of  half  an  inch !  This  has  been  recommended  princi- 
pally with  a  view  to  saving  the  time  of  the  practitioner ;  and  it  opens 
to  us  the  ground  of  the  prejudices,  which  have  sprung  up  in  enlight- 
ened and  more  honest  quarters,  against  the  use  of  ergot  when  it  can 
be  possibly  avoided.  Where  the  safety  of  the  mother  does  not  re- 
quire earlier  interference,  it  is,  doubtless,  a  good  rule  not  to  adminis- 
ter ergot  till  the  head  of  the  child  has  passed  the  brim  of  the  pelvis, 
and  the  labor  has  become  lingering. 

If  the  remedy  be  delayed  till  the  os  uteri  is  well  dilated,  then,  by 
an  admirable  concert  of  sympathy,  the  external  parts  will  have  either 
undergone  a  corresponding  dilatation,  or  a  tendency  to  an  easy  dila- 
tation (§  150,  151,  385,  and  references). 

892|,  g.  "  Previous  to  the  exhibition  of  ergot,"  says  the  discoverei, 
"  it  is  of  the  utmost  consequence  to  ascertain  the  presentation  ;"  and 
now  the  only  question  that  arises  is  relative  to  the  admissible  presenta- 
tions.    The  OS  uteri  is,  of  course,  supposed  to  be  fully  dilated ;  and  it 

R  B 


626  INSTITUTES    OF    MEDICINE. 

appears  to  be  conceded  that  ergot  may  be  employed  when  tne  head  is 
turned  from  its  usual  position.  But,  this  is  not  auspicious.  Breach 
presentations  admit  of  its  use  where  labor  has  become  prolonged,  and 
the  pains  suspended ;  though  here  manual  aid  may  be  safely  applied 
without  the  forceps.  These  instruments  are  always  difficult  but  in 
the  hand  of  experience,  and  are  otherwise  more  or  less  liable  to  ob- 
jection. 

S92|,  h.  It  is  not  alone  in  protracted  labors,  where  the  uterine  ef- 
forts have  ceased  to  be  efficient,  that  ergot  is  applicable  with  a  view 
to  promoting  delivery.  Serious  hemorrhages  sometimes  spring  up, 
where  it  becomes  important  to  hasten  delivery  by  every  possible  means 
that  may  be  less  hazardous  than  the  impending  evil.  In  cases  of  this 
nature,  especially  when  alarming  hemorrhage  comes  on  during  natural 
labor,  and  the  attachment  of  the  placenta  is  right,  we  enjoy  no  means 
so  likely  to  insure  safety  and  immediate  success  as  offered  by  ergot ; 
so  only  the  pelvis  be  not  deformed,  and  the  presentation  suitable, 

892|,  i.  So,  also,  in  ordinary  cases  of  abortion,  where  hemorrhage 
may  become  alarming,  ergot  may  be  employed  to  hasten  the  expul- 
sion of  the  ovum,  and  arrest  the  flow  of  blood.  In  these  instances, 
howevei",  the  tampon  is  probably  preferable,  since  it  is  always  sure, 
and  it  is  not  certain  that  abortion  will  happen. 

892|,  h.  Some  females  are  remarkably  liable  to  profuse  uterine 
hemorrhage  after  natural  labor ;  and  these  are  cases  for  the  adminis- 
tration of  ergot  a  few  minutes  before  the  expulsion  of  the  child  ;  what- 
ever may  be  the  activity  of  the  uterine  contractions.  In  such  instan- 
ces it  is  not  unusual  for  the  pains  to  be  quite  energetic  throughout  the 
labor,  but  to  cease  abruptly  as  soon  as  the  child  is  born.  The  advan- 
tage of  ergot,  therefore,  administered  some  fifteen  or  twenty  minutes 
before  birth  takes  place,  consists  in  its  disposition  to  maintain  the  ute- 
rine contractions  till  the  organ  is  so  reduced  in  volume  that  hemor- 
rhage is  prevented  or  arrested. 

892|,  /.  Again,  where  the  forceps  cannot  be  used  in  puerperal  con- 
vulsions, ergot  may  be  rendered  a  valuable  substitute.  The  objec- 
tions which  have  been  made  to  its  use  in  this  condition,  on  the  ground 
of  its  tendency  to  affect  the  head,  appear  to  be  hypothetical.  In  any 
thing  like  its  therapeutical  doses,  the  common  experience  of  mankind 
has  fully  settled  the  fact  that  it  has  no  tendency  to  induce  or  to  increase 
cerebral  or  any  other  condition  of  disease,  excepting  as  it  may  increase 
convulsions  sympathetically  through  its  uterine  influences. 

The  erudite  Pereira,  in  his  Materia  Medica,  pauses  over  the  exhibi- 
tion of  ergot  in  puerperal  convulsions,  because,  as  he  says,  "  The  nar- 
cotic operation  of  ergot  presents  a  serious  objection  to  its  use  in  cere- 
bral affections"  (§  960,  a). 

There  existed  a  remarkable  prejudice  against  ergot  throughout 
Great  Britain,  for  many  years  after  it  had  come  into  extensive  use  in 
other  countries,  on  account  of  the  stories  about  its  having  produced 
wide-spread  epidemics  at  former  periods.  Indeed,  it  was  not  em- 
ployed, I  think,  in  England,  till  the  year  1824,  or  about  sixteen 
years  after  it  was  in  successful  use  in  America.  Some  of  the  old  prej- 
udices remain  in  Great  Britain,  and  where  they  exist  the  risk  of  that 
formidable  affection,  puerperal  convulsions,  will  be  taken  sooner  than 
one  of  its  most  efficient  means  of  relief  will  be  employed.  We  uee^ 
"not  inquire,  in  the  foregoing  cases,  whether  the  os  uteri  be  dilated,  so 


THERAPEUTICS. ERGOT.  627 

only  labor  have  fairly  begun.  But,  we  may  not  precipitate  ourseU'es 
at  once  upon  ergot.  There  is  something  else  to  be  done  first.  The 
patient,  I  say,  should  be  first  thoroughly  bled,  as  a  preliminary  requi- 
site, not  only  on  account  of  the  cerebral  affection,  but  to  place  the 
whole  genital  organism  in  a  most  favorable  state  for  a  ready  expulsion 
rf  the  child.  Let  each  remedy  come  in  its  appropriate  place.  A  vi- 
olation of  their  proper  order  of  sequence  may  be  fatal,  and  doubtless 
has  been  (§  960,  a).  The  specific,  as  it  is  called,  is,  or  should  be,  oft- 
en the  last  in  the  consecutive  series.  If  cerebral  disease  be  not  first 
moderated  by  loss  of  blood,  the  increased  uterine  irritation  occasion- 
ed by  ergot  cannot  fail  to  increase  the  evil  in  the  head  of  which  it  had 
been  the  sympathetic  cause.  But,  loss  of  blood  strikes  both  at  cere- 
bral and  uterine  disorder.  Nor  have  I  any  doubt  that,  where  any  cere- 
bral symptoms  have  sprung  up  after  the  employment  of  ergot  in  its 
therapeutical  doses,  they  have  been  due  either  to  entirely  different 
causes,  or  to  the  use  of  the  agent  at  so  early  a  stage  of  labor  that  an  in-" 
jurious  violence  has  been  inflicted  on  the  uterus,  and  thus  sympathet- 
ically upon  the  nervous  centres  (§  230).  There  has  been  great  rash- 
ness in  the  use  of  ergot,  from  an  unnatural  haste  of  some  practitioners 
to  get  rid  of  their  patients  in  one  way  or  another.  It  is  this  haste 
which  I  would  reprobate,  as,  also,  a  careless  administration  of  ergot 
without  a  due  reference  to  a  proper  state  of  the  local  requisites,  and 
its  employment  in  such  excessive  doses  as  render  uterine  action  inju- 
riously violent  (§  878).  In  such  instances,  we  need  not  be  surprised 
at  any  untoward  result;  and,  if  the  uterus  be  ruptured,  or  the  child 
destroyed,  or  the  nervous  system  shaken  at  its  centre,  we  may  not 
blame  the  remedy. 

892|,  7rt.  In  cases  where  the  placenta  is  retained  from  want  of  prop- 
er uterine  contractions,  ergot,  if  employed  soon  after  the  birth  of  the 
child,  rarely  fails  of  its  purpose.  The  longer,  howevei',  its  adminis- 
tration is  delayed,  the  less  likely  will  it  be  to  reproduce  the  uterine 
contractions.  Nature  has  accomplished  her  great  purpose  after  the 
expulsion  of  the  child ;  and  if,  from  artificial  influences  upon  the  hu- 
man constitution,  she  pause  at  her  remaining  office,  it  may  often  be 
that  she  is  prematurely  started  upon  her  recuperative  process,  in 
which  she  now  makes  all  haste  to  her  wonted  station.  But,  whether 
so  or  not,  experience  assures  us  that  uterine  imtability  undergoes 
changes  very  rapidly  after  the  expulsion  of  the  foetus,  and  that,  in  the 
same  ratio,  the  reflected  nervous  influences  induced  by  ergot  fail  of 
acting  upon  the  muscular  tissue  of  the  organ  (§  150,  151). 

892|,  n.  Where  retention  of  the  placenta  depends  upon  spasmodic 
action  of  the  uterus,  or  is  owing  to  morbid  adhesions,  ergot  yields  no 
benefit,  and  may  be  injurious.  The  former  condition  certainly  consti- 
tutes a  serious  objection  to  its  use.  The  reason  is,  that  one  part  of 
the  organ  is  now  in  a  more  irritable  state  than  the  rest,  and  ergot, 
therefore,  will  act  with  unequal  effect  and  increase  the  spasm;  just 
as  a  cathartic  will  increase  spasm  of  the  intestine  which  depends  upon 
some  inflamed  portion  of  the  mucous  tissue  of  that  organ  (§  150,  151). 

892|,  0.  Our  parturient  agent  has  shown  itself  capable  of  arresting 
uteiine  hemonhage  in  the  unimpregnated  state,  and  that  it  is  a  use- 
ful agent  in  monorrhagia.  Here  it  displays  another  attribute,  and 
yet  another  differing  from  the  astringent  virtue.  It  does  not  now  act 
as  in  the  foregoing  cases,  as  is  evident  from  its  failure  of  inducing  any 


628  iNSTirorEs  of  medicine. 

of  the  phenomena  of  uterine  contraction,  while,  moreover,  the  uterus 
is  ah-eady  in  its  contracted  state.  Its  effect,  in  these  cases,  is  like 
that  of  common  salt,  or  of  ipecacuanha,  in  restraining  hsemoptysis. 
That  is  to  say,  of  the  individual  substances,  each  one  exerts  some 
change  in  the  action  of  the  part  peculiar  to  itself,  but  differing  more 
or  less  from  that  of  astringents,  by  which  the  secretion  of  blood  is  ar- 
rested (§  904  d,  890,  a). 

Again,  it  is  said  that  ergot  has  been  successfully  employed  in  hem- 
orrhages from  the  stomach,  intestine,  lungs,  nose,  and  gums ;  all  of 
which  concurs  in  farther  illustrating  the  modus  operandi  of  the  pure 
astringents,  and  of  ergot  in  restraining  monorrhagia.  It  should  be 
added,  however,  that  the  anti-hemorrhagic  effect  of  ergot,  except  as 
it  respects  the  uterus,  has  been  overrated. 

892§  p.  All  the  foregoing  effects  of  ergot,  from  its  excitement  of 
uterine  contractions  to  its  restraint  over  hemorrhage,  are  demonstrative 
of  its  operation  through  reflex  action  of  the  nervous  system,  and,  with 
a  multitude  of  other  things  which  I  have  brought  to  the  attention  of 
the  reader,  supply  a  ground  of  analogical  induction  as  to  the  modus  oper- 
andi of  all  other  remedies  (§  893^). — Note  A,  on  the  cattle  of  Labor. 

EMMENAGOGUES. 

892|^,  q.  In  the  foregoing  sections  I  have  been  so  near  upon  em- 
menagogues,  and  as  the  right  treatment  of  amenorrhoea  concerns  so 
nearly  a  vast  number  of  important  cases,  I  shall  briefly  state  the  re- 
sults of  my  own  observation  in  connection  with  this  subject,  and  with 
a  view,  also,  of  multiplying  illustrations  of  the  principles  which  form 
the  ground-work  of  these  Institutes. 

Emmenagogues  are  arranged  in  my  Materia  Medica  under  the  gen- 
eral denomination  of  Uterine  Agents,  of  which  ergot  is  the  first,  can- 
tharides  the  second,  and  guaiacum  the  third  in  importance.  I  drop- 
ped the  usual  denomination  which  appears  in  this  section,  partly  with 
a  view  of  moderating  a  common  belief  that  suspended  menstruation 
is  to  be  always  ti-eated  by  some  agent  bearing  the  name  of  an  em- 
menagogue,  as  the  name  chlorosis  leads  to  medication  of  the  blood. 

All  the  agents  comprised  in  this  group  possess  virtues  that  exercise, 
more  or  less,  extensive  though  various  influences  upon  the  uterine 
system.  In  consideration  of  this  known  relation,  such  of  them  as 
have  received,  the  appellation  of  emmenagogues  (of  which  cantharides 
and  guaiacum  are  the  principal)  are  apt  to  be  employed,  with  a  ref- 
erence alone  to  the  prominent  symptoms  attending  amenorrhoea. 
But,  when  the  failure  of  the  uterine  function  stands  by  itself,  all  the 
emmenagogues  may  be  inapplicable  on  account  of  some  special  mor 
bid  state  of  the  uterus  upon  which  the  cessation  of  the  discharge  de- 
pends. They  are  always  contra-indicated,  cantharides  and  guaiacum 
especially,  in  all  inflammatory  and  irritable  states  of  the  uterus ;  at 
least,  till  these  conditions  are  overcome  by  antiphlogistic  means 
They  are  also  inadmissible  where  menstruation  is  only  suspended,  by 
some  direct  influences,  as  from  exposure  to  cold,  &c. ;  and  they  are 
positively  injurious  where  the  suspension  depends  upon  sympathetic 
influences  propagated  by  some  active  form  of  disease  in  other  organs. 

892|,  r.  In  a  large  proportion  of  cases  amenorrhoea  is  consequent 
on  chronic  maladies  of  the  chylopoietic  viscera,  when  uterine  remedies 
are  often  administered  with   reference  to  the  remote  consequence; 


THEHAPEUTICS. EMMENAGOGUES.  b29 

and  the  condition  of  the  important  organs  in  which  the  uterine  em- 
barrassment had  its  origin,  and  by  which  it  is  commonly  maintained, 
is  apt  to  be  overlooked  or  neglected.  Where,  however,  the  abdom- 
inal derangements  are  sufficiently  pronounced  to  attract  attention,  it 
is  not  less  common  to  look  upon  these  primary  causes  as  the  results  of 
a  mere  failure  of  the  uterus  to  excrete  its  natural  product.  This  inter- 
pretation comes  of  the  humoral  pathology,  and  is  one  of  the  every-day 
practical  illustrations  of  the  amount  of  its  philosophy. 

But,  menstruation  has  a  totally  different  final  cause  than  humoral- 
ism  imagines  (§  428-432).  The  evils  which  are  imputed  to  a  fail- 
ure of  the  evacuation  depend  but  little  upon  this  circumstance.  They 
are  due,  on  the  contrary,  to  the  morbid  state  of  the  organ  throuo-h 
which  the  excretion  fails ;  and  this  condition  is  various  in  its  patho- 
logical nature.  According,  also,  to  the  pathological  state  of  the  ute- 
rus, other  things  being  equal,  will  be  the  nature  and  amount  of  its 
disturbing  reflex  nervous  influences.  In  a  large  proportion  of  cases, 
however,  the  uterus  suffers  but  little,  and  its  function  returns  as  soon 
as  the  remote  influences  are  overcome. 

Hence,  it  is  obvious  that  the  main  treatment  should  be  addressed 
to  the  organs  of  the  abdomen  in  all  the  cases  included  in  this  sec- 
tion. The  state  of  the  uterus,  it  is  ti-ue,  reacts  upon  the  prim.ary  and 
leading  seats  of  disease  ;  but  generally  feebly  (§  905,  a).  Local  means 
should,  therefore,  go  along  with  the  more  constitutional  ones ;  such  as 
leeching  the  perineum,  exercise  on  horseback,  the  hip-bath,  &c.,  ac- 
cording to  the  general  nature  of  the  case. 

892|,  s.  The  foregoing  view  of  our  subject  inculcates  a  variety 
of  treatment  in  the  multifai'ious  aspects  of  amenorrhoea,  and  regards 
all  things  as  emmenagogue,  in  principle,  which  will  restore  the  ute- 
rine function ;  though  that  be  commonly  one  of  the  least  important 
effects.  A  cathartic  may  be  best  when  menstruation  is  suddenly  ar- 
rested by  exposure  to  the  cold,  or  a  hot  bowl  of  motherwort  may  do 
as  well.  Bloodletting  is  the  main  remedy  when  amenorrhoea  is  ow- 
ing to  inflammation  or  congestion  of  the  uterus,  whether  it  be  prima- 
ry or  secondary.  Exercise  in  the  open  air,  especially  on  horseback, 
chalybeate  tonics,  mercurial  and  aloetic  laxatives,  a  well-regulated 
diet,  &c.,  are  the  means  when  it  is  dependent  on  indigestion  (^  892  J  v). 

892|,  t.  Having  accomplished  the  leading  intentions  in  the  chronic 
forms  of  amenorrhoea,  if  the  uterus  still  fail  of  excreting  the  menses, 
those  agents  which  are  known  as  emmenagogues  may  then  be  called 
into  use ;  and  of  these,  cantharides,  administered  till  slight  strangury 
takes  place,  is  not  only  the  most  efficient,  but  far  the  safest.  Guai- 
acum  is  liable  to  irritate  the  stomach  injuriously,  and  to  stimulate,  un- 
favorably, the  whole  system,  and  especially  the  uterus.  There  are 
many  cases,  however,  in  which  the  uterus  may  ultimately  require  this 
peculiar  irritation,  or  where  certain  states  of  constipation  will  yield, 
happily,  to  the  action  of  guaiacum ;  but  they  require  a  sounder  refer- 
ence to  the  exact  condition  of  the  organ  than  when  cantharides  is  em- 
ployed. The  uterus,  indeed,  is  so  liable  to  an  interruption  of  its  men- 
strual function  that  slight  degrees  of  indigestion  will  occasion  its  fail- 
ure ;  and  in  these  cases  cantharides  will  generally  be  entirely  compati- 
ble with  the  abdominal  affection,  and  sufficient  in  itself  to  re-establish 
menstruation.  This  variety  of  things  leading  to  a  specific  result  can  be 
expounded  only  through  alterative  reflex  actions  of  the  nervous  systerr» 
(See  Genito-Urinary  Agents,  p.  683-689). 


630  INSTITUTES    OF    MEDICINE. 


DIURETICS. 


892f ,  a.  Diuretics  are  agents  which  increase  the  urinary  discharge, 
and  are  employed  either  for  that  purpose  specifically,  or  more  com- 
monly with  an  indirect  reference  to  dropsical  affections,  upon  which 
they  are  supposed  to  operate  by  promoting  the  absorption  of  the  fluid 
and  its  excretion  by  way  of  the  kidneys. 

8925,  J,  On  looking  over  this  group  of  remedies,  it  will  be  at  once 
seen  that  it  is  obnoxious  to  objections  which  I  have  made  to  other 
groups,  and  that,  as  in  the  former  cases,  the  denomination  of  diuret- 
ics must  be  received  with  special  qualifications.  Many  remedies,  also, 
are  not  embraced  in  the  group  which  are  capable  of  producing,  under 
particular  circumstances  of  disease,  the  most  powerful  diuretic  effect. 
This  is  especially  true  of  cathartics,  and  of  some  of  them  to  so  great 
an  extent  as  to  have  procured  for  them  the  appellation  of  hydrogogue 
cathartics,  or  such  as  are  capable  of  expelling  dropsical  effusions.  In- 
deed, I  may  say  that  cathartics  are  better  entitled  to  the  name  of  diu- 
retics than  any  other  group  of  remedies  ;  since  no  one  of  them  oper- 
ates upon  the  intestine  without  very  generally  increasing  the  excre- 
tion of  urine  ;  and,  as  to  their  relative  effect  in  subduing  dropsical 
affections,  they  greatly  surpass  the  diuretics  proper.  The  latter  agents 
scarcely  extend  their  influences  beyond  the  kidneys  ;  while  cathartics 
accomplish  their  work  as  diuretics  by  overcoming  the  diseases  upon 
which  dropsical  effusions  depend,  and  by  thus,  also,  withdrawing  mor- 
bific reflex  nervous  actions  which  those  or  other  diseases  inflict  upon 
the  kidneys,  and,  thirdly,  by  exciting  the  kidneys  to  a  freer  production 
of  urine  (^  227, 422  h,  423,  516  d,  no.  6,  524  c,  889  a,  891|  l,  892^  k,  t). 

These  remarks  relative  to  cathartics  lead  me  to  advert  to  their  con- 
trol over  dropsical  affections  as  one  of  the  demonstrations  that  dropsy 
depends  upon  inflammatory  conditions.  That  pathological  cause  be- 
ing removed  by  the  antiphlogistic  virtues  of  cathartics,  the  redundant 
effusions  cease.     The  modus  operandi  is  shown  in  the  last  references. 

Bloodletting,  which  is  not  among  diuretic  remedies,  has  often  as 
gieat  an  effect  as  cathartics,  often  greater,  in  establishing  a  copious 
production  of  urine,  where  it  has  been  greatly  diminished  or  suspend- 
ed. And,  from  what  was  just  said  of  the  pathology  of  dropsy,  it  should 
be  the  best  remedy,  as  it  certainly  is,  in  the  early  stages  of  hydrotho- 
rax  and  ascites. 

To  exemplify  yet  farther  the  nature  of  diuretics,  and  whether  one 
thing  or  another  will  determine  an  increased  flow  of  urine,  and  to 
show  that  this  is  an  insignificant  result  of  all  the  agents  that  may  be 
employed,  and  that  it  is  to  the  seat  and  pathology  of  disease  that  all 
our  prescriptions  should  refer, — keeping  the  attention  there  and  away 
from  the  kidneys, — I  may  refer  to  what  was  said  of  the  diuretic  effect 
of  iodine  in  a  former  section,  and  of  its  modus  operandi  in  subduing 
dropsy  (§  892 j,  Tt,  t.     Also,  last  references). 

Again,  there  is  nothing  more  uniformly  and  powerfully  diuretic 
than  fear,  which,  in  all  its  degrees  and  modifications,  rarely  fails  to 
increase  the  urinary  product ;  being,  also,  in  its  excessive  operation,  a 
most  powerful  sudorific,  while  it  simultaneously  determines  the  blood 
from  the  circumference  to  the  centre.  The  boldest  warrior  is  not 
without  the  universal  instinctive  principle  which  impels  all  animals  to 
flee  from  danger.     On  the  eve  of  battle,  when  most  stimulated  by 


THERAPEUTICS. DIURETICS.  631 

pride  and  the  hope  of  victory,  he  shows  that  another  principle  is  in 
powerful  operation  by  the  frequency  with  which  he  dismounts,  or 
turns  aside  from  the  ranks,  to  let  off  troublesome  accumulations  of 
urine.  And  just  so  with  man  whenever  dangers  impend  ;  whether 
they  threaten  his  life,  his  limb,  or  his  reputation.  And  so  with  any 
event  in  the  success  of  which  he  has  an  immediate  interest.  All  this, 
too,  is  equally  true  of  animals ;  and  it  all  conspires  in  showing  that 
humoralisni,  and  "  dynamic"  and  "  quantitive"  chemistry,  are  upon  the 
wrong  track,  and  that  as  mental  emotions  can  excite  diuresis  and  per- 
spiration only  through  direct  nervous  influence,  so  do  physical  causes  by 
reflex  nervous  action  upon  the  secerning  vessels  (§  422  b,  1067). 

But,  there  is  a  vast  variety  remaining  of  the  foregoing  nature.  Take 
a  modification  of  fear,  as  showing  the  delicate  shades  of  difference 
among  the  passions,  and  how  they  correspond  in  their  effects,  and  in 
their  organic  influences,  with  material  agents.  Thus,  anxiety,  which 
has  fear  for  one  of  its  elements,  exerts,  also,  a  like  but  modified  effect 
upon  man.  So,  again,  jealousy,  which  results  from  the  united  opera- 
tion of  fear  and  love  (§  188J,  d).     Thus  Sappho  : 

#  "  la  dewy  drops  my  limbs  were  chilled, 

My  blood  with  gentle  horrors  thrilled, 
My  feeble  pulse  forgot  to  play, 
I  fainted,  sunk,  and  died  away." 

And,  coming  to  the  pure  element,  love  itself,  we  observe  other  coin- 
cidences with  fear ;  especially  as  it  respects  perspiration.  In  exces- 
sive joy,  also,  we  meet  with  another  powerful  diuretic,  as,  likewise,  in 
the  sympathy  between  man  and  man.  But  it  is  manifest,  in  all  these 
cases,  that  each  agent,  each  passion,  produces  influences  peculiar  to 
itself,  each  one  in  its  individual  or  its  compound  aspect.  It  is  vari- 
ously illustrated  in  the  following  sections  :  227,  228  b,  233f ,  234  e, 
500  c,  g,  k,  n,  512,  652  c,  827  c,  828  a,  844,  902  g,  904  d,  and  in 
other  places  ;  while  it  may  be  said,  in  respect  to  the  passions,  that  we 
may  discern  in  the  different  conditions  of  the  perspirable  matter,  and 
in  the  different  states  of  the  skin,  indications  of  different  organic  influ- 
ences that  are  exerted  by  the  nervous  power,  and  carry  the  same  con- 
clusions to  other  parts  which  may  be  impressed  in  their  organic  states 
(§  227,  228  a,  &c.).  The  same  is  true,  also,  of  those  emotions  which 
are  awakened  by  physical  influences.  Certain  odors  prove  diuretic  to 
some  and  cathartic  to  others ;  and,  as  affirmed  by  Shakspeare, 

•  others,  when  the  bag-pipe  sings  i'  th'  nose, 


Cannot  contain  their  urine  for  affection. 
Masterless  passion  sways  it  in  tlie  mood, 
Of  what  it  likes  or  loathes." 

The  last  is  analogous  in  its  philosophy  to  what  is  said  of  light  in 
section  514,  l.  And  as  to  offensive  sounds,  which  fall  under  the 
same  category,  it  is  related  by  Dr.  Fairfax  that,  "  Mistress  Raymond, 
whenever  she  hears  it  thunder,  even  afar  off,  begins  to  have  a  bodily 
distemper  seize  her.  She  grows  faint,  sick  in  her  stomach,  and  ready 
to  vomit.  At  the  very  coming  over  of  the  thunder,  she  falls  into  a 
downright  cholera,  and  continues  under  a  violent  vomiting  and  purg- 
ing as  long  as  the  tempest  lasts.  And  thus  hath  it  been  with  this  gen- 
tlewoman from  a  girl."  Beddoes  speaks  of  analogous  results.  "  At 
any  moment,"  he  says,  "  inflammation  may  be  kindled  in  any  part  by 
some  causes  which  we  cannot  distinguish ;  by  others  too  subtle  for 


632  INSTITUTES    OF    MEDICINE. 

our  senses,  as,  perhaps,  by  a  thunder  cloud  passing  over  head"  (^  230, 
828  c).  Until  the  nature  of  lightning  was  understood,  it  was  sup- 
posed that  it  corrupted  the  blood  in  such  cases.  But,  later  "experi- 
mental philosophy"  has  enabled  the  chemist  to  expound  it  in  another 
way,  and  to  the  easy  comprehension  of  most  people  (§  349,  d,  e), 
while  the  few  take  a  more  circuitous  method  (§  222-233|,  500,  893- 
905),  although  at  no  little  peril  (§  5^,  a).  Again,  cold,  apphed  sud- 
denly to  the  surface  of  the  body,  is  often  a  powerful  diuretic  (§  422, 
423).  But,  although  neither  this  nor  the  preceding  causes  are  raTiked 
as  diuretics,  they  are  probably  about  as  much  entitled  to  this  designa- 
tion as  those  agents  to  which  it  is  specifically  appropriated  (^  844). 

8923,  c.  The  agents  and  causes  of  which  I  have  now  spoken  dis- 
close the  whole  philosophy  of  the  operation  of  such  as  are  especially 
denominated  diuretics,  and  place  it  mainly  upon  the  ground  of  direct 
and  reflex  actions  of  the  nervous  system. — Note  D  p.  1114. 

Whether,  therefore,  it  be  loss  of  blood,  or  cathartics,  or  cold  ap- 
plied to  the  surface,  or  the  operation  of  fear,  or  other  mental  emotions, 
which  increase  the  excretion  of  urine,  they  all  do  it  by  acting  directly 
or  indirectly  upon  the  secreting  vessels  of  the  kidneys,  and  mostly 
by  means  of  direct  or  reflex  nervous  action.  Loss  of  blood  may  be 
directly  exerted  upon  the  organs,  or  it  may  be,  as  is  generally  true, 
through  the  instrumentality  of  the  nervous  system,  by  removing  dis- 
ease from  some  other  part,  as  the  liver  (which  is  a  common  example), 
and  which  had  sympathetically  diminished  the  excretion  of  urine. 
The  principles,  as  it  respects  the  nervous  power,  and  the  change  of 
organic  actions,  are  the  same  with  cold,  fear,  &c.  Coming,  lastly,  to 
the  diuretics  proper",  such  as  are  truly  remedial  produce  their  effects, 
also,  upon  exactly  the  same  principles  (§  277).  Nevertheless,  it  is 
undoubted  that  certain  substances  of  mild  remedial  virtues,  especially 
such  as  are  not  offensive  to  the  lacteals,  or  to  the  general  organism, 
gain  admittance  more  or  less  readily  into  the  circulation  ;  and,  com- 
ing in  contact  with  the  kidneys,  may  stimulate,  and  increase  the  action 
of,  these  organs.  Such,  for  example,  are  certain  neutral  salts.  Prob- 
ably the  acetates  of  potass  and  soda  may  produce  their  effects  upon 
the  kidneys  more  or  less  in  this  way ;  though  certainly,  also,  through 
the  nervous  influence  when  they  prove  cathartic.  In  respect  to  these 
two  agents,  however,  the  chemical  and  humoral  theorists  are  not  all 
satisfied  with  their  general  hypothesis  (§  278). — Note  Z  p.  1130. 

Nor  is  it  at  all  surprising  that  the  functions  of  the  skin  and  kidneys 
should  be  so  readily  affected  by  the  nervous  influence,  as  developed 
by  the  foregoing  causes,  mental  and  physical,  when  we  consider  the 
final  causes  of  each  of  the  organs,  and  that  Nature  has  ordained  for 
their  fulfillment  a  great  versatility  of  action,  and  that,  therefore,  mor- 
bific and  remedial  agents  will  operate  variously,  according  to  their 
several  virtues,  through  that  natural  constitution  of  the  organs  (§  423 
513,  902  y,  ^).  This  consideration  also  lets  us  into  the  reason  why 
the  urine  flows  so  abundantly  after  some  fluids,  such  as  gin  (which 
contains  the  diuretic  juniper),  and  in  some  cases  before  there  can 
have  been  time  for  their  incorporation  with  the  blood;  a  fact,  indeed^ 
so  often  observed,  that  many  physiologists  have  supposed  that  there 
must  be  some  more  direct  communication  between  the  stomach  and 
bladder  than  by  the  ordinary  route  of  the  absorbents  (^  350,  no   94). 

892^,  d.  The  "  diuretics  proper"  are  the  least  useful  of  all  the  an- 


THERAPEUTICS. EXPECTORANTS.  633 

tiphlogistics ;  having  but  little  effect  upon  inflammations  or  fevers. 
Yet  are  they  often  prescribed  in  high  grades  of  those  affections  (where 
the  urine  is  greatly  deficient),  in  the  vain  expectation  of  reaching 
those  profound  lesions  by  the  removal  of  one  of  their  least  important 
sympathetic  consequences.  Their  use,  however,  with  the  more  en- 
lightened, is  now  mainly  limited  to  dropsical  effusions  in  the  great 
cavities  and  the  extremities ;  however  defective  may  be  the  patholo- 
gy, or  however  inefficient  these  agents  are  compared  with  bloodlet- 
ting, cathartics,  blisters,  mercury,  iodine,  &c.  They  are  always 
most  useful  in  cases  that  are  benefited  by  loss  of  blood  and  by  ca- 
thartics (See  as  to  heart  in  §  500  m,  685^,  QS1\,  694f ,  826  cc). 

892y,  e.  Some  of  the  diuretics  which  possess  compound  virtues, 
such  as  squill,  and  Indian  hemp  {apocynum  canndbinum\  ™ay  prove 
very  detrimental  in  many  cases  of  dropsy ;  the  former,  for  example, 
by  its  acrid,  stimulating  virtue,  the  latter  by  its  severe  action  upon  the 
intestinal  canal.  Where  mercurial  agents  are  employed,  they  should 
be  well  chosen,  and  according  to  the  existing  pathological  states.  In 
the  simple  form  of  dropsy,  or  if  inflammation  exist  in  any  degree  of 
activity,  as  in  the  serous  tissue,  or  in  the  liver,  then  some  one  of  the 
simple  mercurials  should  be  selected,  as  calomel,  or  blue  pill ;  prece- 
ded, however,  by  loss  of  blood,  &c.  If,  on  the  other  hand,  the  drop- 
sical effusion  have  existed  a  good  while,  or  be  attended  by  chronic 
enlargement  of  the  liver,  or  of  some  other  viscus,  the  mercurial  should 
be  chosen  with  reference  to  such  organic  affections ;  though  calomel 
or  blue  pill  may  answer  well.  But,  in  these  cases,  the  iodides  and 
bromides  of  mercury  are  the  most  appropriate ;  and  now  we  may, 
sooner  or  later,  employ  squill  with  or  without  other  diuretics,  though 
it  is  commonly  most  useful  to  combine  two  or  more  together.  If  the 
subject  be  of  a  scrofulous  habit,  iodine  should  be  used  freely. 

W2,\,f.  Much  has  been  said  of  the  connection  of  renal  disease  with 
dropsy,  and  many  physicians  have,  in  consequence,  gone  into  a  chem- 
ical analysis  of  the  urine,  instead  of  the  signs  to  be  observed  in  the 
body,  for  an  exposition  of  the  nature  of  disease.  But,  so  many  coin- 
cidences have  sprung  up  from  other  causes,  that  it  may  be  expected 
that  this  "  experimental  philosophy"  will  not  endure. 

892|,^.  The  greatest  of  all  the  errors  in  relation  to  dropsical  affec- 
tions is  that  which  divides  them  into  active  and  passive.  This  erroi 
appears  to  have  grown  out  of  another — that  which  makes  the  same 
distinction  of  inflammations  (§  752,  &c.) ;  though,  in  the  former  case, 
the  relative  states  of  pathology  are  supposed  to  be  in  even  greater  op- 
position. The  practice  proceeds  upon  the  same  hypothesis  as  that 
which  concerns  the  distinctions  in  inflammation. 

EXPECTORANTS. 

892|,  a.  This  group  of  agents  has  had  too  large  a  connection  with 
disease  to  be  neglected;  or,  at  least,  not  to  be  held  responsible  for 
any  mischief  it  may  have  done.  Like  many  other  denominations, 
the  term  is  significant  of  their  most  visible  effect,  although,  like  many 
others,  it  is  one  of  the  least  important  in  a  large  proportion  of  the  dis- 
eases where  they  are  employed,  while  the  most  important  can  be  ob- 
tained only  by  remedies  that  do  not  fall  within  the  group. 

The  tendency  of  the  name,  and  the  definition  which  is  given  of  ex- 
pectorants, have  turned  a  great  amount  of  attention  upon  the  quantity 


634  INSTITUTES    OF    MEDICINE. 

of  matter  expectorated,  and  away  from  those  pathological  conditions 
upon  which  the  physical  product  depends  (§  889  c,  891  d,  o). 

It  is  greatly,  therefore,  with  expectorants  as  with  sudorifics,  diuret- 
ics, &c.  The  secreted  product  is  only  a  secondary  result ;  complica- 
ted and  various  in  respect  to  the  conditions  and  influences  by  which 
it  is  brought  about,  and  capable  of  being  increased  or  produced,  under 
different  vital  states  of  the  body,  by  agents  of  entirely  opposite  vir- 
tues,— by  the  most  direct  sedatives,  and  by  the  most  active  stimulants. 
Every  thing,  therefore,  which  will,  under  any  contingencies  of  disease, 
increase  or  produce  expectoration,  is  more  or  less  entitled  to  be  con- 
sidered an  expectorant.  Hence,  it  is  apparent  that,  whenever  reme- 
dies are  applied  with  a  view  to  the  supposed  objects  of  expectorants 
they  are  quite  likely  to  aggravate  formidable  grades  of  disease,  or  to 
leave  the  subject,  at  least,  to  an  unresisted  fate  which  might  have  been 
averted  by  appropriate  means. 

892|,  h.  In  my  Arrangement  of  the  Materia  Medico,  I  have  placed 
some  agents,  under  the  denomination  of  expectorants,  as  first  in  im- 
portance, which  others,  who  consider  mostly  the  result  upon  which 
the  group  has  been  founded,  would  rank  lower  down.  But,  as  the 
foundation  of  my  arrangement  relates  to  the  therapeutical  capabilities 
of  the  various  substances,  I  have  designated  tartarized  antimony  as 
the  first,  and  ipecacuanha  the  second  in  importance.  These  agents, 
in  a  general  sense,  are  most  useful  under  the  condition  in  which  ex- 
pectoration is  desirable,  if  relief  be  not  obtained  without ;  though  it 
may  or  may  not  be  a  result  of  their  action.  It  is  now,  as  when  sweat- 
ing may  take  place  profusely,  moderately,  or  not  at  all,  from  what  are 
denominated  sudorifics.  But,  I  should  say  that  the  parallel  does  not 
hold  strictly  in  these  cases ;  since  the  sympathies  between  the  stom- 
ach and  skin  are  so  far  different  from  those  which  prevail  between  the 
stomach  and  the  lungs,  that  mild  impressions  made  upon  the  stomach, 
as  by  hot  water,  will  determine  profuse  perspiration,  or,  as  in  other 
cases,  irritating  food  will  occasion,  speedily,  eruptions  of  the  skin ; 
while  none  but  agents  of  considerable  power  will  institute  reflex 
nervous  actions  in  the  lungs,  or  give  rise  to  that  expectoration  which 
grows  out  of  such  actions.  All  the  expectorants,  therefore,  of  any  im- 
portance ai'e  capable  of  exerting  powerful  effects,  either  for  good  or 
for  evil ;  while,  of  all  the  sudorifics,  tartarized  antimony  and  ipecacu- 
anha are  the  only  ones  that  are  entitled  to  consideration  on  account 
of  the  alterative  reflex  nervous  actions  instituted  by  expectorants. 

Reflex  nervous  actions,  as  excited  by  the  operation  of  agents  upon 
the  stomach,  depend  not  only  upon  the  nature  of  the  agents,  the  nat- 
ural function  of  the  sympathizing  part,  and  the  particular  mode  in 
which  it  may  be  affected  by  disease,  but  upon  the  analogies  that  may 
subsist  in  the  structure  and  vital  constitution  of  the  mucous  tissue  of 
the  stomach  and  the  part  remotely  influenced  (§  133-152,  525-529). 
The  group  of  remedies  now  before  us  refer  to  a  tissue  of  the  same 
species  as  that  of  the  stomach  upon  which  the  remedial  agents  exert 
their  direct  effect ;  and  reflex  nervous  actions  upon  the  pulmonary 
mucous  tissue,  when  induced  by  remedial  agents  applied  to  the 
stomach,  are,  for  this  reason  in  part,  different  from  such  as  are  ex- 
erted by  the  stomach  upon  the  skin,  and  are  generally  much  more 
profound,  and  of  a  more  alterative  nature. 

892|^,  c.  The  effect  of  remedies,  therefore,  in  their  acceptation  of 


1  IlERAPEUTlCrf. EXPECTORANTS.  6^b 

expectorants,  being  determined  by  the  existing  condition  of  disease, 
and  more  or  less  by  the  state  of  the  system  at  large,  and  conditions 
'not  much  allied  admitting  the  agency  of  remedies  that  operate  as  ex- 
pectorants, it  is  clear  that  we  must  have  a  classification  of  these  rem- 
edies according  to  their  general  virtues.  I  have,  therefore,  more  or 
less  after  the  manner  of  othei'S,  distributed  them  into  five  subdivisions. 
These  I  shall  now  state,  along  with  the  several  agents  erabi'aced  un- 
der each  subdivision  ;  and,  for  the  purpose  of  illusti'ating  my  concep- 
tions of  their  relative  bearing  upon  disease,  and  with  only  a  secondary 
view  to  the  expectoration  which  they  may  be,  respectively,  capable 
of  producing,  I  shall  designate  each  one  by  numbers  that  denote  their 
order  of  arrangement,  and  their  relative  therapeutical  uses  where  ex- 
pectoration is  a  desirable  consequence  if  the  remedy  do  not  succeed 
without. 

Non-sti?nulating. — 1.  Potassae  antimonio-tartras.  2.  CepliEelis  ipe- 
cacuanha.    4.  Gillenia  trifoliata.     6.  Asclepias  tuberosa. 

Stimulating. — 3.  Scilla  maritima.  7.  Polygala  senega.  8.  Dore- 
ma  ammoniacum.  10.  Opoponax  chironium.  13.  Eryngium  aqua- 
ticum.  14.  Myrospermum  toluiferum.  15.  Myrospermum  peruife- 
rum.  16.  Naphthaline.  17.  Styrax  benzoin.  18.  Styrax  officinale. 
19.  Liquidambar  styraciflua.  20.  Amyris  gileadensis.  21.  Allium 
sativum.     22.  Erysimum  alliaria.     23.  Sisymbrium  officinale. 

Sti7nulating  and  Narcotic. — 5.  Sanguinaria  canadensis. 

Sedative  aiid  Narcotic. — 11.  Lobelia  inflata. 

Stimulating  and  Antispasmodic. —  9.  Ferula  asafoetida.  Ferula 
persica.     12.  Galbanum  officinale. 

It  will  be  seen,  therefore,  from  the  foregoing  general  distribution 
of  expectorants,  that  four  of  them  only  are  adapted  to  any  thing  like 
acute  inflammation  of  any  tissue  of  the  lungs ;  and  that  the  first  two 
onlj'^  are  wanted.  Moreover,  none  of  the  expectorants  are  employed 
as  such  excepting  in  some  inflammatory  state  of  those  organs ;  or,  at 
least,  according  to  my  views  of  all  the  pathological  conditions  for  the 
relief  of  which  the  expectorants  are  intended.  And  when  it  is  con- 
sidered, also,  how  very  irritable  and  susceptible  the  lungs  are  when 
affected  in  their  parenchymatous  structure,  and  even  those  parts  of  the 
mucous  tissue  which  line  the  bronchi,  larynx,  and  trachea ;  how  lia- 
ble, too,  inflammation  is  to  be  propagated  from  the  upper  portions 
into  the  air-cells  ;  how  many  there  are  in  whom  pulmonary  phthisis  is 
readily  awakened  by  inflammatory  states  of  this  membrane  ;  how  they 
constantly  throw  morbific  influences  over  the  stomach,  the  intestine, 
the  general  organs  of  circulation,  &c. ;  and  how  often  inflammation  of 
the  tracheal  portion  of  the  membrane  eventuates  in  ulceration  ;  besides 
other  sequelce  of  inferior  moment ;  it  becomes  apparent  that  this  group 
of  remedies,  with  the  exception  of  the  two  leading  members,  has 
numbered  its  victims  next  after  those  agents  which  form  the  groups 
of  tonics  and  stimulants. 

Why,  then,  it  is  asked,  perhaps,  does  the  squill  rank,  in  the  arrange- 
ment, as  the  third  in  therapeutical  value,  and  before  the  non-stimulant. 
American  ipecacuanha,  bloodroot  as  the  fifth,  seneka  the  seventh,  gum 
ammoniac  the  eighth,  and  these  last  three  before  asafetida,  &c.  ? 
The  answer  is  important,  although  the  order  of  arrangement  assumed 
that  the  reader  was  sufficiently  conversant  with  the  principles  upon 
ivhich  it  is  founded.     It  assumed,  in  the  first  place,  that  he  was  famil- 


6H6  INSTITUTES^    OF    MEDICINE. 

lar  with  the  general  structure  of  the  lungs,  that  he  had  some  ideaa 
about  a  "  chemical"  difference,  at  least,  in  the  relations  of  different 
portions  of  the  pulmonary  mucous  tissue  to  this  group  of  remedies ' 
(§  134-143) ;  that  he  was  aware  of  the  inflammatory  nature  of  the  dis- 
ease for  which  he  was  prescribing,  as  well  as  its  exact  seat ;  that  he 
distinguished  between  acute  and  chronic  forms  of  inflammation  ;  that 
he  understood,  that,  as  one  portion  or  another  of  the  pulmonary  mu- 
cous tissue  might  be  the  seat  of  disease,  and  according  to  the  special 
modification  of  disease,  it  might  be  relieved  or  inci'eased  by  different 
expectorants,  and  according,  also,  as  the  premises  might  be,  he  fore- 
saw that  this  or  that  expectorant  might  develop  tubei'culous  phthisis, 
or  become  the  indirect  cause  of  disease  in  other  parts,  &c. 

Proceeding,  therefore,  upon  these  principles,  and  as  chronic  in- 
flammation of  the  mucous  tissue  of  the  trachea  and  bronchi  is  a  very 
common  form  of  disease,  and  is  often  benefited,  in  constitutions  that 
are  otherwise  sound,  by  a  stimulating  expectorant,  it  was  important 
that  some  one,  at  least,  should  occupy  a  high  place  in  the  Arrangement. 
But,  it  should  be  also  one  whose  virtues  are  most  of  an  alterative 
nature,  but  most  exempt  from  morbific  tendencies  ;  whence  it  be- 
comes plain  that  the  scilla  maritima  should  stand  immediately  after 
the  cephaelis  ipecacuanha.  It  should  also  precede  the  gillenia,  since 
the  virtues  of  this  last,  as,  also,  of  the  asclepias,  are  analogous  to  those 
of  the  great  product  of  Brazil,  yet  much  inferior.  But,  comparatively 
unimportant  as  the  gillenia  and  asclepias  may  be,  they  are  yet  so  anal- 
ogous to  ipecacuanha,  that  they  may  stand  by  its  side,  and  being  ofeasy 
access  to  the  American  practitioner,  they  should  follow  near  upon  the 
other  two  non-stimulant  expectorants  ;  gillenia  taking  the  precedence 
of  the  asclepias  on  account  of  its  greater  alterative  virtues. 

Asafetida,  I  am  aware,  is  a  favorite  expectorant  with  many ;  hnl  it 
is  less  alterative  than  seneka,  and  the  preceding  gums,  and  is  much 
more  liable  to  offend  the  stomach. 

As  to  bloodroot,  that  substance  stands,  like  castor  oil,  alone  in  the 
Materia  Medica.  It  is  capable  of  peculiar  influences  ;  but,  as  they 
are  oftener  injurious  than  beneficial  I  have  given  to  it  a  higher  rank 
than  was  warranted  by  my  own  experience  or  by  that  of  some  others. 
It  has  been,  howevei%  highly  commended;  and  in  deference,  there- 
fore, to  that  more  favorable  experience,  it  appeared  to  me  that  it 
should  occupy  a  place  in  the  Arrangement  that  might  yield  to  the 
remedy  a  fair  opportunity  for  more  ample  observation  of  its  effects^ 
so  far  as  my  Arrangement  might  have  any  influence. 

The  foregoing  analysis  will  serve,  also,  for  the  disposition  which 
I  have  made  of  the  members  of  all  other  groups.  The  arrangement 
bears  upon  its  face  the  author's  conceptions  of  their  special  relations 
either  to  pathological  conditions  that  are  most  allied,  or  to  such  as  are 
diverted  from  the  common  forms,  or  to  others  which  are  distinguish- 
ed by  greater  peculiarities  ;  while,  also,  the  order  of  each  one,  under 
the  various  assemblages,  denotes  its  therapeutical  capabilities.  If 
the  author,  therefore,  be  right  in  his  premises  upon  which  the  arrange- 
ment is  founded,  each  article  is  thus  rendered  more  or  less  descriptive 
of  its  own  uses,  &c.  (§  892,  aa,  c). 

S92|,  d.  There  should  be  no  difficulty  with  correct  observers  in 
reaching  a  knowledge  of  the  conditions  of  disease  to  which  remedial 
agents  of  such  various  and  even  opposite  virtues  as  the  expectoranta 


THERAPEUTICS. EXPECTORANTS.  637 

are  adapted.  The  general  principles  of  pathology  and  therapeutics 
go  far  in  indicating,  at  once,  which  of  the  groups  are  properly  suited  to 
certain  pathological  states,  which  of  its  members  is  best  adapted  to 
any  modified  condition  of  the  general  pathology,  or  which  of  the 
groups,  or  which  members  of  the  proper  gioup,  should  be  avoided. 
But,  a  nice  discrimination  of  the  variously-modified  forms  of  inflam- 
mation, whether  as  to  its  nature,  intensity,  duration,  complications, 
&c.,  and  a  precise  acquaintance  with  the  peculiarities  of  each  reme- 
dial agent,  will  be  often  necessary  to  guide  us  to  the  just  regulation 
of  influences  which  any  given  combination  of  symptoms  may  demand  ; 
or,  proceeding  blindly  to  execute  the  results  of  an  expectorant,  in  its 
ordinary  acceptation,  and  under  the  belief  that  each  substance  so  de- 
nominated will  alike  fulfill  the  intention,  we  may  as  readily  destroy 
the  patient,  in  the  end,  by  this  indiscriminate  practice,  as  we  might, 
with  certainty,  i>elieve  him  by  a  choice  of  other  means  bearing  the 
same  general  name  of  expectorants.  It  is  not,  therefore,  I  say,  the 
abstract  fact  of  expectoration  that  we  are  to  regard,  but  this  is  to  be 
considered  as  a  result  of  a  favorable  action  which  certain  remedial 
agents  are  capable  of  instituting,  but  which  very  often  fail  of  that  re- 
sult when  their  action  is  in  the  highest  degree  salubrious.  On  the 
contrary,  also,  we  shall  see  that  expectoration  may  be  increased  by 
increasing  the  morbid  conditions;  just  as  the  discharge  of  mucus,  in 
intestinal  inflammation,  is  increased  by  an  irritating  cathartic.  The 
only  difference  consists  in  the  direct  action  of  the  morbific  irritant 
upon  the  affected  part,  in  one  case,  and  by  reflex  action  through  the 
nervous  power,  in  the  other  (§  150,  151,  226,  228,  229).  It  is,  there- 
fore, far  from  being  true  that  the  remedy  is  appropriate  when  the  dis- 
charge from  the  lungs  is  promoted  and  increased,  even  though  an  ex- 
pectorant be  especially  indicated,  and  the  proper  one  may  also  tend 
to  lessen  the  quantity  of  mucus  through  such  alterative  influences  as 
lessen  the  morbid  action  upon  which  it  depends. 

892^,  e.  We  see,  therefore,  more  and  more,  how  indispensable  it  is  to 
look  upon  results  as  indicative  only  of  certain  complex  vital  conditions 
which  should  be  ascertained,  and,  as  far  as  possible,  to  regard  the 
proximate  causes  in  all  our  prescriptions  (§  673,  674,  699,  741).  Here 
we  have  a  patient  with  a  cough.  A  favorable  or  a  fatal  issue  of  his 
case  may  depend  entirely  upon  the  exhibition  of  the  right  expectorant. 
He  may  be  cured  by  tartarized  antimony,  or  may  be  killed  by  squill, 
seneka,  or  bloodroot.  It  is  evident,  therefore,  that  "  coughs"  depend 
upon  impoi'tant  varieties  of  pathological  conditions  ;  though,  when  the 
direct  result  of  pulmonary  disease  those  conditions  are  generally  of 
an  inflammatory  nature.  There  may  be  numerous  gradations  of  the 
form  of  common  inflammation  from  that  which  constitutes  pneumo- 
nia, and  speedily  runs  its  course,  to  that  indolent  state  which  persists 
for  years,  and  makes  little  or  no  impression  upon  the  general  health. 

All  this,  however,  is  doubtless  obvious  to  enlightened  practitioners  ; 
but,  when  it  is  considered  what  morbid  anatomy  is  about,  even  with 
common  inflammation  (§  699),  and,  how  deplorable  the  evils  which 
have  sprung  from  the  pathology  of  scrofula  and  tuberculous  phthisis 
that  has  issued  from  the  purlieus  of  Paris,  I  am  moved  by  the  convic- 
tion that  I  cannot  attempt  a  more  useful  service  to  humanity  than  by 
exploring  the  subject  now  under  consideration. 

It  has  been  no  uncommon  and  fatal  error  to  have  exhibited  stimu- 


638  INSTITUTES    OF    MEDICINE. 

laring  expectorants  (which,  indeed,  commonly  form  the  "  cough  mix- 
tures"), in  active  forms  of  pneumonia,  under  the  belief  that  these  stim- 
ulating agents  possess  the  power  of  at  all  times  producing  expectora- 
tion, and  that  this  result  is  the  main  object  to  be  contemplated.  Some- 
times, however,  these  agents  produce  vomiting,  and  their  effects  are 
then  less  disastrous ;  or,  in  subdued  forms  of  acute  inflammation  this 
sedative  influence  may  barely  counteract  the  stimulant  virtue,  or  it 
may  be  useful.    It  is  like  employing  snuff  for  nasal  catarrh  (^  228  a). 

892^, y.  Coming  to  special  modifications  of  inflammation,  the  expec- 
torants in  common  use  perform  their  morbific  work  according  to  the 
variety  of  the  disease,  and  the  part  of  the  pulmonary  mucous  tissue, 
or  other  tissue  of  the  lungs,  in  which  it  may  hold  its  seat. 

Readily  as  that  modification  which  constitutes  croup  may  be  re- 
moved in  its  early  stages,  a  pernicious  custom  exists  of  prescribing 
stimulating  expectorants.  It  is  true,  they  are  oftea  united  with  tar- 
tarized  antimony  in  the  treatment  of  this  disease ;  and  a  formula  of 
this  kind  exists  in  the  United  States  Pharmacopoeia,  bearing  the  name 
of  the  Co7npound  Honey  of  Squill.  That  may  be  well  enough,  un- 
accompanied with  directions  for  its  use,  with  the  exception  of  the 
honey,  which  is  of  no  use  whatever,  never  fails  to  injure  the  stomach, 
and  often  produces  colic  in  healthy  people.  But,  the  compound  is 
there,  however,  with  the  obvious  design  of  supplying  a  convenient  re- 
source to  the  practitioner  in  cases  of  "  cough,"  and  especially  that 
which  attends  the  croup.  In  Wood  and  Bache's  Dispensatory,  of 
which  the  United  States  Pharmacopoeia  forms  an  important  basis,  it  is 
said  by  the  editors,  that  it  "  requires  an  explanatory  commentary,  in 
order  that  its  precepts  may  be  fully  appreciated,  and  advantageously 
put  into  practice."  Now,  after  stating  that  formula,  the  editors  re- 
mark, that  "  this  is  the  preparation  commonly  known  by  the  name  of 
Coxe's  Hive  Syrupy  Indeed,  such  is  the  translation  of  the  original 
name.     Thus : 

"Mel  Scill^  Compositum.  U.  S.  Compound  Syrup  of  Squill. 
Hive  Syrup.'" 

In  this  are  four  ounces,  each,  of  squill  and  seneka,  and  two  pounds 
of  clarified  honey,  along  with  four  pints  of  water  and  forty-eight  grains 
of  tartarized  antimony,  boiled  down  to  three  pints,  or  about  three 
pounds. 

Such,  then,  is  a  standing  formula  for  croup,  with  the  very  name  of 
the  disease  associated  with  it ;  and  a  more  dangerous  weapon  was 
never  put  into  the  hands  of  the  profession.  Compared  with  the  lan- 
cet, which  is  so  often  represented  in  a  similar  manner,  the  ratio  is 
about  the  same  as  computed  by  Smith  between  the  "  hero  and  the 
murderer"  (§  569,  e).  In  all  the  cases,  however,  the  questions  at  is- 
sue are  to  be  decided  by  the  force  of  facts. — Notes  F  p.  1114,  Mm  p.  1141. 

If  the  mischief  attendant  on  the  "  Hive  Syrup"  were  limited  to 
croup  alone,  these  remarks,  perhaps,  had  never  been  written.  But, 
"  cough"  upon  "  cough,"  reaching  even  to  all  the  stages  of  pulmo- 
nary phthisis,  make  their  frequent  demands  upon  "  Hive  Syrup." 
The  antimony  which  it  embraces  atones  but  little  for  the  offenses  of 
Its  associates  in  most  of  the  cases  where  they  are  called  into  action. 

892*-,  g.  It  is  resolution,  not  expectoration,  which  is  wanted,  when 
It  can  be  obtained,  in  all  the  cases  of  active  inflammation, — ay,  in  all 
of  pulmonary  phthisis  before  suppuration  supervenes  (§  700  h.  705, 


THERAPEUTICS. EXPECTORANTS.  039 

732  d,  862-864,  890  e).  If  the  disease  be  of  such  intensity  that  res- 
olution may  not  be  effected  by  tartarized  antimony  or  ipecacuanha, 
no  time  should  be  lost  in  calling  upon  general  or  local  bloodletting, 
cathartics,  blisters,  &c.  "And  when  we  consider  how  these  accomplish 
the  intention  to  which  the  expectorants  are  inadequate  only  from  the 
force  of  disease,  it  will  go  with  the  many  other  analogous  considera- 
tions disseminated  in  this  work  toward  clearing  up  the  philosophy 
which  interprets  the  operation  of  expectorants,  whether  in  their  cura- 
tive or  morbific  relations  to  disease.  Or,  again,  if  bloodletting  fail  of 
ai'resting  pneumonia,  for  example,  we  may  pursue  the  philosophy  in 
another  aspect ;  since,  while  it  has  relieved  the  violence  of  the  mala- 
dy, it  has  brought  on  expectoration.  It  has  so  modihed  the  inflamma- 
tory condition  that  mucus  is  generated  in  preternatural  quantities ; 
and  therefore  we  see  that  bloodletting  itself  may  operate  as  an  expec- 
torant. We  now  exhibit  tartarized  antimony,  and  it  may  either  in 
crease  or  diminish  the  expectoration ;  and,  in  doing  either,  it  contrib- 
utes to  the  decline  of  the  disease.  The  expectoration,  therefore,  is  a 
mere  result,  a  mere  symptom,  of  a  certain  change  in  the  action  of  the 
organs  by  which  the  mucus  is  secreted  ;  and  it  may  be  the  result  of  a 
favorable  or  an  unfavorable  change.  It  appears,  therefore,  that  wheth- 
er the  agent  will  or  will  not  increase  the  mucous  product,  or,  on  the 
other  hand,  diminish  it,  depends  upon  the  exact  influence  it  may  ex- 
ert upon  the  pathological  condition.  All  this  clearly  brings  the  oper- 
ation of  the  several  agents  upon  a  par,  and  admonishes  us  to  study 
their  virtues,  their  mode  of  operating,  and  the  precise  conditions  of 
disease  to  which  one  or  the  other  may  be  applicable  (^  694f ,  741  b). 

But,  let  us  pursue  yet  farther  the  case  of  pneumonia.  Let  us  sup- 
pose a  slow  termination  of  disease.  Antimonials  finally  cease  to  be- 
stow any  farther  benefit,  and  the  cough  has  subsided  into  one  of  a  low 
chronic  nature,  without  much  expectoration.  Here  it  is,  if  there  be 
no  strong  tendency  to  scrofula,  that  squill,  seneka,  and  other  stimula- 
ting expectorants,  may  become  highly  useful ;  and  if  the  cough  be 
frequent  and  short,  denoting  an  irritable  state  of  the  lungs,  we  asso- 
ciate an  opiate,  which  not  only  allays  the  cough  and  moderates  the 
Btimulant  effect  of  the  expectorants,  but  increases  the  expectoration ; 
and  thus  the  opiate  becomes  an  expectorant,  though  neither  this  nor 
bloodletting  are  ranked  in  that  group  of  remedies  (^  872  a,  891  i). 

A  blister  is  also  applied  to  the  affected  chest,  and  now,  again,  ex- 
pectoration either  increases  or  declines ;  though,  in  either  case,  there 
is  a  manifest  abatement  of  disease  as  a  consequence  of  the  counter- 
irritation  (^  111-117,  233f,  647^,  891^  k,  893  a,  c,  e,  905  a,  227). 

But,  perhaps  the  cough  has  ultimately  become  complicated  with 
disordered  digestion,  or,  it  may  be  chiefly  maintained  by  some  gastric 
derangement.  It  is  dry,  and  the  usual  expectorants  render  it  still 
more  irritating  and  husky.  The  remedy,  therefore,  is  wrong,  and 
has  not  been  addressed  to  the  essential  pathological  condition;  which 
consists  of  some  derangement  of  the  stomach,  while  that  of  the  lungs 
has  become  mostly  sympathetic.  Whatever  will  now  relieve  the  for- 
mer affection  may  remove  the  pulmonic.  For  this  purpose  tonics 
may  be  useful,  and,  as  relief  follows  in  the  lungs,  expectoration  may 
be  one  of  the  results  (§  905).  Tonics,  therefore,  in  cases  of  this  na- 
ture, become  expectorants,  and  equally  so  as  any  of  the  agents  which 
are  confined  to  this  denomination  of  remedies.    It  is  obvious,  too,  that 


G40  INSTITUTES    OF    MEDICINE. 

they  all  operate  upon  common  principles  when  they  promote  expec- 
toration ;  and  whether  the  result  will  follow  one  or  the  other,  will  de- 
pend upon  the  existing  state  of  the  system,  in  a  general  sense,  and 
more  particularly  upon  the  precise  pathological  condition  of  the  lungs. 
It  is  apparent,  therefore,  that  remedies  from  almost  any  group  may 
be  expectorant ;  bloodletting,  cathartics,  emetics,  narcotics,  tonics, 
counter-irritants,  and  even  alcohol.  The  last,  indeed,  in  the  form  of 
hot  toddy,  is  a  popular  remedy  for  colds.  It  may  or  may  not  increase; 
expectoration.  It  may  relieve,  but  more  generally  aggravates  the 
disease  (§  756).     Will  Chemistry  explain  (^  892  h,  892^  v\  ? 

Old  neglected  coughs  from  ordinary  catarrh,  and  what  is  known  as 
the  old  man's  cough,  come  under  that  condition  of  common  inflamma- 
tion to  which  the  stimulating  expectorants  are  adapted.  But,  howev- 
er protracted  may  be  the  specific  varieties,  as  in  hooping-cough,  and 
pulmonary  phthisis,  they  cannot  be  employed  without  endangering 
life.  Their  effect,  indeed,  in  hooping-cough  is  so  obviously  bad  that 
they  are  not  often  employed  in  its  treatment ;  but,  in  pulmonary 
phthisis,  and  especially  in  the  catarrhal  affections  of  scrofulous  consti- 
tutions, we  every  day  witness  the  penalties  which  are  paid  for  substi- 
tuting morbid  anatomy  for  the  vital  signs  of  disease,  and  in  defiance 
of  the  plainest  demonstrations  which  therapeutical  agents  can  supply 
(§  137,  c,  662  «).— Note  F  p.  1114. 

S92|,  h.  The  sympathies  to  which  the  lungs  are  liable  fiom  many 
diseases  of  other  parts,  especially  of  the  digestive  organs,  and  the 
more  or  less  reciprocal  effects  of  their  own  diseases,  by  which  end- 
less reflex  nervous  actions  may  be  set  in  operation,  together  with  the 
situation  of  the  lungs  in  a  bony  cavity,  frequently  render  it  difficult  to 
ascertain  their  exact  pathological  conditions,  and  to  distinguish  what 
may  appertain  to  pulmonary  disease  from  what  may  be  due  to  the  play 
of  sympathies.  The  stethescope,  like  the  long-established  method  of 
percussion,  has  contributed  much  to  clearing  away  the  obscurities,  and 
has  done  its  good  part  in  substituting  pathological  considerations  for 
mere  effects,  and  has  shown  us  that  cough,  difficulty  of  breathing,  &c., 
are  not  diseases,  but  merely  symptoms  of  disease.  The  scientific  physi- 
cian, therefore,  no  longer  administers  expectorants,  &c.,  for  the  relief 
of  cough,  or  dyspnoea,  but  he  applies  the  various  agents  to  overcome 
pneumonia,  pleuritis,  bronchitis,  laryngitis,  pharyngitis,  &c.  In  one 
case  there  is  something  tangible,  intelligible,  and  susceptible  of  cer- 
tain and  speedy  relief;  in  the  other,  or  where  the  prescription  is  made 
to  the  symptom  alone,  all  is  confusion,  uncertainty,  and  death.  Or,  it 
may  be  some  organic  affection  of  the  heart,  or  gastritis,  or  enteritis, 
or  little*more  than  moderate  degrees  of  indigestion,  upon  which  the 
cough  or  dyspnoea  depends  and  yet  where,  from  want  of  a  proper 
anatomical  knowledge,  or  of  physiological  and  pathological  science, 
the  most  unhappy  mistakes  are  made  with  the  expectorants,  but  where 
the  better  informed  are  often  greatly  aided,  in  their  embarrassments, 
by  the  stethescope. 

But  great  as  is  the  acquisition  of  the  stethescope,  the  reign  of  mor- 
bid anatomy  has  surrounded  it  with  many  abuses  ;  the  vital  sio^ns  are 
either  neglected  or  held  to  be  of  very  suboi'dinate  importance,  and  the 
instrument  is  turned  in  pursuit  of  structural  lesions.  If  cough  and  dysp- 
noea supervene  upon  abdominal  derangements,  the  source  of  the  symp- 
toms is  not  seldom  found  in  some  special  lesion  of  the  heart,  or,  others 


THERAPEUTICS. EXPECTORANTS.  641 

detect  in  the  supposed  cardiac  lesions  the  cause  of  an  intermittent 
or  irregular  pulse  that  depends  on  hepatic  disorder  (§  390  h,  688  /.-, 
806,  811).  These  mistakes  are  a  fruitful  source  of  nialpratice,  and 
are  common  among  the  disciples  of  morbid  anatomy(^  697,  699  c,  701). 

892|,  i.  The  foregoing  considerations  appear  to  be  indispensable  to 
all  who  would  enter  understandingly  upon  the  treatment  of  pulmonary 
affections,  or  to  distins;uish  what  is  relative  to  the  lun^s  from  what  is 
due  to  other  organs,  or  to  comprehend  the  modus  operandi  of  the  re- 
medial agents,  whether  they  be  employed  under  the  denomination  of 
antiphlogistics,  vesicants,  pectorals,  expectorants,  &c.,  or  their  philo- 
sophical and  comprehensive  name  of  alteratives. 

To  the  young  practitioner,  at  least,  I  would  say  that  it  should  never 
be  forgotten  that  every  inflammatory  state  of  the  mucous  tissue  of  the 
lungs,  however  mild  or  chronic,  is  liable  to  become  exasperated,  and 
to  give  rise  to  pneumonia,  or  to  croup,  or  what  is  extremely  common, 
to  phthisis  pulmonalis.  And  when  we  again  consider  how  often  the 
last  aflection  has  been  developed  by  the  stimulating  expectorants,  I 
think  that  I  do  not  err  in  my  estimate  of  their  relative  uses  and  de- 
structive effects  in  saying  that  mankind  would  be  benefited  by  exclu- 
ding from  the  treatment  of  pulmonary  diseases  all  the  reputed  mem- 
bers of  that  group  of  remedies  excepting  those  which  belong  to  the 
first  of  the  foregoing  subdivision  (§  892|,  c).  Independently  of  the  di- 
rect practical  results,  attention  would  be  turned  upon  bloodletting, 
antimonials,  &c.,  and  their  sti'ikingly  salutary  effects  in  numerous 
cases  of  common  inflammation  of  the  pulmonary  mucous  tissue,  and 
in  the  early  stages,  especially,  of  those  inflammatory  states  which  lead 
to  pulmonary  phthisis,  would  revolutionize  the  whole  system  of  mor- 
bid anatomy,  and  eradicate  the  pathology  which  has  been  founded 
upon  it.     The  laws  of  the  nervous  system  should  banish  the  "  sipeciality". 

In  the  next  edition  of  my  Materia  Medica  (and  I  make  the  sugges- 
tion on  account  of  its  practical  bearing),  it  is  my  intention  to  substi- 
tute for  the  term  Expectorants  another  which  shall  refer  to  their  mo- 
dus operandi  ;  probably.  Alteratives  adapted  to  Pulmo?iic  Iriflamma- 
tions,  and  I  will  rank  bloodletting  as  the  first,  in  a  general  sense.*  This 
will  take  in,  also,  tartarized  antimony,  and  ipecacuanha,  in  emetic 
doses.  Its  advantages  may  be  variously  illustrated.  Almost  any  con- 
dition, for  example,  of  muco-pulmonic  inflammation  may  be  accom- 
panied with  a  strong  predisposition  to  inflammation  of  the  pleura,  or, 
they  may  occur  together,  or  in  the  form  of  pleuro-pneumonia.  Very 
many  turn  dii'ectly  to  the  expectorants,  and,  if  they  find  their  atten- 
tion arrested  at  once,  under  an  equivalent  denomination,  by  bloodlet- 
ting, and  tartarized  antimony,  and  unfettered  by  the  .term  expecto- 
rants, the  appropriate  remedies  may  have  a  good  chance  of  raising 
inquiry,  and  their  ti'ial  may  awaken  new  views  in  pathology,  and  dis- 
sipate some  of  the  prejudices  against  loss  of  blood.  The  practitioner 
will  soon  imbibe  the  conviction  which  experiment  produced  in  the  dis- 
tinguished Cleghorn,  that  bloodletting  can  scarcely  be  misapplied  under 
any  conditions  of  pneumonia,  and  be  led  to  avoid  the  stimulating  ex- 
pectorants, as  he  will  all  the  tonics,  when  he  approaches  the  treatment 
of  most  inflammatory  affections  (§  1005,  h).  In  proportion  as  the  loss 
of  blood  is  less  likely  to  be  useful  where  any  form  of  pulmonic  in- 
flammation, to  which  this  remedy  may  be  adapted,  shall  refuse  to 
yield  to  its  power,  so  in  a  gi-eater  ratio  will  the  non-stimulating  ex- 

*  This  improvement  was  made  in  the  edition  of  1848. 

S  s 


642  INSTITUTES    OF    MEDICINE. 

pectorants,  and  all  other  means,  be  likely  to  fail.  How  unavailing, 
therefore,  must  be  those  stimulating  expectorants  which  are  so  often 
prescribed,  even  by  those  who  confide  in  early  bloodletting,  at  the  ad- 
vanced stages  of  pneumonia !  The  sole  object  in  view  is  that  of  in- 
creasing or  starting  expectoration,  without  any  reference  to  the  mor- 
bific virtues  of  the  supposed  remedy.  Let  us,  therefore,  have  the 
best  remedy,  however  late,  whatever  the  sex,  whatever  the  constitu- 
tion or  the  age ;  and  that  remedy,  in  the  cases  supposed,  will  be  the 
loss  of  blood,  as  affording  the  best  chance  for  life.  Whenever  acute 
forms  of  inflammation  subside  into  a  chronic  state,  neither  the  pathol- 
ogy nor  the  principles  of  treatment  change,  unless  as  it  respects  par- 
tial modifications.  In  a  general  sense,  the  direct  antiphlogistic  plan 
should  be  continued  (§  752,  &c.,  1007  h,  c,  d,  1008). 

In  the  language  of  the  celebrated  Dr.  Freind,  "  There  are  some, 
perhaps,  who  may  think  these  various  inquiries  into  disease  may  not 
he  of  much  service  to  the  healing  art.  However,  they  must  allow  me 
to  affirm,  that  it  is  of  very  great  importance  to  physic  that  we  have 
an  accurate  knowledge  both  of  the  peculiar  signs  and  of  the  nature 
of  each  distemper,  and,  also,  of  its  seat ;  for  these  being  found,  we 
shall  be  much  happier  in  our  inquiries  into  the  means  of  cure.  Who- 
ever, therefore,  perfectly  understands  the  nature  of  a  pleurisy,  or  peri- 
pneumony,  will  easily  perceive  what  immediate  relief  may  be  had 
from  opening  a  vein ;  for,  upon  this  point  so  depends  the  whole  safe- 
ty of  the  patients,  that,  if  you  should  depart  from  this  kind  of  medi- 
cine  in  vain  will  you  seek  for  any  other." 

But,  I  would  finally  say  of  pneumonia,  that  however  the  disease 
may  abate  under  the  direct  effect  of  loss  of  blood  it  not  unfrequently 
happens  that  the  symptoms  recur  with  more  or  less  violence.  It  is 
this  which  we  are  to  anticipate  and  watch,  and  to  repeat  the  remedy 
fi'om  time  to  time  as  returning  symptoms  may  suggest,  and  before 
the  disease  can  have  recovered  its  original  severity  (§  1005,  h).  In  this 
manner,  we  shall  constantly  make  advances  upon  it,  and,  with  the  aid 
of  other  remedies  judiciously  devised,  we  shall  not  often  fail  of  suc- 
cess. These,  however,  are  cases  in  which  firmness,  and  a  constant 
recourse  to  pathological  considerations,  are  more  or  less  in  requisition. 
Sanguine  hopes  may  be  called  up  by  the  great  relief  which  is  yielded 
by  the  first  outlet  of  blood,  but,  to  be  only  in  a  few  hours  disappoint- 
ed by  the  formidable  signs  of  returning  inflammation;  and  when,  at 
last,  we  shall  have  met  them  again  and  again  by  our  principal  reme- 
dy, the  disease  may  appear  to  have  come  to  a  stand,  and  scarce  fal- 
ters under  the  combined  effect  of  general  bloodletting,  leeching,  anti- 
monials,  &:c.  This  is  no  time  for  discouragement,  but  rather  to  fear 
that  our  means,  in  coming  short  of  the  mark,  have  not  been  applied 
in  sufficient  vigor.  Now  is  the  time,  I  say,  to  push  the  high  princi- 
ples of  our  noble  science,  to  throw  off  the  trammels  of  prejudice,  and 
let  the  blood  flow,  till,  by  the  relief  it  brings,  we  win  new  trophies  for 
ourselves,  and  for  medicine  (§  1005  a,  b,  c,  d,  e,J',g,  7i,  1007  b,  c,  d, 
1008,  1068  c).—See  Y.S.,  1860,  at  p.  872.     Also,  Note  F  p.  1114. 

COUNTER-IRRITANTS. 

893,  a.  I  enter  now  upon  the  consideration  of  those  remedial  agents 
which  establish  their  influences  upon  internal  organs  through  the  me- 
dium of  the  skin  ;  and  here  is  opened  to  us  a  display  of  those  sympa 


THERAPEUTICS. COUNTER-IRRITANTS.  643 

thetic  processes  which  take  then-  origin  in  cerebro-spinal  nerves  along 
with  the  sensitive  fibres  of  the  sympathetic,  and  terminate  in  tlie  motor 
fibres  of  the  ganglionic  system  (§  113,  224,  454  a,  461-461^,  465, 
473  c,  478,  488^,  489,  512,  514/-/?;,  51G  rf,  nos.  12,  13,  520,  891^^,  k). 

That  vesicants  and  leeches  operate  in  the  foregoing  manner  was  ex- 
pressed by  me  in  the  London  Medico-Chirurgical  Revieio  in  1834.  See 
p.  827,  §  1056. — Also,  Rights  of  Authors,  p.  914. 

Counter-irritants  exert  their  effects  upon  parts  remote  from  the  seat 
of  their  application  in  the  same  manner  as  when  cold  applied  to  the 
surface  excites  the  renal  function,  or  lights  up  pneumonia,  and  through 
the  very  complex  mechanism  set  forth  at  the  beginning  of  this  section, 
and  in  other  places.  Here,  too,  in  the  case  of  counter-irritants,  we 
meet  with  an  embarrassing  diversity  of  central  parts  which  govern  the 
reflex  nervous  actions,  and  perplexing  results  as  the  irritant  may  oper- 
ate through  one  centre  or  anothei- — sometimes  taking  the  route  of  the 
brain  and  spinal  cord,  and  then  proving  morbific,  or  at  other  times  op- 
erating through  the  ganglia  or  plexuses  of  the  sympathetic  nerve,  or 
some  portion  of  the  nerve  itself,  in  the  vicinity  of  the  counter-irritant, 
and  then  only  proving  curative  (§  233f,  455  a,  456  a,  461^  a,  473  c, 
478  b,  483  c,  889  g).  We  shall  see,  too,  in  all  these  influences  the 
clearest  demonstration  that  the  nervous  power  is  modified  in  its  nature 
by  the  impression  transmitted  by  the  agent  to  the  nervous  centres  (§ 
481,  89H5r,  k),  and  that  it  operates  either  as  a  directly  morbific  cause 
or  is  curative  of  existing  disease  by  substituting  pathological  conditions 
more  favorable  to  the  recuperative  tendency  of  the  organic  properties 
(§  854,  900,  &c.).  Exactly  the  same  philosophy,  therefore,  is  applica- 
ble to  the  modus  operandi  of  counter-irritants  that  I  have  hitherto  rep- 
resented as  characterizing  all  other  agents.  But  such  is  the  diversity 
in  the  details  relative  to  the  laws  and  phenomena  of  the  nervous  sys- 
tem, whether  resulting  from  its  direct  or  reflex  action,  whether  excited 
by  the  will,  by  mental  emotions,  or  by  direct  physical  irritations  of  the 
nervous  centres  in  the  former  case  (§  227-230,  245,  481),  or  by  trans- 
mitted influences  to  those  centres  from  remote  parts  in  the  latter  case, 
or  as  certain  cerebro-spinal  nerves  are  limited  to  a  subservience  of  vol- 
untary motion  and  sensation,  or  as  others  co-operate  with  the  sym- 
pathetic by  contributing  to  the  essential  office  of  the  latter  in  harmo- 
nizing the  organic  functions,  variously  affecting  the  organic  products  in 
vital  constitution,  and  perpetually  exciting  or  depressing  the  secretory 
and  excretory  processes,  and  seeing  how  the  latter  mechanism  is  the 
great  medium,  through  its  physiological  characteristics,  of  the  trans- 
mission of  the  disturbing  effects  of  morbific  causes,  and  the  restorative 
of  such  as  are  remedial  (§  113,  500  ^r,  and  references  above),  and,  with- 
al, the  isolation  of  intermediate  nerves  when  the  mind  or  physical 
causes  operate  upon  individual  parts,  and  yet  all  determined  by  pre- 
cise, however  complex,  laws,  we  find  ourselves  in  a  labyrinth  where  no 
light  is  admitted  from  the  surrounding  effulgence  of  inorganic  nature, 
and  recognize  the  impracticability  of  expounding  its  problems  in  any 
other  than  a  language  as  foreign  from  chemistry  and  physics  as  are  the 
functions  and  laws  and  phenomena  of  living  beings,  and  the  necessity 
of  a  copious  analysis  of  all  its  parts  (§  5^  b,  59,  64,  165-169).*  And 
this  leads  me  to  recur  to  what  I  have  said  of  the  terms  motor,  sensitive, 
and  reflex  action  in  §  475,  that  I  may  now  add  that  reflex  action  should 
be  regarded  s&  expressing  simply  a  general  result  without  implying  in 
*  Se&  Notes  Aa  p.  1131,  Dd  p- 1132. 


644  INSTITUTES    OF    MEDICINE. 

the  least  the  philosophy  of  the  process.  It  may  be  made  to  stand  for 
any  hypotheses  expressive  of  reaction,  though  least  of  all  for  that  of 
galvanism,  or  any  other  emanating  from  the  science  of  chemistry.  The 
reflection  even  of  polarized  light,  with  all  its  modifications,  would  not 
serve  as  an  analogical  basis  for  the  reflection  of  any  influences  trans- 
mitted to  the  nervous  centres  or  of  the  nervous  power,  and  all  analogy 
disappears  in  those  influences  which  take  their  rise  in  the  centres  them- 
selves, or  such  as  I  have  designated  as  direct  developments  of  the  nerv- 
ous influence,  and  which,  from  the  absence  of  centrq^etal  impressions, 
and  from  engaging  only  the  centrifugal  nerves,  discloses  the  defective 
import  of  the  term  reflex  action.  .  Kor  will  I  neglect  this  opportunity 
of  adding  to  §  409  k  the  important  fact  that  the  hypothesis  of  galvan- 
ism, as  applied  to  reflex  action  of  the  nervous  system,  violates  the  in- 
dispensable requisite  of  a  continuous  circle,  and  contents  itself  with  the 
most  irregular  segments,  and  these  segments  and  curved  lines  consisting 
of  two  parts  differently  endowed,  and  manifesting  peculiarities  of  func- 
tion that  bear  no  analogy  to  galvanism.  Nay  more;  for  in  a  still  more 
discreditable  manner  it  professes  to  be  the  agent  concerned  when  the 
nervous  influence,  as  in  mechanical  irritation  of  the  nervous  centres,  en- 
gages only  the  centrifugal  nerves,  and  then  operates  in  a  straight  line  ! 
The  experiments  upon  the  frogs  prove  nothing  beyond  the  fact,  for 
here  a  continuous  circuit  is  formed  and  galvanism  developed.  They 
are  nothing  more  than  the  rudest  experiments  with  inorganic  matter.* 
893  b.  In  my  Materia  Medica  and  Therapeutics  I  have  arranged  Coun- 
ter-irritants, with  numerous  other  remedies,  as  an  Order  of  Antiphlo- 
gistics,  and  under  the  genei'al  denomination  of  Cutaneous  and  other  Lo- 
cal Ajyplications.  The  counter-irritants  consist  of  Vesicants,  Rulefacients, 
Suppurants,  Escharotics,  Potential  Cauterants,  and  Actual  Cauterants. 

893  c.  Vesicants  are  by  far  the  most  important,  though  mostly  con- 
fined to  the  blistering  insects.  The  two  next  groups  operate  essentially 
after  the  manner  of  vesicants ;  but  escharotics  and  cauterants  are  gen- 
erally limited  to  simply  local  effects,  and  with  only  that  obscure  instru- 
mentality of  the  nerves  which  must  arise  from  their  incorporation  in 
compound  tissues  (§  746  c),  though  often  giving  rise  to  local  reflex  ac- 
tions, especially  moxas,  but  too  moderate  for  much  effect  upon  internal 
parts.  It  is  otherwise,  however,  with  vesicants,  rubefacients,  and  sup- 
purants,  which  not  only  exert  their  useful  effects  through  local  nervous 
centres,  but  in  unsuitable  states  (§  893  n,  p)  the  first  two  often  send 
their  influences  to  the  cerebro-spinal  axis,  and  thus  develop  a  general 
reflex  action  that  disturbs  especially  the  motions  of  the  heart  and  ar- 
teries, which  are  far  more  readily  aflfected  by  these  causes  than  the 
functions  of  any  other  organ  (§  113-117,  224,  226-233f,  339,  409  h, 
446  a,  454-461^,  478,  480-485,  489,  490,  500  dd,  k,  m,  512,  516  d,  no. 
3,  524  d,  no.  7,  526  a,  b,  687^688,  714-719,  746  c,  826  cc,  829,  846, 
891^  g,  k,  8925,  892^  v,  893 1,  902,  904c-905,  905|,  952,  961  a,  1059). 
Again,  also,  when  vesicants  lead  to  irritative  inflammation,  which  is 
often  the  case  with  children,  and  in  the  sanguine  and  nervous  tempera- 
ments, or  in  others  where  general  irritability  is  morbidly  increased,  the 
nervous  power  may  be  brought  into  geiicral  operation,  and  we  may  wit- 
ness the  full  display  of  reflex  nervous  actions  in  one  almost  universal 
commotion  of  the  body  (§  150).  This  may  also  follow  too  extensive  an 
application  of  a  blister,  or  of  rubefacients,  though  no  excessive  irrita- 
tion be  produced  in  the  skin ;  just  as  a  scald  of  limited  extent  may  be 

*  See  Notk'y  p.  1130,  Eick  p.  1150. 


THERAPEUTICS. COUNTER-IRRITANTS.  G45 

salutary,  while  another  less  intense,  but  spreading  over  a  greater  sur- 
face, will  be  often  fatal.     In  all  these  cases,  however,  the  effect  is 
morbific,  and  they  exemplify  the  very  close  analogy  between  the  op- 
eration of  morbific  and  remedial  agents  (§  901).     It  is,  indeed,  the 
amount  of  the  agent,  whether  physical  or  mental,  and  the  existing  state 
of  the   body,  which  makes   all  the  difference  between  salutary  and 
morbid  results.     The  amount  of  a  remedy,  which  had  been  curative 
in  one  case,  may,  in  the  same  dose  in  another  case  nearly  analogous, 
or  if  not  exactly  applied,  lead  to  a  fatal  issue.     In  the  case  of  vesicants, 
their  action  should  be  so  circumscribed  as  to  operate  mostly  through 
local  nervous  centres,  or  by  contiguous,  not  by  remote  sympathy ;    and 
hence  a  use  of  these  terms  (§  497,  638|).      Bloodletting  will  secure  this 
by  lessening  irritability  and  general  reflex  nervous  action  (^  224, 1038). 

In  the  preceding  discussions  upon  the  materia  medica  I  have  been  ex- 
tensively employed  in  seeking  out  the  provisions  which  the  Author 
of  Nature  has  so  bountifully,  however  intricately,  ordained  for  the  re- 
lief of  those  principal  diseases  of  mankind,  fever  and  inflammation. 
And  yet  we  have  often  had  occasion  to  see  that  many  of  the  most  val- 
uable agents  for  these  purposes  are  directly  productive  of  inflamma- 
tion when  unskillfully  applied.  This  is  often  exemplified  by  many  of 
the  cathartics ;  and  the  Peruvian  bark,  and  its  analogous  tonic  asso- 
ciates, will  relatively  cure  or  exasperate  intermittent  fever  according 
to  the  exact  conditions  under  which  they  are  administered.  We  have 
seen,  indeed,  that  even  wine,  brandy,  &c.,  now  and  then  become  rem- 
edies for  fever,  and  even  for  inflammation  (§  752,  &c.,  892^,^).  The 
apparent  contradictions  I  have  endeavored  to  reconcile,  and  to  show 
that  the  occasional  coincidence  in  the  results  of  agents  which  are 
opposed  to  each  other  under  ordinary  circumstances  is  due  to  a  com- 
mon law  which  governs  the  operation  of  all  causes  upon  organic  life. 
The  causes  operate  upon  those  properties  in  which  life  fundamentally 
consists,  and  thus  give  rise  to  healthy,  or  morbid,  or  curative  effects, 
just  as  they  happen  to  affect  those  properties  (§  137  d,  150,  151,  177, 
189  b,  350k,  350^,  569  a,  638,  852  a).  In  disease,  as  we  have  seen, 
their  susceptibility  is  variously  altered  from  the  natural  standard,  and 
variously  so  in  any  given  disease,  as  in  fevers  and  inflammations ; 
according  to  the  numerous  fundamental  and  transient  circumstances 
already  set  forth.  It  may  be,  therefore,  that,  in  a  few  cases  oi  common 
inflammation  bark  or  wine  will  place  the  diseased  conditions  in  as  fa- 
vorable a  state  for  the  recuperative  efforts  of  Nature,  as  bloodletting 
and  cathartics  will  do  it  in  most  other  instances ;  and  when  either 
produce  this  auspicious  change  they  are  antiphlogistics.  It  is  upon 
this  principle,  therefore  (or  that  of  the  general  tendency  of  a  vast 
range  of  therapeutical  agents  to  establish  salutary  changes  in  febrile 
and  inflammatory  disease,  when  duly  employed),  that  I  have  assem- 
bled the  most  useful  part  of  the  Materia  Medica  under  the  general 
denomination  of  Antiphlogistics. — See  Note  Ee  p.  1133. 

The  foregoing  remarks  are  preliminary  to  a  farther  exposition  of 
the  same  principles  which  are  concerned  in  the  therapeutical  opera- 
tion of  the  group  of  agents  upon  which  we  have  now  entered,  and 
which  are  curative  by  exciting  inflammation,  or  analogous  conditions; 
and  the  best  of  them  are  such  as  will  eflfect,  in  a  given  time,  the  near- 
est approach  to  a  full  development  in  the  skin  of  the  most  simple  form 
of  common  inflammation  (§  721,  722,  729  a).     These  means  are,  prin- 


640  INSTITUTES    OF    MEDICINE 

cipally,  cantharides,  issues,  and  setons.  Their  immediate  action  ia 
strictly  morbific ;  and  they  have  no  salutary  effect  upon  existing  in- 
flammations till  they  produce  a  corresponding  disease,  or,  at  least, 
that  raoi'bid  irritation  which  forms  the  access  of  inflammation,  in  some 
part  of  the  surface  of  the  body.  Then  it  is  that  this  artificial  inflain 
mation  or  irritation  so  modifies  the  natural  one,  that  the  latter  may 
subside,  rapidly,  without  any  other  curative  influence ;  while  the  ar- 
tificial one  is  so  peculiarly  constituted  by  the  nature  of  the  remote 
cause,  that  that,  too,  readily  takes  on  a  disposition  to  subside,  and 
thus  the  patient  escapes  from  the  inflictions  both  of  Nature  and  of 
art  (§  133  c,  137  e,  150,  151,  639  a,  852,  853,  854  c,  d,  e,  858,  905  a). 

893,  d.  It  has  appeared  to  me  a  matter  of  no  little  importance  to 
consider  the  foregoing  facts  and  the  philosophy  which  concerns  them ; 
since,  in  connection  with  what  has  hitherto  been  said  of  the  operation 
of  internal  agents,  and  connected  with  what  is  yet  in  prospect  rela- 
tive to  the  special  influences  of  loss  of  blood,  they  open  widely  a  view 
of  the  great  principles  of  solidism  and  vitalism,  and  of  the  stupendous 
laws  by  which  healthy  and  morbid  processes  are  carried  on,  and  illus- 
trate that  connecting  medium  between  them  which  is  constituted  by 
the  various  gradations  of  the  restorative  movements  as  instituted  by 
remedial  agents  under  the  great  recuperative  law  of  organic  beings. 
The  whole  is  but  an  intimate  chain  of  analogies  from  the  most  perfect- 
ly healthy  state  to  the  gravest  conditions  of  disease  (§  901). 

We  see,  also,  distinctly  exemplified  by  the  mode  in  which  blisters, 
setons,  &c.,  produce  their  favorable  results,  that  absolute  remedies  in- 
stitute the  process  of  cure  in  virtue  of  their  morbific  qualities ;  and 
this  becomes  the  more  striking  when  we  associate  with  the  alterative 
influences  of  vesicants  upon  internal  inflammations,  through  the  arti- 
ficial disease  which  is  established  in  the  skin,  those  natural  cutaneous 
inflammations,  as  erysipelas,  &;c.,  that  are  subdued  by  the  direct  con- 
tact of  the  vesicant  with  the  inflamed  surface  (§  893  I,  1059). 

893,  e.  We  may  now  pause,  for  a  moment,  to  observe  how  clearly 
the  various  effects  of  cantharides  prove  the  operation  of  curative 
agents,  either  by  a  direct  action  upon  the  organic  properties  of  a  dis- 
eased part  to  which  they  may  be  applied,  or  through  the  instrumen- 
tality of  the  nervous  power  when  they  extend  their  therapeutical  sway 
to  distant  organs,  and  how,  also,  the  nervous  power  is  variously  mod- 
ified, and  variously  reflected  upon  remote  parts,  according  to  the  na- 
ture of  its  exciting  causes  (§  227,  228,  230,  233^,  497,  500).  The 
common  mode  in  which  cantharides,  setons,  moxa,  scalding  water, 
burns,  &c.,  relieve  or  increase  deep-seated  inflammations,  or  disturb 
the  system  at  large,  is  clearly  manifest ;  and  since  only  one  of  the 
foregoing  agents  is  liable  to  absorption,  every  precept  in  philosophy 
divests  the  coincident  effects  of  cantharides  of  a  shadow  of  possibility 
that  they  are  due  to  an  absorption  of  the  agent.  We  have  seen,  too, 
how  erysipelas  may  be  removed  by  the  direct  action  of  cantharides 
upon  the  part  inflamed  ;  and  this  (especially  when  associated  with  the 
remote  effects  of  all  other  remedial  agents)  assures  us,  as  a  next  link 
in  the  demonstration,  that  a  modification  is  imparted  to  the  nervous 
power,  according  to  the  special  virtue  of  the  remote  cause,  which  op- 
erates, in  that  particular  instance,  upon  the  remote  part  in  a  mode 
corresponding  more  or  less  with  that  which  is  observed  in  the  primary 
action.    And  now  if  we  look  at  what  is  often  goins  forward  in  the  blad- 


THERAPEUTICS. COUNTER-IRRITANTS.  647 

tier,  we  shall  see  yet  farther  (something  for  the  senses,  something  for 
"experimental  philosophy")  that  the  nervous  power  actually  acquii-es 
the  virtue  of  an  inflammatory  agent,  and  analogous,  too,  to  the  specific 
characteristic  of  that  virtue  as  it  appertains  to  cantharides.  Now 
carry  this  to  those  inflammations  which  are  constantly  springing  up  in 
different  parts  as  consequences  of  each  other,  in  the  natural  round  of 
disease,  and  you  will  come  with  me  to  the  conclusion  that  the  same 
philosophy  obtains  throughout.  It  is  exclusive  of  absorption  in  the 
case  of  the  bladder,  besides  other  obvious  objections. 

It  appears,  therefore,  that  Avhen  erysipelas  yields  to  the  direct  action 
of  vesicants  it  is  by  the  substitution  of  the  kind  of  inflammation  which 
cantharides  produces  in  the  sound  skin,  and  which  subsides  spontane- 
ously and  speedily.  Again,  other  local  applications,  as  nitrate  of  silver, 
iodine,  mercurial  ointments,  &c.,  will  effect  the  same  result  by  introduc- 
ing other  and  very  different  pathological  changes,  or  the  erysipelatous 
inflammation  may  be  subdued  by  loss  of  blood,  or  by  cathartics,  or  by 
the  constitutional  action  of  mercury,  or  perhaps  by  stimulants.  It  is 
manifest,  therefore,  from  all  this  variety  of  means,  leading  to  a  common 
result,  that  the  cure  depends  in  all  the  cases  upon  the  substitution  of  some 
artificial  pathological  condition  which  is  capable  of  spontaneous  subsi- 
dence, though  the  changes  which  are  thus  forcibly  introduced  are  as  va- 
rious as  the  remedies  (§  854,  892  b,  c,  897-902,  904  d,  905,  1059). 

But,  though  the  cantharides  supply  an  apt  illustration  of  the  whole 
philosophy  of  our  subject,  and,  like  the  natural  developments  of  in 
flammation  which  follow  each  other  by  reflected  nervous  actions,  de 
note  a  modification  of  the  nervous  power  in  great  conformity  with  tho 
nature  of  the  causes  by  which  it  is  brought  into  operation,  there  is, 
nevertheless,  a  great  variety  of  remedial  agents,  which,  in  their  thera- 
peutical doses,  manifest  no  action  upon  the  organ  to  which  they  are 
applied,  and  through  which  they  overcome  disease  in  parts  remotely 
situated  ;  as  also  other  important  ones,  like  mercury,  when  applied  to 
the  skin.  And,  although  it  be  rendered  obvious  by  the  morbific  effects 
of  these  agents  that  they  modify  the  nervous  power  in  their  therapeu- 
tical aspects  as  much  according  to  the  nature  of  the  several  agents, 
respectively,  as  do  cantharides,  issues,  setons,  or  as  when  one  natural 
inflammation  supervenes  upon  another,  I  have  made  the  qualification 
which  is  due  to  a  subject  hitherto  so  entirely  unexplained,  that  the 
modifications  of  the  nervous  power  take  place  under  the  influence  oj 
its  0W71  natxire  (§  228,  a,  8921  c,  896-901,  1059,  1088  h,  c). 

Finally,  in  respect  to  the  modus  operandi  of  cantharides,  when  con- 
sidered in  ks  analogies  to  other  vesicants,  issues,  &c.,  we  have  an  in- 
tei'esting  view  of  the  specific  relations  which  the  special  virtues  of  cer- 
tain remedial  agents  sustain  toward  the  modified  irritability  of  partic- 
ular parts  of  the  organism,  and  a  proof,  also,  of  the  diversified  condi- 
tions of  irritability  in  different  parts,  and  of  the  remai'kable  manner  in 
which  the  nervous  power  is  reflected  with  salutary  or  morbific  effect 
through  certain  motor  nerves  by  the  peculiarities  of  each  exciting  and 
modifying  cause  (§  233|,  500  g),  while  there  is  simultaneously  pre- 
sented by  the  operation  of  cantharides  a  curative  influence  upon  all 
parts  that  are  affected  by  disease,  and  a  morbific  one  upon  a  special 
part  that  was  antecedently  in  its  natural  state  (§  150,  151,  188  a, 
190  a)\  but  its  action  is  useful  only  through  local  nervous  centres. 

893, y.  From  what  has  been  now  said,  it  is  manifest  that  vesicants, 


648  INSTITUTES    OF    MEDICINE. 

issues,  setuns,  and  other  counter-irritants  do  not  produce  their  favora- 
ble effects  through  the  discharges  to  which  they  give  rise  ;  though  thia 
is  one  of  the  principal  interpretations  in  the  humoral  pathology.  The 
effusion  instituted  by  cantharides  is  so  unimportant  that  it  can  scarce- 
ly be  taken  into  the  account  in  explaining  the  curative  influences  of 
this  agent  (§  863).  Moreover,  it  frequently  happens  that  blisters  af- 
ford all  the  relief  of  which  they  are  capable  by  acting  merely  as  rube- 
facients. This,  indeed,  is  oftener  true  than  is  commonly  supposed, 
since  vesicants  are  generally  permitted  to  remain  till  vesication  is  es- 
tablished ;  though  in  numerous  cases  this  extent  of  their  action  is  un- 
necessary (§  497,  1038). 

Since,  therefore,  cantharides  will  often  answer  its  intention  when 
employed  only  as  a  rubefacient,  and  operates  at  all  limes  through  the 
vital  impressions  it  exerts  upon  the  skin,  it  may  appear  unimportant 
to  some  whether  this  or  another  agent  be  employed  for  the  purpose 
of  counter-irritation.  Such,  indeed,  is,  unfortunately,  supposed  to  be 
true  by  many  practitioners,  who  resort  to  mustard  cataplasms,  or  am- 
monia, &c.,  where  cantharides  would  be  a  far  more  useful  agent.  So 
true  is  this  where  active  inflammation  affects  any  of  the  important 
viscera,  and  vesication  has  become  appropriate,  and  may  be  of  the 
highest  importance,  the  rubefacients,  which  operate  speedily,  have 
little  or  no  salutary  effect,  and  are  often  detrimental  by  increasing 
constitutional  irritation  (§  150,  151). 

893,  g.  The  foregoing  remarkable  difference  in  results  {/)  is  ow- 
ing, in  part,  to  the  difference  in  the  virtues  of  the  remedies,  and,  in 
part,  to  the  difference  in  time  occupied  by  the  several  agents  respec- 
tively. In  all  cases  of  very  rapid  irritation  of  the  surface,  vesication, 
&c.,  whether  induced  by  ammoniated  lotions,  mustard,  boiling  water, 
moxa,  &c.,  the  curative  effect  upon  deep-seated  inflammations  is  far 
less  than  whei'e  the  artificial  disease  is  more  slowly  instituted.  It  is, 
nevertheless,  of  no  little  moment,  in  the  case  of  vesicants  applied  for 
active  forms  of  disease,  that  the  irritation  of  the  skin  should  advance 
with  considerable  rapidity,  and  that  vesication  should  ensue,  at  adult 
age,  in  from  six  to  twelve  hours.  That  is  the  most  useful  period ; 
and  when  the  full  action  of  cantharides  is  longer  delayed,  whether  by 
some  defect  in  the  remedy,  or  by  a  subdued  irritability  of  the  skin, 
the  curative  effect  is  commonly  less  obvious. — See  p.  298,  ^  476^  h. 

It  is  also  proper  to  observe,  in  a  philosophical  as  well  as  practical 
sense,  that  time  has  various  influences,  according  to  the  modification 
of  disease,  its  seat,  its  duration,  the  constitution,  sex,  age  of  the  sub- 
ject, &c.    It  relates  to  the  nervous  power,  and  is  explained  in  ^  479. 

But,  in  no  respect  is  the  influence  of  time  so  remarkable  as  seen  in 
the  difference  of  results  in  the  treatment  of  acute  and  chronic  diseases  ; 
in  which  respect  counter-irritation  is  on  a  par  with  other  remedial  in- 
fluences. When  inflammation  is  recent,  the  usual  rapidity  with  which 
cantharides  operates  is  best  suited  to  almost  all  forms  of  the  disease ; 
:,\xl  when  it  has  run  into  a  chronic  state,  and  has  become  the  subject 
of  habit,  it  frequently  happens  that  tardy  suppurants,  such  as  setons, 
issues,  tartar  emetic  ointment,  &c.,  are  highly  useful  (§  535,  &c.).  Yet 
there  is  no  doubt  that  the  difference  in  results  as  it  respects  the  time 
of  these  cutaneous  agents,  in  the  acute  and  chronic  forms  of  inflamma- 
tion, has  been  often  much  overrated;  especially  the  advantage  of  a 
suppurating  surface  in  chronic  diseases.     It  is  apt  to  be  supposed,  in 


THERAPEUTICS. COUNTER-IRRITANT^J.  64  J 

these  cases,  that  there  is  something  to  be  discharged,  either  "  concoct- 
ed matter,"  or  such  as  refuses  to  be  concocted. 

893,  h.  Although  it  be  true  that  chronic  inflammations  oppose  to 
counter-irritants  the  obstinacy  of  morbid  habit,  and  naturally  suggest 
the  long-continued  and  uninterrupted  influence  of  issues,  &c.,  expeii- 
ence  has  fully  shown,  that,  in  most  cases  of  low  indolent  inflamma- 
tions they  are  surpassed  by  a  frequent  succession  of  blisters.  This 
experience,  too,  has  mostly  banished  from  use  the  savine  ointment, 
and  other  agents,  which  were  but  lately  and  largely  employed  to 
maintain  the  action  instituted  by  cantharides.  The  difference  goes, 
with  an  endless  variety  of  analogous  facts,  in  illustrating  some  of  the 
profound  problems  of  organic  life.  The  uninterrupted  action  of  issues, 
the  prolonged  ulceration  of  vesicated  surfaces,  &c.,  are  more  or  less 
apt  to  establish  a  morbid  habit  peculiar  to  the  modifying  agents;  and, 
although  it  be  a  first  step  in  the  series  of  changes  which  are  necessa- 
ry to  establish  the  full  recuperative  process,  the  pace  is  retarded  by 
the  habit  induced.  To  break  this  force  of  habit,  it  is  only  necessary 
to  intermit  the  agent  during  the  time  required  by  the  healing  of  a  blis- 
ter. The  curative  impression  remains,  and  the  irritability  of  the  or- 
gan diseased  undergoes  an  increased  susceptibility  to  the  agent  at  its 
successive  renewals.  Each  repetition  gains  upon  the  last,  and  often 
presents  the  aspect  of  cumulative  influence.  The  principle  is  shown 
in  relation  to  many  things,  and  may  be  seen  in  the  action  of  antimo- 
ny, opium,  &c.,  in  former  sections  (§  550-556,  558  h,  889  m,  902  i). 

The  influence  of  habit  of  which  I  have  now  spoken,  as  it  respects 
the  artificial  change  induced  in  chi'onic  inflammations  by  the  uninter- 
rupted operation  of  issues,  &c.,  grows  out  of  the  analogous  habit  which 
the  agent  establishes  in  the  artificial  or  curative  disease,  which  soon 
lapses  into  that  chronic  state  which  is  less  and  less  sensibly  felt  by 
parts  morbidly  affected ;  while  those  parts,  and  the  entire  system,  are 
gradually  accommodating  themselves  to  the  artificial  irritation,  and  by 
which  this  irritation  loses  still  farther  its  sympathetic  and  curative  in- 
fluences upon  the  morbid  conditions  for  which  it  is  instituted.  But 
if,  on  the  contrary,  a  succession  of  irritations  be  employed,  the  habit 
of  which  I  have  spoken  is  neither  established  in  respect  to  the  system, 
nor  the  parts  diseased,  nor  in  respect  to  the  artificial  condition  ;  but 
eveiy  successive  repetition  of' the  irritation  produces  nearly  as  pro- 
found an  impression  as  the  first  (§  150,  151).  Here,  too,  along  with 
the  coincident  effects  of  numerous  internal  agents,  we  may  call  up  the 
advantages  of  repeated  leeching,  as  presented  in  a  subsequent  sec- 
tion (§  926),  and  in  which  reflex  nervous  action  is  equally  concerned. 

The  same  great  principles  are  involved  in  all  the  cases.  An  ele- 
gant philosophy  obtains  throughout ;  and,  although  founded  upon  the 
great  Institutions  of  Organic  Nature,  it  is  surrounded  by  so  many  of 
the  qualifying  circumstances  that  are  incident  to  the  instability  of  the 
vital  properties,  it  can  be  fully  appreciated  and  converted  to  the  high 
practical  purposes  of  which  it  is  susceptible  only  by  a  careful,  impar- 
tial, and  unremitting  attention  to  the  phenomena  of  organic  beings. 

893,  ^.  The  principles  to  which  I  have  just  adverted  (§  893,  h)  he 
Et  the  foundation  of  other  practical  facts  connected  with  the  success 
of  counter-irritation.  The  impression  upon  the  skin,  for  instance, 
must  be  carried  to  a  certain  intensity,  and  that  will  depend  upon  the 
nature  and  force  of  disease,  and  other  obvious  contingencies.     If  it  be 


650  INSTITUTES    OF    MEDICINE. 

slight,  the  necessary  impression  may  not  have  been  made  ;  while,  on 
the  other  hand,  if  in  excess,  then  it  may  not  only  disturb  the  general 
functions  of"  the  body,  but  aggravate  the  inflammation  which  it  is  the 
design  of  the  remedy  to  relieve.  In  this  respect,  therefore,  there  is  a 
close  analogy  with  the  action  of  remedies,  when  administered  inter- 
nally, as  it  respects  their  doses. 

Another  important  point  to  be  observed  is  the  extent  of  the  surface 
over  which  an  artificial  irritation  should  be  established.  This  will 
manifestly  depend  upon  a  variety  of  circumstances  ;  upon  the  nature 
of  the  irritant,  upon  the  extent,  force,  and  situation  of  the  disease,  &;c. 
[f  the  usual  agent,  cantharides,  be  employed,  and  the  surface  imtated 
be  of  narrow  limits,  it  may  be  insufficient  to  break  in  upon  the  mor- 
bid process,  however  intense  may  be  the  artificial  irritation.  On  the 
other  hand,  however,  if  a  very  large  surface  be  irritated,  its  reflex 
nervous  action  may  be  morbific,  although  the  artificial  irritation  be 
not  intense.  The  difference  in  effects  is  of  the  same  nature  as  that 
which  attends  the  small,  deep  burn  of  moxa  and  an  extensive  superfi- 
cial scald  ;  the  former  being  of  no  importance,  while  the  latter  may 
be  speedily  fatal  through  a  sudden  and  violent  reflex  nervous  action. 

But,  there  is  a  great  diffei'ence  between  the  effects  of  an  extensive 
surface  vesicated  by  cantharides,  and  by  scalding  water;  and  this 
probably  arises  mostly  from  the  difference  in  the  times  which  the 
remedies  occupy.  In  the  former  case,  the  system  is  gradually  accus- 
tomed to  the  reflex  nervous  actions,  and  may  be  but  little  disturbed, 
while,  in  the  latter,  the  violence  of  the  impression  upon  the  system  is 
proportioned  to  its  instantaneousness  ;  and  the  extent  of  the  surface 
irritated  being  great,  a  violent  shock  ensues.  In  one  case  the  rem- 
edy operates  through  local  centres  of  the  sympathetic  nerve  (§  497, 
893,  «,  c),  in  the  other  the  cerebro-spinal  axis  is  involved,  and  a  gen- 
eral, sudden,  prostrating  nervous  influence  is  developed  (§  476^  A, 
479,509,893,  c,p). 

It  is  eA^ident,  therefore,  that  there  is  only  a  certain  parallel  between 
the  effects  of  vesication  by  cantharides  and  scalding  water,  whether 
upon  a  small  or  an  extensive  surface, — scarcely  exceeding  the  par- 
tial coincidence  by  which  I  have  endeavored  to  illustrate  the  differ- 
ence between  small  and  large  vesications  by  cantharides,  and  to  ex- 
pound again  the  principles  concerned- in  the  effects  of  agents  which 
operate  gradually  or  with  great  rapidity.  The  difference,  indeed,  is 
80  great  between  the  effects  of  vesication  when  the  gradual  result  of 
cantharides,  and  those  which  are  instantly  induced  by  scalding  water, 
that  we  may  safely  vesicate  an  extent  of  surface  by  the  former  agent 
which  it  might  be  fatal  to  attempt  by  the  latter  (§  891,  w).  The  tinc- 
ture of  cantharides,  when  applied  to  the  skin,  produces  vesication 
with  great  rapidity,  is  far  less  curative,  and  oftener  disturbs  the  con- 
stitution, than  when  vesication  over  the  same  extent  of  surface  is  pro- 
duced by  the  common  plaster. — See  Experiments  ^  476J  A,  479. 

Nevertheless,  there  are  certain  inflammations,  especially  of  a  neu- 
ralgic and  rheumatic  character,  and  not  affecting  important  organs,  in 
which  a  rapid  and  violent  imtation  of  a  very  small  surface,  as  by  moxa, 
will  sometimes  overcome  the  disease.  But  these  intense,  sudden,  and 
limited  irritations,  in  affections  of  any  of  the  important  viscera,  are 
never  useful  (§  479). 

If  the  disease  be  of  a  different  character  from  inflammation,  as  the 
suddenly  painf al  affections  of  the  stomach  that  are  incident  to  indiges- 


THERAPEUTICS. COUNTER-IRRITANTS.  65^ 

don,  or,  as  in  colic,  &c.,  the  rapid  irritation  which  is  produced  by  the 
rubefacients  may  then  afford  immediate  relief,  and  more  effectually 
than  might  be  yielded  by  the  vesicating  action  of  cantharides.  These 
rubefacients  are,  also,  often  abundantly  efficacious  in  the  declining 
stages  of  articular  rheumatism,  or  in  low  chronic  states  of  that  disease. 
But  this  is  a  peculiar  modification  of  inflammation  which  will  also 
yield,  under  the  same  circumstances,  to  some  internal  remedies  which 
exert  no  salutary  influence  upon  the  common,  or  other  modifications 
of  inflammation  (§  661,  662,  756  a,  b,  892  b,  892  J  v,904  d,  1059). 

893,  k.  The  vesicating  plaster  is  generally  made  too  small  to  yield 
all  the  benefit  of  which  it  is  capable.  Four  inches  square  is  a  com- 
mon size  for  the  thorax  and  abdomen ;  while  six  or  eight  inches 
square  are  not  only  equally  safe,  but  far  more  efficient,  under  the  or- 
dinary circumstances  which  justify  or  require  this  remedy.  Indeed, 
so  comparatively  safe  is  it  to  institute  an  extensive  irritation  by  means 
of  cantharides,  when  the  state  of  the  system  is  properly  prepared,  and 
the  force  of  disease  is  otherwise  moderated,  and  so  important  is  it  in 
certain  conditions  of  disease  to  effect  a  very  powerful  impression,  es- 
pecially in  the  cerebral  inflammations  that  refuse  to  yield  to  copious 
abstractions  of  blood,  that  I  have  sometimes  rescued  patients  by  the 
apparently  desperate  practice  of  vesicating  simultaneously  the  entire 
scalp  and  a  large  extent  of  surface  upon  the  neck  and  shoulders. 
Where  bloodletting  has  been  thoi'oughly  practiced,  and  inflammation 
remains  obstinately  seated  in  some  great  vital  organ,  a  blister  of  twelve 
inches  square  may  be  necessary  to  determine  a  sufficiently  powerful 
nervous  influence,  of  which  six  inches  would  fail  (^  479). 

But,  in  respect  to  inflammation  of  the  brain,  it  should  be  distinctly 
understood  that  vesication  of  the  scalp  is  entirely  inadmissible,  un- 
less the  irritability,  and  therefore  the  susceptibility,  arising  from  the 
morbid  state,  be  greatly  lessened  by  abstractions  of  blood,  cathartics, 
&c.  The  irritation  of  the  scalp  will  be  otherwise  propagated  with 
morbific  effect  upon  the  brain ;  which  arises,  in  this  instance,  partly 
through  continuous  sympathy  along  the  communicating  vessels  (§ 
498).  Nor  is  it  expedient  to  incur  the  risk  when  immediate  danger 
is  not  impending,  but  to  apply  the  agent  to  the  neck  and  shoulder. 
The  same  objection  lies  against  the  application  of  blisters  to  the  im- 
mediate vicinity  of  the  eyes  and  ligaments  in  their  very  irritable  states 
of  inflammation.  But  if,  in  these  cases,  the  disease  have  lost  its  activ- 
ity, or  be  of  a  chronic  nature,  the  vesicant  is  then  most  efficient  when 
applied  near  to  the  part  affected.  It  sometimes  happens,  however,  in 
chronic  conditions,  that  the  skin  in  the  immediate  vicinity  becomes 
sympathetically  affected  through  the  same  influences  from  the  parts  be- 
neath as  are  propagated  upon  them,  at  other  times,  by  vesicating  the 
overlaying  skin.  These  morbid  states  of  the  adjacent  surface  are  gen- 
erally obscurely  marked  ;  though  sometimes  abundantly  apparent,  as 
in  active  forms  of  articular  rheumatism.  The  obscure  conditions  oft- 
en become  strongly  pronounced  by  an  irritative,  erysipelatous  inflam- 
mation which  is  set  up  by  vesicants,  and  by  leech-bites,  and  which 
commonly  aggravate  for  the  existing  time  the  natural  disease;  though 
the  morbific  influence  is  apt  to  disappear,  and  leave  the  disease  as  it 
was,  as  soon  as  the  artificial  irritations  subside. 

893,  I.  It  may  be  now  said,  as  a  general  rule,  that  the  liability  of 
counter-irritants,  when  applied  near  to  a  part  inflamed,  to  increase  the 


(552  INSTITUTES    OP    MEDICINE. 

inflammation,  is  in  proportion  to  the  intensity  of  the  disease,  the  inten- 
sity of  the  artificial  irritation,  and  the  rapidity  with  which  it  is  pro- 
duced. It  may,  therefore,  be  regarded  as  safe,  in  a  general  sense,  to 
apply  vesicants  and  rubefacients  immediately  over  the  affected  parts 
in  chronic  inflammations.  But  this  is  far  from  being  true  of  moxa, 
where  the  affected  part  is  in  the  vicinity  of  the  surface. 

And  yet  we  have  seen  that  it  may  be  sometimes  perfectly  safe  and 
useful  to  place  an  epispastic  in  direct  contact  with  certain  inflam- 
matory states  of  the  surface.  This,  however,  is  never  true  of  common 
inflammation  of  the  skin,  and  only  so  of  a  few  specific  varieties.  Their 
successful  treatment  in  this  manner,  as  in  the  case  of  erysipelas,  opens 
to  us  another  illustration  of  the  principles  upon  which  remedial  agents 
operate.  The  disease,  being  a  specific  modification  of  inflammation, 
has  not  the  disposition  to  subside  spontaneously  which  belongs  to  com- 
mon inflammation.  The  remedial  agent,  therefore,  varies  the  mode 
of  inflammation,  and  thus  introduces  a  modification  in  which  the  prop- 
erties of  life  are  brought  into  recuperative  action.  But,  it  is  otherwise 
with  common  inflammation,  since  the  virtues  of  cantharides  are  such 
as  to  aggravate  this  condition  when  brought  into  immediate  contact 
with  the  part  affected.  The  same  explanation  applies  to  the  thera 
peutical  effect  of  the  spirits  of  turpentine  when  applied  to  a  bum  or 
a  scalded  surface ;  since,  in  these  cases,  the  inflammatory  state  is 
turned  from  the  common  standard,  and  admits  of  the  institution,  by 
other  irritants,  of  modifications  more  favorable  to  the  recuperative 
process.    And  so  of  nitrate  of  silver  (^  893  d,  1059). 

893,  m.  With  the  qualifications  now  made,  it  is  obvious  from  what 
has  been  said  of  the  modus  operandi  of  counter-irritants,  that  they  will 
be  curative  in  proportion  as  they  are  applied  to  the  vicinity  of  the  seat 
of  disease.  Their  salutary  effects,  like  their  morbific,  depend  more 
upon  this  approximation  than  upon  any  special  sympathetic  relations 
between  certain  parts  of  the  surface  and  the  particular  internal  organs  ; 
since  it  is  mostly  through  local  centres  of  reflex  nervous  action  that 
these  agents  produce  their  curative  effects  (^  497,  893  a,  c,  905  a). 

It  is  also  a  remarkable  fact,  that  it  appears  to  be  of  no  great  moment 
in  what  particular  tissue  of  comDound  organs  the  disease  is  seated. 
Inflammations  of  either  are  alike  affected  by  irritants  as  they  are  by 
loss  of  blood  ;  but  varying,  in  all  the  cases,  according  to  the  general 
vital  constitution  of  the  several  parts  (§  loO,  151). 

893,  n.  We  have  seen  that  it  is  the  tendency  of  inflammation  to  lim- 
it itself  to  the  tissue  which  it  invades,  and  that  its  extension  to  other 
tissues  of  the  same  organ,  or  to  other  parts,  is  by  remote  or  by  contig- 
uous sympathy  (§  497,  498).  It  is  also  particularly  true  of  certain 
tissues  that  they  are  apt  to  extend  the  violence  of  their  remote  influ- 
ences upon  paits  of  similar  organization  ;  especially  in  specific  forms 
of  inflammation.  Thus,  rheumatic  inflammation  of  the  ligaments  is 
very  apt  to  invade  the  pericardium,  and  sometimes  the  dura  mater; 
and,  the  peculiar  inflammation  which  constitutes  the  mumps  (cynanche 
parotidea)  often  involves  the  testes  or  the  mammae.  There  is  much 
reason  to  think,  in  the  former  case,  where  the  heart  so  often  partici- 
pates, that  the  inflammation  is  first  propagated  to  the  pericardium,  and 
subsequently  from  that  organ  to  the  serous  tissue  of  the  heart  (§  141, 
525-529).  In  the  latter  case,  or  that  of  the  mumps,  the  affection  of 
the  parotid  will  frequently  subside  when  the  other  glands  become  af- 


THERAPEUTICS. COUNTER-IRRITANTS.  653 

fectecl ;  and  the  disease  is  then  said  to  have  undergone  a  metastasis, 
— a  magnificent  display  of  our  alterative  reflex  nervous  action.  Artic- 
ular rheumatism  affords  constant  examples  of  this  phenomenon,  in  its 
rapid  and  successive  invasions  of  different  joints,  and  the  frequency 
with  which  it  subsides  in  one  as  it  springs  up  in  another  (§  524  a,  3). 

Now,  there  is  a  prevailing  error  in  the  pathological  construction  of 
this  extension  and  subsidence  of  the  disease,  which  has  led  to  a  veiy  com- 
mon error  in  practice.  It  is  supposed  that  there  is  a  translation  of  the 
disease  from  one  part  to  another,  an  actual  movement  of  the  complaint 
— something,  probably,  after  the  manner  of  the  gases,  as  represented 
in  a  former  section  (§  350j,  n).  The  phenomenon,  in  consequence, 
has  long  borne  the  significant  name  of  metastasis  ;  and  if  gout  happen 
to  go  from  the  foot  to  the  stomach,  it  wanders  so  much  out  of  its  way 
that  it  gets  in  the  s.tomach  the  well-known  and  expressive  name  of 
misplaced  gout.  As  all  men,  therefore,  are  greatly  moved  in  their  prac- 
tical habits  by  theoretical  views  (§  4),  it  is  no  less  common  to  imagine 
that  the  rheumatic  or  gouty  affection  may  be  driven  or  invited  back  to 
its  appropriate  place.  Hence  the  applications  which  are  made  to  the 
primary  seat  of  the  affection,  but  from  which  disease  has  taken  its  de- 
parture. And  so,  also,  counter-irritants  are  applied  to  the  parotid 
gland,  should  the  testes,  or  mamm.ge,  become  affected  in  mumps,  in 
the  expectation  of  calling  back  the  disease  which  is  so  far  astray. 

In  the  first  place,  however,  there  is,  in  all  these  cases,  nothing  con- 
cerned but  reflex  actions  of  the  nervous  system,  and  nothing  is  want- 
ed to  render  the  treatment  appropriate  and  intelligible  but  a  knowl- 
edge of  physiology  and  pathology.  All  the  ambiguous  results  are  di- 
rectly referable  to  the  laws  which  govern  the  operation  of  the  nervous 
power,  which  now  presents  itself  in  the  compound  aspect  of  a  mor- 
bific and  remedial  agent  among  parts  which  have  either  strong  natu- 
ral relations,  or  which  are  especially  susceptible  of  morbific  influences 
that  result  in  the  condition  which  is  the  supposed  subject  of  transla- 
tion from  one  part  to  another;  while,  in  its  turn,  tlio  sympathetic  dis- 
ease propagates,  after  the  manner  of  vesicants,  curative  impressions 
upon  the  primary  seat  of  the  disease  by  like  reflex  nervous  actions. 

Secondly,  the  artificial  irritation  excited  with  a  view  to  recalling 
the  disease  (as  in  vesicating  the  joints  when  gout  attacks  the  stomach, 
and  this,  too,  even  when  that  organ  maybe  the  primary  and  only  seat 
of  the  affection)  is  very  different  from  the  modification  of  inflamma- 
tion which  constitutes  the  pathological  state  of  the  disease  itself,  and 
therefore  would  not  become,  by  any  reflected  influence  upon  the  parts 
beneath,  a  substitute  for  it ;  while  it  is  certainly  an  anti-pathological 
mode  of  recalling  the  specific,  or  any  form  of  inflammatory  disease, 
in  deep-seated  parts,  since  counter-irritation  is  one  of  the  principal 
means  by  which  we  remove  inflammation  of  these  parts. 

The  foregoing  practice,  as  founded  upon  the  doctrines  of  metastasis 
and  revulsion,  is  contra-indicated  not  only  by  physiological  laws,  b-.it 
by  all  experience.  The  practice  has  been  wholly  directed  by  hypothe- 
sis, and  has  not  been  sustained  by  any  favorable  results.  We  need  go 
no  farther  in  proof  of  this  than  the  admitted  failure  of  M.  Louis,  in  his 
application  of  "blisters  to  the  legs,"  to  remove,  upon  the  foregoing 
hypothesis,  the  gravest  forms  of  inflammation  and  disorganization  of 
the  brain,  intestine,  liver,  &c.,  which  befell  the  victims  of  "  The  Ty- 
phoid Affection"  at  La  Charite.     And  here  we  see  again  exemplified 


654  INSTITUTES    OF    MEDICINE. 

in  the  extensive  sway  which  may  be  exercised  not  only  by  the  au 
thority  of  a  favorite  writer,  but  in  the  pernicious  tendency  of  con« 
elusions  in  medicine  that  are  founded  upon  the  results  of  practice  as 
directed  by  errors  in  principles,  the  proneness  of  man  to  rest  his  in- 
quiries, his  hopes,  his  reputation,  the  happiness  and  the  lives  of  man- 
kind, upon  simple  views  of  the  most  abstruse,  stupendous,  and  com- 
prehensive Institutions  in  Nature, — the  Institutions  of  organic  life  (§ 
4,  5^,  5|,  349  d,  350i-350|).  But,  let  us  have  an  example  in  rela- 
tion to  the  effects  of  counter- irritation  by  cantharides,  as  propounded 
by  the  great  head  of  the  Necroscopic  School.     Thus  : 

"  Blisters,"  says  M.  Louis,  "  ought  to  he  banished  from,  the  treat- 
ment of  the  typhoid  affection."  "  If  they  exercised  any  influence 
upon  the  duration  of  the  disease  in  the  patients  who  have  recovered, 
it  was  hy  prolonging  it  a  little." 

Again.  *'  I  have  not  only  rejected  vesication  from  the  treatment  of 
pneumonitis  ;  I  have  also  ceased  to  employ  it  in  pleurisy  and  pericar- 
ditis."  "  How  can  we  believe  that  the  effect  of  a  blister  is  to  check 
an  inflammation,  when  this  blister  is  one  inflammation  superadded  to 
another  ]"  !  "  In  thoracic  inflammations,  their  usefulness  is  neither 
strictly  demonstrated  (according  to  the  numerical  method),  nor  even 
probable." 

"  One  thing  is  viost  assuredly  heyond  question,  and  we  should  never 
be  weary  of  repeating  it :  that  the  therapeutic  value  of  blisters  is  not 
known  ;  that  it  must  be  studied  by  the  aid  of  numerous  and  carefully- 
noted  facts,  just  as  if  nothing  at  all  were  knoion  about  it." 

If  the  reader  be  not  conversant  with  the  history  of  that  kind  of 
"experimental  philosophy"  upon  which  the  foregoing  conclusions  are 
founded,  or  with  the  efforts  which  are  in  progress  to  give  it  an  as- 
cendency over  the  philosophy  which  Nature  teaches,  he  may  obtain 
some  knowledge  of  their  extent  by  referring  to  foregoing  sections  (§ 
5|  a,  349  d,  350|  Tik,  Also,  M.ed.  and  Physiolog.  Comm.,  Essay  on 
the  Writings  of  M.  Louis,  vol.  ii.). 

Instead,  therefore,  of  the  unavailing  efforts  of  applying  blisters  to 
the  extremities  for  the  relief  of  cerebral,  or  hepatic,  or  intestinal,  in- 
flammation, &c.,  let  them  be  directed  to  the  organs  which  are  the  seats 
of  disease,  by  applying  them  over,  or  in  the  vicinity  of,  their  regions,  to 
obtain  the  advantage  of  local  centers  of  reflex  nervous  action  (§  224), 

As  to  the  doctrines  of  metastasis  and  revulsion,  which  have  had 
their  origin  in  the  phenomena  of  reflex  nervous  actions  (especially  as 
witnessed  in  the  successive  development  and  subsidence  of  disease 
as  they  obtain  in  gout,  rheumatism,  and  mumps),  the  whole  system 
is  constantly  supplying  examples  of  the  accession  of  one  disease  as 
the  sympathetic  consequence  of  another,  and  the  subsequent  decline 
of  the  primary  affection  as  a  sympathetic  result  of  the  secondary  de- 
velopment. And  here,  by-the-way,  we  are  presented,  in  the  natural 
process,  "with  a  perfect  exemplification  of  the  principle  upon  which 
counter-irritants  operate  in  subduing  diseases  remote  from  the  seat  of 
their  application  ;  and  we  may  thus  readily  comprehend  how  it  hap- 
pens that  the  discharge  from  an  ulcer,  or  a  seton,  or  blister,  &c.,  will 
be  suddenly  arrested,  or  the  superficial  parts  turned  into  the  worst 
conditions,  by  the  occurrence  of  disease  in  some  internal  part  (^  740), 

The  foregoing  play  of  sympathies,  however,  is  far  from  being  equal- 
ly true  of  all  organs,  or  of  all  forms  of  disease.     It  is  most  distinct- 


THERAPEUTICS. COUNTER-IRRITANTS.  655 

ly  pronounced  where  pulmonary  phthisis  is  preceded  by  gastric  de- 
rangement, when  the  occurrence  of  the  former  often  takes  the  lead 
and  relieves,  for  awhile,  the  latter  affection  ;  but  only  again  to  light  up 
indigestion,  and  ulcerative  inflammation  in  the  intestinal  mucous  tis- 
sue (§  803,  804).  But,  it  is  rare,  perhaps  never,  that  remote  diseases 
are  favorably  impressed  by  any  form  of  disease  that  may  happen  in 
the  alimentary  canal.  On  the  contrary,  indeed,  all  such  conditions 
are  likely  to  aggravate  or  to  maintain  any  affections  that  may  be  re- 
motely situated,  their  reflex  nervous  actions  being  morbific. 

Nevertheless,  such  is  the  analogy  between  the  reflex  nervous  ac- 
tions of  diseased  parts, — between  the  rise  and  decline  of  diseases,  in 
certain  parts,  as  consequences  of  each  other,  and  the  curative  effects 
of  many  internal  agents,  that  a  vast  number  of  therapeutists,  overlook- 
ing the  relations  of  the  alimentary  canal  to  all  other  parts,  confound 
these  internal  remedies  with  the  external  counter-irritants  ;  classing 
them  all  under  the  name  of  revulsives  or  counter-irritants.  And  here 
is  opened  another  wide  door  to  an  excessive  abuse  of  violent  internal 
agents,  and  where  we  may  well  contrast  the  ten-grain  alterative  dose 
of  tartarized  antimony,  and  the  most  powerfully-irritating  cathar- 
tics, administered  with  a  view  of  establishing  counter-irritation  in  the 
stomach  and  intestine,  with  that  prejudice  against  bloodletting  which 
sees  nothing  of  the  counter-irritant  in  the  effects  of  this  remedy.  And 
how  well  does  not  all  this  submission  to  theory  admonish  us  of  the 
importance  of  investigating  the  nature  of  the  influences  which  are  ef- 
fected by  loss  of  blood  (§  4) !  We  all  know  what  is  doing  in  the  way 
of  tartar  emetic.  I3ut  let  us  take  an  example  of  the  same  philosophy 
from  among  the  cathartics ;  for  this  is  the  only  way  of  helping  the 
cause  of  humanity  in  such  cases,  or  of  arresting  another  evil  (§  878) 
upon  a  more  selfish  principle.  Let  us  go  to  the  erudite  and  ablest 
work  on  Materia  Medica  for  an  example ;  and  we  will  have  others 
respecting  certain  substitutes  for  bloodletting  in  a  future  section  (§ 
960).     Thus,  then,  Pereira  : 

"  Pliny  truly  observes  that  the  juice  of  the  elaterium  apple  is  dan- 
gerous when  applied  to  the  eye ;  and  Dr.  Clutterbuck  mentions  that 
some  of  it  '  getting  accidentally  into  the  eye  in  one  instance,  it  occa- 
sioned severe  pain  and  inflammation,  with  an  erysipelatous  swelling 
of  the  eyelids,  that  continued  the  following  day.'  We  have  a  farther 
proof  of  its  irritant  properties  in  the  inflammation  and  ulceration  of 
the  fingers  of  those  employed  in  its  preparation.  When  swallowed, 
therefore,  elaterium  irritates  the  gastro-intestinal  membrane,  and  oc- 
casions vomiting  and  violent  purging."  "  In  some  dropsical  cases,  I 
have  known  a  single  dose  discharge  several  pints  of  fluid  from  the 
bowels.  The  gripings,  and  the  increased  number  of  evacuations, 
prove  that  the  irritation  is  not  confined  to  the  mucous  coat,  but  is  ex- 
tended to  the  muscular  coat.  Under  the  influence  of  a  full  dose,  the 
pulse  is  excited,  the  tongue  becomes  dry,  and  sometimes  furred,  and 
great  thirst  is  produced.  Considered  with  respect  to  other  cathartics, 
we  find  it  pre-eviinently  distinguished  by  the  violence  of  its  purgative 
effect." — Pereira's  Materia  Medica. — Notes  H  K  pp.  1117,  1119. 

And  yet  is  this  cathartic  commended  above  all  other  hydrogogues 
for  the  cure  of  dropsy ;  and  even  boldly  so,  upon  the  principle  of  its 
producing  counter-irritation  in  the  gastro-intestinal  mucous  tissue  ; 
that  is  to  say,  the  same  sort  of  inflammation  which  affects  the  fingers 


056  INSTITUTES    OF    MEDICINE. 

when  the  juice  is  applied  tu  the  skin.  It  should  be  also  said  of  so 
valuable  a  work  as  that  from  which  the  foregoing  extract  is  made, — 
valuable  as  a  system  of  Materia  Mcdica, — that  Pereira  approves  the 
practice,  and  of  course,  therefore,  the  principle.  The  principle  is 
thus  stated  by  the  author  : 

"  Its  effects,"  he  says,  "  in  dropsy,  are  two-fold  ;  first,  absorption  of 
the  effused  fluid ;  secondly,  the  stoppage  of  any  farther  effusion  in 
consequence  of  the  metastasis  of  vital  action  from  the  seat  of  the 
dropsy  to  the  intestinal  membrane." 

And  again,  he  says,  "  In  apoplectic  affections,  elaterium,  as  a  drastic 
cathartic,  sometimes  proves  serviceable  on  the  principle  of  countcr-ir- 
ritation:'—'No'r-E  G  p.  1116.     Also,  ^  1065  d. 

That  is  the  doctrine.  A  metastasis  of  the  inflammation  to  the  in- 
testinal canal ;  and  such  is  the  virtual  effect.  But  I  have  shoAvn  that 
counter-irritants  exert  their  good  effects  only  through  local  centres  of 
reflex  nervous  action,  while  they  are  injurious  Avhen  they  develop  a  gen- 
eral reflex  action  of  any  intensity  through  the  brain  and  spinal  cord, 
however  those  organs  may  otherwise  participate;  and  such  is  the  perni- 
cious effect  attending  this  counter-irritation  of  the  intestinal  canal. 

Opposed  to  metastasis,  revulsion,  derivation,  &c.,  is  the  doc- 
trine o?  repulsion.  Thus,  in  respect  to  the  utility  of  vesicating  the  joints 
in  acute  forms  of  i-heumatism  and  gout  there  is  a  strong  array  of  oppo- 
site opinions.  The  objections  to  the  practice  are  founded  upon  the  same 
pathological  conclusions  that  have  led  to  the  cultivation  of  ulcers,  cu- 
taneous eruptions,  &c. ;  it  being  supposed  that  it  is  often  the  effect  of 
counter-irritants  to  repel  (as  it  is  called)  the  disease  from  the  joints, 
and  to  establish  it  upon  the  heart,  the  stomach,  or  other  important  or- 
gans. This  supposed  effect,  therefore,  is  exactly  the  reverse  of  that 
which  I  have  just  considered,  or  the  induction  of  disease  to  sound 
parts  by  counter-irritation.  In  one  case,  the  advocates  of  metastasis 
suppose  that  they  invite  disease  from  one  part  to  another  not  diseased; 
in  the  other  they  are  employed  in  driving  disease  from  the  affected 
part  to  another  part  not  affected. 

That  is  the  modus  operandi.  But,  its  fallacy  is  shown,  at  once,  by 
the  flitting  character  of  gout  and  rheumatism ;  suddenly  subsiding  in 
particular  joints  and  as  suddenly  invading  others,  or  attacking  the  in- 
ternal viscera,  when  counter-irritants  are  not  employed.  Indeed,  it  is 
now  known  that  inflammation  of  the  tissues  about  the  heart  is  a  vei'y 
common  attendant  of  articular  rheumatism ;  and  the  fact  that  acute 
gout  is,  at  present,  rarely  treated  by  vesication,  yet  as  frequently  as  ever 
invades  important  oi-gans,  disproves  the  assumption  as  to  the  tenden- 
cy of  blisters  to  produce  these  results.  But,  I  am  rot  advocating  the 
employment  of  counter-irritation  in  acute  forms  of  rheumatism  and 
gout ;  certainly  not  till  the  intensity  of  disease  is  greatly  subdued  by 
antiphlogistics  of  a  sedative  nature,  and  general  reflex  action  reduced. 
In  connection  with  the  last  remark  it  is  also  worthy  of  observation, 
that  free  bloodletting  in  acute  rheumatism  is  strongly  opposed  upon 
the  ground  of  its  tendency  to  involve  the  heait  in  rheumatic  inflam- 
mation. But,  in  all  the  reputed  cases  the  inflammation  had  probably 
already  affected  the  heart  before  the  abstraction  of  blood,  and  consti- 
tuted cases  for  a  very  extensive  application  of  the  remedy.  If  loss  oi 
blood  will  surmount  the  disease  more  speedily  in  any  other  part  than 
the  united  force  of  all  other  means,  it  cannot,  surely,  fail  of  a  corre- 
Fponding  effect  upon  the  main  source  of  the  circulation  (§  500  m). 


THERAPEUTICS. COUNTER-IRRITANTS.  057 

893,  o.  Among  the  evil  consequences  of  vesication  is  a  bad  condi- 
tion of  cutaneous  inflammation,  which  either  refuses  to  subside  and 
annoys  the  patient  by  its  excessive  irritation,  or  it  results  in  extensive 
ulceration,  or  in  gangrene.  These  conditions  are  ow^ing  to  a  very 
morbid  state  of  the  skin,  generally  consequent  on  some  formidable 
disease  affecting  the  great  viscera  of  the  abdomen  ;  especially  the  gas 
tro-intestinal  mucous  tissue  (§  689,  I).  They  add,  of  course,  greatly 
to  the  evils  of  the  disease,  and  hasten  a  fatal  termination,  which  is  apt 
to  ensue  upon  the  disease  itself  These  effects  of  blisters  are  most 
frequently  witnessed  in  scarlatina,  and  often  along  with  parotis,  and 
ulcerated,  or  sphacelating,  fauces.  But,  happily,  they  are  rather  rare  ; 
certainly  less  frequent  than  is  surmised  by  many.  It  is  never  possible 
to  know  the  existence  of  the  peculiar  condition  of  the  skin  which  gives 
rise  to  these  consequences  ;  no  more  so  than  we  are  able  to  infer  the 
predisposition  to  erysipelas  which  is  often  established  by  abdominal 
affections  (§  689, 1).  From  their  rarity,  also,  an  apprehension  of  their 
possible  occurrence  should  never  deter  us  from  the  use  of  blisters. 

Strangury  is  another,  and  a  frequent  evil  of  cantharides,  though  it 
does  not  often  aggravate  any  existing  disease.  The  urinary  bladder 
has  no  strong  physiological  relations  beyond  its  own  system  of  organs, 
and  pain  is  not  apt  to  prove  morbific,  of  itself  (§  140,  422,  891  m). 
There  is  no  way  of  preventing  its  occurrence  in  particular  subjects 
with  any  certainty. 

893,  p.  The  foregoing  are  the  most  obvious  injuries  which  are  produ- 
ced by  vesicants,  especially  by  cantharides  (§  893,  6).  These  unfavor- 
able results,  indeed,  are  commonly  regarded  as  the  principal  ones  to 
which  the  common  epispastic  is  liable.  But,  there  are  others,  which, 
though  too  often  neglected,  are  far  more  important,  since  they  are 
frequent,  and  often  determine  a  fatal  issue  of  disease.  These  evils 
arise  from  morbific  influences  which  are  propagated  abroad  either  by 
too  intense  an  iri'itation  of  the  skin,  or  from  creating  the  irritation  un 
der  unfavorable  circumstances  (^  893  c). 

It  is  the  last  condition  which  is  the  most  frequent  cause  of  the  un- 
favorable effects  of  blisters,  and  which,  in  the  hands  of  superficial  ob- 
servers, have  led  to  the  denunciation  of  this  important  antiphlogistic. 

The  inauspicious  states  for  vesication  depend,  especially,  upon  too 
exalted  irritability  of  the  parts  diseased,  or  of  other  organs  ;  particu- 
larly of  the  heart  and  general  circulatory  system.  If  blisters,  or  oth- 
er counter-irritants,  be  applied  to  the  skin  in  this  state  of  morbid  iiTi- 
tability,  the  diseased  parts  are  roused  to  a  greater  intensity  of  morbid 
action,  and  the  whole  vascular  system  to  a  more  violent  movement ; 
so  that  a  series  of  untoward  results  is  thus  instituted,  which  sympa- 
thetically, and  mutually,  aggravate  each  other,  and  give  rise  to  new 
morbid  developments,  till  the  multiplying  reflex  nervous  actions  maybe 
arrested  only  by  their  own  fatal  tendency.  Nor  can  I  doubt  that  many 
of  those  terrible  inflammations,  and  structural  lesions  of  all  organs, 
which  abound  in  M.  Louis'  work  on  the  Typhoid  Affection,  and  which 
have  been  taken  as  the  basis  of  the  most  important  principles  in  pa- 
thology and  therapeutics,  were  owing  to  the  cause  now  under  consid- 
eration ;  since  this  distinguished  man  was  about  as  hostile  to  blood- 
letting as  he  became  toward  vesication,  after  witnessing  the  latter's  ef- 
fects in  the  complicated  malady  which  will  be  long  celebrated  in  the 
annals  of  medicine  (§  893  a,  c). 

T  T 


658  INSTITUTES    OF    MEDICINE. 

The  system,  in  the  advanced  stages  of  fever,  is  generally  in  an  ins- 
table state,  is  oppressed  with  local  congestions  and  inflammations ;  or 
whether  so  or  not,  the  artificial  irritant  becomes  a  source  of  annoy- 
ance, and  often  adds  to  the  dangers  it  was  intended  to  avert.  This, 
indeed,  is  especially  the  time  when  such  useless  local  irritations  should 
be  avoided,  or  quieted  if  they  exist.  Remaining  inflammations  and 
fcongestions  should  be  treated  with  as  little  additional  disturbance  to 
the  system  at  large  as  may  be  possible  in  those  advanced  stages  of 
fever  which  were  the  subjects  of  Louis'  experiments,  and  of  too  many 
others.  Or,  if  it  be  necessary  to  resort  to  counter-irritants  for  their 
removal,  they  should  be,  at  least,  applied  in  the  vicinity  of  the  affect- 
ed organs,  where,  alone,  they  can  be  of  any  avail. 

Independently,  therefore,  of  the  direct  and  immense  advantages  of 
bloodletting,  cathartics,  antimonials,  &c.,  we  realize  more  sensibly  the 
force  of  their  importance,  in  acute  inflammations,  at  least,  when  we 
consider  that  without  the  antecedent  aid  of  one  or  another,  but  of 
bloodletting  especially,  we  are  conapletely  cut  off"  from  the  benefits  of 
counter-irritation.  Nay,  more ;  so  great  are  the  prejudices  against 
the  principal  remedy  for  inflammation  and  fever,  or  so  sparing  is  its 
application,  that  cathartics  inflict  many  evils  when  they  might  other- 
wise be  rendered  highly  salutary,  or  their  necessity,  as  well  as  of 
epispastics,  superseded  by  moderating  general  reflex  nervous  action. 
In  all  grave  inflammations  loss  of  blood  is  indispensable  to  the  most 
useful  effects  of  cathartics,  or  to  their  safety,  and  is  absolutely  the  only 
condition  under  which  counter-irritation  should  be  attempted.  Just 
as  long,  also,  as  the  disease  may  remain  in  force,  or  general  or  local 
abstractions  of  blood  may  continue  to  be  useful,  vesication  should  be 
delayed.  This  remedy  may  then  succeed  with  the  most  happy  effect 
upon  any  remaining  disease,  even  though  it  have  passed  into  some 
other  form  than  that  of  inflammation. 

In  the  chi'onic  states  of  inflammation,  whether  of  impoitant  or  un- 
important parts,  a  frequent  renewal  of  blisters  may  effectually  sui-- 
mount  many  obstinate  maladies.  But  here,  again,  these  agents  are  oft- 
en powerless,  though  not  as  mischievous  as  in  acute  inflammation,  till 
decisive  bloodletting  have  been  adopted,  and,  not  unfrequently,  often 
repeated.  This  is  every  day  witnessed  in  those  advanced  stages  of  indi- 
gestion where  a  low  chronic  gastritis  is  shown  by  tendeiness  over  the 
region  of  the  stomach,  and  where,  too,  the  liver  has  generally  become 
more  or  less  involved  in  morbid  action.  Vesication  will  not  reach  this 
condition  till  general  bloodletting  or  leeching  shall  have  been  duly  pre- 
mised ;  and  cases  are  not  uncommon,  where,  after  repeated  and  large 
abstractions  of  blood,  such  is  the  force  of  morbid  habit  that  the  dis- 
ease finally  issues  in  copious  haematemesis.  There  are,  also,  many  of 
the  fluctuating  states  of  the  stomach  in  chronic  indigestion,  where  no 
inflammation  has  invaded  this  organ,  in  which  blisters  over  the  epi- 
gastric region,  and  without  any  other  remedial  agent,  bestow  great 
relief.  The  appetite  and  digestion  are  at  once  improved,  and  the  pa- 
tient started  along  upon  the  road  to  health,  and  placed  in  a  state  for 
tbe  full  and  rapid  influence  of  change  of  air,  exercise,  &c.  The  anal- 
ogy, too,  in  these  cases,  with  the  useful  effects  of  tonics  and  stimulants 
in  others,  contributes  farther  light  upon  the  therapeutical  influences  of 
the  latter  remedies  (§  890^).  Again,  among  the  sequoias  of  fevers  is 
constantly  before  us  a  variety  of  phases  of  indigestion  in  which  vesi- 


THERAPEUTICS. COUNTER-IRRITANTS.  65S 

cation  of  the  epigastric  and  hepatic  regions  brings  great  relief  to  the 
sufferer,  when  this  remedy  is  properly  sustained  by  a  well-regulated 
diet,  and  other  salubrious  habits. 

893,  q^.  There  are  numerous  remedies,  besides  those  which  have 
been  under  consideration,  that  operate  more  or  less  upon  the  princi- 
ple of  counter-irritation,  and  yet  exert  an  alterative  action  peculiar  to 
each.  This  is  even  true  to  a  certain  extent  of  leeching;  the  irritation 
of  the  bites,  and  even  the  new  action  which  is  instituted  in  the  capil- 
laries of  the  skin  by  the  leeches,  being  analogous  to  the  irritative  pro- 
cess which  is  set  up  by  the  true  counter-irritants  (§  498,  923). 

But  there  are  great  modifications,  in  these  respects,  between  the  lo- 
cal influences  of  leeching,  and  the  effects  of  the  true  counter-irritants , 
and,  if  we  now  turn  our  attention  to  the  large  group  of  agents  under  the 
denomination  of  local  alteratives,  as  set  forth  in  my  Materia  Medica, 
we  shall  see,  that,  in  all  the  instances,  each  substance  has  an  altera- 
tive action  j^eculiar  to  itself;  while,  in  many  of  the  cases,  as  with 
iodine,  the  mercurial  plaster,  veratria,  camphor,  &c.,  there  are  asso- 
ciated influences  analogous  to  those  which  form  the  great  characteris- 
tic of  the  true  counter-irritants.  These,  however,  will  of  course  de- 
pend upon  the  amount  of  absolute  irritation  which  the  several  agents 
may  produce  in  the  skin ;  some,  as  gum  ammoniac  plaster,  proving  a 
very  positive  iiTitant,  and  affording  relief  to  chronic  inflammation  of 
the  joints  more  in  virtue  of  this  counter-irritation  than  of  alterative 
properties  peculiar  to  the  agent  (^  227,  892  h,  900,  905  «,  1059). 

That  common  principles,  however  modified  in  their  general  aspect, 
and  however  varied  in  the  details  relative  to  the  several  agents,  re- 
spectively, are  concerned  in  the  principal  results,  is  obvious  from  the 
fundamental  simplicity  of  organic  laws,  and  especially  so  from  occa- 
sional coincidences  in  the  curative  effects  of  all  the  agents  now  under 
consideration.  We  see,  for  example,  in  cases  of  indolent  tumors, 
chronic  enlargements  of  the  liver,  spleen,  &c.,  that  almost  any  one  of 
these  local  alteratives  will  sometimes  yield  complete  relief.  We  see 
it  following  the  application  of  either  leeches,  or  blisters,  or  ammonia, 
or  mercury,  or  iodine,  or  even  of  simple  friction,  &c. ;  and,  if  we  next 
regard  the  corresponding  effects  of  many  internal  remedies  for  the 
same  conditions  of  disease,  we  shall  not  fail  to  detect  a  coincident  and 
harmonious  philosophy  throughout  (^  892  l,  892 J  u,  892f  «,  904  c). 

In  connection  with  the  foregoing  subject,  it  may  be  useful  to  some, 
who  may  be  baflBed  in  their  attempts  upon  indolent  tumors  of  low  in- 
flammatory gi'owth  to  know  the  advantages  that  have  often  accrued 
to  myself  from  the  frequent  application  of  a  small  number  of  leeches. 
Where  they  may  refuse  to  yield  under  this  mode  of  treatment,  vesi- 
cants, or  iodine,  &c.,  may  ultimately  prove  efficient,  when  they  might 
have  been  powerless  without  the  antecedent  influences  of  leeching. 
The  tumors,  indeed,  may  not  apparently  have  yielded  in  the  least  to 
the  virtues  of  the  leech ;  but  this  remedy  will  have  placed  the  diseased 
part  in  a  state  of  susceptibility  to  the  action  of  other  agents.  The 
principle  has  been  variously  before  us  (§  bb^,c),  and  may  receive  an- 
other exemplification  in  the  frequent  necessity  of  general  bloodletting 
and  cathartics  to  the  salutary  effects  of  vesication,  in  the  treatment  of 
acute  inflammation  (§  137  d,  150,  151,  556  c,  890^^,  892^  u). 

893,  r.  In  all  hemorrhages  from  important  organs,  we  should  regard 
vesication  as  a  remedy  next  in  importance  to  the  general  and  local  ab- 


660  INSTITUTES    OF    MEDICINE. 

straction  of  blood,  if  the  latter  be  also  appropriate,  as  it  commonly  is 
in  the  early  stage  of  the  disease ;  and  when,  at  more  advanced  periods. 
Nature  takes  on  this  recuperative  effort,  vesication  is  the  principal  re- 
maining means  by  which  we  may  contribute  an  aid  that  timely  blood- 
letting would  have  greatly  surpassed,  and  would  have  given  to  art  what 
ultimately  belongs  to  Nature  (§  805). — Notes  F  p.  1114,  Ii  p.  1139. 

893J.  Before  entering  upon  the  following  Summary  Eeview  of  the 
General  Philosophy  of  the  modus  operandi  of  Eemedial  Agents, 
whose  operation  I  have  resolved,  essentially,  by  alterative  influences  of 
reflex  actions  of  the  nervous  system,  and  with  a  reference,  also,  to  what 
I  have  said  so  extensively  of  this  universal  agency  in  the  organic  life  of 
animals,  I  will  recall  an  important  ground  by  which  the  reader  may  be 
aided  in  his  conclusions  upon  this  subject,  and  which  had  escaped  ob- 
servation till  the  publication  of  the  Medical  and  Physiological  Comment- 
aries. Even  Dr.  Philip,  in  his  experiments  (§  476-493),  neglected  the 
analogy  of  which  I  am  about  to  speak,  referred  the  modifiied  secretions 
to  chemical  agencies,  and  sacrificed  his  great  labors  to  the  interests  of 
chemical  physiology  and  the  humoral  doctrines.  This  analogy  is  the 
admitted  operation  of  reflex  nervous  influences  in  exciting  muscular 
movements.  But  that  is  the  only  result  that  is  witnessed.  There  is 
no  obvious  change  in  the  muscular  action  from  what  is  natural.  Not 
so,  however,  with  the  results  in  the  great  processes  of  organic  life. 
Here  the  secretions  are  not  only  increased  or  diminished,  but  modified 
in  their  nature,  and  various  morbid  conditions  produced  or  removed ; 
and  hence  it  is  assumed  that  these  results  must  be  owing  to  very  differ- 
ent causes  from  that  nervous  power  which  simply  produces  contractions 
in  the  muscles.  It  is  entirely  neglected,  in  this  rationale,  that  the  vas- 
cular systems  are  totally  different  in  their  functions  from  those  muscular 
fibres  upon  which  the  nervous  power  makes  its  obvious  demonstrations, 
as  in  convulsions,  vomiting,  respiration,  contractions  Of  the  iris,  of  the 
sphincters,  etc. ;  and,  although  there  is  a  vague  apprehension  with  some 
that  blushing  is  owing  to  nervous  influences,  yet  as  there  is  seen  only  a 
transient  redness,  even  this  ground  of  analogical  reasoning  to  changes 
of  vascular  action  that  give  rise  to  increased,  or  diminished,  or  otherwise 
modified  secretions,  or  the  production  or  removal  of  disease,  etc.,  is 
equally  regarded  as  an  abstract  fiict  that  supplies  no  information  upon 
the  less  obvious  problems.  Neither  is  it  considered  that  the  vascular 
apparatus  manifests  a  far  more  exquisite  susceptibility  to  the  direct  ac- 
tion of  common  stimuli  than  the  muscular  fibre,  and  therefore  that  the 
vessels  may  be  equally  sensitive  to  that  nervous  influence  which  so  readr 
ily  excites  the  fibre  in  muscular  organs.  Another  difficulty  consists  in 
comprehending  the  modifying  influences  of  the  nervous  power  upon  se- 
creted products,  and  in  its  production  and  removal  of  diseases,  etc.,  ac- 
cording to  the  nature  of  the  remote  causes ;  and  this  grows  out  of  the 
habit  of  neglecting  the  phenomena  and  of  reasoning  alone  from  what  is 
physically  demonstrable.  It  should  be  also  considered  that  the  cerfebro- 
spinal  system  in  subserving  the  structures  of  animal  life  exerts  the  ef- 
fect only  of  a  simple  stimulus,  while  the  ganglionic  not  only  unceasing- 
ly modifies  the  natural  organic  functions  and  products,  but,  through 
this  physiological  constitution,  to  a  far  greater  extent  when  morbific 
or  remedial  causes  operate  (§  113,  224,  356  a,  422,  455,  461«-461^, 
475^,  487  h,  488^,  500  g,  m,  524  d,  no.  7,  526  d,  891^  g,  k,  105^). — 
Sec  Note  Aa  p.  1131. 


THERAPEUTICS. REMEDIAL  ACTION.  C6J 


SUMMARY  REVIEW  OF  THE  GENERAL  PHILOSO- 
PHY OF  THE  MODUS  OPERANDI  OF  REMEDIAL 
AGENTS. 

"  It  seems  to  me  that  the  explanation  which  represents  Nature  always  pursuing  a  uni- 
form course  in  her  operations,  drawing  the  same  results  from  the  same  principles,  has  a 
greater  degree  of  probability  than  that  which  shows  her  separating,  as  it  were,  this  phe- 
nomenon from  all  the  others,  in  the  way  which  she  produces  it." — Bichat. 

"Medicines  differ  from  poisons,  not  in  their  nature,  but  in  their  dose." — Linnaeus. 

"  NaTURA  malum  SENTIENS  GESTITAT  MAGNOPERE  MEDERI." — GaLEN. 

"Natura  repugnante,  nihil  proficit  medicina." — Celsus. 

"Natura  deficiente,  quicquam  obtinet  mebica  ars,  perit  ^ger." — Hippocrates. 

894,  a.  The  philosophy  which  concerns  the  operation  of  morbific  and 
remedial  agents  was  a  subject  of  consideration  in  the  first  two  vol- 
umes of  the  Medical  and  Physiological  Commentaries,  and  subse- 
quently in  an  Essay  which  contributes  to  the  third  volume  of  that 
work.  The  question  has  also  been  investigated,  extensively,  in  different 
parts  of  these  Institutes.  But,  it  is  a  part  of  the  plan  of  the  present 
work  that  its  consummation  shall  consist  of  a  distinct  exposition  of  the 
important  matter  now  before  us,  in  the  form  of  a  s.ummary  review  of 
the  relative  facts  and  doctrines  contained  in  former  sections. 

894,  b.  In  approaching,  again,  the  modus  operandi  of  remedial  agents, 
I  may  first  repeat  the  most  essential  points, — that  the  vital  principle 
is  a  real  substantive  agent,  of  which  the  vital  properties,  irritability, 
mobility,  &c.,  are  elements,  implanted  in  organic  beings  for  the  anima- 
tion of  their  structure  ;  that  the  nervous  power  was  superadded  also 
to  the  animal  kingdom;  that  all  organic  functions  are  carried  on, 
through  their  instruments  of  action,  by  the  four  vital  properties  which 
are  common  to  all  animated  beings  ;  that  all  vital  agents,  whether 
stimulant  or  sedative,  whether  natural,  morbific,  or  remedial,  operate 
directly  upon  these  properties,  as  also  the  nervous  power  when  con- 
cerned in  developing  motion  or  changes ;  that  all  disease  consists  in  a 
modification  of  these  properties  and  a  consequent  change  of  function, 
and  is  therefore  only  a  variation  of  the  natural  states ;  that  the  vital 
property  sensibility  possesses  a  modification  which  I  have  denomina- 
ted sympathetic  sensibility ;  that  the  nervous  power  is  a  vital  agent, 
and,  like  other  agents,  develops  motion  and  induces  changes  by  acting 
upon  the  organic  property  irritability,  and  is  exclusively  the  exciting 
cause  of  motion  in  animal  life  ;  that  this  power  or  property  of  the  vital 
principle  in  animals  may  be  called,  in  a  direct  manner,  into  increased, 
or  preternatural,  operation  by  direct  impressions,  physical  or  mental, 
upon  the  nervous  centres,  or  upon  the  trunks  of  nerves  ;  that  this  pow- 
er is  the  efficient  agent  of  remote  sympathy,  is  brought  into  operation 
by  impressions  made  upon  sympathetic  sensibility,  which  are  trans- 
mitted by  this  variety  of  sensibility,  through  sensitive  nerves,  to  the 
nervous  centres,  and  there  develop  the  nervous  power,  which  is  re- 
flected, through  motor  nerves,  upon  the  irritability  of  such  parts  as 
may  be  determined  by  the  various  influences  hitherto  expounded,  and 
thus  become  the  exciting  cause  of  motion,  of  morbific  or  therapeutical 


662  INSTITUTES    OF    MEDICINE. 

chancres,  &c.,  in  those  parts  upon  which  its  impressions  ai'e  made ; 
that  the  nervous  power  is  susceptible  of  modifications  by  the  causes 
which  bring  it  into  universal  operation,  whether  physical  or  mental, 
and  thus  partakes,  under  the  injluence  of  its  own  nature,  of  the  special 
virtues  of  each  exciting  cause,  to  which  principle  is  due  its  alterative 
effects  according  to  the  nature  of  the  exciting  causes ;  and,  finally, 
that  a  common  principle  is  at  the  foundation  of  the  philosophy,  wheth- 
er the  manifestations  of  the  nervous  power  be  displayed  in  subserv- 
ing the  natural  processes,  or  in  disturbing  their  normal  condition  and 
products,  or  in  restoring  disordered  functions,  or  as  the  power  may  be 
concerned  in  developing  motion,  voluntary  or  involuntary,  when  prop- 
agated immediately  from  the  nervous  centres,  and  without,  of  course, 
the  intervention  of  sensitive  nerves,  and  therefore  in  a  direct  manner. 

895.  These  several  fundamental  points  have  been  critically  present- 
ed in  former  sections  (now  too  numerous  for  special  reference),  and 
they  have  all  an  immediate  interest  in  the  operation  of  remedies. 
They  form  the  great  principles  which  concern  the  natural  operation 
of  vital  stimuli,  and  are,  therefore,  fundamental  in  the  production  and 
cure  of  disease.  The  plan  of  Nature  is  thus  perfectly  simple,  consist- 
ent, and  sublimely  beautiful,  in  its  foundation.  The  details  ai'e  dis- 
tinguished for  their  harmonious  variety  and  intricacy,  yet  susceptible 
of  the  most  complete  analysis.  We  trace  the  complexities  to  the  con- 
stitutional nature  of  the  organic  properties, — to  their  liability  to  multi- 
tudinous variations  from  their  natural  state, — to  the  various  natural  mod- 
ifications which  they  sustain  in  different  tissues  and  organs, — to  the 
variety  of  those  organs,  and  the  differences  in  their  respective  func- 
tions,— to  their  intricate  connections  and  dependences  by  means  of 
sympathy, — and  to  the  endless  variety  in  the  nature  of  the  virtues  of 
foreign  agents  which  are  capable  of  inducing  modifications  of  the  or- 
ganic states  of  every  part,  and  according  to  the  natui-e  of  each  agent. 

Such  are  the  great  points  to  be  kept  in  mind ;  but  most  of  all,  as  it 
regards  my  present  inquiry,  are  the  various  considerations  relative  to 
the  nervous  power,  and  its  laws  of  reflex  action,  as  hitherto  set  forth, 
and  through  which  I  interpret  all  the  influences  produced  by  morbific 
and  remedial  agents  upon  parts  that  are  remote  or  but  slightly  distant 
from  the  direct  seat  of  their  operation,  and  often,  in  part,  upon  their 
direct  seat  of  action,  unless  such  influences  are  propagated  by  contin- 
uous sympathy  (^  2  b,  143,  c,  148-151,  495-529,  855,  895,  902/).* 

896.  The  whole  philosophy  of  the  operation  of  morbific  and  reme- 
dial agents  rests,  as  we  have  seen,  upon  physiological  principles. 
Exactly  the  same  philosophy  relates,  also,  to  the  corresponding  ef- 
fects of  mental  causes.  The  wound,  or  the  poison,  or  the  errhine, 
which  convulses  the  muscles,  the  want  of  air  which  determines  respi- 
ration, the  impression  of  light  which  guides  the  motion  of  the  iris,  the 
irritation  of  faeces  or  of  urine  which  maintains  a  contraction  of  the 
sphincters,  the  food  which  excites  the  muscular  action  of  the  stomach 
or  the  contraction  of  the  pylorus,  the  cathartic  which  purges,  the  emet- 
ic which  vomits,  the  narcotic  which  arrests  diarrhoea,  or  allays  irrita- 
bility, or  induces  sleep,  the  gastric  stimulant  or  t^ie  remote  inflamma- 
tion which  rouses  the  sanguiferous  system,  or  the  sedative  which  pros- 
trates the  circulation,  or  as  one  or  another  may  destroy  life,  produce 
their  effects  through  a  common  law  which  is  relative  to  the  nervous 
power,  and  it  is  through  that  same  law  that  the  complex  organization 

*  Continuous  sym-iathv  is  continuous  injluence  of  these  Institutes  (^  129  c,  /,  498  a). 


THERAPEUTICS. REMEDIAL    ACTION.  6fiS 

moves  on  in  harmony  in  all  its  parts,  that  the  mind  brings  into  action 
the  voluntary  muscles,  that  syncope  is  removed  by  pungent  vapors,  or 
by  a  current  of  air,  or  by  a  dash  of  water,  tliat  cold  to  the  surface  de- 
termines the  first  inspiration  of  the  new-born  being,  that  warmth  to 
the  skin  instantly  rouses  all  the  processes  of  life  in  certain  prostrating 
conditions  of  disease,  that  cold  at  the  zero  of  Fahrenheit,  or  mechani- 
cal in-itation,  reanimates  the  torpid  hibernating  animal,  and  sends 
up  his  temperature  from  forty  or  less  to  near  a  hundred  degrees,  that 
the  first  contact  of  solid  food  with  the  stomach  diffuses  a  warmth  over 
the  cold  surface  of  the  famished  traveler,  or  that  tonics  and  stimulants 
do  the  same,  that  shame  or  anger  suffuses  the  countenance,  or  fear 
withdraws  the  blood  from  the  circumference  to  the  centre  and  bathes 
the  skin  in  perspiration  or  renders  the  urine  redundant  and  the  blad- 
der irritable,  that  cold,  when  suddenly  applied,  as  suddenly  increases 
the  excretion  of  urine,  or  the  hot  bath  determines,  as  suddenly,  its  ex- 
pulsion, that  offensive  odors,  offensive  sights,  and  even  their  recollec- 
tion, lead  to  instant  vomiting,  or  to  purging,  or  to  syncope,  that  an 
liour's  change  from  one  part  of  the  town  to  another  suspends  pertus 
sis  or  promotes  digestion  or  the  healing  of  an  ulcer,  that  one  passion 
cures  the  most  obstinate  maladies,  or  another  is  instantly  fatal, — 
each,  and  all,  I  say,  determine  their  effects  either  through  refiex  or 
direct  action  of  the  nervous  system.  Anatomy  and  experiment 
confirm  what  each  phenomenon,  and  all  united,  proclaim  the  work  of 
that  mystic  power,  operating  on  those  organic  properties  which  are 
the  moving  springs  of  every  action,  the  proximate  cause  of  every  ef- 
fect ;  nor  can  another  intelligible  solution  be  rendered  for  a  single 
phenomenon  now  expressed,  or  thousands  of  similar  import,  while 
every  other  must  be  in  conflict  with  the  pronunciations  of  Nature  and 
the  demonstrations  of  art.  Nor  will  an  attempt  be  made  (an  attempt 
that  shall  commend  itself  to  the  understanding)  now,  or  hereafter,  to 
controvert  the  philosophy  which  is  here  presented.  The  first  step  in 
its  overthrow  must  be  the  overthrow  of  Nature.  All  must  bow  to 
this  conclusion,  however  unacceptable  to  the  humoralist,  or  unpalata- 
ble to  the  materialist  (§  1034,  1039,  1040,  1075). 

897.  It  has  been  seen,  also,  that  the  fundamental  philosophy  of  dis- 
ease is  perfectly  simple,  as  also  that  which  concerns  its  cure ;  that  dis- 
ease is  essentially  nothing  more  than  a  deviation  of  the  properties  of 
life  from  their  natural  standard,  and  a  consequent  corresponding 
change  in  the  functions  over  which  they  preside  ;  that  the  artificial 
cure  consists  in  a  restoration  of  those  properties  and  functions  by 
making  upon  the  former  certain  impressions  which  enable  them  to 
obey  their  natural  tendency  to  a  state  of  health  ;  that  remedial  agents 
of  positive  virtues  operate  like  the  truly  morbific,  but  less  profoundly 
in  their  therapeutical  doses,  and  that  the  philosophy  of  their  cure  con- 
sists in  establishing,  in  a  direct  manner,  certain  morbid  alterations  in 
the  already  diseased  properties  and  actions  of  life  which  are  more 
conducive  to  the  natural  tendency  that  exists  in  the  vital  properties  to 
return  from  morbid  to  their  natural  states. 

898.  It  follows,  therefore,  when  disease  subsides  under  the  influ- 
ence of  remedial  agents,  that  it  is  only  in  consequence  of  the  great 
law  of  recuperation,  which  is  brought  into  sensible  operation  by  the 
production  of  morbid  states  which  are  favorable  to  its  development. 
But,  if  disease  terminate  fatally,  it  is  owing  either  to  morbid  altera- 


664  INSTITUTES    OF   MEDICINE. 

tions  which  transcend  the  recuperative  tendency,  or  to  physical  ob- 
stacles which  have  resulted  from  the  altered  vital  conditions.  If  dis- 
ease subside  without  the  intervention  of  art,  it  arises  from  the  opera- 
tion alone  of  that  natural  principle  which  has  been  established  for  the 
preservation  of  health,  and  the  perpetuation  of  organic  beings.  Of 
this  we  have  remarkable  and  striking  examples  in  small-pox,  measles, 
&;c.  For  wise  purposes,  as  we  have  seen,  a  principle  of  mutability 
has  been  established  in  the  properties  of  life,  and  it  is  through  this 
principle,  which  is  designed  for  useful  ends  in  the  animal  economy, 
that  they  are  liable  to  be  variously  altered  from  their  natural  state  by 
physical  and  mental  causes  ;  but  it  is  this  very  principle  which  enables 
them  to  receive  salutary  impressions  from  remedial  agents  (just  as 
morbific  affect  them),  and  to  return  to   their  natural  condition. 

899.  The  changes,  therefore,  to  which  the  properties  of  life  are  lia- 
ble, are  almost  of  endless  variety  ;  depending,  as  we  have  variously 
seen,  upon  the  nature  of  the  operating  causes,  habits,  natural  and  ac- 
quired temperaments,  age,  sex,  &c. ;  and  whenever  they  become  dis- 
eased, they  pass  through  a  variety  of  progressive  changes  till  they 
reach  the  acme  of  their  morbid  states.  And  so,  on  the  other  hand, 
when  remedial  agents  begin  their  operation,  a  series  of  other  changes 
sets  in,  and  continues  in  regular  progress  until  it  ends  in  health.  The 
pathological  conditions,  therefore,  of  any  given  disease  are  constantly 
varying,  and  may  require  frequent  variations  of  treatment. 

900.  It  being  only  necessary  to  introduce  a  peculiar  morbid  change 
in  diseased  conditions  that  shall  favor  the  operation  of  the  natural  ten- 
dency of  the  properties  and  actions  of  life  to  return  to  their  healthy 
state,  a  very  few  remedial  agents  may  be  all  that  are  requisite  to  the 
attainment  of  that  result;  while  experience  shows  that  our  materia 
medica  is  encumbered  with  superfluities.  Take  a  large  variety  of 
pathological  conditions,  such,  for  example,  as  are  presented  by  inflam- 
mation, it  is  not  necessary  that  a  certain  uniform  change  should  be 
established  by  the  remedies,  but  only  such  as  shall  favor  the  recupera- 
tive tendency.  Bloodletting  brings  about  one  kind  of  change,  cathar- 
tics another,  antimony  anothei*,  mercury  another,  and  so  on  ;  while 
each  of  these  agents  may  prove  perfectly  curative  in  many  cases  of  all 
the  modifications  to  which  inflammation  is  liable  from  absolute  mor- 
bific agents.  And  yet  it  is  obvious  that  each  one  produces  changes 
peculiar  to  itself,  while  the  changes  induced  by  either  will  be  as  vari- 
ous as  the  natural  modifications  of  disease  (§  756,  a).  And  just  so  it 
is  in  respect  to  the  great  vai-iety  of  remedies  which  will  tend  to  the 
cure  of  intermittent  fever.  This  disease  will  sometimes  yield  to 
almost  every  thing  in  the  materia  medica,  and  may  be  suddenly  bro- 
ken up  by  an  emotion  of  the  mind.  But  every  agent  exerts  chan- 
ges in  the  moi'bid  properties  of  life  peculiar  to  itself,  but  such  chan- 
ges as  enable  the  properties  and  actions  of  life  to  pass,  afterward, 
through  a  succession  of  spontaneous  changes  under  the  restorative 
principle,  till  they  end  in  health.*  There  is  no  other  philosophy  that 
will  account  for  any  of  these  phenomena,  while  they  all  concur  in 
demonstrating  its  foundation  in  nature.  Hence,  also,  I  may  add,  what 
I  have  already  endeavored  to  expound,  the  occasional  salutary  effects 
of  alcoholic  stimulants  in  the  treatment  of  fever,  and  acute  inflamma- 
tions, and  through  which,  in  part,  I  have  attempted  to  abolish  the  dis- 
tinction between  active  and  passive  inflammation      In  these  exam- 

•  See  Notes  K  p.  IJIQ,  L  p.  1120,  Ek  p.  1133 


THERAPEUTICS. REMEDIAL    ACTION.  665 

pies,  the  alcoholic  stimulants  do  but  introduce  morbid  conditions  that 
are  favorable  to  the  recuperative  process,  and  are,  therefore,  so  far  on 
a  par  with  loss  of  blood  (^  756,  851,  854,  892  b,  8921  v,  1059). 

901.  Nevertheless,  a  distinction  is  very  properly  made  into  curative 
ar»d  morbific  agents,  however  the  former  may  be  productive  of  dis- 
ease, as  they  commonly  are,  in  their  medicinal  doses  when  they  do 
not  correspond  with  the  existing  pathological  conditions.  Their  ab- 
solute mode  of  action,  however,  is  the  same  in  all  the  cases ;  an  1  al- 
though, in  a  general  sense,  remedial  agents  exert  their  salutary  ef- 
fects by  inducing  new  pathological  states,  and  are  generally  liable  to 
produce  disease  when  exhibited  in  health,  these  morbid  states,  when 
not  excessive,  are  of  a  nature  to  allow  the  full  exercise  of  the  recu- 
perative tendency.  On  the  contrary,  however,  there  is  a  class  of 
agents  which  are  more  profoundly  morbific,  and  whose  results  tran- 
scend the  natural  recuperative  process.  It  is  for  the  removal  of  these 
consequences  that  we  employ  the  other  class  of  morbific  agents.  Or, 
there  are  yet  other  means,  like  exercise,  air,  &c.,  whose  influences 
are  of  the  mildest  alterative  nature,  and  appear  to  co-operate  in  a  di- 
rect manner  with  a  tendency  to  restoration  which  had  already  begun  ; 
or,  as  in  hooping-cough,  where  the  restorative  process  is  often  easily 
introduced.  Our  remedies,  therefore,  are  curative  by  substituting 
new  pathological  conditions,  and  nature  does  the  rest ;  and  it  is  only 
with  a  view  to  a  right  interpretation  of  their  modus  medendi  that  I 
have  any  disposition  to  depart  from  established  phraseology,  or  to  con- 
found the  operation  of  remedies  with  that  of  the  ordinary  causes  of 
disease  (§  137,  143,  150-152,  177-182,  185,  893  c,  d,  1059). 

That  what  I  have  now  stated  as  to  the  substitution  of  one  patholog- 
ical state  for  another  in  the  cure  of  disease,  and  that  this  is  the  only 
contribution  which  nature  receives  from  art,  seems  to  be  abundantly 
obvious ;  though  the  proposition  which  I  have  thus  made  appears  not 
to  have  been  a  subject  of  consideration.  As  a  change  arises  when 
efficient  agents  operate,  and  as  that  change,  by  the  supposition,  is  not 
a  restoration  of  the  morbid  to  the  natural  state  it  is  necessarily  a  new 
pathological  condition.  And  so,  also,  of  the  unaided  changes  which 
Nature  institutes,  till  the  natural  state  is  fully  established.  Bloodlet- 
ting, and  emetics,  it  is  true,  will  be  sometimes  followed,  as  in  fevers 
and  in  croup,  by  an  almost  immediate  subsidence  of  the  symptoms ; 
but,  during  their  rapid  operation,  they  have  only  introduced  new  con- 
ditions of  the  pathological  states  which  enable  the  morbid  properties 
to  resume,  at  once,  a  near  approximation  to  their  healthy  standard. 
It  is  certain  that  art  can  accomplish  nothing  more. 

902,  a.  I  now  proceed  to  recapitulate  the  manner  in  which  remedial 
agents  produce  their  effects  upon  parts  remotely  situated  from  the  direct 
seat  of  their  application ;  and  this,  as  I  have  formerly  said,  is  through  re- 
mote, contiguous,  or  continuous  sympathy ;  the  agents  exerting  their 
direct  impression  upon  the  parts  with  which  they  are  in  contact.  Re- 
mote, and  evidently,  also,  contiguous  sympathy,  are  conducted  by  the 
nervous  power  through  the  medium  of  the  cerebro-spinal  and  gangli- 
onic systems ;  while,  as  I  have  also  endeavored  to  show,  continuous 
sympathy  is  independent  of  the  nerves.*  When,  however,  these  en- 
ter into  the  structure  of  parts,  as  in  animals,  they  have  a  certain  con- 
tingent participation.  But  their  primai-y  connections  may  be  wholly 
severed,  and  disease  may  be  yet  propagated  continuously  along  the 

*  Continuous  injlucnce  of  these  Institutes  (§  129  c, /,  498  a). 


666  INSTITUTES    OF    MEDICINE. 

part  to  which  they  appertained ;  as  we  observe,  also,  in  plants.  It 
appears,  therefore,  that  in  these  examples,  the  morbid  condition  ie 
extended,  in  a  continuous  manner,  from  the  organic  properties  of  one 
point  to  the  next  in  apposition  (^  185,  233,  461,  475-^,  647-|,  746  c). 

902,  b.  I  have  variously  shown  that  the  nervous  power  is  capable 
of  acting  as  a  vital  stimulus  to  the  organic  properties,  is  liable  to  be 
variously  developed  by  morbific  and  remedial  agents,  and  to  be  so 
modified  in  its  nature  according  to  the  virtues  of  such  agents,  that  it 
produces,  more  or  less,  in  diseased  parts,  remote  from  the  direct  seat 
of  the  morbific  or  remedial  action,  the  changes  which  the  agents  them- 
selves would  exert  were  they  applied  directly  to  the  remote  organs.  The 
nervous  power  may  be,  also,  equally  determined  with  a  morbific  or  cu- 
rative effect  upon  the  organic  properties  and  actions  of  the  great  ner- 
vous centre ;  or  upon  any  of  its  radiating  parts.  The  philosophy  is 
also  exactly  the  same  when  one  diseased  part  gives  rise  to  disease  in 
parts  that  are  remote ;  and  when  disease  in  remote  parts,  that  has 
been  maintained  by  affections  of  other  parts,  subsides  in  consequence 
of  the  restoration  of  the  latter,  it  is  owing  to  the  removal  of  a  perni- 
cious modification  of  the  nervous  power  that  had  been  constantly 
propagated  by  means  of  the  latter  upon  the  former  {^  409  k,  SQl-g-  k). 

902,  c.  The  type  of  the  foregoing  philosophy  exists  in  various  pro- 
cesses which  are  naturally  going  forward  in  the  animal  body,  A  sin- 
gle example  of  this  nature  is  a  key  to  the  whole  labyrinth.     Thus  : 

"  The  whole  system  of  respiratory  nerves  can  be  excited  to  action 
by  irritation  of  any  part  of  the  mucous  membrane,  from  the  mouth  to 
the  anus,  from  the  nostrils  to  the  lungs," 

Mechanical  irritation  alone  is  adequate  to  the  greatest  variety  of 
effect,  as  broadly  stated  in  the  foregoing  law  of  sympathy.  Tickling 
the  fauces  provokes  vomiting,  irritating  the  anus  produces  purging, 
and  thus  are  the  muscles  concerned  in  respiration,  and  those  of  the 
stomach  and  intestine,  and  even  the  liver  and  the  salivary  glands, 
brought  into  unusual  action  by  slight  mechanical  irritation  of  the  fau- 
ces or  anus.  Irritate  the  same  tissue  in  the  nose,  and  the  respiratory 
muscles  are  thrown  into  another  mode  of  action ;  irritate  the  larynx, 
and  another  mode  is  excited;  call  up  the  recollection  of  the  finger  in 
the  fauces,  and  the  mind  may  determine  all  the  sensible  results  of  an 
active  emetic,  as  set  forth  in  ^  500  i-m,  o,  503,  514,  891^  k,  905  a. 

There  is  the  great  principle.  It  is  greatly  the  work  of  the  nervous 
power,  excited  in  one  series  of  the  cases  by  impressions  transmitted 
from  distant  parts  to  the  nervous  centres,  and  in  the  other  by  the  di- 
rect operation  of  the  mind  upon  the  same  central  parts.  It  is  through 
that  principle  that  emetics  and  cathartics  produce  their  most  sensible 
manifestations,  and  the  same  is  concerned  in  all  their  less  obvious  in- 
fluences upon  eveiy  pare  but  the  intestinal  mucous  tissue,  except  as 
continuous  sympathy  may  contribute  a  part  of  the  influences  which 
extend  to  the  liver,  &c.  It  is  the  same  as  concerns  the  respiratory 
movements,  which,  as  I  have  said,  may  be  regarded  as  an  elementary 
exemplification  of  the  most  entangled  operations  of  the  nervous  pow- 
er. The  modus  operandi  may  be  repeated  in  its  exemplifying  rela- 
tions to  this  subject.  The  point  of  departure,  in  the  process,  is  the 
raucous  tissue  of  the  lungs,  from  which  the  impression  is  transmitted 
through  the  pneumogastric  nerve,  as  well  as  through  the  ganglionic, 
to  the  brain  and  spinal  cord  (especially  the  medulla  oblongata),  where 


THERAPEUTICS. REMEDIAL    ACTION.  667 

the  nervous  power  is  excited  and  reflected  upon  the  organic  proper- 
ties of  the  muscles  of  respiration  through  the  various  motor  nerves 
of  those  organs.  These  muscles  are,  in  consequence,  thrown  into  ac- 
tion, and  the  thorax  expanded  (^  233|,  500  e,  514  I,  &c.). 

If  the  foregoing  simple,  demonstrable  exemplification  be  duly  com- 
prehended, there  can  be  no  difficulty  with  all  the  rest.  In  the  exam- 
ple of  sneezing,  as  a  consequence  of  the  action  of  light  upon  the  eyes 
(§  514,  I),  the  process  is  more  complex,  and  shadows  forth  the  fai 
more  intricate  movements  that  are  in  progress, — the  almost  end- 
less reflex  nervous  actions  which  are  taking  place, — during  the  progress 
or  decline  of  disease,  or  those  which  are  set  up  by  the  operation  of  an 
emetic,  a  cathartic,  &c.  (§  1040). — Note  D  p.  1114. 

902,  d.  Physiological  examples  of  the  foregoing  nature  abound  in 
the  animal  organization,  and  supply  the  most  ample  ground  for  the  in- 
terpretation of  the  effects  of  remedial  and  morbific  agents  in  their 
wide  range  of  influences.  The  modifications  of  reflected  nervous  ac- 
tions that  relate  to  the  respiratory  system  alone,  as  in  coughing,  crying, 
laughing,  yawning,  &c.,  are  a  fruitful  field  of  inquiry  into  great  and 
precise  laws,  and  extensively  applicable  to  the  philosophy  of  medicine. 
The  only  difference  is,  that,  when  disease  is  established  in  a  part,  or 
when  remedial  agents  operate,  the  organic  properties  of  the  part  are 
altered  in  their  nature,  and,  of  course,  the  organic  actions  over  which 
they  preside.  A  specific  impression,  in  the  latter  cases,  is  transmit- 
ted to  the  nervous  centers,  the  nervous  power  more  or  less  mod- 
ified in  a  corresponding  manner,  and  from  thence  reflected  through  oth- 
er nerves,  or  other  fibres,  to  the  same  or  other  parts,  and,  according  to 
the  nature  of  the  modification,  disease  will  be  produced  or  mitigated 
in  those  parts.  However  complex,  and  variable,  therefore,  the  phe- 
nomena, nothing  can  be  more  simple  than  the  principle  through  which 
all  these  changes  are  produced  (^  233|,  475i  647i,  893-^). 

902,  e.  When  an  emetic  operates,  the  modus  operandi  is  essentially 
similar  to  what  happens  in  respiration.  The  mucous  tissue  of  the 
stomach  being  the  point  of  departure,  a  different  influence  is  propa- 
gated to  the  nervous  centres,  corresponding  with  the  nature  of  the 
exciting  cause,  with  the  special  vital  constitution  of  that  portion  of  the 
mucous  tissue,  with  the  compound  nature  of  the  stomach,  with  the 
special  relations  of  this  organ  to  the  central  parts  of  the  nervous  sys- 
tem and  to  the  respiratory  muscles,  &c.  (§  138,  149,  150,  &c.),  while 
the  nervous  power  is  also  modified  in  its  nature  according  to  the  pe- 
culiar virtues  of  the  emetic  (§  227).  The  most  sensible  result,  as  in 
respiration,  depends  upon  the  reflection  of  the  nervous  power  upon 
the  respiratory  muscles,  while  another  current  descends  through  the 
motor  fibres  of  the  pneumogastric  and  sympathetic  nerves  to  the  mus- 
cular tissue  of  the  stomach.  If  the  emetic  operate  also  as  a  cathartic, 
then  a  new^  chain  of  actions  is  established,  in  the  same  way,  upon  the 
abdominal  muscles,  while  a  current  of  the  nervous  power  is  propaga- 
ted upon  the  muscular  coat  of  the  intestines  (§  233|,  889  a-f). 

902, y.  But,  in  the  foregoing  case,  something  more  happens  than  in 
the  natural  processes.  Here  the  exciting  cause  possesses  peculiar  vir- 
tues, is  of  a  morbific  nature,  and  it  not  only  makes  peculiar  impres- 
sions upon  the  alimentary  mucous  tissue,  according  to  the  exact  na- 
ture of  its  virtues,  but  it  modifies  the  nervous  power  in  a  correspond- 
ing manner.     If  the  stomach  be  the  seat  of  disease,  the  direct  impres- 


668  INSTITUTES    OF    MEDICINE. 

sion  upon  that  organ,  or  the  change  which  an  emetic  may  effect  m 
its  vital  condition,  will  be  more  or  less  varied  from  what  is  exerted  in 
a  state  of  health.  It  may,  therefore,  prove  curative  to  the  stomach 
more  or  less  by  this  direct  influence  (§  514  b,  658).  But  the  nervous 
power  is  also  modified  according  to  the  impression  produced  upon  the 
organic  properties  of  the  stomach,  and  is  sent  abroad,  with  alterative 
effect,  upon  various  parts  of  the  system.  According  to  a  law  by  which 
diseased  parts  are  far  more  susceptible  of  influences  from  vital  stim- 
uli than  such  as  are  not  diseased,  the  modified  nervous  power  will  fall 
with  far  greater  effect  upon  the  former  than  the  latter.  The  organic 
properties  and  actions  of  one  may  be  profoundly  and  permanently  af- 
fected, while  the  latter  are  only  moderately  and  very  temporarily  in- 
fluenced. In  consequence,  also,  of  the  deep  effect  which  the  modified 
nervous  power  exerts  on  the  diseased  parts,  they  may  return,  at  once, 
to  their  natural  state  (§  841,  2,  b,  143,  c,  148-151,  855,  895,  481  d). 

But  the  milder  influences  which  are  set  up  by  the  nervous  power 
upon  parts  in  health,  or  in  comparative  exemption  from  disease,  play, 
also,  their  part  in  the  salutary  process.  If  the  emetic  operate  also  as 
a  cathartic,  impressions  are  transmitted  from  the  intestinal  mucous 
membrane  to  the  cerebro-spinal  system,  the  nervous  power  developed 
and  modified  according  to  the  nature  of  these  impressions,  and  radia- 
ted  abroad  as  when  the  result  of  the  action  of  the  emetic  upon  the 
stomach,  and  with  effects  corresponding  to  this  new  development  and 
modification  of  the  nervous  power  (^  227-2334,  514  h,  889  a). 

Again,  the  skin  is  influenced  in  the  foregoing  manner,  and  this  or- 
gan transmits  that  impression  to  the  cerebro-spinal  axis,  and  devel- 
ops and  modifies  the  nervous  power  accordingly,  when  it  is,  as  in  the 
other  instance,  reflected  abroad,  and  is  felt  by  various  parts  according 
to  their  degrees  of  susceptibility.  Various  other  circles  of  modified 
nervous  influences  set  in,  and  become  too  complex  for  analysis ;  but 
all  may  fall  with  one  concurring  curative  effect  upon  the  diseased  sus- 
ceptible organs.  Thus  every  part  may  have  an  allotment  in  the  cu- 
rative process ;  as  more  distinctly  expounded  in  foregoing  sections 
(§  143,  c,  and  references,  500-514,  516  d,  no.  6,  863  d,  889  g,  893  a,  c).* 

902,^.  We  thus  see  that  when  vomiting  springs  from  the  operation  of 
tartarized  antimony,  and  often  from  ipecacuanha,  it  is  only  one  of  the 
consequences,  and  a  minor  one,  of  the  peculiar  irritation  of  the  gas- 
tro-mucous  membrane.  Other  and  far  more  powerful  influences  are 
determined,  simultaneously,  upon  the  organic  properties  and  actions 
of  distant  and  diseased  parts  (perhaps  as  distant  as  the  most  remote 
extremity),  by  the  same  nervous  power  that  shook  the  respiratory 
organs  during  the  act  of  vomiting.  And  often,  indeed,  does  it  happen 
that  those  influences  are  propagated  with  the  most  profound  effect 
when  the  act  of  vomiting  fails  of  being  consummated ;  and  nausea, 
alone,  shall  send  with  prostrating  force  the  modified  nervous  power 
over  the  whole  system ;  when  we  shall  see  it  simultaneously  bathing 
the  whole  surface  with  perspiration  ;  pouring  the  saliva  from  the 
mouth ;  breaking  down  a  tumultuous  excitement  of  the  heart  and  ar- 
teries ;  starting  on  the  instant  a  torrent  of  bile,  and  an  equal  effusion 
from  the  intestinal  mucous  membrane ;  and,  at  the  next  moment,  pre- 
senting a  magnificent  play  of  reflex  actions  for  the  evacuation  of  the  flu- 
ids, after  the  manner  of  an  active  purgative, — these  very  effusions, 
also,  instituting  other  circles  of  reflex  action,  which  join  in  the  great 
*  See  NoTK  Cc  p.  1132. 


THERAPEUTICS. REMEDIAT.    ACTION.  669 

work  of  curative  movements.  Should  vomiting  now  follow^,  then  shall 
you  speedily  see  the  vital  energies  returning, — the  cold,  pale  skin 
giving  place  to  a  florid  hue  and  a  warm  perspiration, — the  sunken 
features  starting  into  the  fullness  of  health, — the  gastric  suffering  gone 
as  a  luxury  obtained, — the  general  whirl  of  anxiety  and  distress  con- 
verted into  calm  tranquillity, — the  headache  dissipated, — the  twang 
of  the  croup,  or  the  grunt  of  pneumonia,  no  longer  sounding  an 
alarm ; — and,  all  this  stupendous  succession  of  events,  from  the  be- 
ginning of  nausea  to  the  restoration  of  the  vital  energies  and  the  near 
resolution  of  disease, — composing  a  most  astonishing  consecutive  sc- 
ries of  reflex  actions, — may  require  less  time  than  I  have  hastily  era- 
ployed  in  this  general  allusion  to  the  subject.  And  now  can  it  be  en- 
tertained that  this  has  been  the  result  of  absorption,  or  that  the  laws  of 
chemistry  or  physics  have  had  any  connection  with  the  phenomenal* 

902,  h.  The  foregoing  may  be  taken  as  an  example  of  the  principle 
whicli  concerns  the  modus  operandi  of  all  curative  or  morbific  agents, 
whether  physical  or  mental,  and  of  all  the  developments  of  disease  that 
arise  as  sympathetic  consequences  of  each  other.  In  respect  to 
emetics,  howevei',  it  should  be  considered  that  all  do  not  produce  the 
foregoing  effects,  and  that  with  the  exception  of  the  act  of  vomiting, 
the  results  will  depend  upon  the  precise  nature  of  the  emetic,  or  the 
manner  in  which  it  modifies  the  nervous  power  and  thus  impresses 
the  organic  properties.  This  explains  the  difference  in  results  be- 
tween tartarized  antimony,  ipecacuanha,  sulphate  of  zinc,  warm  wa- 
ter, tickling  the  fauces,  the  mechanical  irritation  of  undigested  food, 
the  shock  of  a  fall,  of  a  surgical  operation,  sailing,  whirling,  offensive 
eights,  offensive  odors,  loss  of  blood,  and  even  their  recollection  ; 
while  the  nature  and  effect  of  the  greater  number  should  lead  the  phil- 
osophical inquirer  to  pause  at  the  physical  doctrine  of  absorption, 
and  survey  the  other  difficulties  with  which  it  is  fatally  encumbered. 

902,  i.  When  the  alterations,  of  a  sympathetic  nature,  are  more 
slowly  produced,  as  when  mercury  induces  salivation  gradually,  and 
brings  the  whole  system  under  its  influence,  or  when  small,  and  re- 
peated doses  of  tartarized  antimony  overcome  inflammations  of  the 
lungs,  &c.,  the  nervous  pov/er  is  developed  and  modified  at  each  suc- 
cessive dose,  and  the  repetition  of  its  reflection  upon  the  organic  prop- 
erties of  diseased  parts  remote  from  the  stomach  establishes  progi-es- 
sive  changes,  till  an  absolute  condition  of  disease  may  be  induced  in 
certain  parts,  as  when  mercury  salivates ;  while  the  analogous  influ- 
ences which  are  exerted  on  parts  already  diseased  supplant  the  natu- 
rally morbid  states  by  others  of  an  artificial  nature,  from  which  the 
organic  properties  are  able  to  return  to  their  healthy  condition.  But 
these  impressions  must  be  frequently  repeated ;  for  if  the  interval  be 
long  between  the  administration  of  the  doses  of  such  agents  as  only 
produce  their  effects  in  a  gradual  manner,  the  diseased  conditions,  not 
being  placed  in  the  way  of  the  recuperative  tendency,  will  throw  off" 
the  artificial  impression,  and  the  original  intensity  of  disease  will  be 
thus  restored.  The  process  which  I  am  now  considering  is  an  exam- 
ple of  the  cumulative  effect  of  remedial  agents,  some  of  which  are  much 
more  remarkable  than  others,  and  the  ultimate  results  are  pronounced 
with  varying  degrees  of  suddenness.  This  is  also  influenced  by  pe- 
culiarities of  constitution,  or  of  susceptibilities  of  the  organic  proper- 
ties to  changes  now  under   consideraton ;  and  therefore  is  it,  that  sal- 

•  See  *  409  fc,  4761^  h,  514  -516,  943  a,  944  c,  1084 


670  INSTITUTES    OF    MEDICINE. 

ivation  may  be  speedily  induced  in  one  subject  by  less  than  a  grain 
of  calomel,  while  no  amount  of  the  remedy  will  produce  this  effect  in 
others.  And  so  of  the  morbific  effects  of  digitalis ;  an  agent,  also, 
which  exemplifies  the  suddenness  with  which  cumulative  agents  may 
produce  an  explosion  of  disease,  although  no  symptoms  had  admon- 
ished us  of  its  approach.  This  principle  concerns,  also,  the  predis- 
position to  disease  which  is  formed  by  miasmata,  the  virus  of  small- 
pox, of  hydrophobia  (§  516  d,  no.  6,  647^  657  a,  666,  904  bb,  1059). 

902,  k.  The  permanent  operation  of  the  nervous  power  in  particu- 
lar parts  of  the  animal  fabric,  as  in  the  sphincters,  supplies  an  elegant 
parallel  with  the  foregoing  uninterrupted  influences  of  the  same  pow- 
er as  developed  by  remedial  or  morbific  agents.  This  power  oper- 
ates as  a  perpetual  stimulus  to  the  organic  properties  of  the  muscles 
just  mentioned,  in  the  same  way  as  the  ffeces  and  urine  stimulate  the 
mucous  tissue.  And  now,  if  we  mutilate  the  inferior  part  of  the  spinal 
cord,  or  obsei^ve  the  sphincter  ani  when  relaxed  in  bad  cases  of  apo- 
plexy, or  regard  its  condition  when  the  spinal  cord  is  merely  divided, 
we  shall  see  the  relative  bearing  upon  other  organs  of  these  two 
parts  of  the  nervous  system  in  their  connected  state,  but  with  injury 
of  the  brain,  and  how  the  spinal  cord  is  capable  of  an  individual 
influence  (§  473-475,  476^-481,  &c.,  514^,  &c.). 

902,  I.  When  mental  causes  operate  in  the  cure,  or  production  of 
disease,  they  act  directly  upon  the  cerebro-spinal  axis,  and  develop 
and  modify  the  nervous  power  according  to  the  nature  of  each  mental 
affection ;  and,  as  in  the  case  of  physical  agents,  the  nervous  power 
thus  developed  and  modified  may  be  determined  as  well  upon  the  or- 
ganic properties  of  the  brain  and  spinal  cord,  as  upon  other  parts. 
The  blow  upon  the  region  of  the  stomach,  or  the  opening  of  a  thecal 
abscess,  which  have  destroyed  life  on  the  instant,  operate  in  the  same 
way  as  the  paroxysms  of  anger,  or  of  joy,  which  have  been  as  suddenly 
fatal.  In  these  cases  the  nervous  power  is  alike  reflected  with  a  fa- 
tal effect  upon  the  brain  as  well  as  other  important  organs  (^  479). 

902,  m.  A  more  intricate  example  may  now  be  presented  relative 
to  those  natural  means  of  cure  which  occur  in  a  former  section ;  such 
as  change  of  air,  exercise,  &c.  (§  855).  These  are  all  positive  rem- 
edies, and,  of  course,  they  have  their  modes  of  operating.  One  ex- 
ample will  open  the  philosophy  of  the  whole.  How,  then,  does  change 
of  air  suddenly  arrest  an  obstinate  form  of  the  hooping-cough  ]  There 
is  gastric  as  well  as  pulmonary  disease,  and  the  mucous  tissue  of  the 
stomach  is  preternaturally  susceptible  to  the  influence  of  many  causes. 
The  air  exerts  its  impression  upon  the  lungs,  and  upon  the  general 
surface  of  the  body.  But,  there  must  be  other  agencies  in  operation 
before  the  lungs  will  experience  relief  These  agencies  appertain  to 
the  nervous  power,  which  is  developed  by  the  foregoing  impressions, 
and  reflected  upon  the  stomach  and  other  abdominal  organs.  If  there 
be  disease  here,  it  is  more  or  less  relieved,  and  the  more  so  the  great- 
er will  be  the  ultimate  salutary  impression  upon  the  lungs.  The 
abdominal  impression  is  transmitted  to  the  nervous  centres  and  the 
nervous  power  reflected  with  its  alterative  influence  upon  the  pulmo 
nary  mucous  tissue,  and  thus  ends  the  disease.  The  spasmodic  ac- 
tion of  the  respiratory  muscles  is,  of  course,  arrested  by  withdrawing 
the  preternatural  operation  of  the  nervous  power  from  those  muscles,  as 
a  consequence  of  the  subsidence  of  disease  in  the  pulmonary  mucous 


THERAPEUTICS. REMEDIAL    ACTION.  671 

tissue  (§  902,  c).  And  so,  when  change  of  air  promotes  the  healing 
of  ulcers  upon  the  extremities ;  and  should  they  not  be  complicated 
with  derangement  of  the  abdominal  organs,  one  of  the  sure  evidences 
that  the  foregoing  is  the  modus  opeiaRdi  of  this  remedy  is  the  im- 
provement of  appetite  which  commonly  precedes  any  manifest  abate- 
ment of  the  remote  affections.  The  same  philosophy  applies,  also,  to 
the  control  which  air  and  exercise  frequently  obtain  over  phthisis  pul- 
monalis  (§  514  c,  525  c,  527  b)*  It  is  conspicuously  seen  even  in  the 
operation  of  morbific  causes ;  and  the  two  aspects  of  the  subject  go 
to  illustrate  each  other  (§  657,  a).  The  principle  is  of  the  utmost  im- 
portance in  medicine.  Its  laws  are  precise.  Their  knowledge  will 
lead  to  a  greater  dependence  upon  the  functions  of  organic  life  (§ 
878,  890-|-  d.     But  these  problems  lie  in  the  depths  of  physiology. 

903.  It  is  important  to  consider  the  distinction  between  impressions 
which  are  made,  in  organic  life,  upon  irritability  and  sensibility  by 
vital  agents,  whether  natural,  morbific,  or  remedial.  The  latter  prop- 
erty is  the  subject  of  impressions  particularly  in  animal  life  ;  though  it 
becomes  more  or  less  involved  in  organic,  in  all  its  natural  modifica- 
tions, by  the  accidents  of  disease.  But  the  special  modification  which 
I  have  considered  under  the  name  of  sympathetic  sensibility  performs 
the  important  part  of  transmitting  impressions  to  the  nervous  centres 
when  they  give  rise  to  sympathetic  movements  in  organic  life.  In- 
deed, the  whole  rhythmic  action  of  the  organism  is  maintained  by  the 
transmission  of  influences  from  all  parts  to  the  brain  and  spinal  cord 
through  this  modification  of  sensibility,  and  a  consequent  reflected  ac- 
tion of  the  nervous  power  upon  all  the  organs,  as  each  may  require 
the  harmonizing  influence  of  this  great  regulating  property  of  the  vital 
principle  (§  233 J,  1037,  b),  through  the  potential  sympathetic  nerve. 

The  foregoing  is  the  chief  agency  which  sensibility  exerts  in  organic 
life,  and  the  nervous  power  no  other  than  that  of  a  vital  agent,  acting, 
like  other  agents,  upon  irritability,  from  which  the  influence  is  impart- 
ed to  tnobility.  This  we  have  also  seen  to  be  equally  the  case  in  ani- 
mal life,  when  voluntary  motion  is  performed.  In  all  the  cases,  how- 
ever, whei'e  perception  is  excited,  either  common  or  specific  sensibility 
is  more  or  less  interested,  though  neither  modification  takes  any  part 
in  the  organic  or  animal  movements  (§  233^^,  524  d,  no.  7,  647^,  893^). 

If  the  brain,  or  any  part  of  the  nervous  system,  be  the  seat  of  dis- 
ease, of  irritation,  &c.,  the  preternatural  development  of  the  neiToub 
power  is,  as  we  have  seen,  direct,  and  propagated  directly,  and  with 
very  various  effects,  upon  distant  parts.  In  this  process  the  motor 
nei'ves  are  alone  concerned,  and  therefore  sympathetic  sensibility  is 
not  brought  into  operation.  It  is  exactly  the  second  part  of  the  pro- 
cess which  takes  place  when  influences  are  transmitted  from  one  or- 
gan to  another  through  the  medium  of  the  nervous  centres.  There 
is,  therefore,  no  difference  in  the  principle.  The  experiments  of  Wil- 
son Philip,  &c.,  illustrate  the  direct  method  (§  477,  &c.)  ;  the  consti- 
tutional action  of  remedies  the  indirect,  or  by  reflex  nervous  action. 

904,  a.  In  considering  the  philosophy  of  the  effects  of  the  nervous 
power  it  is  important  to  regard  its  nature  as  liable  to  modifications 
from  the  slightest  influences,  both  physical  and  mental.  This  is  evin- 
ced by  all  the  phenomena,  is  analogous  to  the  natural  and  artificial 
modifications  of  irritability  and  sensibility;  and  according  to  its  modi- 
fications, and  other  concurring  causes  hitherto  expounded,  it  produces 
*  See  Note  F  p.  1114. 


672  INSTITUTES    OF    MEDICINE.* 

changes  in  the  organic  properties  and  functions;  establishing  or  re- 
moving disease,  or  killing  in  an  instant. 

I  say,  therefore,  again  and  again,  as  more  deeply  seated  than  all 
things  else  at  the  foundation  of  medical  philosophy,  the  nervous 
power  is  not  only  variously  excited,  exalted,  or  depressed,  or  modifi- 
ed in  its  kind,  and  produces  influences  upon  remote  parts  according 
to  these  changes,  but  it  is  reflected  upon  particular  parts  according 
to  their  existing  susceptibilities,  the  nature  of  the  remote  cause,  and 
the  part  upon  w^hich  the  remote  cause  may  operate  (§  233|).  Thus, 
as  I  have  said,  one  impression  from  cold,  as  a  blast  of  cold  air,  or  a 
drop  of  cold  water  upon  the  skin,  will  rouse  the  respiratory  muscles. 
Another  impression  from  the  same  cause  will  excite  catarrh,  or  pneu- 
monia, or  pulmonary  phthisis,  or  articular  rheumatism  (§  649  l)-d,  657, 
&c.).  Mercurial  ointment  will  determine  the  nervous  power  special- 
ly upon  the  salivary  glands,  and  liver,  and  the  same  effects  arise  from 
the  action  of  mercury  upon  the  stomach.  Cantharides,  internally  or 
externally  applied,  irritates  the  neck  of  the  bladder.  One  degree  of 
impression  by  tartarized  antimony  upon  the  stomach  determines  the 
nervous  power  upon  the  respiratory  muscles,  and  vomiting  is  the  con- 
sequence ;  while  it  simultaneously  reflects  the  same  power  upon  the 
skin  as  it  does  in  smaller  doses,  and  of  which  perspiration  is  a  con- 
sequence,— and  so  on.  But  these  examples  embrace  only  certain 
parts  of  the  influences  in  each  case  ;  while  in  others  they  are  far 
more  complex, — one  sympathetic  result  becoming  the  cause  of  oth- 
ers, till,  through  a  single  impression  upon  the  organic  properties  of 
the  skin,  various  circles  of  alterative  reflex  nervous  actions  may  be 
instituted.  Narcotics  induce  peculiar  modificationis  of  the  nervous 
power  when  they  are  administered  by  the  stomach,  and  the  power 
thus  modified  is  not  only  reflected  upon  various  distant  parts  with 
effects  corresponding  with  its  modifications,  but  especially,  also,  upon 
the  organic  and  animal  properties  of  the  brain  and  spinal  cord. 
Hence  the  obtuseness  of  the  senses,  and  the  venous  congestions  of 
the  brain,  which  follow  their  improper  administration  (^  891^  g,  k). 

904,  b.  We  have  seen  that  hydrocyanic  acid,  strychnia,  &c.,  will 
destroy  life,  when  applied  to  the  tongue,  before  one  act  of  inspiration 
can  be  made,  and  that,  when  swallowed  by  man  in  speedily  fatal  dos- 
es the  odor  of  the  acid  is  indistinguishable  in  the  blood,  or  within  the 
organism  (§  350^  p,  827  d).  Wedemeyer  and  Miiller  testify  to  the  fa- 
tal effect  of  one  drop  of  the  hydrocyanic  acid,  within  a  single  second, 
when  introduced  into  the  eye  of  a  rabbit.  And  so  of  strychnia.  It  is 
also  allowed  by  Miiller,  who  defends  the  doctrine  of  absorption  in  all 
cases,  that  from  a  minute  to  two  minutes  are  necessary  to  one  round 
of  the  blood's  circulation.  The  case  is  a  plain  one ;  the  contradic- 
tion obvious  (§  494,  dd").  Besides,  the  action  of  these  poisons  must 
begin  at  the  instant  of  their  contact  with  the  living  parts,  and  what  is 
progressive  throughout  the  entire  second  of  time  is  physiologically  the 
same  as  at  the  beginning  of  the  second.  Magendie  kills  "  the  most 
vigorous  dogs"  by. applying  to  the  fauces  one  di-op  of  the  hydrocyanic 
acid,  "  after  two  or  three  hurried  inspirations."  Pereira  says  that  he 
"  once  caused  the  instantaneous  death  of  a  rabbit  by  applying  its  nose 
to  a  receiver  filled  with  the  vapor  of  the  pure  acid.  The  animal  was 
killed  without  the  least  struggle."  And  so  did  Magendie.  Pereira  adds, 
that  in  cases  of  this  nature,  "  the  rapid  action  of  the  j^oisons  seems 


THERAPEUTICS. REMEDIAL    ACTION.  673 

almost  incompatible  with  the  idea  of  their  absorption." — Pereira's 
3Iat.  Med.,  p.  27,  242.  The  experiments  by  Stilling  and  Van  Deen 
settle  the  question  as  to  absorption  (§  494).  Consider  the  action  of 
opium.  Apply  it  to  the  rcucous  tissue  of  the  intestine,  and  the  local 
impression  is  such  that  it  immediately  arrests  the  peristaltic  move- 
ments. Apply  it  to  the  surface  of  the  brain,  and  it  instantly  lessens 
the  action  of  the  heart  and  capillary  blood-vessels,  &c.  Now^  combine 
these  phenomena,  when  opium  exerts  its  direct  action  upon  the  stom- 
ach, and  indirectly  upon  the  heart,  capillary  system,  &c.,  and  consider 
the  natural  relations  between  the  stomach  and  nervous  centres.  Take 
a  substantial,  physical  fact,  as  supplied  by  the  advocates  of  absorption. 
Thus  (Note  Aaa  p.  1146): 

"  It  is  very  singular,"  says  Sigmond,  "  that  a  pill  of  opium,  admin- 
istered by  the  stomach  at  night,  will  be  vomited  up  in  the  morning, 
after  having  produced  its  narcotic  effect.  This  is  an  observation  which 
Van  Swieten  originally  made." — Sigmond's  Lectures,  &c. 

My  doctrine  of  alterative  reflex  nervous  action  clears  up  the 
obscurity,  and  admits  of  the  only  explanation  (§  512,  b,  891^  k). 

"  I  am  acquainted  with  a  physician  in  London,"  says  Sigmond, 
"  who,  on  taking  opium,  although  in  a  very  minute  quantity,  will  have 
over  the  surface  of  the  body  a  scarlet  efflorescence"  (§  891,  e). — Ibid. 

Is  not  this  phenomenon  due  to  the  same  principle  as  that  which  is 
concerned  when  indigestible  food  occasions  analogous  eruptions,  or 
when  they  spring  up,  as  in  infancy  especially,  from  gasti-ic  and  intes- 
tinal derangements,  or  when  the  blotches  of  a  surfeit  vanish  during  the 
operation  of  an  emetic,  or  as  croup  disappears  under  the  same  influ- 
ence ]  Turn  to  the  experiments  of  Philip,  Alston,  Hall,  Stilling, 
Buniva,  Van  Deen,  Kreimer,  Procter,  Girtanner,  Johnson,  &:c.,  and 
they  will  be  found  to  confirm  my  conclusion  (§  399,  483,  Exp.  21,  484, 
485,  828  &),*  that  they  depend  upon  alterative  reflex  nervous  actions. 

The  following  are  other  facts  which  demonstrate  the  local  operation 
of  remedial  and  morbific  agents,  and  the  dependence  of  their  constitu- 
tional effects  upon  the  laws  of  reflex  nervous  action.       Thus  : 

"  An  imponderable  quantity  of  atropia,"  says  Pereira,  "  is  sufficient 
when  applied  to  the  eye,  to  cause  dilatation  of  the  pupil." 

Now  consider  the  effect  of  this  "  imponderable  quantity"  in  connec 
tion  with  the  analogous  effect  of  imponderable  light  {§  514,  k),  and 
the  modus  operandi  of  the  latter  will  be  found  to  coincide  with  that 
of  the  former.  The  cases  are  remarkably  parallel,  and  the  more  in- 
teresting as  showing  the  transmission  of  influences  through  sympathet- 

*  In  connection  with  what  I  have  incidentally  said  in  a  former  section  of  the  advanta- 
ges of  opium  in  the  cerebral  congestion  which  is  induced  by  the  intemperate  use  of  alco- 
holic hquors,  and  which  constitutes  a  prominent  part  of  delirium  a  potu  (§  891,  r),  I  may 
say  that  we  witness  here,  in  the  manner  in  which  the  irritability  of  the  nervous  tissues 
is  relieved,  and  the  subsidence  of  disease  as  a  consequence,  not  only  the  special  modifi- 
cation of  irritabihty,  according  to  the  nature  of  the  remote  cause,  but  also  the  speda] 
adaptation  as  a  remedial  agent  of  what  is  morbific  in  cerebral  congestions  as  induced  by 
any  other  cause  (§  150,  151,  191,  650,  662,  686  b,  976  h,  1058  y). 

But,  although  a  knowledge  of  the  remote  causes  aid  us  greatly  in  the  treatment  of  dis- 
ease, we  may  not  proceed  upon  this  consideration  alone,  as  is  commonly  done,  more  em- 
pyrically,  in  delirium  a  potu.  Opium  rarely  fails  of  being  pernicious,  in  that  afiection,  if 
there  be  much  gastric  or  hepatic  derangement,  until  this  condition  be  more  or  less  over- 
come. It  is  always  useful  to  premise  a  cathartic,  of  which  calomel  should  generally  form 
a  component  part ;  and,  in  many  cases,  bloodletting  is  an  indispensable  remedy.  But 
here,  again,  the  exact  pathology,  and  the  complications  of  the  disease,  should  be  well  as- 
certained, or  bloodletting  may  prove  as  pernicious  in  some,  as  opium  does  in  others. 

There  are  also  certain  states  of  the  brain  attendant  on  maniacs  in  which  opium  is  beu 
"ficial ;  but  we  must  be  sure  of  the  right,  or  we  shall  be  sure  to  go  wrong 

TJu 


674  INSTITUTES    OF   MEDICINE. 

ic  sensibility  as  pronounced  in  an  expanded  nei've  and  as  implanted 
in  the  skin  of  the  eyelid,  or  in  the  tunica  conjunctiva,  and  therefore 
throuo-h  different  sensitive  nerves,  while  in  all  the  cases,  the  motor  nerve, 
and  the  part  which  is  impressed  by  the  nervous  power  are  exactly 
the  same  (§  233|).  It  is  also  worthy  of  remark,  as  exemplifying  the 
modification  of  the  nervous  power  by  preternatural  agents,  that  the 
motion  of  the  iris  is  very  different  under  the  different  influences  of  the 
remote  causes  (§  74  a,  188J  d,  514,  I,  1042), 

"  It  is  a  very  interesting  fact,"  says  Sigmond,  "  that  the  application 
of  hyoscyamus  and  belladonna  to  the  eye  was  not  applied  to  any  prac- 
tical purpose  until  a  gentleman  by  accident  applied  a  piece  of  the 
herb  to  his  eye,  when  the  effect  remained  for  three  weeksJ" 

He  states,  also,  that  a  dilatation  of  the  pupils  may  be  produced  by 
only  approximating  the  leaves  of  hyoscyamus  or  belladonna  to  the 
eyes.  This  is  a  closer  parallel  with  the  effect  of  light  than  the  prece 
ding  statement  by  Pereira  (p.  344,  §  516  d,  no.  6). 

Observe  how  many  individuals  are  liable  to  violent  erysipelatous 
inflammation  over  the  whole  surface  of  the  body  from  approaching 
only  within  a  few  yards  of  several  species  of  rhus;  while,  on  the  oth- 
er hand,  many  are  entirely  insusceptible  of  its  action,  as  many  are  of 
the  constitutional  effects  of  mercury  (§  585,  b). 

Here,  again,  is  another  fact,  coincident  with  the  foregoing,  and  which 
also  elegantly  illustrates  the  different  natural  modifications  of  the  or- 
ganic properties  ;  even  in  different  parts  of  the  same  continuous  tissue 
(§  133,  &c.).  "As  an  enema,"  says  Sigmond  (I  quote  from  the  advo- 
cates of  absorption),  "  hyoscyamus,  in  any  quantity,  cannot  be  given." 
Authorities  are  quoted  to  show  that  it  then  produces  delirium,  and 
even  apoplectic  symptoms,  and  also  when  the  "  fumes  were  inhaled  " 
(§  827  b,  1066) — Lectures  in  London  Lancet,  Feby.  18,  1837. 

The  snuff  which  regales  the  nose,  and  the  tobacco  which  equally 
delights  the  mouth,  are  violent  poisons  to  the  intestinal  mucous  tissue  ; 
and  the  constitutional  results  harmonize  with  the  local  effects  in  either 
case  (§  133,  &c.,  150,  151).  Again,  if  remedial  or  poisonous  substan- 
ces act  by  absorption,  why  is  tobacco  smoke  so  innoxious  when  inhaled 
by  the  lungs,  and  yet  so  deleterious  when  swallowed,  or  when  con- 
veyed into  the  rectum?  Most  remedial  agents,  indeed,  produce  con- 
stitutional effects  according  to  the  natural  vital  modifications  not  only 
of  the  mucous,  and  other  tissues  of  different  parts,  but  of  one  contin- 
uous tissue,  as  the  mucous  membrane  of  the  eyes,  nose,  fauces,  oesoph- 
agus, stomach,  small  and  large  intestines,  larynx,  trachea,  and  lungs. 
Where  would  philosophy  be  ;  where  our  interpretation  of  these  vari- 
ous consequences,  if  we  followed  the  chemist  in  his  physical  views  of 
life  1  What  would  tobacco  affect  in  such  a  case  1  Would  it  nauseate 
by  affecting  chemical  affinity,  or  cohesion,  or  elasticity,  or  would  the 
nose  or  the  mouth  enjoy  through  any  such  properties  of  matter, — or 
would  galvanism  help  our  understanding  ]  Is  it  through  any  such 
properties  that  we  feel  the  smart  when  the  fire  burns  1  Does  not 
Pereira  supply  an  important  fact  against  his  general  doctrine  of  op- 
eration by  absorption  when  he  defends  a  moderate  practice  of  opium 
smoking, — especially  as  the  whole  volume  of  smoke  is  drawn  into  the 
lungs'? — {Mat.  Med.,  p.  1293.)  Shall  we  not  rather  look  to  what  is 
known  of  the  natural  modifications  of  irritability  in  the  mucous  tissue 
of  different  organs  %     If  opium  offend  the  stomach,  the  principle  is  the 


THERAPEUTICS. REMEDIAL    ACTION.  67£ 

same  as  when  urine  excoriates  the  mucous  membrane  of  the  lungs, 
and  thus  produces  the  most  violent  reflex  nervous  actions.  But  the 
distinguished  author  above  quoted  shall  lay  down  our  principle  him- 
self.    Thus : 

"  Sir  B,  Brodie,"  he  says,  "  found  that  an  infusion  of  tobacco,  thrown 
into  the  rectum,  paralyzed  the  heart,  and  caused  death  in  a  few  min- 
utes. But  if  the  head  of  the  animal  be  previously  removed,  and  arti- 
ficial respiration  kept  up,  the  heart  remains  unaffected  ;  proving  that 
tobacco  disorders  this  organ  through  the  medium  of  the  nervous  sys- 
tem only"  (§  484,  b).—Ibid.,  p.  869.     Also,  Note  B  p.  1113. 

Should  we  not  rather  say,  through  the  medium  of  the  brain  in  its 
connection  with  the  organic  nerve,  while  other  parts  may  suffer  reflex 
nervous  actions  through  the  spinal  marrow,  or  even  the  ganglionic 
system  alone.  And  now  contrast  with  the  foregoing  peculiarities  of 
tobacco  and  opium  the  fact  that  tliQ  inhalation  of  the  fumes  of  hyos- 
cyamus  produces  vertigo,  tremors,  laborious  respiration,  &c. ;  and 
that  hydrocyanic  acid,  in  the  quantity  of  a  drop,  or  in  vapor,  on  ac- 
count of  the  coincident  relations  of  its  virtues  to  the  naturally  modi- 
fied organic  properties  of  various  parts,  is  instantly  fatal,  whether  ap- 
plied to  the  mucous  tissue  of  the  eyes,  nose,  mouth,  stomach,  or  lungs. 
And  so  of  the  spirituous  extract  of  nux  vomica.  If  absorption  be  good 
in  some  of  the  cases,  it  should  be  equally  so  in  the  others.  Consider, 
too,  how  the  habitual  use  of  narcotics  reduces  the  susceptibility  of  the 
stomach  to  the  influence  of  each  one,  respectively,  and  not  to  the  oth- 
ers, and  how  the  constitutional  effects  go  on,  pari  passu,  in  the  ratio 
of  the  local  effects.  And  consider,  also,  how  music  assuages  suffer- 
ing, or  the  expectation  of  the  dentist  relieves  toothache.  And  why, 
according  to  the  doctrine  of  absorption,  should  not  medicines  produce 
the  same  constitutional  effects  when  injected  into  the  bladder,  as  when 
administered  by  the  stomach  1  Are  you  doubtful  as  to  the  manner  in 
which  certain  substances  produce  their  constitutional  effects  when 
applied  to  the  skin,  as  mercury  and  tobacco,  for  example  1  Consider 
the  foregoing  case  of  hydrocyanic  acid  ;  or  how  an  issue  relieves  deep- 
seated  inflammation  ;  or,  again,  how  belladonna,  or  hyoscyamus,  when 
applied  to  the  lids  of  the  eyes,  as  when  to  the  stomach,  produces  dil- 
atation of  the  pupils  (§  1066,  p.  838,  §  1057^). 

904,  bb.  Let  us  observe  the  constitutional  effects  of  tartarized  antimo- 
ny when  administered  in  small  and  repeated  doses.  This  substance 
possesses,  in  a  general  sense,  the  power  of  lessening  the  irritability  of 
the  stomach  (in  relation  to  its  own  virtues),  where  the  doses  are  small 
at  first,  and  gradually  increased.  From  this  principle,  indeed,  results 
the  necessity  of  increasing  the  doses  as  far  as  they  may  be  borne 
without  nausea,  for  the  purpose  of  maintaining  the  same  influence 
upon  disease  as  is  exerted  by  the  first  and  smaller  doses.  In  this 
way,  in  certain  affections,  as  in  articular  rheumatism,  we  may  some- 
times rapidly  increase  the  doses  from  the  sixteenth  of  a  grain  to  two 
grains,  although  the  first  dose  shall  have  actually  produced  vomiting, 
while  the  two  grains  are  borne  without  nausea.  It  is  also  certain 
that  this  progressive  increase  of  the  remedy,  as  far  as  may  be  admit- 
ted by  the  stomach,  is  indispensable  to  the  full  influence  upon  disease 
which  was  exerted  by  the  smaller  doses  before  the  remedy  had  sub- 
dued the  irritability  of  the  stomach  (§  516  d,  no.  7,  558,  578  d,  841). 

Now  were  the  physical,  and  not  the  physiological,  doctrine  true, 


676  INSTITUTES    OF    MEDICINE. 

there  should  be  no  necessity  for  this  regular  and  rapid  increase  of 
the  doses.  The  neai'er,  indeed,  each  dose  approaches  the  point  of 
nausea  so  will  the  general  arterial  excitement,  and  local  inflamma- 
tions, be  held  in  subjection ;  from  which  it  is  plainly  manifest  that  the 
remote  effects  depend  upon  the  amount  of  influence  produced  upon 
the  stomach.  And  so  of  opium,  and  all  the  narcotics,  and,  indeed,  of 
various  other  agents  which  are  freely  assumed  to  operate  through  the 
circulation.  As  to  antimony,  croup  often  subsides  when  nausea  begins. 
But  again,  on  the  contrary,  we  may  obtain  an  exactly  opposite  se- 
ries of  results  from  tartarized  antimony  ;  by  which  we  prove  our  prop- 
osition by  the  converse  of  the  foregoing  phenomena.  We  may  begin 
the  treatment  by  one  eighth  of  a  grain  without  producing  nausea ;  but 
in  an  hour  or  two  afterward,  a  repetition  of  the  same  dose  nauseates 
the  stomach,  and  prostrates  the  whole  system.  Again,  at  the  same 
interval,  we  repeat  the  same  dosB  and  vomiting  ensues,  accompanied 
by  still  greater  constitutional  effects.  We  then  reduce  the  quantity 
to  the  twelfth  of  a  grain  and  again  we  have  nausea  and  vomiting,  with 
still  greater  constitutional  results.  AVe  go  on  to  reduce  the  dose  in 
this  manner,  and,  as  I  have  witnessed  in  adults,  it  has  been  necessary 
to  diminish  the  quantity  to  the  thirtieth  part  of  a  gi'ain  to  avoid  pro- 
tracted nausea,  and  a  general  prostration  of  the  system.  Here,  then, 
the  remedy  not  only  continues  to  nauseate  the  stomach  in  greatly  di- 
minished doses,  but,  as  in  the  opposite  case,  there  is  a  constant  ratio 
between  its  impression  on  the  imtability  of  the  stomach  and  its  con- 
stitutional influences  and  its  special  effects  on  diseased  remote  organs. 
However  the  dose  may  be  diminished,  so  long  as  it  impresses  the  ir- 
ritability of  the  stomach,  it  breaks  down  the  general  arterial  excite- 
ment, and  often  overthrows  inflammation  just  as  fully,  and  rapidly,  as 
when  two  grains  are  administered  with  a  similar  effect  upon  the  stom- 
ach. Nor  is  this  all  which  antimony  opposes  to  the  doctrine  of  ab- 
sorption ;  since  in  the  cases  first  supposed,  when  it  finally  produces 
nausea  after  repeated  and  gradually-increased  doses  it  does  not  re- 
duce the  irritability  of  the  stomach  after  that  dose,  as  after  the  begin- 
ning of  the  remedy,  and  when  it  did  not  produce  nausea.  On  the 
conti-ary,  the  gastric  irritability  is  now  brought  up  to  a  full  relation  to 
the  remedy  in  that  last  dose,  where  it  either  remains  permanently  for 
some  time,  or  is  quite  as  apt  to  increase  in  susceptibility  to  the  anti- 
monial  influence,  so  that  it  may  be  necessary  to  diminish  the  next  fol- 
lowing dose  to  avoid  a  renewal  of  the  nausea,  and  perhaps  vomiting. 
In  the  mean  time,  the  effects  on  the  constitution,  and  on  remote  dis- 
ease, are  exactly  conformable  to  the  amount  of  influence  upon  the 
stomach.     Clearly,  then,  its  effects  depend  on  reflex  nervous  actions. 

904,  c.  Pereira  has  rendered  our  best  standard  work  on  Materia 
Medica  liable  to  the  objection  which  I  am  now  considering,  as  he  has, 
also,  to  that  of  reasoning  from  the  effects  of  remedies  on  man  in  health, 
and  even  upon  the  naturally  modified  constitution  of  animals  and 
plants,  to  the  altered  susceptibilities  of  man  as  they  exist  in  disease. 
Of  tartar  emetic,  he  says,  we  do  not  know  "the  mode  in  which  it  pro- 
duces its  curative  effect."     And  again,  a  universal  opinion — 

"  Shall  we  deny  the  efficacy  of  bloodletting  in  inflammation,  of  mer- 
cury in  syphilis,  of  cinchona  in  intermittents,  and  of  a  host  of  other 
remedies,  simply  because  we  cannot  account  for  their  beneficial  ef- 
fects %     The  fact  is,"  he  continues,  "  that  in  the  present  state  of  mir 


THERAPEUTICS. REMEDIAL   ACXrON.  677 

knowledge,  we  cannot  explain  the  modus  7nedendi  of  a  large  number 
of  our  best  and  most  certain  remedial  agents." — (Pereira's  Mat.  Med., 
vol.  i.,  p.  417.     1839.) 

This  supposed  ignorance  is  mostly  predicated  of  the  failure  of  de- 
tecting the  medicines  in  the  circulation ;  but  will  it  apply  to  such  ob- 
sei'vers  as  explain  their  modus  operandi  on  other  principles,  and  in 
conformity  with  well-established  facts'?  If  "bloodletting  be  effica- 
cious in  inflammation,  mercury  in  syphilis,"  &c.,  they  are  so  through 
great  and  immutable  laws ;  and  shall  we  rest  in  ignorance  of  those 
laws  because  we  cannot  deny  the  efficacy  of  the  remedies  ]  Is  it  not 
this  very  common  representation  of  the  topics  before  us,  and  of  the 
phenomena  of  living  beings,  which  has  led  to  so  general  a  disi-egard 
of  the  great  principles  in  medicine,  and  to  the  revival  of  the  exploded 
creeds  of  the  iatro-chemical  and  iatro-mechanical  philosophers  ]  Or 
is  it  any  argument  against  the  interpretation  of  the  properties  and  laws 
of  organic  beings,  of  their  modifications  in  disease,  of  the  modus  ope- 
randi of  remedial  agents,  as  set  forth  by  one  inquirer,  that  fifty  differ- 
ent and  conflicting  systems  have  been  projected  by  others  1  Such, 
indeed,  must  be  the  position  of  every  disputed  topic  when  universal 
truth  shall  ultimately  prevail.  The  argument,  therefore,  however 
common,  is  necessarily  fallacious  (§  892,  h,  905f ,  829,  830). 

There  is  no  objection  to  admitting  that  all  remedial  and  morbific 
agents  find  their  way,  very  scantily,  into  the  circulation,  excepting  as 
it  regards  the  matter  of  fact,  and  a  respect  for  those  principles  which 
nature  has  ordained  for  their  exclusion  so  far  as  to  prevent  their  in- 
gress in  injurious  quantities.  No  conclusions,  as  I  have  shown,  can 
be  forined  from  the  effects  of  injections  into  the  circulation ;  which 
are  the  rudest  facts  in  relation  to  a  topic  of  this  nature.  It  therefore 
becomes  the  merest  assumption  to  affirm  that  the  minute  proportions 
of  medicines,  which  may  force  their  way  through  the  well-guarded 
portals  of  the  organism,  produce  those  remarkable  results  which  we 
witness  after  their  administration  by  the  stomach  :  while  we  are  met 
at  the  threshold  of  the  inquiry  by  the  clearest  interpretation  of  their 
modus  operandi  in  the  perfectly  demonstrable  laws  of  sympathy,  in  a 
stupendous  display  of  reflex  actions  of  the  nervous  power  in  the  nat- 
ural conditions  of  the  body,  and  as  modified  by  a  vast  variety  of  ex- 
periments, and  by  the  morbid  processes  that  are  perpetually  before  us. 
904,  d.  Again,  take  the  grand  characteristics  of  the  cinchonas,  arse- 
nic, calomel,  and  the  whole  group  of  agents  for  intermittent  diseases. 
Of  cinchona,  Pereira  says  (after  having  expounded  its  operation  as  a 
tonic  through  the  process  of  absorption),  that  in  intermittent  diseases 
its  "  methodus  medendi  is  quite  inexplicable." — [Ibid.,  vol.  ii.,  p,  1002, 
1006.  1840.)  But,  is  not  its  mode  of  operation  just  as  intelligible  in 
one  case  as  in  the  other  ?  Does  not  the  whole  system  of  nature, 
where  common  results  are  concerned  in  any  integral  part,  enforce  the 
belief  that  the  same  laws  are  concerned  in  both  cases  ;  and  do  not  all 
the  relative  facts  in  physiology,  all  that  is  known  of  the  properties  of 
life,  and  of  the  constitutional  effects  of  vital  stimuli  of  any  denomina- 
tion proclaim  the  fact,  that  nature  is  just  as  consistent  in  this  in- 
stance as  she  is  in  the  simple  principles  which  determine  the  phe- 
nomena of  gravitation,  of  chemical  affinity,  of  the  attraction  of  cohe- 
sion, of  repulsion,  &c.,  or,  in  more  sensible  physics,  of  electricity,  of 
light,  of  magnetism,  &c.?     If  we  refer,  as  does  Pereira,  to  the  effects 


678  INSTITUTES    OP    MEDICINE. 

of  cinchona  as  a  tonic  upon  the  healthy  system,  we  must  explain  the. 
metJiodus  operandi  before  we  can  apply  it  in  the  least  to  any  paralle 
effects  upon  morbid  and  enfeebled  states  of  the  system. .  But  we  may 
not  speak  of  "  augmentation  of  cohesion  of  the  organic  mass,"  &c. 
(5  890,  890^). — Ihid.,  p.  1002.  These  are  only  effects  of  an  antece- 
dent operation,  in  which  the  whole  modus  operandi  consists  (§  842). 
But  the  mode  in  which  cinchona  pi'oduces  its  effects  in  the  perfect  or- 
ganism being  just  as  obscure  as  in  diseased  states,  we  start  with  our 
interpretation  of  its  modus  operandi  in  intermittents  just  as  we  do  of 
the  mode  in  which  cinchona  produces  its  fullest  effects  in  health ;  or 
raises  the  vigor  of  the  stomach,  sharpens  the  appetite,  and  braces  up 
the  animal  man,  in  dyspeptic  affections. 

Now  the  mode  in  which  cinchona  accomplishes  these  last  results  ia 
no  more  obvious  than  its  action  as  a  febrifuge.  One  must  certainly 
be  as  plain  as  the  other,  since  the  essential  influences  and  changes 
are  exerted  upon  the  organic  properties  of  living  parts,  which  are 
governed  by  simple  and  immutable  laws.  To  explain  the  operation 
of  a  given  cause  upon  two  principles  where  the  results  are  of  the 
same  genus,  and  nearly  of  the  same  species,  would  be  to  disjoint  na- 
ture completely,  and  to  render  her  a  deformity. 

With  this  fundamental  principle,  we  move  forward  to  the  interpre- 
tation of  the  effects  of  cinchona  when  it  exasperates  or  produces  dis- 
ease ;  and  so  of  other  morbific  agents.  All  the  results,  as  they  vary 
from  those  which  follow  the  ordinary  stimuli  of  life,  depend  upon  the 
mutability  of  the  organic  properties  and  actions.  Upon  these,  mor- 
bific causes,  like  the  natural  vital  stimuli,  make  their  whole  impres- 
sion ;  but  they  go  farther  in  that  impression  than  the  natural  stimuli 
of  life.  That  is  to  say,  they  make  their  impression  so  pi'ofoundly, 
and  in  virtue  of  their  peculiar  attributes,  as  to  alter  the  natural  condi- 
tion of  the  organic  properties  and  actions ;  and  this  alteration  consti- 
tutes disease.  All  that  follows  are  but  mere  "  sequelae."  Remedial 
agents,  as  we  have  seen,  are  capable  of  doing  the  same  thing;  and 
when  direct  in  action,  they  operate  upon  the  same  principle.  It  is 
for  this  reason,  therefore,  that  they  produce  disease  in  the  healthy  or- 
ganism ;  and  when  they  contribute  to  the  cure  of  disease,  it  is  in  vir- 
tue of  that  morbific  action  which  they  exert  on  healthy  parts.  They 
are  a  class  of  morbific  agents,  however,  which  produce  only  such  dis- 
eases, in  health  (if  not  administered  in  great  excess),  as  are  of  a  tran- 
sient nature ;  and  when,  therefore,  administered  for  the  cure  of  dis- 
ease, they  induce  a  morbid  state  more  favorable  than  the  pre-existing 
to  the  natural  tendency  of  morbid  organic  properties  and  actions  to 
return  to  their  healthy  standard  (^  892  h,  893,  901,  1059). 

Thus  we  get  at  a  common  principle  of  the  meihodus  operandi  of  cin- 
chona as  a  tonic ^  as  z. febrifuge,  and  as  a  morbific  agent;  and  it  is 
equally  applicable  to  all  other  remedies  which  possess  absolute  reme- 
dial virtues.  This  philosophy  enables  us  at  once  to  understand  how 
arsenic,  cobweb,  opium,  alcohol,  mental  emotions,  and  almost  every 
thino-  else,  are,  like  cinchona,  more  or  less  curative  of  intermittent 
fevers ;  and  though  the  alterations  which  are  direct'y  instituted  by 
these  various  agents  are  unlike  in  all  the  instances,  and  correspond 
with  the  peculiar  virtues  of  each  agent,  each  one  induces  such  chan- 
ges in  the  organic  properties  as  enable  them  to  take  on  their  natural 
tendency  toward  a  state  of  health, — some  being  more  conducive  than 


THERAPEUTICS. REMEDIAL    ACTION.  679 

Others,  and  either  liable  to  exasperate  the  disease.  We  thus  see,  also, 
how  it  is  that  our  remedies  must  be  well  adapted  to  the  eccisting  pa- 
thology, or  they  will  prove  morbific ;  since  their  operation  is  as  well 
regulated  by  the  nature  of  the  morbid  conditions  as  by  the  virtues  of 
the  remedies  (§  79,  150,  &c.,  857,  890|  d,  892  d).  We  must  look 
for  the  reason  of  this  ready  subversion  of  intermittent  fever  to  solid- 
ism  and  vitalism.  We  must  regard  nature  in  her  recuperative  efforts 
as  strongly  pronounced  during  the  periods  of  intermission,  and  thus 
learn  from  her  that  the  moibid  properties  of  life  may  require  but  a 
slight  impression  to  establish  an  unintermitting  tendency  toward  a 
state  of  health  (§  177-182,  557  a,  756  a,  775). 

That  there  is  a  methodus  operandi,  in  all  the  foregoing  cases,  is  too 
certain  to  be  questioned ;  and  such  being  the  fact,  it  is  quite  a  becom- 
ing occupation  for  the  human  mind  to  interrogate  its  nature ;  or  as 
the  Wise  Man,  "it  is  the  glory  of  God  to  conceal  a  thing,  and  the  glory 
of  man  to  find  it  out"  (§  892,  h,  905|).— Notes  K  L  pp.  1119,  1120. 

905,  a.  I  will  now  present  a  comprehensive  example  which  illus- 
ti'ates  the  foregoing  doctrines.  A  seton,  passed  through  the  skin  of 
the  neck,  removes  inflammation  of  the  eyes.  In  this  instance,  nothing 
can  possibly  enter  the  circulation,  but  the  whole  influence  of  the  se- 
ton upon  the  eyes  must  be  exerted  through  reflex  actions  of  the 
nervous  system.  By  tracing  out  all  the  effects  of  which  this  seton  is 
capable  we  may  show  that  it  involves  all  the  principles  which  are 
concerned  in  the  production  of  disease  and  its  cure  (§  63-81). 

In  the  first  place,  the  seton  establishes  an  inflammation  in  the  part 
of  the  skin  in  which  it  is  inserted.  Here  we  have  the  whole  inter- 
pretation of  morbific  agents  in  producing  their  direct  diseases. 
Like  the  seton,  all  others  act  upon  the  irritability  of  parts,  directly 
or  by  reflex  action,  alter  its  nature,  and  involve  the  other  organic  prop- 
erties in  corresponding  changes,  when  a  change  of  function  ensues  as 
a  consequence ;  and  then  may  follow  a  variety  of  physical  results. 

Now  let  us  consider  the  seton  in  its  curative  aspect,  as  it  relates  to 
the  ophthalmic  inflammation.  The  morbid  state  of  the  skin  operates 
as  a  peculiar  stimulus,  the  result  of  which  is  transmitted  to  centers  of 
the  nervous  system,  where  it  develops  and  modifies  the  nervous  power, 
and  reflects  it  through  organic  nerves  (^  893  a).*  The  intensity  of  the 
nervous  power,  thus  developed,  is  not  sufficient  to  alter  the  organic 
properties  of  any  part  excepting  the  susceptible  ones  which  conduct 
the  inflammatory  affection  of  the  eyes  through  their  instruments  of 
action,  and  therefore  no  sympathetic  disease  is  produced.  But  irri- 
tability being  pretematurally  susceptible  in  the  inflamed  eyes,  the 
nervous  power  operates  with  effect  upon  it,  and  alters  the  nature  o^ 
that  and  other  properties  so  as  to  enable  them  to  return  to  their  nat 
ural  state;  and  thus  the  inflammation  subsides  (§  150,  151,  854). 

We  will  next  see  how  this  seton  may  become  the  cause  of  disease 
in  other  parts  by  reflex  action,  and  we  shall  then,  also,  have  the  whole 
of  the  principle  which  is  ever  concerned  in  the  development  of  sec- 
ondary diseases ;  and  we  shall  see,  too,  that  the  principle  is  precisely 
the  same  as  that  which  concerns  the  curative  effects  of  remedies  when 
they  operate  upon  remote  parts  through  the  medium  of  another  part; 
as  in  the  curative  effect  of  the  seton  upon  the  inflamed  eyes. 

Let  us,  then,  suppose  that  the  seton  is  permitted  to  remain  in  the 

neck  after  it  has  accomplished  the  cure  of  the  eyes,  till,  finally,  it  ex- 

*  In  this  curative  effect,  as  in  the  case  of  vesicants  (§  893  c),  centres  of  the  sympa- 
thetic nerve  are  more  interested  than  the  cerebro-spinal  axis Note  Dd  p.  1132. 


nSO  INSTITUTES    OF    MEDICINE. 

cites  a  severe  degree  of  inflammation  in  the  surrounding  skin.  By- 
and-by,  we  find  the  patient  beginning  to  lose  his  appetite,  the  tongue 
coats  up,  and  other  marks  of  a  diseased  state  of  the  stomach  set  in. 
This  organ,  therefore,  has  become  involved  in  disease  in  consequence 
of  the  neglected  and  irritative  state  of  the  seton.  Still,  however,  the 
mischief  is  allowed  to  go  on,  and  the  eyes,  which  had  been  relieved 
by  the  seton,  again  become  inflamed.  The  seton  has  been  the  essen- 
tial cause  of  this  round  of  phenomena ;  and  since  nothing  can  -have 
been  introduced  into  the  circulation,  from  beginning  to  end,  we  must 
look  to  the  nervous  influence  for  the  remote  developments  of  disease, 
as  in  the  former  case  for  the  curative  results  (§  514,  Ji).  The  seton, 
after  the  cure  of  the  eyes,  had  taken  on  a  higher  and  modified  state 
of  inflammatory  action,  and  it  transmitted  to  the  brain  and  spinal  cord 
such  influences  as  developed  the  nervous  power  in  greater  intensity 
and  a  more  morbific  condition.  This  state  of  the  nervous  power,  be- 
ing reflected  abroad,  fell  with  greater  force  upon  the  stomach  than  on 
other  parts,  from  its  peculiar  susceptibilities,  and  its  close  natural  re- 
lations with  the  skin  and  cerebral  system  (§  233|).  The  stomach  has 
also  the  eyes  much  under  its  control,  and  the  eyes  are  now  particular- 
ly liable  to  be  injuriously  affected  by  reflex  actions  instituted  by  the 
stomach  on  account  of  their  recent  inflammation,  which  left  them  in  a 
more  than  usually  susceptible  state.  The  stomach,  therefore,  in  trans- 
mitting its  morbid  impressions  to  the  cerebro-spinal  axis,  co-operates 
with  those  from  the  seton  in  increasing  and  reflecting  a  morbific  nervous 
influence  upon  the  eyes.  Thus,  like  vesicants,  setons  are  mobific  when 
their  action  extends  beyond  the  centres  of  the  organic  nerve  (§  893  c). 

We  have  now  to  consider  the  natural  tendency  of  the  properties 
and  actions  of  life  to  return  from  diseased  to  their  healthy  states.  The 
seton,  as  we  have  seen,  is  the  sole  cause  of  the  new  developments 
of  disease  in  the  stomach  and  eyes,  and  these  eflects  ai'e  maintained 
by  keeping  up  the  irritative  inflammation  of  the  skin.  If,  therefore, 
we  withdraw  the  mechanical  irritant  from  the  skin,  the  inflammation 
of  the  part  will  subside  spontaneously  ;  and  having  thus  removed  the 
exciting  cause  of  disease  in  the  stomach  and  eyes,  these  parts,  also, 
return  spontaneously  to  their  healthy  states.  Thus  it  is,  also,  that  the 
irritation  of  setons,  issues,  blisters,  &;c.,  when  applied  over  the  joints, 
&c.,  for  the  removal  of  inflammation  of  the  ligaments  or  other  tissues, 
may,  after  having  greatly  fulfilled  their  purpose,  ultimately  keep  up  a 
degree  of  the  disease,  or  increase  its  intensity.  But,  if  the  skin  be  now 
healed,  the  disease  will  subside  spontaneously, — the  very  healing  of 
the  skin  reflecting  salutary  influences.  This  is  often  verified  by  the 
effects  of  remedies  when  administered  internally ;  disease  being  ulti- 
mately aggravated  by  the  means  which  were  at  first  curative,  but 
again  yielding  with  rapidity  as  soon  as  the  remedy  is  discontinued. 
In  all  the  cases,  the  ultimate  subsidence  of  the  aggravated  conditions 
of  disease  is  owing  to  the  artificial  modifications  of  their  pathological 
cause.  This  recuperative  law  lies  at  the  foundation  of  therapeutics, 
and  it  shows  us  that  the  first  and  greatest  step  in  the  treatment  of  dis- 
eases is  to  remove  their  exciting  causes ;  when  the  natural  physio- 
logical constitution  may  require  no  other  aid  from  art  (§  853). 

The  only  remaining  consideration  to  complete  the  essential  philos- 
ophy of  the  operation  of  remedial  and  morbific  agents  relates  to  the 
direct  action  of  remedies  in  curing  diseases  of  parts  to  which  they 


TBERAPEUTICS. REMEDIAL    ACTION.  681 

may  be  applied.  If  an  emollient  poult/.ce,  as  it  is  called,  or  opium, 
or  leeches,  &c.,  be  applied  to  the  inflamed  skin,  they  may  hasten  the 
subsidence  of  the  inflammation.  This  is  done  by  their  direct  altera- 
tive action  upon  the  diseased  properties  of  the  part,  as  in  the  case  of 
morbific  agents ;  and  in  proportion  to  the  subsidence  of  the  primary 
affection  may  be  that  of  the  sympathetic  diseases.  But,  the  sympa 
thetic  affections  may  be  also  hastened  in  their  decline  by  the  direct 
application  of  remedies  to  the  sympathizing  parts ;  or,  we  may  con- 
tribute to  the  cure  of  the  whole  by  addressing  remedies  directly  to 
one  of  the  organs  which  has  been  sympathetically  involved,  as  to  the 
stomach  in  the  foregoing  case ;  or,  the  sympathetic  affections  may  go 
on  independently  of  the  cure  of  the  primary  disease,  and  require  a 
distinct  treatment ;  or,  it  may  be  necessary  to  cure  them  first,  before 
the  primary  disease  can  be  removed.  The  diseased  state  of  the  stom- 
ach, for  example,  in  the  foregoing  case,  may,  in  its  turn,  establish  a 
morbific  reflex  nervous  action  upon  the  seton,  and  thus  complicate  the 
principle  as  to  exciting  causes,  and  institute  a  mixed  condition  of 
reflex  nervous  influences.  This,  in  fact,  is  more  or  less  the  case,  in 
most  diseases,  after  the  morbid  state  is  propagated  from  the  primary 
seat.  In  the  example  now  stated  all  the  diseased  parts  act  and  react 
upon  each  other,  each  becoming  a  point  of  departure  for  the  develop- 
ment of  a  morbific  nervous  influence,  and  each  affection,  therefore, 
contributing  to  maintain  and  aggravate  the  others.  Other  organs  join 
in,  though  perhaps  not  essentially  disturbed,  and  take  their  part  in  the 
disease  according  to  their  degrees  of  affection,  and  more  or  less,  also, 
according  to  their  relative  vital  importance  and  constitutional  rela- 
tions ;  while  the  great  movement  of  diseased  action  may  be  variously 
influenced  by  the  contingencies  which  grow  out  of  constitution,  tem- 
perament, age,  habits,  external  influences,  &c.  (§  512,  &c.). 

And  so,  on  the  other  hand,  when  the  curative  process  begins,  wheth- 
er instituted  by  nature  or  by  art,  the  whole  organic  system  may  con- 
cur in  the  salutary  change  which  is  started  at  a  single  point  (§  143,  c, 
and  references  there).     It  is  all  the  work  of  the  physiological  laws. 

905,  h.  The  vast  advantages  which  are  every  where  arising  from 
warm  poultices,  and  warm  fomentations,  both  in  the  hands  of  the  phy- 
sician and  the  surgeon,  lead  me  to  advert  still  farther  to  the  philoso- 
phy which  concerns  their  effects,  in  the  hope  that  it  may  not  only  tend 
to  their  more  frequent  substitution  for  powerful  agents,  or  for  the  sur- 
geon's knife,  and,  therefore,  to  a  better  appreciation  of  the  recupera- 
tive law,  and  a  greater  reliance  upon  Nature  herself,  but  that  it  may 
contribute  light  upon  the  fundamental  cause  of  disease,  and  the  reme- 
dial action  of  all  things  else. 

In  what  I  have  hitherto  said  of  the  foundation  of  disease  in  common 
physiological  principles,  and  of  the  near  approximation,  in  their  path- 
ological states,  of  all  the  varieties  and  modifications  of  inflammation, 
in  connection  with  what  has  been  variously  and  specifically  stated  of 
the  common  mode  of  action  which  obtains  with  all  efficient  remedies, 
from  the  vesicant  to  the  sedative,  it  is  evident  that  the  remedial  action 
of  poultices,  and  hot  fomentations,  falls  under  the  universal  philoso- 
phy. From  blisters  and  irritating  cathartics  we  readily  pass  along  an 
intermediate  series  of  analogies  that  are  represented  by  other  agents 
till  we  arrive  at  tonics  and  stimulants.  In  a  former  section  I  was 
employed  in  endeavoring  to  show,  through  the  operation  of  these  last 


B82  INSTITUTES    OF    MEDICINE. 

agents,  that  there  is  no  ground  whatever  for  the  distinction  which  has 
been  made  of  inflammation  into  active  and  passive,  or  sthenic  and 
asthe-nic,  conditions  (§  733^)  752-756).  The  example  supplied  by 
erysipelas,  in  which  blisters  and  leeches  may  afford  relief  when  ap- 
plied to  the  inflamed  surface,  either  separately  or  conjointly,  is  only 
another  impressive  evidence  of  the  close  approximation  of  the  various 
pathological  states  of  inflammation  ;  and  the  variety  in  the  remedial 
virtues  of  the  curative  agents  which  have  now  passed  under  review 
goes  to  prove  that  they  operate  merely  by  inducing  conditions  of  dis- 
ease more  favorable  to  the  recuperative  process.  Loss  of  blood  pro- 
duces one  kind  of  change,  cathartics  another,  tonics  another,  vesicants 
another,  and  so  on ;  but  each  one  induces  a  change  from  which  the 
morbid  properties  are  capable  of  passing  to  their  natural  state  (§ 
892|,  h).  These  principles  enable  us  to  understand  how  a  great  va- 
riety of  physical  and  mental  causes  will  often  succeed  in  removing 
some  particular  malady,  as  one  or  another  may  be  brought  into  action 
at  its  different  pathological  phases,  as  in  intermittent  fever ;  and  rec- 
oncile, also,  those  embarrassing  contrasts  which  have  led  to  many  er- 
rors in  pathology  and  therapeutics,  as  when  tonics  and  stimulants  re- 
move inflammation,  or  when  patients  equally  survive  the  treatment 
of  gastro-enteritis  by  capsicum  or  lobelia,  as  practiced  by  the  bold 
and  unprincipled  empiric.  A  more  violent  inflammation  may  be  the 
temporary  consequence  ;  but  it  differs  from  the  original  in  being  mod- 
ified by  the  peculiar  morbific  virtues  of  capsicum  or  lobelia,  and  in 
which  modifications  the  diseased  properties  are  sometimes  capable  of 
exerting  their  recuperative  energy  (§  1059). — See  Note  Ee  p.  1133. 

This  conducts  me  to  a  more  circumstantial  exposition  of  the  reme- 
dial action  of  local  sedatives,  especially  of  those  for  which  this  sec- 
tion was  designed.  In  the  mean  time,  however,  on  looking  at  the 
group  of  local  sedatives,  as  arranged  in  my  Materia  Medica,  we  find 
linseed,  and  bread  and  milk  poultices,  holding  the  very  first  rank, 
while  sedatives  of  the  most  active  virtues,  such  as  stramonium,  aco- 
nite, belladonna,  cicuta,  cyanide  of  potassium,  morphia,  opium,  hen- 
bane, &c.,  follow  the  poultices  and  hot  fomentations  as  infeiior  reme- 
dies. 

But  this  aiTangement,  like  that  of  all  other  groups,  is  founded  upon 
the  supposed  relative  usefulness  of  the  several  agents  in  fulfilling  the 
objects  of  each  group,  respectively.  Since,  therefore,  emollient  poul- 
tices and  warm  fomentations  effect  the  greatest  amount  of  relief,  and 
are  far  more  generally  applicable  in  practice  than  all  the  rest,  as  local 
sedatives,  they  should  hold  the  first  rank  in  the  arrangement,  notwith- 
standing the  activity  of  their  virtues  is  immensely  less  than  that  of  the 
other  substances  which  I  have  mentioned.  It  is  the  effect  of  all,  how- 
ever, to  lessen  irritability  and  sensibility,  and  thereby  to  moderate  or 
subdue  inflammatory  action.  But  rqany  of  the  local  sedatives  go  far- 
ther than  this.  They  also  affect  irritability  and  sensibility,  especially 
the  former  property,  in  their  existing  nature  or  Jciiid,  and,  of  course, 
induce  a  corresponding  change  in  the  kind  of  action.  Now,  it  is  this 
alteration  in  land,  beyond  the  mere  sedative  effect,  which  makes  up 
the  differences  between  the  various  agents  of  the  group  of  local  seda- 
tives. Poultices  and  warm  fomentations  produce  the  least  of  this 
change  in  kind  ;  their  effect  scarcely  reaching  beyond  that  of  reducing 
an  exalted  state  of  irritability  and  sensibility,  or  of  keeping  it  down 


THERAPEUTICS. REMEDIAL    ACTION.  683 

where  it  is  liable  to  ensue.     The  acetate  of  lead  follows  next,  in  this 
simple  but  most  valuable  effect. 

The  foregoing  moderate  influences,  with  little  or  no  specific  altera- 
tion in  kind  of  the  morbid  properties  and  actions,  is  just  what  is  want- 
ed in  a  vast  number  and  variety  of  morbid  states,  as  in  superficial  in- 
flammations, abdominal  irritations,  sprains,  bruises,  piles,  &c.,  or  as 
means  of  prevention  in  the  hands  of  conservative  surgery.  There  is 
nothing  comparable,  for  these  purposes,  with  warm  poultices  and 
warm  fomentations.  Their  immense  services  in  the  healing  art,  1 
say  again,  should  turn  the  attention  of  physicians  and  surgeons  with 
increasing  reliance  upon  recuperative  Nature.  Let  us  study  the  pre- 
cepts as  inculcated  by  the  fathers  of  medicine,  an  imbodiment  of 
which  may  be  seen  in  three  of  the  mottoes  at  the  head  of  a  former  sec- 
tion (§  894).— IN'oTE  E  p.  1114. 

In  respect  to  the  poultices,  &c.,  no  doubt  the  moist  heat  exerts  some 
slight  alterative  effect  beyond  that  of  simply  reducing  the  exalted  prop- 
erties and  actions  of  inflammatory  conditions.  But,  all  the  other  chan- 
ges and  results  which  take  place  are  brought  about  by  Nature,  and 
not  by  the  poultices  (§  878,  891  i,  891 1  g-1^. 

If  local  inflammations,  to  which  poultices  and  warm  fomentations 
are  applicable,  have  given  rise  to  disturbing  reflex  actions,  or  to  in- 
flammation of  other  parts,  these  sympathetic  results  may  subside  spon- 
taneously when  the  primary  disease  gives  way.  But  the  poultices  have 
nothing  farther  to  do  with  any  of  these  great  movements  of  Nature 
than  simply  to  lessen  the  irritability  of  the  inflamed  part  with  which 
they  are  in  contact.  In  conservative  surgery,  poultices  have  even  less 
participation  in  all  those  terrible  compound  fractures  and  dislocations 
whose  cure  they  enable  Nature  to  conduct  with  but  even  little  inconve- 
nience to  their  subjects,  and  which,  till  in  recent  times,  were  doomed  to 
the  amputating  knife.  In  all  these  cases,  the  simple  agents  are  only 
instrumental  in  keeping  down  irritability,  and  thus  preventing  inflam- 
mation and  constitutional  disturbances.  They  act  partly  upon  the  prin- 
ciple of  keeping  exciting  causes  out  of  the  way  of  Nature  (§  856,  a). 

Finally,  a  word  as  to  the  contribution  which  is  made  by  these  great 
I'emedies  toward  the  resolution  of  those  phlegmonous  inflammations 
which  are  disposed  to  result  in  suppuration,  or  how,  in  other  cases, 
they  promote  that  disposition. 

If  the  phlegmon  have  not  reached  the  turning  point,  as  it  were,  of 
the  inflammatory  process,  or  when  the  formative  is  about  passing  into 
the  suppurative  stage,  an  emollient  poultice,  by  lessening  irritability, 
will  be  very  likely  to  promote  resolution,  and  thus  to  prevent  the  sup- 
purative stage. 

But,  when  suppuration  has  begun,  Nature,  herself,  has  taken  on  the 
wq^'k  of  cure,  and  an  abatement  of  morbid  irritability  is  the  first  recu- 
perative change  in  this  natural  process.  Now  it  is,  therefore,  that 
poultices,  through  their  tendency  to  lessen  morbid  irritability,  co-op- 
erate with  the  natural  process,  and  thus  promote  suppuration  (§  733, 
735  a,  862). 

GENITO-URINARY  AGENTS. 

905^,  a.  In  c(>nsiderj,tion  of  what  I  have  said  o^ Emmenagogues  (§ 
892|,  q),  and  to  illustrate  yet  farther  the  action  of  remedial  agents, 
before  entering  upon  the  subject  of  bloodletting,  I  have  concluded  to 


684  -  INSTITUTES    OF    MEDICINE. 

set  forth  the  ground  of  distinction  which  induced  me  to  assemble  into 
two  groups  those  agents  which  bear  the  general  denominations,  in  my 
Materia  Medica,  of  Uterine  Agents,  and  Genito-  Urinary  Agents.  By 
introducing,  also,  the  several  members  of  each  group,  along  with  the 
numerical  order  of  arrangement,  it  will  be  farther  seen  how  far  the 
arrangement  has  been  founded  upon  physiological  principles,  and  how 
far  it  is  adapted  to  the  modifications  vvhich  are  presented  by  patholog- 
ical conditions  (§  137  d,  872  b,  892^  b,  c).  There  will  be  thus,  also^ 
farther  exemplified  the  relative  specific  relations  of  many  remedial 
agents  to  certain  tissues,  or  parts  of  a  common  tissue,  and  farther,  also, 
by  the  recurrence  of  the  same  agents  in  different  groups,  their  thera- 
peutical capabilities  in  their  aspect  of  compound  virtues  (§  129,  135, 
136,  137  b,  c,  150,  151). 

Uterine  Agents,  in  the  order  of  their  value  {numerically). — 1. 
Secalecornutum.  2.  Oleum  ergotce.  3.  Cantharis  vesicatoria.  4.  San- 
guisuga.  5.  Guaiacum  officinale.  6.  Juniperus  sabina.  7.  Ferrum, 
et  ferri  sales.  8.  Aloe  socotrina.  9.  Balsamodendron  myrrha.  10. 
Hydrargyri  sub-murias,  etc,     11.  Hydrargyri  iodidum.     12.  lodiniura. 

13.  Potassii  bromidum.  14.  Ferri  bromidum.  15.  Ipomaea  purga. 
16.  Juniperus  Virginiana.  17.  Aristolochia  serpentaria.  18.  Ruta 
graveolens.     19.  Ferula  asafoetida.     20.  Sodae  biboras.    21.  Mentha 

'  pulegium.     22.  Helleborus  niger. 

Genito-Urinary  Agents,  in  the  order  of  their  value  {numerically). — 
I.  Copaifera  multijuga.  2.  Piper  cubeba.  3.  Cantharis  vesicatoria. 
4.  Strychnos  nux  vomica.  5.  Barosma  crenata.  6.  Abies  balsamea. 
7.  Oleum  terebinthinae  (pinus  et  abies).  8.  Pistacia  terebinthus.  9. 
Arctostaphylos  uva-ursi.  10.  Cissampelos  pareira.  11.  Laurus  cam- 
phora.     12.  Tinctura  ferri  sesquichloridi.     13.  Chenopodium  olidum. 

14.  Chimaphilla  umbellata.  15.  Cinchona  officinalis.  16.  Amyris 
Gileadensis.     17.  Pistacia  lentiscus.     18.  Physalis  alkakengi. 

905^,  b.  The  foregoing  assemblages  suggest,  by  the  remedial  vir- 
tues of  the  several  members  of  each  class,  respectively,  a  great  varie- 
ty of  pathological  conditions  relative  to  the  uterus  in  one  case,  and, 
in  the  same  manner,  the  genito-urinary  organs  in  the  other.  We  have 
already  seen  how  ergot  is  mainly  useful  in  parturition  ;  and  its  ob- 
vious effects  through  reflex  nervous  action  supply  a  clear  analogy 
for  expounding  the  effects  of  the  other  agents  (§  893^).  The  other 
members  of  the  Class  of  Uterine  Agents  are  such  as  are  denominated 
emmenagogues,  with  the  exception  of  the  fourth.  But,  leeches  should 
evidently  follow  cantharides,  in  the  oi'der  of  importance,  as  capable  of 
yielding  relief,  not  only  in  the  next  greater  number  of  cases,  but  in 
very  difficult  pathological  conditions  of  the  uterus;  while  the  high  place 
which  they  occupy  is  significant  of  irritable  and  inflammatory,  or  con- 
gestive affections  of  the  uterus  which  may  often  call  upon  their  aid, 
and  admonishes  the  practitioner  to  beware  of  most  of  the  other  ageftts 
which  follow.  It  is  not,  however,  to  such  cases  alone  that  leeches  to  the 
perinaeum  are  appropriate,  but  to  many  cases  where  menstruation  has 
been  long  arrested  by  slight  derangements  of  the  uterus,  as  sympa- 
thetic consequences  of  gastric  or  other  abdominal  derangement,  but 
where  the  influence  of  vital  habit  is  such  that  neither  cantharides  nor 
the  stimulating  emmenagogues,  if  admissible,  will  affect  the  condition 
of  the  organ ;  though  its  susceptibility  to  these  agents  may  be  estab- 
lished by  leeching  (§  137  d,  892f  q,  893  q).     Should  leeching,  there- 


THERAPEUTICS. REMEDIAL  ACTION.  685 

tore,  fail,  it  is  appropriate  that  an  emmenagogue  which  may  now  suc- 
ceed, and  often  by  itself,  should  stand  next  in  the  order  of  airange- 
ment ;  and  of  these,  guaiacum  is  the  best. 

It  need  scarcely  be  said,  that  in  the  reference  which  I  have  made 
to  emmenagogues  in  section  892|,  §',  I  embrace  alone  those  which 
have  been  hitherto  grouped  together  with  a  special  reference  to  the 
symptom,  and  upon  which  the  denomination  has  been  founded  (Ev  in, 
iiriv,  month,  and  ayoj,  to  lead). 

We  soon  come  upon  the  ferruginous  preparations,  and  these,  again, 
are  significant  that  the  uterine  embarrassment  often  grows  out  of  indi- 
gestion, or,  less  frequently,  that  some  primary  affection  of  the  uterus 
has  been  the  sympathetic  cause  of  a  gastric  derangement  that  reacts 
upon  the  uterus  and  maintains  its  pathological  condition  (§  902  h, 
905  a).  But,  it  does  not  often  happen  in  primary  uterine  affections 
that  an  appropriate  treatment  will  not  readily  succeed ;  especially 
leeches  if  inflammatory,  or,  otherwise,  cantharides,  and  the  subordi- 
nate means.  Such,  however,  is  the  disposition  of  the  system,  espe- 
cially of  the  digestive  organs,  to  sympathize  with  inflammatory,  or  ir- 
ritable states  of  the  uterus,  that  these  cases  soon  become  complicated, 
and  we  may  then  turn  to  the  example  of  the  seton  for  the  principles 
of  treatment,  nor  waste  our  efforts  at  unavailing  attempts  with  em- 
menagogues addressed  to  the  symptom,  hut  let  them  he  such  as  shall 
meet  the  uterine  complications. 

Where  ferruginous  agents  are  proper,  so,  also,  in  a  general  sense, 
is  guaiacum,  or  some  analogous  means.  But,  the  attendant  gastric 
derangement  is  apt  to  be  accompanied  by  constipation,  which  is  more 
or  less  dependent  on  an  associated  functional  derangement  of  the  liv- 
er (§  129).  Aloes,  therefore,  properly  follows  next  in  the  order ;  and, 
although  it  may  affect  rather  specifically  the  mucous  tissue  of  the  ute- 
rus, urinary  organs,  and  lungs,  in  its  irritable  states  by  reflex  nervous 
influences,  it  acts  as  an  emmenagogue  mostly  by  contributing  relief  to 
hepatic  disorder,  augmenting  the  natural  stimulus  of  the  intestine,  and, 
in  other  ways,  removing  constipation,  and  thus,  also,  the  symptom  (§ 
889  i,  889  /,  902  b,  1063  b). 

The  simple  mercurial  preparations,  which  follow  as  the  tenth  in  or- 
der, equally  admonish  us,  also,  to  keep  our  attention  upon  the  patho- 
logical condition,  and  away  from  the  symptom,  excepting  as  it  is  very 
vaguely  significant  of  some  morbid  state  of  the  uterus  which  can  be 
known  only  through  other  phenomena.  The  rank  of  this  agent  implies, 
also,  its  degree  of  utility,  the  ratio  of  its  frequency  in  contributing  aid, 
its  adaptation  to  a  variety  of  pathological  conditions  that  maybe  com- 
plicated with  the  uterine  derangement,  and  the  probability  that  it  may 
be  advantageously  associated  with  leeching,  and  only  as  a  subordinate 
agent.  It  comes  into  use,  especially,  in  inflammatory  states  of  the 
uterus,  or  when  hepatic  derangement  takes  the  lead,  and  is  inobedi- 
ent  to  milder  ti-eatment. 

The  next  are  the  iodides  of  mercury,  and  the  bromides  of  mercury 
are  about  the  same ;  and,  who  does  not  see  that  their  special  refer- 
ence is  not  to  the  uterus,  but  to  some  other  visceral  derangement ; 
perhaps  of  a  syphilitic,  or  scrofulous  nature,  or  under  those  diatheses  1 
But  which,  and  how  much,  what  the  pathological  shades,  what  the  ex- 
act condition  of  the  uterus,  how  far  it  receives  and  reflects  sympathet- 
ic influences,  are   matters  for  critical  inquiry  (§  894  h,  901,  902  b) 


686  INSTITUTES   OF    MEDICINE. 

The  union  of  mercury  with  iodine  also  suggests  a  general  antiphlo- 
gistic treatment,  and  that,  like  the  more  simple  mercurials,  it  may  be 
often  associated  with  leeching. 

Iodine  or  the  bromide  of  potassium  is  wanted  next,  on  account  of 
the  scrofulous  diathesis,  or  other  special  conditions  to  which  those  reme- 
dies are  adapted.  It  denotes  that  the  uterine  function  is  often  sus- 
pended by  chronic  visceral  disease  which  has  gone  on  to  disorganiza- 
tion, especially  of  the  liver  or  spleen ;  though,  in  other  cases,  it  sup- 
poses the  same  condition  of  the  uterus  as  a  primary  affection  (§  S92J). 
It  may  be  only  the  indigestion  so  often  incident  to  the  scrofulous  con- 
stitution which  arrests  menstruation,  and  often  without  much  derange- 
ment of  the  uterine  system ;  and  here  iodine  contributes  an  important 
aid.  The  uterus  surrenders  as  soon  as  the  morbific  reflex  nervous 
actions  are  withdrawn.  The  bromide  of  iron  maybe  often  now  call- 
ed in  advantageously  (§  150,  151,  894  h,  901,  902  I). 

Jalap  is  wanted  to  carry  out  a  decisive  antiphlogistic  treatment, 
which  is  occasionally  demanded ;  sometimes  for  primary  inflammation 
of  the  uterus,  or  again  for  some  general  plethoric  habit,  or  some  ob- 
stinate chronic  gastritis,  and  where  the  functional  derangement  of  the 
uterus  is  of  very  little  importance.  In  many  of  these  cases,  general 
bloodletting  should  take  the  lead  in  the  treatment ;  and  the  menses 
may  start  under  the  beginning  impression  of  the  remedy  (§  872  h, 
892J  h,  c,  1060). 

But,  there  are  no  cases  which  so  constantly  baffle  the  practitioner 
as  those  which  are  presented  by  the  nervous  temperament ;  and  these 
are  common  (§  601).  A  reference  to  the  characteristics  of  that  tem- 
perament will  show  us,  at  once,  how  it  has  happened  that  asafoetida 
is  the  only  agent  that  has  been  introduced  with  a  specific  reference 
to  ilie  symptom,  in  this  class  of  remedies.  The  whole  body  is  so  alive 
to  reflex  nervous  actions,  as  disease  may  touch  upon  one  part  or  an- 
other, and  more  profoundly  as  it  may  plant  itself  in  gi"eater  force,  that 
nothing  can  be  now  accomplished  but  through  the  precepts  of  the  most 
enlightened  medical  philosophy.  It  is  here,  too,  that  \ve  see  most 
distinctly  pronounced  the  complete  possession  which  gastric  derange- 
ments may  take  of  the  uterus,  and  overthrow  its  function,  or  where  it 
may  be  interrupted  by  a  sudden  i-eduction  of  the  temperature  of  the 
feet,  or  by  a  midnight  frolic,  or  by  drawing  the  habitual  corset  a  little 
tighter.  Now,  too,  any  disturbance  of  the  uterus,  whether  primary  or 
secondary,  reacts  on  most  other  parts,  while  they,  in  their  turn,  resent, 
as  it  were,  the  injury  (§  514,  h,  &c.).  The  treatment  of  these  cases, 
therefore,  may  be  as  complex  as  the  morbid  sympathies.  But,  in  a 
general  sense,  the  best  and  often  the  only  requisite  emmenagogue 
will  consist  of  a  carefully-regulated  diet,  early  sleep,  free  exposure  to 
the  open  air,  accompanied  with  a  suitable  kind  of  exercise,  sometimes 
shower  bathing,  or,  at  other  times  warm  bathing,  removal  of  corpo- 
real restraints,  cheerfulness  of  mind,  and  a  little  rhubarb  and  mag- 
nesia to  improve  digestion,  keep  down  acidity,  and  to  help  any  slug- 
gish state  of  the  bowels.  We  must  repair  the  constitution  of  theso 
patients  ;  and  there  will  then  be  no  difficulty  with  the  symptom.  It 
has  been  a  neglect  of  the  means,  the  neglect  of  pathology,  and  the 
name  of  emmenagogue,  which  have  led  to  most  of  the  failures  of  art, 
and  have  contributed  to  swell  the  nomenclature  of  "  nervous  diseases" 
r§  659,  855,  856,  878,  902  m).     Nor  has  the  fashion  of  "  Specialities:' 


THERAPEUTICS. REMEDIAL   ACTION.  687 

which  forms  one  of  the  perversions  of  morbid  anatomy,  as  handed 
over  from  France,  and  one  of  the  roads  to  distinction  and  practice, 
been  wanting  in  a  Uberal  contribution  to  the  very  en"ors  which  it  pro- 
fesses to  reform.  The  principal  observers  are  generally  able,  always 
industrious ;  and  would  they  but  merge  their  tangible,  isolated  ob- 
jects in  the  comprehensive  philosophy  of  medicine,  they  would  give 
an  impulse  to  science,  and  a  direction  to  practice,  which  would  bring 
honor  to  themselves,  and  bestow  a  service  on  mankind.  We  need  no 
better  demonstration  of  this  than  what  I  have  just  been  saying  of  the 
nervous  temperament  {§  701,  960  c). 

905^,  c.  We  come,  next,  to  the  Genito-Vrinary  Agents,  where  a 
great  variety  of  remedial  virtues  occurs,  but,  unlike  the  case  of  em- 
menagogues,  where  all  have  a  special  reference  to  the  genito-urinary 
system,  with  the  uterus  excepted  as  to  its  relations  to  cantharides 
and  chenopodium.  It  is  a  group,  therefore,  which  illustrates,  through- 
out, what  is  denominated  specific  action,  and  exemplifies  extensively 
the  special  modifications  of  irritability  in  different  parts  of  the  body 
(§  133,  &c.,  150,  191). 

When,  therefore,  these  agents  are  ehiployed  with  reference  to  the 
genito-urinary  system  their  local  action  is  alone  contemplated.  The 
favorable  changes  which  they  induce  are  of  a  direct  nature  as  it  re 
spects  that  system  of  organs ;  and  they  do  not,  therefore,  contribute 
relief  by  effecting  the  removal  of  diseases  situated  remotely  from 
those  parts  (§  905^,  h). 

Hence,  it  is  readily  seen  how  liable  to  misapplication  such  a  group 
of  agents  must  necessarily  be  without  a  sound  knowledge  of  physiol- 
ogy, and  an  enlightened  view  not  only  of  the  general  conditions  of 
disease,  but  of  the  pathological  varieties  and  shades  of  difference 
which  are  constantly  presented  by  any  given  common  form  of  dis- 
ease;  especially  of  inflammation  (§  639  a,  b,  650,  662,  669,  671-674, 
718,  722,  819  a,  motto,  no.  7).  To  such  an  observer  the  assemblages 
in  the  various  groups  are  peculiarly  valuable,  and  for  such,  indeed, 
are  they  alone  designed.  To  him,  each  group,  each  remedy,  every 
virtue  in  a  compound  remedy,  and  whether  so  by  Nature  or  by  art, 
has  its  individuality,  which  is  recognized  as  the  eye  glances  from  one 
agent  to  another,  while  it  carries  along  an  associated  recognition  of  a 
vast  variety  of  pathological  states,  and  a  just  appreciation  of  the  rel- 
ative therapeutical  value  of  the  various  means  which  may  be  the  sub- 
jects of  his  transient  inquiry.  But,  the  group  now  under  considera- 
tion being  exclusive,  and,  withal,  not  as  liable  to  morbific  effects  as 
are  most  other  classes,  the  uninformed  has  less  chance  at  mischief 
than  when  he  approaches  the  cathartics,  &c. ;  where  physiological 
and  pathological  knowledge  is  far  more  important. 

It  is  readily  seen,  therefore,  that  one,  or  more,  of  the  foregoing 
agents  may  be  exactly  adapted  to  a  given  modification  of  disease,  in- 
flammation, for  example,  affecting  either  the  mucous  tissue  of  the  va- 
gina, or  of  the  bladder,  or  of  the  urethra,  while  it  would  be  very  un- 
suited  to  another  modification ;  and,  from  what  we  have  seen  of  the 
natural  modifications  of  the  vital  constitution  in  the  same  tissue  as  it 
may  occur  in  different  compound  organs,  and  in  different  parts  of  a 
continuous  tissue  as  it  traverses  different  organs  (§  134-137),  it  is  ev- 
ident that  great  circumspection  is  often  necessary  in  the  application  of 
these  agents ;  and  farther,  also,  that  what  may  be  immediately  useful 


688  INSTITUTES    OT     MEDICINE. 

in  some  special  state  of  inflammation  as  affecting  one  of  the  several 
parts  of  the  genito-urinary  mucous  tissue  may  be  detrimental  in  an 
apparently  coincident  form  of  the  same  disease  in  either  of  the  other 
parts;  and  vice  versa  (§  137  c,  150, 151,  870  aa).  Here  we  have,  for 
example,  amenorrhcea,  as  considered  in  the  foregoing  section,  de- 
pending on  active  inflammation  of  the  uterus  where  general  blood- 
letting may  be  demanded,  and  may  be  sufficient ;  but,  in  event  of  its 
failure  to  establish  menstruation,  cantharides,  which  would  have  been 
otherwise  pernicious,  may  now  complete  the  requisite  instrumentality 
of  art  (§  137  d,  e,  143  c,  859  h,  863  d,  867,  871,  905  J  b.) 

Take,  next,  the  same  agent  as  the  best  internal  remedy  for  leucor- 
rhcBa.  Here,  again,  the  inflammatory  states,  which  constitute  that  af- 
fection, vary  constantly,  not  only  as  to  force  and  habit  (§  535,  &c.),  but 
more  greatly  in  the  absolute  modifications  of  inflammatory  action. 
For  all  this  knowledge  we  must  go  to  our  general  principles,  then  to 
all  the  minutiae  of  symptoms  (§  685,  686).  Among  the  last  none  are 
so  important  as  the  exact  character  of  the  discharge,  which  varies,  by 
gradations,  from  purulent  to  mucous,  and  from  this  last  to  a  bloody,  or 
a  brown  watery,  or  a  more  simple  watery  fluid;  just  as  we  have  seen 
of  analogous  phases  in  the  condition  of  ulcers,  or  of  intestinal  inflam- 
mation (§  693,  740).  Now,  it  is  clearly  wrong  to  treat  any  one  of 
these  several  conditions  exactly  in  the  same  manner ;  and  where  the 
differences  are  broadest,  so  also  must  be  the  variations  of-treatment. 
In  indolent  states  of  the  disease,  and  where  the  discharge  is  mostly 
purulent,  if  the  general  health  be  tolerably  sound,  we  may  proceed, 
at  once,  to  the  exhibition  of  cantharides ;  and,  as  soon  as  slight  stran- 
gury takes  place  the  disease  will  generally  surrender.  But,  should 
it,  in  the  cases  supposed,  refuse  to  submit,  or  should  the  individual 
be  insusceptible  of  the  special  action  of  cantharides,  as  will  common- 
ly be  denoted  by  the  failure  of  its  effect  upon  the  bladder,  we  may 
safely,  and  commonly  with  certainty  of  success,  resort  to  vaginal  in- 
jections of  the  best  nitrate  of  silver,  in  proportions  varying  from  three 
to  eight  grains  in  an  ounce  of  water.  But,  if  the  discharge  consist  of 
mucus,  or  any  other  than  the  puriform  matter,  cantharides  will  ag- 
gravate the  affection,  and  the  nitrate  of  silver,  at  most,  will  do  no 
good.  If  it  be  mucus,  it  denotes  an  intensity  of  inflammation  which 
calls,  at  least,  for  a  simple  vegetable  diet,  and  probably  for  leeches 
to  the  perinaeum,  along  with  the  general  antiphlogistic  treatment. 
In  these  cases,  therefore,  we  have  nothing  to  do  with  the  genito- 
urinary agents.  Equally  inapplicable,  also,  aVe  they  to  those  patho- 
logical states  from  which  result  the  watery  discharges ;  and  here  we 
are  completely  thrown  upon  the  special  circumstances  of  every  indi- 
vidual case,  and  upon  the  general  principles  of  the  science. 

This  last  remark  leads  me  to  another  more  important  than  the  rest ; 
namely  that  all  the  pathological  varieties  which  go  to  constitute  the 
symptom  may  be  variously  complicated  with  morbid  affections  of  oth- 
er important  organs,  especially  those  of  the  abdomen,  through  alter- 
ative influences  of  reflex  action  of  the  nervous  system.  This,  indeed, 
is  always  the  case  in  the  wateiy  discharges,  almost  always  in  the  mu- 
cous, and  very  often  in  the  puriform.  In  all  the  cases,  too,  the  vaginal 
or  uterine  affection  may  be  entirely  a  sympathetic  result  of  primary 
disease  in  the  digestive  organs ;  and  such  is  usually  the  case  where 
the  discharge  is  of  a  watery  nature.     We  may  be  sure,  however,  that 


THERAPEUTICS  REMEDIAL    ACTION.  689 

the  sympathetic  affection  will  react  upon  the  system  at  large,  espe- 
cially in  the  more  intense  form  which  is  denoted  by  the  mucous  pro- 
duct; and  this,  whether  the  genital  affection  be  primary  or  secondary. 

Here,  then,  we  must  apply  ourselves  to  the  general  health,  attack 
what  may  be  the  citadel  of  disease ;  but,  to  do  this  efficiently,  and 
that  our  prescriptions  may  carry  with  them  the  combined  virtues  of 
tuto,  cito,  et  jucunde,  the  practitioner  may  not  undervalue  the  Insti- 
tutes of  Medicine. 

Whenever  the  uterus  is  the  seat  of  disease  in  its  mucous  tissue,  like 
all  other  organs  which  may  be  especially  affected  in  one  of  its  parts, 
the  other  component  parts  suffer,  more  or  less,  sympathetically  {§  138, 
141  b,  514/,  528). 

A  common  form  of  discharge  takes  place  from  the  uterus  which  is 
more  or  less  of  the  nature  of  lymph.  Here  there  is  pretty  high  in- 
flammation, as  well  as  obstinate.  It  calls,  of  course,  for  general  blood- 
letting, leeching,  &c.   I  say  nothing  of  cases  requiring  local  remedies. 

Copaiva  is  the  first  among  the  agents  in  the  group  before  us.  This 
denotes  the  frequency  with  which  it  is  called  into  use  in  the  treat- 
ment of  gonorrhoea,  and  its  relative  value  for  this  specific  purpose. 
Cubebs  follows  next ;  and  as  two  agents  of  similar  virtues  in  rela- 
tion to  a  specific  object,  and  of  nearly  equal  pretensions,  and  both  of 
them  stimulant,  lead  off  in  a  general  class  of  remedies,  they  are,  by 
the  position  they  occupy,  standing  mementoes  of  the  frailty  and  vul- 
nerability of  man,  and  incentives  to  study  well  the  varying  conditions 
of  gonoiThoea.  Here  we  have  rai'ely  more  than  a  local  complaint  for 
our  professional  skill ;  and  yet,  how  much  suffering  is  inflicted,  how 
many  made  wretched  in  their  domestic  relations,  by  the  indiscreet 
use  of  these  two  valuable  agents,  and  by  astringent  injections  !  The 
haste  of  the  patient  may  be  always  moderated,  or  conquered,  by  firm- 
ness in  the  appropiiate  means,  and  the  practitioner  rewarded  in  con- 
science, and  thanks,  where  he  may  elect,  for  the  preliminary  treat- 
ment, that  antiphlogistic  plan  which  will  speedily  prepare  the  way 
for  the  remedies  of  more  local  action,  if  it  do  not  in  itself  succeed. 
Here,  too,  we  may  notice  in  the  contingent  circumstance,  as  in  all 
other  groups,  that  when  gonon-hoea  yields  to  general  or  local  blood- 
letting, or  to  cathartics,  or  to  water  gruel  and  perfect  rest  alone,  an- 
other of  the  multifarious  demonstrations  of  the  common  mode  of  Re- 
medial Action. 

905|.  In  concluding  the  subject  of  Remedial  Action  as  hitherto 
expounded,  and  before  entering  upon  that  of  loss  of  blood,  I  shall  take 
the  liberty  of  protesting  against  the  unreserved  imputation  of  ignorance 
as  to  the  modus  medendi  of  remedies,  and  of  which  I  have  quoted  some 
examples  (§  904  e,  «fec.).  It  is  true  that  they  who  allege  this  ignorance 
cultivate  the  humoral  and  chemical  doctrines,  ignore  all  distinction  in 
the  powers  by  which  the  two  kingdoms  are  governed,  and  satirize  the 
laws  of  the  nervous  system  if  supposed  to  involve  any  thing  moi*e  than 
chemical  action.  These  positions  certainly  imply,  as  far  as  they  reach, 
all  the  acknowledged  ignorance,  and  the  objection,  therefore,  which  I 
now  raise  is  against  the  imputation  of  this  ignoi'ance  to  those  who  have 
taken  the  trouble  of  informing  themselves  about  the  things  which  they 
profess  to  understand.  They  object  to  a  degradation  to  such  a  level. 
Where  the  ignorance  exists  its  confession  is  laudable  and  useful. 

Xx 


690  INSTITUTES   OF   MEDICINE. 


THE  INFLUENCES  AND  MODUS  OPERANDI  OF 
LOSS  OF  BLOOD, 

Considered  with  a  Reference  to  the  practical  Application  of  the  Reme- 
dy and  the  various  Circumstances  of  Disease. 

906,  a.  "  The  serous  portion  of  the  blood,  or  even  pure  blood,  may  escape  from  the  over- 
distended  vessels,  just  as  water  transudes  through  the  permeable  sides  of  a  vessel,  in  which 
it  suffers  compression.  To  this  source  are  to  be  referred  several  hemorrhages  and  dropsies 
produced  by  simple  transudation  in  a  tissue  mechanically  congested ;  and  although  these  af- 
fections have  really  nothing  active  in  their  nature,  yet  are  they  considerably  diminished, 
and  sometimes  altogether  removed,  by  bloodletting,  which,  in  such  cases,  acts  in  a  man- 
ner purely  inechanical,  by  removing  from  the  vessels  the  fluid  by  which  their  parietes 
were  kept  in  a  state  of  over-distention." — Andral's  Pathological  Anatomy. 

h.  "  If  bloodletting  be  considered  in  a  mechanical  light,  as  simply  lessening  the  quantity 
of  blood,  I  cannot  account  for  its  effects ;  because  the  removal  of  any  natural  mechanical 
power  can  never  remove  a  cause  which  neither  took  its  rise  from,  nor  is  supported  by  it." 
— Hunter  on  the  Blood  and  Inflammation. 

c.  "  It  is  a  great  modern  improvement  in  th-e  practice  of  the  healing  art,  in  bleeding  for 
the  cure  of  inflammation,  to  take  the  blood  away  as  quickly  as  possible;  since  intense  in- 
flammations of  the  brain,  lungs,  bowels,  &c.,  are  equally  removed  by  fainfness,  whether  it 
happens  after  the  loss  of  ten  ounces  of  blood,  or  of  fifty ;  or  even,  as  sometimes  occurs, 
when  it  happens  without  bleeding  at  all,  after  merely  tying  the  arm  m  preparation."- 
Arnott's  Elements  of  Physics. 

d.  "  If  we  have  to  deal  with  an  extensive  and  violent  inflammation,  we  do  not  abstract 
blood  by  a  minute  opening ;  we  make  a  large  orifice,  or  we  open  a  vein  in  both  arms  at 
the  same  time  ;  we  place  the  patient  in  an  erect  posture,  and  endeavor  to  produce  deli- 
quum.  It  sometimes  happens  that  the  patient  faints  from  fear,  or  before  any  considera- 
ble quantity  has  been  lost;  and  this faintness,  as  Dr.  Arnott  remarks,  answers  as  well  as 
that  which  results  from  venesection"  (§  960,  a). — Graves,  in  London  Med.  and  Surg. 
Journal,  vol.  iii.,  p.  391. 

e.  Ad  extremos  'morbos  extrema  remedia  exquisite  optima." — Hippocrates  (^  960  h). 

906, yi  Whether  the  father  of  medicine,  or  his  latest  descendants, 
be  right  or  wrong  in  their  medical  precepts,  especially  in  relation  to 
the  therapeutical  uses  of  bloodletting,  it  will  be  an  object  of  the  pres- 
ent inquiry  to  ascertain  (§  376|,  a).  The  contrast  of  views,  especial- 
ly when  we  consider  the  details  inculcated  by  Hippocrates  in  respect 
to  loss  of  blood,  as  well  as  other  remedies,  suiting  them  all  to  the  ex- 
igencies of  disease,  or  leaving  the  whole  work  to  Nature,  and,  with 
all  his  enlightened  precaution,  regarding  the  loss  of  blood  as  the  re- 
medium  principale,  renders  it,  I  say,  an  object  of  deep  interest  to  de- 
termine the  nature  of  the  right,  and,  in  so  doing,  to  ascertain  also  how 
far  philosophy  and  practical  habits  have  outstripped  the  Ancestor. 

We  may  also,  perhaps,  come  to  some  determination  whether  a 
knowledge  of  the  principles  upon  which  bloodletting  operates  be 
worthless,  or  necessary  to  its  just  and  intelligible  use  (§  893,  n). 
Whether  we  should  know  what  absolute  influences  it  exerts,  or  how 
it  exerts  them,  before  we  can  appreciate  its  applicability,  and  its  ap- 
propriate extent,  in  many  important  morbid  states  where  the  remedy 
may  be  more  demanded  than  in  other  conditions  whose  phenomena 
clearly  indicate  its  necessity  (§  857). 

Perhaps,  also,  it  may  be  useful  to  science,  as  well  as  humanity,  to 
strip  this  remedy  of  its  mechanical  interpretations,  and  to  place  it  upon 
the  dignified,  practical  ground  of  the  physiological  institutions  of  organ- 
ic Nature,  which,  if  unacceptable  to  the  materialist,  will,  at  least, 
engage  his  attention  as  a  philosopher. 

906,  g.  Before  entering  upon  the  investigation  of  this  subject  i 
take  leave  to  say,  that  the  modus  operandi  of  loss  of  blood,  as  set  forth 


THERAPEUTICS. LOSS  OP  BLOOD.  691 

in  this  work,  is  exclusively  original  with  myself.  If  there  be  any  mer- 
it in  the  philosophy,  its  abuse  and  misrepresentation  by  the  British 
and  Foreig?i  Medical  Review,  and  the  Medico- Chirurgical  Review,  of 
London,  entitle  me  fully  to  all  the  proprietorship.  Whatever  is  said 
of  the  vital  influences  of  the  loss,  and  of  the  whole  theory  of  the  asso- 
ciate influence  of  the  nervous  power,  appeared  for  the  first  time  in 
the  Medical  and  Physiological  Commentaries  (§  222,  b).  Copyists, 
it  is  true,  have  appeared,  especially  of  the  accumulated  facts,  without 
the  slightest  reference  to  him  who  performed  the  labor  (§  435,  b). 

Although,  therefore,  the  same  philosophy,  and  the  same  practical 
applications  of  loss  of  blood,  are  preserved  in  the  Institutes  as  set  forth 
in  the  Commentaries,  they  are  now  rewritten  and  presented  in  anoth- 
er shape,  with  greater  brevity,  and  with  reference  to  that  systematic 
order  which  shall  best  subserve  the  young  Inquirer.  The  same  is 
also  true  of  other  subjects  which  may  have  been  investigated  in  the 
Commentaries. — See  Rights  of  Authors,  p.  912.* — Note  Wp- 1127. 

907.  Notwithstanding  the  practical  importance  of  a  distinct  appre- 
hension of  the  modus  operandi  of  loss  of  blood,  it  should  never  be  the 
leading  indication  for  its  use  ;  but  only  subservient  to  the  suggestions 
of  the  morbid  phenomena,  of  pathological  principles,  and  of  experi- 
ence. The  just  application  of  the  remedy  should  be  determined  by 
these  combined  considerations  (500  m^  688,  694|,  826  cc^  Note  Ll). 

908.  Again,  by  taking  a  comprehensive  view  of  the  direct  influen- 
ces of  loss  of  blood,  we  shall  not  fail  to  discover  the  close  analogy  of 
its  modus  operandi  with  that  of  all  other  remedies,  and  that  it  reflects 
an  important  light  upon  the  whole  ground  of  remedial  action  ;  while 
its  loss  involves  in  its  effects  some  principles  peculiar  to  itself. 

909.  The  hypotheses  which  have  hitherto  prevailed  respecting  the 
operation  of  loss  of  blood  have  been,  for  the  most  part,  mechanical ; 
but  I  have  demonstrated  in  my  Essay  on  the  Philosophy  of  its  Opera- 
tion, that  the  effects  of  blood-letting  are  wholly  incapable  of  such  ex- 
planation. Nevertheless,  even  dry  cupping,  and  ligatures  to  the  limbs 
as  extensively  inculcated  by  Erasistratus  and  facetiously  commemorated 
by  Galen,  are  again  restored  as  substitutes  for  loss  of  blood  (§  1004  c). 

910.  The  numerous  advocates  of  the  mechanical  doctrine  of  inflam- 
mation and  venous  congestion  predicate  their  views  of  the  operation 
of  bloodletting  in  conformity  with  the  supposed  existence  of  passive 
relaxation  of  the  affected  vessels,  and  stagnation  of  blood  within  them, 
and  extend  the  hypothesis  to  the  hot  stage  of  idiopathic  fever.  The 
philosophy,  therefore,  is  vitiated  by  the  pathological  views  upon  which 
it  is  founded.  Moreover,  were  the  doctnne  of  debility  (§  569),  pass- 
ive relaxation  of  the  vessels,  and  stagnation  of  blood,  correct,  it  is  ev- 
ident that  not  only  such  relaxation,  but  that  the  stagnated  and  coagu- 
lated blood,  would  not  be  suddenly  removed  by  diminishing,  to  any 
extent,  the  general  circulating  mass,  as  is  constantly  witnessed  in  in- 
flamed parts ;  while,  also,  were  such  a  physical  impossibility  within 
the  power  of  the  remedy,  those  vessels  would  immediately  become 
again  congested,  and  the  more  so  from  the  prostrating  nature  of  the 
remciy  (§  935,  977).— Note  Dd  p.  1132. 

911.  General  bloodletting,  cupping,  and  leeching,  manifest  some 
important  differences  in  their  effects,  but  operate  upon  modifications 
of  a  common  principle.  A  knowledge  of  these  modifications  is  ne- 
cessary to  a  right  administration  of  the  remedy   as  it  respects  one  ci 

*  The  Works  of  Authors  quoted  in  this  Essay  may  be  found  in  the  "  Commentaries. 


G92  INSTITUTES    OF    MEDICINE. 

the   other  modes  of  abstracting  blood.     Neither  method   has  been 
founded  upon  any  rational  principle. 

912.  How,  then,  does  bloodletting  operate?  How  are  diseased 
parts  immediately  and  permanently  unloaded  of  their  blood,  in  some 
instances  by  the  abstraction  of  two  or  four  ounces  of  blood,  when,  in 
other  cases,  under  apparently  the  same  circumstances,  a  great  extent 
only  of  the  remedy  will  effect  the  same  result  1  Why,  in  such  cases, 
may  the  former  quantity  induce  syncope,  when  the  latter  has  no  such 
effect  1  "  Syncope,"  says  Robert  Jackson,  "  occurs  sometimes  in  yel- 
low fever  from  the  loss  of  a  few  ounces  of  blood,  sometimes  scarcely 
from  the  loss  of  six  pounds."  Why  does  this  coincidence  obtain 
with  so  many  other  remedial  agents  ]  Why  do  we  see  the  redness  of 
an  inflamed  eye  give  way  permanently  while  the  blood  is  flowing  from 
the  arm,  and  why  does  the  same  change  take  place  as  rapidly,  and 
even  more  perfectly,  in  any  of  the  great  organs  when  equally  inflamed 
and  loaded  with  blood  1  Why  may  the  action  of  the  heart  be  weak- 
ened by  small  quantities  of  blood  taken  by  leeches,  when  larger  quan- 
tities would  be  required  to  produce  a  similar  effect  by  venesection  (§ 
5 1 6  (Z,  no.  6, 557, 686  b,  756  a,  775, 889  1, 893  a,  c,  900, 904  c,  921 ,  1059)  ? 

Now  it  is  obvious  that  the  foregoing  results  can  be  explained  only 
upon  the  physiological  principles  which  I  am  about  to  set  forth  ;  while 
there  is  not  one  phenomenon  attending  all  the  diversified  effects  of 
loss  of  blood  that  is  not  susceptible  of  a  clear  interpretation  upon  those 
principles — an  interpretation,  too,  which  coiTesponds  with  all  that  I 
have  said  of  the  modus  operandi  of  every  other  remedial  and  morbific 
agent — nay,  even  with  the  natural  stimuli  of  life. 

913.  The  inquiry  now  proposed  will  extend  from  the  beginning  ol 
the  physiological  influences,  through  their  gradations,  to  their  con- 
summation in  syncope.  It  will  be  also  accompanied  by  practical  il- 
lustrations, and  by  exemplifications  of  the  various  conditions  of  dis- 
ease to  which  the  remedy  may  be  appropriate. 

1.    LEECHING. 

914.  It  will  be  most  useful,  in  the  first  instance,  to  observe  the 
phenomena,  and  deduce  the  principles,  which  attend  the  direct  ab- 
straction of  blood  from  those  extreme  capillary  vessels  which  are  the 
instruments  of  all  morbid  processes.  Leeching,  therefore,  is  first  in 
order ;  the  physiological  eff^ects  of  which  may  be  divided  into  seven 
stages.    Observe,  also,  that  the  vessels  are  torn  not  cut  as  in  cupping. 

915.  1st.  The  earlist  effect  of  loss  of  blood  consists  in  a  contraction 
of  the  blood-vessels.  This  is  universally  true  of  all  modes  of  abstract- 
ing blood  (§  944  c). 

In  leeching,  an  impression  is  first  exerted  upon  the  organic  prop- 
erties of  the  extreme  and  capillary  vessels  of  the  part  by  the  direct 
abstraction  of  their  natural  stimulus,  the  pabulum  vitcB,  as  also  by  the 
long-continued  suction  of  the  leeches,  and  by  the  subsequent  effusion 
of  blood.  These  causes  institute  a  change  in  the  vital  state  of  the 
vessels  (§  189,  498,  930,  944  c). 

916.  2d.  A  vital  contraction  follows  immediately,  as  the  conse- 
(juence,  in  the  extreme  and  capillary  vessels  of  the  part  to  which 
leeches  are  applied.  The  removal  of  their  natural  stimulus  is  neces- 
sarily felt  by  the  highly-susceptible  organic  properties  of  the  small 
vessels  (^  188,  189.  191,  410,  411,  746  c,  931,  935  b.  1040^. 


THERAPEUTICS. LOSS  OF  BLOOD.  693 

917.  3d.  Then  follows,  by  continuous  sympathy  and  reflex  nervous 
action,  a  propagation  of  the  foregoing  changes  to  the  entire  system  of 
extreme  and  capillary  vessels  throughout  the  body.  This  arises  from 
the  capillary  series  possessing,  every  where,  an  organization  and  func- 
tion of  a  common  nature,  and  from  their  exquisite  sensitiveness  to  the 
nervous  power  (§  129  d,  e,  141,  222-232,  482,  525,  526  a,  935  h). 

918.  4th.  The  larger  vessels,  sooner  or  later,  participate,  sympa- 
thetically, in  the  contraction.  This  sympathy,  however,  begins  as 
soon,  at  least,  as  the  general  capillary  system  feels  the  foregoing  in- 
fluences (§  944  c). 

919.  5th.  A  partial  reflex  nervous  action  begins  upon  the  heart 
as  soon  as  the  changes  have  somewhat  advanced  in  the  capillary  ves- 
sels to  which  the  leeches  are  applied,  and  a  rapidly-increased  amount 
of  this  cardiac  influence  ensues  as  soon  as  the  whole  capillary  system 
is  involved  in  the  contractions  which  the  leeches  institute  at  the  place 
of  their  application  (§  498^^^^,  524  a).* 

The  effect,  as  expressed  in  section  917,  is  originally  propagated  along 
the  extreme  vessels  by  continuous  sympathy,  but  reflex  action  is 
soon  brought  into  operation,  when  both  denominations  concur  together ; 
but  it  is  chiefly  by  reflex  nervous  action  that  the  heart  is  influenced 
(§  933.    Y ox  continuous  sympathy  see  ^129  c,f,  498,  746  c,  and  Index  II). 

920.  6th.  Such  are  the  simple  elements  of  the  processes  which  take 
place  in  leeching.  But,  during  their  progress  they  become  more  or 
less  compounded.  The  reflex  nervous  influence  which  is  propagated 
from  the  extreme  to  the  larger  vessels  reacts  from  the  latter  upon  the 
former,  and  this  reacting  sympathy  increases  the  contraction  of  the 
small  vessels.  So,  also,  as  soon  as  the  vital  changes  in  the  extreme 
vessels  throw  their  reflex  nervous  influence  over  the  heart  the  changes 
which  take  place  in  this  organ  reflect  back  a  sympathetic  influence 
upon  the  extreme  and  capillary  vessels,  by  which  their  power  over  the 
heart  and  larger  vessels  becomes  multiplied  (§  514  h,  &c.,  526  a,  934). 

This  complex  circle  of  reflex  nervous  actions  continues  to  ad- 
vance till  the  heart  becomes  overpowered  in  its  action,  and  syncope 
takes  place  (§  222-233|,  498-514,  893  a,  c,  894-905,  1039). 

921.  a.  7th.  An  artificial  change  being  instituted  in  the  extreme 
vessels  to  which  leeches  are  applied,  where  the  organic  properties 
are  most  strongly  pronounced,  and  that  change  being  more  or  less 
permanent,  it  continues  to  excite  a  powerful  reflex  nervous  action 
upon  the  whole  capillary  system,  and  thence  upon  the  heart,  long  af- 
ter the  blood  has  ceased  flowing  (§  514  g,  &c.,  516  d,  no.  6,  939). 

921,  b.  It  is  for  this  reason  (no.  7),  and  this  only  that  the  powers 
of  the  general  circulation  may  he  sometimes  more  prostrated,  and  be 
longer  maintained  in  a  state  of  prostration,  by  the  loss  of  four  ounces 
of  blood  by  leeching  than  they  might  have  been  by  the  abstraction 
of  sixteen  ounces  of  blood  from  a  large  vein,  or  by  eight  ounces  taken 
by  the  process  of  cupping  (§  514^,  930,  939/  944  c).* 

921,  c.  For  the  same  reason,  also,  syncope  sometimes  comes  on 
only  many  hours  after  the  discharge  of  blood  has  ceased.  Stimulants, 
too,  may  but  slowly  rouse  the  general  circulation,  because  the  pros- 
trating influence  of  the  artificial  change  in  the  extreme  vessels  can- 
not be  as  soon  overcome  as  when  syncope  is  produced  by  general 
bloodletting,  where  no  such  specific  impressions  are  made  (§  514,g-, 
516  d,  no.  6),  and  therefore  no  persisting  reflex  nervous  influence. 
*  See  sensitiveness  of  the  heart  to  the  nervous  influence  at  ()  500  m,  826  cc,  829. 


694  INSTITUTES    OF    MEDICINE. 

922,  a.  It  is  owing  to  the  peculiar  nature  of  the  change  established 
in  the  vital  condition  of  the  lacerated  vessels,  by  leeching,  that  the 
blood  continues  to  flow  out  for  many  hours.  The  process  thus  insti- 
tuted must  be  somewhat  analogous  to  that  of  secretion,  and  clearly 
allied  to  the  hemorrhagic  action  which  nature  institutes,  though  gen- 
erally more  prostrating  than  the  natural  process. 

922,  h.  There  is,  however,  a  remarkable  difference  between  the 
direct  effects  of  leeching  and  spontaneous  hemorihage,  in  respect  to 
their  force ;  the  former  subduing  inflammation  and  congestions  more 
fully  and  speedily  than  the  latter.  It  is  rare  that  an  equal  quantity 
of  blood  spontaneously  effused  impresses  the  system  with  a  force 
equal  to  that  from  leeching;  while  large  capillary  hemorrhages  are 
daily  occurring  without  very  sensibly -reducing  the  animal  or  organic 
powers,  and  where,  too,  the  quantity  of  blood  effused  is  so  px'odigious- 
ly  great  that  it  cannot  be  safely  imitated  by  art  under  the  same  cir- 
cumstances of  disease.     The  nervous  power  is  differently  developed. 

Although,  therefore,  in  these  cases,  nature  institutes  a  change  stri- 
kingly analogous  to  that  of  leeching,  it  is  not  of  the  safne  specific  na- 
ture. In  spontaneous  hemorrhage,  too,  nature  sets  up,  for  her  own 
safety  as  it  were,  a  special  modification  of  action  in  the  system  at 
large  that  shall  sustain  its  powers  under  the  enormous  losses  of  blood 
which  are  often  necessary,  by  the  natural  process,  to  the  cure  of  inflam- 
matory and  congestive  diseases  (§  136  c,  150-152,  524  «,  <Z,  890  e).* 

923,  a.  Besides  the  foregoing  play  of  vascular  sympathies,  a  strong 
impression  may  be  propagated  by  the  whole  organ  to  which  leeches 
are  applied  to  another  organ  with  which  it  has  strong  natural  sympa- 
thetic relations.  In  low  inflammations  and  venous  congestions  of  the 
liver,  four  ounces  of  blood  taken  from  the  verge  of  the  anus  by  means 
of  leeches  may  break  up  those  obstinate  hepatic  affections,  when  twice 
as  much  from  the  skin  over  the  region  of  that  organ  may  produce  far 
less  effect.  Hei'e  the  specific  impression  is  propagated,  in  part,  along 
the  mucous  tract  of  the  intestines,  in  the  manner  expressed  in  sections 
A%S,f,g;  and  this  continuous  sympathy  gives  rise  to  alterative  reflex 
nervous  action,  the  former  of  which  is  my  continuous  influence  {^  498  a). 

923,  b.  But,  again,  it  is  true  in  a  more  limited  sense,  that  the  influ- 
ence of  leeching  may  be  propagated  along  the  large  blood-vessels  to 
the  parts  in  the  vicinity  where  there  is  a  direct  vascular  communica- 
tion ;  though  even  in  these  cases,  the  impression  is  extended  more 
through  the  sympathies  which  bind  together  the  extreme  vessels,  and 
the  nervous  communication  of  the  parts  (§  526,  a).  Comparatively 
little  seems  to  be  due  to  the  imputed  derivation  of  blood.  Thence, 
upon  our  principles,  appears  the  reason  why,  according  to  Dr.  War- 
drop,  "  in  diseases  of  the  head,  as  well  as  in  diseases  of  the  eye,  more 
particularly  those  affecting  the  internal  parts  of  the  globe,  leeches  ap- 
plied to  the  frontal  vessels  give  much  more  relief  than  is  obtahied  by 
abstracting  an  equal  quantity  of  blood  from  the  temporal  vessels  by 
leeches  applied  to  the  temples."  He  also  states  that  a  like  advantage 
will  be  obtained,  in  cerebral  affections,  by  applying  leeches  to  the  li- 
ning membrane  of  the  nose,  or  behind  the  ears.  He  thinks  the  effect 
greater  than  w^hen  applied  to  other  parts. — Note  Do  p.  1132. 

923,  c.  In  all  the  cases,  however,  the  effects  appear  to  be  mainly 
produced  through  the  agencies  which  I  have  stated.  Whenever  I  have 
applied  leeches  to  the  nasal  septum  abdominal  disease  attended  the 
*  NoTKs  Ff  p.  1135,  Gg  p.  1138,  Ii  p.  1139. 


THERAPEUTICS. LOSS    OF    BLOOD.  695 

head -affections.  The  leeches  have  sometimes  relieved  the  headache, 
when  general  bloodletting,  cathartics,  &c.,  had  failed,  while  the  gas' 
trie  derangement  had  also  persisted.  But,  simultaneously  with  the 
relief  of  the  head  the  secretions  from  the  bowels  improved,  the  tongue 
cleared  up,  and  the  stomach  and  other  abdominal  organs  were  re- 
lieved. It  would  appear,  therefore,  that,  as  in  the  case  of  leeches  to 
the  verge  of  the  anus  under  similar  circumstances,  the  specific  impres- 
sion of  leeching  the  nasal  septum  is  propagated  continuously  and  by 
reflex  nervous  action,  by  the  instrumentality  of  the  mucous  mem- 
brane, to  the  viscera  of  the  abdomen,  and  that  the  head  is  as  well  re- 
lieved by  thus  removing  this  source  of  morbid  sympathies,  as  by  the 
more  direct  impression  (^  524  a,  no.  2). — Note  U  p.  1126. 

923,  d.  Hence  it  follows,  as  shown  also  by  experience,  that  leech- 
ing will  generally  exert  the  greatest  effect  upon  diseased  organs  when 
applied  to  some  part  with  which  the  organ  affected  may  have  strong 
physiological  relations  (§  129,  139, 140).  For  this  reason,  and  for  the 
advantage  of  continuous  sympathy,  leeches  should  be  applied  to  the 
anus  in  muco-intestinal  inflammation ;  but,  to  the  cutaneous  region 
when  inflammation  affects  the  peritoneal  coat  of  the  intestines  or  ab- 
domen. There  are  greater  natural  sympathies  between  the  skin  and 
peritoneum  than  between  the  mucous  membrane  and  the  peritoneal. 
Where  no  remarkable  relations  subsist  among  organs  the  leeches 
should  then  be  applied  near  the  vicinity  of  the  part  affected,  as  when 
the  pleura,  or  parenchyma  of  the  lungs,  or  the  joints,  are  the  seats  of 
inflammation.  In  such  cases  we  obtain  the  advantage  of  local  reflex 
actions  as  in  the  case  of  blisters,  &c.  (§  497,  891-i-^-A:,  893  a,c,f). 

924.  And  now  a  word  more  as  to  the  doctrine  of  Revulsion^  or  that, 
for  example,  which  supposes  that  when  leeches  are  applied  to  the  feet 
for  the  relief  of  cerebral  disease  the  effect  depends  upon  the  diver- 
sion of  blood  from  the  head  toward  the  feet.  And  so  of  cathartics  in 
their  action  upon  the  intestinal  canal,  and  of  blisters  by  diverting  the 
blood  to  the  skin,  &c.  (§  893,  n).  Nothing  can  be  more  unfounded. 
But,  do  not  leeches,  when  applied  to  the  feet,  exert  a  greater  influ- 
ence upon  diseased  conditions  of  the  uterus  than  upon  any  other  part  ] 
They  probably  do ;  and  it  is  a  forcible  illustration  of  remote  sympa- 
thy, and  coincident  with  that  which  is  supplied  by  the  suspension  of 
the  catamenia  from  exposure  of  the  soles  of  the  feet  to  cold,  or  by  the 
production  of  catanh  when  a  current  of  cold  air  from  a  key-hole  im- 
pinges upon  the  neck.  Just  so,  if  the  female  now  plunge  her  feet 
into  warm  water,  or  apply  leeches  upon  or  near  the  soles  of  the  feet, 
the  catamenia  may  be  restored.  So,  too,  in  relation  to  cerebral  affec- 
tions, who  does  not  know  that  a  natural  sympathy  subsists  between 
the  feet  and  the  head  ?  "  In  affections  of  the  head  and  thoracic  vis- 
cera," says  Dr.  Wardrop,  "  I  have,  in  many  instances,  recommended 
patients  to  apply  leeches  on  the  head,  chest,  and  on  the  feet,  alternate- 
ly ;  and  almost  universally ,  I  may  venture  to  say,  a  decided  prefer- 
ence has  been  given  to  theyle/."*  The  philosophy  is  the  same  in  all 
the  cases,  and  revulsion  is  reflex  nervous  action.  Dr.  Wardrop,  how- 
ever, had  already  preferred  the  application  of  leeches  to  the  nasal 
septum,  or  to  the  temples,  in  affections  of  the  head;  though  his  obser- 
vations as  to  the  feet  are  also  founded  on  sound  experience.  As  to 
leeching  in  amenorrhoea,  the  remedy  has  the  greatest  effect  when  ap- 
plied to  the  perinaeum,  or  to  the  upper  part  of  the  thighs. — Note  Dd 

*  It  is  well  illustrated  by  Brown-Sequard's  exper.  of  i}ro(iucing  epileptiform  convulsions  as  in  ^  1 U37  a 


696  INSTITUTES    OF    MEDICINE. 

925,  a.  What  has  been  now  said  of  disease  supposes  that  leeches 
are  appUed  under  circumstances  favorable  to  their  effect.  Before  this 
condition  can  happen,  however,  in  numerous  cases  where  leeching 
may  be  ultimately  useful,  it  may  be  necessary  to  make  a  strong  impres- 
sion by  general  bloodletting ;  and  if  two  or  more  general  bloodlettings 
be  likely  to  be  wanted,  the  leeching  should  be  delayed  (§  893  g-i,  p, 
927),  or  until  the  exciting  nervous  action  is  subdued. 

925,  b.  Nevertheless,  if  the  chance  of  leeching  alone  be  taken  in 
these  cases,  the  number  of  leeches  should  be  very  large  for  adults, 
that  the  benefits  of  general  bloodletting  may  be  more  or  less  obtained, 
through  a  rapid  and  copious  abstraction  of  blood.  This  practice  will 
often  succeed  in  infancy  when  it  will  fail  at  more  advanced  age  ;  since 
the  loss  of  blood  is  more  sensibly  felt  in  the  former  case,  and  less  is 
required,  and  the  requisite  amount  is  therefore,  also,  more  rapidly  ab- 
stracted, notwithstanding,  too,  the  ratio  of  the  loss,  in  proportion  to 
age  and  size,  may  be  actually  greater  than  in  adults.  Thus,  too,  the 
advantatjes  of  g-eneral  bloodlettintj  are  more  or  less  obtained.  In  sim- 
ilar  cases  cupping  is  also  more  beneficial  to  children  than  to  adults 
(§  576,  e). 

925,  c.  Leeching,  or  cupping,  however,  should  never  supersede  gen- 
eral bloodletting  in  the  cerebral  inflammations  and  congestions  of  in- 
fants. In  the  phlegmatic  temperament  of  adults  leeching  may  an- 
swer where  it  would  be  inefficient  in  other  temperaments  (§  600). 
But  I  speak  of  these  cases  rather  to  illustrate  a  principle  than  to  raise 
any  doubt  as  to  the  propriety  of  general  bloodletting  in  the  grave  vis- 
ceral inflammations  of  any  age  after  infancy  (§  1009). — Note  Ggg. 

926.  Experience  teaches  that  frequent  and  small  abstractions  of 
blood  by  means  of  leeches  is  often  more  beneficial  in  chronic  inflam- 
mations than  a  greater  quantity  at  more  distant  intervals.  This  cor- 
responds with  what  I  have  said  of  the  vital  influences  of  leeching,  and 
of  the  effect  of  habit  in  maintaining  disease  (§  549,  560).  In  these 
cases,  the  impression,  being  frequently  repeated,  maintains  the  salu- 
tary change  which  may  be  produced  more  perfectly  against  the  mor- 
bid influence  of  habit  than  greater  losses  of  blood  at  distant  intervals 
(§  514  g,  535,  540,  542,  548,  549,  557).  We  see  the  same  principle 
more  frequently  exemplified  in  the  effect  of  blisters  upon  chronic  in- 
flammation ;  where  it  is  better  to  apply  them  frequently,  and  to  a 
moderate  extent,  than  more  rarely  and  over  a  larger  surface.  The 
philosophy  is  the  same,  also,  in  respect  to  the  relative  effects  of  a  large 
dose  of  calomel,  and  that  dose  divided  into  four.  Analogies  likewise 
subsist  between  the  salutary  effects  of  copious  leeching,  extensive 
vesication,  and  a  large  dose  of  calomel,  in  acute  inflammations  (§  559, 
893  //-).  And  so  of  numerous  other  agents.  A  common  philosophy 
obtains  in  all  the  cases,  and  each  example  illustrates  and  confirms  the 
principles  on  which  all  other  agents  operate.  And  I  may  here  cairy 
the  same  examples  to  illustrate  the  philosophy  of  the  operation  of  gen- 
eral bloodletting,  and  the  peculiarities  which  appertain  to  that  mode 
of  abstracting  blood  ;  since,  as  will  appear,  its  influence  on  the  oro-an- 
ic  properties  and  functions  is  more  immediately,  and  may  be  more 
profoundly,  felt  than  leeching  or  other  agents  ;  and,  being  antiphlo- 
gistic, it  is  therefore  better  adapted  to  high  grades  of  active  inflamma- 
tion and  fever  (§  557).  The  philosophy  of  the  whole  is  alone  re- 
solvable through  reflex  actions  of  the  nervous  system  (^  893  h\ 


THERAPEUTICS. LOSS   OF   BLOOD.  697 

927,  a.  Notwithstanding,  therefore,  the  last  proposition  in  respect 
to  leeching,  it  often  happens  that  the  force  of  diseased  habit  is  so  great 
as  to  demand  a  more  decisive  and  more  frequent  resort  to  leeching. 
It  is  even  not  unfrequent  that  the  force  of  morbid  habit  attendant  on 
chronic  inflammations  requires  the  previous  abstraction  of  blood  from 
a  vein,  and  perhaps  repeatedly  and  largely;  not  only  with  a  view 
to  the  special  physiological  influences  of  general  bloodletting,  but  that 
a  large  diminution  of  the  general  volume  of  blood  may  be  suddenly 
effected  (§  925,  a).  The  utility  and  necessity  of  this  practice  are  fre- 
quently seen  in  the  treatment  of  those  chronic  inflammations  of  the 
mucous  tissue  of  the  stomach  which  follow  long-protracted  indiges- 
tion, and  especially  if  the  liver  also  have  become  invaded  by  the  same 
condition  of  disease.  The  advantages  of  general  bloodletting  in  these 
cases  relate  as  much  to  the  general  condition  of  the  system  over  which 
a  morbific  influence  has  been  established  as  to  the  seat  of  inflamma- 
tion. The  general  modification  exerts  a  reacting  effect  upon  the  part 
inflamed,  and  adds  to  the  obstinacy  of  the  diseased  habit  of  the  part, 
and  leeching  will  not  reach  these  influences  (§  143  c,  847  g).  Here 
it  is,  particularly,  that  we  witness  corresponding,  and  even  more  suc- 
cessful, eflforts  of  nature  at  relief  in  the  torrents  of  blood  that  are  ef- 
fused from  either  the  mucous  tissue  of  the  stomach  or  of  the  lungs ; 
especially  the  former  (§  890,  e). 

927,  h.  Again,  in  certain  mild,  though  obstinate  cases  of  purely  lo- 
cal inflammations,  and  before  the  constitution  is  brought  under  the 
influence  of  the  morbid  action  ;  or,  in  cases  where  exciting  reflex  nerv- 
ous actions  have  been  subdued  by  general  bloodletting,  local  bleeding 
by  leeches  is  pre-eminently  useful.  In  either  of  these  cases,  general 
bloodletting  continued  to  a  large  extent,  by  the  suddenness  and  vio- 
lence of  its  impression,  may  so  disturb  the  system  at  large  that  the  in- 
flammation may  be  kept  up  by  influences  produced  by  this  artificial 
derangement  of  the  whole  body  (^  889  m,  889  mrri).  But  here  there 
is  no  countervailing  action  against  the  effect  of  leeching  •  and  while 
the  small  vessels  engaged  in  the  inflammatory  process  refuse  to  give 
way  if  the  disease  have  been  of  short  duration,  there  is  no  danger  of 
establishing  any  injurious  influences  upon  the  general  capillary  sys- 
tem. This,  however,  will  take  place,  more  or  less,  when  leeching  e^f- 
ceeds  that  degree  which  is  necessary  to  determine  a  change  in  the  part 
inflamed.  It  may  even  follow  from  very  copious  leeching  in  severe 
chronic  inflammations,  where  morbid  action  is  rendered  obstinate  by 
the  influence  of  habit,  before  the  diseased  process  yields.  In  the  for- 
mer case,  the  system  is  injured  partly  by  the  influences  determined 
by  the  excessive  change  induced  in  the  instruments  of  morbid  action, 
.  and,  in  part,  by  the  general  influence  from  an  unnecessary  loss  of 
blood.  In  the  latter  case,  the  bad  effects  appear  to  be  mainly  inci- 
dent upon  the  loss  of  blood  in  its  general  relation  to  the  system  at 
large.  In  these  cases,  therefore,  it  is  important  to  graduate  the  extent 
of  leeching  by  the  exigencies  and  the  peculiarities  of  each  individual 
case ;  and  it  is  especially  important  with  infants,  upon  whom  leech- 
ing produces  not  only  its  jDoculiar  effects  very  powerfully,  but,  also, 
more  than  in  after  life,  the  effects  that  appertain  more  strictly  to  gen- 
eral bloodletting.  Such  is  the  obstinacy  of  the  depressing  change  in 
the  instruments  of  disease,  as  liable  to  arise  from  leeching  in  in- 
fancy, when  this  remedy  has  been  earned  far  beyond  any  useful  do- 


698  INSTITUTES    OF    MEDICINE. 

oree  in  inflammations  of  the  nature  now  under  consideration  atj,l  its 
influence  upon  the  whole  extent  of  the  circulatory  organs  is  main- 
tained with  such  violence,  that,  having  also  superadded  to  it  the  gen- 
eral effect  from  excessive  loss  of  blood,  it  may  be  impossible  to  coun- 
teract its  destructive  tendency  (§  514  g,  516  d,  no.  6}.  It  is  not  alone 
the  effect  that  arises  from  an  excess  of  general  bloodletting  with  which 
we  now  contend,  but  a  greater,  perhaps,  in  that  pernicious  chango 
which  has  been  induced  in  the  extreme  vessels  to  which  the  leeches 
had  been  applied,  and  which,  indeed,  has  been  more  or  less  propa- 
gated by  reflex  nervous  action  over  the  system  (921). 

928.  From  what  has  now  been  said,  the  reason  is  apparent  why 
cautious  leeching  may  be  sometimes  a  means  of  relief  in  those  inflamma- 
tions that  are  now  and  then  induced  by  a  misapplied  or  an  excessive 
loss  of  blood.  In  these  rare  affections,  the  triumph  of  art  is  beauti- 
fully illustrated  when  accurately  guided  by  the  light  of  science.  The 
effect  should  be  limited,  if  possible,  to  local  nervous  centers.  They 
are  cases,  too,  in  which  the  distinction  between  general  bloodletting 
and  leeching  is  forcibly  shown,  since  the  former  has  caused  the  dis- 
ease and  the  latter  cures  it  (§  1024  a,/  Dr.  M.  HALL).-SeeiVo«ep.  708. 

2.    GENERAL    BLOODLETTING. 

929.  In  general  bloodletting  the  effects  are  varied  from  those  of 
leeching,  and  in  a  way,  as  we  have  already  seen,  of  practical  im- 
portance (§  927,  928).  Its  influences  may  be  considered  under  five 
general  aspects,  and  successively  as  in  leeching  : 

930.  1st.  The  earliest  impression  is  made  simultaneously  upon  the 
organic  properties  of  the  large  and  small  vessels  throughout  the  body, 
since  the  loss  of  blood  is  now  immediately  coextensive  with  the  whole 
circulating  mass,  is  suddenly  withdrawn,  and  in  a  comparatively  large 
quantity.  Here,  therefore,  as  of  the  local  vessels  in  leeching,  a  change 
is  instituted  in  the  vital  state  of  the  blood-vessels  throughout  the  body 
(§  526  a,  915,  921,  944  c). 

931.  a.  2d.  The  foregoing  impression  suddenly  rouses  the  arterial 
system  to  a  greater,  but  very  modified  action,  by  which  the  vessels, 
especially  the  extreme  and  capillary,  are  brought  into  a  state  of  con- 
traction, and  far  beyond  any  diminution  of  their  contents  that  may 
arise  from  the  quantity  of  blood  removed  from  the  body  (§  916). 

931.  J.  The  contraction  thus  instituted  is  vastly  greater  in  the  small 
than  in  the  large  vessels,  mainly  because  of  the  greater  endowment 
of  the  former  with  irritabihty  and  mobility  (§  188,  205,  482,  944  c). 

932.  3d.  Owing,  also,  to  the  same  causes  through  which  the  ex- 
treme vessels  feel  the  loss  of  blood  more  sensibly  than  the  larger 
ones,  powerful  reflex  nervous  actions  are  determined  upon  the  for- 
mer by  the  changes  which  take  place  in  the  larger  series  of  vessels 
(§  222-233±,  409-411,  475^,  500  m,  687^688,  694|,  826  cc,  920). 

933.  4th.  As  soon  as  the  foregoing  change  begins  in  the  vessels,  it 
throws  a  reflex  nervous  action  over  the  heart.  There  is,  as  yet,  so 
little  diminution  of  the  general  volume  of  blood,  that  the  earliest  in- 
fluences upon  the  action  of  the  heart  must  be  due,  entirely,  to  this  re- 
flex nervous  impression  (§  919,  500  ?«,  826  cc,  829). 

934.  5th.  As  the  heart  becomes  influenced,  it  excites  a  powerful 
reflex  influence  that  falls  upon  the  extreme  and  capillary  vessels ; 
between  which  and  the  heait  there  exist  very  strong  vital  and  sympa- 
thetic relations  {§  385,  526  a,  920,  1039). 


THERAPEUTICS. LOSS    OF    BLOOD.  G99 

Here,  therefore,  as  in  leeching  (§  920),  the  contraction,  and  other 
changes,  which  take  place  in  the  small  vessels,  grow  out  of  a  double 
influence ;  namely,  that  which  is  exerted  by  the  direct  impression 
from  loss  of  blood,  and  that  which  is  reflected  upon  them  by  the 
changes  that  arise  in  the  heart  and  larger  vessels.  And  so,  as  in 
leeching,  reflex  nervous  action  between  the  heart  and  blood-vessels 
passes  and  repasses,  and  increases  in  an  increasing  ratio  as  the  blood 
flows  from  the  arm,  till  its  prostrating  effect  reaches  the  point  of  syn- 
cope. In  leeching,  however,  the  sympathies  between  the  heart  and 
blood-vessels  are  not  as  reciprocal  as  in  general  bloodletting ;  but  a 
greater  influence  is  often  propagated  in  leeching  by  the  small  vessels 
upon  the  centre  of  circulation  (§  921,  and  references  in  ^  932).* 

935,  a.  That  the  failure  of  the  heart's  action  does  not  arise,  as  com- 
monly supposed,  from  a  mechanical  diminution  of  the  volume  of 
blood  is  shown  by  the  frequent  occurrence  of  syncope  from  the  loss 
of  two  or  three  ounces ;  nor  does  it  depend,  in  the  least,  upon  with- 
drawing the  stimulus  of  blood  from  the  heart.  On  the  contrary,  as  it 
respects  both  hypotheses,  the  blood  is  actually  accumulated  about  the 
heart  in  consequence  of  the  contraction  of  the  capillary  vessels ;  and 
this  accumulation,  from  the  beginning,  is  a  cause  of  the  failure  of  the 
heart's  action,  and  is  at  its  greatest  extent  when  syncope  takes  place 
(§  936,  and  references  in  §  932). 

935,  h.  It  is  also  equally  true  that  the  general  contraction  of  the 
small  vessels,  in  all  the  modes  of  abstracting  blood,  is  not  referable  to 
either  of  the  foregoing  causes;  and  for  the  reasons,  in  part,  that  the 
contraction  far  surpasses  any  diminution  of  the  general  volume  of 
blood,  that  the  phenomenon  is  always  attendant  on  syncope  arising 
from  mental  causes,  and  that  the  contraction,  if  proceeding  from  elas- 
ticity or  from  any  other  cause  than  one  of  a  vital  nature,  could  never 
determine  the  powerful  reflex  nervous  actions  which  it  exerts  upon 
the  heart  (§  916,  917,  932,  937). 

935,  c.  In  like  manner,  the  diminution  of  the  volume  of  blood  in  in- 
flamed parts  is  only  a  remote  effect  of  lessening  the  quantity  of  the 
circulating  mass.  The  blood  is  not  only  temporarily,  but  permanent 
ly  expelled  from  the  injected  vessels.  This  shows  that  its  expulsion 
is  effected  by  a  vital  change  in  the  condition  of  the  vessels ;  otherwise, 
they  would  not  contract  in  a  ratio  exceeding  that  of  the  correspond- 
ing vessels  of  other  parts,  nor  would  their  contraction  be  permanent. 
Vessels  that  are  enlarged  in  inflammation  to  many  times  their  natural 
diameter  are  often  reduced  to  nearly  their  natural  volume  while  the 
operation  of  bloodletting  is  in  progress  (§  910,  977,  1056). 

Various  circumstantial  facts  might  be  adduced  to  show  the  vital  na- 
ture of  the  contraction  which  attends  the  capillary  vessels.  The  fol- 
lowing are  relative  to  idiosyncrasy ;  and  the  principle  which  I  have 
set  forth  is  an  evidence  of  the  accuracy  of  the  reporter's  interpreta- 
tion of  the  phenomena,  throughout.  Thus  :  Dr.  Paige,  "  of  large  ex- 
perience and  great  respectability,"  states,  in  the  November  number 
(1845)  of  the  "  New  York  Journal  of  Medicine,"  that,  on  bleeding 
"  a  woman  about  forty  years  of  age,  and  after  having  drawn  a  very 
few  ounces,  and  while  the  blood  was  still  flowing  from  the  vein,  she 
was  taken  with  very  severe  pain  all  over  the  external  parts  of  the  sys 
tem,  and  extending  to  the  most  remote  extremities.  I  suffered  the 
blood  to  flow,  however,  but  the  pain  increased  instead  of  diminish- 

*  This  sensitiveness  of  the  heart  and  arteries  to  the  nervous  influence  excited  by 
loss  of  blood  corresponds  exactl}'  with  that  from  all  things  else,  as  shown  in  §  500  m. 


700  INSTITUTES    OF    MEDICINE. 

ing."  "  Several  years  afterward  I  met  with  exactly  the  same  symp- 
toms on  bleeding  a  young  man  in  case  of  an  ardent  fever ;  but,  having 
thought  much  of  the  first  case  above  mentioned,  I  had  come  to  the 
conclusion,  in  my  own  mind,  that  the  pain  depended  on  the  spasmodic 
contraction  of  the  small  vessels  of  the  surface  and  extremities  as  they 
became  emptied  of  their  blood,  I,  in  this  case,  immediately  admin- 
istered a  free  dose  of  some  diffusible  stimulus  (I  think,  of  ammonia), 
and  the  pain  subsided  very  soon,  so  that  I  was  able  to  take  as  much 
blood  as  I  wished"  (§  399,  and  references  in  ^  932). 

935,  d.  Again,  bloodletting  being,  in  popular  language,  a  debilita- 
ting remedy,  its  rapidly  salutary  effects  contradict  the  prevailing  hy 
pothesis  that  inflammation  and  venous  congestion  are  constituted  by 
debility  of  the  vessels,  and  stagnation  of  blood.  Had  this  doctrine 
any  foundation,  the  capillaries  in  inflammation,  and  the  veins  in  con- 
gestion, would  immediately  become  more  injected  with  blood,  and 
those  diseases  should  be  exasperated  by  what  is  known  to  be  their 
most  efficient  remedy.     It  also  fully  contradicts  "  coagulation." 

The  effects  of  bloodletting,  therefore,  prove  that  the  pathological 
cause  of  inflammation  and  venous  congestion  consists  not  only  of  an 
increased  energy  of  the  organic  properties,  but  that  these  properties 
are  also  modified  in  kind ;  while  the  rapid  subsidence  of  the  forego- 
ing affection,  under  the  influence  of  loss  of  blood,  proves,  abundantly, 
that  the  whole  process  advances  upon  vital  principles.  The  loss  of 
blood  so  impresses  the  diseased  properties,  that  their  pathological  state 
is  changed  on  the  instant  (§  137  d,  143,  150-152),  and  they  are  brought 
to  obey  their  natural  recuperative  law  so  immediately,  that  the  vessels 
of  an  inflamed  eye  contract  and  disappear  while  the  blood  is  yet  flow- 
ing from  the  arm.  And  so  of  all  other  parts  that  are  concealed  from 
observation  (^  476^  h,  478,  479,  503-506,  516  d,  no,  6,  750  5,  751,  817). 

935,  e.  The  extent  and  durability  of  this  change  will  depend  upon 
a  variety  of  circumstances ;  such,  for  example,  as  relate  to  constitu- 
tion, the  nature  of  the  remote  causes,  and  whether,  also,  the  impres- 
sion have  resulted  purely  from  the  loss  of  blood,  or,  in  part,  from 
mental  emotions,  or  from  gastric  irritation ;  and  it  will  be  often  influ- 
enced by  the  manner  in  which  the  blood  may  be  abstracted,  whether 
from  a  large  or  a  small  orifice,  or  whether  the  operation  be  suspeJid- 
ed  for  a  minute  and  then  resumed.  Each  of  these  circumstances, 
also,  discloses  the  nature  of  the  principles  upon  which  loss  of  blood 
produces  its  effects,  especially  the  agency  of  the  nervous  influence. 

936,  a.  When  general  bloodletting  is  practiced  in  health  the  action 
of  the  heart  begins  to  fail  as  soon  as  the  vessels  begin  to  contract ;  but 
it  is  the  tendency  of  inflammation  to  delay  or  prevent  the  vascular 
changes  under  an  equal  loss  of  blood,  while,  on  the  other  hand,  those 
changes  are  often  promoted  by  venous  congestion,  or  by  numerous 
adventitious  influences,  either  mental  or  physical. 

936,  h.  Again,  it  frequently  happens,  after  the  action  of  the  heart  is 
more  or  less  subdued  by  loss  of  blood,  that  it  speedily  recovers  its 
force  on  account  of  the  removal  of  the  prostrating  influence  of  some 
morbid  condition,  or  of  nausea,  or  of  mental  disturbance,  which  re- 
moval may  be  suddenly  effected  even  in  the  case  of  some  depressinor 
form  of  disease,  and  perhaps  as  soon  as  the  blood  begins  to  flow  from 
the  vein  (§  938,  h),  just  as  the  nervous  power  may  be  modified. 

937,  a.  Since  the  influences  of  general  bloodletting  are  exerted,  from 


THERAPEUTICS. LOSS    OF    BLOOD.  701 

the  beginning,  simultaneously  upon  the  whole  capillary  system  (§  930), 
the  amount  and  rapidity  of  the  primary  change  will  depend  on  the 
suddenness  with  which  the  blood  is  abstracted  ;  and  whenever  loss  of 
blood  produces  a  great  and  sudden  contraction  of  the  whole  capillary 
system,  however  small  the  quantity,  syncope  will  approach  (§  935). 

937,  T).  And  so,  also,  it  was  found  by  Le  Gallois  and  Philip,  in  their 
direct  experiments  upon  the  brain  and  spinal  cord,  that  the  extent  of 
the  nervous  influence  upon  the  heart,  blood-vessels,  and  alimentary 
canal,  depended,  always,  on  the  suddenness  of  the  impression  on  the 
nervous  centres,  and  that  when  most  sudden  and  violent  it  was  capa- 
ble of  extinguishing  at  once  the  functions  of  life  (§  478,  479,  510,  511). 

937,  c.  Now,  as  will  have  fully  appeared,  the  sympathetic  changes 
which  take  place  in  the  heart  and  blood-vessels,  in  general  bloodlet- 
ting, depend  upon  the  operation  of  the  nervous  power ;  just  as,  in  the 
direct  experiments  by  Le  Gallois  and  Philip,  the  organic  functions 
were  variously  affected  according  to  the  nature  of  the  influences, 
which  were  inflicted  upon  the  nervous  centres.  It  is,  therefore,  al- 
ready apparent  that  the  effects  of  bloodletting  upon  disease  will  often 
depend  much  upon  the  rapidity  with  which  the  blood  is  abstracted. 
And  this  important  practical  consideration  points  out  another  differ- 
ence between  general  bloodletting  and  leeching,  and  why,  in  the  lan- 
guage of  Mr.  Travers,  "  syncope  is  in  proportion  to  the  suddenness, 
rather  than  the  quantity  of  the  hemorrhage."  Hence  it  is  that  syncope 
follows  from  the  loss  of  a  smaller  quantity  of  blood  when  drawn  from 
a  large  than  from  a  small  orifice,  or  from  both  arms  than  when  from 
one  (^  1056)  ;  from  the  more  sudden  excitement  of  reflex  nervous  action. 

937,  d.  It  is  also  another  important  practical,  as  well  as  phil- 
osophical, consideration,  that  if  tne  subject  be  in  an  erect  posture, 
syncope  will  follow  sooner  than  in  the  horizontal,  from  the  greater  in- 
ability of  the  heart  in  the  former  case  to  transmit  the  blood  to  the 
brain ;  and  this  circumstance,  as  will  appear,  should  govern  us  as  to 
thfi  position  of  the  patient. 

938,  a.  Again,  the  ratio,  in  which  the  various  influences  that  arise 
from  general  bloodletting  will  succeed  each  other  in  disease,  will  also 
depend  on  the  existing  condition  of  the  organic  states,  especially  of 
the  heart  and  blood-vessels  (§  143,  149,  150,  152).  It  often  happens 
that  an  increased  and  uniform  susceptibility  pervades  the  whole  san- 
guiferous system ;  and  when  this  peculiar  state  exists,  the  abstraction 
of  a  very  small  quantity  of  blood  may  instantly  determine  a  paroxysm 
of  syncope  (§  526  a,  961),  the  nervous  power  then  acting  intensely.* 

93S,  h.  This  proposition,  like  all  the  others  which  are  made  with- 
out qualification,  supposes  the  influences  to  depend  upon  the  absolute 
loss  of  blood,  and  not  to  be  affected  by  adventitious  causes,  such  as 
emotions  of  the  mind,  intestinal  irritation,  &c.  "When  these  accidental 
and  transient  causes  institute  their  reflex  and  prostrating  nervous 
actions,  they  should  be  carefully  noted ;  since  it  is  commortly  impor- 
tant that  a  certain  amount  of  blood  should  be  abstracted  to  produce 
the  requisite  impression  upon  disease.  In  such  cases,  therefore,  it  is 
commonly  necessary  to  go  on  with  the  operation,  sooner  or  later,  but 
generally  early,  after  the  patient  has  revived.  The  nervous  influences 
of  the  adventitious  causes  generally  make  but  little  or  no  impression 
upon  disease  ;  and  the  loss  of  too  little  blood  often  adds  violence  to 
inflammation  and  fever  by  imparting  greater  energy  to  the  action  of 

*  See  p.  298,  t)  4761  h,  479. 


70S?  INSTITUTES    OF    MEDICINE. 

the  heart,  or  by  relieving  the  general  circulation  when  it  may  be  em- 
barrassed by  some  local  venous  congestion  (§  988). 

3.    CUPPING. 

939,  a.  Cupping  differs  in  some  of  its  effects  from  leeching  and  gen- 
eral bloodletting.  Its  influences  are  of  an  intermediate  nature,  but 
are  most  allied  to  the  latter.  It  never  makes  the  profound  impression 
upon  the  vital  condition  of  the  parts  to  which  it  is  applied  that  is  ex- 
erted by  leeching,  and  its  influences  upon  the  system  at  large  are  also 
less,  under  equal  circumstances.  Cupping,  indeed,  often  fails  of  re- 
lief where  leeching  is  speedily  efficient.  In  a  genei'al  sense,  six 
ounces  of  blood  taken  by  leeching  is  probably  equal  in  its  curative  ef- 
fect"? to  nearly  twice  that  quantity  abstracted  by  cupping. 

939,  h.  In  cupping,  the  blood  is  abstracted  from  the  larger  series 
of  capillary  vessels,  whose  office  is  probably  but  little  more  than  to 
supply  the  smaller  series,  in  which  the  organic  properties  are  most 
strongly  pronounced  (§  384,  &c.) ;  nor  is  that  action  instituted,  by  cup- 
ping, in  those  vessels  from  which  the  blood  is  taken,  that  obtains  so  pro- 
foundly in  leeching,  and  upon  which  no  little  of  the  general  and  local 
effects  depend,  especially  the  peculiarity  of  the  reflex  nervous  action. 
939,  c.  The  distinction  is  also  explained  by  the  persistence  with 
which  the  blood  continues  to  be  discharged  long  after  the  leeches  have 
performed  their  office,  although  smaller  and  fewer  vessels  are  divided 
than  in  cupping,  and  these  few  torn,  while  in  cupping  the  blood  ceases 
to  escape  as  soon  as  the  cupping-glasses  are  removed.  All  of  which 
is  absolute  proof  that  a  remarkable  change  is  instituted  in  the  vital 
condition  of  the  capillary  vessels,  by  leeching,  and  that  the  prolonged 
effusion  of  blood  is  in  no  respect  of  a  mechanical  nature,  but  wholly 
due  to  a  vital  action  which  is  artificially  set  up  in  the  vessels,  and 
which  is  not  at  all  instituted  by  cupping. 

939,  d.  It  is  evident,  therefore,  from  principle  as  well  as  experience, 
that  cupping-glasses  should  not  be  applied,  as  is  often  done,  to  pro- 
mote the  bleeding  of  leech-bites.  It  embarrasses  the  specific  action 
instituted  by  the  leeches.  A  mechanical  is  substituted  for  a  natural 
process  ;  while,  also,  as  in  cupping,  the  abstraction  of  blood  is  so  rapid 
that  its  effects  become  more  like  those  of  venesection. 

939,  e.  Cupping  approximates  general  bloodletting  not  only  in  the 
rapidity  with  which  the  blood  is  abstracted,  but  in  which  it  determines 
reflex  nervous  actions  upon  the  whole  ciixulatory  system,  and  in  the 
quantity  of  blood  which  is  required  for  its  physiological  and  therapeu- 
tical effects.  It  is  more  remotely  allied  to  leeching  in  the  change 
which  is  locally  induced,  though  this  change  is  not  of  a  specific  char- 
acter, but  consists  of  a  more  simple  vital  contraction  of  the  small  ves- 
sels that  propagates  comparatively  little  impression  upon  other  parts 
of  the  circulatory  system.  When  the  impression  becomes  general,  it 
is  then  mostly  due,  as  in  venesection,  to  the  removal  of  a  quantity  of 
blood  adequate  to  a  universal  influence. 

939, y.  It  becomes  more  and  more  apparent,  therefore,  that  gener- 
al bloodletting,  cupping,  and  leeching  are  in  some  respects  distinct 
remedies,  and  that  cujjping"  is  the  least  useful  and  rarely  required. 
The  difference  between  them  lies  in  a  difference  in  the  operation  of 
the  principles  which  are  common  to  the  several  modes.  Some  of  these 
differences  appertain  to  the  cerebro-spinal  system,  which  is  far  more 


THERAPEUTICS- LOSS  OP  BLOOD.  703 

concerned  in  the  phenomena  of  general  blood-letting  than  in  the  usual 
effects  of  leeching,  which  is  apt  to  engage  mostly  local  nervous  centres. 
The  effects  of  general  blood-letting  may  be  obtained  in  an  inferior  de- 
gree by  cupping,  through  mere  inconsiderable  degrees  of  the  same  in- 
fluences, as,  also,  in  a  still  lesser  degree  by  applying  cupping-glasses  in 
the  operation  of  leeching.  The  difference  in  leeching  is  owing,  in  part, 
to  a  more  profound  impression  upon  the  sympathetic  nerve,  though  the 
other  methods  transmit  their  influences  through  this  nerve  (§  921,  922). 

Of  the  Nervous  Power  in  its  Relation  to  the  Effects  of  Loss  of  Blood. 

940.  This  very  important  element  in  the  phenomena  which  arise 
from  loss  of  blood  must  be  amply  reviewed.  It  is  the  nervous  power  to 
which  are  owing  all  the  remarkable  results  that  are  in  active  progress 
after  the  beginning  of  the  constitutional  effects  of  blood-letting.  The 
operation  of  this  power  commences  at  the  earliest  contraction  of  the 
small  vessels,  and  increases  in  the  ratio  of  that  contraction.  It  is  the 
same  power  that  exerts  so  vast  a  range  of  influences  in  directing  the 
effects  of  all  other  remedial,  as  well  as  morbific  agents,  and  whose  char- 
acteristics have  been  already  extensively  considered.  The  same  philos- 
ophy, too,  is  here  applicable  as  in  all  other  cases  in  which  the  nervous 
power  is  instrumental  in  organic  actions,  or  in  modifying,  or  in  propa- 
gating disease  (§  222-234,  450-530). 

941.  The  development  of  the  nervous  power  from  loss  of  blood  is 
owing  to  the  vital  impressions  that  lead  to  the  contraction  of  the  small 
vessels.  The  influence  upon  the  nervous  centres  is  thus  of  two  kinds — 
that  transmitted  by  vascular  contractions  in  other  parts,  and  that  from 
the  contraction  of  their  own  vessels ;  being,  in  the  latter  case,  analo- 
gous to  what  we  have  seen  to  arise  from  direct  experiments  (§  476- 
494),  from  the  operation  of  the  passions,  and  from  the  reflected  action 
of  remedial  and  morbific  agents  (§  227,  500,  944  c,  1039,  1040,  1056). 

942.  a.  Now,  therefore,  in  view  of  the  extensive  premises  before  us, 
loss  of  blood,  both  by  its  profound  influence  upon  the  small  vessels  of 
the  nervous  centres,  and  by  effects  transmitted  there  by  vascular  con- 
tractions in  other  parts,  develops  the  nervous  power  in  a  peculiar  man- 
ner and  in  unusual  intensity  (§  227,  232).  This  influence  of  this  pow- 
er, reflected  abroad,  increases  that  contraction  of  the  general  capillary 
system  which  is  at  first  instituted,  in  all  parts,  in  general  blood-letting, 
by  the  direct  effect  of  loss  of  blood  upon  the  organic  properties  of  the 
whole  system  of  blood-vessels  (§  930,  931,  944  c).— Note  Q,  p  .1122. 

942,  b.  In  leeching,  the  local  impression  generates  an  alterative  re- 
flex nervous  action  upon  susceptible  parts  through  centres  of  the  gan- 
glionic nerve,  and  when  strongly  made  is  transmitted  to  the  brain  and 
spinal  cord  and  occasions  a  general  reflex  nervous  influence  (§  113, 
224,  893  «,  c).  The  general  contraction  of  the  vessels  is  thus  more 
and  more  accelerated  as  the  loss  of  blood  goes  on,  the  nervous  power  is 
more  and  more  excited,  and  prostrates  the  action  of  the  heart,  and 
this  in  an  increasing  ratio  as  syncope  approaches — Note  Dd  p.  1132. 

942,  c.  There  is  not,  therefore,  as  has  been  universally  supposed,  a 
withdrawment  of  the  nervous  influence  from  the  heart  during  a  parox- 
ysm of  syncope ;  but,  on  the  contrary,  an  increased  determination  of 
that  power  upon  the  organs  of  circulation,  which,  indeed,  is  then  at  its 
acme  (§  475^  476^  h,  479,  481  c,  487  g,  500  m,  509,  828  b,  951  c,  d). 

943,  a.  Again,  it  has  been  shown  by  Le  GaUois,  Philip,  and  others, 


704  INSTITUTES    OF    MEDICINE. 

that  the  stomach  and  intestines  are  readily  and  powerfully  influenced 
by  impressions  made  upon  the  central  parts  of  the  nervous  system  (§ 
491) ;  as  they  also  are,  like  the  heart,  by  mental  emotions.  As  soon, 
therefore,  as  the  nervous  centres  are  influenced  by  loss  of  blood  the 
nervous  influence  is  felt  as  well  by  the  stomach  as  by  the  heart  and 
blood-vessels.  This  gastric  irritation  is  propagated  back  to  the  brain 
and  spinal  cord,  and  increases  their  depressing  influence  on  all  the 
organs.  This  is  especially  manifest  immediately  before  the  occur- 
rence of  syncope,  which  it  contributes  to  hasten.  Hence,  also,  the 
frequent  nausea  and  eructations,  and  the  intestinal  evacuations,  which 
supervene  upon  the  impressions  made  on  the  brain  and  spinal  cord,  or  as 
syncope  approaches  (§  902,  g).  It  is  for  this  reason  that  cathartics 
often  operate  during  the  progress  of  general  bloodletting,  when  they 
had  failed  antecedently,  and  where  no  intestinal  inflammation  had  ex- 
isted to  interfere  with  their  effects.  And  this  consideration,  by-the- 
way,  is  impoitant  to  the  practitioner  when  he  is  deliberating  whether 
bloodletting  should  precede  the  exhibition  of  a  cathartic  or  an  emetic. 

943,  b.  But,  it  is  also  true  that  the  intestinal  disturbance  is  often 
owing  to  the  effect  of  nervous  influence  excited  by  some  emotion  of 
the  mind  (§  892|,  b) ;  when  its  reaction  upon  the  nervous  centres  may 
be  equally  as  great  as  when  the  disturbance  results  from  the  loss  of 
blood,  but  has  little  or  no  effect  upon  disease,  and  may  embaiTass  the 
practitioner,  and  sacrifice  the  patient  to  an  imperfect  application  of 
the  remedy  (§  938).  Nevertheless,  it  is  important  to  say  that  excep- 
tions sometimes  occur ;  and  when  such  demonstrations  are  made,  they 
yield  the  most  convincing  proof  of  my  doctrine  of  the  agency  of  the 
nervous  power  in  the  physiological  results  of  bloodletting,  and  its  al- 
terative influence  upon  disease  by  whatever  cause  the  influence  may  be 
excited.  Thus  :  *'  A  patient,"  says  Dr.  Armstrong,  "  was  so  alarmed 
at  the  preparation  for  bleeding,  that  syncope  occurred,  and  complete- 
ly stopped  an  inflammation  of  the  pleura."  Again,  "  cheer  up  the  pa- 
tient, and  he  is  always  sure  to  do  well"  (§  227-230,  232,  1067). 

944,  a.  When  syncope  arises  from  the  depressing  emotions,  or  from 
other  causes  whose  primary  impression  is  upon  the  brain,  the  action 
of  the  heart  is  directly  prostrated  through  the  nervous  influence,  and 
by  a  reflex  action  instituted  by  the  stomach  ;  while  a  cei'tain  depress- 
ing effect  is  exerted  by  the  nervous  power  upon  the  extreme  and  cap- 
illary blood-vessels,  and  an  influence  from  this  change  is  propagated 
by  reflex  action  to  the  heart.  The  succession  of  changes  then,  as  re- 
spects the  heart  and  blood-vessels,  begins  more  on  the  side  of  the 
heart  than  when  they  are  determined  by  loss  of  blood  ;  the  contrac- 
tion of  the  capillary  vessels  being  also  more  consequent  on  the  failure 
of  the  heart's  action  than  on  the  alterative  influence  of  the  nei'vous 
power.  We  must  also  explain,  in  the  foregoing  manner,  the  syncope 
which  follows  blows  upon  the  stomach,  the  crush  of  limbs,  surgical 
operations,  &c. ;  and  when  death  is  suddenly  produced  by  any  of 
these  causes,  it  is  owing  either  to  a  sudden  extinction  of  the  cerebro- 
spinal functions,  or  to  a  powerful  determination  of  the  nervous  influ- 
ence upon  the  heart,  &c.,  by  which  the  action  of  that  organ  is  arrested 
(§  230,  480,  &c.,  510,  511).  The  same  is  true  of  the  prostrating  ef- 
fects of  nausea,  and  many  other  accidental  influences  which  spring 
up  during  the  operation  of  bloodletting. — See  ^  476^  k,  479,  902^. 

944.  b.  Since,  therefore,  in  the  case  of  bloodletting,  its  influences 


THERAPEUTICS. LOSS  OP  BLOOD.  705 

are  profound,  not  only  on  the  instruments  of  disease,  but  upon  the 
whole  capillary  system,  and  the  failure  of  the  heart's  action  is  greatly 
due  to  this  deep  impression  on  their  vital  constitution,  while  in  the 
case  of  the  accidental  causes  the  effect  consists  mostly  in  a  direct  de- 
pression of  the  heart's  action,  and  a  consequent  failure  of  supply  to 
the  capillary  vessels,  without  essentially  affecting  their  vital  states,  it 
is  obvious  that  we  may  not  depend  on  syncope  as  a  test  of  the  influ- 
ences of  loss  of  blood  (§  959). 

944,  c.  The  contraction  of  the  blood-vessels  as  arising  from  loss  of 
blood  is  an  incidental  result  of  a  profound  impression  upon  the  vires  vi- 
tcv,  which  is  essentially  the  cause  of  the  development  and  modification 
of  the  nervous  influence.  The  contraction,  therefore,  is  only  an  evidence 
that  such  profound  impression  has  been  made,  just  as  in  other  exem- 
plifications by  cathartics  and  emetics  (§  889  /,  902  g).  The  vascular 
contraction  occasioned  by  fear,  &c.,  produces  no  such  effects  (§  892f  J, 
900, 902,  954  d,  961  e,  966,  986  b,  p.  837,  ^  1057^,  p.  827,  p.  920  Note). 

944,  d.  Syncope  is  often  consummated  by  removing  the  ligature.  In 
this  case  the  action  of  the  heart  bad  been  enfeebled  almost  to  an  acces- 
sion of  the  paroxysm,  and  the  additional  quantity  of  blood  suddenly 
thrown  upon  the  heart,  so  far  from  rousing  the  organ,  overpowers  its 
action.  It  is  in  this  way,  in  part,  when  the  heart  has  been  gradually 
prostrated  during  the  access  of  congestive  fever,  that  a  sudden  develop- 
ment of  the  attack  sometimes  produces  syncope.  Something,  however, 
is  evidently  owing,  in  this  case,  to  the  reflex  nervous  influence  of  the 
extreme  vessels  upon  the  heart,  but  probably  more  to  the  sudden  deter- 
mination of  blood  from  the  circumference  at  the  access  of  the  cold  stage. 

945.  If  syncope  be  obstinate,  the  means  of  relief  will  be  such  as 
operate  through  the  medium  of  the  nervous  centres,  and  should  be  of 
such  a  nature  as  will  subdue  the  depressing  character  of  the  nervous 
influence,  and  render  it  stimulant  to  the  heart  and  blood-vessels. 
Pungent  vapors  to  the  nose,  cold  air,  cold  water  dashed  upon  the 
surface,  stimulants  introduced  into  the  stomach  and  intestine,  and  ex- 
citing means  of  a  coi'responding  kind,  as  well  as  perfect  rest,  will 
therefore  be  the  proper  remedies  (§  481,  e,  891|^  k). 

In  the  Medical  and  Physiological  Commentaries,  vol.  i.,  p.  178 
(1840),  I  proposed,  in  cases  of  obstinate  and  alarming  syncope,  the 
operation  of  acupuncturation  of  the  heart ;  deriving  my  suggestion 
from  Marshall's  experiments  upon  frogs,  which  were  revived  by  that 
process  when  apparently  dead  from  carbonic  acid.  Very  lately  (1843), 
T  see  in  the  Annali  TJniversali  di  Medicina,  that  Dr.  A.  Carraro  has 
successfully  repeated  these  experiments,  and  makes  the  same  appli- 
cation to  the  human  subject  as  had  been  done  by  myself.  The  whole 
is  also  commonly  supposed  to  be  original  with  Carraro. 

When  syncope  supervenes,  if  the  subject  be  laid  in  a  horizontal 
posture  animation  returns,  and  it  may  be  again  suspended  by  revers- 
ing the  position.  These  phenomena  depend  upon  causes  now  essen- 
tially modified.  "  No  mg,n  ever  saw  the  sensorial  functions  continue 
a  single  minute  after  the  heart  had  ceased  to  move.  When  the  body 
is  horizontal,  the  heart  circulates  the  blood  more  easily,  than  when 
any  part,  and  especially  so  large  a  part  as  the  head,  is  elevated."  If 
syncope  return  when  the  head  is  again  elevated,  it  will  depend  on  a 
more  simple  cause  than  what  originally  produced  it.  It  will  now 
arise  from  a  permanently  enfeebled  state  of  the  heart,  and  "  its  ina- 


706  INSTITUTES    OP    MEDICINE. 

bility  to  continue  the  circulation,  and  thus  to  supply  the  brain  and  ail 
other  parts  with  blood  ;"  and  such  is  always  the  last  in  the  series  of 
causes  in  a  paroxysm  of  syncope.  In  the  first  instance  the  action 
of  the  heart  is  prostrated  through  the  nervous  influence  of  the  brain 
and  spinal  cord;  in  the  second,  the  functions  of  the  brain  are  impair- 
ed or  suspended  through  the  enfeebled  action  of  the  heart  (§  476-i-/). 
946,  a.  Many  examples  may  be  found  in  my  Essay  on  the  Philoso- 
phy of  the  Operation  of  Loss  of  Blood,  which  show  the  great  altera- 
tive nature  of  the  nervous  power  as  developed  by  bloodletting.  Let 
one  sufiice  at  present.  Thus :  "  A  patient,"  says  Dr.  Armstrong, 
"  having  lost  only  an  ounce  of  blood,  from  the  shock  of  the  operation 
►syncope  came  on,  and  effectually  removed  an  acute  inflammation  of 
the  brain"  (§  476|-  A,  478,  479,  494,  509-511,  827  d,  828  h,  c,  943). 

946,  b.  Examples  of  the  foregoing  nature  admit  but  one  interpre- 
tation. They  are  clear  illustrations  of  the  peculiar  pi'operties  and 
laws  by  which  organic  beings  are  governed.  They  are  simple  ele- 
ments of  the  whole  philosophy  of  which  I  have  spoken,  as  it  respects 
the  specific  nature  of  the  properties  and  actions  of  life,  of  their  mu- 
tability, and  of  the  tremendous  influence  which  the  nervous  power  is 
capable  of  exerting  upon  them.  It  is  the  same,  also,  when  life  is  in- 
stantly extinguished  by  a  drop  of  hydrocyanic  acid,  or  of  the  alcohol- 
ic solution  of  the  extract  of  nux  vomica,  applied  to  the  tongue,  oi 
by  a  blow  on  the  epigastrium,  by  surgical  operations,  &c,,  through 
reflex  actions  of  that  power  (§  222,  455  d,  476^  h,  479,  500  c,  509,828). 

947.  The  philosophy  of  syncope,  as  expressed  by  M.  Piorry,  has 
been  the  philosophy  of  no  small  part  of  the  medical  world ;  while  all 
the  antecedent  influences  of  bloodletting  have  been  more  universally 
referred  to  the  mechanical  diminution  of  the  circulating  fluid,  and  syn- 
cope construed  upon  this  doctrine. 

"  Syncope,^^  says  the  eminent  Piorry,  "  whatever  may  he  its  cause, 
consists  in  a  suspension  or  diminution  of  cerebral  action.  If  it  take 
place  sp)ontaneously  and  from  a  moral  cause,  it  is  the  action  of  the  en- 
cephalon  that  is  suspended ;  it  is  the  influence  of  this  organ  upon  the 
heart  which  is  diminished^ 

We  have  seen,  however,  in  the  ordinary  state  of  the  body,  that  the 
nervous  system  has  little  other  influence  upon  the  organic  functions 
than  that  of  contributing  to  their  fundamental  action  ;  these  functions 
being  all  carried  on  by  the  organic  properties,  which  are  maintained 
in  operation  by  stimuli  peculiar  to  each,  but  mostly  by  the  blood. 
The  nervous  power  becomes  a  stimulant,  or  depressant,  or  modifying 
cause,  to  the  organic  and  animal  functions  only  as  developed  by  those 
stimuli  or  by  other  physical  or  moral  causes  (§  177-191,  223,  226,  227, 
232,  478,  &c.).  It  is  also  fully  demonstrated  that  the  entire  removal 
of  the  brain  and  spinal  cord  does  not  affect  the  action  of  the  heart,  if 
respiration  be  artificially  maintained  (^  477,  479,  481  h),  when  the 
muscular  motion  of  the  heart  is  excited  by  reflex  action  of  the  gang- 
lionic system  (^  475-^).  When  we  consider,  also,  how  powerfully  the 
heart  may  be  influenced  by  slight  mechanical  or  other  agents  applied 
to  the  brain,  or  spinal  cord  (§  480,  &c.),  even  when  the  cerebral  cir- 
culation is  destroyed,  and  the  whole  inferior  portion  of  the  organ  re- 
moved, we  shall  better  understand,  in  this  way,  how  loss  of  blood, 
odors,  offensive  sights,  and  mental  causes,  produce  syncope,  than  by 
supposing  that  it  is  through  their  direct  suspension  of  the  cerebral 


THERAPEUTICS.-vLOSS    OF    BLOOD.  707 

functions.  Violent  passions  have,  doubtless,  the  effect  of  extinguish- 
ing, at  once,  the  powers  and  functions  of  the  brain ;  but  then  the  ac- 
tion of  the  heart  ceases  at  once,  and  is  clearly  owing  to  the  sudden 
lesion  of  the  brain,  while  in  syncope  the  action  of  the  heart  is  only  di- 
minished. Nevertheless,  even  in  the  former  case,  a  pernicious  ner- 
vous influence  is  suddenly  determined  upon  the  whole  circulatory 
system  (§  479,  509,  510).  Again,  it  is  only  the  depressing  emotions, 
like  fear,  grief,  disgust,  and  such  causes  as  in  any  degree  exert  a  sed- 
ative influence  on  the  circulation,  that  are  known  to  produce  undoubt- 
ed syncope,  while  those  like  joy  and  anger,  which  always  excite  the 
action  of  the  heart,  alone  extinguish  life  instantaneously.  One  affec- 
tion, too,  is  common,  while  the  other  is  rare ;  and  when  the  latter 
takes  place  it  is  probable  that  there  exists  an  apoplectic  predisposi- 
tion. In  one  case  the  action  of  the  heart  is  suddenly  depressed  ;  in 
the  other  it  is  powerfully  excited.  Doubtless,  too,  in  the  latter  in- 
stance the  violent  impulse  of  the  blood  upon  the  brain  contributes, 
per  se,  to  the  sudden  subversion  of  the  cerebral  powers.  While,  there- 
fore, in  syncope  from  fear  and  grief  the  blood  is,  at  the  onset,  divert- 
ed from  the  head  ;  in  sudden  death  from  joy  or  anger  a  preternatural 
quantity  is  determined  upon  the  brain  (^  227,  476^  h,  500  m,  826  cc). 
948.  It  appears,  therefore,  that  the  various  changes  which  take 
place  in  the  action  of  the  heart,  when  they  arise  from  loss  of  blood, 
are  chiefly  dependent  on  reflex  nervous  influence,  or  remote  sympa- 
thy, and  that  this  influence  is  greatest  when  syncope  ensues  (§  481,  h). 
Nor  is  there  at  any  stage  of  that  complex  series  of  changes,  from  the 
first  impression  that  follows  the  loss  of  blood  to  their  end  in  syncope, 
a  deficiency,  but  a  redundancy,  of  blood  at  the  centre  of  circulation ; 
and,  if  death  ensue,  the  vital  fluid  is  always  found  accumulated  in  the 
cavities  of  the  heart  (§  1039). 

949.  Summarily,  also,  we  have  now  seen  that  it  is  the  effect  of 
loss  of  blood,  per  se,  to  so  modify  the  vital  states  of  the  capillary 
blood-vessels  as  to  result  in  their  contraction,  and  that  when  this  con- 
traction begins  in  the  vessels  as  the  effect  of  the  loss,  it  excites  the 
nervous  influence  in  proportion  to  the  extent  and  suddenness  of  the 
impression ;  that  this  influence  is  then  propagated  abroad,  and  in- 
creases the  contraction  of  the  capillaries  at  large ;  that  this  effect  of 
the  nervous  influence  is  reflected  back  upon  the  nervous  centres,  by 
which  the  nervous  influence  is  still  farther  excited ;  that  circles  of 
reflex  actions  become  thus  established  ;  that  the  nervous  influence  is 
now,  also,  exeited  with  a  depressing  effect  upon  the  heart,  and  intes- 
tinal canal,  and  that  this  effect  is  reverberated  upon  the  brain  and  spi- 
nal cord,  by  which  the  intensity  of  the  nervous  influence  is  farther  in- 
creased;  that  the  reflex  nervous  actions,  and  the  multiplying  causes  of 
nervous  influence,  become,  therefore,  exceedingly  complex,  and  in- 
crease in  their  ratio  till  the  heart  is  prostrated  by  that  influence  and 
by  the  central  determination  of  blood,  when  syncope  takes  place  as 
an  immediate  consequence  (§  476^  7i,  481  h,  500  m,  944  c). 
■  But,  we  have  also  seen,  that  if  too  little  blood  be  taken,  in  certain 
conditions  of  disease,  results  of  an  opposite  nature  to  the  foregoing, 
and  an  aggravation  of  disease,  may  ensue,  though  they  will  be 
brought  about  through  the  same  physiological  principles  (§  965, 
983-989).     Natural  laws^'are  at  the  foundation  (§  901,  904  a,  bb). 

And  now  I  say,  if  the  foregoing  results  of  loes  of  blood  be  com- 


708  INSTITUTES    ^F    MEDICINE. 

pared  -vs'itli  the  effects  of  other  remedial  or  morbific  agents,  it  will  be 
found  that  a  close  analogy  and  harmony  of  laws  distinguish  their  mo- 
dus operandi.  And  such  is  always  the  simplicity  of  nature  in  her  fun- 
damental institutions  (§  137  e,  150-152). 

950.  From  what  has  been  now  seen  of  the  profound  influences  of 
bloodletting  upon  the  nervous  centres,  especially  when  syncope  ap- 
proaches, we  readily  account  for  those  inflammations,  and  that  fai 
oveiTated  irritation  of  modern  physicians,  which  occasionally  super- 
vene on  the  loss  of  blood  (§  1020-1023);  sometimes,  though  rarely, 
from  an  excess  of  the  remedy,  but  more  frequently  from  its  defi- 
ciency, and  still  more  so  from  its  frequent  application  in  small  quan- 
tities where  a  greater  loss  is  demanded.  If  the  loss  be  excessive,  or 
blood-letting  not  appropriate  to  the  case,  it  gives  rise  to  a  morbific  re- 
flection of  the  nervous  power  upon  the  capillary  blood-vessels.  When 
the  loss  is  small  and  frequently  repeated,  an  irritable  state  of  the  whole 
vascular  system  is  thus  established,  which  may  not  only  increase  the 
inflammation  which  the  remedy  was  intended  to  subdue,  but  may  be- 
come the  foundation  of  disease  in  other  parts  (§  476^  /«,  479,  500  m,  965 
&,  982-1001,  1005  e,  1024  ;  also,  Kriemer's  Experiments,  §  485). 

In  all  these  cases  the  whole  system  of  capillary  blood-vessels  has  a 
large  share  in  the  primary  impression;  but  a  peculiar  influence  is  de- 
tei'niined  upon  them  by  the  violence  inflicted  on  the  extreme  capillaries 
of  the  brain.  Inflammation,  therefore,  may  be  lighted  up,  as  a  conse- 
sequence,  either  in  the  brain  or  some  other  part,  but  especially  the 
brain  (§  230,  231).  Hence,  also,  the  general  vascular  excitement,  and 
that  delirium,  coma,  stertorous  breathing,  and  those  convulsions,  retch- 
ings, and  involuntary  irftestinal  evacuations  ;  some  of  which  so  frequent- 
ly follow  excessive  loss  of  blood.  Although  blood-letting,  therefore,  be 
a  remedy  for  inflammation,  the  excessive  use  of  it,  as  will  be  farther 
shown,  may  ih(^uce  that  affection ;  and  even  then  the  cautious  abstrac- 
tion of  blood  by  leeches  still  proves,  by  its  curative  influence,  as  re- 
ported by  some,  the  nature  of  the  afiection,  and  the  sanative  power  of 
the  remedy  when  well  directed  (§  901,  997,  1024  a,  1057).*— Note  Q. 

951,  a.  Let  us  now  regard  the  foregoing  morbific  effect  of  loss  of 
blood  (§  950)  in  connection  with  two  examples,  one  of  coincident,  the 
other  of  an  opposite,  nature,  to  show  the  effect  of  the  nervous  power 
upon  the  capillary  vessels  of  all  parts,  as  illustrative  of  this  agency  in 
the  operation  of  blood-letting,  as  well  as  of  all  other  remedies.  The 
first  example  is  the  greatest  glance  that  has  been  made  toward  the  prac- 
tical philosophy  of  the  nervous  system  as  expounded  in  this  work, 
and  as  first  developed  in  the  Aled.  and  Physiolog.  Covim. — Thus : 

'•  It  is  certain,"  says  Miiller,  "  that  nervous  influence  is  the  princi- 
pal cause  of  the  accumulation  of  blood  in  the  capillaries  of  certain  parts 
during  the  state  of  vital  turgescence."  "  In  the  instantaneous  injection 
of  the  cheeks  with  blood  in  the  act  of  blushing,  and  of  the  whole  head 
under  the  influence  of  violent  passions,  the  local  phenomena  are  evi- 
dently induced  by  the  nervous  influence.  The  active  congestion  of  cer- 
tain organs  of  the  brain,  for  example,  while  they  are  in  a  state  of  ex- 
citement, is  a  similar  phenomenon"  (p.  827,  p.  920  Note). — ^Note  Q. 

These  several  examples,  however  various  may  be  the  remote  causes 
of  the  phenomena,  are  so  nearly  alike  that  they  may  be  regarded  as  one, 

*  The  curative  effect  is  to  be  explained  by  leeches  operating  through  local  aervous  cen- 
ters. See  §  497,  893  a,  c,  923  d,  939/,  974  6,  1024  a. 


THERAPEUTICS. LOSS  OF  BLOOD.  709 

Rnd  it  is  not  less  obvious  that  they  involve  the  philosophy  of  inflamma- 
tion as  induced  by  loss  of  blood,  or  as  it  springs  from  other  causes. 

951,  b.  And  now  for  the  opposite  result,  which  is  brought  about 
by  precisely  the  same  immediate  exciting  cause,  the  nervous  influ- 
ence, though  not  so  supposed  by  the  distinguished  observer. 

"  When  a  patient,"  says  Dr.  Armstrong,  "had  lost  only  an  ounce 
of  blood,  from  the  shock  of  the  operation  syncope  came  on  and  ef- 
fectuafly  removed  an  acute  inflammation  of  the  brain."  Again,  "  a 
patient,"  says  the  same  writer,  "  was  so  alarmed  at  the  preparation 
for  bleeding,  that  syncope  occurred,  and  completely  stopped  an  in- 
flammation of  the  pleura"  {See  ^  476-|^  h,  479,  955  a). 

951,  c.  Looking  at  the  foregoing  examples  in  their  true  relations, 
there  may  be  advantageously  considered,  besides  their  immediate  ob- 
ject, certain  other  points  which  reflect  a  strong  light  upon  the  nature 
of  the  nervous  power,  the  causes  and  mode  of  its  development,  its 
modifications  by  the  nature  of  its  exciting  causes,  its  subsequent  prop- 
agation to  parts  remote  from  the  brain  and  upon  the  brain  itself,  and 
its  remarkable  influences  upon  all  parts.  In  the  examples  before  us 
we  see  that  power  variously  and  in  unusual  operation.  We  see  that 
it  is  positively  developed  by  excessive  loss  of  blood,  by  shame,  by  the 
violent  exciting  passions,  producing  a  high  arterial  action,  or  inflam- 
naation  of  the  brain  or  of  other  parts  in  one  case  (§  950),  instanta- 
neous injection  of  the  cheeks  with  blood  in  another,  and  the  brain  and 
whole  head  in  another  (§  951,  a)  ;  and  these  are  corresponding  re- 
sults. We  see,  also,  that  an  exactly  opposite  effect  is  produced  by 
the  loss  of  only  one  ounce  of  blood,  and  in  another  instance  by  the 
operation  of  fear  alone  (§  951,  b) ;  an  acute  inflammation  of  the  brain 
being  overthrown  in  the  former  case,  and  an  inflammation  of  the  pleu- 
ra in  the  latter.  The  common  nature  of  the  modifying  cause  cannot 
be  mistaken ;  and  when  we  consider  the  variety  of  more  remote  ex- 
citing causes,  excessive  loss  of  blood  in  one  case,  an  ounce  in  anoth- 
er, shame,  anger,  and  fear  in  others,  the  close  analogies,  yet  diversifi- 
ed results,  in  one  series  of  the  cases,  and  the  absolute  opposition  in 
the  other  series,  yet  each  example  in  this  series  exactly  alike,  though 
involving  the  loss  of  an  ounce  of  blood  in  one  of  the  instances  and 
fear  in  the  other ;  when,  I  say,  we  consider  these  things,  we  must  ad- 
mit not  only  the  common  nature  of  the  intervening  cause,  but  that  this 
cause  is  liable  to  be  variously  modified  by  the  agents  which  rouse  it 
into  action,  and  that,  however  apparently  estranged  from  each  other 
may  be  many  of  these  agents,  they  modify  the  incidental  cause  in 
modes  corresponding  with  the  effects.  A  common  philosophy  applies, 
therefore,  to  all  the  cases,  and  this  philosophy  is  equally  true  of  those 
morbific  and  remedial  agents  which  determine  the  same  effects  upon 
distant  parts  when  applied  to  the  alimentary  canal,  or  to  the  skin,  &c., 
and  therefore,  also,  of  the  whole  compass  of  remote  sympathy.  The 
type  of  the  whole  is  in  the  examples  before  us  (§  475^,  500  m,  1056). 

951,  d.  It  is  farther  worthy  of  remark  that  the  examples  (§  951,  b) 
show  how  powerfully  the  nervous  influence  may  be  determined  upon 
the  organic  constitution  of  the  brain  by  the  loss  of  a  single  ounce  of 
blood,  and  in  the  case  of  the  pleuritic  inflammation  by  fear  alone ; 
while  either  case  is  a  conclusive  proof  of  the  philosophy  which  I  have 
propounded  of  the  modus  operandi  of  bloodletting,  and  that  it  is  in 
no  respect  of  a  mechanical  nature.  These  examples  also  demonstrate 
my  position  that  the  nervous  influence  is  most  profoundly  felt  when 
syncope  comes  on. 


710  INSTITUTES    OF    MEDICINE. 

952,  a.  Some  of  the  finest  illustrations  of  the  effect  of  bloodletting 
upon  the  organic  properties  of  the  extreme  vessels  of  the  arterial  sys- 
tem, either  directly  through  the  loss  of  blood,  or,  by  alterative  reflex 
nervous  actions,  are  shown  by  the  changes  which  take  place  in  the 
blood  while  flowing  from  the  arm  in  inflammatory  diseases. 

952,  b.  Some  of  the  most  remarkable  of  the  foregoing  changes  may 
be  induced  by  a  very  small  loss  of  blood.  Thus,  a  patient  of  mine 
was  attacked  with  pneumonia,  after  convalescence  had  begun  from  a 
protracted  fever.  She  was  placed  in  an  erect  posture,  and  an  ounce 
of  blood  was  drawn,  in  a  full  stream,  into  each  of  three  wine-glasses ; 
when  syncope  took  place.  In  the  first  glass  the  blood  had  a  thick, 
strong,  indented,  buff,  and  a  fimbriated  edge ;  in  the  second  the  buff 
was  sensibly  less,  and  the  other  peculiarities  were  diminished  ;  in  the 
third    they  had  disappeared. 

952,  c.  On  the  contrary,  however,  in  a  case  of  inflammatory  fever 
Hewson  observed  the  unusual  phenomenon  of  the  appearance  of  the 
inflammatory  buff  only  on  the  fourth  cup. 

952,  d.  "  There  is  a  very  considerable  difference  to  be  sometimes 
observed  in  the  quantity  of  coagulable  lymph  in  blood  taken  in  differ- 
ent cups  from  the  same  patient  at  the  same  bleeding.  In  some  in- 
stances this  difference  has  been  observed  nearly  one  half" — War- 
drop.  Sometimes  more  than  one  half. — Scudamore.  "  The  same  is 
relatively  increased  during  the  continuance  of  bleeding;  and  it  is  sur- 
prising how  great  a  change  will  take  place  in  this  respect  at  minute 
periods." — Thackrah.  And  so  Gendrin,  Stokes,  &c.  Again,  how- 
ever, the  foregoing  phenomena  are  sometimes  directly  revei-sed  ;  and 
an  increased  quantity  of  fibrin,  and  a  diminution  of  serum,  have  been 
found  in  each  successive  cup.  These  conditions,  too,  as  well  as  the 
preceding,  depend,  in  a  measm-e,  upon  the  rapidity  with  which  the 
blood  is  abstracted.  Mead,  the  able  humoralist  of  other  days,  ob- 
serves, that  "  the  blood  may  certainly  undergo  any  imaginable  changes 
by  alterations  made  in  its  motions  only"  (§  500  m,  687^). 

952,  e.  If  syncope  take  place,  the  blood  not  only  generally  loses  its 
inflammatory  characteristics  {b),  but  the  clot  is  often  much  softer  and 
more  voluminous.  Should  the  inflammation  afterward  go  on,  the 
blood  will  be  found  to  have  resumed  its  former  peculiarities. 

952, yi  Blood,  drawn  from  a  person,  or  from  an  animal  about  to 
faint,  coagulates  very  rapidly.  In  this  case,  the  rapidity  of  coagula- 
tion appears  to  bear  a  remarkable  ratio  to  the  depression  of  the  or- 
ganic properties  of  the  solids ;  as  may  be  readily  seen  in  slaughter- 
houses. But,  again,  on  the  other  hand,  when  death  is  suddenly  pro- 
duced through  the  nervous  system  by  blows  on  the  stomach,  apoplexy, 
&c.,  or  by  running,  lightning,  organic  affections  of  the  heart,  &c.,  or 
when  the  powers  of  life  are  greatly  reduced  by  malignant  fevers,  the 
blood  generaly,  though  not  always,  remains  fluid. 

These  seeming  paradoxes  are  resolved  by  supposing  peculiar  influ- 
ences of  the  solids  upon  the  blood,  according  to  the  specific  modifica- 
tions of  their  organic  properties ;  these,  as  well  as  all  the  other  dif- 
ferences and  changes,  being,  therefore,  an  evidence  that  bloodlettino- 
produces  its  effects  upon  the  vires  vifce  of  the  solids,  and  that  the  or- 
ganic properties,  other  things  being  equal,  will  be  affected  according 
to  the  quantity  of  blood  taken,  the  manner  of  taking  it,  &c. 

952,  g.  Musgrave,  in  adverting  to  the  rapid  changes  which  tako 
place  in  the  blood  during  the  operation  of  general  bloodletting,  re- 


THKRAPEUTICS. LOSS  OF  BLOOD.  711 

marks  that  these  alterations  "  require  the  agency  of  some  third  power ; 
for  to  suppose  that  the  blood  undergoes  so  sudden  a  change  merely 
by  the  quantity  being  lessened,  would  hardly  be  more  extraordinary, 
than  to  imagine  that  pouring  a  glass  of  brandy  out  of  a  bottle  would 
turn  the  rest  into  cider"  (§  1087).*-See  Kriemer's  experiment  ^  485. 

952,  h.  How  futile,  therefore,  the  recent  observations  of  Andral  as 
to  the  relative  quantity  of  lymph  in  inflammatory  diseases  !  The  most 
bloodless  subjects  are  often  liable  to  inflammation,  and  the  loss  of  one 
or  two  ounces  may  affect,  essentially,  the  proportion  of  lymph  in  the 
next  two  ounces  (^  688  ee).  Here,  therefore,  is  proof  in  the  very  na- 
ture of  things,  which  stamps  all  these  inquiries  as  humoral  assump- 
tions. Indeed,  Andral,  himself,  had  long  before  settled  the  fallacy  of 
these  later  observations  by  the  well-grounded  statement,  in  his  Path- 
ological Anatomy,  that  "  no  one  solid  can  undergo  the  slightest  mod- 
ification without  producing  some  derangement  in  the  nature  and  qual- 
ity of  the  materials  destined  to  form  blood,  or  to  be  separated  from 
it."     And  this,  too,  from  the  father  of  modern  humoralism  (§  699  c). 

GENERAL    AND    PRACTICAL    OBSERVATIONS    ON    BLOODLETTING. 

Of  the  General  Extent  of  the  Remedy. 

953,  The  vital  influences  of  loss  of  blood  originate  in  the  vital  re- 
lations of  the  blood  to  the  organic  properties  of  the  solids.  The  blood 
being  the  fahulum  vitce,  the  solids  are  extremely  sensitive  to  any  loss 
of  this  fluid  they  may  sustain.  This  sensitiveness  resides  in  the  or- 
ganic properties  (§  184,  &c.).  Inflammation  and  fever  being  also  es- 
sentially constituted  by  a  morbid  condition  of  those  properties  (which 
are  more  susceptible  for  being  thus  affected  (§  137  d,  143  c)),  the  loss 
of  blood,  especially  in  general  bloodletting,  makes  an  instantaneous 
and  profound  impression  upon  them,  by  which  their  morbid  condition 
is  so  radically  altered  that  nature  reacts  at  once,  and  sometimes 
completes  the  cure  almost  on  the  instant  (§  137  e,  151,  152). 

954,  a.  There  can  be  no  general  rule  as  to  the  quantity  of  blood 
■which  should  be  abstracted  in  any  given  case  of  disease,  or  as  to  the 
rapidity  with  which  the  abstraction  should  be  made.  This  must  al- 
ways depend  upon  the  circumstances  of  each  individual  case,  and  upon 
the  effects  of  the  remedy  during  its  application,  which  should,  of  course, 
be  superintended  by  the  physician  (§  675). 

954,  h.  It  is,  nevertheless,  certain,  in  a  general  sense,  that  some 
definite  quantity  of  blood  should  be  removed;  and  this,  according  to 
the  nature  of  the  affected  organs,  the  character  and  intensity  of  the 
disease,  &c.  (§  133-156).  This  is  necessary  not  only  to  the  present 
effects,  but  to  the  permanent  influences  of  the  remedy.  This  perma- 
nence cannot  often  be  maintained  without  the  continued  operation  of 
a  certain  diminished  supply  of  blood  to  the  general  capillary  system 
(§  514  g,  516  d,  no.  6).  Dry  cupping,  therefore,  and  all  similar  ex- 
pedients which  are  prompted  entirely  by  enoneous  views  of  the  mo- 
dus operandi  of  loss  of  blood,  produce  none  of  the  effects  which  ap- 
pertain to  bloodletting  in  any  of  its  modes.  I  cannot,  therefore, 
accede  either  to  the  dry  cupping  of  the  distinguished  mechanical  phy- 
sician, Dr.  Arnott,  or  to  his  opinion  "  that  it  is  a  great  modern  im- 
provement in  the  practice  of  the  healing  art,  in  bleeding  for  the  cure 
of  inflammation  to  take  the  blood  away  as  quickly  as  possible;  since 

*  This  conclusion  was  no  farther  theoretical,  but  was  founded  upon  a  common-sense 
view  of  the  exigencies  of  the  case. 


712  INSTITUTES    OF    MEDICINE. 

intense  inflammations  of  the  brain,  lungs,  bowels,  &c.,  are  equally  re- 
moved by  faintness,  whether  it  happens  after  the  loss  of  two  ounces 
of  blood,  or  of  fifty." — Arnott's  Physics,  &fc. 

954,  c.  In  general  bloodletting,  the  nearer  the  loss  is  carried  to  the 
point  of  syncope  the  more  profound  and  permanent  will  be  its  effects. 
In  grave  forms  of  inflammation  and  fever  this  amount  of  influence  is 
required,  and  perhaps  at  repeated  applications  of  the  remedy  (§  999). 

954,  d  When  syncope  is  induced  by  loss  of  blood  alone  it  is  a  test 
that  the  vital  condition  of  the  small  blood-vessels  has  been  strongly  af- 
fected ;  but  more  or  less  so,  in  a  general  sense,  in  the  ratio  of  the 
quantity  abstracted.  Like  the  contraction  of  those  vessels,  syncope 
is  one,  though  a  less  simple,  consequence  of  the  vital  impression  ex- 
erted upon  them  (§  944  c,  961  e). 

955,  a.  It  should  be  said,  therefore,  in  qualification  of  the  statement 
in  section  951,  h,  that  it  is  exceedingly  rare  that  the  loss  of  a  single 
ounce  of  blood,  by  venesection,  will  subvert  inflammation  of  any  or- 
gan, especially  of  the  brain,  even  though  the  nervous  influence  be  so 
intensely  developed  as  to  establish  syncope  (§  961,  c).  The  following 
are  common  examples,  and  go  with  the  others  to  illustrate  my  doc- 
trine of  the  nervous  influence.     Thus,  Dr.  Armstrong  : 

955,  b.  "  A  patient,  at  the  point  of  death  from  acute  inflammation 
of  the  pleura  and  lungs,  was  bled  to  the  extent  of  fifty  ounces,  when 
he  had  obtained  no  relief.  If  we  had  stopped  here,  in  two  hours  the 
patient  would  have  died.  After  abstracting  about  six  ounces  more 
blood   syncope  came  on,  from  which  he  recovered  convalescent." 

If  this  patient  had  been  bled  in  an  erect  posture  and  from  both 
arms,  and  had  syncope  followed  the  loss  of  fifteen  or  twenty  ounces 
of  blood,  it  is  scarcely  probable  that  he  would  have  been  saved. 

Again,  another  patient  of  Armstrong's  "  had  been  once  bled,  af- 
ter which  the  inflammation  of  the  pleura  and  lungs  returned.  He 
had  nearly  expired  from  the  bleeding  ;  but  the  symptoms  were  so  ur- 
gent that  I  determined  to  bleed  him  decisively,  and  I  told  his  friends 
that  he  might  perhaps  even  die  under  the  operation.  I  bled  him  de- 
cisively, and  syncope  came  on  suddenly  and  continued  some  time,  so 
that  I  thought  he  would  have  died.  He  recovered  afterward  vdth 
small  doses  of  calomel  and  opium"  (§  892|,  i,  1068). 

955,  c.  Examples  of  the  foregoing  nature  have  been  of  constant  oc- 
currence, in  the  hands  of  enlightened  understanding,  from  the  time 
of  Hippocrates,  who  began  the  example.  The  proper  rule  in  extreme 
cases  was  observed,  as  above,  by  Armstrong,  and  was  thus  laid  down 
by  Celsus  :  "  It  may  happen,"  says  Celsus,  "  that  a  disease  may  re- 
quire bloodletting  when  the  system  seems  unable  to  bear  it.  Yet,  if 
there  appear  no  other  remedy,  and  the  patient  must  perish  unless  re- 
lieved by  a  rash  attempt,  it  is  then  the  part  of  a  good  physician  to  de- 
clare that  bloodletting  is  the  last  resource  of  his  art,  but  that  it  may 
precipitate  death.  Having  done  this,  he  should  bleed,  if  desired. 
There  can  be  no  room  for  hesitation  in  cases  like  this,  since  it  is  bet- 
ter to  try  a  doubtful  remedy  than  none  at  all.  And  this  ought  espe- 
cially to  be  done  when  a  paroxysm  of  fever  has  nearly  destroyed  a 
patient,  and  another  equally  severe  is  likely  to  follow.  So,  also,  in 
palsy,  and,  again,  when  angina  suffocates"  (§  892  c,  892^  i,  1068). 

955,  d.  Here  the  importance  is  fully  shown,  not  only  of  abstracting 
a  certain  quantity  of  blood,  but  of  obtaining  a  full  impression  from  the 


THERAPEUTICS. LOSS  OF  BLOOD.  713 

cerebro-spinal  influence,  in  many  cases  of  inflammatory  affections,  as, 
also,  the  error  of  Marshall  Hall's  recommendation  that  "  bloodletting 
should  never  be  carried  to  actual  syncope,  but  only  to  the  very  first 
signs  of  approaching  syncope,  which  is,  in  fact,  to  be  prevented  by  im- 
mediately laying  the  patient  in  the  recumbent  position."  Many  exam- 
ples of  the  foregoing  nature  are  presented  in  the  Commentaries,  and 
others  will  follow  in  the  present  work. 

955,  e.  Where  bloodletting  has  been  already  carried  to  a  large  ex- 
tent, yet  the  original  disease  still  perseveres ;  or  when  we  are  called 
at  the  advanced  stages  of  inflammation  or  fever,  or  where  inflamma- 
tions may  spring  up  in  subjects  exhausted  by  long  confinement,  or  in 
broken-doviTi  constitutions,  the  rules  of  practice  are  less  precise,  and 
depend  more  upon  the  circumstances  of  each  individual  case.  But, 
in  a  general  sense,  so  long  as  any  severe  or  obstinate  inflammation 
may  be  present,  whether  acute  or  chronic,  we  shall  scarcely  go  wrong 
in  absti-acting  more  or  less  blood,  not  seldom  freely,  either  by  the  lan- 
cet or  by  leeches.  This  is  the  dictate  of  philosophy,  and  it  is  enforced 
by  the  soundest  experience.  They  are  often  cases,  however,  which 
demand  habits  of  critical  observation,  accuracy  of  judgment,  and  an 
unremitting  attention  to  medical  pursuits.  Otherwise,  it  will  he  often 
but  little  better  than  the  hazard  of  the  die.  Without  these  requisites, 
where  uncertainty  prevails  in  critical  conjunctures  it  is  better  to  leave 
the  whole  matter  to  nature.  In  such  emergencies  she  will  oftener 
triumph  than  the  unskillful  practitioner,  who  may  only  embarrass  her 
efforts.  "  Medici  plus  interdum  quiete,  quam  movendo,  proficerunV 
This  principle  holds  in  the  foregoing  cases  where  art  is  imbecile  from 
ignorance.  And  so  it  is  from  inadequate  bloodletting  in  the  early 
stages  of  inflammation  and  fever. 

But,  let  it  be  remembered  that  the  two  most  important  objects  to 
be  considered  in  the  treatment  of  disease  is, 

1st.  To  adapt  our  remedies  in  all  respects  to  tlie  nature  and  existing 
condition  of  the  patliological  states. 

2d.  To  carry  tliem  as  far  as  and  no  farther  than  the  institution  oj 
such  a  change  as  will  enable  Nature  to  tahe  upon  herself,  most  success- 
fully, the  work  of  cure  (§  857). 

956.  General  bloodletting  is  the  proper  mode  of  depletion,  espe- 
cially after  the  age  of  infancy  (§  576,  e),  in  all  forms  of  fever,  and  in 
all  the  active  inflammations  of  the  internal  viscera.  This  is  particu- 
larly required  at  the  beginning  of  the  treatment,  on  account  of  the 
universal  change  which  general  bloodletting  induces  in  the  sanguif- 
erous organs  ;  thereby  relieving,  at  once,  the  instruments  of  disease  of 
a  redundant  quantity  of  blood,  and  immediately  reducing  the  force 
with  which  the  blood  is  distributed.  There  is  also  thus  obtained  a 
farther  important  advantage  from  the  potent  reflex  nervous  influence 
which  is  determined  upon  the  instruments  of  disease  by  a  great  and 
sudden  change  of  action  throughout  the  arterial  system,  as  well  as 
from  influences  exerted  upon  the  general  vital  conditions  of  numer- 
ous organs  ;  the  very  eflect  upon  the  skin,  for  example,  and  especially 
upon  the  intestinal  canal,  reflecting  a  nervous  influence  upon  other  or- 
gans which  may  be  the  seats  of  disease  ;  just  as  when  antimony  or  ip- 
ecacuanha send  their  influences  abroad  in  a  moi*e  direct  manner 
through  the  intestinal  mucous  tissue,  or  call  up  the  co-operation  of 
the  skin  with  that  tissue  in  subduing  pulmonary  inflammations  (§ 
614,  h),  by  exciting  a  complex  circle  of  reflex  nervous  actions. 


714  INSTITUTES    OF    MEDICINE. 

957.  On  the  other  hand,  if  the  treatment  have  been  begun  by  ether 
remedies,  or  if  it  have  been  neglected,  and  disease  have  thus  acquir- 
ed the  force  of  habit  (§  539),  or  if  general  arterial  excitement  have  ex- 
isted and  gone  dow^n  spontaneously,  or,  in  neglected  cases,  under  tho 
influence  of  remedial  agents,  even  of  loss  of  blood,  and  however  sud- 
denly, the  results  in  the  preceding  section  can  be  obtained  only  in  an 
inferior  degree  by  general  bloodletting.  Comparatively  little  change 
of  action  may  then  be  induced  in  the  vessels  generally ;  or  the  effect 
of  general  bloodletting  may  be  lost  in  the  influence  of  habit  (§  539,  &c.). 
Here,  too,  the  remedy  is  on  a  par,  in  principle,  with  all  others.  Nev- 
ertheless, general  bloodletting  is  likely  to  be  important  at  any  stage 
of  visceral  inflammation  so  long  as  the  disease  exists  in  much  intensi- 
ty ;  whatever  treatment  may  have  been  pursued,  or  however  the  dis- 
ease may  have  been  neglected.  But,  should  a  manifest  abatement 
have  followed  under  any  of  the  foregoing  circumstances,  leeching  may 
then  become  far  more  eflficient  than  venesection  (§  892|  i,  1008). 

958,  a.  In  the  ordinary  forms  of  active  inflammation,  and  where 

f)racticable  in  fever  (§  961-970),  the  first  bloodletting  should  be  the 
argest,  and  this  should  be  in  proportion  to  the  exigencies  of  the  case. 
We  may  often  accomplish  all  that  is  desirable  by  a  single  blow,  as  it 
wei'e ;  which  is  incomparably  better,  in  grave  inflammations  and  fe- 
vers, than  a  dozen  smaller  ones,  which  may  even  fail,  or  prove  detri- 
mental, in  the  end,  where  greater  decision,  at  the  onset,  would  have 
completed  a  cure  (§  950,  965). 

958,  b.  It  appears,  also,  from  what  has  been  said,  that  the  opera- 
tion of  general  bloodletting  should  always  be  conducted  by  the  physi- 
cian ;  and  it  is  doubtless  owing  to  disappointments  that  have  arisen 
from  consigning  the  application  of  this  important  remedy  to  the  hands 
of  barbers  and  leechers  that  it  has  fallen  into  disrepute  with  many. 
Leeching  may  be  done  by  the  unprofessional,  because  it  operates 
upon  a  modified  principle  from  that  of  general  bloodletting ;  and  it  is 
much  less  important  as  to  the  precise  quantity  of  blood  which  should 
be  abstracted,  particularly  on  account  of  slowness  (^  476^  h,  921,  937). 

But,  in  general  bloodletting,  every  thing  may  depend  upon  an  ex- 
act effect  at  the  moment  of  the  operation ;  and  that  will  depend  not 
only  upon  the  precise  quantity  of  blood  abstracted,  but  upon  the  posi- 
tion of  the  patient,  the  size  of  the  orifice,  the  flow  of  the  blood,  the 
management  of  the  patient's  mind  so  that  mental  emotions  shall  not 
interfere,  and  upon  other  well-regulated  influences  which  the  skillful 
physician  can  alone  determine,  and  alone  estimate.  Nor  can  the  most 
experienced  and  gifted  practitioner  ever  foretell,  in  any  given  case  of 
disease,  what  quantity  of  blood  should  be  abstracted,  by  the  general 
method,  under  the  best-regulated  circumstances. 

This  practice  of  intrusting  the  operation  of  general  bloodletting  to 
the  ignorant  will  cease  to  be  tolerated  when  the  modus  operandi  of  the 
remedy  shall  come  to  be  appreciated  and  acknowledged ;  nor,  until 
then,  will  it  undergo  in  the  hands  of  the  professional  that  just  appli- 
cation, according  to  the  exigencies  of  disease,  which  rarely  fails  to 
illustrate  its  remedial  effects. 

958,  c.  I  must  now  refer  the  reader  to  those  divisions  of  my  sub- 
ject where  the  distinctions  are  considered  between  leeching,  general 
bloodletting,  and  cupping,  for  other  remarks  relative  to  the  just  quan- 
tities of  blood  that  should  be  abstracted  in  certain  given  forms  of  dis- 


THERAPEUTICS. LOSS    OP   BLOOD.  715 

ease,  and  which  were  there  introduced  for  the  purj)ose  of  illustrating 
the  distinctions  between  those  several  modes  of  bloodletting. 

959,  a.  Finally,  therefore,  from  what  has  been  now  said  of  the  prin- 
ciples upon  which  bloodletting  operates,  as  well  as  from  experience, 
the  rule  as  laid  down  by  Dr.  Marshall  Hall,  and  other  late  writers, 
that  "  Syncope  is  a  uniform  criterion  of  the  quantity  of  blood  to  he  ab- 
stracted, and  which  the  nature  of  the  case  may  demand,""  is  fallacious. 
Dr.  Wardrop  gives  us  the  same  rule.  "  The  state  of  fainting,"  ho 
says,  "  is  to  be  considered  an  index  of  the  quantity  of  blood  which  is 
necessary  to  be  removed  for  the  relief  oi  the  disease."  On  the  con- 
trary, syncope  may  depend  on  so  many  other  causes  than  loss  of 
blood,  the  actual  tolerance  at  the  first  operation  may  be  so  little  that 
its  repetition  may  be  indispensable  soon  after  the  patient  revives,  and 
perhaps  to  a  large  extent  even  before  binding  up  the  arm.  These 
cases  of  early  syncope,  where  the  remedy  m§y  be  appropriate,  are, 
also,  the  very  ones  which  most  demand  repeated  abstractions  of  blood ; 
and  the  effect  produced  at  each  application  of  the  remedy  should  be  the 
measure  of  the  quantity  to  be  abstracted  (§  GST-g-,  688  d,  e,  936-938, 
943,  944,  961,  967,  981-988), 

959,  b.  "  Dr.  Moseley,"  says  Robert  Jackson,  "  advises  us  to  bleed, 
ad  deliquium,  in  yellow  fever.  I  coincide  with  him  in  recommending 
extensive  bleeding  in  this  form  of  disease  ;  but  I  do  not  accede  to  the 
rule  which  he  assumes  for  judging  of  the  measure.  It  is  vague  and 
uncertain.  Deliquium  occurs  sometimes  from  the  loss  of  a  few  oun- 
ces of  blood,  sometimes  scarcely  from  the  loss  of  six  pounds.  The 
act  of  fainting  is  not,  therefore,  a  rule  of  dependence  for  regulating 
practice"  (§  992,  994).— Note  Ff  p.  1135. 

960,  a.  Many  expedients  have  been  attempted  as  substitutes  for 
bloodletting;  from  the  comparatively  rational  method  by  cathartics, 
blisters,  and  other  subordinate  antiphlogistics,  to  the  ne  plus  ultra  ot 
dry  cupping.  It  would  be  difficult  to  assign  their  appropriate  rank, 
in  theoretical  conceptions,  to  some  of  the  novelties  which  have  been 
brought  forward,  from  time  to  time,  to  fulfill,  or  to  surpass,  the  inten- 
tions of  bloodletting,  or  to  banish  this  principal  remedy  from  the  heal- 
ing art.  Louis  undertook  its  explosion  with  more  signal  success  than 
any  other  champion  of  the  "  meditation  upon  death."  (See  Exami- 
nation of  the  Waitings  of  M.  Louis,  in  3Ied.  and  Phys.  Comm.,  vol.  ii., 
p.  679-815.)  Others,  more  inclined  than  Louis  to  lend  a  helping 
hand  to  nature,  resort  to  bold  experiment,  whose  evil  results,  if  inci- 
dent to  bloodletting,  it  must  be  allowed,  would  consign  this  remedy 
to  a  well-merited  reproach.  Thus  Pereira,  in  his  Materia  Medica, 
remarks  that, 

"  I  tried  tobacco  somewhat  extensively,  a  few  years  since,  as  a  substi- 
tute for  bloodletting  in  inflammatory  affections.  But,  while  it  produced 
such  distressing  nausea  and  depression,  that  it  was  with  difficulty  I  could 
induce  patients  to  persevere  in  its  use,  I  did  not  find  its  antiphlogistic 
powers  at  all  proportionate,  and  eventually  I  discontinued  its  employ- 
menty 

Such,  then,  is  the  philosophy  which  rears  itself  against  the  well- 
tried  and  faithful  agent ;  while  it  is  regardless,  by  its  own  showing,  of 
the  disastrous  results  of  agents  long  since  condemned  as  fruitless  and 
destructive,  and  would  vainly  endeavor  to  "  substitute"  them  for  the 
safest  and  only  effectual  remedy  for  all  grave  inflammations. 


716  INSTITUTES    <?F    MEDICINE. 

When  Pereira  urudertook  to  "  substitute,  tobacco  for  bloodletting 
in  inflammatory  affections,"  it  was  with  the  full  knowledge  that  its  use 
had  been  mostly  abandoned,  as  wanting  in  curative  virtues,  and  hos- 
tile to  life ;  that  surgeons,  even,  had  greatly  forsaken  it  as  an  enema 
in  strangulated  hernia,  on  account  of  the  frequent  deaths  it  had  pro- 
duced (§  892f  b,  893  n).  It  was  mainly  such  diseases  as  confirmed 
dropsy,  tetanus,  intractable  ileus,  and  hydrophobia,  that  were  handed 
over  to  its  tender  mercies.  Nay,  more ;  our  able  author  says  of  it, 
himself,  as  employed  for  the  relief  of  dropsy,  that, 

"  In  small  doses,  it  is  an  uncertain  diuretic,  and  in  larger  doses  it 
causes  such  a  distressing  nausea  and  depression,  that  practitioners 
have  long  since  ceased  to  use  it  in  dropsical  cases." 

How  many  perished  under  the  experiment  with  this  unmanageable 
poison  in  Pereira's  attempt  "  to  substitute  it  for  bloodletting  in  in- 
flammatory affections,'*  either  from  the  direct  effect  of  the  poison,  or 
from  the  neglect  of  bloodletting,  our  author  does  not  say  ;  tbough  con- 
fessions here  would  have  been  some  atonement  to  science  and  hu- 
manity.— Note  H  p.  1117. 

Nor  may  the  contemners  of  bloodletting,  and  of  those  who  com- 
mend its  judicious  use,  in  the  treatment  of  inflammations,  complain 
when  "  their  poisoned  chalice  is  thus  commended  to  their  own  lips." 
Were  we  to  contrast  the  victims  of  tobacco,  alone,  during  its  rage 
as  a  panacea,  with  such  as  may  be  assumed  to  have  fallen,  through  all 
time,  by  the  lancet,  it  will  not  be  denied  by  the  stoutest  prejudice  that 
the  odds  are  fearfully  on  the  side  of  the  poison.  It  is  profitable,  there- 
fore, to  pursue  this  inquiry,  and  to  interrogate  yet  farther  the  disposi- 
tion which  may  exist  in  the  most  enlightened  quarters  to  hold  on  upon 
the  worthless,  but  deadly  engines  of  the  Materia  Medica.  The  ten- 
dency may  be,  at  least,  to  induce  a  greater  toleration  of  the  useful 
means,  and  thus  to  compensate,  in  a  measure,  for  the  effects  of  poisons 
when  administered  in  what  are  regarded  as  their  therapeutical  doses. 
We  may,  therefore,  consult  another  eminent  writer  of  our  own  day, 
the  able  author  of  the  American  Medical  Botany  ;  though  he  does  not 
say,  nor  have  we  reason  to  think,  that  he  had  "  attempted  to  substitute 
tobacco  for  bloodletting  in  inflammatory  affections."  I  make  the  quo- 
tation, therefore,  to  show  how  there  will  sometimes  escape  from  the 
best  writers  and  practitioners  an  apparent  justification  of  the  woi'st 
practices  humanity  is  called  upon  to  encounter ;  and  to  contrast  the 
tacit  acquiescence  of  all  in  commendation  of  poisons  which  operate  with 
deadly  effect  in  their  authorized  doses  (and  not  unfrequently  conced- 
ing, at  the  same  time,  the  consequences  here  alleged),  with  the  denun- 
ciations of  bloodletting  which  are  wafted  from  transatlantic  shores  to 
startle  Americans  into  mute  astonishment.*   Thus,  then,  our  author : 

"  At  the  present  day,"  he  says,  "  tobacco  does  not  seem  to  be  ex- 
tensively in  use,  having  passed  into  neglect  rather  because  more  fash- 
ionable remedies  have  superseded  it,  than  because  it  has  really  been 
weighed  and  found  wanting." 

In  this  respect,  the  able  writer  is  manifestly  at  fault ;  and  if  we  only 
turn  over  this  same  leaf  from  which  I  have  made  the  quotation,  we 
shall  read  on  the  next  page  as  follows :  . 

"This  powerful  medicine  has  been  also  employed  with  some  pal- 
liative effect  in  hydrophobia,  and  certain  other  spasmodic  diseases, 
Its  internal  use,  however,  requires  great  caution,  since  patients  have, 

*  This  must  now  be  qualified,  as  at  p.  760  note^  and  Note  Mm  p.  1141.-1865. 


THERAPEUTICS. LOSS  OF  BLOOD.  717 

tn  various  instances,  been  destroyed  by  improper  quantities  adminis- 
tered by  the  hands  of  the  unskillful  or  unwary.  Notwithstanding  the 
common  use  and  extensive  consumption  of  tobacco  in  its  various  forms, 
it  must  unquestionably  be  ranked  among  narcotic  poisons  of  the  most 
active  class.  The  great  prostration  of  strength,  excessive  giddiness, 
fainting,  and  violent  affections  of  the  alimentary  canal,  which  often  at- 
tend its  internal  use,  make  it  proper  that  so  potent  a  drug  should  be 
resorted  to  by  medical  men,  only  in  restricted  doses,  and  on  occasions 
of  magnitude." 

Here,  then,  we  are  justly  told  that  tobacco  should  be  used  with 
caution  even  in  hydrophobia.  And,  suppose  it  could  be  said*  of 
bloodletting,  as  the  writer  affirms  of  tobacco,  that  "  patients  have,  in 
various  instances,  been  destroyed  by  improper  quantities,"  even  though 
a  part  of  the  injury  might  be  ascribed  to  "  the  hands  of  the  unskillful 
and  unwary ;"  the  advocates  of  the  remedy  would  scarcely  allege, 
on  seeing  it  fall  into  disuse,  what  the  foregoing  writer  does  of  tobac- 
co, that  "it  has  passed  into  neglect  rather  because  more  fashionable 
remedies  have  superseded  it,  than  because  it  has  really  been  weighed 
and  found  wanting."  No ;  they  would  acquiesce  upon  the  ground 
that  it  "  had  been  weighed  and  found  wanting."  And  now  suppose, 
again,  that  such  "  weighing  and  wanting"  were  plausably  affirmed  of 
bloodletting,  as  is  conceded,  in  reality,  by  its  best  advocates,  of  tobac- 
co, even  in  the  hands  of  the  best  practitioners, — in  their  own  hands, — 
or  only  through  ignorance  and  carelessness  alone,  the  remedy  would 
be  so  hunted  down  that  the  rational  treatment  of  inflammationil  and 
fevers  by  bloodletting  would  probably  subject  the  practitioner  to  pub- 
lic odium.  Indeed,  we  know  that  this  was  remarkably  the  case  with 
the  illustrious  Robert  Jackson,  when  he  first  began  the  explosion  of 
the  tonic  and  stimulant  treatment  which  prevailed  so  fatally  in  the 
British  Army.  He  was  generally  denounced  as  "  a  murderer"  by  the 
British  Doctors  ;  till  the  astonishingly  diminished  mortality  in  the  Brit- 
ish Army  soon  showed  them  who  the  real  murderers  were  (§  569,  e). 
On  the  other  hand,  however,  with  what  calm  indifference  we  con- 
template the  ravages  of  the  tonic  and  stimulant  treatment  of  fevers, 
and  the  no  less  inconsiderate  use  of  the  most  violent  agents  of  the  Ma- 
teria Medica,  for  the  mere  purpose  of  devising  some  expedient  that 
shall  do  away  with  the  necessity  of  bloodletting  in  acute  inflammations 
and  fevers !  (§  1065,  c,  d,  1068,  c).* 

As  to  tobacco,  in  the  treatment  of  strangulated  hernia,  we  possess 
in  tartarized  antimony,  or  even  in  the  lobelia  inflata,  far  better  and 
safer  means  for  establishing  a  relaxation  of  the  muscular  system ;  es- 
pecially in  the  former  agent.  Nay,  in  very  many  cases,  bloodletting, 
to  the  extent  of  syncope,  will  not  only  accomplish  the  intention  as 
fully,  but  bestow  the  immense  advantage  of  subduing  any  inflamma- 
tion of  the  intestine,  which  is  so  apt  to  be  produced  by  strangulation. 
Besides  the  immediate  hazard  of  life  which  is  incident  to  enemas  of 
tobacco,  there  is  the  gi-eat  objection,  that  should  it  fail  of  its  contem- 
plated purpose  the  prostration  which  it  occasions  will  render  an  op- 
eration by  the  knife  of  very  doubtful  result,  but  which  might  have 
been  perfectly  safe  before  the  administration  of  the  tobacco.  The  pa- 
tient will  be  little  apt  to  bear  the  superadded  shock  which  is  inflicted 
by  so  severe  an  operation ;  and  the  intestine,  too,  in  a  state  of  inflam- 
mation which  will  now  contribute  greatly  to  the  same  general  ex- 
*  NoTcs  F  p.  1115,  H  p.  1117,  Gg  p.  1138,  Mm  p.  1141. 


71J?  INSTITUTES    OF    MEDICINE. 

haustion.  And  since  the  question,  among  surgeons,  has  turned  main- 
ly upon  the  abstract  effect  of  tobacco  as  an  agent  of  immediate  death, 
and  witnout  much  reference  to  those  ulterior  results,  and  since  it  is  no 
proof  that  a  remedial  agent  does  not  destroy  because  the  patient  sur- 
vives its  immediate  operation,  I  may  also  say  that  its  pernicious  ten- 
dency reaches  these  cases  in  the  obstacle  which  it  places  in  the  way 
of  subsequent  bloodletting,  which  is  often  important  to  the  patient 
soon  after  the  i-eduction  of  the  intestine,  if  it  have  not  preceded  it  (§ 
576,  e)* 

But,  it  is  not  alone  this  or  that  agent,  or  other  individual  means, 
which  has  been  attempted  as  a  substitute  for  bloodletting  in  the  treat- 
ment of  inflammations.  The  whole  class  of  poisonous  agents  to  which 
tobacco  belongs  has  been  declared  on  high  authority,  as  we  have  seen 
(§  891,  c),  to  be  "the  most  important  medicines  we  possess."  And  to 
justify  yet  farther  what  I  have  said  of  British  therapeutics,  and  to  sus- 
tain the  contrast  with  American  philosophy  and  practice  (§  349  d, 
350f  k,  kk,  709,  note),  I  shall  quote  Pereira's  Materia  Medica  rela- 
tive to  his  opinion  of  opium  when  compared  with  the  uses  of  blood- 
letting, cathartics,  antimonials,  &c. 

"  Opium,''^  he  says,  "  is  undoubtedly  the  most  hnportant  and  valuable 

*  The  fascinations  which  attend  tobacco  as  a  luxury  led  to  its  extensive  use  as  a  rem- 
edy for  disease ;  and  the  question  arises  whether,  from  what  is  now  known  of  its  perni- 
cious effects  when  applied  to  the  gastrointestinal  mucous  membrane,  and  even  to  the 
skin,  in  health  as  well  as  disease,  its  moderate  use  as  a  luxury  can  be  justified  by  the 
physician?  This  question  I  shall  briefly  investigate,  for  another  purpose,  alsoj-that  of  il- 
lustrating yet  farther  certain  peculiarities  of  remedial  agents  in  relation  to  vital  habit 
(^  533,  &c.). 

There  could  be  little  doubt,  upon  principle,  that  the  various  modes  of  using  tobacco 
would  be  detrimental  in  most  conditions  of  disease,  on  account  of  the  increased  suscep- 
tibility of  organs  (^  137  d,,  150,  151).  But  it  would  be  still  a  question  of  facts  in  relation 
to  this  particular  agent  (§  650).  The  requisite  facts  are  before  us,  and  are  decisive  against 
the  luxury  in  morbid  conditions. 

But,  this  does  not  prove  that  the  moderate  use  of  tobacco  will  injure  the  health  of  those 
who  are  in  possession  of  health  (§  137,  d).  We  cannot  reason,  as  I  have  endeavored  to 
show,  from  the  effects  of  remedies  upon  man  in  health  to  man  in  disease;  excepting  as  it 
respects  their  violence  when  manifested  in  healthy  subjects.  Of  this  principle  tobacco 
affords  a  very  full  exemplification,  and  shows  that  the  principle  is  equally  true  in  its  op- 
posite aspect,  and  that  we  may  not  reason  from  the  effects  of  an  agent  which  is  deleteri- 
ous in  disease  to  its  effects  under  the  condition  of  health ;  as,  indeed,  is  shown  by  food 
itself. 

We  must,  therefore,  take  the  facts  in  all  the  cases,  and  what  other  facts  teach  us  as  to 
the  constitution  and  laws  of  organic  beings,  and  as  agents  operate  upon  different  parts. 
With  this  kind  of  philosophy,  we  are  enabled  (unexpectedly,  according  to  the  usual 
method)  to  decide  that  the  moderate  use  of  tobacco  is  rarely  deleterious  in  health,  and 
has,  therefore,  but  little,  if  any,  tendency  to  abbreviate  life.  The  law  of  vital  habit,  as 
well  as  observation,enablesus,  also,  to  know  that  the  habitual,  is  safer  than  the  inter- 
rupted, use  of  tobacco ;  so,  only,  there  be  no  excess.  The  insusceptibiUty,  which  the 
contuiued  use  establishes,  soon  passes  off  on  suspending  the  influence,  and  leaves  the  in- 
dividual more  or  less  liable  to  nauseating  and  other  morbific  effects,  on  resuming  the  lux- 
ury. If  this  be  often  repeated,  it  would  probably  lead  to  chronic  or  other  forms  of  disease 
(§  535,  &c.). 

There  is,  therefore,  a  remarkable  difference  between  the  ultimate  effects  of  the  habitu- 
al use  of  tobacco  and  of  most  other  poisonous  agents  of  the  Materia  Medica.  The  narcot- 
ics, for  example,  are  constantly  morbific,  while  continued  in  their  moderate  therapeutical 
ilose,  though  less  so  by  use  than  at  the  beginning.  But  this  is  not  true  of  many  of  the 
ordinary  causes  of  disease,  which  observe  a  coincidence  with  the  effects  that  arise  from 
the  habitual  and  interrupted  use  of  tobacco.  The  miasmata  which  lay  the  foundation  of 
fever  are  examples  (§  544,  550,  551,  552  a).  This  brings  into  view  the  differences  in  the 
vital  constitution  of  different  parts  of  the  mucous  system,  and  the  examples  are  clear  il- 
lustrations of  those  distinctions  ;  since,  in  the  case  of  the  poisonous  agents  of  the  Materia 
Medica  (including  tobacco),  they  exert  their  influences  upon  the  mucous  tissue  of  the 
stonaach  and  intestine,  while  tobacco,  as  a  luxury,  and  miasmatic  agents,  are  mostly  op- 
erative upon  other  parts.  The  same  is  seen  in  the  skin,  since  tobacco  will  not  establish 
the  habit  of  endurance  in  that  organ  (§  136,  137  h,  &c.).  Tobacco  is  also  another  wit- 
ness, m  its  associated  aspects  as  a  luxury  and  as  a  poisoa,  against  the  doctrine  cif  opera- 
tion by  absorption. 


THERAPEUTICS. LOSS  OP  BLOOD.  719 

remedy  of  the  wliole  Materia  Medica."  "  Its  good  effects  are  not,  as 
is  the  case  with  some  valuable  medicines,  remote  and  contingent,  but 
they  are  immediate,  direct,  and  obvious ;  and  its  operation  is  not  at- 
tended with  pain  or  discomfort.  Furthermore,  it  is  applied,  and  with 
the  greatest  success,  to  the  relief  of  maladies  of  every  day's  occurrence, 
some  of  which  are  attended  with  the  most  acute  human  suffering. 
These  circumstances,  with  others  not  necessary  here  to  enumerate, 
conspire  to  give  to  opium  an  interest  not  possessed  hy  any  other  arti- 
cle of  the  Materia  Medica  ;" — and  certainly  not  by  bloodletting. 

And  now  suppose  that  the  Author  of  these  Institutes  had  made  the 
same  affirmation  of  opium,  instead  of  having  bestowed  the  like  com- 
mendation upon  bloodletting  in  his  fonner  work ;  he  would  have  cheer- 
fully acquiesced  even  in  the  misrepresentations  of  his  Commentaries 
by  the  British  Medical  Press,  and  in  the  countenance  afforded  by  the 
British  Medical  Profession  of  the  great  injustice  inflicted  upon  himself, 
as  an  atonement  for  the  injury  he  might  have  done. — NoTEWp.  1127. 

Nor  did  I  scarcely  do  justice  to  the  cause  which  I  endeavor  to  ad- 
vocate, when,  in  a  former  section,  I  spoke  of  the  influence  of  the  Brit- 
ish "  Association"  in  their  concerted  action  to  overthrow  the  fabric  of 
Medicine,  and  to  raise  upon  its  ruins  the  absurdities  of  a  foreign  Chem- 
ist (§  349,  d).  The  record  should  have  been  also  made  that  the  work 
on  "  Organic  Chemistry  applied  to  Physiology'''  had  been  a  year  be- 
fore the  Profession,  ere  its  successor,  the  work  on  *'  Animal  Chem- 
istry applied  to  Pathology  and  Therapeutics,"  was  "  communicated  to 
the  British  Association  for  the  Advancement  of  Science  "  and  "  Edited 
FROM  THE  Author's  Manuscript,  by  William  Gregory,  M.D.,  Pro- 
fessor OF  Medicine  in  the  University  and  King's  College,"  and  before 
other  distinguished  British  medical  writers  became  the  systematic  In- 
terpreters of  the  Author's  meaning,  as  well  as  Champions  of  his 
doctrines  (§  350^,  350|,  Aiil^f).  The  hurricane,  I  say,  swept  over 
the  Nation,  and  such  was  its  force  upon  the  Continent,  and  even  in 
America,  that  the  learned  in  those  Countries  had  serious  doubts  of 
the  stability  of  any  science,  and  that  the  great  bulwarks,  which  had 
been  slowly  and  progressively  reared  by  the  observation  and  wisdom 
of  a  long  series  of  ages,  would  be,  hereafter,  at  the  mercy  of  any  as- 
pirant. For  all  this,  the  British  Nation  must  and  will  be  held  respon- 
sible (^  1062^-1065,  1068,  a.) 

And  now,  let  us  remember,  that  when  radical  and  enduring  changes 
may  be  wrought  in  any  science  which  is  built  upon  the  foundations  of 
Nature,  and  when,  especially,  the  phenomena  have  been  open  to  all, 
they  will  hereafter  advance  as  slowly,  at  least,  as  the  errors  had  sprung 
into  existence.  The  wisdom  of  one  generation  is,  at  most,  but  a  shad- 
ow in  advance  of  the  last ;  and,  however  discoveries  may  come  up  in 
the  open  field  of  Nature,  the  great  laws  which  have  been  educed 
from  what  was  known  in  the  past  will  be  of  no  easy  subversion.  Nor 
can  I  doubt,  that  come  what  may  to  Medicine,  we  shall  sooner  or  later 
go  back  to  Hippocrates,  and  begin  a  reconstruction  upon  the  founda- 
tions which  his  genius  and  observation  had  laid  (376|^,  376f). 

Developments  of  important  facts  in  science  and  in  art  may  advance 
with  rapidity ;  but,  even  those  details,  which  are  apt  to  grow  out  of 
principles  already  known,  are  commonly  progressive  according  to  the 
sum  of  knowledge  which  may  be  handed  over  by  one  generation  to 
*he  next  succeeding.     It  is  not,  however,  equally  true,  that  a  portion, 


720  INSTITUTES    OF    MEDICINE. 

or  the  whole  of  mankind,  relapse  into  ignorance,  speculation,  and  su- 
perstition, through  the  same  gradual  process.  The  decline  of  the 
Roman  Empire,  and  the  subsequent  darkness  which  overshadowed 
the  earth  for  six  hundred  years,  or  the  later  fall  of  Spain  from  the 
highest  to  the  lowest  rank  among  the  nations  of  Europe,  are  a  melan- 
choly commentary  upon  the  rapid  and  disastrous  influences  of  luxurious 
ease,  and  arbitrary  opinion,  upon  knowledge  and  philosophy,  and  illus- 
trate the  tardy  pace  of  the  human  mind  in  regaining  its  independence, 
recovering  the  path  of  Nature,  and  retrieving  what  it  has  lost.  Nor  is 
it  an  improbable  conjecture  that  the  serious  failure  of  a  harvest  in  Eu- 
rope, or  any  serious  impediment  to  the  outlet  of  British  manufactures, 
or  an  ascendency  of  Puseyism,  would  soon  place  our  Ancestor  by  the 
side  of  Spain. 

But,  practical  examples  in  bloodletting  are  the  best  demonstrations 
of  the  utility  of  the  specific  objects  contemplated  in  the  present  arti- 
cle. I  shall  therefore  supply  another,  which  may  be  derived  from  the 
distinguished  Mr.  Liston,  so  able  in  surgery,  and  who  advises 

"  Every  practitioner  to  think  twice  of  the  prohahle  and  possible  ef- 
fects in  every  case  of  disease  before  he  determines  upon  and  proceeds  to 
open  a  vein  for  the  purpose  of  draining  off  the  vital  fuid." 

This  distinguished  surgeon  also  recommends  the  use  of  aconite  for 
the  cure  of  erysipelas  (§  892|,  d).  Just  now,  also  (1845),  Dr.  Flem- 
ing (President  of  the  Royal  Medical  Society  of  Edinburgh)  appears 
with  an  able  work  on  the  same  most  destructive  agent;  and,  although 
agreeing  with  him,  most  entirely,  as  to  the  value  of  this  remedy  in 
neuralgia,  when  topically  applied,  and  there  be  no  active  inflammation, 
every  consideration  of  experience  is  opposed  to  his  declaration,  that, 

"  Aconite  not  only  effects  a  cure  in  a  shorter  period  than  any  other 
mode  of  trea.tment,  in  acute  rheumatism,  but  appears  to  possess  the  great 
negative  advantage  of  not  increasing  the  liability  to  extension  of  the  dis- 
ease to  the  membranes  of  the  hearth 

The  great  difficulty  with  bloodletting  in  acute  articular  rheumatism 
has  consisted  in  its  too  limited  application  ;  and  if  the  remedy,  as  is 
said,  be  chargeable  with  the  vice  of  lighting  up  the  disease  in  the 
heart,  it  is  for  the  foregoing  reason  (§  893  n,  950,  965,  1000,  1001). 
Bouillaud  is  thought  to  have  occasioned  no  little  of  this  mischief  by 
"  copious  bloodletting,"  and  mainly  because  of  his  expression, — "  coup 
sur  coup."  But,  he  rarely  ventured  beyond  a  pound  or  two  of  blood  ; 
and  this  quantity  was  made  up  by  successive  bleedings, — "  coup  sur 
coup."  His  practice,  therefore,  was  but  a  feeble  resuscitation  of  that 
far  more  successful  treatment,  in  France,  by  copious  abstraction  of 
blood. — {Med.  and  Phys.  Comm.,  vol.  i.,  p.  325,  326.) 

Finally,  I  hold  that  the  internal  use  of  aconite  is  inadmissible  in  all  ac- 
tive forms  of  inflammation,  and  endangers  life  under  all  circumstances 
of  health  or  disease.  Had  Dr.  Male,  of  Birmingham,  who  employed 
this  remedy  to  the  extent  of  some  eighty  drops  of  the  tincture  in  four 
days,  in  augmented  doses  varying  from  five  to  ten  drops,  for  the  re- 
lief of  simple,  chronic  pain  in  the  back,  upon  the  recommendation  set 
forth  in  the  work  by  Dr.  Fleming,  been  as  obviously  the  victim  of 
bloodletting  as  he  was  of  the  aconite,  it  can  hardly  be  doubted  that 
such  a  case  would  have  been  marshaled  against  bloodletting  in  all 
forms  of  disease. — Note  H  p.  1117. 

Nor  will  I  neglect  this  opportunity  of  objecting  to  the  proposition 


THERAPEUTICS. — LOSS  OF  BLOOD.  721 

ot  Dr.  Graves,  of  Dublin,  that  belladonna,  instead  of  blooc letting, 
should  be  employed  in  those  congestive  fevers  in  w^hich  cereoral  dis- 
ease is  attended  by  contraction  of  the  pupil,  and  upon  the  ground, 
mainly,  that  belladonna  so  affects  the  brain  as  to  produce  a  dilatation 
of  the  pupil.  It  is  evident,  however,  that  this  reasoning  is  fallacious ; 
for,  if  belladonna  be  given  in  any  of  the  common  forms  of  cerebral  dis- 
ease that  disease  will  be  aggravated  in  proportion  as  the  pupil  dilates 
under  the  influence  of  this  agent.  In  justice,  also,  to  the  remedy 
which  I  advocate,  I  may  say,  if  its  applicability  rested  on  no  better 
foundation,  and  if,  especially,  surrounded  by  the  same  objections  as 
belladonna,  its  recommendation  would  be  justly  regarded  as  rash  and 
unphilosophical  (§  469,  476  c,  487,  48S|-,  500  h,  569,  892  d,  906,  mot- 
to, d). 

960,  h.  It  may  be  also  difficult  to  say,  whether  the  mere  negative 
pretext  for  loss  of  blood,  such  as  dry  cupping,  or  the  substitution  of 
violent  internal  agents  without  a  plausible  apology,  or  the  more  com- 
mon and  exclusive  dependence  upon  cathartics,  and  other  acknowl- 
edged but  minor  antiphlogistics,  has  been  most  destructive  of  life. 
Certain  it  is,  however,  that  they  who  most  discourage  bloodletting  are 
genei'ally  the  greatest  advocates  of  the  violent  agents  of  the  Materia 
Medica.  And,  it  is  not  a  little  astonishing  with  what  calm  indiffer- 
ence we  contemplate  the  ravages  of  this  unmitigated  practice,  or  the 
tonic  and  stimulant  treatment  of  fevers ;  and  more  especially  when 
the  consequences  are  alienating  multitudes  to  the  soft  embraces  of 
homoeopathy  (§  857,  878,  893  «).— Note  H  p.  1117. 

960,  c.  I  have  already  stated  my  opinion  that,  among  the  sequelae  of 
morbid  anatomy  as  originally  taught  by  the  modern  Parisian  school, 
and  adopted  by  others,  is  the  system  of  "  Specialities ;"  a  name  suffi- 
ciently significant  of  its  dismemberment  of  medicine.  To  this  inno- 
vation upon  a  comprehensive  science,  whose  parts  can  be  no  more 
separated,  and  viewed  in  the  abstract,  than  any  one  of  the  great  or- 
gans of  life  can  be  separated  from  the  rest,  and  yet  go  on  with  its  own 
functions  and  the  residue  of  the  shattered  whole  with  theirs,  may  be 
traced  up  many  of  the  great  errors  in  practice  as  well  as  in  medical 
philosophy  (§  129,  137  e,  163,  638,  685,  686).  That  the  "special" 
system  was  an  immediate  emanation  from  the  hospitals  of  Paris  is 
evident  not  only  fiom  the  natural  relations  of  the  pursuits,  but  from 
the  fact,  also,  that  they  sprung  up  together.  Nature  thus  became  dis- 
jointed ;  every  thing  in  disease  took  on  the  aspect  of  materialism ; 
nothing  was  to  be  seen  but  lesions  of  structure  within,  and  blotches 
and  scabs  upon  the  surface ;  one  kind  of  fever  was  located  in  the  liv- 
er, another  in  the  spleen,  and  dropsy  in  "  Bright's  disease  of  the  kid- 
neys." Medicine  was  cut  up,  in  the  Parisian  hospitals,  into  numerous 
tragments,  and  brought  under  all  the  details  of  the  mechanical  princi- 
ple of  "  a  division  of  labor."  Much,  however,  is  owing  to  an  igno- 
rance of  the  laws  of  the  nervous  system  in  their  relations  to  disease. 
But,  it  is  also  to  the  same  method,  in  part,  that  we  must  ascribe  the 
attempts  of  a  smaller  number  to  substitute  tobacco,  belladonna,  aco- 
nite, &c.,  for  bloodletting,  in  the  treatment  of  inflammation  and  fever  ; 
and  it  is  upon  this  ground  that  Magendie'  was  led  to  imagine  that  he 
had  produced,  in  the  presence  of  his  class,  yellow  fever  in  dogs,  and 
typhus  fever  in  cats  (§  744),  and  which,  especially,  has  induced  many 
to  believe  in  the  matchless  virtues  of  quinia  as  displayed  by  Piorry 

Z  z 


722  INSTITUTES   OF    MEDICINE. 

when  he  attempted  the  dislodgment  of  intermittent  fever  from  an  in- 
durated spleen  (§  892,  Jc,  892|  i). 

960,  d.  But,  it  is  not  alone  the  intrinsic  nature  of  the  fundament- 
al evil  which  has  introduced  the  new  system  of  teaching  medicine. 
There  never  was  a  time  when  so  many  zealous  aspirants  were  com- 
mended to  places  either  by  clamors,  or  by  the  force  of  industry.  The 
revolution  was  also  only  a  part  of  the  fashion  of  the  day  ;  and  its  pre- 
cipitation harmonized  exactly  with  the  achievements  in  medical  chem- 
istry, and  other  analogous  varieties  in  the  wide  field  of  philosophy. 
Fortunately,  this  corruption  has  not  yet  fastened  itself  upon  the  Medi- 
cal Colleges  of  Great  Britain  or  America ;  and  the  hope  may  be  there- 
fore entertained  that  the  worst  of  it  has  passed  (^  1008). 

960,  e.  Nor  will  I  leave  the  foregoing  allusions  to  the  comparative 
value  and  abuse  of  the  great  agents  for  disease,  without  referring  to 
the  general  apathy  which  is  manifested  at  the  havoc  which  the  whole 
band  of  empyrics  are  dealing  out  with  their  domestic  engines  of  death  ; 
while,  were  the  lancet  equally  common  in  their  hands,  and  only  now 
and  then  a  startling  slaughter,  that  solitary  result  would  rouse  the  in- 
dignation of  the  profession,  and  distm-b  the  peace  of  society. 

960, _/!  The  advocates  of  bloodletting  have  sometimes  affected  its 
reputation  by  the  mere  language  in  which  it  is  recommended.  They 
are  said  to  be  rash ;  and  bloodletting  shares  the  odium.  Thus,  Dr. 
Elliotson,  in  speaking  of  enteritis,  remarks,  that  "  The  first  thing  one 
has  to  do  is  to  bleed  the  patient  well.  You  mitst  set  him  vpright  as  he 
can  be,  and  bleed  him  from  a  large  orifice  without  any  mercy ^  The 
prejudiced,  or  unreflecting,  look  only  at  the  language  ;  but  an  upright 
posture,  and  a  large  orifice,  render  the  operation  safe,  and  compara- 
tively mild,  though  it  proceed,  as  it  should,  ad  dellquium. 

960,  g.  I  have  no  doubt  that  much  of  the  antipathy  to  bloodletting 
has  grown  out  of  an  illusion  natural  to  the  fears  of  man.  It  is  not 
wholly  predicated  of  debility;  for  we  constantly  meet  with  admoni- 
tions against  its  use  in  high  inflammations,  which  are  not  remarkable 
for  their  prostrating  effect.  But,  there  is  nothing  more  deeply  implant- 
ed than  the  knowledge  of  the  immediate  importance  of  the  "  vital  fluid" 
to  the  life  of  every  animal ;  and  this  conviction  has  been  farther  roused 
into  operation  by  perverting  the  authority  of  Holy  Writ,  that  "  in  the 
blood  is  the  life  thereof;"  though,  had  Scripture  said  that  in  Calomel, 
Jalap,  and  Emetic  Tartar,  or  Tobacco,  Aconite,  Lobelia,  and  Bran- 
dreth's  Pills,  is  the  death  thereof,  the  quotation  would  have  been 
hourly  apposite.  We  are,  also,  dead  in  a  few  seconds  from  the  divis- 
ion of  a  large  artery  ;  and  we  scarcely  see  a  difference  in  the  rapidity 
of  the  result  when  this  method,  or  a  division  of  the  medulla  oblonga- 
ta, is  employed  for  the  destruction  of  life.  Hence,  many  come  to  as- 
sociate bloodletting,  as  practiced  for  the  relief  of  disease,  with  the  ex- 
treme method  of  effecting  death.  I  shall  not  dwell  upon  this  want  of 
philosophy,  but  shall  only  now  say,  that  it  is  the  same  defect  which 
leads  the  objectors  to  bloodletting  in  disease  to  its  constant  applica- 
tion to  pregnant  women,  and  to  others  dying  of  apoplexy,  or  from  the 
shock  of  a  fall,  or  from  drinking  cold  water,  and  where  there  may 
have  been  no  other  inducement  for  the  practice  than  the  capricious 
desire  of  the  subject,  or  the  prejudice  of  society.  I  shall,  however, 
endeavor  to  indicate  still  farther  the  fallacy  of  the  latter  practice,  and 
to  point  out,  as  it  respects  disease,  some  of  the  principal  causes  wfiich 


THERAPEUTICS. LOSS    OF   BLOOD.  723 

modify  the  necessities  of  the  system  in  relation  to  its  ordinary  supply 
of  blood,  and  how  it  sustains  the  privation  by  the  same  contingent  in- 
fluences. 

960,  li.  Let  us,  finally,  have  a  word  upon  the  doctrine  laid  down 
and  so  well  understood  by  Hippocrates,  that,  "  Severe  diseases  require 
sevei-e  revicdies'^  (§  906,  motto,  e). 

From  what  has  been  said  under  the  general  consideration  of  Thera- 
peutics, it  appears  that  this  rule  is  to  be  received  in  a  broad,  not  a 
universal,  sense  (§  906, y).  We  have  seen,  for  example,  that  it  is  re- 
markably liable  to  exception  in  small-pox,  &c.  This  grows  out  of 
the  nature  of  the  predisposing  causes  of  disease,  which  alter  the  prop- 
erties of  life  according  to  the  nature  of  each  agent.  Each  one,  as  I 
have  said,  affects  them  in  hind,^  and  in  a  way  peculiar  to  itself.  We 
have  seen  this  impressively  exemplified  in  the  self-limited  diseases  ; 
and  it  is  shown  in  the  morbific  effects  of  all  the  agents  of  the  Materia 
Medica.  One  will  alter  the  vital  states,  either  in  health  or  disease, 
more  profoundly  and  more  permanently  than  others.  Such,  also,  is 
the  principle  upon  which  depend  the  hereditary  predispositions  to  dis- 
ease. Then  we  have  those  dormant  changes  which  constitute  the  pre- 
disposition to  idiopathic  fever,  and  which  may  be  in  a  state  of  incuba- 
tion for  a  year  or  more  before  the  final  explosion. 

In  all  such  cases,  the  properties  of  life  are  more  or  less  permanent- 
ly affected,  though  not  profoundly,  till  an  explosion  of  more  absolute 
disease  shall  follow  ;  but  often  as  the  result  of  a  long  and  impercepti- 
ble series  of  morbid  changes.  In  tuberculous  phthisis,  cancer,  syphilis, 
&c.,  the  properties  of  life  are  deeply,  as  well  as  more  permanently 
and  obstinately  affected,  and  it  may  be  impracticable  for  art  to  induce 
such  changes  as  shall  place  the  diseased  states  in  a  recuperative  con- 
dition; though  disorganization  may  be  now  the  main  obstacle. 

Then  we  have  the  varieties  and  gradations  of  febrile  and  inflamma- 
tory diseases,  which,  according  to  the  nature  of  the  predisposing  causes, 
either  yield  spontaneously,  or  submit  readily  to  appropriate  remedies, 
or  the  force  of  disease  may  be  too  intense  for  active  treatment  (§  961). 

Here,  too,  we  derive  important  lessons  from  experience,  in  a  more 
restricted  sense,  which  go  with  what  experience  has  reduced  to  prin- 
ciples in  respect  to  the  modifying  effects  of  the  remote  causes  of  dis- 
ease, in  establishing  the  principle  that  the  treatment  of  disease  must 
be  governed  by  the  existing  pathological  states,  and  with  a  reference 
to  the  nature  of  the  predisposing  causes,  and  that  great  modifications 
may  be  necessary  in  diseases  of  a  common  genus,  though  all  the  cases 
may  be  distinguished  by  equal  violence,  and  by  many  prominent  phe- 
nomena that  may  be  very  analogous.  It  is  now,  therefore,  that  we 
find  the  general  rule,  that  "  severe  diseases  require  severe  remedies," 
may  demand  a  great  modification  (§  52,  137  d,  e,  143  c,  150-152,  163, 
650,  666,  670,  673,  674  d,  675,  685,  686,  847  g,  854  d,  856  b,  857, 
858,  859  b,  861,  863,  868  b,  870  aa). 

The  application  of  the  rule  will  depend,  I  say,  in  a  general  sense, 
upon  the  nature  of  the  remote  causes,  the  organs  affected,  and  the 
extent  in  which  the  restorative  principle  is  impaired.  A  vast  variety 
of  diseases  require  no  aid  from  art.  Others,  again,  like  pneumonia, 
enteritis,  &c.,  require  a  prompt  and  energetic,  interference.  But, 
againfthere  are  maladies  of  great  violence,  as  in  the  examples  already 
mentioned  of  small-pox,  measles,  scarlatina,  &c.,  in  which  the  same 


724  INSTITUTES    OF    MEDICINE. 

treatment  cannot  be  pursued,  in  a  general  sense,  as  in  many  diseases 
whose  symptoms  are  much  more  violent  (^961,  964,  976,  c). 

It  might,  therefore,  seem  that  Nature  is  here  contradicting  herself. 
But  it  is  far  otherwise.  The  apparent  contradictions  are  only  illus- 
trations of  her  perfect  consistency,  and  of  the  great  laws  that  morbific 
causes  alter  the  nature  of  the  properties  and  functions  of  life  accord- 
ing to  the  virtues  of  each  cause,  and  that  artificial  impressions  can  be 
salutary  only  in  proportion  as  the  morbific  causes  impair  the  recuper- 
ative principle.  But,  owing  to  constitutional  peculiarities,  and  vari- 
ous incidental  influences,  the  disposition  to  the  restorative  process  in 
the  self  limited  diseases  may  be  more  or  less  impaired,  or  inflammation 
of  important  organs  may  supervene,  when  Nature  will  require  the  in- 
tervention of  art,  according  to  the  existing  modifications  and  compli- 
cations of  disease.  Again,  as  in  the  hot  stage  of  fever,  the  very  recu- 
perative efforts  of  Nature,  if  I  may  say  so,  are  often  so  excessive  as 
to  result  in  actual  increase,  or  in  developments  of,  disease,  and  there- 
fore require  the  interposition  of  art  for  a  certain  degree  of  restraint 
(§  675).     These  principles  will  be  now  illustrated  by  the  efiects 

Of  Bloodletting  in  the  Congestive  Forms  of  Disease. 

961,  a.  It  often  happens  that  idiopathic  fever  is  attended  with  ve- 
nous congestion  of  one  or  more  important  organs ;  and,  as  we  have 
seen,  it  is  the  tendency  of  this  inflammatory  condition  of  the  venous 
tissue  to  embarrass  the  organs  of  circulation,  especially  the  heart. 
The  same  peculiar  influences  are  sometimes  witnessed  in  the  inflam- 
mations of  other  tissues  ;  particularly  in  the  advanced  stages  of  phthi- 
sis pulmonalis  (§  961,y).  In  all  the  congestive  forms  of  disease,  es- 
pecially when  of  an  acute  nature,  the  general  susceptibility  of  the 
system  to  the  loss  of  blood  is  increased.  I  may  also  say  that  the  pros- 
tration which  is  induced  by  venous  inflammation  is  quite  different  from 
that  which  results  from  inflammations  of' any  other  tissue  (§  135-137, 
140,  150).  It  is  also  greatly  different  from  that  which  attends  the 
cold  stage  of  fever.  In  the  first  case,  very  morbific  nervous  actions 
are  reflected  upon  many  important  organs,  and,  unless  artificially  re 
lieved,  the  powers  of  life  may  sink  rapidly  to  a  state  of  extinction. 
Nature  is,  as  it  were,  knocked  down,  and  is  incapable  of  a  recupera- 
tive effort.  In  the  last  cases,  however,  the  impression  is  manifested 
chiefly  in  the  circulatory  system.  There  is  not  that  profound  lesion, 
in  the  absence  of  venous  congestion,  which  prevents  the  recuperative 
effort ;  and  hence  it  probably  always  happens  in  pure  fever  that  reac- 
tion soon  follows  the  stage  of  depression  (§  675,  764).  Something 
like  the  converse  of  this  is  seen  in  those  erysipelatous  inflammations 
of  the  throat  which  sometimes  give  rise  to  an  apparently  great  com- 
motion of  the  system.  But,  if  there  be  no  great  amount  of  abdominal 
disease  attendant  on  these  cases,  the  reflex  nervous  action  is  ex- 
pended upon  the  circulatory  apparatus  ;  when  any  remedy  that  will 
relieve  the  throat  will  be  followed  at  once  by  a  subsidence  of  the  ar- 
terial excitement  (§  140,  927  h).  But,  these  cases  are  apt  to  be  com- 
plicated with  obscure,  though  severe  congestive  disease  of  the  abdom- 
inal organs,  especially  of  the  liver,  which  has  thrown  deeply  a  morbific 
predisposition  over  many  other  parts,  and  which,  in  consequence,  feel 
more  profoundly  the  influences  propagated  by  the  intense  inflamma- 
tion of  the  fauces      In  such  instances,  however,  the  general  arterial 


THERAPEUTICS. LOSS  OF  BLOOD.  725 

excitement  is  less  than  in  some  of  the  violent  affections  of  the  fauces 
which  may  be  greatly  of  a  local  nature,  or  where  any  accompanying 
abdominal  disease  may  be  of  a  different  nature  from  congestion  (§ 
689  I,  973),  and  according  to  the  nature  of  the  reflex  nervous  actions. 

961,  b.  Venous  congestion,  independent  of  fever,  is  a  common  form 
of  disease,  and  manifests  the  same  tendency,  as  when  connected  with 
idiopathic  fever,  to  embarrass  the  organs  of  circulation.  But,  this  is 
only  a  contingent  effect ;  since  the  general  manifestations  of  the  disease 
in  respect  to  the  circulatory  apparatus  exist  in  a  subdued  form  of  that 
excitement  which  attends  the  ordinary  forms  of  inflammation  (§  390  b, 
688  C-X-,  786,  &c.,  978).  But,  when  venous  congestion  becomes  sud- 
denly aggravated,  or  other  causes  may  increase  the  susceptibility  of 
ihe  system  so  that  the  congestive  disease  may  be  more  sensibly  felt  in 
its  sympathetic  influences,  there  often  takes  place  a  general  prostra- 
tion of  the  animal  functions,  and  a  very  impaired  condition  of  the  or- 
ganic, through  a  peculiarly  alterative  reflex  nervous  action.* 

It  is,  however,  in  congestive  fever  that  we  witness  the  strong  dem- 
onstrations of  venous  congestion  in  generating  extensive  and  profound 
lesions  through  its  very  morbific  reflex  nervous  actions.  This  is  espe- 
cially true  if  the  local  disease  exist  at  the  invasion  of  the  constitution- 
al malady.  It  has  then  already  shed  a  malign  influence  in  connection 
with  the  predisposition  to  the  general  disease ;  and,  as  these  influen- 
ces progress  together,  they  come  in  with  intense  force  when  the  explo- 
sion takes  place,  and,  unless  art  should  now  interpose,  the  diseases  go 
on  mutually  exasperating  each  other,  and  calling  into  existence  other 
congestions,  or  inflammations,  which  make  all  haste  to  join  in  the 
circles  of  disordered  movements  (§  143,  514  Ji,  666,  902  g).  The 
presence  of  venous  congestion  not  only  aggravates  the  constitutional 
disease,  but,  in  itself,  modifies  the  nature  of  that  affection  for  the 
worse  (§  786,  &c.),  prolongs  the  stage  of  intense  morbid  action  (§ 
764,  a),  often  prevents  the  succession  of  the  hot  stage,  and  does  its 
own  peculiar  part  in  overthrowing  the  organic  functions  ;  often  ex- 
erting its  malign  influence  till  subdued  by  art  (§  927).  Here,  too,  it 
is  that  art  must  make  its  demands  upon  science  more  extensively,  more 
deeply,  than  in  any  other  conditions  of  disease.  The  proper  manage- 
ment of  bloodletting,  cathartics,  &c.,  or  whether  a  stimulant  shall  be 
first  administered,  or  whether  under  the  most  appalling  aspects  of  the 
combined  force  of  disease  we  shall  leave  all  to  Nature  till  she  will 
admit  of  help,  are  often  problems  upon  which  life  is  poising  at  the 
moment,  and  can  be  resolved  only  by  the  enlightened  physician. 

But,  it  commonly  happens  that  remedial  aid  may  be  promptly  and 
efficiently  administered ;  and,  it  will  be  my  purpose,  therefore,  to  in- 
dicate that  system  of  treatment  which  is  demanded  in  a  vast  propor- 
tion of  the  cases  (§  1056,  1068,  a). 

As  a  preliminary  step,  I  must  refer  the  reader  to  what  I  have  said 
of  the  pathology  of  venous  congestion  (§  786-818),  and  especially  to 
the  Medical  and  Physiological  Commentaries,  for  the  proof  of  the  in- 
flammatory nature  of  venous  congestion,  and  its  dire  effects  upon  or- 
ganic life.  It  is  also  important  to  add,  in  this  place,  that  although 
there  exist  more  or  less  apparent  prostration  of  life  in  the  aggravated 
conditions  of  venous  congestion,  and  of  active  phlebitis,  as,  also,  in 
congestive  fever,  the  term  is  here  employed  in  a  conventional  sense, 
and  not  as  significant  of  debility,  or  of  any  necessary  depression  of 

*  The  blood  often  gravitates  from  congested  veins  after  death,  especially  of  the  liver, 
leading  to  a  false  conclusion  that  there  had  been  no  such  affection  (§  699  c,  800). 


726  INSTITUTES   OF    MEDICINE. 

vital  action.  The  circulatory  organs  are,  indeed,  often  more  or  less 
sunken  in  their  action ;  but  the  immediate  instruments  by  which  the 
morbid  processes  are  carried  on  are  actually  exalted  in  their  organic 
properties.  These  properties,  too,  are  now  greatly  diverted  from 
their  natural  state ;  and  it  is  that  alteration  in  kind  which  essentially 
constitutes  the  local  condition  of  disease,  and  from  which  arise  its  mor- 
bific reflex  influences,  and  it  is  this,  and  the  partial  loss  of  volun- 
tary control  over  the  muscles  of  animal  life,  which  have  led  to  the 
doctrine  of  debility  (§  410,  476  c,  487  h,  500  7i,  569,  639,  743,  746, 
780,  915-921,  999  ^).— Note  Ff  p,  1135. 

961,  c.  In  consequence  of  the  foregoing  morbid  state,  the  sudden 
abstraction  of  two  or  four  ounces  of  blood,  in  congestive  fevers,  ute- 
rine phlebitis,  &c.,  will  often  produce  syncope.  But,  where  the  com 
plications  consist  of  the  ordinary  forms  of  inflammation  and  venous 
congestion  a  greater  loss  of  blood  will  be  sustained  at  its  first  ab- 
straction ;  though  generally  less  than  when  the  same  inflammation  is 
unattended  with  congestion  (§  137  d,  140,  476|  7i,  803,  804,  806,  973). 

961,  d.  In  the  foregoing  cases  a  small  loss  of  blood  will  frequently 
create  a  greater  tolerance  of  the  remedy ;  especially  if  syncope  super- 
vene. It  happens,  therefore,  in  numerous  cases,  that  we  may  proceed, 
soon  afterward,  to  abstract  sixteen  to  forty  ounces  without  producing 
syncope.  The  first  impression  on  the  organic  properties  so  modifies 
their  condition  and  lessens  their  susceptibility,  and  mitigates  the  force 
of  disease,  and  releases  the  embarrassed  circulation,  that  the  subse- 
quent and  greater  loss  of  blood  often  fails  of  producing  any  powerful 
influence,  unless  carried  to  a  pretty  large  extent.  Dr.  Burnett,  in 
describing  the  congestive  fevers  of  the  Mediterranean,  says,  "  it  will 
often  happen,  after  a  few  oimces  of  blood  have  flowed,  that  syncope 
will  be  induced.  But,  in  the  course  of  an  hour  the  bleeding  may 
generally  be  repeated,  and  thirty  or  forty  ounces  may  be  taken  away 
without  producing  syncope."     Such  has  been  often  my  experience. 

961,  e.  In  cases  of  the  foregoing  nature  there  is  more  or  less  de- 
termination of  blood  from  the  circumference,  and  its  consequent  accu- 
mulation about  the  right  cavities  of  the  heart,  by  which  this  organ  is 
embarrassed  in  its  action,  generally  contributes  to  the  early  syncope. 
Among  the  results  of  the  vital  change  effected  in  the  capillary  vessels 
by  a  small  loss  of  blood  is  their  immediate  expansion,  and  a  returning 
equilibrium  of  the  circulation.  It  is  true  that  loss  of  blood,  by  increas- 
ing the  contraction  of  the  capillary  vessels,  increases,  also,  the  deter- 
mination of  blood  upon  the  heart;  and  it  is  in  part,  as  I  have  said,  for 
this  reason,  that  a  small  loss  of  blood  often  overpowers  the  circulatory 
organs.  But,  when  syncope  passes  away,  this  state  of  the  circulation, 
and  other  morbid  phenomena,  will  have  been  more  or  less  subdued. 
The  influence  of  loss  of  blood  which  results,  as  a  primary  effect,  in 
increasing,  or  producing  a  contraction  of  the  capillary  blood-vessels, 
is  so  essentially  different  from  that  of  the  morbific  cause  which  deter- 
mines, apparently,  the  same  phenomenon  in  the  cold  stage  of  fever,  as 
in  the  analogous  conditions  of  venous  congestion,  that  it  alters  the 
morbid  state,  and  thus  places  the  vessels  in  a  way  to  undergo  an  ac- 
tive expansion ;  or  reaction,  as  it  is  called.  And  herein  we  witness  a 
critical  instance  of  the  alterative  nature  of  loss  of  blood,  and  how  its 
influences  are  exerted,  and  how  apparently  the  same  phenomenon  is 
not  the  same,  and  may  be,  therefore,  due  to  even  opposite  causes  (§ 
150-152,  650,  1039,  1040,  1056,  944  c,  954  d). 


THERAPEUTICS. LOSS    OF    BLOOD.  72T 

961,y.  We  sometimes  observe  a  similar  prostration  of  the  circula- 
tory organs  from  acute  inflammation,  when  attended  with  pain,  espe- 
cially of  the  intestines.  Here,  too,  is  the  same  inability  at  first  to 
bear  the  loss  of  blood,  and  the  same  tolerance  created  by  its  abstrac- 
tion (§  961,  a).  Thus,  Dr.  Wardrop  :  "A  gentleman  was  seized  with 
acute  pains  in  his  bowels,  accompanied  with  a  good  deal  of  tender- 
ness on  slight  pressure,  along  with  some  degree  of  febrile  excitement. 
On  opening  a  vein  in  his  arm,  only  a  few  ounces  of  blood  were  re- 
moved, when  the  pulse  sank  and  he  fainted.  In  two  hours  afterward 
I  bled  him  again,  and  he  did  not  fall  into  a  state  of  syncope  until  he 
had  lost  about  thirty  ounces  of  blood"  (p.  79,  Note  as  to  pain). 

Many  examples  of  the  foregoing  nature  occur  in  the  "  Commenta- 
riesP 

962.  When  syncope  is  produced  by  a  small  loss  of  blood,  and  by 
the  loss  alone  (§  938),  and  where  this  remedy  is  demanded,  the  dis- 
ease is  serious,  and  will  probably  require  one  or  more  prompt  repeti- 
tions of  general  bloodletting.  Nothing  short  of  this  treatment  will  be 
likely  to  subdue  the  obstinate  venous  congestions  which  are  the  usual 
cause  of  the  prostration  of  the  system,  and  of  the  intensity  of  the  fe- 
brile force,  if  complicated  with  this  constitutional  form  of  disease. 

963.  If  mental  causes,  or  intestinal  irritation,  have  contributed  to 
early  syncope,  we  may  generally  proceed  to  the  farther  abstraction  of 
blood  soon  after  the  patient  revives,  which,  in  the  cases  now  under 
consideration,  is  commonly  important  (§  937).  If  loss  of  blood, 
alone,  have  been  the  cause  of  the  early  paroxysm,  a  longer  interval 
(four,  six,  or  eight  hours)  may  be  most  expedient,  or  necessary  (§ 
794,  795,  801).     The  state  of  nervous  influence  decides  the  whole. 

964.  a.  In  the  cases  now  supposed,  the  prostration  is  sometimes  so 
great  that  it  may  be  necessary  to  create  a  tolerance  of  loss  of  blood  by 
previous  stimulation,  or  before  resorting  to  the  repetition  of  bloodlet- 
ting (§  961,  V).  And  here,  too,  enlightened  experience  abounds  in 
the  records  of  medicine.     Thus: 

"  Immediately  upon  the  application  of  warmth  to  the  surface,"  says 
Dr.  Gallup,  "  take  a  little  blood ;  perhaps  two,  four,  six,  or  eight 
ounces,  according  as  the  patient  may  bear  it.  If  he  be  a  little  faint,  it 
is  nothing  but  what  is  common  ;  a  little  time  will  remove  it.  He  will 
soon  bear  a  second  bleeding  in  this  condition  better  than  the  first." 

Aretaeus  not  only  describes  this  condition  of  disease,  but  advises 
the  same  enlightened  practice,  especially  if  the  congestion  be  the  oc- 
casion of  great  prostration  and  "  syncope."  "  Venas  itaque  in  cubito 
protinus  caedito,  multumque  sanguinis,  sed  non  semel  totum  mittito ; 
imo,  et  bis,  et  ter,  alio  die,  quo  interim  vires  instaurcntur  repitito." 
Alexander  of  Tralles  discourses  in  the  same  manner  upon  this  subject. 
The  language  of  A.  Pare  is  remarkably  graphic  in  describing  the  treat- 
ment of  the  Plague  and  "  Pestilent  Diseases."  It  con-esponds  with 
the  best  philosophy  of  our  own  day. 

"  So  soon,"  he  says,  "  as  the  heart  is  strengthened  and  corroborated 
^ith  cordials  and  antidotes,  we  must  come  to  phlebotomy  and  purging." 
"  You  may  perceive  that  the  patient  is  ready  to  swoon  when  that  his 
forehead  waxeth  moist  with  a  small  sweat  suddenly  arising,  by  the 
aching  or  pain  at  the  stomach,  with  an  appetite  to  vomit,  and  desire 
to  go  to  stool,  gaping,  blackness  of  the  lips,  and  sudden  alteration  of 
the  face  into  paleness,  and,  lastly,  most  certainly  by  a  small  and  slo\^ 


728  INSTITUTES    OF    MEDICINE. 

pulse  :  and  then  you  must  lay  your  finger  on  the  vein,  and  stop  it  until 
the  patient  come  to  himself  again,  either  by  nature,  or  else  restored 
by  art ;  that  is  to  say,  by  giving  him  wine,  or  any  such  like  thing : 
then,  if  you  have  not  taken  blood  enough,  you  must  let  it  go  again,  and 
bleed  so  much  as  the  greatness  of  the  disease  or  the  strength  of  the 
patient  will  require  or  permit"  (§  892|,  i). 

9G4,  h.  No  injury  can  grow  out  of  the  use  of  stimulants  in  these 
cases  while  the  powers  and  actions  of  life  are  so  morbidly  aftected  as 
to  be  still  more  injured  by  the  loss  of  a  small  quantity  of  blood.  In 
these  cases;  bloodletting,  without  previous  stimulation,  impairs  still 
farther  the  vires  vitse,  which  are  now  too  morbid  to  react  under  its 
influence,  and  it  increases,  permanently,  the  determination  of  blood 
from  the  circumference  to  the  centre. 

964,  c.  In  other  cases  like  the  foreacoin":  disease  is  so  intense  at  its 
mvasion,  and  Nature  so  little  recuperative,  that  it  may  be  impossible 
to  create  a  tolerance  of  loss  of  blood.  No  reaction  appears  in  these 
cases,  and  all  such  patients  must  perish  (§  149,  150,  794,  795,  801, 
808  b).     Nothing  will  rouse  an  exciting  reflex  nervous  action. 

964,  d.  At  other  times,  even  in  the  active  forms  of  inflammation, 
the  power  of  the  system  to  bear  the  loss  of  blood  may  be  destroyed 
by  other  remedies.  Thus,  it  frequently  happens  in  croup,  that  emet- 
ics, especially  of  tartarized  antimony,  render  bloodletting  impractica- 
ble, particularly  when  they  produce  catharsis  instead  of  vomiting ; 
and  the  patients  may  then  die  from  their  inability  to  sustain  the  ne- 
cessary loss  of  blood.  Thence  appears  the  importance  of  carefully 
considering  their  relative  order  in  the  administration  of  remedies,  es- 
pecially where  loss  of  blood  may  be  essential.  I  am  certain,  from  ob- 
servation, that  bloodletting  has  lost  its  reputation,  with  some,  in  pneu- 
monia, &c.,  from  its  having  been  applied  unsuccessfully  under  the 
prostrating  influence  of  tartarized  antimony,  and  when,  in  conse- 
quence, the  powers  of  the  system  would  only  admit  of  a  moderate  loss 
of  blood,  and  would  not  bear  the  superadded  depressing  nervous  action. 

965,  a.  Dr.  M.  Hall,  and  some  other  writers,  suppose  that  the  pow- 
er of  the  system  to  bear  an  increased  loss  of  blood  is  owing  to  an  in- 
crease of  disease ;  which  appears  to  me  an  important  practical  error. 
On  the  contrary,  the  first  bloodletting  generally  diminishes  the  activity 
of  inflammation,  however  it  may  subsequently  acquire  its  original  or 
greater  force.  It  is  true  that  an  increase  of  inflammation  will  act  in 
the  manner  supposed  ;  but  it  does  not  thence  follow  that  there  has 
been  an  increase  of  disease  in  other  cases  because  the  patient  bears 
a  second  better  than  the  first  bloodletting.  Indeed,  in  the  cases  now 
before  us  an  increase  of  the  venous  congestion  after  the  first  blood- 
letting often  diminishes  the  tolerance  of  loss  of  blood,  on  account  of 
the  peculiar  influences  of  that  form  of  disease.  This,  too,  is  especially 
apt  to  occur  where  the  abstraction  of  blood  has  been  inadequate  to 
the  exigencies  of  the  case  ;  and  these  cases,  in  consequence,  have 
brought  great  disrepute  upon  the  remedy,  though  it  be  the  only  prac- 
tice that  supplies  a  chance  of  relief. 

965,  b.  When  too  little  blood  has  been  abstracted  for  the  exigen- 
cies of  the  disease,  although  frequently  repeated,  it  may  increase  the 
force  of  the  malady.     Inadequate  depletion  so  modifies  the  organic 

Eowers  that  it  rouses  them  into  greater  energy  ;  the  whole  circulation 
ecomes  released  from  its  embarrassment  in  the  capillarv  system ; 


THERAPEUTICS. LOSS  OP  BLOOD.  729 

and  the  heart  being  thus,  and  in  other  ways,  set  at  liberty  and  invig- 
orated in  force,  propels  the  blood  with  increasing  violence.  This  me- 
chanical influence,  in  itself,  lights  up  the  flame  of  disease,  and  kindles 
it  in  other  parts  already  disposed  to  join  in  the  disordered  movements. 
But  much  is  also  due  to  an  augmented  irritability  of  the  instruments 
of  action ;  when  irritability  would  probably  have  been  lessened  by  a 
greater  loss  of  blood.  The  effect  produced  by  the  smaller  loss,  in 
rousing  and  otherwise  modifying  the  general  capillary  action,  reflects 
a  stimulatiug  nervous  influence  upon  the  immediate  instruments  of 
the  local  malady,  which,  in  its  turn,  had  equally  sustained,  in  the  more 
direct  manner,  an  exalted  state  of  action ;  and  thus  are  instituted  cir- 
cles of  reacting  sympathy  between  the  general  and  local  capillary  ves- 
sels (§  982-1003).  The  same  results,  it  is  true,  with  the  exception  of 
the  morbific,  attend  the  loss  of  blood  when  carried  to  the  extent  of 
its  curative  influences  (§  961  d,  966,  994  b,  1005  e).  The  remedy, 
therefore,  in  all  grave  visceral  congestions,  as  well  as  in  inflamma- 
tions, should  reach  the  point  of  absolute  depression.  The  powers 
of  life  are  then  not  only  subdued  in  energy,  but  the  strength  of  the 
impression  places  them  in  the  way  of  the  recuperative  process  (§ 
961  e,  1056,  1068).*— Notes  Ee  p.  1133,  Ff  p.  1135,  Go  p.  1138,  Ll. 

966.  Leeching  is  absolutely  inadmissible  in  the  foregoing  forms  of 
disease.  It  is  now  a  great  object  to  relieve  the  heart  of  its  morbid 
sympathies  with  the  capillary  system,  and  of  the  accumulated  blood, 
and  thus  establish  something  like  an  equilibrium  in  the  organs  of  cir- 
culation. But,  since  it  is  the  primary  effect  of  loss  of  blood  to  pro- 
duce a  contraction  of  the  capillary  vessels,  and  to  thus  determine  an 
unusual  volume  of  blood  upon  the  centre  of  circulation,  that  mode  of 
bloodletting  should  obtain  which  is  least  obnoxious  to  these  objections 
(§  921).  This  is  genei'al  bloodletting;  and  although  it  increase  the 
general  contraction  of  the  small  vessels,  its  impression  is  then  so  rap- 
id that  it  more  or  less  subverts,  with  a  corresponding  instantaneous- 
ness,  their  morbid  state.  An  immediate- dilatation  of  the  vessels  is 
the  consequence,  the  blood  circulates  with  greater  freedom,  and  thus 
the  heart  is  enabled  to  throw  off"  the  accumulated  blood ;  while  the 
favorable  change  induced  in  the  extreme  vessels  moderates  or  re- 
moves their  depressing  reflex  nervous  action,  by  which  the  heart  is 
farther  roused  into  increased  energy  (§  921,  934,  944  c,  965  b). 

967.  The  prostration  of  which  I  have  spoken  in  this  division  of  my 
subject  is  commonly  mistaken  for  debility  (§  469,  476  c,  487  7i,  488|, 
500  h,  569).  Stimulants  are  therefore  too  apt  to  usurp  the  place 'of 
bloodletting  and  other  analogous  means,  and  to  occasion  a  frightful 
mortality.  On  the  contrary,  there  should  be  no  delay  of  that  decisive 
use  of  the  remedium  principale  which  may  be  demanded  by  the  exi- 
gencies of  the  case.  Seize  the  first  moment  that  nature  is  ready, 
should  any  preliminary  steps  be  required  (§  964,  a),  or  she  will  soon 
advance  to  a  more  forbidding  state,  and  baffle  the  well-directed  eflforts 
of  art  (§  863,(^,999  0-1007,  1019).— Notes  Ee  p.  1133,  Ff  p.  1135,  Ii. 

968.  Since,  therefore,  it  is  always  important  to  do  as  much  as  mav 
be  requisite,  and  as  nature  may  admit,  at  the  early  stages  of  disease 
requiring  the  loss  of  blood,  we  must  not  be  deterred  by  early  syncope 
from  early  attempts  to  abstract  the  quantity  of  blood  which  the  exi- 
gencies of  the  case  may  seem  to  demand.  It  is  astonishing  how  soon, 
111  congestive  fevers,  the  morbid  powers  of  life  will  rally  under  the 

*  It  is  a  paradox  to  most  that  a  large  loss  of  blood  maj'  be  curative  wlien  a  smaller 
would  be  fatal,  but  the  former  perhaps  unnecessary  to  life  (§  1001,  1005  g). 


730  INSTITUTES    OF    MEDICINB. 

loss  of  a  few  ounces  of  blood,  and  how  soon  we  may  subsequently 
proceed  to  a  more  decisive  use  of  the  remedy, 

969,  a.  Where  venous  congestion  is  associated  with  idiopathic  fe- 
ver, and  the  stage  of  reaction  appertaining  to  the  constitutional  dis- 
ease has  come  on,  the  prostrating  influence  of  loss  of  blood  is  vastly 
lessened,  and  far  greater  quantities  are  often  borne  at  its  first  ab- 
straction ;  and  this  especially,  as  will  appear  in  the  next  following  di- 
vision of  our  subject,  if  some  active  form  of  inflammation  be  also  at- 
tendant ;  though  even  now  it  oftener  happens  that  a  second  bloodlet- 
ting is  better  sustained  than  the  first.  In  all  these  cases  the  several 
forms  of  disease  constantly  interchange  modifying  reflex  nervous  ac- 
tions, and  these  modifications  are  as  constantly  varying,  either  sponta- 
neously  or  through  the  operation  of  foreign  causes. 

969,  h.  It  will  appear,  also,  that  simple  venous  congestion  of  the 
brain  sometimes  manifests  a  strong  exciting  influence  upon  the  organs 
of  circulation ;  when  bloodletting  is  borne,  at  its  first  application,  to 
an  extent  which  never  obtains  under  the  usual  depressing  influence 
of  the  disease  (§  688  c-f,  h,  806,  978). 

969,  c.  Although  it  be  generafly  true  that  it  is  the  tendency  of  ve- 
nous inflammation,  whether  in  its  active  form,  as  in  phlebitis,  or  in  its 
sub-active,  as  in  venous  congestion,  to  depress  the  general  circulation, 
and,  when  the  latter  is  attendant  on  idiopathic  fever  to  delay  the  stage 
of  reaction,  and  that  it  is  the  usual  effect  of  loss  of  blood  to  increase 
that  depression,  progressively,  till  syncope  comes  on,  there  are,  never- 
theless, numerous  instances  in  which  the  remedy  manifests  an  oppo- 
site effect.  That  is  to  say,  relief  may  be  so  instantaneous  that  the 
pulse  will  increase  in  volume  and  force,  the  dark  and  trickling  blood 
spout  out  with  a  florid  hue  after  a  few  ounces  have  escaped,  and 
while  still  flowing  from  the  arm.*  In  these  cases  the .  abstraction  of 
blood  should  be  continued  till  the  pulse  is  again  subdued,  or  the  ne- 
cessary impression  will  not  be  produced  (§  806,  1056). 

969,  d.  So  variable  in  intensity  are  the  morbid  changes  in  the  dif- 
ferent varieties  of  congestive  fever,  especially  the  local  congestions, 
as  in  the  plague,  yellow  fever,  typhus,  &c.,  at  different  times,  that  an 
impression  exists  with  many  that  those  diseases  must  be  treated  at 
one  time  with  stimulants,  while  bloodletting  may  be  necessary  at  an- 
other. But  this  is  neither  true  nor  philosophical.  On  the  contrary, 
since  the  same  disease  is  always  essentially  the  same  (or  there  is  an 
end  to  all  medical  philosophy,  §  752,  &c.);  and  since  also  disease  is 
most  intense  and  malignant  where  bloodletting  is,  at  first,  most  imper- 
fectly borne,  if  this  agent  be  important  in  the  mild  forms,  it  is  more 
so  where  the  prostration,  and,  therefore,  the  amount  of  disease,  is 
greatest.  This,  too,  is  universally  sustained  by  all  the  best  experi- 
ence (§  1005.     Also,  p.  868-872,  ^  1068).— Notes  Ff  p.  1135,  Kk. 

970,  a.  Cases  not  unfrequently  occur' which  present  many  of  the 
phenomena  of  the  prostrated  conditions  of  venous  congestion,  and 
congestive  fever,  which  have  no  affinity  with  those  diseases,  but  which 
are  constantly  confounded  with  them.  Such  is  the  case  with  injuries 
from  falls,  the  shock  of  surgical  operations,  &c.  Here  the  powers  of 
life  are  actually  and  simply  reduced;  certainly  not  modified  as  by 
the  action  of  specific  morbific  causes  (§  790  h,  961  h). 

970,  h.  In  the  latter  instances   the  abstraction  of  blood  has  been 
often  fatal,  and  should  never  be  practiced  unless  some  inflammation 
•  See  Kbiemeb's  experiment  p.  310,  ^  485. 


THERAPEUTICS. LOSS  OF  BLOOD.  /31 

subsequently  spring  up.  But  if  the  prostrating  nervous  influence  be 
great,  even  though  the  brain  have  sustained  concussion,  stimulants 
should  be  administered.  This  should  also  be  the  practice  in  the 
analogous  conditions  which  are  produced  by  drinking  cold  water 
when  in  an  excited  state  from  the  united  effect  of  hard  labor  and  hot 
weather.  Opiates  should  be  also  employed  to  relieve  the  stomach. 
In  apoplexies,  when  the  pulse  is  sunken  bloodletting  should  be  de- 
layed, or  cautiously  practiced  at  first.  The  morbid  state  of  the  brain, 
or  pressure  on  the  organ,  has  determined,  in  such  cases,  a  perni- 
ciously depressing  influence  on  all  the  powers  of  life,  and  the  impres- 
sion from  loss  of  blood  superadded  to  this  morbid  influence  may  de- 
stroy the  patient  at  once.  Bloodletting  will  be  ultimately  necessary, 
and  perhaps  to  a  large  extent.  It  commonly  happens,  however,  that 
an  opposite  or  exciting  nervous  influence  is  determined  upon  the 
heart  and  capillary  vessels,  at  the  invasion  of  apoplexy ;  that  the 
pulse  is  full  and  bounding,  the  face  flushed,  &c.  In  these  cases,  de- 
cisive bloodletting,  cathartics,  &c.,  are  the  principal  remedies. — [Med. 
and  PJiys.  Coinm.,  vol.  i.,  p.  342-361 ;  vol.  ii.,  p.  234-238.) 

970,  c.  There  are  many  sympathetic  affections  supervening  on  con- 
gestive disease  of  the  abdominal  organs  which  appear  to  most  observ- 
ers to  be  the  leading  condition  of  disease ;  such  as  diff'use  inflamma- 
tion of  the  mucous  tissue  of  the  fauces,  erysipelas,  painful  affections 
of  the  head,  &c.  These,  however,  as  I  have  before  said,  should  be 
considered  rather  in  the  light  of  symptoms,  while  the  essential  means 
of  cure  should  be  directed  to  the  primary  and  principal  seat  ot  dis- 
ease (§  6S9, 1).  In  the  cases  supposed,  many  different  tissues  may  be 
affected,  and  there  may  be,  also,  much  variety  in  the  morbid  states. 
There  is  congestion  (sub-inflammation)  of  the  venous  tissue  of  the 
liver,  &c.,  more  active  inflammation  of  the  fauces,  or  of  tlie  skin. 
But,  the  mucous  tissue  of  the  stomach,  and  intestines,  is  also  more 
or  less  severely  affected,  and  the  head  suffers  sympathetically.  These 
last  conditions,  however,  are  not  inflammatory,  perhaps ;  but  so  near- 
ly approximate  that  pathological  state  that  they  are  readily  converted 
into  it  by  any  increasing  force  of  hepatic  congestion  {§  803),  by  the 
undue  irritation  of  cathartics,  or  by  improper  food,  stimulants,  &:c.  (§ 
527  d,  528,  529).  All,  other  parts  suffer,  also,  more  or  less,  in  their 
vital  states ;  and,  although  variously,  there  is  yet  determined  through- 
out, by  the  leading  conditions  of  disease,  a  general  coincidence  be- 
tween the  morbid  states  that  may  be  strongly  pronounced  and  those 
which  are  less  so,  and  where  predisposition  is  only  taking  place  (§ 
143  c,  150-152,  870  aa).  This  may  be  more  distinctly  appreciated 
by  referring  to  what  I  have  said  of  the  influences  of  remote  causes 
(§  630  c,  652,  657  a,  659,  689  /,  694|,  813,  817,  847  g,  1058  m). 

I  am  now  brought  to  the  application  of  the  foregoing  remarks. 
We  see,  therefore,  from  the  analogy  which  prevails  throughout  the 
moi'bid  states,  how  a  single  remedy,  like  loss  of  blood,  will  strike  a 
blow  at  any  one  of  the  pathological  conditions ;  and  the  more  pro- 
found its  influence  upon  the  principal,  the  more  completely  will  it 
subvert  the  minor  affections.  But  loss  of  blood  is  far  from  being 
always  necessary  in  these  complex  conditions ;  and  we  may  then  find 
that  some  internal  remedy,  as,  for  example,  a  compound  of  six  or 
eight  grains  of  the  submuriate  of  mercury,  twelve  or  twenty  of  jalap, 
and  one  to  five  of  ipecacuanha,  will  stretch  its  power  to  every  part  of 


732  INSTITUTES    OF    MEDICINE. 

the  organism,  touch  every  part  with  a  corresponding  salutary  in. 
fluence.  and  start  every  part  at  once  on  the  way  of  recuperation 
(§  143,  2334,  514,  674  d,  733,  804,  811,  847  g,  1056,  1059). 

The  foregoing  example  is  also  a  good  illustration  of  an  important 
doctrine  which  1  have  propounded  to  explain  what  humoralism  had 
neglected ;  the  exemption  of  all  parts  of  the  body  from  any  deleteri- 
ous action  of  the  blood  in  those  local  forms  of  disease  which  are  ca- 
pable of  modifying  its  character.  The  blood  is  always  affected  in 
nearly  one  universal  way  in  any  given  condition  of  disease  ;  whatever 
the  sympathetic  complexities.  The  whole  condition  of  the  solids, 
from  the  highest  to  the  lowest  grade  of  disease,  moves  on  under  re- 
ciprocal harmonizing  influences  of  all  parts  upon  each  other,  though 
the  greater  malady  exert  a  controlling  power.  The  morbid  blood, 
therefore,  is  exactly  adapted  in  its  condition  to  all  parts,  and,  there- 
fore, molests  none  (§  137  e,  143  c,  847,  870  aa,  984). 

Of  Bloodletting  in  the  recognized  Forms  of  Inflammation. 

971.  Although  I  have  demonstrated  in  my  Essay  on  Venous  Conges- 
tion, contained  in  the  Medical  and  Physiological  Commentaries,  that 
its  pathological  state  is  constituted  by  inflammation  of  the  venous  tis- 
sue, the  subject,  notwithstanding  its  importance,  has  received  as  yet 
but  little  attention  from  the  hands  of  others ;  but  stimulants,  as  usual, 
especially  in  Great  Britain  and  France,  continue  to  be  the  favorite 
means  of  treatment ;  though  not  so,  nor  ever  so,  in  these  United  States. 
The  decision  of  the  right  still  rests  with  futurity ;  but  that  future,  in 
the  prospective  view  of  America,  in  the  rise  of  the  North  of  Europe, 
and  the  retrospective  view  of  Southern  Europe,  cannot  be  distant.* 

972.  I  now  approach,  however,  conditions  of  disease  which  have 
been,  from  immemorial  time,  of  an  admitted  inflammatory  nature  ; 
however  various  the  hypotheses  as  to  their  pathological  cause.  We 
now  lose  sight,  or  mostly  so,  of  that  depressing  influence  of  venous 
congestion  which  so  often  gives  malignancy  to  fever,  and  embarrasses 
or  disarms  the  hand  of  art,  and  are  in  the  rriidst  of  innumerable  mod- 
ifications of  the  same  pathological  state  as  presented  by  other  tissues, 
that  reflect  upon  the  system  a  series  of  different  influences,  though 
often  of  an  intensely  morbific  nature  (§  935,  d). 

973.  a.  To  comprehend  fully  the  effects  of  loss  of  blood  in  the  in- 
flammatory conditions  now  before  us,  it  is  still  important  to  bear  in 
mind  the  reciprocal  sympathies  among  the  capillary  vessels  of  all  parts 
and  with  the  heart,  as  set  forth  in  the  preceding  divisions  of  our  sub- 
ject, since  upon  them  depend,  as  in  simple  forms  of  venous  conges- 
tion and  active  phlebitis,  the  disturbing  reflex  nervous  influences  of 
all  local  inflammations.  But  these  constitutional  results,  although  de- 
pendent upon  reflex  actions  of  the  nervous  system  as  when  they  spring 
from  venous  congestion  and  active  phlebitis,  present  an  aspect  more 
or  less  different.  The  local  conditions  exalt,  instead  of  depressing, 
the  general  action  of  the  circulatory  organs.  There  is  an  expanded, 
instead  of  a  contracted  state,  of  the  general  capillary  system  ;  the  cir- 
culation is  free,  the  heart  unincumbered  with  accumulated  blood,  and 
beats  with  more  than  its  natural  vigor  and  frequency.  These  inflam- 
mations, therefore,  commonly  act  upon  the  system  at  large  after  the 
manner  of  direct  stimulants,  and  thus  tend  to  counteract  the  depress- 
ing effect  of  loss  of  blood  (§  226,  229,  500  m). 

*  The  stimulating  treatment  of  all  diseases  has  become  very  general  in  the  U.  S.  A. 
—Notes  F  p.  1114,  H  p.  1117,  Ee  p.  1133,  Ff  p.  1135,  Mm  p.  1141.— 1865. 


THERAPEUTICS, LOSS  OF  BLOOD.  733 

973  h.  The  point,  therefore,  to  be  now  observed  is  an  apparently 
oposit<3  effect  of  reflex  nervous  action,  excited  by  inflammation,  upon  the 
organs  of  circulation  from  that  w^hich  attends  the  loss  of  blood  or  any 
other  sedative  agent.  One  is  exciting,  the  other  depressing.  One 
excites  general  arterial  action,  the  other  subdues  it. 

974,  a.  Certain  parts,  under  equal  degrees  of  common  inflammation, 
maintain  the  general  exciting  influence  upon  the  organs  of  circulation 
against  the  depressing  effects  of  bloodletting  more  than  others,  and 
this  is  especially  true  of  the  brain  (§  230).  In  many  forms,  also,  of 
specific  inflammation,  as  in  acute  rheumatism,  the  local  vessels  are  in 
a  peculiarly  irritable  state,  and  produce  an  excessive  exciting  influ- 
ence upon  the  whole  sanguiferous  system  ;  the  heart  itself  often  par- 
ticipating, by  sympathy,  in  the  rheumatic  inflammation  (§  525,  526  b, 
527).  Something  in  this  respect  is  also  due  to  the  nature  of  the  tissue 
which  may  be  the  seat  of  the  affection ;  articular  rheumatism,  for  ex- 
ample, deriving  an  obstinate  character  from  the  peculiar  vital  consti- 
tution of  the  ligaments  (§  133,  134).  Here  the  affection  may  yield 
only  to  gi-eat  losses  of  blood ;  especially  if  the  chief  dependence  be 
placed  upon  this  remedy.  Owing  to  the  same  persistence  of  local  dis- 
ease, and  its  general  influences,  cathartics  make  less  impression  than 
in  most  other  active  inflammations,  unless  of  the  brain.  For  the  same 
reasons,  also,  gradually-increased  doses  of  the  antimonials  are  com- 
monly borne  to  a  large  extent,  and  vascular  action  yields  slowly  to 
their  influence.  A  common  principle  is  concerned  with  all  the  rem- 
edies, according  to  their  developments  of  reflex  nervous  action. 

974,  h.  On  the  other  hand,  when  inflammation,  in  rare  instances,  is 
aggravated  or  induced  by  an  excessive  loss  of  blood,  such  is  the  com- 
bined nature  of  the  exciting  cause  and  its  curative  effects,  that  the 
modified  irritability  of  the  vessels  may  readily  yield,  at  the  moment, 
to  a  farther  loss  ;  but  if  general  bloodletting  be  now  practiced,  it  will 
soon  go  on  with  its  deleterious  influence  (§  950). 

974,  c.  Inflammation  of  the  brain  develops  very  powerfully  and  ob- 
stinately an  exciting  nervous  influence,  which  not  only  holds  in  sub- 
jection, against  the  usual  influence  of  loss  of  blood,  the  whole  capillary 
system  and  the  heart,  but  this  nervous  power  is  determined  upon  the 
vascular  system  of  the  brain  itself  with  greater  intensity  than  upon 
the  instruments  of  inflammation  in  any  other  part  (§  227,  no.  1,  230). 
Hence  it  is,  that  general  bloodletting  is  commonly  necessary  to  a 
greater  extent  in  inflammations  of  the  brain  than  of  other  organs. 
This  is  the  reason,  also,  why  general  bloodletting  is  required  by  the 
cerebral  inflammations  and  congestions  of  infants,  when  leeching  will 
often  succeed  in  inflammations  of  equal  intensity  in  other  parts  at  that 
period  of  life  (§  576  e,  925  h,  c,  951  b,  d,  955,  992,  944  c,  1056).* 

975,  a.  Again,  another  general  law.  So  great  is  the  sympathy  be- 
tween vessels  of  the  same  order,  and  especially  those  in  which  the 
organic  properties  are  most  active,  that  while  those  which  are  engaged 
in  the  process  of  inflammation  remain  unsubdued  the  whole  series 
throughout  the  body  is  liable  to  be  thus  held  in  a  state  of  excitement. 
This  is  peculiarly  true  when  the  brain  is  the  seat  of  inflammation  ; 
for,  while  the  contraction  of  its  capillaries  tends,  as  a  sedative,  to  pros- 
trate the  general  circulation,  their  morbid  excitement,  on  the  other 
hand,  not  only  contributes  to  sustain  the  general  circulation,  but  the 
influence  of  a  stimulant  is,  by  this  cause,  still  exerted  upon  the  organ, 

*  See  Note  Q  p.  1122. 


734  INSTITUTES    OF    MEDICINE. 

and  still  propagated  to  the  heart  and  arteries  (§  226,  229,  230,  480- 
483,  500,  526  a,  916-921,  929-936).  The  excitement  of  the  vessels 
of  the  brain  is  partly  promoted  by  their  peculiar  relation  to  the  organ 
which-  is  the  principal  centre  of  the  nervous  power,  and  in  part  by  the 
tendency  of  that  condition  to  prevent  a  contraction  of  the  correspond- 
ing vessels  in  other  parts.  This  peculiarity  depends  upon  a  special 
nervous  influence  which  is  exerted  upon  the  vessels  of  the  brain  in  a 
state  of  inflammation  (§  231),  and  is  thus  distinguished  from  that  con- 
dition of  the  vessels  in  other  parts  when  the  seat  of  inflammation.  In 
inflammations  of  other  organs,  therefore,  the  nervous  influence  by 
which  excited  vessels  hold  in  partial  subjection  the  corresponding 
series  throughout  the  body  is  less,  and  is  sooner  overcome  by  loss  of 
blood,  and  general  prostration  follows  sooner,  than  when  the  brain  is 
the  seat  of  inflammation  (§  140,  1039,  1040).— Note  Hh  p.  1138. 

975,  h.  Hence  the  reason  why  greater  loss  of  blood  is  generally  ne- 
cessary in  cerebral  inflammations  to  produce  syncope  than  in  similar  af- 
fections of  other  parts.  In  the  latter  cases,  and  where  general  bloodlet- 
ting is  used,  the  capillaries  of  the  brain  are  brought  imder  impression  as 
soon  as  the  loss  is  felt  by  the  instruments  of  disease  ;  and  the  depress- 
ing nervous  influence  then  becomes  a  powerful  co-opei'ating  cause  of 
the  general  prostration  (§  930-934,  940-942).  But,  it  is  now  obvious, 
that  when  the  brain  is  the  seat  of  inflammation  this  influence  is  ob- 
tained with  greater  difficulty.  Before  it  can  be  established  by  loss  of 
blood  a  positive  change  in  its  highly-excited  capillaries  must  be  effect- 
ed, and  that  opposite  state  of  nervous  influence  which  arises  from  their 
excitement  must  be  first  overcome  (§944c).  This  depression  may  be 
often  obtained  most  perfectly,  and  propagated  most  extensively,  by 
long-continued  syncope.  This  will  sometimes  happen  in  most  inflam- 
mations of  other  parts,  and  sometimes  of  the  brain  itself,  by  the  loss 
of  small  quantities  of  blood  (§  951  h,  955  h,  1056).— Also  p.  920  Note. 

975,  c.  We  learn  from  the  foregoing  philosophy  the  reason  why,  in 
cerebral  inflammations,  there  is  oftener  a  rise  of  inflammation  after 
syncope  from  loss  of  blood,  than  in  inflammations  of  other  parts.  But, 
in  all  the  cases,  if  a  repetition  of  the  remedy  be  required,  the  same 
influences  will,  in  a  general  sense,  operate  again,  and  again  enable  us 
to  abstract  all  the  blood  that  may  be  salutary  at  the  next  operation ; 
and  so  on,  till  a  permanently  salutai'y  change  is  established.* 

976,  a.  Again,  in  certain  diseases  where  the  cerebral  and  ganglionic 
systems  appear  to  be  much  involved,  but  in  an  unknown  manner,  and 
where,  perhaps,  there  are  no  special  marks  of  inflammation  in  any 
part  of  the  body,  vast  quantities  of  blood  may  be  lost  without  inducing 
syncope.  In  these  cases  there  is  great  nervous  irritability.  I  have 
seen  upward  of  thirty  ounces  of  blood  taken  from  the  arm  of  a  man, 
in  hydrophobia,  after  the  radial  artery  had  ceased  to  be  felt ;  the  pa- 
tient being  all  the  while  in  an  erect  posture,  and  remaining  to  the  last 
without  any  sense  of  faintness.  Similar  cases  are  recorded  by  the 
East  India  surgeons. 

976,  h.  On  the  other  hand,  we  have  an  opposite  state  of  the  cere- 
bral influence  in  some  cases  of  mania,  and  the  delirium  of  drunken- 
ness, where,  from  its  depressing  effect,  the  condition  of  the  system  has 
been  erroneously  compared  to  that  of  debility  (§  569,  d).  In  some 
particular  cases  bloodletting  is  imperfectly  borne  ;  evidently  from  its 
strong  impression  upon  the  nervous  centres.  In  the  case  of  drunk- 
*  See  Note  Ccc  p.  1148. 


THERAPEUTICS. LOSS  OP  BLOOD.  735 

enness  there  is- venous  congestion  of  the  brain,  and  so  modified  by 
the  remote  causes   as  to  often  lead  to  early  syncope  (§  816  h,  978). 

976.  c.  Analogous  modifications  will  also  arise  from  any  peculiar 
manner  in  which  the  organic  properties  of  other  parts  may  happen  to 
be  affected  ;  not  only  in  specific  inflammations,  but  from' those  shades 
of  difference  which  attend  common  inflammation  (§  652  c,  722).  Par- 
ticular influences  will  be  determined  upon  the  whole  system  by  these 
modifications,  according  to  the  nature  of  the  combined  influences  trans- 
mitted to  the  nervous  centres,  by  the  exact  modification  of  disease  and 
the  special. influences  it  may  exert  on  other  parts,  and  give  a  cor- 
responding direction  to  loss  of  blood  (§  150,  151,  228,  500,  514  h). 
Thence  it  will  appear  that  much  will  depend  upon  the  natural  rela- 
tion of  other  organs  to  the  nervous  centres,  and  to  other  parts  of  the 
body,  and  the  special  vital  constitution  of  each  (§  133-138,  143-152). 

Other,  and  more  accidental  causes,  may  contribute  to  these  results. 
They  have  all  an  important  bearing  upon  the  effects  of  loss  of  blood, 
often  playing  an  important  part  in  the  phenomena  of  bloodletting ; 
leading  to  syncope  from  the  loss  of  an  ounce  of  blood  where  we  may 
have  calculated  upon  a  pound  or  more,  or  where  yet  more  may  be  de- 
manded by  the  exigencies  of  the  case.  The  effect,  therefore,  of  loss 
of  blood  may  throw,  at  once,  a  flood  of  light  upon  some  obscure  con- 
dition of  disease,  as  some  ill-defined  venous  congestion,  or  upon  some 
natural  peculiarities  of  constitution,  &c.  Or,  again,  it  may  be  useless, 
or  hazardous,  to  bleed  a  patient  far  advanced  in  typlioid  pneumonia, 
or  in  the  pleurisy  of  confirmed  phthisis,  or  in  less  serious  inflammations 
incident  to  the  scrofulous  diathesis,  oi*  in  the  phlegmatic  temperament. 

It  is  therefore  manifest,  that  peculiar  impressions  will  be  deter- 
mined upon  the  nervous  centres  by  the  loss  of  blood,  and  thence  re- 
flected with  vai-ying  effects  upon  other  parts,  according  to  the  natural 
constitution  of  each  individual,  the  nature,  extent,  force,  duration,  and 
org-anic  lesions  of  disease,  the  organs  affected,  especially  if  the  brain 
be  its  seat  or  otherwise  participate,  and  according  to  the  nature  and 
extent  of  the  cerebral  derangement,  and  the  nervous  influence  which 
may  be  exerted  by  this  and  by  other  parts  (150,  151,  892|  i,  1008). 

977.  But  it  cannot  be  too  strongly  urged,  that  in  abstracting  blood, 
and  in  the  administration  of  cathartics,  emetics,  antimonial  altera- 
tives, &c.,  it  should  be  considered  that  it  is  the  constant  tendency  of 
an  inflamed  part  to  prevent  a  contraction  of  the  capillaries  of  other 
parts,  and  therefore  to  maintain  the  action  of  the  general  circulatory 
system  (§  933,  944  c).  We  shall  not  obtain  a  proper  amount  of  this 
general  impression,  if  important  to  the  case,  until  the  loss  of  blood  is 
sensibly  felt  by  the  part  inflamed  ;  and  this  may  depend  upon  a  great 
variety  of  circumstances,  even  upon  the  contingency  of  a  large  or  small 
Stream  of  blood,  the  posture  of  the  subject,  the  state  of  his  mind,  &c. 
But,  in  all  severe  inflammations  the  general  impression  should  be 
fully  produced,  and  this  is  only  effected  at,  or  near  the  point  of  syn- 
cope ;  the  patient  being  always  in  a  sitting  or  elevated  posture. 

978.  Although,  as  we  have  seen,  it  is  the  tendency  of  venous  con- 
gestion to  depress  the  powers  of  circulation,  there  are  many  chronic 
cases  of  this  disease  in  which  the  law  relative  to  inflammation  of  oth- 
er tissues  is  found  to  obtain,  though  in  an  inferior  degi'ee.  The  pulse 
is  more  or  less  excited  and  hard,  and  loss  of  blood  is  more  or  less 
borne,  at  the  beginning  of  the  treatment,  as  in  the  other  cases.     This 


736  INSTITUTES    OP    MEDICINE. 

is  especially  true  not  only  of  chronic,butof  the  more  rapid  foimof  the 
disease,  when  affecting  the  brain.  The  chronic  conditions,  ho\vever, 
sometimes  become  suddenly  aggravated,  and  the  general  circulation 
sinks  down  suddenly  under  this  aggravated  state,  when  syncope  may 
follow  a  small  abstraction  of  blood  (§  688  c-h,  786,  &c.,  976  h). 

979.  Fi'om  the  foregoing  considerations  it  appears  that  general  blood- 
letting is  the  great  remedy  for  all  inflammatory  affections  of  important 
organs,  with  those  exceptions  of  a  chronic  nature  to  which  leeching 
is  more  appropriate,  and  which  occur  in  that  division  of  our  subject 
for  the  purpose  of  illustrating  its  philosophy  (§  914,  &c.).  There 
should  be  no  hesitation,  in  the  active  forms  of  this  disease,  with  the 
most  cautious  practitioner,  in  meting  out  a  full  measure  of  the  capital 
remedy.  The  tendency  of  the  affection  to  sustain  the  system  under 
the  loss  of  blood,  and  the  phenomena  of  increased  excitement,  should 
nerve  the  weakest  arm  to  an  obvious,  easy,  and  important  duty.  This 
duty,  however,  it  is  my  purpose  to  enforce  yet  farther,  when  I  shall 
have  reached  the  experience,  and  the  details  of  practice,  that  remain 
as  the  choicest  legacies  of  the  illustrious  dead. — Note  Hh  p.1138. 

980.  The  foregoing  remarks  upon  the  tendency  of  inflammation  to 
sustain  the  system  under  the  loss  of  blood,  and  the  rapidity  with 
which  small  losses,  in  venous  congestion,  will  place  the  organic  prop- 
erties in  a  state  to  bear  a  measure  which  would  prostrate  the  organa 
of  circulation  in  health,  are  farther  illustrative  of  the  great  law  of 
adaptation,  by  which  nature  has  contrived  all  things  in  organic  life  for 
its  ever-varying  exigencies  (§  143  c,  733  d,  847  g,  870  aa). 

Of  Bloodletting  in  Simple  Continued,  and  Simple  Intermittent  Fever, 

981.  Where  fever  is  not  complicated  with  local  congestions  and 
Inflammations  loss  of  blood  is  not  often  required,  unless  to  reduce  the 
force  of  arterial  excitement  when  so  considerable  as  to  endanger  the 
appearance  of  those  local  affections.  If  this  condition,  or  any  condi- 
tion of  the  febrile  action,  do  not  soon  abate  under  the  influence  of 
cathartics,  an  emetic,  and  appropriate  alteratives,  recourse  should 
then  be  had  to  general  bloodletting ;  though  it  will  not  be  often  ne- 
cessary to  carry  the  remedy  beyond  a  moderate  extent.  If  the  treat- 
ment, however,  be  early  and  judiciously  begun,  the  disease  will  com- 
monly surrender,  in  its  early  stage,  without  the  co-operation  of  the 
principal  remedy  for  those  conditions  of  fever  which  are  associated 
with  inflammation  and  venous  congestion. 

In  the  cases  of  high  arterial  excitement  to  which  I  have  now  refer- 
red, it  is  important  to  consider  that  three  principal  causes  are  in  op- 
eration which  may  lead  to  the  development  of  inflammations.  The 
most  important  is  the  morbid  and  highly  irritable  state  of  the  capilla- 
ry and  extreme  blood-vessels.  The  second  is  the  force  of  the  circu- 
lation, which  contributes,  as  a  mechanical  cause  acting  upon  the  mor- 
bidly susceptible  vessels.  The  third  is  the  augmented  volume  of 
blood  in  those  vessels,  and  whose  influence  is  chiefly  that  of  a  vital 
stimulus  (§  137  d,  710  h,  784). 

982.  But,  it  often  happens,  as  when  fever  and  venous  congestion 
appear  in  connection,  that  inflammation  presents  itself  simultaneously 
with  the  constitutional  malady,  or  the  latter  may  be  preceded  by 
either  local  form  of  disease,  or  these  local  states  may  spring  up  in 
the  progress  of  the  general  malady  (§  779,  813).     In  the  last  two  in- 


THERAPEUTICS. LOSS  OF  BLOOD.  737 

Stances,  the  affection  which  is  first  in  order  contributes  mure  or  less 
as  an  exciting  cause  of  the  supervening  disease  (^  714,  715,  779). 
If  the  general  disorder  then  continue  to  advance,  congestions  or  in- 
flammations of  other  parts  are  liable. to  spring  up  in  quick  succession  ; 
the  general  affection,  and  the  local  developments,  and  the  predispo- 
sition of  organs  to  inflammation  or  congestion,  being  the  principal 
causes  of  the  successive  explosions  of  disease,  and  mutually  aggrava- 
ting each  other  (§  137  d,  714,  715). 

983.  From  w^hat  has  been  now  said,  and  of  the  treatment  of  inflam- 
mation and  venous  congestion,  we  may  make  up  our  minds  that  there 
can  be  no  tampering  with  the  complicated  forms  of  fever,  whether  as- 
sociated with  one  or  the  other  of  the  local  conditions  of  disease.  In 
either  case,  especially  in  continued  fever,  general  bloodletting  is  more 
imperatively  demanded  than  by  either  of  the  local  conditions  in  their 
independent  state  ;  and  the  earlier  this  important  step  is  taken  the 
oetter.  Nor  should  we  strike  with  a  sparing  hand,  nor  move  at  a  tar- 
dy pace ;  but  rather  let  the  first  be  a  heavy  blow,  and  as  oft  repeated 
as  the  foe  may  rise,  yet  always  proportioned  to  its  own  degree  of 
strength.  Let  those,  however,  who  may  not  relish  this  "  rash  advice," 
gather  wisdom  and  moral  courage  from  the  experience  and  philoso- 
phy that  yet  avvait  us  from  abler  hands. 

984,  a.  Nevertheless,  in  the  complications  of  intermittent  fever  with 
venous  congestion,  and  sometimes  with  inflammation,  such  is  the  na- 
ture of  the  predisposing  cause,  and  the  local  affections  are  so  apt  to 
be  imbued  with  its  influence,  that  it  frequently  happens  that  bloodlet- 
ting may  fail  of  the  requisite  impression  upon  the  local  forms  of  dis- 
ease, and  the  special  aid  of  the  Peruvian  febrifuge,  or  analogoub 
means,  may  be  useful,  or  necessary,  in  subduing  the  local  affections 
after  a  due  impression  has  been  made  by  loss  of  blood,  cathartics,  &c. 
In  advanced  typhus,  stimulants,  bark,  and  strong  broths  are  important. 

984,  h.  The  foregoing  reference  to  the  remote  causes  of  disease  with 
a  view  to  some  special  deviation  from  the  general  principles  of  treat- 
ment is  exactly  on  a  par  with  the  antidotal  treatment  of  poisons.  The 
quinia,  which  may  be  ultimately  necessary  to  overcome  intermittent 
fever,  or  its  associated  inflammations  and  venous  congestions,  presents 
a  remote  resemblance  to  the  elaborate  ferruginous  mixture  in  cases 
of  poisoning  by  hydrocyanic  acid,  and  other  analogous  examples. 
It  is  true,  that,  in  the  latter  cases  the  counter-agent  acts  in  a  purelj 
chemical  manner,  while  in  the  former  the  special  agent  operates 
through  vital  influences  alone.  I  have  thus  adverted  to  this  analogy 
in  deference  to  the  humoral  pathology,  and  especially  on  account  of  a 
vague  belief  that  quinia  cures  intermittents  by  neutralizing  the  mias- 
matic poison  (§  662,  809-816,  891^  k,  892  b,  892^  v,  894  c,  d,  1059). 

But  the  whole  of  this  philosophy  will  be  set  right  by  considering 
the  modus  operandi  of  the  best  antidotes  for  poisonous  doses  of  opium  ; 
namely,  coffee  and  the  cold  dash.  Here  there  is  no  difference,  in  their 
acceptation  as  poisons,  between  the  opium  and  the  miasma.  Both 
have  equally  established  their  morbific  effects. 

And  now  as  to  the  "antidotes  for  opium."  Who  ever  imagined 
that  coffee  removes  the  morbid  states  by  entering  the  circulation,  and 
there  neutralizing  the  opium?  The  modus  operandi  is  the  same  as  I 
have  set  forth  for  opiates  in  §  891^  g,  h,  and  for  the  cold  dash  and 
seton  in  §  514  d,  905  a.     I  need  not  add  that  the  modus  operandi  of 

A  A  A 


73S  INSTITUTES    OF    MEDICINE. 

quinia,  in  the  cure  of  intermittents,  is  exactly  equivalent  to  coffee 
and  the  cold  dash  in  that  of  poisoning  by  opiuni*(§  137  e,  150-152, 
662  a,  h,  892  h,  c,  904  c,  d),  and  the  nervous  system  will  alone  explain. 

In  all  such  cases,  therefore,  the  special  treatment  may  be  considered 
antidotal ;  since,  as  in  the  cases  where  we  merely  attempt  to  neutral- 
ize a  poison  while  it  yet  exists  in  the  stomach,  we  equally  apply  the 
treatment  in  the  former  case  to  certain  specific  effects  which  have  re- 
sulted from  causes  which  are  alike  distinguished  by  very  special  vir- 
tues. In  one  case  we  attack  the  cause  itself;  in  the  other,  the  effects 
which  it  may  produce. 

It  is  therefore  sufficiently  evident  that  in  the  administration  of  quin- 
ia in  the  treatment  of  intermittent  fever,  and  in  other  analogous  ex- 
amples, we  leave,  more  or  less,  the  general  principles  which  apply  to 
the  generic  character  of  the  diseases,  and  turn  some  agent  of  special 
virtues  against  the  modifying  influences  of  such  predisposing  causes  as 
are  capable  of  bending  the  general  pathology  from  its  more  common 
form.  But,  it  is  rare  that  the  general  plan  of  treatment  is  not  more 
or  less  in  demand  ;  or  that  the  special  remedy  will  come  under  the 
law  of  universal  adaptation  till  the  whole  system  is  submitted  to  in- 
fluences by  such  remedies  as  are  consistent  with  all  the  varied  coexist- 
ing pathological  conditions  (§  847  g,  870  aa). 

Some  other  examples  of  practical  importance  will,  at  the  same 
time,  advance  our  philosophy  upon  the  subject  under  investigation. 
Thus,  bloodletting  may,  or  may  not  be  necessary  in  a  scrofulous  in- 
flammation. If  it  attack  the  lungs,  it  will  be  important;  especially 
in  its  early  and  active  stages.  Here  the  remedy  is  of  universal  adap- 
tation. If  the  superficial  lymphatic  glands  be  the  seat  of  the  affection, 
leeches  may  be  proper.  But,  in  such  cases,  we  are  apt  to  leave  the 
general  principles  of  treatment,  and  to  refer  specifically  to  the  nature 
of  the  predisposing  cause,  which  is  here  implanted  in  the  constitution 
of  the  individual  (§  561,  586,  659,  661,  666).  Experience  has  shown 
that  iodine,  which  does  not  belong  to  the  remedies  for  common  in- 
flammation, is  especially  adapted  to  certain  states  of  scrofulous  in- 
flammation. But,  it  is  only  to  subdued  forms  of  the  disease  that  it  is 
suited ;  while  loss  of  blood  is  universally  applicable  in  all  the  active 
gi'ades  of  the  disease,  whatever  be  the  part  invaded,  and  may  place 
every  pait,  and  the  whole  system,  in  a  condition  for  the  salutaiy  ef- 
fects of  iodine  (§  137  e,  143  c,  150,  151,  163,  870  aa,  892  b,  8921-  v). 

Again,  if  the  inflammation  be  syphilitic,  and  the  constitution  be  in- 
vaded by  its  predisposing  influences,  bloodletting,  cathaitics,  &c., 
may  or  may  not  be  necessary.  But,  a  general  antiphlogistic  plan 
should  be  pursued ;  at  least  so  far  as  to  exclude  stimulating  food, 
which  may  be  all  that  the  case  will  require  (§  856).  In  a  general 
sense,  however,  we  should  have  a  more  direct  reference  to  the  nature 
of  the  remote  cause,  and  administer  mercurial  preparations  ;  since  ex 
perience  has  shown  this  to  be  the  safest  and  most  efficient  treatment 
Here,  then,  mercury  assumes  the  character  of  what  is  called  "  a  spe- 
cific" (§  865,  892  aa) ;  though  it  is  one  of  the  antiphlogistics  which 
fall  within  the  principle  of  general  adaptation  to  inflammatory  dis- 
eases (§  662,  859  b,  872  a,  890|,  892  b,  c,  898,  900,  904  c,  d,  1059). 

984,  c.  When  speaking  of  expectorants,  and  at  other  times,  I  have 
stated  the  importance  of  deriving  our  indications  of  cure  from  what 
we  may  witness  of  the  results  attendant  on  the  recuperative  efforts  of 

*  This  agrees  with  the  efFects  of  a  strong  infusion  of  coffee  in  health.  So,. also.  Era. 
mert  found  that  coffee  increases  the  violent  action  of  nux  vomica  (§  SOS). 


THERAPEUTICS. LOSS    OF    BLOOD.  739 

nature  (§  862,  863,  892|  ^).  1  am  now  led  to  recur  to  the  subject  ou 
account  of  the  great  abuse  of  the  principle  in  the  treatment  of  acute 
inflammatory  affections  of  the  lungs  by  stimulating  expectorants; 
which  are  admiKistered  for  the  reason  alone  that  expectoration  is  one 
of  the  consequences  of  the  natural  process  of  cure.  On  looking  a  littlo 
farther,  however,  we  find  that  bloody  mucus,  and  pure  blood,  are 
often  expectorated  in  pneumonia,  and  in  incipient  phthisis ;  and  that 
hemorrhages  are  frequently  occurring,  as  the  consequence  of  conges- 
tion or  inflammation,  from  all  parts  of  the  body.  Here,  then,  is  a 
rsmed}  for  inflammations  of  all  parts,  suggested  by  Nature ;  while 
expectoration  refers  to  one  part  only.  What  is  thus  inculcated  as  to 
the  practical  application  of  the  more  comprehensive  principle  is  en- 
forced by  all  the  most  enlightened  experience  (§  863, y").* 

985.  Finally,  when  bloodletting  is  judiciously  practiced,  it  often  su- 
persedes the  use  of  a  long  train  of  other  remedial  agents  which  may 
ultimately  bring  relief,  or  lessens  their  number  and  dose,  substitutes 
the  milder  for  the  more  energetic,  prepares  the  way  for  their  quick 
and  salutary  effects,  and  saves  to  the  patient  much  suffering,  and  se- 
cures a  speedy  convalescence. 

Of  Bloodletting  in  the  Cold  Stage  of  Fever. 

986,  a.  Bloodletting  has  been  practiced  successfully  by  many  phy- 
sicians in  the  cold  stage  of  intermittent  fever.  It  is  not,  however, 
with  any  reference  to  this  consideration  that  I  have  given  to  the  sub- 
ject the  distinction  of  a  chapter  by  itself;  but  for  the  greater  purpose 
of  illustrating  still  farther  the  influences  which  are  exerted  by  the  loss 
of  blood,  and  the  instrumentality  of  the  nervous  system. 

986,  b.  That  the  disease  should  be  thus  suddenly  arrested  is  entire- 
ly conformable  to  what  I  have  said  of  the  modus  oj^erandi  of  bloodlet- 
ting, and  goes  to  confirm  the  philosophy.  The  capillaries  being  then 
in  a  state  of  universal  contraction  from  disease,  if  loss  of  blood  have 
its  special  influences  upon  the  organic  properties  of  these  vessels,  it 
should  be  the  effect  of  such  a  cause,  in  suddenly,  greatly,  and  univer- 
sally increasing  that  contraction,  by  alterative  reflex  nervous  in- 
fluences, so  to  modify  the  morbid  state  as  to  interrupt  the  succession 
of  the  hot  stage.  But  the  abstraction  of  blood  must  be  carried  to  the 
point  of  syncope,  that  it  may  thus  determine  a  powerful  nervous  in- 
fluence upon  the  instruments  of  the  morbid  process ;  or  that  change 
will  not  be  established  which  is  necessary  to  prevent  the  stage  of  re- 
action. In  these  cases,  however,  the  necessary  quantity  of  blood  is 
commonly  small ;  and  syncope,  therefore,  is  easily  induced.  But,  as 
the  morbid  contraction  depends  upon  a  different  cause,  and  as  the  vital 
properties  are  differently  affected  from  what  bloodletting  produces, 
although  the  remedy  occasion  the  same  phenomenon,  it  often  happens 
that  no  inconsiderable  loss  of  blood  will  be  sustained  before  that 
change  can  be  established  in  the  small  vessels  which  is  necessary  to 
perfect  the  contraction  which  is  incident  to  bloodletting,  and  which  is 
the  precursor  of  syncope  {^  1040,  1056,  and  "  contraction"  §  944  c). 

987.  How,  therefore,  shall  we  interpret  by  any  other  philosophy 
than  that  which  I  have  propounded  the  sudden  interruption  of  fever 
in  its  cold  stage  by  the  loss  of  a  small  quantity  of  blood,  when  no 
amount,  perhaps,  would  have  arrested  the  disease  if  taken  at  any  oth- 
er period  1     The  qujantities,  also,  necessary  to  suo<jess  depend,  in  part, 

*  See  Notes  F  p.  1114,  Ff  p.  1135,  Gg  p.  1138,  Ii  p.  1139. 


740  INSTITUTES    OF    MEDICINE. 

upon  the  precise  period  of  tlie  cold  stage ;  whether  at  its  beginnii.ir. 
or  near  its  termination  in  the  hot  stage.  Less  is  necessary,  cceteris 
faribus,  in  the  former  than  in  the  latter  instance  ;  although  nature,  in 
the  latter  case,  is  preparing  for  a  recuperative  effort  (§  675).  And  so 
the  result  will  be  influenced  by  the  application  of  the  i-emedy  dui-ing 
the  first  paroxysm,  or  by  its  delay  till  a  later,  and  this  often  in  propor- 
tion to  the  delay.  It  is  true,  diseases  generally  yield  most  I'eadily  in 
their  forming  stage  ;  but  in  intermittent  fever  the  disease  may  be  said 
to  be  renewed,  in  a  measure,  at  each  paroxysm.  Like  other  affec- 
tions, however,  it  acquires  more  or  less  obstinacy  from  the  force  of 
habit,  and  from  the  influence  of  local  inflammations  and  venous  con- 
gestions which  so  often  spring  up  in  its  progress.  But  that  habit  is 
more  or  less  broken  during  the  intermission ;  when  Nature  is  aiming 
at  restoration  (§  557,  &c.). — Note  K  p.  1119. 

988,  a.  Here,  also,  may  be  shown  absolutely  the  error  of  all  the 
mechanical  hypotheses  which  have  been  put  forth  as  to  the  philosophy 
of  bloodletting,  and  which  have  so  extensively  governed  the  applica- 
tion, or,  rather,  have  led  to  the  neglect,  of  the  remedy.  If  we  con- 
sider the  prevailing  one,  that  loss  of  blood  operates  by  mechanically 
reducing  the  volume  of  the  circulating  mass,  and  thus  empties  the  en- 
larged capillaries  in  inflammation  and  in  the  hot  stage  of  fever,  it  is 
at  once  contradicted  by  the  immediate  and  salutary  effect  of  the  loss 
in  the  cold  stage  of  fever,  when  the  same  capillaries  and  the  same  in- 
struments of  disease  are  already  so  contracted  that  the  blood  has  re- 
ceded from  them  toward  the  central  part  of  the  circulation  ;  while  the 
immediate  effect  of  the  loss  of  blood  is  to  determine  an  increased 
volume  upon  the  capillaries  (§  910,  935). 

988,  b.  It  is,  howevei',  unnecessary  to  pursue  the  inquiry ;  but  it  is 
well  to  advert  to  the  fact  that  the  phenomenon  now  before  us  is  equally 
demonstrative  of  the  error  of  imputing  syncope  to  the  reduction  of 
blood  within  the  cavities  of  the  heart ;  since,  in  the  cold  stage  of  fever, 
blood  is  always  accumulated  about  that  organ,  and  as  the  contraction 
of  the  capillaries  is  farther  increased  by  loss  of  blood,  so,  also,  is  the 
central  determination  (§  935). 

For  the  full  understanding  of  the  foregoing  subject,  the  inquiring 
reader  will  refer  more  extensively  to  what  has  been  said  of  the  agency 
of  the  nervous  power  in  determining  the  effects  of  loss  of  blood. 

989.  The  foregoing  considerations  enable  us  to  understand  why 
bloodletting  is  more  useful  just  as  the  subsidence  of  the  hot  stage  be- 
gins than  at  its  earlier  periods.  Nature  is  now  consummating  her 
efforts  at  relief.  The  capillary  vessels  are  every  where  about  to  con- 
tract to  their  natural  volume,  as  a  consequence  of  another  modification 
of  their  vital  state,  and  differing,  therefore,  from  that  of  the  cold  stage, 
and  from  that  which  is  induced  by  loss  of  blood.  The  secretions  are 
about  to  break  forth  in  virtue  of  this  recuperative  process,  and  blood- 
letting will  now  accelerate  what  nature  is  instituting.  At  any  othei 
fltage  of  reaction  this  curative  effect  is  less,  since  nature  does  not  then 
so  co-operate  with  the  remedy  as  when  the  hot  stage  is  on  its  decline. 
Should  syncope,  even,  be  induced  during  the  rise  of  the  hot  stage,  re- 
action will  be  very  apt  to  return,  though  it  pursue  a  mitigated  course. 
A  much  smaller  loss  of  blood  will  also  subdue  the  general  circulation 
when  the  hot  stage  is  beeiiminsr  to  decline  than  during  its  rise,  and 
leave  a  more  permanent  impression  upon  diseas^.     Nevertheless,  the 


THERAPEUTICS. LOSS  OF  BLOOD         '      741 

violence  of  reaction,  &c.,  may  be  such  as  to  increase  or  give  rise  to 
local  inflammations  ;  and  where  this  is  apprehended,  or  for  the  relief 
of  pain,  general  bloodletting  should  be  practiced  early  (§  675,  803  d, 
1003).  This  section  involves  diversified  agencies  of  the  nervous  power. 

Of  Bloodletting  in  Apoplexy, 

990,  a.  The  modus  operandi  of  bloodletting,  as  well  as  the  adapta- 
tion of  this  remedy  to  the  special  circumstances  of  disease,  and  its 
critical  influences  according  to  those  circumstances,  especially  in  its 
relative  effects  thi-ough  the  instrumentality  of  the  nervous  power,  may 
be  now  advantageously  considered  by  contrasting  its  results  in  certain 
states  of  apoplectic  affections  with  what  has  been  said  of  the  counter- 
acting nature  of  inflammation,  and  of  the  nervous  influence,  in  prece- 
ding sections.     This  influence  must  apply  equally  to  all  the  cases. 

990,  h.  It  is  the  well-directed  application  of  bloodletting  which 
constitutes  the  principal  means  in  the  treatment  of  sanguineous  apo- 
plexy ;  and  although  it  may  be  often  important  to  delay  the  abstrac- 
tion of  blood,  it  will  be  generally  necessary  in  the  progress  of  the 
cure.  Such,  indeed,  is  the  concurring  opinion  of  almost  all  writers 
of  eminence ;  although  it  is  a  remarkable  fact  that  the  practice  is  not 
founded  upon  successful  experience,  or  any  agreement  in  pathologi- 
cal views.  Even  those  who  condemn  bloodletting  in  pneumonia,  en- 
teritis, or  other  grave  inflammations,  are  neither  intimidated  by  age, 
nor  by  expiring  nature,  when  apoplexy  makes  its  invasion.  Some 
are  prompted  by  a  supposed  rupture  of  a  vessel,  which  they  expect 
to  stanch  by  bleeding  from  another;  while  a  few,  more  philosophical, 
regard  the  eff"usion  as  the  result  of  a  morbid  process  analogous  to  se- 
cretion. It  is  with  all,  however,  a  mechanical  operation.  There  is 
too  much  blood  in  the  brain,  and  it  must  be  drawn  off"  by  the  lancet. 
That  is  their  modus  operandi,  and  that  the  extent  of  it.  Hence  the 
disastrous  results  of  indiscriminate  bloodletting  in  apoplexy.  But,  if 
the  philosophy  which  I  have  set  forth  as  to  the  operation  of  loss  of 
blood  be  founded  in  nature,  it  will  readily  appear  that  the  sudden  and 
violent  lesions  of  the  brain  in  apoplectic  affections  offer  us  cases  for 
great  and  unusual  discrimination  as  to  the  time,  extent,  &c.,  of  the 
remedy;  while,  also,  they  confirm  that  philosophy,  and  enforce  the 
importance  of  an  enlightened  understanding  of  the  principles  through 
which  bloodletting  operates.  It  is  said  by  Clutterbuck,  that  "  there 
is  perhaps  no  disease  the  treatment  of  which  requires  to  be  so  much 
directed  by  theory  or  general  principles  as  apoplexy.  The  practice 
in  general  use  is,  for  the  most  part,  unnecessarily  violent;  and,  in 
some  respects,  contradictory.  Bloodletting  to  an  unreasonable  ex- 
tent, vomiting,  purging,  blistering,  sinapisms,  and  a  great  variety  of 
other  stimulants,  have  all  been  administered  with  an  almost  indiscrim- 
inate and  unsparing  hand ;  as  if,  to  insure  recovery  it  were  only  ne- 
cessary to  have  recourse  to  sufficiently  active  means,  without  much 
regard  to  their  nature  or  effects." 

990,  c.  Besides  the  importance  of  a  proper  reference  to  the  influ- 
ences of  bloodletting  in  cases  of  apoplexy,  there  are  often  present 
certain  inscrutable  conditions  of  the  brain  which  are  liable  to  embar- 
rass the  most  enlightened  judgment.  It  is  often  impossible,  for  ex- 
ampl<>,  t:)  understand  the  exact  pathological  condition  of  the  brain, 
upon  which  the  due  regulation  of  bloodletting  may  essentially  de- 


742  INSTITUTES    OF    MEDICINE. 

pend.  If  there  be  hemiplegia,  it  is  almost  certain  that  extravasatioc 
')f  blood  has  taken  place.  This  condition,  with  the  rare  exception 
of  the  rupture  of  a  diseased  artery,  is  indicative  of  venous  congestion 
of  the  brain,  with  which  inflammation  may  coexist  (§  803,  805).  We 
have,  therefore,  in  these  numerous  instances,  a  formidable  condition 
of  cerebral  disease,  and  a  laceration  of  the  cerebral  substance.  Again, 
however,  there  may  be  only  a  state  of  venous  congestion,  or  of  serous 
effusion,  or  some  pathological  condition  which  is  not  denoted  by  any 
visible  signs  after  death.  With  the  exception  of  paralysis,  the  phe- 
nomena may  be  exactly  the  same  in  all  these  conditions  of  the  disease 
at  its  invasion.  In  the  fii'st  two  varieties,  bloodletting,  sooner  or  later, 
is  probably  necessary,  in  almost  every  case,  to  overcome  the  morbid 
action ;  though  its  early  application  may  induce,  or  hasten,  a  fatal  re* 
suit.  In  the  last  two,  which  are  known  as  serous  and  nervous  apo- 
plexy, the  loss  of  blood  is  comparatively  unimportant,  and  may  be  in- 
jurious at  every  stage  of  the  disease  (§  673). 

990,  d.  But  the  treatment  of  apoplexy  has  been  less  the  fault  of 
hypotheses  than  an  unsuitable  application  of  bloodletting ;  neglect- 
ing the  peculiar  relations  which  the  brain  sustains  to  other  organs, 
and  the  consequent  modification  of  their  properties  and  functions 
when  the  brain  is  suddenly  and  violently  disturbed.  So  far  as  this 
organ  is  independently  concerned,  whether  the  proximate  cause  of 
apoplexy  consist  in  pressure  from  excreted  blood,  or  simple  inflam 
mation,  or  venous  congestion,  bloodletting  is  clearly  indicated,  and, 
to  avert  an  impending  attack,  should  be  applied  without  much  re- 
serve. But  when  the  paroxysm  ensues,  it  is  not  alone  the  brain 
which  suffers  in  a  new  and  peculiar  manner.  Every  vital  organ  sus- 
tains a  shock,  and  each  becomes  a  subject  for  particular  care.  Dis- 
ease is  now  coextensive  with  the  system,  for  the  powers  and  functions 
are  universally  deranged  (§  226,  227,  no.  1,  230,  231,  480-485,  489- 
492,  508-511,  943,  946,)  and  plainly  deranged  by  nervous  influences. 
990,  e.  Hence  the  importance  of  ascertaining,  as  nearly  as  may  be, 
how  extensively  the  powers  of  life  are  disturbed  in  each  individual 
case,  that  we  may  not  complete  their  extinction  by  precipitate  treat- 
ment (§  920,  934,  937,  940,  941,  943,  944,  947-949). 

990, y!  The  consequences,  which  are  determined  by  the  sudden  le- 
sion of  the  brain  in  apoplexy,  will  not  only  depend  much  upon  the 
natural  constitution  of  the  individual,  often  upon  the  precise  nature 
and  seat  of  the  lesion,  and  the  antecedent  condition  of  the  organ,  but 
they  will  be  variously  modified  by  the  pre-existing  state  of  other 
parts ;  whether  the  system  was  in  a  state  of  health  at  the  time  of  the 
seizure,  or  whether  important  organs  may  have  been  previously  dis- 
eased, and  thus  incur  a  more  profound  lesion  after  the  attack,  and 
send  back  upon  the  brain  the  shock  they  have  sustained,  and  again 
receive  the  reverberation ;  and  whether,  also,  such  disease  may  not 
have  developed  the  cerebral  derangement,  and  remain  a  powerful 
aggravating  cause  (§  514,  h,  &c.). 

990,  g.  The  variety  of  lesion  sustained  by  the  properties  of  life,  in 
apoplexy,  is  denoted  by  the  symptoms,  and  the  symptoms  only.  The 
pulse  of  an  athletic  subject  may  become,  as  in  cases  of  concussion, 
almost  insensible  at  the  moment  of  the  attack ;  while  that  of  the  fee- 
ble may  acquire  a  volume  and  force  exceeding  its  natural  state.  The 
general  circulation  is  roused  at  one  time,  and  prostrated  at  another. 


THERAPEUTICS. LOSS  OF  BLOOD.  74S 

The  nervous  power  has  now  the  effect  of  an  excitant  upon  the  system, 
and.  again  it  is  a  deadly  sedative  (§  226,  476,  &c.).  In  one  patient, 
the  pulse  falls  suddenly  to  forty  sti'okes  in  a  minute,  while  in  another 
it  is  as  suddenly  raised  to  more  than  a  hundred.  In  one,  it  beats  with 
staid  regularity  ;  in  another,  it  intermits  ;  in  another,  it  hobbles  ;  and. 
in  a  fourth,  it  rises  and  falls  in  volume  in  coincidence  with  the  pro- 
longed acts  of  respiration.     There  is  nothing  uniform  about  it. 

990,  h.  It  need,  not  be  said  how  profoundly  the  stomach  is  affected, 
how  variously  respiration,  how  differently  the  voluntary  muscles,  the 
sphincters,  &c.,  suffer  (§  476,  &c.),  all  referable  to  the  nervous  power. 

990,  i.  Considering,  therefore,  the  varied  influences  of  the  brain 
upon  the  properties  of  life  in  apoplectic  affections,  and  the  manner  in 
which  we  have  seen  that  bloodletting  affects  this  organ,  and  the  con- 
sequent impressions  which  are  propagated  from  it  over  the  whole 
system  it  must  be  obvious,  where  the  general  lesion  is  very  profound, 
that  the  abstraction  of  blood  at  the  onset  of  the  attack  may  so  increase 
the  pernicious  influence  of  the  brain  upon  the  sinking  powers  of  the 
system  that  neither  nature  nor  art  can  repair  the  injury.  This  will 
be  especially  true  of  such  cases  if  we  bleed  to  syncope  (§  940,  941). 
But  the  abstraction  of  blood  is  powerfully  felt,  in  a  direct  manner,  by 
the  vital  properties  of  every  organ ;  and  where  these  powers  are  ex- 
cessively depressed  by  the  nervous  influence,  and  that  influence  con- 
stantly maintained,  by  the  peculiar  condition  of  the  brain,  it  will  hap- 
pen, in  the  foregoing  cases,  that  there  will  be  no  ultimate  recoil  from 
the  depressing  effect  inflicted  by  the  loss  of  blood.  Here  will  be  also 
another  shock  added  to  the  direct  injury  from  loss  of  blood,  since  the 
violence  thus  inflicted  upon  the  system  at  large  will  be  extended,  by 
sympathy,  to  the  brain  ;  while  this  organ  will  reflect  every  pernicious 
impression  it  receives  from  others  (^  1056). — See  p.  298,  \  476-2-  ^• 

990,  h.  It  should  be  also  considered  that  effusion  probably  exists 
within  the  brain,  and  that  bloodletting  cannot  reach  this  part  of  the 
exciting  cause  ;  that  the  effect  of  the  effusion,  although  it  be  diminish- 
ed, must  continue  for  an  indefinite  time,  and  that  if  we  lessen  too 
much  the  energies  of  the  system,  they  will  at  last  fail  from  its  increas- 
ing influence.  While,  therefore,  we  strive  to  arrest  one  evil  there 
should  be  an  equal  care  not  to  increase  another. 

990,  I.  The  importance  of  bloodletting  will  depend,  also,  upon  the 
nature  of  the  fluid  effused ;  of  which  we  may,  perhaps,  form  some 
conjecture  from  the  antecedent  history  of  the  case.  In  serous  apo- 
plexy, the  cerebral  congestion,  or  inflammation,  is  generally,  from 
the  beginning,  in  a  low  state,  and  is  probably  much  subdued  by  the 
effusion.  It  may  be,  therefore,  chiefly  the  immediate  object  of  blood- 
letting to  diminish  the  impulse  of  the  circulation  upon  the  brain,  and, 
perhaps,  to  lessen  a  state  of  congestion  in  the  abdominal  organs  that 
may  continue  to  operate  upon  the  brain.  Serous  apoplexy,  however, 
is  not  common.  I)r.  Cheyne  and  others  consider  the  ratio  of  the  san- 
guineous to  the  serous  as  98  to  100. 

990,  m.  In  the  sanguineous  apoplexy  we  have  a  more  or  less  differ- 
ent state  of  things,  and  other  objects  are  presented  for  consideration, 
than  in  the  serous  form.  We  have,  then,  not  only  to  lessen  the  im- 
pulse of  blood,  and  to  strike  at  any  remote  predisposing  congestions, 
but  we  must,  as  speedily  as  possible,  reduce  the  congested  state  of 
the  cerebral  veins,  and  thus  arrest  the  progress  of  the  hemoi'rhage, 


744  INSTITUTES    OF    MEDICINE. 

and  re-establish  the  natural  circulation  and  healthy  functions  of  the 
brain. 

But  the  moment  when  bloodletting  may  be  applied  with  advantage, 
and  the  extent  of  the  remedy,  must  be  directed  as  much,  or  more,  by 
the  existing  state  of  the  general  symptoms  as  by  any  pathological 
condition  that  may  have  led  to  the  paroxysm  (§  150,  151,  990  c). 

990,  n.  It  behooves  the  physician  to  meet  every  case  of  apoplexy 
with  entire  self-possession,  and  to  consider  that  no  subject  requires 
the  exercise  of  greater  skill,  and,  perhaps,  of  firmness.  It  is  often 
now  as  with  the  surgeon  when  he  is  summoned  to  some  embarrass- 
ing operation,  and  in  the  right  performance  of  which  the  life  of  the 
subject  is  immediately  concerned.  The  authority  of  custom,  sanc- 
tioned by  the  most  acute  and  renowned  observers,  will  be  likely  to 
embarrass  our  judgment,  paralyze  our  independence,  and  hold  us 
spell-bound,  when  all  may  be  depending  on  the  unbiased  dictates  of 
the  understanding.  The  difference  of  an  hour  in  the  application  of 
bloodletting  maybe  for  the  weal  or  the  woe  of  the  patient.  Shall  we 
.  deliberate  1  Professional  reputation  may  be  in  peril ;  but  the  greater 
will  be  the  reward  to  a  sensitive  and  enlightened  mind.  Where  art 
can  be  of  any  advantage  there  will  be  always  time  for  calm  investi- 
gation of  doubtful  cases.  Such  are  the  recuperative  powers  of  na- 
ture they  will  generally  struggle  for  a  time  with  success ;  at  least  in 
cases  where  art  can  be  instrumental.  "  It  is  probable,"  says  Heber- 
den,  "  that  far  the  greatest  part  of  paralytic  and  apoplectic  patients 
would  recover  some  degree  of  life  and  strength  by  the  unassisted  ef- 
forts of  nature."  It  is  this  partial  recovery  which  we  should  await, 
in  certain  cases,  before  resorting  to  the  abstraction  of  blood.  If  Na- 
ture be  too  much  struck  down  by  the  blow  for  an  independent  effort, 
we  shall  hardly  contribute  any  useful  succor  by  inflicting  another. 
If,  also,  the  powers  of  life  be  greatly  prostrated,  action  is,  of  course, 
in  a  languid  state.  Whatever  disease  may  exist  in  the  brain  is,  for 
the  present,  controlled  by  the  same  principle.  Hemorrhage  is  sus- 
pended ;  and  the  functions,  every  where,  whether  natural  or  morbid, 
are  nearly  at  a  stand.  It  is  here,  in  the  severest  cases,  in  respect  to 
the  general  condition  of  life,  as  it  is  in  concussions  of  the  brain ; 
when,  it  is  said  by  Mr.  Abernethy,  "  it  would  appear  in  the  first  stage 
that  very  little  can  be  done."  This  has  now  become  the  doctrine  of 
surgeons. 

990,  o.  When  bloodletting  is  of  doubtful  expediency  in  apoplexy, 
and  this  is  commonly  only  soon  after  the  seizure  in  cases  that  admit 
of  relief,  the  abstraction  of  blood  should  advance  slowly,  and  its  influ 
ence  be  carefully  observed  (§  937).  The  result  from  a  small  quantity 
of  blood  may  be  such  a  relief  to  the  brain  that  the  pernicious  influ- 
ence of  the  organ  may  be  so  withdrawn  from  the  system  that  the  rem- 
edy may  be  soon  repeated,  and  to  a  greater  extent  (§  961,  d). 

990,  p.  Having  brougiit  the  system,  in  bad  forms  of  the  disease,  out 
of  its  alarming  prostration,  either  by  moderate  stimulation,  or  cautious 
bloodletting,  or,  what  is  generally  better,  by  intrusting  it  to  its  own 
resources,  it  will  become  important  to  estimate  the  probable  extent  of 
disease  in  the  brain  and  other  organs.  And  here  I  cannot  but  repeat 
the  important  fact  that  sanguineous  effusions  are  generally  the  result 
of  disease,  and  that  they  very  rarely  depend,  even  within  the  crani- 
•im,  upon  any  primary  rupture  of  blood-vessels.     Dissections  prove 


THERAPEUTICS. LOSS  OF  BLOOD.  745 

that  this  condition,  in  almost  all  cases  of  sanguineous  apoplexy;  is  at- 
tended by  venous  congestion.  This  view  of  the  pathology,  while  it 
is  entirely  more  inauspicious  to  the  hopes  of  the  patient  than  that 
which  regards  the  effusion  as  the  simple  result  of  a  ruptured  vessel, 
requires  more  energetic  means  of  treatment  than  the  latter.  Indeed, 
were  simple  rupture  the  source  of  the  effusion  I  see  not  in  what  re- 
spect art  is  likely  to  be  instrumental.  It  cannot  be,  as  is  commonly 
supposed,  by  diminishing  the  force  of  the  circulation  that  we  obtain 
much  ascendency  over  the  complaint.  Indeed,  in  many  cases,  where 
the  pulse  is  prostrated,  relief  is  effected  while  the  energy  of  the  heart 
rises  under  the  influence  of  the  lancet.  The  philosophy  of  the  effects 
of  this  remedy  relates  mainly  to  its  impression  upon  the  organic  prop- 
erties of  the  capillary  vessels,  directly  and  by  reflex  nervous  action. 

990,  q.  We  may  conclude,  then,  that  with  all  the  advantages  of  the 
most  enlightened  pathology,  and  the  most  appropriate  treatment,  the 
apoplectic  must,  generally,  exist  for  a  long  time  in  a  perilous  con- 
dition. In  the  early  stages,  a  formidable  state  of  morbid  action  is  to 
be  overcome  by  energetic  measures,  whose  timely  application  is  more 
surrounded  by  difficulties  than  in  any  other  disease.  The  brain,  too, 
in  the  cases  supposed,  has  sustained  a  fearful  laceration,  and  a  con- 
crete effusion  of  blood  is  probably  compressing  and  irritating  the  whole 
organ,  and  which  can,  at  best,  but  slowly  undergo  absorption.  In  san- 
guineous apoplexy  there  is  also  an  increased  liability  to  repeated  at- 
tacks of  the  congestion  and  consequent  effusion  of  blood. 

990,  r.  It  has  not  been  my  object  to  speak  of  cases  that  obviously 
admit  of  immediate  bloodletting.  These  are  common,  and  may  de- 
mand an  extensive  application  of  the  remedy.  But  the  only  rule  that 
can  be  assigned  in  regard  to  the  quantity  of  blood  that  should  be  ab- 
stracted will  probably  be  found  in  the  foregoing  considerations. 

990,  s.  In  estimating  the  effects  of  cerebral  disease  on  the  system, 
we  must  duly  consider  the  various  relations  of  the  brain  to  other  parts. 
Considered  simply  as  an  organ,  it  is  liable  to  the  same  modes  of  dis- 
ease as  other  organs,  and  to  the  same  relative  sympathies  as  exist  among 
other  parts.  But  this  is  a  small  part  of  the  important  relations  of  the 
brain.  It  is  especially  destined  to  preside  over  the  great  functions  of 
the  body,  however  they  may  be  the  result  of  powers  that  exist  and 
act  in  independence  of  the  brain;  and  whenever  its  organic  functions 
become  diseased,  these  specific  relations  to  the  system  are  affected  in 
consequence  (§  455,  456).  This  complex  derangement,  in  apoplectic 
affections,  will  produce  the  most  varied  results  ;  and,  according  to  tho 
influences  of  the  brain  upon  other  parts,  and  their  reaction  upon  th<^ 
brain,  will  be  the  endless  variety  of  phenomena. 

990^,  a.  In  conclusion  of  the  foregoing  subject  I  may  finally  say, 
that,  from  what  has  been  here  presented  relative  to  the  nervous  pow- 
er, and  from  the  extensive  researches  of  a  more  critical  nature  in  pre- 
ceding sections,  it  appears  that  the  nervous  power  is  peculiar  to  ani- 
mals;  that  it  is  a  vital  stimulus,  sui  generis ;  that  its  important  office 
is  to  subserve  the  function  of  sympathy,  and  to  impress  upon  the  or- 
ganic products  some  very  special  vital  conditions  ;  that  its  only  par- 
ticipation in  the  function  of  motion  is  that  of  acting  upon  the  organic 
property,  mobility,  through  its  primary  operation  upon  irritability ; 
that  it  is  extremely  susceptible  of  influences  from  the  operation  of 
external  and  internal  causes, mental,  vital, and  physical;  that  these  in- 


746  INSTITUTES    OF    MEDICINE. 

fluences  result  in  preternatural  developments  and  various  modifica- 
tions of  the  nervous  power,  under  the  influence  of  its  own  nature,  but 
corresponding,  also,  with  the  nature  of  the  remote  causes,  respectively ; 
that  it  is  then  reflected  with  a  special  alterative  effect  upon  remote 
parts,  according  to  their  existing  susceptibilities,  and  according,  also, 
to  the  nature  of  the  causes  by  which  it  is  developed  or  modified, 
whether  by  the  will,  mental  emotions,  or  by  organic  or  physical  causes, 
and  that  the  motor  channels  which  are  elected  for  its  remote  effects 
are,  apparently,  independent  of  the  order  of  the  distribution  of  nerves ; 
that,  when  thus  reflected,  it  maintains,  in  one  case,  the  harmonious 
action  of  organs,  or  disturbs  that  harmony  in  another,  or  induces  dis- 
ease in  another,  or  becomes  a  curative  agent  in  another;  according 
to  the  nature  of  the  influences  which  may  be  exerted  upon  it. 

990^,  h.  Now,  therefore,  in  view  of  all  these  things,  as  well  as  of 
what  has  been  hitherto  said  of  the  functions  of  organic  life,  and  of  the 
consequences  which  have  befallen  the  philosophy  and  the  practice  of 
medicine  from  the  prevalence  of  the  chemical,  physical,  and  humoral 
doctrines  of  life,  disease,  and  therapeutics,  it  is  evident  that  there  is 
nothing  of  greater  importance  in  medicine  than  a  proper  understand- 
ing of  the  attributes  of  the  nervous  power,  and  that  it  must  be  re- 
garded merely  in  the  light  of  a  vital  stimulus,  or  a  vital  depressant,  or 
a  vital  alterative,  and  that  it  has  no  other  participation  in  the  actions 
and  results  of  animal  and  organic  life  (^  227,  475-|^,  524  d.  no.  7,  647-^). 

I  have,  finally,  reserved  for  this  place  another  demonstrative  proof 
that  the  nervous  power  is  in  no  other  than  the  foregoing  sense  the 
cause  of  a  single  phenomenon  in  organic  beings,  and  that,  therefore, 
all  the  causes  which  bring  it  into  operation,  or  otherwise  affect  its 
pronunciations,  exert  their  influences  directly  upon  the  power  itself, 
and  that  an  irresistible  analogy  is  thus  brought  to  concur  with  the 
many  specific  facts  in  proof  of  the  direct  operation  of  all  other  vital 
agents  upon  the  properties  of  life  which  are  common  to  plants  and 
animals,  and  not  upon  the  physical  structure  (§  189).  I  say,  then, 
that,  since  the  nervous  system  is  carried  into  all  parts  of  the  organiza- 
tion of  animals,  but  has  no  existence  in  plants,  and  since  both  animals 
and  plants  possess  organic  functions  in  common,  and  since,  also,  the 
organic  functions  of  animals  are  variously  affected  through  the  instru- 
mentality of  the  nervous  system,  not  only  by  causes  operating  directly 
upon  the  nervous  centres  and  the  trunks  of  nerves,  but  indirectly 
through  the  circuitous  route  of  the  sensitive  and  motor  systems  of 
nerves,  and,  especially,  farther,  si7ice  there  is  no  anatomical  union  what- 
ever hetwccn  the  extreme Jibres  of  the  sensitive  and  motor  nerves,  nor  be- 
tween tliem  and  the  fibres  or  ultimate  parts  of  any  other  tissue,  it  follows 
as  a  physical  necessity  that  the  organic  properties  and  functions  can 
be  influenced  through  the  nervous  system  only  by  a  real  substantive 
anient  which  is  entirely  different  from  the  physical  structure  itself,  and 
which  is  capable  of  extending  its  influences  from  one  tissue  to  another 
between  which  there  is  no  physical  union,  and  that,  therefore,  all  the 
primary  essential  impressions  must  be  exerted  directly  upon  the  agent 
itself.  Whence,  also,  it  follows,  that  all  the  results  which  ensue  in 
other  tissues,  as  consequences  of  the  transmission  of  the  nervous  influ- 
ence from  the  expanded  nerves  to  those  tissues,  are  due  to  primary 
impi-essions  by  the  nervous  power  upon  the  organic  properties  of  such 
tissues,  through  the  medium  of  the  complex  structure.     Lastly,  it  neces- 


THERAPEUTICS. LOSS    OF    BLOOD.  74"^ 

sarily  results  from  the  foregoing  demonstration,  that  the  organic  prop- 
erties appertain  just  as  much  to  a  real  substantive  agent,  and  are  as 
different  from  the  physical  structure,  as  the  nervous  powder  is  different. 

The  foregoing  facts  and  arguments  relative  to  the  disconnected 
state  of  the  nervous  and  other  tissues  are  equally  true  of  all  the  tis- 
sues respectively,  and  as  true,  also,  of  the  organic  properties  as  of 
the  nervous  power  in  the  aspect  of  the  anatomical  facts  (§  168-185, 
190-192,  200,  208,  215,  217,  219,  220,  226,  228,  230,  233,  233|,  234 
c,  d,  e,f,  500,  1040,  1056).   The  soul  offers  a  conclusive  analogy  {^115  b). 

990^,  c.  Nevertheless,  if  the  physical  fact,  even  as  to  the  sensitive  and 
motor  nerves,  were  not  demonstrably  true,"  it  would  in  no  respect  affect 
the  laws,  since  those  of  all  vital  functions  are  deduced  from  the  phenom- 
ena (§  466) ;  not,  as  with  physical  optics,  from  the  mechanism  (§  131). 

The  Experience  and  Ophdons  of  Distinguished  Physicians  as  to  Blood-letting 
ill  Inflammatory,  Congestive,  and  Febrile  Diseases. 

991,  a.  It  would  not  be  appropriate  to  this  work  to  set  forth  the  vast 
range  of  experience  in  favor  of  blood-letting  in  the  treatment  of  inflam- 
matory, congestive,  and  febrile  diseases,  which  I  have  explored  in  the 
Medical  and  Physiological  Commentaries,  and  as  contributed  by  men 
whose  genius,  observation,  and  success,  will  command  the  admiration 
of  ages.  But  great  controverted  questions  call  for  something  more  than 
opinions,  however  great  the  authority,  or  however  those  opinions  may 
imply  all  the  requisite  experience.  Unless  excepted,  I  refer  to  the  early 
stages  of  disease  (^  557  a,  869). 

991,  b.  Bampfield  introduces  his  remarks  by  saying,  very  justly,  that, 
"  In  medical  science,  all  reasoning  and  hypothesis  must  yield  to  the 

results  of  experience,  and  deductions  from  facts.  I  have  employed 
venesection,"  he  adds,  "  not  only  in  dysentery,  but  other  internal  and 
external  inflammatory  complaints  in  the  East  and  West  Indies,  with 
the  most  happy  results.  And  is  it  not  our  sheet-anchor,  our  principal 
remedy,  in  the  cure  of  yellow  fever,  when  had  recourse  to  within  the 
first  eighteen  hours  of  the  attack  ?" 

Mr.  Bampfield  exposes  the  origin  and  fallacy  of  the  objections  that 
have  been  made  ajjainst  bloodlettinjr.  He  "  has  been  astonished  and 
shocked  to  find  bloodletting  in  hot  climates  condemned;" — while  oth- 
ers, of  the  temperate  climates,  think  it  only  adapted  to  the  tropics,  or 
condemn  it  universally. — Notes  Ff  p.  1135,  Go  p.  1138. 

992,  a.  Let  us  consider,  next,  the  solemn  statements  of  one  who  is 
known  as  the  "  Ulysses  of  Medicine,"  from  his  vast  practical  oppor- 
tunities in  numerous  climates,  as  Surgeon-general  of  the  British  Army; 
and  let  us  observe  how  his  experience  illustrates  and  confirms  the 
great  principles  relative  to  bloodletting,  and  the  universality  of  those 
principles,  and  their  practical  application  under  all  circumstances  of 
climate.  It  should  be  premised,  however,  that  I  have  rarely  found 
the  heroic  practice  of  Jackson  necessary  or  expedient  in  its  largest 
extent;  and  should  be  inclined  to  attribute  more  to  the  modifying  in- 
fluences of  climate  in  the  following  cases,  were  it  not  that  his  practice 
was  remarkably  distinguished  for  its  decision  and  success  in  various 
parts  of  the  globe,  while  it  is  sustained  by  many  of  the  best  observers 
in  every  variety  of  climate.     Thus,  then,  Robert  Jackson  : 

"  The  end  is  not  attained  in  many  cases,  particularly  in  the  more 
concentrated  forms  of  fever  that  appear  among  the  military  in  tropi- 


748  INSTITUTES    OF    MEDICINE. 

cal  climates,  at  a  less  expense  than  eighty  or  ninety  ounces  of  blooA 
drawn  at  once."  After  stating,  in  another  place,  that  the  quantity  of 
blood  abstracted  in  fever,  at  one  time,  during  the  years  1813  and  1814, 
at  the  Hospital  of  the  Royal  Artillery,  was  rarely  less  than  three 
pounds,  frequently  four  or  five,  and  sometimes  six  pounds.  Dr.  Jack- 
son remarks  that  such  quantities  taken  at  once  "  may  appear  unsafe 
to  some  readers.  But  I  am  warranted  to  say,  from  a  retrospect  of 
the  whole  proceeding,  that  no  accident  occurred  in  any  instance  from 
the  most  excessive  bleedings  that  were  made ;  and  I  may  add,  that  the 
strength  was  so  little  impaired  by  this  apparently  revolting  practice, 
that  the  greater  number  of  persons,  who  were  treated  in  this  manner, 
returned  to  their  duty  within  a  fortnight,  in  the  full  vigor  of  health" 
(§  1019,  (Z).  Such,  also,  was  Jackson's  practice  in  other  countries  (§ 
973  h). 

992,  h.  Let  us  also  hear  Jackson  upon  the  specific  point  of  cerebral 
inflammation,  which  demands,  as  I  have  said,  more  than  any  other 
disease,  a  fearless  and  extensive  use  of  the  lancet  (§  974). 

"  The  quantity  of  blood,"  says  Jackson,  "  which  may  be  abstracted 
in  cerebral  inflammation,  without  even  compromising  the  safety  of  the 
patient's  life,  exceeds  a  measure  which,  were  my  experience  of  the 
fact  not  clearly  ascertained,  I  should  not  venture  to  lay  before  the 
public.  Four  pounds,  taken  away  at  one  time,  may  be  considered  a 
moderate  bleeding  in  the  more  concentrated  forms ;  six  pounds  have 
been  taken  on  several  occasions,  and  a  hundred  and  twelve  ounces  at 
a  single  bleeding  in  some.  The  practice,  so  formidable  in  appeai'- 
ance,  implied  no  danger.  It  saved  life  by  direct  effect  (§  938  i,  955, 
1019  d).  The  practice  is  reasonable  in  theory  (§  924-934,  942,  944, 
948,  949).  It  is  proved  in  experience  to  be  founded  in  truth.  The 
quantity.,  moreover,  is  to  he  Pleasured  by  the  effect  which  arises  under  the 
abstraction,  not  by  an  ojnnion  formed  under  the  presumption  of  what 
may  be  right." 

In  some  cases  of  fever  attended  by  cerebral  inflammation  Jackson 
sometimes  abstracted  a  hundred  and  sixty  ounces  of  blood,  or  ten 
pounds  (avoirdupois),  in  a  day ;  and  he  remarks  in  connection  with 
this  statement,  that,  "  instead  of  danger  at  the  time,  or  debility  as  a 
consequence  of  such  extraordinary  depletion,  fainting  did  not  always 
occur,  and  the  patient,  in  inost  cases,  returned  to  his  duty  within  eight 
days''  (§  974,  1068  c).— Notes  Ff  p.  1135,  Hh  p.  1138,  Ccc  p.  1148, 

992,  c.  In  the  foregoing  (§  992,  b),  as  in  the  concentrated  forms  of 
fever  (§  992,  a),  we  have  a  clear  exemplification  of  what  I  have  taught 
as  to  the  tendency  of  inflammation  to  maintain  the  system  against  the 
depressing  influence  of  loss  of  blood,  and  that  when  the  brain  is  the 
seat  of  inflammation  an  exciting  nervous  influence  is  more  powerfully 
developed,  and  operates  with  greater  force  upon  the  diseased  state  of 
the  organ,  and  upon  the  heart  and  whole  capillary  system,  than  a  sim- 
ilar affection  of  any  other  part  (§  480-483,  971-974). 

Secondly, — "  The  quantity,"  says  Jackson,  "  is  to  be  measured  by 
the  effect  which  arises  under  the  act  of  abstraction,  not  by  an  opinion 
formed  under  a  presumption  of  what  may  be  right.  Whatever  be  the 
quantity,  it  is  the  effect  produced  which  constitutes  the -rm-ly.  for  guiding 
the  measure."  I  have  thus  repeated  this  doctrine,  for  it  is  the  most 
important  that  can  be  found  in  the  annals  of  medicine.  This  rule  is 
universal,  and  it  is  for  this  reason  that  the  best  practitioners  never  sug- 


THERAPEUTICS. LOSS  OF  BLOOD.  749 

gest  the  quantity  of  blood  which  should  be  abstracted  in  any  given 
form  or  case  of  disease. 

Thirdly, — "  Instead  of  debility,  as  a  consequence  of  such  extraor- 
dinary depletion,"  says  Jackson,  "  fainting  did  not  always  occur ;  and 
the  patient,  in  most  cases,  returned  to  his  (military)  duty  within  eight 
days,  in  the  full  vigor  of  health"  (§  1019,  d). 

What  an  admirable  illustration  is  this  of  the  fallacy  of  the  tempo- 
rizing practice,  or  the  more  sad  effects  of  the  stimulant  treatment ! 
How  forcibly  it  evinces  the  importance  of  making  a  decisive  impres- 
eion,  at  one  blow,  in  all  grave  inflammations !  How  truly  does  all 
this  proclaim  the  existence  of  peculiar  properties  of  life,  in  whose  al- 
teration the  essence  of  disease  consists,  and  whose  restoration  is  ef- 
fected by  the  direct  impression  upon  them  of  loss  of  blood  !  How  for- 
cibly does  it  refute  the  humoral  pathology,  and  that  not  less  errone- 
ous assumption  that  disease  is  constituted  by  some  positive  change  oi 
structure,  or  the  yet  more  glaring  fallacy  that  it  consists  in  debility ! 

092,  d.  I  have  said  that  it  has  not  often  fallen  to  my  lot  to  carry  out 
Jackson's  practice,  excepting  in  principle  (§  992,  a).  This  may  be 
owing,  in  part,  at  least,  to  the  fact  of  having  commonly  enjoyed  the 
opportunity  of  applying  remedies  at  the  early  stages  of  disease. 
Where  I  have  found  the  full  extent  necessary,  it  has  been  mostly 
among  children ;  estimating  the  ratio  of  the  loss  according  to  the  rel- 
ative ages  and  size.  The  most  remaikable  example  has  occurred  in 
the  case  of  my  only  child ;  whose  general  history  of  health  is  stated 
in  the  Commentaries  for  another  purpose  (vol.  i.,  p,  693). 

Not  long  after  his  very  protracted  disease  had  given  way,  and  be- 
ing at  the  age  of  nine  years,  he  was  suddenly  and  violently  attacked 
with  well-marked  inflammation  of  the  brain,  lungs,  and  small  intes- 
tine. I  raised  him  to  an  erect  posture,  and  bled  him  till  syncope 
came  on.  The  symptoms  gave  way ;  but,  in  six  hours  afterward, 
those  of  the  brain,  and,  in  an  inferior  degree,  of  the  lungs  and  intes- 
tine, had  reappeared.  I  then  bled  him  again,  in  the  same  posture, 
and  to  the  extent  of  syncope.  Before  exhibiting  any  medicine,  I  still 
awaited  the  ultimate  effect  of  the  loss  of  blood.  The  cerebral  symp- 
toms gradually  presented  themselves  again,  and  I  bled  him,  for  the 
third  time,  as  before,  at  the  expiration  of  about  twelve  hours  after  the 
second  bloodletting.  Soon  afterward,  I  gave  him  one  tea-spoonful  of 
castor  oil,  which  completed  the  direct  course  of  treatment.  In  two 
days  after  the  last  bloodletting,  I  took  him  upon  the  rail-road  a  dis- 
tance of  five  miles,  and  returned  (§  955  b,  958  a).  It  may  be  worth 
adding,  in  connection  with  my  former  statements  relative  to  his  ex- 
treme infirmity  of  health  during  the  first  seven  years  of  his  life,  that 
he  has  enjoyed  a  very  robust  constitution  since  the  illness  described 
in  this  section ;  being  now  seventeen  years  of  age  (§  870  aa,  892^  i, 
974,  1068). 

The  quantity  of  blood  abstracted  in  the  foregoing  case  was  very 
large  at  each  abstraction,  and  exceeded,  in  the  ratio  of  the  age  and 
size  of  the  subject,  what  I  shall  have  recorded  of  the  experience  of 
others. 

993.  The  experience  of  Moseley  corresponds  with  that  of  Jackson, 
and  where  the  remedy  had  been  apparently  of  ample  extent,  he  re- 
marks that,  "  it  has  frequently  happened  in  the  fever  of  the  West  In- 
dies, that  accidental  bleeding  from  the  orifice  when  the  patient  had 


750  INSTITUTES    OF    MEDICINE. 

fallen  asleep.,  to  far  greater  quantities  than  has  ever  been  directed  to 
be  taken  away,  has  carried  off  the  fever  entirely,  and  the  surprise  on 
discovering  a  profusion  of  blood  in  the  bed  has  been  changed  to  joy 
for  the  alteration  produced  in  the  patient"  (§  973,  b). 

There  are  few  practitioners  of  much  experience  who  have  not  wit- 
nessed similar  events  (§  1019,  e). 

994,  a.  And  how  well  is  all  this  sustained  by  Dr.  Rush,  who  has 
"  always  observed  that  the  cure  of  a  malignant  fever  is  most  com- 
plete, and  the  convalescence  most  rapid,  when  the  bleeding  has  been 
continued  until  a  paleness  is  induced  in  the  face,  and  until  the  pa- 
tient is  able  to  sit  up  without  being  fainty."  "  Bleeding,"  he  adds, 
"  should  be  repeated  while  the  symptoms,  which  first  indicated  it,  con- 
tinue, should  it  be  until  four  fifths  of  the  blood  contained  in  the  body 
are  taken  away ;" — being  conformable  to  the  precept  of  Celsus,  that 

"  We  must  not  run  from  one  remedy  to  another,  so  long  as  that  re- 
mains which  was  there  at  first"  (§  1007) ; — or,  as  Porter  has  it,  "it  is 
not  sufficient  to  diminish  an  increased  action,  unless  the  constitution  he 
kept,  until  the  2>eriod  of  danger  is  over,  in  a  condition  that  will  render 
a  renewal  of  that  action  unlikely  to  occur'"'  (§  954,  h). 

994,  h.  The  same  result  of  an  almost  unsurpassed  experience  is 
again  and  again  reiterated  by  Rush.  "  The  half-way  practice  of  mod- 
erate bleeding,"  he  says,  "  has  kept  up  the  mortality  of  pestilential  fe- 
vers in  all  ages  and  in  all  countries.  It  is  much  better  not  to  bleed  at 
all  than  to  draw  blood  disproportioned  in  quantity  to  the  violence  of 
the  fever  (§  960,  h).  Bleeding  must  not  be  discontinued  so  long  as 
the  symptoms  which  first  denoted  its  necessity  continue." 

In  very  pi'ostrating  forms  of  fever,  he  says,  that  "  bloodletting  les- 
sened the  sensible  debility  of  the  system.  Hence  patients  frequently 
rose  from  their  bed,  and  walked  across  the  room,  ^ftiv  horns  after  the 
operation"  (§  569  e,  898,  992).— Note  Ff  p.  1135. 

995.  And  so,  also,  Armstrong:  "In  pneumonia,"  he  says,  "bleed 
your  patient  to  approaching  syncope  ;  otherwise,  instead  of  benefiting 
him,  you  will  do  him  harm"  (§  960,  V). 

And  again  :  "  In  inflammations  of  the  serous  membranes,  or  of  the 
parenchymata,  I  bleed,"  he  says,  "  more  decidedly  than  I  ever  did." 
"  I  have  treated  nearly  three  hundred  cases  of  severe  enteritis  with 
bleeding,  &c.,  and  with  a  success  far  greater  than  I  have  heard  from 
any  other  plan.  There  is  no  success  on  record  at  all  comparable 
with  it"  (§  1005,  e,  i). 

996.  And  so  Mr.  Lawrence,  who  says,  that, 

"  In  cases  of  inflammation,  where  the  blood  comes  freely  out  of  the 
vein,  I  generally  let  it  run  on  till  it  stops ;  for  that  seems  to  me  the 
only  way  of  doing  good"  (§  960). 

997,  a  Wardrop,  in  his  excellent  work  on  Bloodletting,  lays  down 
the  same  rule  and  the  same  experience.     Thus  : 

"  When  a  large  quantity  of  blood  is  not  taken  away  at  the  first 
bleedintr,  in  inflammation,  or  at  a  second  depletion  quickly  succeed- 
in  "■,  I  have  generally  found  that,  on  all  future  occasions,  it  is  seldom 
practicable  to  abstract  any  considerable  quantity,  however  necessary 
it  may  appear;  and  thus  it  is,  that  when  copious  bleedings  are  not 
employed  at  the  cnmmencemjnt  of  the  treatment  of  inflammatory  dis- 
eases, and  if  the  patient  afterward  recover,  it  has  generally  been  from 
the  employment  of  a  great  number  of  bleedings.     Moreover,  it  is  only 


THERAPEUTICS. LOSS  OF  BLOOD.  751 

in  such  cases  wherein  the  pernicious  effects  of  bleeding  are  exemplified" 
(§  950).  "  There  seems  always,"  he  says,  "  to  be  a  disposition  in  pa- 
tients, as  well  as  in  medical  men,  to  economize  blood"  (§  960,  1007  b). 

997,  b.  It  is  an  aphorism  with  Gregory,  that,  in  severe  inflamma- 
tions and  fevers,  "  the  danger  of  a  large  bleeding  is  less  than  the  dan- 
ger of  the  disease." 

998,  "  With  gangrene,  infarction,  and  abscesses  in  prospect,"  says 
Beddoes,  "  transient  syncope,  from  loss  of  blood,  is  a  slight  evil.  The 
rule,  that  the  constitution  recovers  much  more  kindly  frora  debility  by 
bloodletting  than  by  disease,  affords  great  encouragement"  (§  569, 
1007  b).  "  Numerous  facts  show  that  in  high  inflammations  the  lancet 
can  scarce  be  used  too  freely." 

999,  a.  Jackson  says  that  "  Dr.  Rush  carried  subtraction  of  blood 
to  a  great  extent  in  yellow  fever ;  but  the  quantity  subtracted  was  ob- 
tained by  repeated  subtractions,  not  by  abstraction  at  one  time.  The 
mode  of  depletion  was  not  abrupt,  such  as  arrests  disease  by  force, 
and  such  as  I  have  in  view  in  the  present  history"  (§  929-934,  938  Z>, 
942,  944,  948,  949,  955). 

999,  b.  It  may  be  true  that  Dr.  Rush  sometimes  fell  short  of  the 
proper  effect.  It  may  be  true  that  his  moral  courage  was  unequal  to 
that  of  his  great  cotemporary,  since  each  was  extensively  denounced 
as  "a  murderer;"  and  Rush  could  hardly  fail  of  being  sometimes 
embarrassed  by  his  strange  delusion  that  "  debility  is  the  universal 
predisposing  cause  of  disease."  Nevertheless,  a  glance  at  a  preceding 
section  (§  994)  will  assure  us  that  the  general  charge  is  without  founda- 
tion. His  philosophical  acumen  led  him  to  bleed  extensively,  and 
with  success,  in  many  cases  where  there  appeared  no  hope  to  others 
but  in  powerful  stimulation.  There  is  also  a  distinction  to  be  made 
between  the  yellow  fever  of  Philadelphia,  and  that  which  called  forth 
the  heroic  practice  of  Dr.  Jackson.  The  prostration  of  the  heart  from 
intense  sympathetic  influences  reflected  from  the  vessels  engaged  in 
the  morbid  processes  was  often  greater,  and  there  was  less  active  in- 
flammation to  sustain  decisive  bloodletting,  and  more  of  venous  con- 
gestion to  diminish  the  tolerance  of  loss  of  blood,  and  to  impart  ma- 
lignancy to  fever,  in  the  former,  than  in  the  latter  instance.  Nature, 
therefore,  frequently  interposed  an  obstacle  which  compelled  the 
American  philosopher  to  be  sometimes  content  with  small  and  repeat- 
ed abstractions  of  blood  {§  974,  975,  977,  983,  985).— Note  Frp.  1135. 

999,  c.  The  foregoing  reference  to  Rush's  doctrine  of  "  debility" 
(§  999,  5)  leads  me  to  an  extension  of  a  preceding  section,  where  I 
have  explained  the  acceptation  in  which  I  employ  the  term  prostra- 
tion (§  961,  b),  and  which  goes  with  former  sections  in  elucidating  the 
nature  of  that  condition  which  is  commonly  mistaken  for  "  debility" 
(§  487  h,  569).  What  I  now  purpose  saying  is,  that  the  condition  of 
the  heart  takes  a  very  large  share  in  those  morbid  demonstrations 
which  have  led  to  so  many  theoretical  and  practical  errors.  But,  the 
heart,  in  these  cases,  is  mostly  obedient  to  disturbing  influences  prop- 
agated upon  it  by  the  instruments  which  are  carrying  on  the  morbid  pro- 
cesses, and  where  the  powers  may  exist  in  a  very  exalted,  though,  also, 
otherwise  modified,  state.  Those  extreme  vessels,  however,  determine 
upon  the  heart  a  prostrating  nervou-3  influence,  and  often,  also,  an  ac- 
cumulation of  blood  about  its  right  cavities,  which  contributes  yet 
farther  to  the  embarrassment  of  the  organ.     This  will  be  readily  ap- 


752  INSTITUTES    OF    MEDICINE. 

preciated  from  what  has  been  variously  said  upon  relative  topics  in 
former  sections ;  but  the  whole  principle  may  be  seen  by  refemng  to 
the  instrumentality  of  the  nervous  power  in  the  operation  of  loss  of 
blood ;  while,  also,  the  philosophy  which  is  there  set  forth  borrows  a 
conesponding  illustration  from  the  subject  embraced  in  this  section 
(§  916-922,  929-938,  942-949,  500  m,  687-^-089,  694|). 

The  heart,  being  prostrated  in  the  foregoing  manner,  increases,  by 
reflex  nervous  actions,  the  morbid  state  of  the  instruments  of  disease, 
complicates  all  the  phenomena,  and  does  its  large  part  in  leading  all 
but  those  who  will  take  the  trouble  to  investigate  the  philosophy  of 
life,  and  analyze  the  symptoms  of  disease,  and  apply  them  critically, 
according  to  the  share  which  belongs  to  each  tissue  and  organ,  to  rest 
their  intellectual  efforts  upon  the  syinptoms  alone,  and  their  hopes  in 
tonics  and  stimulants.  But,  he  who  will  penetrate  this  seeming  labyr- 
inth, yet  accessible  to  all,  will  discover,  at  once,  that  the  remedies 
should  be  addressed  to  the  immediate  instruments  of  disease,  and  that 
whatever  will  bring  relief  to  these  will  certainly  relieve  the  heart,  and 
dissipate  the  phantom,  debility  ;  while,  on  the  other  hand,  every  cause 
that  may  increase  that  pathological  state  of  the  instruments  which  are 
the  absolute  seat  of  difficulty  and  danger,  will  as  surely  engender, 
sooner  or  later,  increasing  embarrassment  of  the  heart,  and  a  conse- 
quent multiplication  of  the  morbific  influences  which  radiate  from  the 
centre  of  the  circulation  (§  892  c,  965  b,  966-968,  500  ?«).— Nole  I. 

1000.  Few  medical  philosophers  have  done  so  much  for  therapeu- 
tics as  Sydenham ;  and  with  his  name  is  associated  one  of  those  great 
revolutions  in  practice  in  which  bloodletting  is  the  foremost  remedy. 
There  was  then,  as  now,  that  timid  caution  which  has  contributed  so 
largely  to  the  common  prejudice  against  the  abstraction  of  blood. 

"  Nothing,"  he  says,  "is  more  frequently  urged  as  a  capital  argu- 
ment by  those  who  condemn  bleeding,  than  the  mischief  which  arises 
from  bleeding  in  an  improper  manner"  (§  892  a,  892^  c,  960  a,  1005). 

1001,  a.  The  "improper  manner"  to  which  Sydenham  refers  (§ 
1000)  is  justly,  however  forcibly,  expressed  by  Botallus.     Thus  : 

"  Bleeding  does  no  service  in  many  cases,  either  because  persons 
have  recourse  to  it  too  late,  or  use  it  too  sparingly,  or  commit  some 
error  in  both  these  particulars.  But,  if  our  fears  be  so  great,  and  we 
take  away  so  small  a  quantity  of  blood,  how  is  it  possible  to  judge 
what  good  or  mischief  bleeding  may  do?  For,  if  a  disease  which  re- 
quires the  loss  of  four  pounds  of  blood  for  its  cure,  and  yet  but  one 
be  taken  away,  destroy  the  patient,  it  does  not  therefore  prove  de- 
structive because  bleeding  was  used,  but  because  it  was  employed  in 
an  improper  manner  (§  950,  965  h).  But  ill-designing  and  indolent 
men  endeavor  to  lay  the  fault  to  the  bloodletting ;  not  because  it  did 
really  do  mischief  (otherwise  than  by  its  improper  use),  but  because 
they  desire  to  give  every  body  an  ill  opinion  of  it.  Or,  suppose  they 
do  not  do  it  from  wickedness,  they  cannot  be  excused  from  ignorance 
and  perverseness."  It  is  also  his  opinion  that  "  one  hundred  thou- 
sand men  perish  from  the  want  of  bloodletting,  or  from  its  not  being 
timely  employed,  where  one  perishes  from  excessive  bloodletting, 
when  practiced  by  a  physician'^  (§  1005). — Note  p.  729. 

1001,  b.  Botallus  was  critically  right  in  qualifying  his  remark  by 
adding,  "  when  practiced  by  a  physician."  No  little  of  the  preju- 
dice which  rational  medicine  encounters  arises  from  the  former  indis- 


THERAPEUTICS. LOSS  OF  BLOOD.  753 

creet  use  of  the  lancet,  in  the  hands  of  the  surgeon,  immediately  af- 
ter concussions  from  falls,  &c.  The  sad  experience  of  some  of  the 
most  able  has  led  to  admonitions  like  that  which  is  recorded  in  a  for- 
mer section  (§  960  a,  page  720  ;  §  1007,  h). 

But  shall  physicians  deliberate  when  inflammation  is  careering  in 
the  great  organs  of  life  ?  Can  there  be  a  question  of  the  applicability 
of  bloodletting  to  phrenitis,  pleuritis,  peritonitis,  pneumonia,  and  to 
many  other  grave  inflammations,  under  their  ordinary  circumstances? 
It  is  true,  we  have  lately  seen  practitioners,  Dr.  Dickson,  for  exam- 
ple, boasting  of  their  success  without  having  "  ever  wetted  a  lancet." 
But  I  do  not  believe  that  this  exclusive  practice  has  many  open  advo- 
cates ;  and  to  admit  its  imputed  results  would  be  to  renounce  the  dic- 
tates of  our  own  and  of  common  observation.  A  more  limited  oppo- 
sition, however,  to  bloodletting  in  grave  inflammations  is  making  an 
inroad  upon  former  experience  ;  nor  is  it  the  least  remarkable  cir- 
cumstance that  it  enlists  the  most  able  disciples  of  the  anatomical 
school.  And  although  they  may  often  admit  the  utility  of  the  remedy 
in  a  general  sense,  when  they  come  to  its  practical  application  to  par- 
ticular diseases,  we  are  told  that  it  is  either  useless,  or  prejudicial  (§ 
960).     [The  "  stimulating  plan"  is  now  in  vogue,  1 860. — Note,  p.  872]. 

1002,  a.  But  once  more,  as  to  the  prostrating  forms  of  fever,  from 
which  it  will  farther  appear  that  neither  the  yellow  fever,  nor  others 
of  an  analogous  character,  have  been  so  modified  by  climate,  seasons, 
&c.,  as  to  preclude  the  abstraction  of  blood;  and  that  if  loss  of  blood 
be  demanded  by  simple  inflammation,  it  is  much  more  so  when  in- 
flammations are  complicated  with  idiopathic  fever,  and  especially  when 
that  fever  is  of  a  "  malignant  nature,"  and  constantly  imparting  its 
malign  influence  to  the  local  developments  (§  999,  b). 

Dr.  Stevens,  of  the  West  Indies,  the  celebrated  advocate  of  the 
saline  treatment  of  fevers,  afl&rms,  in  his  late  work  on  the  Blood,  that, 
"  Those  who  were  well  bled,  in  the  yellow  fever,  and  properly  evac- 
uated in  the  beginning,  almost  invariably  recovered."  "  He  took 
blood  till  he  had  nothing  to  fear  from  increased  action."  I  have  in- 
troduced this  statement  for  the  purpose,  also,  of  showing  that  the 
credit  which  he  imputes  to  the  saline  treatment  of  yellow  fever  is 
wholly  due  to  the  decisive  bleeding  and  purging  which  he  adopted. 
The  saline  practice  in  fevers  was  pretty  largely  in  vogue  some  cen- 
turies ago,  and  has  been  lately  brought  forward  to  give  plausibility  to 
the  humoral  doctrines. 

1002,  h.  Mr.  Evans  recently  states,  that  in  the  Indies  "  we  bleed 
largely  in  the  yellow  fever,  repeating  the  operation  in  two  hours  if 
there  remain  the  slightest  pain  on  pressing  the  epigastrium ;  and,  in 
general,  if  any  gastric  aflection  remain  after  the  second  bleeding,  to- 
ward the  close  of  twenty-four  hours,  we  repeat  it  a  third  time,  and 
apply  the  leeches  afterward." 

This  practice,  as  I  learned  on  a  visit  at  different  islands  a  few 
years  ago,  prevails  throughout  the  West  Indies ;  and,  in  Eastern  In- 
dia, it  is  well  known  that  bloodletting  was  never  in  higher  repute  in 
all  congestive  fevers  than  at  the  present  day. 

1002,  c.  Baker  remarks,  that  it  is  necessary  to  abstract,  by  repeated 
bleedings,  twelve  or  more  pounds  of  blood  in  the  malignant  fevers  of 
Brazil.  The  distinguished  Hillary  urges  free  bloodletting  on  the  first 
a'ld  second  days  of  yellow  fever,  and  in  the  worst  forms  of  the  disease 

B  B   B 


754  INSTITUTES    OF    MEDICINE. 

1002,  d.  "  Here  is  a  case,"  says  Mills,  "  of  the  typhus  gravior  of 
Cullen,  or  such  as  is  commonly  denominated  putrid.  The  petechige 
(so  much  dreaded  by  the  opponents  of  bloodletting)  disappeared  after 
the  second  bleeding;  an  effect  I  daily  witness  fiom  the  use  of  the 
lancet,  which  clearly  proves  that  this  symptom  proceeds  from  vascu- 
lar action."*  And  so,  also,  Dr.  Parry ;  who  introduced  the  only  suc- 
cessful or  philosophical  treatment,  that  of  bloodletting,  in  purpura 
hemon'hagica ;  now  treated  by  stimulants  and  astringents,  but  in  vain. 

1002,  e.  By  the  same  process  of  induction  from  the  vital  phenom- 
ena that  conducted  Parry  to  the  true  pathology  of  purpura  hemor- 
rhagica, Lind,  Blane,  Milman,  Rouppe,  Fordyce,  Girtanner,  Pinel, 
Baglivi,  Heberden,  De  Haen,  Moore,  Bampfield,  Darwin,  Beddoes, 
Woodall,  and  others,  inferred  the  inflammatory  nature  of  scurvy  (the 
great  pillar  of  humoralism),  and  practiced  bloodletting  as  the  first  step 
in  its  treatment.     Diet  here  illustrates  the  vis  medicatrix  (§  853). 

1002, y.  What  shall  be  said  of  the  celebrated  jail  fevers,  where  ev- 
ery body  now  stimulates  ?  Let  us  hear  the  illustiious  Pringle,  who, 
more  than  any  one  of  the  old  school,  taught  the  pathology  of  living 
putridity.  He  was'  one  of  the  last  of  a  long  line  at  whose  beginning 
stands  the  Roman  projector  of  humoralism  ;  having  died  in  1782, 
when  solidism  again  triumphed  for  awhile.  He  was  a  man  of  vast 
experience,  great  success,  and  of  universal  renown.  He  was  an 
English  baronet,  pi'ofessor,  physician-general  of  the  British  forces, 
and  studied  and  treated  diseases  in  Germany,  Flanders,  Scotland, 
London,  &c.  He  was,  in  brief,  like  Robert  Jackson,  a  "Ulysses  in 
Medicine,"  and,  like  Jackson,  he  found  that  the  same  diseases  required 
the  same  general  treatment  in  all  climates ;  being  utterly  regardless 
of  the  humoral  doctrines  at  the  bed-side  of  disease. 

Pringle,  I  say,  bled  in  all  forms  of  fever — jail  fever,  typhus  syn- 
copalis,  and  whatever  the  imaginary  degree  of  putridity.  "  Bleed- 
ing," he  says,  "  in  putrid  fevers,  is  indispensable."  "  It  is  the  first 
thing  to  be  done  in  the  beginning  of  the  treatment." 

Riverius,  an  eminent  French  physician  of  the  seventeenth  century, 
like  Pringle,  considers  "putridity  a  reason  for  bleeding  at  all  stages 
of  petechial  fevers," — "  non  ullum  unde  eirvincrc  periculum" — nor  did 
any  injury  result  from  it. 

Grant  says  that,  "even  in  the  putrid  diathesis  of  fevers  (as  he  calls 
it),  where  much  evacuation  is  required,  more  or  less  blood  ought  to 
be  taken  before  proceeding  to  other  evacuations." 

Baillou,  in  the  enlightened  days  of  humoralism,  advises  "bloodlet- 
ting in  all  ^mtrid  and  malignant  fevers,  even  when  there  is  a  tendency 
to  hemorrhage  from  dissolution  of  the  blood"  (§  1002,  c).  And  so  of 
many  other  distinguished  theorists  in  the  school  of  putridity. 

1003.  Let  us  now  regard  the  language  of  the  best  experience  as 
to  the  treatment  of  a  form  of  fevers  for  which  "  bark"  is  commonly 
supposed  to  be  an  almost  unfailing  specific,  but  which,  even  its  alka- 
loids, often  entails  the  most  obstinate  forms  of  local  chronic  disease, 
when  untimely,  or  excessively,  employed  (§  892,  &c.).     Thus : 

"  It  may  be  laid  down,"  says  Armstrong,  "  as  an  established  prin- 
ciple, that  if  venesection  does  not  absolutely  cure  intermittent  fevers, 
it  paves  the  way  for  other  remedies,  and  is,  on  that  account,  highly 
necessary."  Or,  as  Hippocrates  has  it,  "  he  who  would  purge  bodies, 
must  first  make  them  permeable:'  Baglivi,  Torti,  and  other  distin- 
*  See  Note  T  p.  1125. 


THERAPEUTICS. LOSS  OF  BLOOD.  755 

guished  Italian  physicians,  affirm,  positively,  that  the  local  complica- 
tions of  their  intermittents  could  not  be  cured  without  bloodletting. 
Sir  John  Pringle,  in  treating  the  intermittents,  mild  or  malignant,  in 
"  low,  marshy  countries,  found  it  necessary  to  begin  with  opening  a 
vein,  and  to  repeat  the  operation  according  to  the  urgency  of  the 
symptoms."  "A  person,"  he  says,  "  unacquainted  with  the  nature  of 
this  disease,  and  attending  chiefly  to  the  paroxysms  and  remissions, 
would  be  apt  to  omit  this  evacuation,  and  to  give  bark  prematurely." 
This  is  what  led  Cleghorn  into  his  fatal  mistake  (§  1005,  h).  But  we 
ultimately  hear  from  him,  that,  "  for  his  part,  when  called  early  enough, 
he  used  to  take  away  some  blood  from  all  people,  of  all  ages,  when 
affected  with  tertians,  unless  there  was  a  strong  contra-indication." 
And  so  Senac :  "  the  physicians  bleeding  five  or  six  times  in  an  epi- 
demic tertian."  Cragie  says,  that,  in  Great  Britain,  remittents  re- 
quire the  loss  of  twenty-five  to  thirty  ounces  of  blood  (§  960,  a). 

1004,  a.  It  would  be  superfluous  to  extend  the  foregoing  species 
of  testimony  afforded  by  modern  practitioners  in  favor  of  bloodletting 
in  the  treatment  of  inflammatory,  congestive,  and  febrile  diseases.    In 
the  article  on  Bloodletting,  embraced  in  the  Medical  and  Physiolog- 
ical Commentaries,  I  have  presented  the  experience  of  all  the  distin- 
guished practitioners  from  the  earliest  ages  of  philosophical  medicine, 
and  it  may  be  there  seen  that  without  exception  they  have  concurred 
in  their  testimony  as  to  the  transcendent  utility  of  blood-letting. 

1004,  b.  The  "  father,"  himself,  says,  that,  "in  all  active  inflamma- 
tions we  should  open  a  vein,  and  if  the  disease  be  vehement  and  pros 
trating,  the  loss  of  blood  will  bring  strength  to  them  that  lose  it, — 
'  robur  ipsis  affuerit.'  "  He  abstracted  blood  for  the  relief  of  those 
syncopes  which  attend  the  worst  forms  of  congestive  typhus ;  as  did, 
also,  Galen,  Celsus,  Aretaeus,  Trallian,  Paul,  Aurelian,  Avicenna,  &c. 
1004,  c.  Oribasius,  about  three  hundred  years  after  Christ,  states 
that  he  was  bled  to  the  extent  of  two  pounds  for  an  attack  of 
the  plague,  and  that  his  reliance  was  mainly  upon  this  remedy. 
Galen  bled  largely  in  this  disease,  and  he  is  the  first  who  records  the 
quantity.  "  I  remember,"  he  says,  "  to  have  taken  away  in  some  in- 
stances, at  one  bleeding,  six  pounds  of  blood,  which  immediately  ex- 
tinguished the  fever,  nor  was  there  any  loss  of  strength  in  consequence'" 
(^'992).  Such  was  his  success  by  this  mode  of  treatment,  that  the 
spectators  exclaimed,  eacpa^ag,  avdpcons,  ~ov  TrvpeTov; — "Oh!  man 
thou  hast  cut  the  throat  of  the  distemper."*  Avicenna  says  that  he 
has  sometimes  abstracted,  in  the  plague  and  "  putrid  fevers,"  at  one 
bleeding,  five  or  six  pounds  of  blood, — "  quinque  aut  sex  sanguinis 
librcB.  auferantur"  (§  1019,  d.)  Bleeding  largely  in  the  plague  was  a 
general  practice  after  the  revival  of  learning,  and  was  practiced 
through  the  16th,  17th,  and  18th  centuries;  as  it  was,  also,  in  other 
fevers,  and  in  inflammatory  and  congestive  affections.  The  exigen- 
cies of  the  disease  was  the  criterion  as  to  the  quantity  of  blood  to  be 
abstracted.  Septalius  states  that  it  was  the  universal  custom  of  phy- 
sicians to  bleed  in  the  plague  of  1575  and  1576.  "  Communi  consen- 
su in  hujusmodi  nobilc  remcdium  nullo  modo  pretermittendum  esse  dccre- 
verant.'''  And  so  Riverius,  of  a  similar  epidemic,  "  Deo  sit  laus  et  ho- 
nos !  quotquot  hoc  tractati  sunt  modo  f elicit er  evaserunt  P^  In  later 
times,  Faulkner  commends  bloodletting  in  the  plague,  and  says  that 
"when  the  blood  was  in  a  dissolved  state,  the  remedy  was  not  less 

*  Galen's  success  so  raised  the  hostilit)-  of  the  Roman  phj'sicians  as  to  banish  him 
from  Rome  for  several  years ;  they  denouncing  the  remedj',  and  he  immortalizing  them. 


756  INSTITUTES   OF    MEDICINE. 

favorable."  Assalini  remarks  that,  "At  the  commencement  of  the 
plague,  I  saw  the  necessity  of  making  use  of  bleeding  in  proportion 
to  the  strength  of  the  patients." — Note  Ff  p.  1135. 

And,  as  to  the  less  prostrating  forms  of  fever  and  inflammation, 
Baglivi  supplies  an  example  of  the  general  practice  in  the  16tl,  17th 
and  18th  centuries.  He  observes,  "  Omnes  acutas  et  inflammatorias 
febres,  hie  Romae,  curare  incipio  per  sanguinis  missionem."  And  so 
of  all  the  eminent  Roman  physicians  dow^n  to  the  recent  day  of  Rasori. 

1004,  d.  It  has  been  often  thought  remarkable  that  Hippocrates 
had  never  designated  the  quantity  of  blood  which  may  be  demanded 
by  any  given  form  of  disease.  The  reason  is,  he  was  too  much  of  a 
philosopher.  He  knew  that  no  rule,  in  this  respect,  would  be  useful ; 
but,  on  the  contrary,  unwarranted  by  nature,  and  liable  to  the  worst 
results.  Look  at  his  writings,  and  you  will  find  him  bleeding  accord- 
ing to  the  symptoms,  and  the  general  history  of  the  case.  This,  in 
deed,  he  often  says,  was  his  rule.  He  had  no  other  in  relation  to 
quantity. 

1005,  a.  Before  leaving  these  practical  considerations  it  may  be 
well  to  listen  to  the  confessions  of  a  disastrous  experience  which  befell 
some  of  the  most  enlightened  of  our  profession  from  their  neglect  or 
misapplication  of  bloodletting.  Let  us  select  examples  of  prostrating 
forms  of  disease,  where  it  too  commonly  happens  that  its  nature  and 
exigencies  are  misapprehended,  or  imperfectly  understood,  and  where 
"  debility"  is  regarded  as  the  essential  pathology,  and  is  supposed  to 
demand  the  stimulant  plan  of  treatment.  These  examples  will  cover 
the  whole  ground,  and  disarm  the  stoutest  prejudice  in  other  less  ter- 
rific foi'ms  of  prostrated  strength. 

1005,  h.  The  distinguished  Mr.  Hey  shall  speak  first,  and  of  those 
cases  of  puerperal  fever  in  which  *'  debility"  presents  its  most  ap- 
palling aspects.  This  able  man  had  unhappily  treated  the  disease 
either  with  tonics  and  stimulants,  or  with  inadequate  bloodletting. 
He  finally  introduces  a  case  (his  ninth  case),  which  was  the  last  in 
which  Mr.  Hey  employed  the  bark  and  wine,  or  procrastinating,  treat- 
ment. It  was  the  last  mistaken  act  that  divided  the  professional  life 
of  Mr.  Hey  into  two  distinct  eras.  The  patient  died,  and  with  her 
death  came  his  full  conviction  of  his  error.  "  If  the  disease,"  he  says, 
"  is  clearly  ascertained,  no  other  consideration  is  of  much  importance. 
The  state  of  the  pulse  affords  little  information,  either  as  to  the  pro- 
priety of  bleeding,  or  the  quantity  of  blood  to  be  taken  away  ;  and  if 
we  are  deterred  either  by  the  apparent  weakness  of  the  patient,  by 
the  feebleness  and  frequency  of  the  pulse,  or  by  any  other  symptom, 
from  bleeding  copiously,  we  shall  generally  fail  to  cure  the  patient." 

1005,  c.  And  now  mark  another  maxim  of  this  able  man,  who  felt 
his  way  to  truth  over  many  a  victim  of  malpractice  ;  and  what  he  says 
of  puerperal  fever  is  equally  applicable  to  all  other  fevers  when  com- 
plicated with  inflammation  or  venous  congestion.  "  There  is  a  vast 
difference,"  he  says,  "  in  the  puerperal  fever  at  different  times,  and  in 
different  situations  and  circumstances.  In  some  cases  it  appears  like 
a  phlegmonous  inflammation  ;  in  others  it  destroys  with  more  rapid- 
ity and  certainty  than  the  plague.  But,  the  means  of  cure  are  pre- 
cisely the  same  in  both  ;  but  in  the  worst  forms  the  measure  of  blood- 
letting is  greater  and  less  limited,  and  the  period  within  which  it  must 
be  employed  is  far  more  circumscribed."     "  The  truth  is."  he  says 


THERAPEUTICS. LOSS    OF    BLOOD.  757 

Estill  lamenting  his  mistakes),  "  that  bloodletting  has  seldom  been  fairly 
tried.  Either  the  quantity  of  blood  taken  away  has  been  too  small, 
or  the  time  when  it  was  taken  too  late  for  any  use  ;  and  thus  the  prin- 
cipal remedy  for  the  disease  has  been  brought  into  disrepute"  (§  965  h, 
1000,  1001. — Also,  §  500  m,  694f,  showing  the  import  of  the  pulse). 
1005,  d.  But  Mr.  Hey  was  mistaken  as  to  the  novelty  of  the  prac- 
tice. Like  many  others,  he  depended  too  much  upon  his  own  genius 
and  experience ;  neglecting  the  past,  and  thinking  that  medicine  is 
the  work  of  a  day.  Hence  his  ignorance  of  the  labors  and  of  the 
choice  experience  of  his  predecessoi's.  Bloodletting  had  predomi- 
nated, as  the  only  great  remedial  agent  for  all  inflammatory  affections 
and  fevers  of  the  most  depressing  character,  ages  before  Mr.  Hey 
came  to  illustrate  the  truth  by  other  martyrs ;  and  this  in  England, 
GJ-ermany,  Arabia,  Italy, — the  island  of  Cos  (§  1004,  b).  The  "  dis- 
repute" of  which  Mr.  Hey  speaks  was  then  only  local,  not  general ; 
for,  while  the  temporary  reign  of  the  "  bark  and  wine  treatment"  crip- 
pled the  best  practitioners  in  Great  Britain,  reason  and  sound  practice 
were  unrestrained  in  other  countries. — Note  Ff  p.  1135. 

1005,  e.  The  equally  able  and  distinguished  Mr.  Gordon  had  the 
same  melancholy  experience  with  bark  and  wine,  and  the  procrasti 
nating  treatment  of  puerperal  fever;  and,  like  Mr.  Hey,  he  shifted 
his  practice  to  early  and  copious  abstractions  of  blood,  and  has  left  a 
record  of  the  happy  fruits  of  his  dear-bought  knowledge.  He  has  one 
remark  which  proves  the  inutility  or  the  positive  injury  of  inadequate 
bloodletting.  "  He  lost,"  he  says,  **  every  patient  when  he  bled  only 
to  the  extent  of  ten  or  twelve  ounces ;  but  that  all  recovered  w^hen 
he  had  the  courage  to  abstract  twenty  or  thirty  ounces"  (§  950,  965  b). 
Armstrong,  by  "  copious  bloodletting,  lost  only  five  out  of  forty-three 
cases"  (For  the  works  &c.  quoted  see  Med.  and  Phys.  Comm.  ut  cit.). 

1005, yi  And  here  is  Denman,  the  eminent  author  of  works  on  Mid- 
wifery, who,  like  Hey,  and  Gordon,  had  carried  havoc  into  the  cham- 
bers of  puerperal  women.  He,  too,  once  bowed  at  the  fascinating 
"idol.  Debility;"  but  having  lost  most  of  his  patients  under  the  se- 
ductions of  this  ignis  fatuus,  he  turned  himself  to  the  Genius  of  philos- 
ophy, and,  as  a  noble  atonement  to  inankind,  left  behind  him,  like 
Gordon,  and  Hey,  a  record  of  his  errors. 

"  I  am  now  convinced,"  he  says,  "  by  manifold  experience,  that  my 
reasoning  was  fallacious,  and  my  facts  groundless,  and  that  which  1 
had  considered  proofs  of  the  insufficiency,  or  the  impropriety,  of  blood- 
letting in  puerperal  fever,  ought,  in  reality,  to  have  been  attributed 
to  the  neglect  of  performing  it  in  an  efficient  manner,  and  at  the  very 
beginning  of  the  disease"  {§  1000,  1001).— Note  H  p.  1117. 

1005,  g.  Leake  says  that,  "  every  puerperal  woman,  in  Lowder's 
time,  who  was  blooded,  died ;  ten  ounces  being  considered  a  large 
bleeding;"  while  Leuret,  accustomed  to  the  timid  practice  of  Low- 
der,  affirms  that,  "  he  had  never  seen  a  woman  escape  after  bleeding." 
Here  it  will  be  readily  perceived  that  the  inefficient  bloodletting  ag- 
gravated the  disease  (§  950,  965),  just  as  it  is  allowed  to  have  done, 
in  the  same  affection,  by  Hey,  and  Gordon,  and  Denman. 

1005,  h.  With  the  familiar  name  of  Cleghorn  are  associated,  as  in 
the  former  instances,  a  sound  judgment  and  large  experience.  Let 
us  consider  his  experience  in  a  pestilential,  prostrating,  bilious  pneu- 
monia that  ravaged  the  island  of  Minorca ;  and  let  us  not  fail  of  being 


758  INSTITUTES   OF   MEDICINE. 

admonished  by  his  example,  also,  of  the  importance  of  taking  for  our 
guide  the  lofty  principles  of  our  science,  and  the  experience  which  is 
taught  by  adversity  as  well  as  by  happier  auspices. 

This  epidemic  pneumonia  was  complicated  with  idiopathic,  conges- 
tive, fever,  attended  by  "  insidious  intervals  and  treacherous  remissions," 
and  by  great  prostration,  or  "  debility"  (§  569).  And  now  mark  the 
vacillating  treatment  so  characteristic  of  weaker  minds,  or  where  ig- 
norance of  medical  philosophy  leads  to  an  obstinate  adherence  to 
the  suggestions  of  prejudice  and  timidity.  Mark,  also,  the  uselessness^ 
or  the  injury,  of  small  abstractions  of  blood,  and  the  triumph  of  great- 
er (§  950,  965,  1000,  1001). 

"  I  attempted,"  says  Cleghorn,  "  to  cure  the  patients  by  bleeding 
once  or  twice  a  day,  except  during  the  insidious  remissions  ;  but  they 
generally  perislied.  This  unforeseen  event  startled  me  greatly,  and 
led  me  to  review  the  whole  progress  of  the  disease,"  &c.  He  then 
determined  "  to  adopt  the  advice  of  Duretus,  and  to  use  the  lancet 
with  more  caution."  But  his  failures  became  still  more  frequent  and 
mortifying  (§  811-815)— Note  Ff  p.  1135,  Ccc  p.  1148. 

"  At  length  I  was  convinced,"  he  says,  "  that  instead  of  too  much, 
too  little  blood  had  been  taken  away  in  the  beginning,  and  that  I  had 
been  misled  by  the  insidious  intervals.  I  then  began  to  bleed  more 
plentifully,  taking  away  thirty  or  forty  ounces  within  the  first  three 
days  of  the  distemper.  This  method  succeeded  well  in  several  of  the 
cases"  (§  965,  b). 

Still  he  was  not  satisfied.  "  At  last,"  he  goes  on,  "  about  the  mid- 
dle of  March,  when  the  disease  raged  with  the  utmost  fury,  having 
found  that  there  was  the  most  absolute  necessity  for  bleeding  largely 
without  delay,  in  order  to  preserve  life,  I  began  to  put  in  practice  the 
following  method  of  cure,  which  seldom  or  never  failed;  not  only 
in  young,  robust  people,  but  even  in  those  of  more  advanced  age,  pro- 
vided I  saw  the  sick  before  tlie  end  of  the  third  dayP 

This  "  method"  consisted  in  abstracting  blood  in  the  horizontal  pos- 
ture, "  till  the  pains  abated  or  the  patient  began  to  faint ;  taking  from 
eighteen  to  twenty-seven  ounces,  avoirdupois.  If  the  symptoms  con- 
tinued, a  few  hours  afterward  the  same  quantity  was  again  taken 
away,  without  regarding  the  state  of  the  blood,  &c.  Next  morning, 
if  there  were  any  remaining  symptoms,  the  bleeding  was  repeated,  and 
the  blood  carefully  weighed.  From  fifty-four  to  sixty  ounces  were 
frequently  taken  away  during  the  first  twenty-four  hours  of  attend- 
ance. If  any  symptoms  returned,  the  patients  were  immediately  bled 
again  to  the  asnount  of  fourteen  or  twenty-seven  ounces." 

What  a  contrast  in  treatment, — what  a  contrast  in  results  !  Blood- 
letting, decisive  bloodletting,  was  at  last  almost  the  only  remedy  em- 
ployed, and  it  now  succeeded  in  every  instance  where  its  timid  appli- 
cation had  been,  before,  as  universally  fatal  (§  950,  954  b,  965  b,  1000 
1001).  But  a  "  horizontal  posture"  is  unfavorable  and  may  not  be  safe. 

And  here  let  us  not  fail  to  observe  the  same  results  in  the  practice 
of  Cleghorn  as  in  that  of  Jackson  and  others  in  analogous  epidemics 
(§  992-999).  "Under  this  method  of  treatment,  it  was  remarkable," 
says  Cleghorn,  "  to  observe  how  rapidly  the  sick  recovered  their  usual 
health  and  strength,  notwithstanding  the  great  loss  of  blood  which  they 
had  sustained  ;  while  many,  who  had  been  bled  more  sparingly,  con- 
tinued in  a  languid,  infirm  state,  for  some  months.'"     Patients  of  the  lat- 


THERAPEUTICS. — LOSS  OF  BLOOD.  759 

ter  diss  were  only  imperfectly  relieved.  Congestion  still  remained 
about  some  of  the  great  viscera,  especially  the  liver,  by  w^hich,  also, 
the  powers  of  digestion  were  maintained  in  a  prostrated  state.  Un- 
der these  circumstances,  eri'ors  in  diet,  and  mental  and  bodily  fatigue, 
often  contribute  to  maintain  and  exasperate  the  consecutive  derange- 
ments ;  till,  at  last,  it  frequently  happens  that  a  slow  increase  of  the 
local  diseases  becomes  the  exciting  cause  of  another  explosion  of  the 
constitutional  malady.  Thus  the  patient  not  unfrequently  goes  on 
revolving,  year  after  year,  through  mitigated  and  exasperated  condi- 
tions of  disease,  which  more  decisive  treatment  by  bloodletting,  at  its 
onset,  would  have  prevented  (§  868,  883  h,  892  d). 

I  have  stated  the  several  successive  steps  of  Cleghorn's  plan,  that 
each  may  be  compared  with  the  others.  The  quick  transition  from 
wx'ong  to  right  evinces  the  hand  of  a  master.  The  record  is  full  of 
the  most  important  instruction ;  and  while  I  hold  it  up  to  the  present 
generation,  I  would  that  not  only  its  practical  instruction,  like  the  sad 
experience  of  Gordon,  and  Hey,  and  Denman,  should  be  duly  regard- 
ed, but  equally,  too,  that  the  frankness  of  each  should  be  emulated. 

1005,  i.  Dr.  Boyd,  also,  subsequently  to  Cleghorn's  time,  in  descri- 
bing the  malignant  fever  of  Minorca,  states  that  bloodletting  must  be 
carried  to  the  extent  of  positive  relief,  without  reference  to  quantity. 
He  sometimes  repeated  the  operation  four  times  in  a  day.  Our  inland 
practitioners,  at  the  south  and  west  of  New  York,  will  see  in  the 
congestive  fever  of  Minorca  a  simile  of  their  own  as  sometimes  com- 
plicated with  "bilious  pneumonia;"  while  their  practice  responds 
more  or  less  to  that  of  Boyd  and  Cleghorn. 

1005,  J.  Erysipelas  is  another  wide-spread  and  prostrating  disease 
in  its  epidemic  form,  which  has  beguiled  the  multitude  into  the  fatal 
use  of  "  the  bark  and  wine  treatment."  In  his  Essay  on  Bloodletting, 
Dr.  "Wardrop  states  that,  "  during  a  long  attendance  at  a  public  hos- 
pital, a  certain  physician  had  never  known  bloodletting  employed  in 
erysipelas,  and  that  nearly  all  the  cases  that  he  had  seen  of  that  dis- 
ease, affecting  the  head  and  face,  had  terminated  fatally."  And  so 
Armstrong:  "  The  wine  and  bark  system  is  of  all  the  most  fatal  prac- 
tice in  erysipelas."  "  Five  individuals  had  erysipelas  in  one  house, 
were  treated  with  bark  and  wine,  and  all  died"  (§  995). 

When  "  erysipelas"  presents  itself  as  an  epidemic,  it  displays  its 
connection  with  a  far  graver  form  of  disease  in  the  abdominal  viscera ; 
especially  hepatic  congestion.  And  such,  probably,  is  always  its  com- 
plications when  sporadic  only.  But,  the  symptom  is  conspicuous ; 
and  hence  the  name,  and  hence,  also,  the  usual  treatment.  The  at- 
tention is  apt  to  be  turned,  mainly,  to  the  sympathetic  inflammation 
of  the  skin.  The  obscurely  marked,  or  what  Cleghorn  would  call  the 
"  insidious,"  affection  of  the  liver,  &c.,  is  not  appreciated,  and  the  force 
of  the  treatment,  therefore,  too  often  takes  the  wrong  direction.  Noth- 
ing, indeed,  is  more  common  in  "  epidemic  erysipelas"  than  an  absence 
of  the  cutaneous  affection  in  the  worst  forms  of  the  disease;  and  these 
very  cases,  from  their  exact  resemblance  in  all  other  respects  to  those 
which  are  marked  by  the  symptoyn,  go  by  the  same  name,  and  get  the 
same  treatment.  I  have  seen  many  instances  of  this  nature  ;  particu- 
larly during  the  late  prevalence  of  the  disease  in  Vermont  and  New- 
hampshire.  I  have  seen  their  subjects  fall  victims  to  the  disease  within 
two  and  three  days  from  the  attack,  where  there  was  no  inflammation 


760  INSTITUTES    OF    MEDICINE 

of  the  skin;  and,  in  other  instances,  where  the  skin  was  mottled  with 
patches  of  a  low  degree  of  inflammation.  I  found  the  practitioners, 
however,  generally  taking  the  right  course,  and  regarding  the  affec- 
tion of  the  skin  as  symptomatic  only.  But,  the  disease  jiresented  it- 
self in  a  very  grave  form ;  and  it  was  interesting  to  obser\'e  that, 
while  it  had  many  victims  under  opposite  modes  of  treatment,  the 
greater  success  of  the  depletive  plan  generally  won  over  the  few  who 
had  preferred  stimulating  (§  689  /,  861,  894,  mottoes,  905^  h,  961  5, 
964  c.  Also,  Med.  and  Physiolog.  Comm.,  vol.  ii.,  p.  6u3-607,  Article 
Erysipelas). 

1005,  k.  Let  us  consider,  also,  the  adverse  re?j  xlw  of  the  stimulant, 
and  even  of  the  tartar  emetic  treatment  of  pneutrionia  (§  Q92^,g).  It 
is  the  opinion,  for  example,  of  Dr.  Stokes,  that  '*  General  bloodletting 
is  not  to  he  considered  the  chief  means  of  removing  the  diseased  "  In 
the  typhoid  form,  the  best  practice  is  to  use  wine  in  conjunction  with 
local  bleedings."  "  Grenex'al  bloodletting,"  he  says,  "  is  to  be  used 
with  extreme  caution,  and  the  vital  forces  are  to  be  carefully  support- 
ed." But,  "  In  two  instances  only  has  he  seen  pneumonia  cut  short  by 
bleeding"  !  This  admission  appears  to  be  conclusive  against  the  doc- 
trine of  "  saving  the  vital  fluid,"  according  to  this  distinguished  writer, 
and  especially  that  of  "supporting  the  vital  forces  by  wine"  (§  569  c, 
983).— Stokes,  on  Diseases  of  the  Chest,  p.  226,  227,  231. 

Dr.  Williams,  in  his  work  on  Diseases  of  the  Chest,  appears  to  have 
enjoyed  as  little  success  in  the  treatment  of  pneumonia,  and  for  the 
obvious  reason  that  he  considers  "  local  depletion  the  utmost  that 
can  be  attempted  in  typhoid  pneumonia.  Considerable  advantage 
may,  under  these  circumstances,  be  sometimes  obtained  from  dry  cup- 
ping on  the  chest,  which,  for  a  time,"  he  thinks,  "  tends  more  effectu- 
ally than  even  bloodletting,  to  draio  the  fluids  from  the  congested  or- 
gans, while  it  does  not  waste  the  blood  from  the  system"  (§  960), 
This  philosophy  has  numerous  admirers,  who  regard  it,  with  Dr.  Ar- 
nott,  as  "  a  great  modern  improvement  in  the  healing  art,"  and  as 
one  of  the  luminous  proofs  that  the  nineteenth  century  has  witnessed 
a  great  revolution  in  medicine;  or,  as  Louis  has  it,  that  "  medicine  is 
now  in  its  infancy."  Apropos,  of  this  distinguished  Frenchman,  who 
is  opposed,  mathematically,  to  the  abstraction  of  blood  in  pneumonia, 
erysipelas,  "  typhoid  fever,"  and  acute  intestinal  inflammation  ;  with 
their  complications,  also,  of  other  local  inflammations.  And  so,  too. 
of  many  other  distinguished  French  physicians,  who  rely  mainly  on 
the  watching  system,  or  on  the  tartar  emetic  practice.  But,  what  are 
the  results  %  Chomel  makes  the  average  mortality  from  pneumonia, 
at  the  hospitals,  one  in  four;  Louis  lost  one  in  three;  and  Legarde 
one  in  three.  Leconteulx  reported  twelve  out  of  thirty,  by  the  anti- 
monial  treatment.     These  last  were  treated  by  Laennec. 

But,  in  these  United  States,  where  bloodletting  is  thoroughly  prac- 
ticed, the  loss  does  not  exceed  one  in  twenty  to  twenty-five.  There 
is  here,  however,  no  exclusive  system,  no  "  numerical  method;"  but 
the  treatment  proceeds  upon  Hippocratic  principles.  The  symptoms, 
and  various  other  circumstances,  attending  each  individual  case,  reg- 
ulate the  practice.  It  is  not  all  bloodletting,  nor  all  tartarized  anti- 
mony. Cathartics,  calomel,  blisters,  &c.,  form  as  well  a  part  of  the 
treatment.  Nor  have  we  much  knowledge  of  the  effects  of  bloodlet- 
ting in  the  advanced  stages  of  the  disease  :  mainly  for  the  reason  that 
we  adopt  it  early  (p.  517,  note).* — Notes  F  p.  1114,  Mm  p.  1141. 

*  Our  large  cities  and  hospitals,  but  not  the  countrj-,  must  be  now  excepted  (p.  872, 
P.S.).— 1860.— Bloodletting  is  now  every  where  greatly  abandoned.— 1667. 


THERAPEUTICS. LOSS  OF  BLOOD.  761 

It  is  said  by  Dr.  Osborne,  in  his  work  on  Dropsical  Diseases,  that 
"  Since  what  has  been  termed  the  tartar  emetic  treatment  has  been 
introduced  into  Great  Britain,  and  the  practice  of  bleeding  has  con- 
sequently been  to  some  degree  discouraged,  it  appears  to  me  that  the 
advanced  stages  and  fatal  terminations  of  pneumonia  have  been  fre- 
quent; and  in  this  judgment  I  am  confirmed  by  records  on  the  large 
scale"  (§  960,  a).— See  P.S.  1860,  at  p.  872.— Note  F  p.  1114. 

1005,  I.  As  to  any  modifying  influences  from  climate  in  England, 
either  in  respect  to  pneumonia,  or  other  inflammations,  or  all  the  va- 
ineties  of  fever,  we  have  only  to  consult  such  authors  as  Armstrong, 
Jackson,  Johnson,  Wardrop,  Elliotson,  Lawrence,  Smith,  Davies, 
Weatherhead,  &c.,  &c.,  to  be  convinced  that  those  diseases  are  now, 
as  ever,  the  same  there  as  in  America,  and  require  the  same  general 
plan  of  treatment.  Looking  back  to  the  age  of  Sydenham,  and  along 
the  intermediate  periods,  we  find  that  every  thing,  on  this  subject, 
has  remained  without  any  essential  change.  It  is  practice  alone  that 
has  fluctuated.  And,  if  we  cast  our  recollections  through  the  vista 
of  time,  over  various  countries,  till  we  reach  the  age  of  Hippocrates, 
we  shall  still  find  that  diseases,  of  a  given  denomination,  have  been 
the  same,  and  have  ever  required  the  same  general  treatment, 

1005^, «.  From  what  has  been  now  said,  under  the  present  division 
of  my  subject,  and  more  especially  from  the  wide  range  of  experience 
presented  in  the  Medical  and  Physiological  Commentaries,  it  appears 
that  there  is  one  universal  consent  among  the  great  physiological 
practitioners  as  to  the  importance  of  decisive  bloodletting  in  all  forms 
of  active  inflammation,  and  in  high  grades  of  fever  ;  whether  it  appear 
in  the  shape  of  the  plague,  of  yellow  fever,  of  typhus,  or  other  inflam- 
matory or  congestive  forms.  It  has  been  so  from  the  earliest  days  of 
the  science  ;  in  all  countries,  in  all  climates,  in  all  constitutions,  at  all 
ages ;  and,  whether  in  the  Mediterranean  or  the  Caribbean  Isles,  the 
jungles  of  Asia,  the  pestiferous  regions  of  Africa,  the  paludes  of  Italy, 
or  the  high,  and  temperate,  and  salubrious  countries  of  Europe  and 
America,  we  witness  the  immutable  principle  that  diseases  and  their 
general  method  of  cure  are  every  whei'e  nearly  the  same.  Constitu- 
tion, habits,  and  age,  certainly  modify  the  details  of  treatment,  more 
or  less ;  climate  comparatively  little.  The  great  fundamental  laws 
of  disease  remain  without  change,  as  do,  also,  the  leading  conditions 
of  disease.  We  have  all  that  Hippocrates  described  before  our  own 
eyes,  and  we  are  astonished  at  the  identity.  We  think  him,  at  one 
moment,  a  prophet;  and  when,  at  the  next,  we  realize  a  simple  narra- 
tive of  only  what  he  observed,  we  are  either  amazed  at  his  sagacity 
and  philosophy,  or  that  we  should  have  been  so  slow  to  have  discov- 
ered the  truth  ourselves  (§  624,1068,  Note  Ggg  p.  1151).* 

lOO.'i^,  b.  The  human  constitution,  its  laws,  susceptibilities,  &c.,  are, 
in  a  general  sense,  every  where  the  same  ;  while  the  remote  causes 
of  disease  are  the  same  now  as  at  the  beginning  of  time,  produce 
their  effects  upon  the  same  properties,  whose  nature  cannot  be  per- 
manently affected  (§  180-182,  286),  and  whose  results  are  connected 
by  a  chain  of  analogies.  The  pathology  of  inflammation,  or  of  simple 
or  congestive  fever,  therefore,  is  the  same,  respectively,  in  principle, 
at  all  times,  and  in  all  countries,  and  the  great  principles  of  treatment 
must  also  be  immutable.  But,  modifying  causes  impart  various  shadea 
of  difference  to  every  epidemic,  to  every  individual  case.  To  under 
*  See  N0TK8  Ff  p.  1135,  Go  1138  Hh  1138. 


7C2  INSTITUTES    OF    MEDICINE. 

Stand  the  complex,  or  even  leading  condition  of  each  case,  what  ita 
general  nature,  what  peculiarities  may  arise  from  various  causes,  what 
the  exact  adaptation  of  remedies,  how  much  the  successive  changes 
may  be  due  to  nature  or  to  art,  requires  unceasing  vigilance  (^  624). 

1006,  a.  And  now  let  me  ask,  whether  the  vast  expenence,  and  the 
precepts  relative  to  bloodletting,  of  the  able  physicians  who  have  giv- 
en to  medicine  its  rank  and  dignity,  are  to  be  impugned  by  chemists, 
or  by  the  prejudice,  or  the  limited,  or  the  careless,  observation  of 
many  physicians,  who  are  too  apt  to  deceive  themselves  into  the  be- 
lief that  they  imbody  the  only  experience  which  can  be  available  in 
disease,  or  which  enlightened  philosophy  can  approve  (§  1007,  V)  % 

Doubtless,  it  will  appear  absurd  that  I  should  have  embraced  the 
chemists,  and  as  foremost,  too,  in  the  preceding  interrogatory.  But, 
is  it  not  the  order  of  the  day  (§  5^  a,  349  d,  960  a,  page  719)  ?  And 
being  so,  I  will  reply,  once  more,  in  the  language  of  Dr.  Paris,  when 
he  was  defending  medicine  against  the  harmless  recreations  of  the 
Chemists,  about  the  year  1825,  and  mainly  because  Professor  Brande 
had  ventured  upon  the  open  opinion  that  chemistry  was  neglected  in 
medical  education,  and  that  the  "  London  Pharmacopeia  is  a  record 
of  the  want  of  chemical  hnowledge  where  it  is  most  imperiously  requir- 
ed." The  answer,  perhaps,  is  abundantly  set  forth  in  a  former  sec- 
tion (§  676,  h).  As  showing  yet  farther,  however,  the  instability  of 
science,  and  as  embracing  a  precept  which  every  lover  of  truth  will 
do  well  to  ingraft  upon  his  morning  prayer,  I  shall  quote  Dr.  Paris 
once  more,  though  upon  a  subject  simple  in  its  nature,  and  of  very 
minor  importance  to  that  which  is  relative  to  the  laws  of  organic  life 
and  the  great  principles  of  medical  science.     Thus  : 

"  I  cannot  conclude  these  observations  upon  Mr.  Brande's  attack, 
without  expressing  a  deep  feeling  of  regret,  that  a  gentleman,  whose 
deserved  rank  in  society,  and  whose  talents  and  acquirements  must 
entitle  him  to  our  respect,  should  have  condescended  to  countenance 
and  encourage  that  vile  and  wretched  taste  of  depreciating  the  value 
and  importance  of  our  most  venerable  institutions,  and  of  bringing 
into  contempt  those  acknowledged  authorities  which  must  always  meet 
with  the  approbation  of  the  best,  and  the  sanction  and  support  of  the 
wisest,  portion  of  mankind  (§  676,  b).  And  I  shall  here  protest  against 
the  prevailing  fashion  of  examining  and  deciding  upon  the  preten- 
sions of  every  medicinal  compound  to  our  confidence,  by  a  mere  chem- 
ical investigation  of  its  composition,  and  of  rejecting,  as  fallacious,  ev- 
ery medical  testimony  which  may  appear  contradictory  to  the  results 
of  the  Laboratory.  There  is  no  subject  in  science  to  which  the  max- 
im of  Cicero  more  strictly  applies,  than  to  the  present  case.  Let  the 
Ultra  Chemist,  therefore^  cherish  it  in  his  remembrance,  and  profit  by 
its  application : 

"  '  PRjESTAT  NATURiE  VOCE  DOCERI,  QUAM  INGENIO  SUO  SAPERE.'  " 

Paris'  Pharmacologia,  p.  103.     London,  1825,  (§  1034).^ 

And  now,  for  the  purpose  of  showing  how  any  special  commentary 
upon  any  given  substitution  for  the  well-settled  method  of  induction 
or  for  any  well-ascertained  laws  of  Nature,  is  alike  applicable  to  any 
other  fundamental  innovation,  and  how,  also,  the  overthrow  of  one 
grand  scheme  of  the  day  is  the  immediate  parent  of  another,  I  shall 
quote  from  the  Medical  and  Physiological  Co?nmentarics  a  paragraph 
relative  to  M.  Louis"  attempt  to  foist  upon  medicine  the  celebrated 


THERAPEUTICS. LOSS  OF  BLOOD.  763 

••NuMEUiCAL  Method,"  and  ask  tho  reader  to  apply  it  to  "  Organic 
Chemistry  in  its  Applications  to  Physiology  ;'"  and  to  "  Animal  Chem- 
istry applied  to  Pathology  and  Thei  apeutics .'"     Thus  : 

"  Thus  mounted  upon  the  wreck  of  philosophy,  '  the  Numerical 
Method'  ('  Organic  Chemistry^)  became  the  engine  in  learing  that  fab- 
ric whose  construction  it  was  destined  to  serve.  This  is  the  charm 
with  which  the  Numerical  Method  (Organic  Chemistry)  is  invested ; 
while  it  gives  to  its  author  that  ascendency  in  mind  which  few  can 
truly  obtain  by  the  legitimate  rules  of  induction.  '  After  much  delib- 
eration,' as  Isocrates  says,  '  he  found  the  thing  could  not  be  com- 
passed in  any  other  manner ;'  or,  as  our  Author  has  it,  '  fortunately 
for  the  progress  of  science,  the  Numerical  Method  (Organic  Chemis- 
try) is  considered  by  the  most  judicious  and  experienced  men  as  a 
necessary  instrument  for  establishing  general  principles  in  medicine^  (§ 
6^  a,  349  d,  960  a,  page  719).  Accordingly,  former  systems,  and  for- 
mer facts, yeZZ  as  by  enchantment  (§  376^,  433).  The  mind  sickened 
at  the  absence  of  all  principles  to  guide  it,  and  was  therefore  the  more 
willing  victim  when  assailed  by  the  irresistible  power  of  numbers 
{symbols)  (§  960  a,  p.  719).  If  the  demonstration  was  made  with  re- 
iterated professions  of  a  regard  for  facts ^  it  was  because  the  method 
could  have  had  no  existence  without  them ;  while  the  perpetual  epi- 
thet of  '  rigorous'  left  no  room  for  skepticism.  But,  as  related,  ac- 
cording to  Lord  Bacon,  'of  good  Queen  Bess,  the  Commissioners 
used  her  like  strawberry-wives,  that  laid  two  or  three  great  strawber- 
ries at  the  mouth  of  their  pot,  and  all  the  rest  were  little  ones.  So 
they  made  her  two  or  three  good  prizes  of  the  first  particulars,  but  fell 
straightways.'  " — {Med.  and  Phys.  Comm..,  vol.  ii.,  p.  782.) 

"  This  manner  of  digression,  however,  some  dislike  as  frivolous  and 
impertinent;  yet  we  are  of  Beroaldus'  opinion, — such  digressions  do 
mightily  delight  and  refresh  the  reader.  They  are  like  sauce  to  a 
bad  stomach  ;   and  we  do  therefore  most  willingly  use  them." 

1006,  b.  The  reader  will  recollect  that  I  had  been  last  speaking 
of  the  respect  which  is  due  to  the  experience  of  the  great  sages  in 
medical  philosophy.  I  was  early  led  to  listen  to  their  conclusions, 
and  to  adopt  their  counsel,  as  summarily  expressed  in  the  foregoing 
maxim  derived  from  Cicero  (§  1006,  a).  For  thirty  years  I  have 
watched  attentively  the  effects  of  bloodletting  as  practiced  by  myself 
and  by  many  others,  and  have  long  since  come  to  the  conclusion,  that 
it  is  safer  to  put  "  the  two-edged  sword"  into  the  hands  of  the  igno- 
rant, or  the  imbecile,  or  those  who  make  a  trade  of  the  profession, 
than  to  foi'ever  blunt  its  edges,  so  that  it  will  not  cut,  before  it  be  trust- 
ed to  their  use.  We  every  where  see  victim  after  victim  sacrificed  to 
timid  admonitions,  and  worse  example ;  while  you,  and  all  of  us 
know,  that  it  is  a  rare  phenomenon  that  a  patient  is  slain,  seldom  in- 
jured, by  the  lancet.  This  is  the  test,  and  the  strength  of  it  is  before 
the  reader.* 

1006,  c.  On  the  other  hand,  is  it  not  too  often  the  case  that  eminent 
and  able  teachers,  who  constantly  instruct  us  to  pause  where  blood- 
letting is  indicated,  observe  a  phlegmatic  silence  as  to  the  .injurious 
tendencies  of  active  internal  agents,  or  urge  them  upon  us  as  if  they 
were  as  powerless  as  water  %  These,  not  bloodletting,  make  up  the 
great  abuses  of  practice.  Here,  protestations  against  abuse  would  come 
with  a  benign  effect ;  or  if  uttered,  they  are  apt  to  be  in  an  unworthy 
spirit  of  distrust  of  the  whole  medical  art. — Note  F  p.  1114. 

*  In  1870,  after  a  practice  of  fifty-four  years,  large  and  without  intermission,  I  reiter- 
ate the  same.     Vide  §  1068,  h,  p.  870.     , 


764  INSTITUTES    OF    MEDICINE. 

Let  us  at  least  consider  that  all  other  remedial  agents  of  any  great 
importance,  even  those  of  the  best  antiphlogistic  nature,  are  irritants 
under  many  circumstances  of  inflammation,  and  are,  therefore,  more 
or  less  liable  to  increase  that  affection,  unless  morbid  irritability  be 
previously  subdued  by  loss  of  blood.  This  is  even  true  of  antimo- 
nials  and  ipecacuanha,  in  irritable  states  of  the  alimentary  canaL 
How  obvious,  then,  the  importance  of  often  preparing  the  way  for 
their  salutary  effects  by  loss  of  blood ;  and,  in  doing  which,  we  also 
greatly  supersede  the  necessity  of  other  remedies. 

1006,  d.  If  we  contrast  even  the  scanty  cases  of  injury  from  uterine 
hemorrhage,  and  other  accidental  losses  of  blood  that  may  be  sustained 
in  health  (or  try  our  best  at  the  records  of  excessive  bloodletting,  as 
preserved  by  the  most  watchful  Brunonian),  with  the  terrible  and 
wide-spread  effects  of  procrastination,  or  timidity,  in  the  use  of  the 
remedy  where  it  has  been  demanded  by  disease,  and,  more  than  all, 
with  the  "  bark  and  wine  treatment,"  we  shall  have  little  to  fear  from 
the  possible  abuses  of  the  lancet.  A  few  may  be  rash  from  ignorance, — 
perhaps  from  the  encouragement  of  others  ;  but  will  not  this  encour- 
agement stimulate  a  host  to  lay  aside  their  fears,  and  to  moderate 
their  Brunonian  practice  1  Where,  then,  according  to  the  "  numeri- 
cal method,"  will  be  the  balance  (§  569,  e)] — Notes  F  H. 

1006,  e.  Where  inflammatory  diseases  are  comparatively  mild,  their 
mildness  will  naturally  restrain  every  practitioner ;  and  when  ex- 
isting in  severity,  there  will  be  little  or  nothing  to  fear  from  the 
liberal  abstraction  of  blood  so  long  as  the  symptoms  resist  this  princi- 
pal remedy,  and  its  proper  auxiliaries.  At  most,  there  can  be  only 
now  and  then  a  disastrous  result;  while  timid  caution  has  its  myriads 
of  victims.  Defective  judgment  there  must  always  be; ;  and  it  is  bet- 
ter, therefore,  that  it  should  lean  to  the  side  of  safety.  If  going 
wrong,  the  error,  in  respect  to  excess  of  bloodletting,  will  be  very 
soon  discovered.  The  timidity  of  man  needs  no  encouragement, 
when  the  question  relates  to  "  debility,"  and  "  the  precious  fluid"  (§ 
569,  e).  But  come  to  cathartics  and  emetics,  nay,  tobacco,  opium, 
aconite,  belladonna  (§  960,  a),  he  is  bold  and  indiscriminate.  Here  is 
opened,  I  again  say,  an  inexhaustible  field  of  inquiry, — far  more  ab- 
struse and  difficult  than  the  management  of  bloodletting.  You  may 
bleed  in  intestinal  inflammation,  perhaps  to  a  vast  extent,  and  speedi- 
ly surmount  the  disease ;  when,  had  an  irritating  cathartic  been  ex- 
hibited, the  scale  might  have  been  as  speedily  turned  in  the  other  di- 
rection (§  878,  893  n,  1063  c,  1064,  1065). 

1006, y^  Different  ages  of  the  world  appear  to  have  been  distin- 
guished by  different  degrees  of  moral  firmness,  and  by  remarkable 
differences  in  practical  habits ;  and  the  light  of  settled  experience  and 
of  the  best  philosophy  in  medicine  is  almost  as  apt  to  suffer  a  parox- 
ysm of  darkness  at  the  advanced  as  at  the  earlier  stages  of  science. 
Certain  it  is  that  knowledge  had  reached  a  high  advance  at  the  time 
of  Hunter,  when  bloodletting  had  given  a  temporary  place  to  the  stim- 
ulating plan  of  treatment.  Theory  and  experience  governed  in  one 
case,  hypothesis  in  the  other.  No  sooner,  however,  had  Mr.  Hunter 
announced  the  substitution  of  the  stimulant  for  the  depletive  treat- 
ment, than  we  hear  from  Robert  Jackson,  that  "  Abstraction  of  blood 
in  contagious  fever,  which,  but  a  few  years  since  was  viewed  with 
abhorrence,  even  branded  with  the  epithet  of  murder,  is  noiu  consid- 
ered the  main  engine  of  successful  treatment"  (§  960,  a,  p.  717). 


THERAPEUTICS. LOSS  OF  BLOOD.  765 

And,  if  we  look  abroad  upon  the  characteristics  of  the  present  day, 
do  we  not  find  in  animal  magnetism,  homcBopathy,  the  humoral  pa- 
thology, the  supplications  to  the  laboratory  of  the  chemist  for  revela- 
tions as  to  the  laws  and  processes  of  living  beings,  in  health  and  dis- 
ease, and  many  kindred  errors  and  superstitions,  a  melancholy  com- 
mentary on  the  human  mind  ] 

1006,  g.  The  general  treatment  of  inflammatory  and  febrile  dis- 
eases having  been  well  ascertained  by  Hippocrates  and  his  immedi- 
ate successors,  all  departures  from  their  philosophy  must  be  of  short 
duration.  It  will  remain  forever  a  model  in  the  science  of  medicine, 
as  much  as  Grecian  architecture,  and  Grecian  poetry,  will  continue 
to  be  the  true  models  of  taste  through  all  coming  time.  The  reason 
is,  that  the  philosophy  of  medicine,  like  the  principles  of  taste,  has  its 
foundation  in  nature,  and  that,  of  all  her  institutions,  medicine  is  the 
most  intensely  interesting.  The  master-spirits  of  antiquity  observed 
nature  correctly,  and  drew  their  conclusions  from  this  only  source  of 
correct  knowledge.  They  formed  no  deductions  from  the  distortions 
of  nature,  erected  no  hypotheses  upon  the  ruins  of  organization,  nor 
sought  in  the  laboratory  of  the  chemist  what  can  be  found  only  in  liv- 
ing beings.  Drawing  their  conclusions  from  Nature  herself,  they  must 
remain  impregnable  against  all  the  adversities  of  time.  The  fabrics 
of  philosophy  may  be  mutilated ;  but  the  breach  will  be  soon  repair- 
ed, and  the  offender  will  find  his  proper  place  in  the  archives  of  his- 
tory. Where  the  foundation  has  been  substantially  laid,  the  innova- 
tions of  error  are  like  the  momentary  peltings  of  the  storm  upon  the 
"  house  that  is  built  upon  a  rock"  (^  376J,  376|).— Note  Ff  p.  1135. 

1007,  a.  The  general  experience  of  which  I  have  hitherto  spoken 
has  been  mostly  relative  to  bloodletting  in  the  active  conditions  of  in- 
flammatory and  febrile  affections".  But  its  advantages  are  very  far 
from  being  limited  to  diseases  of  a  concentrated  form,  and  of  rapid 
progress.  They  reach,  also,  and  profoundly,  the  moderated  condi- 
tions which  make  up  the  varieties  of  chronic  inflammation.  And 
here,  again,  I  cannot  but  entertain  the  hope  that  I  may  have  so  dem- 
onstrated the  close  similitude  of  those  forms  of  inflammation  which 
are  contradistinguished  by  the  designations  of  active  and  passive,  that 
they  will  cease,  at  least,  to  be  regarded  as  extremes  of  disease  that 
require  exactly  opposite  modes  of  treatment ;  and,  therefore,  that  a 
better  practice  may  obtain  in  those  chronic  cases  which  have  been 
generally  consigned  to  "  bark  and  wine,  and  an  invigorating  diet"  (§ 
752-756.     Also,  Med.  and  Phys.  Comm.,  vol.  ii.,  p.  524-546). 

1007,  b.  A  few  examples  will  best  illustrate  and  enforce  the  prin- 
ciple ;  and  to  render  them  emphatic  and  comprehensive,  let  us  select 
constitutions  broken  down  by  prolonged  suffering  and  wretchedness. 
An  instructive  case  is  recorded  by  the  eminent  Kentish.  It  was  the 
squalid  subject  of  a  mortified  extremity,  which  had  been  advancing 
to  its  present  state  for  a  year.  At  this  period  the  leg  was  removed 
above  the  knee.  The  patient  had  been  crowded  for  months  with  ton- 
ics and  stimulants,  and  "  was  reduced  to  bones."  The  stump  put  on 
an  inflammatory  action.  The  admirable  surgeon  saw  nothing  but 
death  in  prospect,  unless  he  opposed  the  dictates  of  philosophy  to  the 
prejudices  of  the  lookers-on.  "  What !"  said  they,  "  bleed  a  poor 
man  who  has  been  confined  above  a  year,  and  is  quite  reduced  to  a 
skeleton!     Oh,  shame!  shame!"     But  philosophy  triumphed,  and  ig- 


766  INSTITUTES    OF    MEDICINE. 

norance  stood  rebuked.  Blood  was  drawn,  and  nature  began  to  ral- 
ly. Still,  the  system  remained  oppressed  with  the  effects  of  former 
disease,  and  of  former  practice.  More  blood  was  again  and  again 
taken  ;  and  at  each  outlet  nature  acquired  fresh  vigor.  The  inflam- 
mation gave  way,  and  the  patient  recovered.  Near  a  year  afterward 
Kentish  saw  his  patient,  who  was  then,  at  sixty  years  of  age,  a  mon- 
ument of  the  benefits  of  science,  and  of  moral  courage  (^  863  h. 
998,  1001).     In  such  cases  the  hypothesis  oi  an<Bmia  displays  its  worst. 

Dr.  Borland,  a  hospital  surgeon  at  St.  Domingo  in  1796  and  1797, 
jast  away  the  tonic  and  stimulant  plan  which  had  prevailed,  and  em- 
ployed bloodletting  and  cathartics  in  the  treatment  of  ulcers.  By 
these  means  "he  often  succeeded,"  says  Jackson,  "even  in  persons 
who  were  emaciated  to  the  last  degrees  of  emaciation  by  the  contin- 
uance of  the  disease"  (§  992,  a,  1057  k). 

1007,  c.  Here  is  another  case  of  a  parallel  nature;  only  more  il- 
lustrative of  the  safety  and  utility  of  bloodletting  in  enfeebled  states 
of  the  constitution,  where  disease  may  demand  the  remedy  in  more 
robust  subjects.  It  is  a  case  of  diabetes,  by  Dr.  Barlow,  in  the 
"  Cyclopaedia  of  Practical  Medicine,"  The  subject,  a  hoy,  was  re- 
duced by  the  disease  to  a  feeble  and  emaciated  state.  In  this  condi- 
tion he  was  bled  to  the  extent  of  209  ounces,  or  thirteen  pounds, 
within  fifty-one  days.  The  operation  was  repeated  twelve  times ;  so 
that  each  bleeding  of  this  emaciated  boy  averaged  seventeen  ounces. 
The  result  of  it  was,  a  rapid  restoration  of  health  and  strength,  and 
a  return  to  his  plough  (§  992  h,  1032,  (Z).— Note  Z  p.  1130. 

1007,  d.  Again:  "A  lady,"  says  Dr.  Wardrop,  "in  a  state  of  preg- 
nancy, had  been  greatly  debilitated,"  &c.  "She  was  emaciated,  and 
BO  feeble,  that  her  recovery  was,  by  those  around  her,  considered  hope- 
less. She  had  a  distinct  tenderness,  on  pressure,  in  the  epigastrium, 
and  her  pulse,  which  at  first  gave  the  impression  of  great  languor,  on 
more  minute  examination,  was  very  contracted,  feeling  like  a  thread, 
and  incompressible,  while  the  heart's  action  was  vigorous.  Bloodlet- 
ting was  immediately  resorted  to,  though  with  hesitation,  by  the  med- 
ical attendants.  No  sooner  had  a  few  ounces  of  blood  flowed  from 
the  vein,  than  the  pulse  began  to  rise  and  acquired  volume,  and  up- 
ward of  twenty  ounces  were  abstracted  before  its  vigor  was  sub- 
dued."    Recovery  then  went  on  progressively  (§  997). 

1008,  The  foregoing  cases  of  chronic  inflammation  (§  1007),  which 
are  common  in  the  walks  of  the  profession,  concur  in  showing  that 
medicine  is  a  science  of  principles,  and  that  a  general  treatment  is 
universally  applicable  to  inflammation  at  all  stages  of  its  existence, 
and  under  all  circumstances.  Bloodletting  may  not  always  be  an  ap- 
propriate remedy;  but  a  low,  or  non-stimulant  diet,  may  be  the  prin- 
cipal antiphlogistic  means  (§  752-756,  960,  975  c,  1006  h). 

Of  Bloodletting  in  Infancy  and  Old  Age. 

1  shall  now  devote  a  brief  consideration  to  the  applicability  of 
bloodletting  to  the  diseases  of  infancy  and  of  old  age  ;  especially  with 
a  view  of  presenting  the  experience  of  a  few  able  practitioners. 

1st.   Of  Bloodletting  in  Infancy. 

1009,  a.  We  have  already  seen  how  the  operation  of  remedial 
agents,  as  well  as  the  pathology  of  disease,  is  more  or  less  modifiei 


THERAPEUTICS. LOSS  OF  BLOOD.  767 

by  the  physiological  peculiarities  that  ai'e  incident  to  the  well-marked 
stages  of  life  (§  153-159,  574,  &c.). 

1009,  b.  These  peculiarities  are  stiongly  pronounced  in  infancy; 
and,  when  speaking  of  that  period  of  life,  it  was  seen  that  diseases  are 
marked  by  great  activity,  and  by  a  rapid  progress  (§  576).  Hence  it 
is  obvious  that  there  should  be  a  corresponding  promptitude  of  treat- 
ment, and  with  remedies  that  make  their  impression  speedily  and  pro- 
foundly. But,  it  was  also  said,  that  nature  is  now  strongly  inclined 
to  the  restorative  process,  and  that  there  is  great  susceptibility  to  the 
action  of  remedial  agents.  For  these  reasons,  therefore,  the  same 
remedies  operate  with  greater  effect  than  at  adult  age ;  so  that  in 
many  cases  where  general  bloodletting  would  be  indispensable  at  the 
latter  age,  leeching  may  be  equally  efficient  in  infancy  ;  or  an  emetic, 
or  a  cathartic,  perhaps,  may  effect  what  loss  of  blood  could  alone 
achieve  in  later  life  (§  1008). 

1009,  c.  But,  where  bloodletting  is  demanded  by  the  diseases  of  in- 
fancy there  is  no  age  at  which  it  is  better  borne,  and  none  at  which 
its  early  application  is  so  important.  It  may  be  also  said,  in  a  gen- 
eral sense,  that  either  general  or  local  bleeding  is  indispensable  in  all 
the  grave  internal  inflammations  of  infantile  life ;  and  that  the  general 
method  should  always  be  practiced  in  the  cerebral  inflammations  and 
cerebral  congestions  of  this  age,  as  of  all  others  (§  974).  In  similar 
affections  of  other  organs,  leeching  is  generally  preferable  in  early  in- 
fancy, as  indicated  under  the  philosophy  of  the  operation  of  loss  of 
blood  (§  927  b,  925). 

1010,  a.  The  annals  of  medicine  abound  with  the  best  experience 
in  favor  of  bloodletting  in  the  inflammatory  affections  of  infants. 

Sydenham  remarks,  that,  "bloodletting  maybe  as  safely  performed 
in  young  children  as  in  adults,  and  in  some  of  their  diseases  there  is 
no  curing  them  without  it." 

1010,  b.  Rush  was  an  unhesitating  advocate  of  bloodletting  in  in 
flammatory  diseases  at  all  stages  of  infancy.  "  It  is  more  necessary," 
he  says,  "in  the  diseases  of  infants,  than  in  adults"  (§  1017,  c). 

1010,  c.  Piorry  canfies  bloodletting  in  the  cerebral  inflammations 
and  congestions  of  infants  to  a  great  extent, — entirely  beyond  any 
thing  which  I  have  witnessed ;  quite  as  far  as  quinia  in  his  treatment 
of  indurated  spleen  (§  892,  k).  He  employs  from  one  to  several  ven- 
esections, and  twenty  to  fifty  leeches  to  the  head,  with  purgatives, 
&c.  This  is,  doubtless,  excessive  ;  but  such  is  the  fatality  of  infantile 
phrenitis,  and  such  the  ability  to  bear  the  loss  of  blood  in  cerebral  in- 
flammation, that  the  remedy  should  have  no  limit  short  of  affording 
relief  (§  974,  992  b).  Again,  it  is  the  experience  of  this  distinguish- 
ed observer  of  the  effects  of  loss  of  blood,  that,  "  in  many  young 
children  affected  with  trachitis,  large  evacuations  of  blood  have  en- 
feebled them  but  little;"  though  "excessive  hemorrhage  has  sometimes 
produced  convulsions."  Such  has  been  my  own  observation,  and  also 
of  excessive  umbilical  hemorrhage.      I  have  seen  no  resulting  death. 

1010,  d.  Evanson  and  Maunsell  think,  "that  in  the  child,  more 
particularly,  bleeding  is  required  in  the  first  stage  of  all  acute  inflam- 
mations. It  may  be  practiced  with  safety  in  the  youngest  infant,  pro- 
vided we  hold  in  view  the  relation  between  the  necessities  of  the  case 
and  the  strength  of  the  patient."  "  The  buffing  f>f  the  blood,"  say 
they,  "  is  not  a  safe  guide  in  the  child ;  as  we  have  diseases  absohito- 


768  INSTITUTES    OF    MEDICINE. 

ly  requiring  bleeding  {e.g.,  croup,  bronchitis,  &c.),  which  seldom  pro- 
duce the  appearance  in  question." 

1011.  It  is  unnecessary  to  multiply  examples  of  the  foregoing  ex- 
perience. They  abound  in  the  archives  of  medicine.  Even  at  an 
early  era  of  the  art  bloodletting  was  practiced  as  fearlessly  in  infan- 
cy as  it  was  at  adult  age. 

1012.  As  to  my  own  habits,  they  have  been  always  uniformly  one 
way.  Where  inflammation  has  affected  any  important  organ,  or  has 
been  otherwise  attended  with  danger,  and  it  seemed  not  likely  to  yield 
at  once  to  milder  means,  I  have  taken  no  risk,  but  have  resorted,  with- 
out delay,  to  the  remedium  principale ;  nor  have  I  ever  had  occasion 
to  regret  a  practice  which  I  would  so  earnestly  commend  to  others 
(§  576,  e.     Also,  P.S.  1860,  at  p.  872,  and  Note  F  p.  1114). 

1013.  Finally,  it  cannot  be  doubted  that  Lommius  is  right  in  the 
opinion,  that, 

*'  It  is  much  more  eligible  to  snatch  a  child,  by  means  of  bloodlet- 
ting, from  imminent  danger  of  death,  however  the  strength  may  be 
wasted,  than  to  let  him  perish  by  the  violence  of  the  fever." 

2d.   Of  Bloodletting  in  Old  Age. 

1014.  Here,  again,  as  every  where  else,  we  find  that  physiology 
lends  its  powerful  aid  in  the  treatment  of  disease,  and  agrees  with  the 
most  enlightened  experience.  Old  age  is  but  a  summary  expression 
of  all  the  natural  obstacles  which  have  accumulated  in  the  way  of  the 
organic  functions,  and  which  are  about  to  arrest  them  forever  (§  580- 
584,  633).  The  properties  of  life  are  now  most  incapable  of  sustain- 
ing any  of  the  lesions  by  which  they  are  invaded  at  earlier  ages. 
They  are  approaching  their  natural  extinction,  and  are  readily  abol- 
ished by  disease.  They  are  crippled  by  physical  causes  of  their  own 
production,  and  have  lost  much  of  their  susceptibility  to  the  ordinary 
effects  of  remedial  agents.  Changes  from  a  morbid  to  a  healthy  con- 
dition are  slowly  determined, — save  only  by  that  remedy  which  makes 
its  powerful,  instantaneous,  and  simultaneous  impression  upon  the 
main  instruments  of  vital  action  throughout  the  body.  In  every  part 
the  properties  of  life  sustain  a  deep  and  abiding  effect  from  loss  of 
blood.  Their  condition  is  directly  and  instantly  altered  in  the  instru- 
ments of  disease,  and  this  alteration  is  maintained  by  corresponding 
reflex  nervous  influences  determined  by  other  parts  (§  514,  7i),  as 
well  as  by  the  continued  operation  of  a  diminished  volume  of  blood, 
and  an  equalized  circulation.  The  secretions  break  forth  ere  we  bind 
up  the  arm  ;  and  thus  nature  comes  to  our  aid  by  another  efficient  pro- 
cess (§  862,  863).  It  is  all  the  work  of  a  moment ;  and  the  great 
revolution  begun  in  every  part,  it  may,  and  often  does,  terminate 
speedily  in  health. 

In  the  formidable  diseases  of  old  age,  therefore,  the  remedies  must 
be  such  as  shall  reach  profoundly  the  properties  and  actions  of  life, 
and  reach  them  without  delay.  Such  as  would  be  insufficient  in  youth 
must  surely  fail  when  declining  nature  is  least  disposed  to  co-operate 
with  art. 

1015.  a.  The  foregoing  conclusions  are  amply  corroborated  by  a 
large  and  enlightened  experience,  which  equally  demonstrates  the 
groundless  nature  of  the  prevailing  objections  to  bloodletting  in  all  tho 
diseases  of  old  age  ;  save  only  those  apoplectic  affections  in  which  tho 


THERAPEUTICS. LOSS  OF  BLOOD.  760 

system  may  be  least  able  to  sustain  the  shock  of  the  operation  (§ 
990). 

In  the  Mem.  de  I'Acad.  Roy.  de  Med.,  1S40,  is  a  report  by  M,  Prus, 
setting  forth  the  safety  and  advantages  of  bloodletting  as  practiced  ex- 
tensively in  the  inflammatory  affections  of  the  aged  occupants  of  the 
two  immense  establishments,  the  Hospice  de  la  Vieillesse,  and  Bicetre. 
He  also  adds,  that,  in  consequence  of  the  changes  which  the  arteries 
undergo  in  aged  people,  we  should  always  examine  the  state  of  the 
pulse  at  the  heart.  "How  often,"  he  says,  "have  patients,  whose 
radial  pulse  was  feeble  and  irregular,  but  whose  heart  announced  an 
energetic  action,  been  bled  with  the  highest  advantage,  and  thus  pre- 
served from  a  speedy  and  otherwise  inevitable  death !" 

1015,  b.  Such,  too,  is  the  experience  of  Hourman  and  Dechambre 
in  their  treatment  of  the  inflammatory  diseases  of  the  old  women  of 
La  Salpetriere ;  and  M.  Piorry  bears  his  testimony,  that  aged  men 
bore  the  same  abundant  bleeding  [des  saignees  ahondantes)  as  the  old 
women  of  Salpetriere. 

1016,  Such,  then,  is  enlightened  hospital  experience,  and  only  a 
small  proportion  of  such  experience.  It  is  manifest,  therefore,  that  if 
bloodletting  be  thus  admissible  and  important  with  the  aged  inmates 
of  public  infirmaries,  there  is  no  ground  for  that  distinction  which 
has  been  set  up,  in  a  genei*al  sense,  between  hospital  and  private  pa- 
tients, and  which  enjoins  the  use  of  tonics  and  stimulants  in  one  case 
where  it  admits  of  bloodletting  in  the  other  (§  752-756). 

1017,  a.  But,  since  "  experientia  docet,"  it  may  be  useful  to  some 
to  be  informed  circumstantially  of  what  has  happened,  in  the  way  of 
expei'ience,  in  the  private  walks  of  the  profession. 

Hippocrates,  Galen,  Celsus,  Trallian,  and  other  ancients,  advocated 
bloodletting  in  the  inflammatory  diseases  of  old  age.  "  In  bleed- 
ing," says  Celsus,  "  the  physician  should  not  consider  so  much  the 
age  as  the  strength  of  the  patient." 

1017,  b.  We  are  told  by  Wepfer  that  it  is  a  very  prevailing  custom 
among  the  Swiss,  even  at  eighty  and  ninety  years  of  age,  to  resort  to 
bloodletting  once  a  year,  or  oftener,  as  a  prophylactic. 

"  I  admonish  you,"  says  Vitel,  "  against  the  advice  of  those  physi- 
cians who  would  dissuade  you  from  bleeding  the  aged,  who  may  be 
the  subjects  of  inflammatory  or  eruptive  fevers.  The  fear  of  debility 
is  unfounded.  Bloodletting  is  as  necessary  to  them  as  to  the  young, 
and  not  less  beneficial." 

F.  Hoffmann  remarks,  "  Communis,  s,edi pessimus  error  est,  eetatem 
senilem  plane  non  ferre  sanguinis  subtractiones,  quasi  vero  in  gran- 
daevis  non  redundaret  sanguineus  latex,  ut  potius  ejus  et  virium  de 
fectu  laborarent."  "  In  senili  astate  magis  necessaria  sanguinis  missio, 
quam  alia  ad  morbos  grandaevis  familiares  arcendos,"  etc.  "  Venae- 
sectio  sepius  senibus  utilissima,  imo  ad  longaevam  vitam  confert." 
"  Complura  certe  memoria  teneo  exempla  senum,  qui  ad  nonagesimum 
annum  fere,  salvi,  incolumes  et  a  morbis  aetate  provectis  familiaribus 
immunes  vixerunt,  solo  vencBsectionis  remedio,  bis  per  annum  admisso.''' 
"  Id  quod  etiam  a  me  in  peculiari  dissertatione,  De  Magna  Vence  sec- 
tionis  ad  intam  sanavi  et  longam  Remedio,  assertum  est  ac  demon- 
strandum."— Opera,  t.  i.,  p.  135,  455,  450. 

Forestus  bled  the  aged  equally  without  hesitation, — "  firmus  puer, 
et  robustus  senex,  tuto  curantur." 

Ceo 


770  INSTITUTES    OP    MEDICINE. 

Van  Swieten,  the  able  practitioner  and  learned  commei.tator,  con- 
siders bloodletting  as  important  at  the  extremes  of  age,  as  at  the  in- 
termediate periods. 

Finally,  all  the  best  writers  of  the  sixteenth  and  seventeenth  cen- 
turies advocate  bloodletting  for  the  inflammatory  and  febrile  diseases, 
not  only  of  middle  age,  but  at  the  extremes  of  life.  They  protest, 
also,  against  arresting  spontaneous  hemorrhages,  even  when  occurring 
at  advanced  age.  The  Brunonians  have  looked  on  with  admiration, 
when  nature  has  thus  rescued  the  sick  from  the  evils  of  the  bark  and 
wine  treatment  (§  890,  <?).— Notes  Ff  p.  1135,  Go  p.  1138,  Ii  p.  1139. 

1017,  c.  In  later  times,  the  records  of  medicine  continue  to  abound 
with  demonstrations  of  the  safety  and  necessity  of  bloodletting  in  the 
inflammations  and  fevers  that  may  befall  old  age. 

From  what  was  stated  of  Rush's  experience  of  bloodletting  in  in- 
fancy (§  1010,  Z>),  it  appears  that  he  considered  the  i-emedy  most  im- 
portant at  the  extremes  of  life ;  for,  in  another  work,  he  says,  "  Expe- 
rience proves  that  bloodletting  is  more  necessary,  under  equal  circum- 
stances, in  old  age,  than  in  any  other." — (See  my  'Examination  of  Re- 
vieivs,  in  Med.  and  Phys.  Coram.,  vol,  iii,,  p.  76-78.) 

Hosack  deprecates  the  prejudice  which  exists  against  bloodletting 
in  old  age. 

Sir  Gr,  Blane  demonstrates  the  safety  and  utility  of  the  remedy  in 
the  inflammatory  diseases  of  aged  people.  He  states  the  case  of  an 
individual  at  the  age  of  one  hundred  years,  who  was  cured  of  pneu- 
monia by  free  bloodletting  from  the  arm.  In  another  instance,  a  lady 
of  eighty-two  years  suddenly  lost,  by  spontaneous  hemorrhage  from 
the  nose,  a  quart  of  blood,  "  which  was  followed  neither  by  faintness 
nor  weakness,  but  by  improvement  in  health,  in  point  of  vigor  and 
alacrity." 

Frank  cured  an  octogenarian  of  pneumonia  by  bleeding  him  nine 
times.  Gui  Patin  cured  his  father  of  pneumonia,  at  the  age  of  eighty, 
by  bleeding  him  freely  from  the  arm  eight  times.  Freteau  bled  at  the 
age  of  seventy  to  the  extent  of  four  pounds  in  six  days. 

And  thus  might  I  go  on  with  numerous  other  coincident  authorities  ; 
all  showing  individually,  and  proving  collectively,  that  old  age,^er  se, 
constitutes  no  objection  to  loss  of  blood.  But,  were  there  even  haz- 
ard in  the  remedy,  its  possible  dangers  would  be  incomparably  less 
than  those  of  many  acute  diseases  which  now  so  readily  destroy.  It 
is  no  defense  that  the  patient  dies  naturally,  when  the  chances  of  life 
are  withheld  by  the  neglect  of  bloodletting. 

Spontaneous  Hemorrhage. 

1018.  I  shall  now  briefly  consider  nature  in  her  efforts  to  relieve 
the  system  of  inflammations  and  congestions ;  since  it  is  from  the  va- 
rious expedients  of  Nature  that  we  derive  many  of  our  best  indications 
of  cure ;  and  the  summary  mode  in  which  she  institutes  the  hemor- 
rhagic process,  and  the  consequent  relief  of  protracted  diseases,  are 
alone  conclusive  against  the  Brunonian  doctrine  of  debility,  and  may 
encourage  the  timid  practitioner  in  the  use  of  the  lancet  (§  862,  863, 
890  e,  990  m). 

1019,  a.  John  Hunter  has  seen  several  quarts  of  blood  thrown  up 
from  the  stomach  in  a  few  hours,  even  by  emaciated  patients ;  and 
recovery  has  speedily  followed  thjB  evacuation.     Cases  of  this  nature 


THERAPEUTICS. LOSS    OP   BLOOD.  771 

are  witnessed  by  all  practitioners  of  much  experience.  The  same  im- 
mense quantities  of  blood  are  often  discharged  from  the  lungs,  and  in- 
testine ;  breaking  up  the  most  formidable  congestive  fevers,  and  chron 
ic  inflammations  which  have  resisted  all  other  means  of  treatment  for 
years  (§  733  d,  890  e). 

1019,  h,  Lancisi  relates  the  case  of  a  man  of  seventy  years  of  age, 
who  suddenly  lost,  in  a  threatened  attack  of  apoplexy,  eleven  pounds 
of  blood  from  his  nose,  and  four  more  in  fifteen  days  afterward,  with- 
out any  sensible  failure  of  strength. 

1019,  c.  Boerhaave  "has  known  almost  the  entire  blood  of  the  body 
to  have  been  lost  by  hernoiThage,  and  yet  the  subject  recover." 

1019,  d.  Haller  relates  many  examples  of  excessive  hemorrhage, 
xn  one  of  his  cases,  one  hundred  and  twenty-five  ounces  of  blood  were 
lost  at  each  menstruation,  for  several  years ;  besides  a  daily  abstrac- 
tion of  blood  from  the  arm  for  fourteen  months.  In  another  instance, 
he  states  that  one  thousand  pounds,  or  four  barrels  of  blood,  were  lost 
in  one  year,  or  nearly  three  pounds  daily  for  that  period.  In  another 
there  was  a  hemorrhoidal  flux  of  five  pounds  daily  for  sixty-two  con- 
secutive days,  or  a  total  of  three  hundred  and  ten  pounds  ;  being  prob- 
ably twice  the  weight  of  the  whole  body.  One  more  lost  one  hundred 
and  ninety-two  ounces,  or  about  thirteen  pounds,  from  his  stomach,  in 
a  single  night,  and  recovered.  Haller,  himself,  lost  one  hundred  and 
twenty-eight  ounces,  or  eight  pounds  of  blood,  within  twenty-four 
hours.  —  (See  special  references  in  Med.  <^  Phys.  Comm.  vol.  i.) 

1019,  e.  Similar  examples  are  constantly  presented  to  our  observa- 
tion, and  a  large  variety  may  be  found  assembled  in  the  Medical  and 
Physiological  Commentaries.  They  show  us  that  when  Nature  takes 
the  work  in  hand  she  does  not  stop  to  calculate  the  ounces,  or  the 
pounds,  but  pushes  on  till  she  has  accomplished  a  rational  purpose. 
"Honest  Brunonians,"  says  Dr.  Beddoes,  "have,  of  late,  minutely 
recorded  cases,  to  them  incomprehensible,  where  immense  discharges 
of  blood  have  suddenly  stopped  protracted  fever,  and  left  the  patients 
improved  in  strength"  (§  890,  e,  993).— Notes  Ff  p.  1135,  Go,  Ii. 

1019, yi  Among  the  multitude  of  these  extraordinary  hemorrhagic 
eff"usions  it  is  rare  that  death  is  an  immediate  consequence  (§  890,  e), 
and  rarer  still  where  art  has  superintended  the  loss  of  blood.  In  the 
latter  case,  syncope  comes,  in  good  time,  to  the  aid  of  the  patient; 
far  sooner  than  in  the  spontaneous  process.  Nor  can  art  imitate  na- 
ture in  the  full  extent  of  her  depletory  system.  The  philosophy 
which  respects  the  difference  in  effects  appears  to  be  this.  When  the 
remedy  is  instituted  by  nature,  the  parts  concerned  in  the  morbid  ac- 
tion are  made  the  instruments  of  relief,  and  the  general  law  of  adap- 
tation is  in  force  (§  137  c,  733  d,  847  g).  The  peculiar  modification  of 
action  upon  which  capillary  hemorrhage  depends,  and  the  influence  it 
exerts  upon  the  system  at  large,  resist  the  earlier  effects  of  loss  of 
blood  when  artificially  abstracted  in  the  same  way  as  the  loss  is  resisted 
by  inflammations.  I  have  seen  this  principle  operating  with  various 
effect  in  inflammations,  according  as  they  are  modified  by  remote  caus- 
es, and  according  to  the  activity  and  extent  of  disease,  the  organ  or 
organs  affected,  &c.  (§  805,  813,  922  b). 

1019,  g.  The  more  we  interrogate  nature  as  to  the  loss  of  blood  the 
more  shall  we  find  her  proclaiming  that  this  is  her  expedient,  beyond 
any  other,  by  which  she  attempts  the  removal  of  fearful  diseases. 


772  INSTITUTES    OF    MEDICINE 

Haemoptysis,  haematamesis,  the  hemorrhoidal  flux,  intestinal  henvjr- 
rhage,  are  all  instituted  for  this  purpose.  We  constantly  witness  the 
spontaneous  effort  where  the  properties  of  life  are  so  prostrate  that 
art  looks  on  with  dread  and  amazement ;  and  what  nature  had  thus 
wisely  begun  is  often  declared  to  be  the  effect  of  a  putrid  disruption 
of  the  living  body,  and  calls  for  every  counteracting  means.  Fortu- 
nately, these  means  sometimes  consist  of  the  lancet,  and  other  anti- 
phlogistic remedies.  But  this,  with  many,  is  only  where  the  strength 
is  vigorous,  and  where  it  is  feared  that  unrestrained  nature  may  pos- 
sibly reduce  it.  Examples  of  this  kind  are  common  in  pulmonary 
hemorrhage  ;  and,  although  in  these  instances  the  blood  be  taken  with 
a  view  of  astringing  a  suspected  rupture  of  a  blood-vessel,  the  error 
does  not  affect  the  true  philosophy  of  the  case  ;  and  when  nature  may 
be  too  "  sparing  of  the  vital  fluid"  to  overcome  the  real  condition  of  the 
lungs,  a  singular  illustration  will  be  obtained  of  a  co-operation  of  the 
lancet  toward  a  salutary  result  where  it  had  been  employed  to  de- 
feat the  curative  effort  of  nature  (^  922  b,  Note  Bbb  p.  1148). 

1019.  h.  But  error  is  often  committed  in  these  cases.  If  hemor 
rhage  be  profuse,  it  should  be  allowed  to  go  on  within  the  limit  of 
safety ;  since  the  depletion  proceeds  from  the  instruments  of  disease. 
A  rapid  abstraction  of  blood  from  the  arm,  superadded  to  the  hemor- 
rhage, may  airest  the  spontaneous  discharge  too  speedily ;  while  that 
which  is  artificially  taken  would  be  more  curative  if  left  to  the  natu- 
ral process.  But,  again,  where  the  spontaneous  discharge  is  small, 
the  lancet  may  be  imperatively  demanded  ;  while  it  is  here  employed 
with  greater  caution  than  in  the  former  cases. — Note  F  p.  1114. 

Of  misapplied  and  excessive  Bloodletting,  "  Morbid  Irritation,'^  and 
''^excessive  Reaction  from  Loss  of  Blood." 

1020.  In  the  Medical  and  Physiological  Commentaries  I  have  in- 
vestigated extensively  those  reputed  consequences  of  loss  of  blood 
which  are  known  as  "  morbid  in-itation,  and  excessive  reaction"  (vol. 
i.,  p.  239-281). 

1021.  We  certainly  meet  with  examples  of  the  foregoing  nature, 
arising  from  improper  bloodletting.  But,  it  is  generally  too  little,  not 
too  great  a  loss  of  blood,  which  does  the  mischief.  The  untoward  re- 
sults are  owing  to  the  unfavorable  impression  which  is  thus  made  upon 
the  organic  properties,  both  by  the  direct  effect  of  the  agent,  and  by 
the  operation  of  the  nervous  influence  upon  the  heart  and  the  main 
instruments  of  vital  action  (§  965,  b).  The  heart,  in  consequence, 
beats  either  with  greater  frequency  or  greater  force.  This  is  what  is 
denominated  "irritation"  and  "excessive  reaction,"  and  is  assumed 
as  a  proof  that  too  much  blood  has  been  abstracted ;  when,  on  the 
contrary,  had  the  loss  been  carried  to  a  greater  extent  these  phenom- 
ena would  have  been  rarely  presented  (^  500  m,  687-|,  694f ). 

1022.  And  now  to  show  conclusively  that  the  foregoing  consequen- 
ces depend  more  or  less  upon  imperfect  bloodletting,  and  a  consequent 
aggravation  of  disease,  it  will  be  found,  as  I  have  shown  extensively 
in  my  former  Essay  on  Bloodletting,  that  in  most  of  the  cases  recoi'd- 
ed  by  Dr.  Marshall  Hall  and  other  advocates  of  the  doctrine  of  "  ex- 
cessive reaction,"  that  the  symptoms  and  post-mortem  appearances, 
as  by  themselves  recorded,  denote  either  the  antecedent  existence  of 
inflammation  and  a  subsequently  exasperated  degree,  or  inflammation 


THERAPEUTICS. LOSS    OF    BLOOD.  773 

resulting  from  the  loss  of  blood,  or  from  an  antecedent  predisposition. 
The  last  two  causes  may  act  conjointly  ;  and,  as  I  have  already  shown, 
too  small  an  abstraction  of  blood  is  not  an  unusual  cause  of  inflamma 
tion.  Excessive  bloodletting,  on  the  other  hand,  is  a  rare  phenom- 
enon ;  but,  unlike  too  small  a  loss,  it  may  establish  inflammation  in- 
dependently of  any  antecedent  predisposition  (§  950,  965  b). 

1023,  a.  When  inflammation  is  induced  by  excessive  loss  of  blood, 
the  physiological  influences  are  not  the  same  as  those  which  obtain 
when  it  ensues  upon,  or  is  aggravated  by,  too  small  a  loss  (§  965  b, 
1022).  In  very  numerous  cases  of  this  nature  there  has  been  a  pre- 
existing tendency  to  the  disease ;  or,  more  frequently,  a  morbid  con- 
dition already  established,  but  not  fully  developed.  Thus,  it  is  not  an 
unusual  event  that  the  physician  abstracts  blood  for  pain  in  the  head, 
or  a  "  stitch  in  the  side,"  or  for  some  uneasiness  of  breathing.  The 
abstraction  of  blood  is  judiciously  moderate.  But,  there  has  been  an 
accumulating  tendency  to  inflammation  ;  and  the  blood  thus  abstracted 
proves  not  to  have  been  commensurate  with  the  demands  of  the  case. 
It  releases  and  gives  force  to  the  general  circulation,  and  increases 
the  irritability  of  the  extreme  vessels.  Phrenitis,  pneumonia,  or  pleu- 
ritis,  is  the  consequence.  The  physician  is  alarmed  by  the  unexpect- 
ed event ;  yet  so  like  inflammation  are  the  consecutive  symptoms, 
that  he  ventures  upon  the  lancet  for  their  relief.  But,  the  symptoms 
had  followed  upon  the  loss  of  blood,  and  his  decision  is  restrained. 
He  therefore  stops  at  the  very  point  of  mischief,  and  adds  another  im- 
pulse to  disease.  He  may  yet  bleed  again  and  again,  as  the  malady 
resists  all  other  agents ;  but  the  same  caution  prevails,  and  the  evil 
increases  at  every  partial  outlet  of  blood  {Note  p.  729). 

These  cases  accumulate  rapidly  upon  the  hands  of  the  unskillful  or 
timid.  Records  are  examined,  and  parallel  examples  are  found  to 
abound.  Dissections  are  made,  and  reveal  the  usual  physical  signs 
of  inflammation.  The  conclusion,  therefore,  comes  up,  as  expressed 
by  Dr.  Hall,  that  there  is  a  disease  "  exactly  like  inflammation,  but 
totally  different  from  it"  ! 

Just  so  it  is  with  child-bed  women.  There  is  often  a  great  ten- 
dency, in  these  cases,  to  local  inflammations ;  and  these  may  be  more 
or  less  speedily  developed  by  moderate  flooding,  especially  if  there 
have  been  previous  venous  congestion,  as  is  very  frequently  the  case 
(§  803,  965  b).  Dr.  Hall  has  many  of  these  examples,  and  were  they 
really  cases  of  simple  irritation,  or  simple  exhaustion  and  excessive  re- 
action from  loss  of  blood,  they  could  not  be  adduced  to  illustrate  the 
effects  of  bloodletting  in  disease.  They  should  form  a  class  by  them- 
selves ;  designated  as  cases  of  the  morbific  effects  of  "  excessive  loss 
of  blood"  upon  the  comparatively  healthy  system.  They  must,  there- 
fore, be  admitted  to  have  no  bearing  upon  cases  where  bloodletting 
may  have  been  demanded,  and  to  be  worse  than  useless  for  illustrating 
the  effects  of  bloodletting  as  a  remedy.  As' well  might  one  say,  that 
cathartics  shall  not  be  given  in  disease,  or  only  so  with  fear  and  trem- 
bling, because  they  may  be  pernicious  in  health.  And  he,  being  well, 
who  should  physic  himself  in  order  to  be  better,  would  be  mad  in- 
deed should  he  attempt  to  remove  the  evils  of  his  mistake  by  swal- 
lowing one  dose  after  another.  Just  so  it  is  in  respect  to  bloodletting, 
or  accidental  hemorrhage,  in  health.  If  inflammation  follow  in  the 
\atter  instance,  it  will  be  important  to  ascertain  whether  excessive 


774  INSTITUTES    OF    MEDICINE. 

bloodletting  have  been  the  exciting  cause,  or  whether  it  did  not 
spring  from  a  previous  disposition  to  disease ;  since  the  treatment 
will  be  entirely  different  in  the  two  cases.  The  former  case  is  rare, 
as  known  from  the  accidental  and  profuse  hemorrhages  that  are  daily 
occurring.  Nor  is  even  simple  in-itation  a  common  result;  the  inju- 
ry consisting  mainly  in  feebleness.  And  here  I  may  say,  that  it  is  a 
remarkable  fact,  that  the  effects  described  by  Dr.  Hall  as  incident  to 
lying-in  women  rarely  supervene  upon  excessive  flooding;  thus  show- 
ing that  in  the  cases  of  disease  the  affection  existed  already,  or  waa 
about  taking  place. 

1023,  h.  When,  however,  inflammation  is  actually  induced  by  ex- 
cessive loss  of  blood,  the  effects  of  the  physiological  influences  are  dif- 
ferent from  those  which  I  have  set  forth  as  constituting  the  philoso- 
phy of  the  operation  of  loss  of  blood,  as  the  effects  are  morbific  in 
one  case,  but  are  not  so,  or  are  curative,  in  others.  The  modus  ope- 
randi, however,  is  exactly  the  same  in  all  the  cases ;  and,  being  so, 
the  morbific  effect  confirms  my  philosophy  of  the  modus  operandi  of 
the  curative  influences.  In  the  former  case,  an  injury  is  inflicted, 
suddenly,  and  severely,  upon  the  vires  vita,  of  all  parts,  and  the  ner- 
vous influence  is  powerfully  determined  upon  all.  The  brain  suffers 
the  impression  particularly  ;  and  if  "  irritation,"  or  "  excessive  reac- 
tion," follow,  I  know  of  no  recorded  instance  which  has  not  also  pre- 
sented the  usual  phenomena  of  inflammation,  either  in  the  bxain  or 
some  other  organ.  If  death  ensue,  effusions  of  serum,  or  of  lymph,  or 
disorganization,  &c.,  are  the  concurring  results.  Still,  however,  an- 
other cause,  and  not  the  loss  of  blood,  may  have  produced  the  dis- 
ease, and  have  been  overlooked,  as  is  most  probable  ('^  1006). 

1024,  a.  Dr.  Hall,  who,  particulai'ly,  called  our  attention  to  the 
foregoing  "  irritation,"  and  "  excessive  reaction,"  as  frequent  effects 
of  excessive  loss  of  blood,  and  distinguishes  those  conditions  from  in- 
flammation, concedes  that  "  exhaustion  fi'om  loss  of  blood  is  not  only 
not  incompatible  with  repletion  and  a  tendency  to  effusion  within  the 
head,  but  it  actually  supposes  that  condition  of  the  encephalon,  when 
long  protracted."  He  also  states  that  leeches  to  the  head  are  one  of 
the  remedies.  So,  too,  may  general  bloodletting  relieve  the  symp- 
toms, but  only  temporarily  in  the  cases  supposed ;  since,  when  in- 
flammation is  induced  by  an  excessive  loss  of  blood,  such  is  the  com- 
bined nature  of  the  exciting  cause  and  its  curative  effects  the  modifi- 
ed irritability  of  the  vessels  may  readily  yield,  at  the  moment,  to  a 
farther  loss,  but  will  soon  display  the  morbific  influence  (^  901). 

1024,  h.  In  my  remarks  upon  the  physiological  effects  of  bloodlet- 
ting I  endeavored  to  show  that,  when  the  loss  of  blood  is  canned  to 
a  state  of  syncope,  and  more  especially  to  any  injurious  excess,  the 
greatest  severity  of  its  influence  is  sustained  by  the  brain  (§  950). 
It  is  to  the  head,  then,  that  we  should  generally  look  for  the  local  inju- 
ry, if  any  attend  the  reputed  cases  of  irritation  and  exhaustion  from 
an  excessive  loss  of  blood.  This  is  precisely  what  we  find  stated  by 
the  late  writers  who  have  treated  of  this  subject;  at  least  in  a  general 
sense. 

1024,  c.  But,  as  the  question  under  consideration  is  of  no  little  prac- 
tical importance,  it  may  be  well  to  have  before  us  Dr.  Hall's  highly- 
descriptive  account  of  the  severe  grades  of  what  he  calls  "  exhaustion 
with  excessive  reaction,"  and  as  supplying  the  most  ample  proof  that 


THERAPEUTICS. LOSS    OF    BLOOD.  775 

the  supposed  condition  is,  in  reality,  a  state  of  active  inflammation. 
Thus : 

"  The  beating  of  the  temples,"  says  Dr.  Hall,  "is  at  length  accona- 
panied  by  a  throbbing  pain  of  the  head,  and  the  energies  and  sensi- 
bilities of  the  brain  are  morbidly  augmented  ;  sometimes  there  is  in- 
tolerance of  light,  but  still  more  frequently  intolerance  of  noise  and 
of  disturbance  of  any  kind,  requiring  stillness  to  be  strictly  enjoined, 
the  knockers  to  be  tied,  and  straw  to  be  strewed  along  the  pavement ; 
the  sleep  is  agitated  by  fearful  dreams,  and  the  patient  is  liable  to 
awake  or  to  be  awoke  in  a  state  of  great  hurry  of  mind,  sometimes 
almost  approaching  to  delirium ;  occasionally  even  continued  deliri- 
um ;  more  frequently  there  are  great  noises  in  the  head,  as  of  singing, 
of  crackers,  of  a  storm,  or  a  cataract ;  in  some  instances  there  are 
flashes  of  light ;  sometimes  there  is  a  sense  of  great  pressure  or 
tightness  in  one  part  or  round  the  head,  as  if  the  skull  were  pressed 
by  an  iron  nail,  or  bound  by  an  iron  hoop." 

1024,  d.  Now,  the  foregoing  symptoms,  which  Dr.  Hall  considers 
as  denoting  a  state  exactly  o/^^oszYc  to  that  of  inflammation  when  they 
attend  considerable  losses  of  blood,  are  precisely  such  as  are  charac- 
teristic of  cerebral  inflammation  when  induced  by  other  causes.  But, 
as  if  to  remove  all  doubt  as  to  this  conclusion,  this  distinguished  phi- 
losopher reiterates  the  foregoing  account,  and  designates  other  phe- 
nomena not  less  significant  of  cerebral  inflammation,  such  as  "frequent 
delirium,"  "hardness  of  pulse,"  "huffy  blood,"  &c. ;  and,  to  give  to 
the  subject  its  utmost  force  he  calls  to  his  aid  the  opinions  of  Cook, 
Coke,  Kellie,  Tweedie,  Hammond,  Cox,  and  others ;  all  of  whom 
agi'ee  in  testifying  to  the  symptoms  that  mark,  exactly,  the  character 
of  inflammation  of  the  brain.  Nay,  more,  he  allows  this  conclusion, — 
that  they  are  "  attacks  which  resemble  inflammation  of  the  head,  chest, 
or  abdomen,  and  yet  are  totally  different  in  their  nature." 

Thus  then,  as  to  our  author's  excellent  description  of  the  general 
phenomena,  which  he  imputes  to  this  disease  that  is  considered  so  op- 
posite to  inflammation,  they  are,  to  my  mind,  conclusive  against  our 
author's  doctrine. 

1024,  e.  Morbid  anatomy  contributes,  also,  its  corresponding  proof. 
"  The  next  point  for  our  consideration,  in  the  inquiry  into  the  morbid 
effects  of  loss  of  blood,"  says  Dr.  Hall,  "  will  be  that  of  the  organic 
changes  induced  during  the  state  of  sinking.  These  are  chiefly  ob- 
sei-ved  in  the  brain,  in  the  cavities  of  the  serous  membranes,  in  the 
bronchia,  in  the  lungs,  and  in  the  track  of  the  alimentary  canal,  un- 
der the  forms  of  effusion,  oedema,  and  tympanitis."  At  other  times, 
our  author  admits  of  morhid  redness,  and  absolute  disorganization,  as 
rapid  consequences  of  this  affection   so  opposite  to  inflammation. 

1024, y!  Such,  indeed,  is  the  entire  coincidence  between  our  au- 
thor's supposed  cases  and  those  of  inflammation,  that  we  are  told  by 
the  author  that  there  is  often  no  other  test  of  their  distinction  than  the 
treatment  which  is  adapted  to  inflammation.  We  must  bleed  ;  and 
if  the  patient  bear  it  well, — ivell ; — if  otherwise,  we  must  then  en- 
deavor to  repair  the  wrong.  This  after-knowledge,  this  dependence 
for  the  diagnosis  upon  the  effects  of  treatment,  may  help  the  under- 
standing; but  will  it  be  likely  to  help  the  patient,  or  to  improve  the 
science  ?  And  how  is  the  treatment  improved  by  this  species  of  in- 
telligence 1     The  greatest  zealot  would  abandon  the  diagnostic  test 


77b  INSTITUTES    OF    MEDICINE. 

it'  lie  found  it  injurious.  But,  says  Dr.  Hall,  the  patient  "  may  be 
greatly  relieved  by  the  loss  of  blood  ;"  "  the  temporary  relief  which 
follows  general  bloodletting  may  be  so  uniform  as  to  impose  on  the 
inexperienced."     Then  I  maintain  that  the  loss  is  useful. 

1024.  g.  In  the  foregoing  cases,  as  related  by  Dr.  Hall,  and  others, 
where  there  had  been  bloodletting,  we  may  generally  recognize  the 
occurrence  of  cerebral  inflammation  independently  of  the  loss  of  blood, 
and  often  of  its  pre-existence ;  and  I  as  sincerely  believe  that  farther 
bloodletting  was  the  proper  remedy  for  the  disease.  In  the  cases 
where  irritation,  and  excessive  reaction,  are  said  to  have  been  con- 
sequent on  spontaneous  hemorrhage,  it  is  not  less  apparent  that,  in 
most  instances,  inflammation  had  already  existed,  or  there  was  a  strong 
predisposition  to  it. 

1025.  There  are  few  practitioners  in  the  United  States  who  have 
seen  more  of  bloodletting  than  myself;  and  I  am  therefore  quite  con- 
versant with  cases  of  the  foregoing  nature,  as  I  have  met  with  them 
in  the  hands  of  others.  In  numerous  instances  where  the  attending 
physician  had  imagined  "  excessive  reaction,  and  prostration  from  ex- 
cessive loss  of  blood,"  I  could  discover  nothing  but  the  onward  march 
of  inflammation,  that  called  for  greater  abstractions  of  blood  ;  and  that 
this  opinion  was  right  has  been  generally  confirmed  on  resuming  the 
depletive  treatment. — Hole  p.  763. 

1026.  Finally,  as  I  have  said  in  the  "  Commentaries,"  the  rules  for 
bloodletting  which  have  been  propounded  by  Dr.  Hall,  and  all  others 
of  a  like  nature,  are  captivating  by  their  simplicity.  This  was  the 
secret  of  the  popularity  of  Brown's  Elements  of  Medicine,  and  of  the 
long,  unmolested  sway  of  the  Humoral  Pathology.  A  later  and  more 
universal  example  is  seen  in  the  chemical  views  of  life  and  disease. 

Many  have  imbibed  an  erroneous  impression  that  Dr.  Hall  is  a  warm 
advocate  for  the  use  of  the  lancet ;  and,  as  the  case  of  Dr.  Hall  is  very 
extensively  applicable  to  physicians,  I  shall  state  the  nature  of  the 
misapprehension.  Dr.  Hall  advocates  bloodletting  only  in  certain  af- 
fections where  few  would  deny  the  propriety  of  the  remedy ;  and  in 
such  cases  he  commends  its  liberal  use.  But,  what  he  has  so  far  said 
with  emphasis  has  the  effect  of  discouraging  its  application  in  the  vast 
class  of  congestive  fevers,  and  depressing  inflammations,  and  even  in 
many  of  the  cases  to  which,  on  general  principles,  he  admits  its  ap- 
plicability (Rights  of  Authors,  p.  913,  and  Index  II,  art.  Hall,  M.). 

But  it  is  not  alone  by  his  exclusive  precepts  that  his  purpose  is  at- 
tempted. On  more  than  one  occasion  he  broadly  affirms,  that  "  it  is 
difficult  to  say  whether  more  injury  has  been  done  by  an  undue,  or 
by  an  inefficient,  use  of  the  lancet."  Such  is  the  balance  which  is 
often  struck  by  apparent  advocates  of  bloodletting ;  but,  I  am  still  apt 
to  think,  with  Botalli,  that  "  One  hundred  thousand  men  perish  from 
the  want  of  bloodletting,  or  from  its  not  being  timely  employed,  where 
one  perishes  from  excessive  bleeding,  when  prescribed  by  a  physician." 

General  Conclusions  as  to  Bloodletting, 

1027.  From  all  that  has  been  now  said  on  the  subject  of  bloodlet- 
ting, I  arrive  at  the  following  general  conclusions  : 

1.  That  loss  of  blood  produces  its  direct  and  efficient  impression 
upon  the  vires  vitcB  of  the  capillary  blood-vessels,  by  modifying  their 
8ction. 


THERAPEUTICS. LOSS    OF    BLOOD.  777 

2.  That  the  quantity  of  blood  to  be  abstracted  relates  directly  to 
the  foregoing  impression. 

3.  That  the  most  salutary  effect  of  loss  of  blood  will,  therefore, 
consist  in  its  nearest  approximation  to  a  full  but  just  impression  upon 
the  vires  vitce. 

4.  That,  to  produce  and  maintain  the  foregoing  impression  will  re- 
quire the  abstraction  of  a  certain  quantity  of  blood  in  every  case,  the 
measure  of  which  will  be  the  antecedent  and  resulting  symptoms. 

5.  That  bloodletting  may  add  to  the  force  of  disease  by  coming 
short  of  that  impression ;  or,  it  will  be  injurious  if  carried  to  excess, 
or  may  even  induce  new  inflammations. 

6.  That  bloodletting  may  be  a  remedy  for  other  diseases  than  inflam- 
mation and  fever. 

7.  That,  when  employed  as  a  prophylactic,  on  passing  from  northern 
to  tropical  countries,  it  must  be  with  such  moderation  as  shall  not  in- 
crease irritability ;  and  then  only  in  the  plethoric  and  robust. 

8.  That  general  bloodletting,  cupping,  and  leeching,  operate  upon 
common  principles,  which  are  more  or  less  modified  in  each  mode  of 
abstracting  blood.  That  cupping  is  intermediate,  in  this  respect,  be- 
tweeiT  general  bloodletting  and  leeching. 

9.  That  general  bloodletting  is  a  far  more  important  remedy  than 
leeching ;  and  that,  while  cases  constantly  arise  in  which  the  latter 
cannot  be  substituted  for  the  former,  there  are  numerous  instances  in 
which  general  bloodletting  cannot  take  the  place  of  leeching.  That 
cupping  will  sometimes  answer  the  purposes  of  either,  and  may  be, 
though  rarely,  better. 

1 0.  That  the  nervous  system  has  a  special  and  large  allotment  in  the 
effects  of  loss  of  blood,  and  that  loss  of  blood  operates,  in  the  first  place, 
by  inducing  a  profound  effect  upon  the  extreme  blood-vessels  when  the 
influence  thus  exerted  is  propagated  by  sensitive  fibres  of  the  sympathetic 
or  nerve  of  organic  life  upon  the  nervous  centres,  the  nervous  power  ex- 
cited, and  then  reflected  through  excito-motory  fibres  of  that  nerve 
upon  the  sanguiferous  organs,  and  with_a  special  alterative  effect  upon 
the  susceptible  capillary  blood-vessels  that  may  carry  on  the  morbid 
process,  that,  when  the  vessels  of  the  nervous  centres  contract,  the  reflex 
nervous  influence  is  increased  by  the  projection  of  a  direct  development 
of  that  influence  upon  the  sanguiferous  organs,  and  that  these  influences 
multiply  in  an  increasing  ratio  till  syncope  takes  place. 

11.  That  in  bloodletting  five  principal  objects  are  contemplated:  1. 
To  reduce  the  volume  of  blood.  2.  To  thus  establish  a  change  of  action 
in  the  capillary  blood-vessels.  3.  To  thus  obtain  the  alterative  action 
of  the  nervous  influence.  4.  To  reduce  the  exciting  nervous  influence 
attendant  on  inflammation  and  fever,  whether  reflex  or  direct,  that  dis- 
ease shall  abate,  and  that  cathartics,  counter-irritants,  &c.,  when  neces- 
sary, may  operate  without  exciting  a  morbific  reflex  nei'vous  action. 
5.  To  thus,  also,  prepare  the  way  for  other  remedies  by  promoting  their 
salutary  effects  and  preventing  their  deleterious,  which  have  equally  a 
reference  to  the  condition  of  the  nervous  influence. 

12.  That  spontaneous  hemorrhage,  occurring  at  adult  age,  should  not 
be  restrained,  unless  manifestly  proceeding  to  excess. 

"Truth,  like  a  single  point,  escapes  the  sight, 
And  claims  attention  to  perceive  it  right ; 
But  what  resembles  truth  is  soon  descried. 
Spreads  like  a  siu'face,  and  expanded  wide." — Pomfret. 


APPENDIX. 


PROGRESS   OF  "  PHYSIOLOGICAI>   AND   PATHOLOGICAL   CHEMSTRY,"  OR 
"  EXPERIMENTAL   IVIEDICINE." 

1028.  During  the  former  editions  of  the  foregoing  work  the  Author 
has  seen  no  inducement  to  modify  any  of  his  conclusions,  or  to  disturb 
any  of  the  facts  upon  which  they  are  founded,  and,  for  the  same  reason, 
every  statement  appears  in  the  present  edition  (1857)  as  presented  orig- 
inally in  1847.  Whatever  may  have  been  subsequently  disclosed  in 
Physiology  and  Chemistry  is  essentially  in  harmony  with  all  that  the 
author  incorporated  in  the  foundation  upon  Avhich  his  Institutes  are 
erected,  and  places  them  beyond  the  probability  of  being  much  invali- 
dated. In  his  discussion  of  Organic  Chemistry  as  applied  to  Physiology, 
Pathology,  and  Therapeutics,  it  is  evident  that  he  could  not  cjoubt  that 
this  invasion  upon  Medicine  would  prove  ephemeral,  and  that  the  Chem- 
ist would  soon  retreat  into  the  appropriate  field  of  Nature.  (§  4^-  d,  5^- 
6, 1 8, 42-67, 349  a,  350|  n,  351, 356, 376^,  435  c,  676  b,  960  cZ,  1006  a,  &c.) 

These  expectations  have  been  realized  sooner  than  the  author  had  an- 
ticipated, as  he  will  now  show,  for  the  benefit  of  his  junior  readers,  by  a 
few  extracts  from  one  of  the  latest  and  most  approved  works  upon  Or- 
ganic Chemistry,  by  the  justly  celebrated  Professor  Lehmann.  It  is 
true,  our  Author  has  favoured  us  with  an  able  and  elaborate  Treatise  in 
behalf  of  "  Physiological  Chemistry  ;"  but  whoever  mfty  peruse  its  pages 
will  everywhere  discern  the  obstacles  which  necessarily  beset  his  path, 
and  the  vagueness  of  his  conclusions,  and  many  unavoidable  contradic- 
tions, after  having  discarded  those  indispensable  elements  which  are 
summarily  involved  in  the  foUow^ing  quotations,  and  which  amount  to 
a  virtual  admission  that  we  must  seek  in  the  doctrines  of  vital  solidism 
for  the  only  true  philosophy  of  life  and  disease.     Thus,  our  Author : 

1029.  "  As  soon  as  we  subject  to  investigation  the  highly  compli- 
cated chemical  phenomena  of  life,  toe  enter  upon  the  actual  domain  of  hy- 
pothesis. It  unfortunately  happens,  however,  that  the  correct  logical  con- 
ception of  an  hypothesis  has  been  completely  lost  sight  of,  and  its  place 
supplied  by  the  vaguest  fictions ;  whence  the  term  has  fallen  into  such 
discredit  that  many  have  been  desirous  of  setting  aside  all  hypotheses, 
unmindful  that  even  the  simplest  form  of  experiment  cannot  be  pre- 
sented without  their  aid. 

"  Physiological  Chemistry  has  given  rise  to  many  delusions  of  this 
nature,  owing  to  its  imperfect  development,  and  to  the  necessity  presented 
by  Physiology  and  Pathology  for  chemical  elucidation.  Some  few  isolated 
deductions  were  drawn  from  superficial  chemical  experiments,  and  ar- 
ranged in  a  purely  imaginary  connection  by  the  aid  of  chemical  symbols 
and  formulae,  for  whose  establishment  analysis  in  many  cases  did  not  af- 
ford any  sanction.  Thus,  for  instance  [a  very  important  and  comprehen- 
sive example],  in  the  attempt  to  form  a  conclusion  regarding  the  meta- 


780  INSTITUTES    OF    MEDICINE. 

morphosis  of  the  blood  from  an  elementary  analysis  of  its  solid  residue, 
and  of  the  composition  of  the  individual  constituents  of  the  excretions, 
there  is  an  utter  absence  of  all  scientific  groundwork;  for,  independently 
of  the  fact  that  the  elementary  analysis  of  so  compound  a  matter  as  the 
blood  is  incapable  of  yielding  any  reliable  results,  and  cannot,  therefore, 
justify  the  adoption  of  any  special  chemical  formula,  it  is  surely  most 
illogical  to  attempt  to  compare  the  composition  of  the  blood  collefttively 
with  that  of  the  separate  excrementitious  matter.  In  such  deductions, 
expressed  by  chemical  formulae,  the  addition  of  atoms  of  oxygen,  and  the 
subtraction  of  those  of  water,  carbonic  acid,  and  ammonia,  are  lohoUy 
arbitraivj,  for  chemical  analyses  do  not  alFord  the  slightest  grounds  for  the 
majority  of  these  equations."*  "  Chemical  equations  having  no  other 
foundation  than  the  presumed  infallibility  of  empyrical  formulae,  must 
cause  us  to  deviate  from  the  path  of  physical  inquiry,  and  involve  us  in 
a  chaos  of  the  most  untenable  delusions."    {VideTjVESiOr  ^  50,  409  h). 

"  Have  the  numerous  analyses  of  morbid  blood  instituted  during  the  last 
icw  years  fulfilled  the  expectations  of  Physicians  ?  (§  6h,  a.)  With  all 
due  gratitude  to  the  indefatigable  investigators  who,  with  no  other  aid 
than  that  which  zoo-chemistry  could  offer,  boldly  attempted  to  throw 
light  on  those  obscure  inquiries,  it  must  be  admitted  that,  when  we  seri- 
ously inquire  into  the  recompense  of  all  their  labors  and  sacrifices,  we  find 
that  the  result,  although  too  dearly  bought,  was  altogether  inadequate  to 
satisfy  the>  requirements  of  Pathology.  (§  376J.)  Have  the  numerous 
analyses  of  the  urine  led  to  much  more  than  the  assumption  of  several  new 
species  of  disease,  or  so-called  diatheses?  (§427,691.)  Although  we 
might  have  anticipated  greater  results,  we  can  hardly  wonder  that  the 
efforts  hitherto  made  should  either  wholly  or  partially  have  deceived  our 
expectations ;  for  although  these  investigations  may  have  rendered  chem- 
istry no  unworthy  auxiliary  to  a  physical  diagnosis,  analyses  of  morbid 
products  can  hardly  afford  an  insight  into  the  chemical  laboratory  of  the  or- 
ganism, while  the  means  are  wanting  to  prosecute  them  with  the  scien- 
tific accuracy  attainable  in  the  case  of  mineral  analyses.  Animal  Chem- 
istry is  still  ivholly  unable  to  afford  us  a  precise,  and  at  the  same  time  a 
practically  useful  method  of  investigating  the  blood;  and  how  should  it 
be  otherwise  while  we  continue  to  be  in  doubt  regarding  the  chemical 
nature  of  its  ordinary  constituents?  The  mineral  substances  o^  nonnal 
blood  arc  not  yet  determined,  or,  at  all  events,  continue  to  be  made  the 
subject  of  dispute;  we  scarcely  know  the  names  of  the  fatty  matters  it 
contains  ;  one  of  its  most  important  constituents,^inV?,  cannot  be  chem- 
ically exhibited  in  a  pure  state  ;  we  are  ignorant  of  the  nature  and  mode 
of  secretion  of  the  globulin  of  the  blood-corpuscles;  we  are  still  far  from 
being  able  to  separate  and  determine  the  so-called  protein  oxides  (§  18, 
53  c,  409  a,  b) ;  and  we  are  also  ignorant  of  the  excrementitious  sub- 
stances occurring  in  the  blood.  How,  then,  amidst  these  and  a  thousand 
OTHER  UNCERTAINTIES  AND  DOUBTS,  Can  an  investigation  of  the  blood  be 
scientifically  and  trustworthily  conducted?  We  analyze  healthy  and  mor- 
bid milk;  and  yet  we  are  ignorant  of  the  substances  whose  admixture  we 
have  termed  casein.  The  urine,  in  its  morbid  conditions,  presents  many 
varieties ;  and  yet  our  knowledge  of  that  secretion,  frequently  as  it  has 
been  analyzed,  amounts  to  little  more  than  an  acquaintance  with  the  quan- 
titive  relations  oi  some  of  its  priricipal  constituents;  creatinine  and  hippu- 
ric  acid  have  not  been  determined  by  any  analysis,  while  absolutely  noth- 
ing is  known  regarding  the  most  important  pigment  of  this  secretion. 

•  This  sustains  my  criticism  of  LiEBio.p.  221-222,  h  409  b. 


Organic  Chemistry. — APPENDIX. — Physiology.  781 

Many  experiments  have  been  made  and  theories  broached  on  nutrition 
and  digestion,  and  yet  to  almost  the  present  day  the  existence  of  lactic 
acid  in  the  gastric  juice  has  been  contested.  Although  hypotheses  are 
not  wanting  regarding  the  mode  of  action  of  Pepsin,  we  knoiv  nothing  of 
its  nature  (§  363-365),  and  we  are  wholly  ignorant  of  the  proximate  met- 
amorphosis of  albimiinous  bodies  in  the  stomach  during  digestion.  Will 
Mulder  be  able,  even  with  his  most  accurate  analyses,  to  support  his 
protein  theory  by  the  aid  of  sulphamide  and  phosphamide  ?  Or  is  this 
term  destined  to  indicate  a  x>o.st  epoch  of  Organic  Chemistry?  (§  38-51, 
350f  n,  376^,  409  a,  h.)  When  such  is  the  state  of  Organic  Ghemisti^j,  can 
we  wonder  that  there  should  be  obscurity  regarding  the  chemical  pro- 
cesses in  the  animal  body,  their  various  isolated  and  combined  actions, 
their  casual  connection,  and  their  dependence  on  external  influences  and 
internal  conditions'?  Unfortunately,  we  might  be  led  to  believe,  from 
the  lectures  and  writings  of  many  physicians,  that,  ti-usting  to  the  apho- 
ristic and  often  highly  apodictic  assertions  of  certain  chemists,  they  felt  se- 
cure of  having  reached  the  object  of  their  inquiries.  (§  5|,  a.)  Although 
at  present  little  more  than  the  direction  is  indicated,  we  may  hope  in 
due  time,  and  after  innumerable  efforts,  to  see  our  endeavours  crowned  with 
success/"  And  so  said  Fourcroy  seventy  years  ago,  p.  9,  §5,  376^. 
From  all  which,  it  appears  that  our  friends  are  upon  the  MTong  track. — 
Professor  Lehmann's  Physiological  Chemist?^,  vol.  i.,  p.  19,  23,  Philadel- 
phia, 1855. 

1030.  Again,  we  have  a  summary  admission  f»om  this  eminent  Chem- 
ist which  shows  us  forcibly  that  there  can  be  no  dependence  upon  organic 
analyses  for  any  knowledge  of  the  natural  or  morbid  processes  or  prod- 
ucts of  the  living  body — not  even,  indeed,  of  the  elementary  constitution 
of  the  tissues  in  their  natural  condition.     Thus : 

"  The  theory  of  the  chemical  nature  of  the  animal  tissues  is  a  depart- 
ment of  physiological  chemistry  which,  as  yet,  has  been  very  little  culti- 
vated, and  the  reasons  of  this  unsatisfactory  state  of  our  knowledge  are 
too  obvious  to  require  any  detailed  exposition.  We  will,  therefore,  sim- 
ply observe,  that  the  most  important  obstacle  to  the  chemical  investiga- 
tion of  the  tissues  is,  that  their  elements  are  too  intimately  combined  or 
associated  with  one  another  to  admit  of  their  being  pi-epared  for  chemical 
analysis  by  a  previous  mechanical  separation.  This  separation  of  the  va- 
rious elementary  tissues  which  are  deposited  among,  penetrate  between, 
and  envelop  each  other,  is  rendered  the  more  difficult  by  the  circum- 
stance that,  with  scarcely  an  exception,  they  are  equally  insoluble  in  the 
ordinary  indifferent  menstrua  employed  by  chemists.  If  we  have  re- 
course to  the  stronger  or  more  energetic  solvents,  as,  for  instance,  acids 
and  alkalies,  we  have  seldom  any  assurance  that  the  dissolved  substance 
is  the,  otherwise,  unchanged  histological  element,  and  the  portion  remain- 
ing undissolved  is,  in  reality,  a  simple  chemically  pure  material.  Indeed, 
in  a  majority  of  cases,  there  cannot  be  a  doubt  that  the  chemical  consti- 
tution of  the  tissue  on  which  we  are  experimenting  is  entirely  changed  by 
such  reagents"  (§  53  b,  417  a).  And  so  of  the  blood  and  secretions,  §  1029. 
(Professor  Lehmann's  Physiological  Chemistry,  vol.  ii.,  p.  174.) 

Among  the  many  very  luminous  comments  by  which  our  author  dis- 
credits organic  analyses  we  should  naturally  expect  to  find  the  same 
discouragement  of  pathological  chemistry.  On  entering  upon  the  con- 
sideration of  "  Exudations  and  Pathological  Formations,"  he  remarks 
that, 


783  INSTITUTES   OF    MEDICINE. 

♦'We  have  often  had  occasion  to  comment  upon  the  inefficiency  and 
imperfection  of  our  chemical  knowledge,  when  compared  with  the  great 
eocpectations  which  have  been  entertained  in  respect  to  its  applications  to 
Physiology  and  Pathology ;  yet  there  is  scarcely  any  subject  which  more 
thoroughly  calls  for  our  confession  of  weakness  and  incapacity  than  the  one 
we  are  now  about  to  consider"  (§  5,  376^,  676  5,  1006  a).  Again: 
"The  science  of  Pathological  Histology,  which  alone  can  guide  the 
Chemist,  is  so  full  of  uncertainties,  subjective  conceptions,  and  varying  con- 
jectures, notwithstanding  some  signal  advances,  that  it  scarcely  ever  pre- 
sents any  starting-point  for  chemical  investigation." — "A  Chemist  can- 
not be  satisfied  that  he  knows  a  substance  until  he  has  submitted  it  to 
an  elementary  analysis,  and  can  attain,  at  all  events,  an  approximate  de- 
termination of  its  atomic  weight.  In  fact,  a  body  which  has  been  sub- 
mitted by  the  Chemist  to  a  few  reactions  only,  however  striking  they 
may  be,  but  for  which  he  is  unable  to  establish  a  formula  based  upon  el- 
ementary analysis,  may  be  almost  considered  as  unknown  to  him  (§  1029). 
In  this  sense  (and  in  exact  investigations  Ave  can  only  take  this  view)  all 
substances,  as  transition  stages  fx-om  the  protein-bodies  of  a  plastic  exu- 
dation, are  tvholly  unknown  to  us,  and  must  remain  equally  unexplained 
until  we  are  able  to  elucidate  the  mystery  of  protein"  (§18  d,  e,  53  b,  409 
a,  b).  The  troubles  multiply  after  death,  among  which  is  the  "  rapid 
decomposition,  even  while  the  body  is  yet  warm,"  and  upon  Avhich  we 
have  quoted  a  luminous  remark  of  Tiedemann  in  §  54,  a.  "  In  a  word," 
says  our  Author,  "  whiie  even  the  quantitative  investigation  of  objects  de- 
rived from  healthy  animals  has  to  contend  with  such  difficulties  that  very 
few  animal  juices  admit  of  being  very  accurately  examined,  the  qualita- 
tive analysis  of  pathological  products  is  opposed  by  insuperable  obstacles." 
"  If,  therefore,  we  have  very  slight  prospect  of  being  able  to  trace  patho- 
logical processes  by  a  qualitative  examination  of  exudations,  or  of  attain- 
ing any  scientific  aim  by  such  a  mode  of  procedure,  we  are  led  to  inquire, 
with  some  hesitation,  whether  the  quantitative  analysis  of  these  products 
would  be  attended  "by  any  better  results." — Lehmann,  ibid.,  vol.  ii.,  p. 
271-274. 

I  have  taken  the  liberty  of  placing  many  of  our  Author's  words  in 
Italics  and  capitals,  and  have  introduced  references  to  Sections  in  these 
Institutes,  and  shall  preserve  this  plan  hereafter  for  the  sake  of  the  read- 
er's eye,  and,  more  or  less,  as  a  substitute  for  comment.  Many  of  the 
remarks  which  I  have  rendered  emphatic  in  all  the  foregoing  quotations 
express  a  fundamental  fact,  which  vitiates  all  organic  analyses  beyond 
the  mere  disclosure  of  a  probable  elementary  composition.  Upon  this  I 
have  hitherto  insisted  as  an  insuperable  ditficulty  (§  53,  b,  &c.).  I  may 
also  say,  in  explanation  of  my  general  silence  upon  our  Author's  facts 
and  hypotheses,  that  I  am  not  aware  of  any  one  whose  essential  nature 
I  have  not  examined  and  controverted  in  the  foregoing  work.  But  a 
better  reason  may  be  found  in  the  consideration  that  our  Author  has, 
himself,  surrounded  his  facts  and  hypotheses,  throughout  his  work,  with 
admitted  doubts,  distrust,  and  ambiguities,  of  which  the  foregoing  are 
but  a  few  examples.  It  is,  however,  an  able,  but,  as  appears  to  me,  an 
abortive  attempt  to  reconstruct  the  fallen  fabric  of  Organic  Chemistry. 
Our  Author  is  merciless  upon  the  past,  and,  as  our  extracts  show,  is  al- 
most hopeless  for  the  future      (§  626  5,  819  5,  and  Notes,  pp.  196,  911). 


Organic  Chemistry. — ^appendix. — Aniraal  Sugar.         783 


PRODUCTION   OP   ANIMAL   SUGAR. 

1031,  a.  It  is  now  my  purpose  to  bring  under  the  test  of  the  forego- 
ing results  of  chemical  experience,  as  well  of  certain  physiological  prin- 
ciples, the  new  function  which  has  been  lately  ascribed  to  the  liver  of 
generating  sugar,  in  connection  with  the  supposed  mechanical  filtration 
of  sugar  from  the  blood  by  the  kidneys  and  maramge.  But,  independ- 
ently of  this  great  incongruity  between  the  supposed  catalytic  action  of 
the  liver  and  the  mechanical  oflace  of  other  complex  glandular  organs, 
we  are  startled  with  the  announcement  that  the  liver  is  a  farther  excep- 
tion to  the  principle  of  analogy  in  discharging  multiplied  and  perfectly 
distinct  functions  in  the  economy  of  life.  "  Qu'il  re'sulte  de  la  que  le 
foie  n'est  pas  un  organe  simple,  mais  un  organe  a  fonctions  multiples, 
puisqu'il  se'crete  d'une  part  du  sucre,  de  I'autre  de  la  bile." — Cl.  Ber- 
nard, Leqons  de  Physiologie  Exp.,  &c.,  p.  88  ;  1854,  1855. 

Without,  certainly,  denying  the  alleged  fact  in  respect  to  the  liver,  it 
is  proper  to  inquire  into  its  probability  until  it  becomes  established,  and 
in  doing  this  we  shall  have  analyzed  some  important  facts  in  their  rela- 
tion to  the  functions  of  glandular  organs.  Should  the  supposed  forma- 
tion of  sugar  by  the  liver,  as  a  product  distinct  from  the  bile,  and  des- 
tined to  subserve  totally  different  purposes,  be  rendered  no  longer  doubt- 
ful, we  shall  hail  it  as  a  remarkable  accession  to  physiological  science, 
however  much  it  may  disturb  any  supposed  principles,  or  however  little 
may  be  its  practical  bearings ;  and,  whatever  may  be  the  final  issue, 
nothing  can  detract  from  the  great  merit  of  the  inquiries  which  con- 
ducted the  philosopher  to  the  supposed  discovery.  (§  5^,  a-f.)  Our 
argument,  however,  will  be  particularly  with  Professor  Lehmann,  who 
has  gone  more  fully  than  Bernard  into  many  important  bearings  of  the 
question. 

1031,  b.  Now,  in  respect  to  the  production  of  bile.  Professor  Lehmann 
is  a  perfectly  orthodox  Physiologist ;  but,  apparently,  only  so  because 
the  reagents  employed  in  Chemistry  have  not  yet  transformed  the  constit- 
uents of  blood  into  any  of  those  so-called  proximates  which  they  so  read- 
ily effect  in  the  bile.  (§  54  a,  1029,  1030.)  Doubtless,  however,  when 
that  shall  have  been  consummated,  as  is  not  unlikely  to  happen,  the 
liver  will  lose  its  isolated  rank  in  Physiology,  and  fall  to  the  level  of 
other  "strainers."     Thus,  our  Author: 

"  In  passing  to  the  consideration  of  the  individual  biliary  substances, 
and  inquiring  which  of  these  exist  preformed  in  the  blood  of  the  portal 
vein,  we  find  that  none  of  the  most  essential  constituents  of  the  bile  can 
be  detected  in  it."  "  The  error  of  supposing  that  biliary  substances  have 
been  demonstrated  in  the  blood  of  the  portal  vein  by  means  of  sugar  and 
sulphuric  acid,  arises  from  the  similar  reaction  which  Pettenkofer's  test 
gives  with  olein  and  oleic  acid." — Lehmann,  ibid.,  vol.  i.,  p.  480.  Our 
author  says,  also,  that  "  During  the  slow  passage  of  the  blood  through 
the  liver,  it  undergoes  such  important  modifications,  that  a  vaevQ  filter- 
ing off  of  certain  constituents  of  the  blood  through  the  liver  is  not  to  be 
thought  of."  And  so  Miiller,  §  42,  and  Mulder,  §  350f  e,  and  Liebig, 
§  53  c,  409  b. 

It  is  even  denied  by  Kane  and  others,  that  the  bile  is  absorbed  into 
the  blood  in  cases  of  jaundice — only  the  coloring  matter.  "The  prob- 
lem," say  Becquerel  and  Rodier,  "  as  to  whether  the  bile  passes  into  the 
blood  has  occupied  the  attention  of  Chemists  as  well  as  Fhysicians,  but 


784  INSTITUTES    OF    MEDICINE. 

it  does  not  appear  to  have  been  thoroughly  solved  by  either." — Bec- 
QUEREL  AND  Rodier's  Pathological  ChemisU-y,  p.  239.     London,  1857. 

As  to  lactic  acid  and  urea,  Lehmann  declares  that  "  The  recognition 
of  lactates  in  healthy  blood  is  just  as  difficult  or  impossible  as  that  of  urea 
in  the  same  fluid." — {Ibid.,  vol.  i.,  p.  96.)  The  supposed  pre-existence 
of  Liebig's  "important  instrument," pro^em,  in  the  blood  (§  18  c,  409), 
and  of  the  great  digester,  pepsin,  also,  is  abandoned ;  which,  indeed,  may 
be  equally  said  of  most  other  organic  products. 

Now,  in  these  facts  which  Chemistry  has  been  gradually  learning  in 
its  career  of  "  experimental  philosophy"  it  should  recognize  a  very  strong 
analogy  in  proof  that  the  formation  of  all  the  secreted  products  of  an 
organic  nature,  and  in  the  natural  condition  of  the  body,  depends  upon 
the  organs  by  which  they  are  elaborated,  and  that  they  had  no  pre-ex- 
istence in  the  blood.  The  various  modifications  which  lymph  undergoes, 
as  deposited  by  the  most  simple  structures  in  different  parts  of  the  body, 
reflects  a  flood  of  light  upon  our  subject  (§  408,  409  e-h) ;  and  I  may 
appeal  to  Liebig  for  a  great  general  law  which  carries  our  analogy 
through  all  organic  nature  (§  42).  The  analogy,  however,  supplied  by 
the  simple  tissues  should  be  at  least  conceded  to  the  glandular  organs, 
since  it  is  here  corroborated  by  a  strict  analogy  of  structure ;  and  where 
chemical  reagents  determine  from  the  blood  the  same  so-called  proxi- 
mates  which  they  are  capable  of  deriving  from  the  secretions,  these  sup- 
posed proximates  should  be  regarded  equally  as  artificial  transformations 
(§  43,  53  b,  54  b,  417,  1030),  and  Organic  Chemistry  should  cling  to 
catalysis  as  its  only  consistent  and  dignified  ground  (§  350|  a-g,  409  j). 
But  such  has  never  been  the  philosophy  of  Organic  Chemistry.  It  dis- 
cards, ostensibly,  the  organic  force,  or  vital  principle,  or  plastic  power 
(for  they  are  convertible  terms),  while  there  is  scarcely  a  modern  treat- 
ise upon  chemical  physiology  which  does  not  invoke  the  aid  of  that 
power  in  its  lucubrations  upon  the  phenomena  of  life,  and  then  with 
senseless  ingratitude  casts  it  away  as  a  phantom  of  the  imagination ; 
though  it  should  be  excepted  in  behalf  of  Lehmann  that  he  is  consistent 
throughout  in  disclaiming  all  connection  with  any  thing  but  the  mere 
properties  of  dead  matter.  It  is  not,  therefore,  remarkable  that,  when 
these  philosophers  manufacture  sugar  or  urea  out  of  the  blood  they 
should  neglect  their  pronunciation  relative  to  the  constituents  of  the 
bile.  Our  able  Author  is  of  this  number,  although  he  finds  much  diffi- 
culty with  diabetic  urine.  But  this  is  partially  overcome  by  the  assump- 
tion that  "  no  one  can  doubt  that  it  is,  for  the  most  part  at  all  events, 
derived  from  vegetable  food." — (Lehmann,  ibid.,  vol.  i.,  p.  259.)  And 
"  M.  Mialhe,  especially,  believes  that  the  formation  of  sugar  can  not  be 
independent  of  a  saccharine  or  amylaceous  diet." — (Becquerel  and  Ro- 
DiER,  ibid.,  p.  249.)  No  one,  however,  acquainted  with  the  literature 
of  medicine  is  ignorant  of  the  fact  that  the  saccharine  matter  in  diabetes 
is  said  to  be  often  as  abundant  when  the  patient  subsists  as  exclusively 
upon  animal  as  vegetable  food,  and  that  there  are  those  who  have  con- 
sidered a  vegetable  diet  most  conducive  to  the  disappearance  of  saccha- 
rine matter  in  diabetes.  (See  Essay  on  the  Philosophy  of  Diabetes,  in 
Medical  and  Physiological  Commentaries,  \o\.  i.,  p.  674-682  (1840),  where 
this  ground  is  considered,  and  where  the  Author  anticipates  the  ultimate 
failure  of  detecting  sugar  and  urea  in  the  general  circulating  mass  of 
blood,  in  opposition  to  the  statements  then  in  vogue ;  or,  as  Christison 
had  it,  the  blOod  is  sometimes  "  loaded  with  urea."     Also,  ^  1007  e). 


Organic  Chemistry. — APPENDIX. — Animal  Sugar.         785 

Nor  can  th--  laboratory  approach  an  intelligible  answer  why  such  a 
profusion  of  saccharine  matter  is  elaborated  during  lactation,  unless  it 
be  allowed  to  be  the  product  of  the  mammary  gland  (§  424).  Whence 
comes  this  substance  in  the  nursing-mothers  of  the  human  race  that  are 
wholly  restricted  to  a  meat  diet,  as  in  dyspeptic  troubles,  if  vegetable 
food,  as  is  admitted  (ut  supra),  must  yield,  "  for  the  most  part  at  all 
events,"  that  substance  to  diabetic  urine?  Or  where  shall  we  look  for 
it  in  the  nursing-mothers  of  the  strictly  carnivorous  tribes  %  Will  the 
laboratory  answer  why  saccharine  matter  is  not  accumulated  in  the 
blood  when  lactation  is  suppressed  ?  Or  if,  according  to  Bernard,  sugar 
be  found  throughout  the  circulating  mass  of  blood  during  digestion, 
why  is  not  some  small  part  of  it  at  least  "strained  oiF,"  as  in  diabetes? 
According  to  this  Philosopher,  when  it  gets  involved  in  the  circulating 
mass,  it  must  be  an  effete  substance,  since  it  is  said  to  be  generated  by 
the  liver  to  be  extinguished  in  the  lungs  for  the  uses  of  the  general 
economy.  Nor  will  it  do  to  assume  that  the  quantity  is  too  small ;  for 
it  appears  to  be  far  more  easy  of  detection  by  Bernard  in  the  blood  of 
the  renal  arteries  than  urea  can  possibly  be  under  any  circumstances. 
The  fact,  therefore,  contradicts  the  experiments.  Moreover,  is  it  prob- 
able that  the  same  disposition  would  be  made  of  sugar  by  the  lungs  when 
circulating  in  arterial  blood  as  when  presented  to  those  organs  by  the  ve- 
nous blood  of  the  hepatic  veins?  (§  409,  e.)  No  incongruous  hypotheses 
will  answer  here  ;  and  it  is  evident  that  the  Chemist  would  avoid  the  in- 
quiry.    (See  Lehmann,  ut  cit.,  vol.  ii.,  p.  344.) 

It  is  true,  it  made  no  difterence  with  CI.  Bernard  (who,  doubtless,  had 
the  foregoing  facts  before  him)  whether  animals  were  fed  upon  vegeta- 
ble or  animal  food.  He  was  always  sure  to  find  sugar  somev^iere  be- 
tween the  liver  and  the  lungs,  or,  at  all  events,  in  the  supposed  laboratory 
itself     But  we  will  hear  him : 

"  We  fed  a  great  number  of  dogs,  at  the  College  of  France,  during  six 
or  eight  months  exclusively  with  meat.  The  animals  being  then  killed, 
1-90  gr.  of  sugar  was  found  in  the  liver,  and  this  is  as  large  a  propor- 
tion as  is  found  in  dogs  that  have  been  allowed  a  mixed  diet  (ralimenta- 
tion  mixtey\ — Bernard's  Le(^ons  de  Physiologie  Exj).,  appliq.  a  la  Medi- 
cine, p.  G9.     1854-5. 

Bernard  also  allows  the  fact  (important  in  its  connection  with  the 
foregoing),  that  long  abstinence  occasions  an  entire  failure  of  the  pro- 
duction of  sugar.  Nor  did  he  find  it  in  any  of  the  cases  beyond  the  pre- 
cincts of  the  liver,  which  farther  embaiTasses  the  phenomenon  of  lacta- 
tion in  cai'nivoi'ous  animals,  and  of  diabetic  sugar  as  it  presents  itself  in 
man  when  subsisting  upon  animal  food  alone.  Moreover,  Bernard  failed 
of  detecting  sugar  in  the  liver  of  some  diabetic  patients,  which  leads 
Becquerel  and  Rodier  to  say  that, 

"  The  theory  of  Bernard,  although  bearing  the  stamp  of  probability, 
presents,  nevertheless,  certain  difficulties  which  farther  experiment  can 
alone  remove.  As  long  as  the  absence  of  sugar  in  the  livers  of  a  certain 
number  of  diabetic  patients  remains  unexplained,  his  theory  must  be  re- 
garded as  incomplete." — Becquerel  and  Rodier,  ibid.,  p.  249. 

Nevertheless,  there  appears  to  us  no  difficulty  in  accounting  for  the 
production  of  sugar  either  by  the  mammse  in  lactation,  or  by  the  kidneys 
in  diabetes,  although  the  subjects  subsist  exclusively  upon  animal  food, 
or  be  subjected  to  prolonged  abstinence.  Glucose  or  grape  sugar,  which 
is  said  to  be  identical  with  diabetic  sugar,  consists  of  twelve  atoms  each 

D  DD 


786  INSTITUTES    OF    MEDICINE. 

of  carbon,  hydrogen,  aild  oxygen.  These  are  the  main  constituents  of 
the  blood,  whatever  the  diet ;  and  if  the  Chemist  fail  of  fabricating  sugar 
out  of  the  blood  or  liver  after  prolonged  abstinence,  it  does  not  show  in 
the  least  that  it  may  not  be  generated  by  some  part  of  the  living  organ- 
ism. But  it  does  show  that  Organic  Chemistry  is  at  fault  in  its  prem- 
ises when  it  confounds  the  living  body  with  a  chemical  apparatus.  Well, 
therefore,  has  it  been  said,  when  chemically  considered,  that 

"M.Bernard,  while  asserting  that  the  liver  may  secrete  sugar  without 
the  ingesta  of  such  alimentary  substances  as  are  usually  considered  ne- 
cessary to  its  formation,  nevertheless  admits  that  prolonged  abstinence 
may  even  produce  complete  disappearance  of  the  sugar.  This  result — 
the  formation  of  sugar  without  constituent  materials — is  the  most  un- 
acceptable portion  of  his  theory,  and  new  experiments  are  requisite  before 
it  can  be  satisfactorily  proved." — Becquerel  and  Rodier's  Pathologi- 
cal Chemistry,  p.  248. 

Nor  is  it  a  less  interesting  feature  of  the  subject,  that  the  liver  should 
be  regarded  as  the  producer  of  saccharine  matter  in  virtue  of  its  or- 
ganization and  properties,  both  by  Bernard  {xit  cit.)  and  by  Lehmann  {ut 
cit.,  vol.  i.,  p.  257,  624  ;  vol.  ii.,  p.  344),  as,  also,  of  the  bile,  while  the 
mammary  gland  in  fulfilling  its  wonderful  final  cause,  alike  in  all  its  va- 
riety of  structure,  and  the  kidney  in  a  special  form  of  disease,  are  de- 
graded to  the  mere  mechanical  office  of  filtration.  (§  408,  424.)  I  need 
not  speak  of  the  dormant  condition  of  the  former  gland  in  all  mammif- 
erous  animals  in  the  absence  of  maternal  relations,  but  may  say  that, 
according  to  Lehmann,  "  in  a  normal  state  it  is  probable  that  no  sugar 
Jinds  its  way  into  the  urine"  (§  829),  and  that  "  it  is  only  seldom  we 
meet  with  saccharine  matter  in  other  diseases  than  diabetes ;"  and  even 
"in  the  blood  of  diabetic  patients,  I  never  could  find,"  says  Lehmann, 
"  more  than  0-047  p.  m.  of  sugar ;"  {ut  cit.,  vol.  i.,  p.  257,  623.)  Becque- 
rel and  Rodier  go  farther  than  this : 

"The  only  disease,"  say  they,  "in  which  it  has  been  found  is  diabe- 
tes ;  and  in  this  its  presence  has  given  rise  to  so  much  difference  of  opin- 
ion, that  doubts  remain  in  the  minds  of  many  respecting  it.  It  is  cer- 
tainly, however,  found  in  no  other  disease.  Among  the  thousands  of 
specimens  of  serum  which  we  have  examined,  it  has  never  been  once  de- 
tected ;  nor  has  any  other  Chemist  alluded  to  its  presence  except  in  dia- 
betes. But  even  in  this  disease,  its  existence  in  the  blood  has  been  con- 
sidered doubtful,  and  is  even  denied  by  some  Chemists  —  Guendeville, 
Vauquelin,  Segelas,  Wollaston,  and  Henry."  And,  as  to  the  test  of 
light,  "it  is  as  the  result  of  upwards  of  a  thousand  analyses  of  the  blood 
by  means  of  the  polarimeter,  that  we  feel  authorized  to  affirm,  that  if 
sugar  exists  in  the  blood  of  persons  suffering  from  other  diseases  than 
diabetes,  the  fact  is  extremely  rare  and  exceptional — Becquerel  and 
Rodier's  Pathological  Chemistry,  p,  71,  72. 

It  appears,  therefore,  that  Organic  Chemistry  has  receded  to  about 
the  conclusions  which  we  adopted  upon  physiological  grounds  seventeen 
years  ago,  and  fortified  by  the  observations  of  a  distinguished  Chemist  of 
that  day,  whom  we  quoted  in  the  Atedical  and  Physiological  Commeiitaries 
(vol.  i.,  p.  674),  in  the  following  manner,  and  to  which  we  now  refer  in 
behalf  of  vital  solidism.     Thus,  the  Commentaries  : 

Mr.  Kane  has  stepped  forward  in  behalf  of  the  dignity  of  chemical 
science,  and  it  is  to  such  philosophers  that  an  "  acknowledgment"  is  due 
from  Physiologists,     In  respect  to  the  blood  of  diabetes,  he  remarks, 


Organic  Cliemistry, — ^APPENDIX. — Animal  Sugar.         787 

that,  "  the  resalts  of  these  analyses  show  that  in  diabetes,  the  relative 
proportions  of  the  organic  principles  remain  quite  within  the  limits  of 
the  composition  of  the  blood  in  perfect  health.  In  fact,  the  blood  cannot, 
as  far  as  these  experiments  go,  be  considered  as  at  all  aifected  in  this 
distressing  malady." — Kane,  in  Dublin  Journ.  of  Med.  and  Chem.  Science, 
vol.  i.,  p.  24  (Compare  with  \  5i  a,  847  «,  1007  c). 

But,  however  this  may  be,  it  cannot  be  doubted  that,  in  the  multitu- 
dinous experiments  which  are  made  with  chemical  reagents,  some  pro- 
*  cess  may  be  found  which  is  capable  of  generating  from  the  blood  a  trans- 
formation more  or  less  analogous  to  saccharine  matter.  Upon  the  whole 
ground,  also,  of  the  chemical  philosophy  of  organic  products,  no  objec- 
tion can  be  alleged  against  our  conclusion ;  since,  if  the  formation  of 
sugar  in  the  vegetable  and  animal  organism  be  a  chemical  phenomenon, 
nothing  would  be  more  likely  than  its  manufacture  by  the  Chemist  out 
of  other  organic  compounds  having  the  requisite  elements,  though  this 
conclusion  is  very  far  from  showing  the  accuracy  of  the  former.  But,  it 
is  far  more  important  to  science  and  philosophy,  and  especially  to  prac- 
tical medicine,  that  we  have  Lehmann's  authority  for  saying  that  these 
analyses  cannot  be  trusted.    (§  1029,  1030.) 

§  1032,  a.  Let  us  now  consider  the  question  in  connection  with  urea. 
We  have  seen  that  Lehmann  states  that  "  the  recognition  of  lactates 
in  healthy  blood  is  just  as  difficult  or  impossible  as  that  of  urea  in  the 
same  fluid"  (§  1031)  ;  and  he  remarks  that  "many  Chemists  have  long 
sought  in  vain  to  detect  urea  in  normal  blood ;  Simon  believed  that  he 
had  found  it  in  calves'  blood,  and  Strahl  and  Lieberkuhn,  and  recently 
Garrod,  maintain  that  they  have  detected  it  in  human  blood.  Without 
doubting  the  correctness  of  these  Chemists,  it  is  only  recently  that  I  have 
been  able  to  convince  myself  by  decisive  experiments  that  urea  is  pres- 
ent in  normal  blood." — (Lehmann,  ut  cit.,  vol.  i.,  p.  153.)  But  may  it 
not  have  been  an  artificial  product  ?    (§  417,  1029.) 

Becquerel  and  Eodier  remark  that  "  urea  probably  exists  in  healthy 
blood,  but  in  too  small  a  quantity  to  be  discovered  by  chemical  analyses." 
This  conjecture  arises  from  the  supposed  discovery  of  urea  in  the  blood 
by  Prevost  and  Dumas  after  extirpating  the  kidneys  of  animals,  and 
from  its  discovery  by  some  Chemists,  "  chiefly  in  Great  Britain,"  in 
Bright's  disease.  But  Becquerel  and  Rodier  have  failed  of  detecting  it 
in  that  affection.     The  question  is  then  propounded — 

"Does  the  same  thing  occur,  however,  when,  from  any  other  cause, 
the  urinary  secretion  is  greatly  diminished,  as  in  retention  of  urine,  and 
in  the  various  diseases  to  which  the  kidney  is  liable?  On  this  subject, 
analysis  is  as  yet  silent ;  and  here,  as  in  Bright's  disease,  much  remains 
to  be  done."   (Sec  cases  of  both  in3fed.  andPhys.  Comm.,  vol.  i.,  p.  601,  n.). 

As  to  the  prevailing  prejudice  which  often  refers  cerebral  disorders  to 
a  urea-diathesis,  these  Authors  remark  that 

"  It  has  indeed  been  asserted  that  when  the  accumulation  (of  urea) 
became  considerable,  we  might  attribute  to  it  those  cerebral  symptoms 
which  are  commonly  met  with  in  the  last  stage  of  many  renal  diseases. 
This  may  possibly  be  the  case,  but  it  altogether  remains  to  be  proved." 
And,  as  to  kiestine,  which  has  become  ingrafted  upon  the  philosophy  of 
pregnancy,  it  is  now  said  by  Becquerel  and  Rodier  that  "  this  discovery  is 
a  pure  illusion.'''' — Becquerel  and  Rodier,  ibid.,  p.  70,  353.  (See  Medi- 
cal and  Physiological  Commentaries,  article  Humoral  Pathology,  where  ob- 
jections are  brought  against  the  supposed  absorption  of  urine  in  cases  of 
suppression.) — Note  Z  p.  1130,  an  explanation  oi  urcemia. 


/bb  INSTITUTES    OF    MEDICINE. 

But  Lelniiann  has  finally  succeeded  in  elaborating  urea  from  healthy 
blood,  and  therefore  again  violates  the  analogy  both  of  function  and  or- 
ganization which  he  ascribes  to  the  liver,  of  Avhich  he  affirms  "  that  a 
mere  Jiltej'ing  off'  oi'  certain  constituents  of  the  blood  through  the  liver  is 
7iot  to  be  thought  of;''  and  although,  "like  Becquerel,  he  has  failed  in 
establishing  the  fact  that  there  is  an  augmentation  of  urea  in  certain 
forms  of  disease,  although  English  physicians  have  shown  an  inclination 
to  assume  a  urea  diathesis"  (aramia),  yet,  having  finally  elaborated  urea 
out  of  the  blood,  he  neglects  not  only  his  own  forcible  analogy,  but  the 
fact  that  urea  is  readily  formed  in  the  laboratory,  in  a  variety  of  ways, 
especially  by  transformations  of  cyanite  of  ammonia  and  of  urine ;  and, 
therefore,  not  only  overleaps  the  clearest  induction  from  the  premises  that 
chemical  reagents  may,  at  least,  accomplish  the  same  artificial  result 
when  brought  to  act  upon  blood  (§  53,  c;  Liehig),  but,  in  common  with 
other  distinguished  Chemists,  is  led  to  regard  the  kidney  as  a  mere  strain- 
er. (§  409  e,  4:'22,  423.)  Whether,  however,  "  catalysis,"  or  the  philos- 
ophy of ''  strainage"  be  adopted,  before  either  can  prevail  beyond  a  me- 
chanical age,  they  must  answer  us,  in  some  slightly  intelligible  manner, 
how  it  happens,  in  conformity  with  the  known  facts  of  either  Chemistry 
or  Mechanics,  that  the  urine  undergoes  such  sudden  augmentations  from 
the  operation  of  fear  and  from  the  contact  of  cold  air  with  the  surface 
of  tlie  body  (§  246,  422,  892|)  ;  and  why,  also,  the  milk  is  liable  to  sud- 
den and  remarkable  changes  from  mental  emotions.  But  this  would  be 
of  very  little  importance  were  it  confined  to  the  source  in  which  it  orig- 
inated. Our  Author,  however,  has  contributed  a  good  part  toward  as- 
signing to  the  liver  its  proper  rank  in  nature — abating  the  catalytic  doc- 
trine of  its  modus  ojjerandi;  and  it  may  therefore  be  reasonably  expect- 
ed that  the  time  is  near  when  the  contrast  in  function  between  the  liver 
and  testis  on  the  one  part,  and  the  mamma  and  kidney  on  the  other,  as 
now  presented  for  the  government  of  medical  philosophy,  will  turn  the 
attention  of  Physicians  from  the  dogmas  of  the  Laboratory,  and  the  an- 
alogies drawn  from  "  Strainers,"  to  the  study  of  living  nature,  and  end 
in  restoring  Physiology  to  its  proper  cultivators.  (§  4^  d,  376 1,  409  i, 
493  d.) 

1032,  b.  It  is  true,  the  kidney  is  an  organ  of  excretion,  and  may, 
therefore,  eliminate  any  foreign  matter  from  the  blood,  though  not  by 
filtration.  We  do  not  deny  that  effete  organic  compounds,  even  sugar 
if  it  stray  through  the  lacteals  in  morbid  states  (§  192,  277-295,  826- 
827),  may  be  eliminated  more  or  less  unchanged  by  the  kidneys ;  though, 
for  reasons  already  assigned  (§  38-51,  «&;c.),  this  fact  cannot  be  satisfac- 
torily determined,  either  as  to  the  blood  or  urine,  by  chemical  reagents ; 
and  for  this,  too,  we  have  the  authority  of  Lehmann,  Liebig,  and  Mulder. 
(§  42,  53  c,  450J  e,  409  y,  1029.)  But  wea  is  not  introduced  from  with- 
out, and  holds  the  same  relation  to  the  urine  as  cholesterin  and  the  jtsz- 
nous  2'>rinciple  do  to  the  bile,  if  we  allow  these  and  urea  to  exist  natural- 
ly in  the  conditions  in  which  they  are  presented  after  the  application  of 
chemical  reagents.  (§  53  b,  417  a,  1029,  1033.)  But  it  is  quite  other- 
wise, in  the  former  respect,  with  saccharine  matter,  which  abounds  in 
vegetable  food.  If  this,  therefore,  were  not  destined  for  the  nuti'ition  of 
animals,  and  underwent  no  change  in  the  process  of  digestion,  it  should, 
like  any  other  foreign  substance,  be  freely  eliminated,  in  the  same  or 
some  modified  condition,  by  the  kidney.  But  the  general  failure  of  de- 
tecting it  in  the  circulating  mass  of  blood,  in  connection  with  the  great 


Organic  Chemistry. — appendix. — Animal  Sugar.         789 

amount  which  is  appropriated  by  man  and  herbivorous  animals,  and  its 
great  abundance  in  milk  and  diabetic  urine,  and  its  absence  in  all  but 
diabetic  urine  assure  us  of  two  facts,  namely,  that  it  does  not  enter  the 
circulation  unchanged,  in  healthy  states  of  the  body  (§  192,  277-295, 
826-827),  and  that  the  mammary  gland  is  capable,  under  certain  very 
remarkable  physiological  influences,  and  the  kidney  in  a  special  form  of 
disease,  of  recombining  its  elements  into  saccharine  matter,  whether  those 
elements  exist  in  intimate  union  with  the  blood,  or  be  derived  from  the 
disintegration  of  the  tissues.  But  in  morbid  states  of  the  digestive  or- 
gans, as  always  attend  diabetes,  it  might  be  supposed  that  saccharine 
matter  would  be  readily  taken  up  by  the  lacteals,  when,  like  any  other 
effete  substance,  it  should  be  excreted  by  the  kidney  in  some  shape  or 
other  (§  192,  277-295,  426,  826-827).  It  is  certainly  a  remarkable 
coincidence  that  the  mamma  and  kidney  should,  in  special  conditions  of 
those  organs,  and  in  such  conditions  only  (§  424,  426,  427),  be  alike 
capable  of  forming  saccharine  matter  out  of  the  blood.  But  this  is  en- 
tirely less  remarkable  than  the  double  function  assigned  to  the  liver  of 
generating  bile  and  sugar  for  important  uses  in  the  animal  economy. 
Nevertheless,  while  the  former  circumstance  disproves  the  physical  ra- 
tionale of  filtration,  it  is  more  improbable  that  the  mamma  and  kidney, 
under  those  special  conditions,  and  those  only,  should  alike  become 
"  strainers"  of  a  substance  which  is  admitted  to  exist  in  a  greatly  insuf- 
ficient amount,  at  most,  in  the  circulating  mass  of  blood.  It  is  also,  I 
repeat,  a  far  more  probable  hypothesis,  that  the  kidney  should  produce 
sugar  out  of  certain  elements  of  the  blood  in  that  remarkable  affection 
known  as  diabetes  mellitus,  than  that  the  liver  should  not  only  perfonn 
liabitually  the  two  great  functions  of  generating  bile  and  sugar  (the  one 
for  important  uses  in  digestion,  and  the  other  for  nutrition),  but  that  its 
saccharine  function  should  be  abnormally  increased  in  diabetes  and  also 
when  required  by  the  exigencies  of  lactation,  and  then  applied  to  that 
specific  purpose — and  when,  also,  there  is  a  special  gland  provided  for 
the  generation  of  milk.*  Let  it  be  considered,  too,  that  the  formation  of 
sugar  by  the  mammary  gland  has  no  reference  to  the  internal  economy, 
but,  totally  unlike  the  uses  attributed  to  sugar  as  supposed  to  be  gener- 
ated by  the  liver,  it  is  destined  to  undergo  the  same  process  of  digestion 
as  the  sugar  which  is  supplied  by  plants.  Now,  these  are  principles 
which  can  be  set  aside  only  by  absolute  demonstration  (^  1086). 

Moreover,  in  diabetes  the  condition  of  the  urine  is  remarkably  altered 
in  other  respects,  especially  in  regard  to  quantity ;  and  the  quantity 
alone  denotes  an  essential  change  in  the  natural  function  of  the  kidney. 
And  it  may  be  said  farther,  for  the  sake  of  the  analogy,  that  in  morbid 
conditions  of  all  organs,  indeed  of  all  parts  of  the  body,  and  according  to 
the  nature  of  the  malady,  the  secreted  products  are  diverted  from  their 
natural  character.  This  is  even  strongly  exemplified  in  the  various 
phases  of  common  inflammation,  and  not  less  remarkably  in  the  specific 
forms  of  that  disease  (§  733,  740-741,  653  c).  And  again,  I  say,  since 
it  is  allowed  that  sugar  is  not  absorbed  by  the  veins  or  lacteals,  it  would 
be  clearly  a  foreign  substance  if  intermingled  with  the  circulating  mass 
of  blood,  and  would  be  at  once  excreted  by  the  kidneys,  and,  therefore, 
in  lactation,  were  the  sugar  generated  by  the  liver,  it  should  not  go  by 
way  of  the  mammary  gland.     It  appears  to  me  that  Nature  is  not  so 

*  "  Crystallized  milk-sugar  has  exactly  the  same  empj-rical  formula  as  anhydrous 
glucose,  so  that  it  therefore  contains  equal  equivalents  of  carbon,  hydrogen,  and  oxygen." 


790  INSTITUTES    OF    MEDICINE. 

inconsistent  as  to  justify  the  supposition  tliat  she  has  provided  against 
the  entrance  of  sugar,  unchanged,  into  the  general  circulation,  and  at  the 
same  time  has  constituted  the  liver,  or  any  other  part,  with  a  view  to  the 
reproduction  in  the  torrent  of  the  blood  of  what  she  has  so  carefully  ex- 
cluded in  her  arrangements  for  supplying  the  requisite  means  of  nutria 
tion — and  this,  more  especially,  as  she  has  provided  the  mammary  gland 
for  the  generation,  in  part,  of  saccharine  matter,  though  not  to  be  con- 
founded with  the  torrent  of  blood,  but  to  undergo  transformation  in  the 
stomach.*  Or  why,  again,  has  she  so  completely  provided  for  the  meta- 
morphosis of  sugar  in  the  alimentary  canal,  if  it  is  to  be  at  once  regen- 
erated by  the  liver  (§  409,  ^»-411) ;  and  thus,  also,  impose  upon  this  organ, 
in  violation  of  all  her  analogies,  two  perfectly  distinct  functions  for  the 
generation  of  products  of  fundamental  uses  in  the  animal  economy,  and 
whose  uses,  respectively,  are  perfectly  distinct  from  each  other  ?  It  will 
be  no  answer  to  say  that,  in  ordinary  states  of  the  body  the  hepatic 
sugar  is  at  once  disposed  of  in  the  lungs ;  for,  besides  the  fundamental 
objections  already  made,  this  hepatic  sugar  is  supposed,  in  lactation,  to 
be  partly  diverted  from  its  great  physiological  purpose  to  supply  means 
of  nutrition  to  an  external  subject,  which  has  no  more  relation  to  the  in- 
dividual than  the  plant  has  to  the  stomach  !  Or,  if  we  glance  at  diabe- 
tes, there  is  the  same  inconsistency  there.  And  yet  another  objection 
may  be  seen  in  another  violation  of  analogies,  in  supposing  that  a  glan- 
dular organ  pours  into  the  torrent  of  the  circulation  one  of  its  most  im- 
portant products,  while  another  not  less  specific  takes  the  ordinary  course 
toward  open  surfaces  (^  417). — Notes  N  R  pp.  1121,  1123. 

CI.  Bernard  appears  to  be  aware  of  the  inharmonious  nature  of  the 
new  function  which  he  has  assigned  to  the  liver  with  that  of  the  pro- 
duction of  bile.  "Is  it  pi'obable,"  he  says,  "that  the  albuminous  sub- 
staiiies  of  the  blood,  on  reaching  the  hepatic  cells,  separate  into  two 
compounds,  a  hydrocarbon,  destined  to  form  sugar,  and  a  nitrogenous 
one  for  liile  ?  If  this  were  so,  these  two  compounds  would  be  formed  at 
the  same  moment."  Bernard  thinks,  therefore,  that  "his  experiments 
seem  to  denote  that  the  formation  of  sugar  and  bile  does  not  take  place 
simultaneously,  but  that  they  alternate  with  each  other."  {Lemons,  ut  cit.) 
But  this  will  not  correspond  with  the  consistent  philosophy  of  organic 
life.  It  is  also  worthy  of  remark  that  Bernard's  explanation  of  the  dis- 
position of  the  supposed  hepatic  sugar  in  the  lungs  is  very  unsatisfactory, 
even  in  a  chemical  sense  ;  and,  farther,  that  there  is  scarcely  any  agree- 
ment between  him  and  Lehmann  as  to  the  uses  of  sugar  in  the  animal 
economy  (§  83,  316,  409/,  i,  419  b,  423,  424). 

I  shall  now  introduce  a  paragraph  which  denotes  the  course  of  argu- 
ment pursued  in  the  Medical  and  Physiological  Commentaries  upon  the 
questions  before  us : 

When  the  secretion  of  milk  is  suppressed,  I  have  there  said,  do  we  find 
that  the  saccharine  matter  is  accumulated  in  the  blood,  or  do  we  find  a 
trace  of  it  there,  or  is  its  secretion  "replaced"  by  any  other  part?  Or, 
shall  Ave  go  on  believing  with  Puzas,  Leveret,  Sauvages,  Van  Swieten, 
Selle,  Astruc,  Eaulin,  and  many  others,  that  it  is  generated  by  the  legs, 
and  forms  the  proximate  cause  of  phlegmasia  dolens  ?  Or,  when  the  se- 
cretion of  bile  is  suspended,  do  its  peculiar  constituents  appear  in  the 
blood,  or  their  elaboration  devolve  upon  any  other  part?  We  have 
shown  that  it  is  not  so.  Would  you  believe  the  oath  of  any  one  who 
might  swear  that  he  had  detected  semen  in  the  blood,  or  in  the  saliva  of 

*  Notwithstanding  the  exigencj'  of  digestion,  even  educated  ph3-sician.s  (except  in 
physiology)  apply  butter,  &c.,  to  the  skin  as  a  means  of  nourishment  (§  1088  b-d)[ 


Organic  Chemistry. — appendix. — Animal  Sugar.         791 

a  female?  And  yet  it  is  affirmed  to  exist  in  the  blood,  (See  note, 
p.  589.  Also,  this  work,  §  83,  h,  note.)  Shall  we  admit  that  the  virus 
of  the  rattlesnake,  the  viper,  the  bee,  &c.,  exists  in  the  blood?  If  the 
viper  and  rattlesnake  die  after  the  removal  of  their  venom-glands,  it  is 
far  from  proving  that  it  is  in  consequence  of  an  accumulation  of  their 
specific  virus  in  the  blood.  It  is  the  same  logic  here  as  it  has  been  with 
urea  after  extirpating  the  kidneys.  Do  we  find  the  peculiar  odor  of  the 
skunk,  of  the  beaver,  of  the  musk,  &c.,  in  the  blood  ?  Thus  might  we 
go  on  with  a  thousand  different  formations,  which,  if  admitted  to  exist 
in  the  blood,  would,  of  course,  assign  to  this  fluid  as  many  component 
parts.  But  if,  on  the  other  hand,  it  be  absurd  to  suppose  that  the  latter 
formations  do  not  depend  upon  their  peculiar  emunctories,  why  is  it 
not  equally  so  to  imagine  that  animal  sugar,  urea,  or  cholesterine,  &c., 
are  merely  strained  off  from  the  blood  ?  {§  409,  e.)  Finally,  as  to  urea, 
about  which  humoralism  has  been  so  much  concerned  in  the  philosophy 
of  diabetes,  we  may  say,  that  Le  Canu,  whose  analysis  of  the  blood  is 
admitted  to  be  the  best,  agrees  with  former  Chemists  in  denying  its  nat- 
ural existence  in  that  fluid. — Med.  and  Phys.  Comm.,  vol.  i.,  p.  680.    1840. 

§  1032,  c  If,  however,  the  validity  of  the  experiments  by  which, sac- 
charine matter  and  urea  are  said  to  have  been  obtained  by  analyses  of 
the  blood,  and  of  other  parts,  be  admitted,  there  is  not  much  difficulty  in 
interpreting  the  supposed  results  in  conformity  with  a  standard  supplied 
by  "experimental  philosophy" — not  even  the  curious  phenomenon  de- 
clared by  Bernard  of  the  existence  of  sugar  in  all  parts  of  the  circula- 
tion during  digestion,  but  its  subsequent  limitation  to  the  blood  between 
the  liver  and  the  lungs.  (§  48,  49,  53  c,  &c.,  Liebig ;  350f  e,  /,  Mulder; 
1029,  Lehmann.) 

The  blood  is  so  constantly  fluctuating  in  its  effete  materials  (§  426,  427), 
that  they  may  be  regarded  as  taking  an  important  part  in  the  transfor- 
mations, either  contributing  directly  to  the  artificial  formation,  or  exer- 
cising predisposing  affinities  upon  the  elements  of  the  blood,  when  chem- 
ical reagents  are  brought  into  action  upon  this  fluid  (§  6,  54  a) ;  and,  if 
we  now  consult  the  foregoing  references,  we  shall  find  the  most  eminent 
Chemists  virtually  coinciding  in  this  opinion.  But  I  may  quote  the 
more  specific,  and  later  authority  of  Lehmann,  which  I  shall  do  in  the 
language  of  a  Keviewer,  for  the  sake  of  some  other  statements  which 
occur  in  the  same  connection.     Thus  : 

"  It  is  a  doctrine  generally  accepted  by  the  Physiologists  of  the  pres- 
ent day,  that  the  glandular  organ  furnishes  nothing  to  the  secretion,  but 
that  its  tissue  (or,  at  all  events,  certain  of  its  cells)  exerts  a  catalytic 
action  on  the  elements  of  the  blood  as  it  traverses  the  organ.  In  accord- 
ance with  this  view,  Lehmann  has  afforded  us  a  very  satisfactory  expla- 
nation of  the  origin  of  the  sugar  in  the  liver.  On  comparing  the  compo- 
sition of  the  blood  of  the  portal  and  hepatic  veins,  he  found  that  the 
saccharine  blood  of  the  hepatic  veins  contains  less  fibrin  and  less  hsema- 
tin  than  the  non-saccharine  blood  which  enters  the  liver  by  the  portal 
vein.  He  then  proved,  by  a  very  logical  chemical,  process,  that  pure 
crystallized  hjEmatin  might  he  resolved  into  glucose  [grape  sugar]  conjugated 
with  a  nitrogenous  substance,"  &c. — British  and  Foreign  Med.  Rev.,  Jan., 
1857,  p.  32.     New  York. 

Now,  it  is  true  that  this  experiment  is  against  our  purpose,  excepting 
in  the  important  fact  that  it  is  supposed  that  blood,  in  certain  conditions, 
may  be  chemically  transformed  into  sugar.     But  how  far  is  the  experi- 


792  INSTITUTES    OF    MEDICINE. 

ment  reliable  as  to  the  distinction  which  is  made  between  hepatic  and 
portal  blood  (§  1029)?     Let  us  hear  Bernard: 

"  Since  the  publication  of  his  Lemons,  Bernard  has  been  led  to  give 
up  Lehmann's  explanation,  and  has  been  driven  to  the  belief,  from  certain 
experiments  which  he  has  recently  made,  that  it  is  not  in  the  blood,  hut  in 
the  HEPATIC  TISSUE  itself,  that  we  must  search  for  the  substance  ivhich  precedes 
and  directly  gives  origin  to  the  sugar.'" — British  and  Foreign  Med.  Rev.,  ibid. 

Our  interpretation  will  also  readily  explain  the  reason  why  saccharine 
matter,  or  something  analogous  to  it,  may  be  made  out  of  the  hepatic 
blood,  or  out  of  the  liver,  when  it  has  not  been  produced,  or  but  in  a 
minute  quantity,  from  portal  blood.  In  the  one  case  the  i-equisite  con- 
ditions are  present;  in  the  other  they  are  not.  This  is  obvious  enough 
from  the  quantity  of  bile  elaborated  from  the  portal  blood  (^  417). 

Again,  this  kind  of  "  experimental  philosophy"  will  explain  the  reason 
why,  according  to  Vernois,  "  sugar  may  be  found  in  the  liver  of  the 
foetus  and  not  in  that  of  the  mother,  and  vice  versa  ;"  and  why  it  is  found 
in  the  liver  particularly  after  respiring  an  irritating  vapor,  which, 
through  the  reflex  action  of  the  lungs,  modifies  the  whole  sanguiferous 
function,  and  consequently  the  condition  of  the  blood.  Associated  with 
this  there  may  be  something  appertaining  to  the  liver  Avhich  may  often 
enable  chemical  reagents  to  effect  a  transformation  analogous  to  sugar. 
Again  :  if  such  be  the  philosophy,  we  should  probably  find  the  Chemist 
often  failing  to  produce  sugar  from  the  liver  in  various  conditions  of 
disease.  Accordingly  we  learn  from  Becquerel  and  Rodier  that  "  in 
140  cases,  wherein  the  nature  of  the  disease  was  noted  by  M.  Vernois,  he 
only  found  sugar  fifty-six  times." — Ut  cit.,  p.  247,  248. 

§  1032,  d.  As  the  variety  of  means  which  have  been  employed  to  in- 
crease the  supposed  normal  proportion  of  sugar  in  the  blood,  and  the 
artificial  production  of  diabetes,  in  no  respect  affect  our  conclusions,  it 
is  unnecessary  to  speak  of  them.  Our  interest  lies  in  the  great  physio- 
logical problems  alone,  under  the  direction  of  the  leading  facts.  But  I 
may  say  of  Bernai'd's  experiment  of  producing  saccharine  urine  by  prick- 
ing the  floor  of  the  fourth  ventricle  between  the  roots  of  the  pneumo- 
gastric  and  auditory  nerves,  that  it  is  not  only  an  elegant  exemplification 
of  the  wonderful  mysteries  of  the  nervous  system  in  its  influences  upon  or- 
ganic functions,  especially  so  in  connection  Math  the  inductive  process  by 
which  he  arrived  at  the  experiment,  and  should  admonish  him,  profoundly, 
of  the  fallacious  nature  of  his  chemical  and  mechanical  doctrines  of  life, 
but  that  it  demonstrates  a  direct  influence  upon  the  functions  of  the  kid- 
ney which  places  the  mechanical  hypothesis  of  "  strainage"  upon  its  prop- 
er footing.  It  is  in  vain  to  assume  that  this  influence  was  exerted  spe- 
cifically upon  the  liver,  and  that  that  organ  was  thus  stimulated  to  an 
extraordinary  production  of  sugar ;  for  the  condition  of  the  kidneys  was 
not  affected  alone  in  the  elimination  of  sugar,  but  in  two  other  and  oppo- 
site respects,  according  to  the  precise  place  in  which  the  floor  of  the  fourth 
ventricle  was  pricked  between  the  origin  of  the  nerves.  In  one  place  the 
urine  would  be  increased  in  qnantity,  and  yielded  an  abundance  o^  albumen  ; 
while  a  little  variation  of  the  place  of  puncture  rendered  the  urine  small 
in  quantify,  and  restricted  the  organic  matter  to  sugar  alone.  (Bernard, 
Lerons,  «fec.,  p.  339-340.)  Moreover,  the  kidneys  and  ureters  were  quite 
as  violently  affected  by  this  prick  as  the  capillary  circulation  of  the  ab- 
dominal organs,  while  the  vessels  on  the  surface  of  the  liver  "were  more 
apparent  tlian  natural"    The  whole  capillary  system  of  other  parts  of  the 


Organic  Chemistry. — APPENDIX. — Animal  Sugar.         793 

abdomen  was  thrown  into  a  state  of  great  activity  and  engorgement,  and 
I  shall  quote  the  statement  in  a  note*  for  the  purpose,  also,  of  showing 
how  remarkably  the  vascular  system  may  be  affected  by  apparently  the 
slightest  impressions  upon  the  nervous  centres,  and  variously,  too,  as  the 
impressions  may  be  a  little  vai'ied  (iit  supra),  and  to  show,  moreover,  the 
absurdity  of  referring  the  physical  products  to  the  united  agency  of  the 
nervous  power  and  the  chemical  forces,  and  how  great  the  fallacy  of  ex- 
pecting to  give  direction  to  practical  medicine  by  any  analyses  of  the 
blood  or  secretions  while  they  are  unceasingly  changing  in  disease 
through  influences  propagated  by  the  nervous  power  (§  5 J,  e).  Nor 
will  the  reflecting  mind  fail  to  observe  the  vast  contribution  which  this  ex- 
periment makes  to  the  incalculable  importance  of  those  by  Wilson  Philip, 
as  herein  recorded,  nor  how  forcibly  the  experiment  confirms  the  applica- 
tions which  I  have  made  of  the  English  Philosopher's  (§  476-494,  &c.). 

But  again :  if  it  be  assumed  that  the  influences  were  exerted,  in  the 
experiment,  upon  the  liver,  and  that  the  kidneys  merely  "strained  off" 
the  redundant  sugar,  how  does  it  happen  that  no  sugar  ever  appears  in 
the  urine  during  the  digestion  of  food,  Avhen,  as  affirmed  by  Bernai'd,  it 
is  found  throughout  the  circulating  mass  of  blood?  Why  never  found 
in  the  urine  in  any  hepatic  affection,  and  never  in  any  other  disease  than 
diabetes?  And  what  shall  be  inferred  of  the  pathology  of  diabetes,  or 
of  the  indications  of  cure  as  supplied  by  Organic  Chemistry,  when  we 
contemplate  the  successful  treatment,  by  bloodletting,  of  the  remarkable 
case  recorded  in  §  1007,  c? — Note  Z  p.  1130,  on  urcemia. 

Since  the  foregoing  was  written,  information  has  reached  us  that  later 
observers  have  shown,  that,  whatever  may  be  the  influences  exerted  by 
the  injury  of  the  fourth  ventricle,  as  it  respects  the  hepatic  blood,  they 
have  no  bearing  upon  the  functions  of  the  liver,  but  of  the  lungs.  From 
these  observations  it  would  result  that  the  special  condition  of  the  hepat- 
ic blood  is  owing  to  some  modification  of  the  respiratory  function,  which 
is  rendered  farther  probable  by  the  injury  being  inflicted  at  the  origin  of 
the  pneumogastric  nerve  (^  461). 

1033,  a.  After  the  remarks  in  the  foregoing  section  (§  1032),  and 
upon  the  hypothesis  that  it  is  truly  sugar  which  is  discovered  in  blood 
by  the  reagents  (tests),  or  whatever  compound  it  may  be,  it  must  be  con- 
ceded in  behalf  of  the  hypothesis,  that  the  same  apparent  result  is  brought 
about  by  different  modes  of  proximate  analysis.  But  even  this  coinci- 
dence neither  establishes  the  certainty  that  the  products  consist  of  sugar, 
nor  render  it  unquestionable  whether  any  two  of  them  are  alike.  (§  54, 
a,  b.)  It  is  but  a  guess,  liable  to  the  doubts  which  are  so  forcibly  ex- 
pressed by  Professor  Lehmann  in  sections  1029,  1030.  Nevertheless,  in 
a  physiological  sense,  it  is  the  most  involved  and  important  inquiry  which 
Organic  Chemistry  has  yet  presented,  and  hence  the  space  which  is  here 
allotted  to  it.  Should  this  persevering  Offspring  of  the  inorganic  world 
succeed,  in  connection  with  experiments  upon  living  nature,  in  establish- 
ing the  supposed  double  function  of  the  liver,  it  will  have  contributed  a 
large  service  to  Physiology.     But  such  ai'e  the  complete  contradistinc- 

*  "Quand,  apres  avoir  pique  cliez  im  Chien  ou  chez  un  Lapin  Torigine  des  pneumo- 
gastriques,  nous  lui  avons  ouvert  la  ventre  au  moment  oi^  la  surexcitation  porte'e  sur  la 
foie  presentait  son  summum  d'intensite,  nous  avons  vu  qu'alors  il  y  avait  une  plus  grande 
ectivite  de  la  circulation  abdominale,  le  S3-steme  capillaire  etait  gorge  de  sang,  et  les 
vaisseaux  de  la  surface  du  foie  plus  apparents  qu'a  I'etat  normal.  Les  reins  sont  alors 
eux-m6mes  tres  surexcites,  les  ureteres  sont  tres  irritables  ;  il  suffit  de  la  toucher  avec 
la  pointe  d'un  liistouri  pour  les  voir  se  contracter  energiquement." — Bernard,  Ler^ons, 
&c.,  p.  331,     1854-55.— See  Budge's  Exp.  §  494  e,  and  §  635. 


794  INSTITUTES    OF    MEDICINE. 

tions  between  organic  and  inorganic  beings,  that  it  may  be  safely  conv 
eluded  that  it  can  go  no  farther  than  to  distinguish  the  difference  between 
the  physical  constitution  of  one  substance  and  another.  Here  it  ends, 
and  here  the  vitalist  takes  up  the  result  and  carries  it  into  the  profound 
labyrinth  of  organic  life.  Even  so  Liebig,  §  18  c,  42,  53  c,  59,  64  e, 
350,  nos.  59,  79.  (Also,  §  5,  6,  53  b,  222  b,  351,  362,  376i,  409  j, 
All,  &c.) 

In  the  mean  time,  as  an  appendage  of  some  moment  to  the  foregoing 
discussion,  and  that  it  may  be  compared  with  the  extracts  from  Leh- 
mann's  work,  in  sections  1029,  1030,  I  shall  now  state,  as  an  example 
of  searching  for  sugar,  an  unsuccessful  process  observed  by  Lehmann  for 
detecting  its  presence  in  the  portal  blood  of  horses : 

"  The  blood,  after  being  neutralized  with  dilute  acid,  and  treated  with 
four  times  its  quantity  of  water,  was  coagulated  by  heat,  the  expressed 
and  filtered  fluid  was  evaporated,  the  residue  extracted  with  sjnrit  of  85°, 
and  the  spirituous  fluid  precipitated  by  an  alcoholic  solution  of  potash. 
The  portion  insoluble  in  water  was  mixed  with  a  little  water,  filtered, 
treated  with  dilute  sulphuric  acid,  for  the  purpose  of  effecting  the  meta- 
morp)hosis  of  any  dextrine  that  might  be  present,  and  then  examined  fob 
sugar"  ! — Lehmann's  Physiological  Chemistry,  vol.  ii.,  p.  391. 

There  is  also  the  celebrated  test  known  as  Barreswill's  solution,  which 
consists  of  "carbonate  of  soda  (in  crystals)  40  parts;  bitartrate  of  pot- 
ash 50  parts  ;  caustic  potash  40  parts  ;  distilled  water  400  parts.  Make 
a  solution,  and  add  the  following :  Sulphate  of  copper  30  parts  ;  water 
100  parts.  Filter  the  two  solutions  when  mixed.  This  solution,  when 
added  to  a  liquid  containing  glucose,  gives  a  reddish  precipitate  of  re- 
duced copper." 

Another  chemical  test  is  that  of  caustic  potash,  "  a  fragment  of  which, 
added  to  serum  containing  glucose,  gives  an  albuminous  precipitate  of  a 
brownish  color,  due  to  the  combination  of  albumen  with  ulmate  of  potash." 

Becquerel  and  Rodier  say,  that  the  chemical  processes  I'elied  upon  are 
"  almost  exclusively"  the  last  two — B.  and  R.'s  Patholog.  Chem.,  p.  72, 
73.  Lehmann  commends  Trommer's  test,  which  consists  mostly  of  caus- 
tic potash  and  sulphate  of  copper,  but  which  has  been  disputed.  "  But 
if  this  test  be  not  admitted,"  he  says,  "  equal  objections  may  be  advanced 
against  all  the  reagents  employed  in  mineral  chemistry ;  the  application 
of  most  of  them  demanding  more  precaution  and  skilful  manipulation 
than  this  test."  He  thinks  well  of  the  polarizing  apparatus ;  says  that 
"  Pettenkofer's  test  is  not  available  for  the  detection  of  sugar ;"  and  he 
would  not  trust  the  fermentation-test,  nor  Maumene's.  After  mention- 
ing these,  and  their  attendant  qualifications,  we  have  the  farther  discour- 
aging remark,  that  ''  all  other  tests  which  were  formerly  employed  for 
the  discovery  of  sugar  are  open  to  so  many  sources  of  fallacy,  as  com- 
pared with  the  methods  we  have  already  indicated,  that  we  may  pass 
them  over  in  silence." — Lehmann,  ut  cit.,  vol.  i.,  p.  251,  256. 

1033,  b.  Now,  all  the  foregoing  (§  1033,  a)  would  be  commendable, 
did  it  end,  so  far  as  Chemistry  is  concerned,  with  the  experiments  them- 
selves;  although,  as  we  have  seen  (§  1029,  1030),  it  can  rarely  supply 
any  reliable  ground  for  induction.  But  it  is  an  example  only  of  a  vast 
amount  of  experimental  Chemistry  which  has  been  carried  far  into  the 
labyrinth  not  only  of  the  physiological  but  morbid  states  of  the  body, 
and  commended  to  Physicians  under  the  illusory  name  of  "  experimental 
medicine." 


Organic  Chemistry. — ^appendix. — Animal  Sugar.         795 

But,  suppos-^  it  to  be  all  true,  there  never  was  and  never  will  be  a 
physician  who  will  or  can  apply  it  in  practice,  very  few  who  can  under- 
stand it,  no  one  qualified  for  the  analyses,  no  time,  in  acute  diseases  at 
least,  for  inquiries  so  difficult  and  tedious,  and  no  one  who  will  fall  into 
the  absurdity  of  applying  to  a  competent  Chemist,  if  he  can  find  one,  to 
search  for  disease  in  morbid  changes  of  the  blood,  or  secretions,  not  even 
of  the  urine.  In  chronic  affections,  a  few  simple  observations  upon  the 
latter,  and  which  are  alone  reliable,  will  sometimes  inform  the  physician 
of  the  presence  of  some  unusual  substances  as  the  products  of  disease; 
but  this  knowledge  can  never  aid  him  much  in  the  treatment  of  the  mal- 
ady (§  427).  Take  the  strongest  of  all  examples,  diabetes  mellitus;  a 
knowledge  of  the  existence  of  sugar  in  the  urine  has  neither  contributed 
to  a  knowledge  of  the  pathology  of  the  disease,  nor  given  the  slightest 
direction  to  an  enlightened  practice.  An  exclusively  animal  diet  has 
not  reached  the  pathological  condition,  and  the  sugar  has  gone  on  as 
usual  whatever  the  food  consumed.  Nor  is  it  any  better  with  the  "  urea- 
diathesis,"  or  with  "  albuminous  urine,"  whether  the  latter  respect  the 
kidneys  or  dropsical  conditions ;  but,  on  the  contrary,  it  has  led  to  many 
blunders  between  the  presence  of  disease  and  the  ingesta,  or  between  one 
disease  or  another  (§  426,  427,  639,  673,  675,  679,  686  d).  If  the  Phy- 
sician rely  upon  these  superficial  and  uncertain,  or  imaginary  signs,  if 
he  have  not  the  sagacity  to  discover  the  nature  of  disease  through  the 
ready  and  intelligible  signs  supplied  by  Nature,  or  cannot  avail  himself 
of  experimental  observations  upon  the  eflfects  of  remedies  which  have 
been  accumulating  for  ages,  or  be  incapable  of  applying  in  practice  the 
principles  which  have  been  founded  upon  these  observations  in  their  con- 
nection with  other  intelligible  principles  in  physiology  and  pathology, 
his  case  is  as  hopeless  as  must  be  that  of  his  patients  (§  5^-,/').  And 
yet,  it  is  a  remarkable  fact,  that  many  medical  Authors,  who  take  the 
"experimental  medicine"  of  the  day  upon  trust,  are  vastly  more  certain 
of  the  accuracy  of  the  experiments,  and  of  their  application  to  the  heal- 
ing art  (and  yet  without  applying  them),  than  the  very  able  men  who 
have  been  employed  long  and  assiduously  in  the  inquiry.     (§  1065,  h,  c.) 

It  was  but  very  recently  that  the  Medical  Profession  in  Europe  and 
America  calculated  upon  Morbid  Anatomy  as  a  grand  basis  for  medicine, 
and  the  present  writer  took  a  long  ground  against  it.  And  Avhere  is  it 
now  ?  Dissipated  by  Liebig  as  by  an  enchantei''s  wand.  Where  now 
is  the  so  late  "Numerical  Method?"  (§  1006,  a.)  Swallowed  up  by  the 
Laboratory.  Where,  the  Humoral  Pathology,  which  Andral  reproduced 
and  ingrafted  upon  Vital  Solidism  ?  (§  819,  &c.)  Ingrafted  upon  Chem- 
istry. Where  the  so  late  "  experimental  philosophy"  which  aimed  at  the 
causes  and  cure  of  human  maladies  by  the  introduction  of  poisons  and 
remedial  agents  into  the  circulation  of  animals?  (744.)  "  Given  place 
to  an  '  experimental  philosophy'  in  which  organic  life  has  no  participa- 
tion" (§  5|^  a).  Where  the  "  division  of  labor"  in  the  fragmentary  sys- 
tem of  "  specialities  ?"  Concentrated  in  the  hands  of  Organic  Chemis- 
try (§  960,  c).  Where,  I  ask,  are  the  memories  even  of  those  so  recent 
as  Hunter  and  Bichat  ?  All  buried  in  the  common  Cemetery.  Where, 
in  brief,  is  Organic  Life  ?  Echo  ansvvei's,  extinguished  by  the  Labora- 
tory (§  695-709.  See,  also,  the  Author's  Essays  on  Morbid  Anatomy, 
and  on  the  writings  of  M.  Louis,  in  Medical  and  Physiological  Comment- 
aries). 

§  1034.  Finally,  in  the  discussion  of  controverted  questions  between 


796  INSTITUTES    OF    MEDICINE. 

the  Physiologist,  as  he  looks  upon  animated  nature  in  its  healthy  and 
morbid  aspects,  and  the  Chemist,  who  is,  or  should  be,  concerned  alone 
with  dead  matter,  it  is  sometimes  difficult  to  maintain  a  perfect  modera- 
tion of  style  when  the  Laboratory  becomes  dogmatic,  and  especially  when 
exclusive  (§  1,  i,  350,  Mottoes).  And  I  may  be  now  permitted  to  at  least 
correct  a  misapprehension  of  Professor  Lehmann's,  Avho,  in  the  seclusion 
of  the  Laboratory,  like  all  others  of  the  same  laborious  and  abstract  pur- 
suits, is  evidently  uninformed  of  the  doctrines  of  the  vital  Physiologist, 
or  does  him  an  injustice  which  I  should  be  unwilling  to  surmise.  I  al- 
lude to  the  following  paragraphs,  although  there  is  much  more  of  the 
same  nature : 

"We  have  not  hesitated  to  avow  that  we  have  assumed  a  thorougldij 
radical  point  of  view  in  reference  to  specific  vital  phenomena  and  vital 
forces ;  for  we  cannot  rest  satisfied  with  the  mysterious  obscurity  in  which 
they  have  been  artificially  enveloped." 

Our  Author  then  proceeds  to  designate  the  Science  of  Life  as  a  sys- 
tem of  "  metaphysicology"  and  to  confound  Physiologists  with  the  "  ad- 
vocates of  a  romantic  poetry  of  nature  f^  though,  it  is  true,  he  had  the 
encouraging  success  of  Liebig  before  him  (§  350,  Mottoes).  Thus,  our 
Author : 

"  It  would  be  well  if  these  spiritualists  would  look  down  from  the  high 
stand  they  have  chosen,  and  deign  to  believe  that  there  are  some  among 
those  experimentalists,  who,  clinging  to  matter,  and  gathering  their  facts 
Avith  ant-like  industry  from  the  lowly  earth,  notwithstanding  that  they 
have  long  held  communion  with  the  poet-philosopher,  Plato,  and  the 
philosophical  natural  inquirer,  Aristotle,  and  have  some  familiarity  with 
the  Paraphrases  of  Plegel  and  Schelling,  are  yet  unwilling  to  relinquish 
their  less  elevated  position.  If  these  happy  admirers  of  their  o"\ati  Ideal 
had  descended  from  their  airy  heights,  and  closely  examined  organic  and 
inorganic  matter,  they  would  not  have  deemed  it  necessary  to  assume, 
that,  besides  carbon,  hydrogen,  nitrogen,  and  oxygen,  organic  substances 
must  also  contain  an  organagenium,  or  latent  vital  force,  or  Avhatever  else 
they  may  be  pleased  to  call  it.  Had  they  sought  information  from  a 
Chemist,  they  would  have  learned  that,  when  exposed  to  the  clear  light 
of  rigid  logic,  there  is  no  essential  difference  betaveen  organic 
AND  inorganic  BODIES.  A  Chemist,  totally  unacquainted  with  organic 
matter,  would  a  2>riori  have  deduced  all  these  iiicideidal  differences  of  mat- 
ter from  the  doctrine  of  affinity  and  the  science  of  stoichiometry,  evolved 
from  dead  matter.  (§  1052.)  However  these  advocates  of  a  romantic 
poetry  of  nature  may  despise  the  swarm  of  industrious  investigators, 
who  are  often  unwearingly  occupied  for  years  together  in  endeavoring 
to  collect  a  ^q\v  firm  supports  for  the  great  edifice  of  a  true  philosophy 
of  nature,  we  do  not  despair  of  seeing  our  work  rise  in  simple  grandeur, 
more  durable  and  lasting  than  these  sophisms  of  natural  philosophy, 
which,  passing  through  ages,  from  Pythagoras  and  Empedocles  to  Schel- 
ling and  Hegel,  have,  like  the  sand  of  the  ocean  shore,  been  alternately 
upborne  by  one  wave  and  ingulfed  by  the  next." — Lehmann's  Physio- 
logical Chemistry,  vol.  i.,  p.  33,  34. — See  p.  157,  §  350,  mottoes  h-l. 

That  this  is  not  a  hasty  rhapsody  appears  from  a  note,  in  which  our 
Author  states  that  he  had  "expressed  similar  ideas  in  an  Article  which 
appeared  in  the  '  GegenAvart.'  "  At  another  time,  also,  he  caricatures 
the  doctrine  of  vital  solidism  as  "  a  belief  in  supernatural  forces  of  mat- 
ter."—/ied,  vol.  ii.,  p.  380. 


Organic  Chemistry. — APPENDIX. —  Vital  Solidism.  797 

There  is  no  doubt  that  our  amiable  Author  (whom  no  one  is  disposed 
to  disturb  in  his  legitimate  pursuit)  is  very  correct  as  an  expositor  of 
the  objects  and  opinions  of  Organic  Chemists  when  he  asserts  their  be- 
lief that  "  there  is  no  essential  difference  between  organic  and  inorganic 
bodies  ;"  as,  indeed,  appears  abundantly  in  these  Institutes.  It  is,  there- 
fore, all  a  foregone  conclusion  with  the  Chemist,  before  he  approaches 
the  living  being  with  acids,  and  alkalies,  and  metallic  oxides,  and  retorts, 
and  crucibles,  that  he  will  quickly  "  deduce  all  the  incidental  differences 
of  matter  (animate  and  inanimate)  from  the  doctrines  of  the  Laboratory 
as  evolved  from  dead  matter."  Hence,  it  is  evident,  besides  his  affirma- 
tion, that  our  Author  has  deduced  all  his  knowledge  of  Haller,  Baglivi, 
Hunter,  Bichat,  Mliller,  C.  Bell,  M.  Hall,  Tiedemann,  and  other  illus- 
trious Physiologists  of  recent  times,  from  what  he  has  gathered  from 
"the  Poet-Philosopher,  Plato,  and  the  philosophical  natural  inquirer, 
Aristotle,  along  with  the  Paraphrases  of  Hegel  and  Schelling ;"  glanc- 
ing, it  is  true,  at  their  kindred,  Pythagoras  and  Empedocles,  but  skip- 
ping over,  even,  such  ultra  "  Spiritualists"  as  Hippocrates,  Celsus,  Ga- 
len, Aretaeus,  Avicenna,  &c.,  from  whose  works  he  might  have  "  deduced 
a  priori  all  the  incidental  differences"  between  them  and  their  modern 
Antitypes.  (§  4^,  5-6,  189,  292,  334,  350i,  350^5',  351,  360-3G4,  36G, 
376i,  3761  ^',  744,  1005  a,  1029,  1030,  1075  b.) 

Nevertheless,  although  our  Author  "  cannot  rest  satisfied  with  the 
mysterious  obscurity  in  which  the  vital  phenomena  have  been  artificially 
enveloped,"  and,  although  "a  Chemist,  totally  unacquainted  with  organic 
matter,  would  a  2)riori  have  deduced  all  these  incidental  differences  of 
matter  from  the  doctrine  of  affinity  and  stoichiometry  evolved  from  dead 
matter,"  he  is  coerced,  not  unfrequently,  to  contradict  himself  (§  626,  b), 
and  to  admit,  as  in  the  following  example,  that  the  "  incidental  difler- 
ences"  relative  to  absorption  alone  have  been  altogether  beyond  any  ex- 
planation in  physics,  which  is  apparently  a  very  simple  phenomenon 
compared  with  many  other  processes  of  life,  even  as  it  occurs  in  plants 
(§  1053).     Thus,  our  author  : 

"If,  however,  we  still  continuously  encounter  a  number  of  phenomena 
in  the  living  body,  which  seem  to  be  at  variance  with  the  endosmotic  laws 
with  which  we  ai'e  at  present  acquainted,  and  if  many  interesting  exper- 
iments, as,  for  instance,  those  of  Bocker,  still  appear  to  defy  explanation 
by  simple  molecular  action,  this  merely  proves  that  Ave  are  still  deficient 
in  the  physical  knowledge  necessary  for  the  comprehension,  in  a  physical 
sense,  of  the  casual  [!]  connection  of  such  phenomena."  (See  §  1052.) 
"We  may,  however,  conclude,  from  the  scanty  facts  before  us,  that  the 
movements  of  soluble  matter  within  the  living  organism,  and  more  es- 
pecially the  phenomena  of  absorption,  must  be  stipposed  to  depend  upon 
certain  physical  laws."  —  Lehmann's  Physiological  Chemistry,  vol.  ii., 
p.  376-399.— Also  ^  176  d. 

And  again,  our  Author,  still  forgetting  himself,  is  at  considerable 
pains  in  showing  that  "  if  zoo-chemistry  ever  fulfil  its  object,  it  must  be 
by  the  joint  aid  of  Chemistry  and  Physiology." — Ibid.,  vol.  i.,  p.  24.  But 
how  far  our  Author  (and  Liebig,  Avho  is  of  the  same  opinion)  is  quali- 
fied to  reason  upon  the  profound  problems  of  life  will  sufficiently  appear 
from  the  following  jumble  : 

"Weariness  of  the  senses  is  the  diminished  impressibility  of  the  nerves 
of  sense,  but  its  cause  cannot  reasonably  be  sought  for  in  any  other  than 
a  CHEMICAL  CHANGE,  experienced  by  the  conducting  substance  of  the 


798  INSTITUTES    OF    MEDICINE. 

nerves.  Such  a  chemical  metamorphosis  of  the  nerves  of  sense  from 
external  impressions  can  no  longer  greatly  excite  our  astonishment,  since 
we  have  witnessed  the  unexpected  phenomenon  of  a  picture  produced  sud- 
denly, and  as  it  were  by  magic,  from  the  chemical  changes  effected  by 
the  i-ays  of  light  07i  an  iodized  silver  plate  [!]  Should  we  not  be  equally 
justified  in  saying  that  the  iodized  plate,  which,  after  being  exposed  for 
a  few  seconds  to  a  sti-ong  light,  gives  oiily  faint  and  half-effaced  images, 
IS  WEARIED  LiivE  THE  RETINA,  whcu,  after  repeated  and  continuous  per- 
ception of  an  image,  it  gives  back  only  the  faint  outlines  of  the  object?"  ! ! 
—Ibid.,  vol.  i.,  p.  30.     (Also  §  349  e,  350 1  n,2),  350f  e,f,  350|  e.) 

But  this  is  only  an  example  of  a  vast  amount  of  a  corresponding  na- 
ture by  which  I  have  endeavoured  to  show  that  Chemistry  and  Physiology 
are  profoundly  distinct  from  each  other,  and  that  when  the  Chemist  de- 
parts from  his  legitimate  pursuit  to  gather  laurels  in  Medical  Science, 
whatever  may  be  his  ability,  he  is  acting  the  part  of  a  mere  Charlatan 
(§  3761  626  b). 

Our  Author  takes  it  hard  that  Chemical  Philosophers  should  meet 
with  any  opposition  in  their  invasions  upon  Physiology  and  practical 
Medicine,  notwithstanding  his  own  declaration  that  they  are  not  to  be 
trusted  in  their  organic  inquiries  (§  1029, 1030).  But  since  he  indulges 
the  illusion  that  none  but  the  most  imaginative  have  raised  an  obstacle 
to  the  ambitious  career  of  Organic  Chemistry,  it  is  not  quite  apparent 
why  our  Author's  self-complacency  should  have  been  so  much  disturbed 
as  seems  to  be  implied  in  the  concluding  part  of  a  foregoing  quotation 
(page  796).  The  capital  error  of  our  friends  is  forcibly  presented  in  that 
extract — "  Who  are  often  unwearingly  occupied  for  yeais  together  in  en- 
deavouring to  collect  a  few  firm  supports  for  the  great  edifice  of  a  true 
philosophy  of  nature,"  and  which  has  been  often  the  subject  of  comment 
by  eminent  Philosophers,  as  may  be  seen  at  pages  157,  173,  §  350,  Mot- 
toes, h,  i,  h,  I,  and  No.  97  of  pai*allel  columns. 

Our  Author's  error,  therefore,  as  will  be  readily  seen,  proceeds  from 
an  unceasing  devotion  to  the  phenomena  of  dead  matter  (§  376  j),  which, 
as  a  consequence,  leads  to  a  total  disregard  of  all  the  facts  which  have 
been  accumulated  by  the  students  of  living  nature,  and  an  oblivious- 
ness to  the  grand  consideration  that  even  such  students  can  have  no  just 
appreciation  of  the  natural  processes  of  animated  beings  unless  also 
well  skilled  in  Pathology  and  Therapeutics  (§  5^  e,  f,  5|  a,  6,  53  c, 
129,  134,  137  d,  151,  163,  165  h,  167,  191,  234-235,  237,  285,  303|, 
3761  376|,  447  a,  b,  c,  516  d,  No.  6,  676  b,  801'a,  819,  1006  a,  1029, 
1030,  198,  640,  1060). 

But  our  Author  has  now  the  consolation  of  knowing  that  he  has 
achieved  his  object  of  convincing  a  multitude  of  Physicians  (§  5^,  a)  that 
they  are  worthy  of  his  rebuke,  and  that  the  true  philosophy  of  medicine 
can  be  acquired  only  through  an  implicit  dependence  upon  the  Labora- 
tory of  the  Organic  Chemist  (§  376^-).  Nevertheless,  our  Author  is  too 
shrewd  a  politician  not  to  have  observed  the  action  which  has  been  set- 
ting in  against  a  pursuit  in  which  the  Physiologist  and  Physician  have 
had  no  participation  whatever  ;  nor  is  he  less  aware  of  the  causes.  Lest 
the  monopoly,  therefore,  should  be  lost,  he  deals  a  few  blows  upon  the 
most  submissive  part  of  the  Profession  in  this  wise: 

"Enthusiasm,"  he  says,  "in  the  cause  of  Organic  Chemistry  has  de- 
generated among  many  Physiologists  and  Physicians  into  a  fanaticism, 
which,  even  in  the  best  cause,  tends  to  invalidate  a  host  of  truths  in  its 


Organic  Chemistry. — appendix. —  Vital  Solidism.         799 

t;ndeavours  to  uphold  a  single  fact  (§  5i  a,  530). — ^Lehmann,  iUd.^ 
;o\.  i.,  p.  1. 

But,  then,  how  will  our  Author  compromise  the  trouble  with  this 
class  of  "Physiologists  and  Physicians,"  if  "  there  is  no  essential  differ- 
'^nce  between  organic  and  inorganic  bodies,"  or,  especially,  if  "  a  Chem- 
•st,  totally  unacquainted  with  organic  matter,  would  a  priori  deduce  all 
the  incidental  differences  from  the  doctrine  of  affinity  and  the  science  of 
stoichiometry,  evolved  from  dead  matter  f  Our  Author's  entire  work 
proceeds  upon  these  premises,  along  with  a  profusion  of  ridicule  upon 
the  physiological  doctrines  of  life  and  disease,  of  whose  deductions  from 
the  phenomena  of  living  nature,  through  a  long  course  of  ages,  he  is  as 
profoundly  ignorant  (as  he  virtually  admits)  as  he  is  able  and  accom- 
plished in  that  mere  physical  department  of  science  to  which  he  has 
devoted  his  thoughts  and  his  labors.  Our  Author,  therefore,  seeing  the 
"handwriting  upon  the  wall,"  as  appears  in  preceding  quotations  (§  1029, 
1030),  ventures  the  future  upon  denunciations  of  those  whose  peculiar 
province  it  is  to  unfold  the  Science  which  Nature  has  isolated  from  all 
others  in  its  fundamental  laws.  But  I  ask  our  Author  and  others  who 
have  not  been  less  vehement  in  unmannerly  malediction  upon  all  Med- 
ical Philosophers  of  the  past,  whether  the  phrensy  of  a  morbid  ambition 
is  not  most  likely  to  react  upon  themselves '?  (§  6,  376^.)  And  I  put  it, 
also,  to  Physicians,  whether  they  will  continue  to  follow  the  wake  of 
Organic  Chemistry,  or  assume  the  independence  of  thinking  and  acting 
for  themselves  ?  And  here  I  shall  take  the  liberty  of  repeating  a  pas- 
sage from  the  Commentaries  which  covers  a  greater  range  of  the  fictions 
that  have  been  substituted,  in  recent  times,  for  philosophical  medicine. 
The  Author  was  referring,  specifically,  to  M.  Louis's  attempt  to  prepare 
the  way  for  his  anatomical  and  numerical  methods  by  proclaiming  that 
'■^Medicine  is  now  in  its  infancy  f  while  it  is  but  just  to  the  French  Phi- 
losopher to  say,  that  the  German  is  more  dogmatically  abusive,  in  vari- 
ous parts  of  his  work,  of  every  Physiologist  and  Physician  who  has  ad- 
mitted "a  vital  force  or  whatever  they  may  call  it"  (in  our  Author's 
language),  from  Hippocrates  to  the  present  day.     The  Commentaries  thus  : 

"That  the  World  should  have  passively  acquiesced  in  this  unreserved 
obliteration  of  all  its  medical  knowledge  and  principles  (executed,  too, 
in  no  very  gracious  manner),  was  neither  just  to  itself,  nor  watchful  of 
its  dignity.  That  it  should  have  received  the  ostracism  with  a  com- 
mendation proportioned  to  its  abruptness  and  insensibility  must  remain 
forever  the  most  extraordinary  record  of  all  human  affairs ;  and,  when 
after  ages  shall  look  back  upon  the  present,  groping  its  way  in  a  mid- 
night darkness  of  its  own  creation,  and  rejoicing,  as  it  were,  with  the 
prattling  "  infancy"  of  a  once  noble  and  stupendous  science,  and  witness, 
as  its  results,  the  experimental  processes  by  which  the  new  being  was 
to  be  carried  forward  to  maturity — the  myriads  of  victims  who  furnished 
their  quota  to  the  morbid  anatomist — the  attempts  at  converting  morbid 
into  healthy  blood  by  chemical  agencies,  first  in  a  '  porringer,'  and  then, 
by  analogy,  up  to  the  living  organism — the  conflict  between  the  remain- 
ing disciples  of  Nature  and  the  abuses  of  the  Laboratory — the  almost 
universal  substitution  of  the  forces  of  physics  for  those  specific  powers 
which  had  hitherto  rendered  Physiology  and  Medicine  intelligible  and 
consistent  sciences,  besides  a  multitude  of  other  strange  devices,  contrib- 
uted and  cordially  received  from  all  manner  of  workmen,  as  choice  ma- 
terials for  the  new  foundation — when,  we  say,  after  ages  shall  look  back 


800  INSTITUTES    OF    MEDICINE. 

upon  this  dark  spot  on  the  brightest  escutcheon  of  the  world,  it  must  be 
regarded  without  sympathy,  and  as  an  act  of  voluntary  humiliation 
(§  376^,  530,  819  b). — Medical  and  Physiological  Commentaries, 
vol.  ii.,"  p.  G84.     1840. 

§  1035.  Although  the  foregoing  review  of  Physiological  and  Patho- 
logical Chemistry  may  be  unimportant  to  all  but  the  present  writer,  he 
will,  nevertheless,  say,  that  personal  considerations  had  nearly  deterred 
him  from  making  them.  In  all  his  writings  he  had  regarded  his  position 
as  so  isolated,  that  he  had  not  anticipated  much  sympathy  and  less  en- 
couragement, and  he  has,  therefore,  been  agreeably  disappointed  in  find- 
ing numerous  and  very  able  advocates,  and  by  many  unexpected  and 
very  distinguished  honors  that  have  been  conferred  upon  him  by  the 
most  renowned  Medical  Societies  in  Europe.  These  marks  of  recogni- 
tion, he  hopes  of  approval,  have  always  awakened  the  most  profound 
gratitude.  But  the  more  he  has  prosecuted  his  studies,  the  more  impos- 
sible has  he  found  it  to  modify  his  opinions  on  Medical  Philosophy,  and 
the  more  desirous  has  he  become  of  submitting  this  enlarged  experience 
to  the  judgment  of  mankind ;  and,  although  he  is  not  unmindful  that 
perfect  independence  is  conceded  to  the  Cultivators  of  science,  yet  he  is 
most  anxious  to  be  just  to  those  whose  writings  have  proved  to  him  a 
fountain  of  knowledge,  and  whose  kindnesses  have  aAvakened  the  deepest 
sensibilit)'.  And,  while  thus  employed  in  this  very  personal  manner,  he 
will  not  forego  the  gratification  of  uniting  to  that  of  the  medical  world  his 
own  admiration  of  the  labors  of  Becquerel  and  Rodier,  and  particularly 
of  those  researches  which  are  presented  in  their  work  on  "  Pathological 
Chemistry  in  its  application  to  the  Practice  op  Medicine."  The 
very  flattering  dedication  to  himself  which  occurs  in  the  London  edition 
of  that  work  might,  in  connection  with  the  considerations  just  stated, 
have  prompted  him  to  have  still  maintained  the  silence  (unimportant  to 
be  sure)  which  he  has  for  some  time  observed,  did  he  not  find  in  the  work 
so  great  an  amount  of  enlightened  research,  and  which  he  can  heartily 
commend  to  the  American  Medical  Profession.  It  is,  indeed,  rather  a 
system  of  practical  medicine  than  Avhat  the  Title  imports.  Its  authors 
have  been  attentive  observers  of  disease,  and  their  valuable  experience  is 
presented  in  its  direct  relation  to  Pathology  and  Therapeutics.  Their 
pathological  chemistry  of  the  blood  is,  also,  but  little  liable  to  the  objec- 
tions so  forcibly  stated  by  Professor  Lehmann  (§  1029),  since  it  often  ex- 
tends but  little  beyond  the  specific  gravity,  and  the  proportions  of  water, 
globules,  albumen,  fibrin,  and  fatty  and  extractive  matters,  in  different 
forms  of  disease,  and  their  comparison  with  a  noi'mal  standard.  And, 
although  these  analyses  advance  our  knowledge  of  pathological  condi- 
tions, the  present  writer  cannot  but  adhere  to  his  opinion  that  the  treat- 
ment of  disease  must  turn  essentially  upon  the  import  of  symptoms  and 
of  remote  causes,  in  comiection  with  the  principles  which  have  been  de- 
duced from  the  phenomena  of  healthy  and  morbid  actions,  and  from  the 
results  of  hygienic  and  therapeutical  treatment  (§  413-403,  G39-709) ; 
nor  has  he  any  doubt  that  his  Authors  think  so  too.  They  belong  to 
the  school  of  Vitalists,  ever  designating  the  blood  as  the  vital  fluid,  and 
quote,  approvingly,  from  Simon's  Animal  Chemistry,  the  following  en- 
lightened opinion  respecting  yji?7»,  which  stretches  far  into  other  great 
problems  in  vital  physiology.  Although  stated  as  an  abstract  fact,  it 
associates  with  itself  the  whole  labyrinth  of  physiological  results,  and  is 
unapproachable  by  chemical  laws.     Thus : 


Physiology. — appendix. — Structure.  801 

"  The  fibrin,  in  its  normal  physiological  condition,  is  the  result  of  the 
transformation  of  a  certain  amount  of  the  globules.  This  transforma- 
tion, which  is  of  a  vital  7iature,  is  due  to  the  action  of  the  oxygen  of  the 
atmosphere  on  the  one  hand,  and,  on  the  other,  to  the  numerous  reactions 
which  take  place  during  the  passage  of  the  blood  through  the  different 
tissues  and  organs  of  the  body.  The  globules,  before  being  assimilated 
to  these  tissues,  and  thus  contributing  to  interstitial  nutrition,  pass 
through  a  transition  state,  which  is  the  fibrin  (§42)." — Becquerel  and 
Rodier's  Pathological  Chemistry,  p.  105. 

However  much  the  writer  may  differ  from  the  chemical  school  of  med- 
icine, his  attention  has  been  directed  to  their  researches  during  the  great- 
er part  of  his  professional  life,  and,  he  acknowledges,  with  intense  inter- 
est and  never-failing  information,  while  he  also  commends  to  his  medi- 
cal class  the  same  habits  of  inquiry.  He  had  known  nothing  of  the  com- 
position of  organic  nature,  nothing  of  those  elementary  combinations 
which  so  forcibly  distinguish  it  from  the  inorganic  kingdom,  and  many 
other  relative  details,  nor  could  these  Institutes  have  been  written,  with- 
out the  revelations  afforded  by  Chemistry  (§  376f,  b). 

PROGRESS  OF  PHYSIOLOGY. 

STRUCTURE    OF    ORGANS. 

1036.  Many  interesting  disclosures  have  been  recently  made  in  the 
minute  anatomy  of  some  of  the  complex  organs,  and  the  microscope* has 
been  brought  to  bear  advantageously  upon  the  subject  in  connection  with 
improved  methods  of  minute  injection.  The  structure  of  the  kidnej^, 
whose  rank  in  organic  life  I  have  advocated  in  foregoing  sections  (§  417, 
422-427,  892f  a-c,  1032),  has  been  subjected  to  much  critical  inquirj', 
and  although  the  exposition  of  its  elaborate  organization  call  up  an  as- 
sociation with  the  most  complex  mechanism  of  art,  it  reminds  us  as  lit- 
tle of  "  a  strainer"  as  it  does  of  a  musical  instrument  (§  1032).  But  the 
most  curious  and  intensely  interesting  discovery  relative  to  this  organ  is 
Brown-Sequard's  development  of  a  startling  function  appertaining  to  the 
renal  capsules,  and  which  should  silence  forever  all  attempts  to  "deduce 
the  incidental  differences  between  organic  and  inorganic  bodies  from  the 
principles  evolved  from  dead  matter"  (§  1034,  Lehmann). 

The  anatomical  details  of  the  nervous  system,  especially  of  the  spinal 
cord,  have  been  also  ably  investigated  by  Lenhossek,  Van  Der  Kolk, 
Brown-Se'quard,  and  others,  and  impart  a  great  interest  to  the  study  of 
the  organic  life  of  animals.  All  this,  and  much  more  of  a  correspond- 
ing nature,  opens  very  widely  the  wonderful  mechanism  of  organic  be- 
ings, develops  more  forcibly  that  incomprehensible  variety  of  Omniscient 
Design  which  is  apparently  excluded  from  the  mechanical  constitution 
of  inorganic  bodies,  and  thus,  and  in  other  ways,  aids  in  placing  the 
chemical  and  physical  doctrines  of  life  and  disease  upon  their  proper 
level.     (See  Index,  article  Design.) 

Nevertheless,  it  must  be  conceded  that  this  knowledge  does  not  indi- 
cate the  functions  of  organs,  or  their  modus  operandi,  or  the  physiologi- 
cal laws  which  they  obey,  nor  ever  will.  It  simply  enables  us  to  trace 
out  the  channels  through  which  the  properties  of  life  carry  on  their  stu- 
pendous work  (§  130,  131  ;  Bichat,  Liebig,  Milton).  As  it  affects,  there- 
fore, in  no  other  respect  the  facts  and  the  doctrines  set  forth  in  this  work 
than  to  give  them  confirmation,  I  shall  not  advert  specifically  to  the  dis- 

E  1.:  ic 


802  INSTITUTES    OF    MEDICINE. 

coveries  in  this  branch  of  Physiology  (§  2  c,  83,  131,  133  a,  136,  699- 
708). 

THE   NERVOUS    SYSTEM.       SYMPATHY. 

1037,  a.  There  is,  however,  one  discovery  relative  to  the  nervous  sys- 
tem, which,  although  it  do  not  disturb  in  the  least  any  law  or  proposi- 
tion laid  down  in  these  Institutes,  but  goes  to  confirm  the  whole,  and, 
withal,  corrects  a  partial  error  in  the  supposed  functions  of  a  portion  of 
the  spinal  cord,  I  shall  now  state  in  a  summary  manner.  I  need  not 
say  that  this  interesting  disclosure  comes  to  us  from  Dr.  Brown-Sequard, 
whose  genius  and  industry  have  also  enlightened  the  physiological  world 
upon  special  influences  of  the  nervous  system,  which,  if  not  as  important 
in  their  relations  to  the  laws  of  that  system,  are  more  attractive.  Among 
these  may  be  mentioned  his  remarkable  experiment  of  producing  epilep- 
tiform convulsions,  through  a  special  association  of  the  nervous  influence 
with  a  particular  point  in  the  skin  by  sections  of  the  spinal  cord,  and  an 
extension  of  the  researches  begun  by  Petit,  Magendie,  and  Flourens,  upon 
turning  and  rolling,  developing,  apparently,  as  in  the  auditory  nerve, 
centres  of  nervous  influence  in  the  nerves  themselves ;  which  appeared  in 
a  collation  of  his  writings,  entitled  "  Experimental  Researches  applied  to 
Physiology  and  Pathology,  p.  18,  36,  80,  84,  99 ;  1853. 

These  experiments,  therefore,  like  Bernard's,  of  pricking  the  medulla 
oblongata  (§  1032,  d).  not  only  possess  a  refreshing  novelty,  but  consti- 
tute now  and  forcible  methods  of  demonstrating  the  influence  of  the 
nervous  power  upon  organic  actions  and  muscular  motion,  and  of  illus- 
trating the  laws  of  sympathy ;  while,  also,  they  contribute  a  welcome 
part  in  rescuing  Physiology  from  Organic  Chemistry  (222-235,  452- 
530,  635,  893  a,  c,  902,  905  a,  924). 

§  1037,  b.  Brown-Sequard' s  discovery  relative  to  the  spinal  cord  modi- 
fies the  statement  made  in  the  brief  sections  405,  468,  at  pages  290,  291, 
so  far  as  the  experiments  show  that  a  division  of  the  posterior  roots  of 
the  spinal  nerves  does  not  destroy  sensation,  and  which  are  conductors 
only  to  the  central  gray  matter.  It  would  have  been  sufficient,  there- 
fore, to  have  stated  this  fact  (in  itself  unimportant  to  these  Institutes), 
did  not  the  experiments  reflect,  in  other  respects,  a  great  amount  of  light 
upon  our  doctrines  of  remote  sympathy,  and  place  them  upon  a  clear 
and  intelligible  ground.  They  present,  also,  an  admirable  analysis,  as  I 
apprehend,  of  the  anatomical  media  of  common  and  specific  sensibility 
(§  188  h,  197-199,  450),  and  that  element  of  remote  sympathy  which  I 
have  designated  as  sympathetic  sensibility,  and  which  belongs  especially  to 
the  organic  life  of  animals  (§  197,  201-204,  451  d,  903).  The  conclu- 
sions at  which  Dr.  Brown-Sequard  arrived  are  summarily  and  well  ex- 
pressed by  a  Reviewer  as  follows : 

"  1.  The  idea  that  the  sensitive  impressions  are  conducted  to  the  en- 
cephalon  along  the  posterior  columns  is  entirely  erroneous.  2.  The  gray 
matter  of  the  spinal  cord,  although  itself  deprived  of  sensibility,  is  an 
organ  of  transmission  of  the  sensitive  impressions.  3.  There  are  two 
kinds  of  sensitive  fibres  in  the  posterior  columns  of  the  spinal  cord,  some 
going  up  towards  the  encephalon  (centripetal  or  ascending  fibres),  some 
going  in  the  opposite  direction  (centrifugal  or  descending  fibres).  4.  There 
are  also  ascending  and  descending  fibres  in  the  posterior  gray  horns,  and 
very  likely  in  the  posterior  parts  of  the  lateral  columns.  5.  These  as- 
cending and  descending  fibres  in  the  posterior  columns  come  mostly,  if 


Befiex  Action. — appendix. —  Organic  Properties.  803 

not  entirely,  from  the  posterior  roots  of  the  spinal  nerves.  6.  The  pos- 
terior roots  send  also  fibres  to  the  posterior  gray  horns,  and  very  likely 
to  the  posterior  parts  of  the  lateral  columns.  7.  All  these  fibres  soon 
leave  the  posterior  columns,  the  posterior  gray  horns,  &c.,  in  order  to  go 
into  the  central  gray  matter.  8.  All  th^se  sensitive  fibres  decussate  veiy 
near  to  their  entrance  into  the  spinal  marrow  from  the  posterior  roots. 
9.  There  are  some  transverse  fibres  in  the  spinal  cord,  coming  from  the 
posterior  roots,  which  do  not  seem  to  transmit  sensitive  impressions. 
The  motor  nerves  remain,  after  their  entrance  into  the  spinal  marrow,  on 
the  same  side,  until  they  reach  the  lower  part  of  the  medulla  oblongata, 
where  they  decussate." — Medico-Chirurgical  Hevieiv,  p.  183,  July,  1856. 

In  his  work  on  "  Experimental  Researches  applied  to  Physiology  and 
Pathology"  (1853),  after  relating  his  experiments  on  the  crossed  trans- 
mission of  impressions  in  the  spinal  cord,  the  Author  remarks:  "  I  be- 
lieve I  am  entitled  to  conclude,  from  the  facts  above  stated — 1st,  that 
most  of  the  impressions  made  on  one  side  of  the  body  are  transmitted  to 
the  sensorium  by  the  opposite  side  of  the  spinal  cord,  so  that  the  impres- 
sions on  the  left  side  of  the  body  are  transmitted  by  the  right  side  of  the 
spinal  cord,  and  vice  versa ;  2d,  that  the  assumed  function  of  the  cross- 
ing of  fibres  in  the  pons  Varolii,  and  the  neighboring  parts,  does  not  be- 
long to  these  fibres,  but  to  the  fibres  of  the  spinal  cord,  all  along  which 
they  cross  each  other"  (p.  67,  68). 

The  foregoing,  and  other  experiments,  were  repeated  by  Dr.  Brown- 
Se'quard  in  some  of  the  Medical  Colleges  of  this  country  during  the  win- 
ter of  1856-7,  at  many  of  which  the  present  writer  was  so  fortunate  as 
to  be  a  spectator. — Note  A  a  p.  1131. 

§  1038.  The  experiments  upon  the  auditory  and  other  nerves  (§  1037, 
a),  which  (as  well  as  the  organization  of  the  nerves,  particularly  the 
auditory)  denote  special  centres  of  nervous  influence  in  the  nerves  them- 
selves, concur  with  other  facts  in  supplying  indications  through  which 
we  may  quite  readily  comprehend  the  philosophy  of  contiguous  sympa- 
thy. The  plexuses,  also,  and  the  ganglia,  are  thus  rendered  more  palp- 
able media  through  which,  in  part,  the  phenomena  are  brought  about 
(§487^,497,499a,516cZ,No.9,520-523,524c^,  No.4,  893  a,  c). 

THE   NERVOUS    POWER.       ORGANIC    PROPERTIES. 

§  1039.  Moreover,  we  are  indebted  to  Brown-Se'quard  for  a  multitude 
of  experiments  illustrative  of  the  laws  of  reflex  action,  as  applied  by 
myself  to  pathology  and  therapeutics  (see  references  p.  912),  and 
variously  establishing  the  laws  of  the  vital  functions  as  set  forth  in  these 
Institutes  (§  462-494,  &c.).  The  experiments  enforce  the  distinction 
between  the  nervous  power  and  the  properties  of  oi'ganic  life  (§  167, 168, 
170  a,  172,  175  a,  b,  176-178),  assure  us  that  the  former  acts  only  as  a 
stimulus,  or  other  modifying  cause,  to  the  organic  properties,  variously 
modifying  organic  actions,  and  developing  muscular  motion,  voluntary 
or  involuntary,  through  its  operation  upon  the  essential  properties  of 
life  that  are  inherent  in  all  parts,  profoundly  concerned,  as  a  modifying 
agent,  in  the  processes  of  disease  (§  222-240),  and  fulfilling  the  great 
laws  of  sympathy  (§  452-534).  Some  of  these  results  are  remarkably 
open  to  observation;  such  as  the  influence  of  the  nervous  power  upon 
the  small  bloodvessels,  and  vessels  of  secretion,  whether  by  irritating  or 
dividing  a  nerve.  That  by  our  Author,  of  paralyzing  arteries  by  the 
division   of  nerves,  confirms  the  similar   ones  by  Buniva  and  others 


804  INSTITUTES    OF    MEDICINE. 

(§  399,  485),  and,  with  analogous  observations,  establishes  the  doc- 
trine inculcated  in  these  Institutes  upon  the  main  ground  of  the  phe- 
nomena of  life,  that  the  whole  Capillary  System  possesses  the  power  of 
an  active  dilatation  and  contraction  (§  384-387,  392  a,  d,  393-399,  410, 
411, 746, 747, 914-920,  929-934,  940, 947,  950,  951,  961, 974,  975,  &c.). 
"My  experiments  prove,"  says  "Brown-Se'quard,  "that  the  bloodvessel* 
are  contractile,  and  that  the  nerves  are  able  to  put  them  in  action."— >- 
(ExPER.  Res.,  &c.,  p.  10,  note.)  As  an  example,  Claude  Bernard  pro- 
duced dilatation  of  the  bloodvessels  of  the  face  by  dividing  the  cervical 
sympathetic  nerve ;  Brown-Sequard  occasioned  a  contraction  of  the 
same  vessels  by  applying  galvanism  to  that  nerve,  and  hence  regards  the 
sympathetic  as  the  motor  nerve  of  the  bloodvessels  of  the  face. — Ibid. 
This  doctrine  was  advanced  by  me  in  1 834,  in  Med.  Chir.  Rev. — See  p  .827 . 
Experiments  of  the  foi'egoing  nature  have,  indeed,  been  multiplied  by 
Physiologists  to  an  incalculable  extent ;  but  perhaps  no  one  of  them  has 
revealed  the  prodigious  influence  of  the  nervous  power  upon  the  capil- 
lary bloodvessels  and  the  secreting  apparatus  so  impressively,  or  made 
such  havoc  with  Chemical  Physiology,  as  Bernard's  simple  operation  of 
pricking  the  medulla  oblongata  (§  1032,  d).  As  the  whole  of  this  ground, 
however,  has  been  gone  over  extensively  in  the  earlier  part  of  this  work, 
the  present  reference  to  the  subject  is  to  simply  show  that  the  laws  and 
principles  herein  inculcated  have  been  abundantly  confirmed  by  subse- 
quent researches.  Indeed,  all  these  experiments  are  only  equivalent,  as 
it  respects  the  functions  of  life,  to  those  which  Avere  performed  by  Wil- 
son Philip,  and  far  less  with  the  universal  reference  that  distinguished 
the  corresponding  labors  of  this  Philosopher,  and  without  his  great  phys- 
iological objects.  But  these  experiments  appear  to  have  been  forgot- 
ten (p.  290-321,  §  462-494,  and  p.  107,  §  224,  &c.).  Indeed,  we  see  it 
just  now  announced  that  "  all  these  facts  [late  observations,  but  analo- 
gous to  such  as  abound  in  these  Institutes]  establish  beyond  doubt  that 
the  bloodvessels,  as  well  as  muscles  of  animal  life,  may  contract  by  a  re- 
flex action." — (Brown-Sequard,  in  Boston  lied,  and  Surg.  Journ..,  July? 
1857,  p.  477.)  This  fact  alone  is  evidently  fatal  to  the  catalytic  and  every 
other  chemical  doctrine  of  secretion  (§  409  hh,  k,  493  cc,  893  a).* 

where  the  nervous  power  exerts  its  effects. 

§  1040.  Let  us  now  observe  where  the  Nervous  Power  exerts  its  effects. 
Authors  are  in  the  habit  of  speaking  of  the  Nervous  Influence  as  acting 
upon  organs  as  a  whole,  and  not  upon  their  minute  structure.  This  is 
doubtless  for  the  purpose  of  brevity ;  and,  although  in  these  Institutes 
the  Nervous  Power  is  generally  correctly  represented  as  exerting  its  ef- 
fects upon  the  minute  organization,  as  in  §  231,  233f,  245,  395,  410, 
447,  450,  483,  487,  516  a,  896,  902,  917-924,  940,  946  b,  949,  950, 
951  c,  953,  961,  971-980,  986  b,  990^,  999  c,  &c.,  I  have  also  frequent- 
ly employed  the  collective  method.  This  is  calculated  to  defeat  a  right 
apprehension  of  the  action  and  compass  of  that  power  as  a  vital  agent. 
I  am  therefore  prompted,  in  this  reference  to  the  subject,  by  the  desire 
of  turning  the  attention  of  the  student  to  the  specific  fact,  that  he  may 
the  more  readily  appreciate  the  offices  of  the  Nervous  Power  in  its  rela- 
tion to  the  properties  of  life  in  their  fulfilment  of  organic  functions,  or  as 
they  are  essentially  engaged  in  the  voluntary  and  involuntary  movements 
of  the  muscles  of  animal  life. 

Whenever,  therefore,  the  Nervous  Power  is  concerned  in  modifying  or 

*  Kkikmeu  had  long  before  shown,  ■what  Bernard  has  lately  done,  tho  iiifiiience  of 
the  nerves  upon  the  blood,  and  applied  \>y  me  to  important  principles  (§  485,  1)52,  &c.). 


Reflex  Action. — ^APPENDIX. —  Organic  Properties.  805 

otherwise  aiFecting  the  actions  of  organs,  its  influence  is  exerted  either 
upon  the  individual  bloodvessels,  or  upon  the  minute  vessels  by  which 
the  secreted  or  excreted  products  are  generated,  or  upon  such  other  mi- 
nute parts  as  may  enter  into  the  structure  of  organs — reaching,  therefore, 
to  the  vasa  vasorura,  and  as  well,  in  all  these  respects,  to  the  nervous 
system  itself  when  the  Nervous  Power  is  determined  upon  it  (§  230,  509, 
950) ;  or,  when  it  excites  motion  in  muscles  it  is  by  acting  upon  the  in- 
dividual fibres  through  their  inherent  properties. 

DISTINCTION  BETWEEN  THE   NERVOUS    POWER  AND  THE   ESSENTIAL  PROP- 
ERTIES   OF    LIFE. 

§  1041.  Many  of  Brown-Sequard's  experiments,  as  well  as  Bernard's 
and  other  late  observers,  confirm,  also,  the  distinction  which  I  have  en- 
deavoured to  show,  extensively,  between  the  Nervous  Power  and  the  es- 
sential Properties  of  Life,  and  that  the  functions,  whether  organic  or  vol- 
imtary  motion,  are  carried  on  by  the  latter,  to  Avhich  the  Nervous  Pow- 
er sustains  the  relation  of  a  vital  stimulus.  (See  Index,  Articles  Nerv- 
ous Power,  Organic  Life,  Vital  Properties,  and  Organic  Functions.)  Some 
of  these  experiments  are  curious  as  well  as  ingenious.     As  examples  : 

"I  have  succeeded,"  says  Brown-Sequard,  "in  keeping  alive,  from 
the  8th  of  April  until  the  4th  of  July,  a  young  cat,  about  which  I  have 
already  published  a  note  in  Med.  Exam.,  1852.  The  palsied  parts  in 
this  animal  had  grown  in  length  as  much  as  the  sound  parts.  The 
growth  was  such  in  the  palsied  limbs  that  they  had  acquired  more  than 
double  the  length  they  had  at  the  time  of  the  operation.  The  functions 
of  organic  life  appeared  to  exist  without  any  disturbance."* 

Again,  says  our  Author  : 

"  I  lately  made  an  experiment  with  a  view  of  ascertaining  how  long  a 
limb,  separated  from  the  body  of  an  animal,  may  be  kept  alive  by  means 
of  injected  blood.  I  succeeded  in  retaining  local  life  in  one  of  the  limbs 
of  a  rabbit  more  than  41  hours.  The  animal  was  a  very  vigorous,  full- 
grown  one.  I  killed  it  by  hemorrhage,  and,  two  hours  afterward,  rigid- 
ity had  begun  in  most  of  the  muscles  of  the  two  posterior  limbs,  and 
only  a  few  bundles  of  muscular  fibres  had  still  a  slight  irritability.  A 
fine  injection  of  defibrinated  blood  was  then  pushed  in  the  femoral  artery 
of  the  I'ight  posterior  limb.  Fifteen  minutes  after  the  beginning  of  the 
injection,  local  life,  i.  e.,  irritability,  was  restored  in  the  limb  receiving 
blood,  and  cadaveric  rigidity  had  disappeared." — Experimental  Research- 
es, ^c,  ut  cit.,  p.  15,  92.     Also,  §  109  b,  171,  193,  261,  264,  493  cc. 

Corresponding  with  these  observations  are  many  others  in  a  chapter 
"  On  apparently  spontaneous  actions  of  the  contractile  tissues  of  the  animal 
hodif  {ibid.,  p.  101-124).  In  speaking  of  Spontaneous  Movements  in 
limbs  of  persons  who  have  died  of  Cholera,  our  Author  remarks,  that 
"  Physicians  who  know  how  quickly  after  death  the  nervous  system 
loses  its  vital  powers  will  admit  easily  that  these  movements  cannot  be 
the  result  of  the  action  of  that  si/stem.^'  Certainly  not,  any  farther  than  as 
the  Nervous  Power  operates  as  a  stimulus  to  the  organic  properties,  the 
probability  of  which,  in  the  cases  before  us,  I  have  endeavoured  to  show 
in  §  637.  In  these  cases  the  Nervous  Power  is  maintained  in  operation 
after  apparent  death  by  the  special  influences  of  the  disease.  Something 
like  this  is  seen  in  the  rise  of  temperature  in  subjects  dead  of  apoplexy 
(§  447,  d).  And  this  leads  me  to  refer  to  the  common  phraseology,  "  ex- 
haustion of  the  nervous  power,"  to  express  conditions  of  the  system  which 

*  In  such  cases  the  palsied  parts  continue  to  be  supplied  with  the  modifying  stimu- 
lus of  the  nervous  power  through  the  sympathetic  nerve  (§  461  Jr,  487  b,  483  c,  490). 


806  INSTITUTES    OF  MEDICINE. 

are  especially  due  to  its  powerful  operation  (§  940-952).     The  express 
sion  is  evidently  without  any  meaning. 

§  1042.  But,  as  I  apprehend,  the  foregoing  phenomenon,  in  being  anal- 
oo-ous  to  the  movements  of  the  limbs  which  take  place  in  decapitated  an- 
imals, is  very  different  from  the  contraction  of  the  intestines,  the  heart, 
&c,,  which  take  place  even  after  the  extirpation  of  the  organs  (§  259- 
265) ;  and  I  am  happy  to  quote  Brown-Se'quard  as  sustaining  an  im- 
portant doctrine  in  these  Institutes,  that,  "  contrary  to  the  general  opin- 
ion, a  nervous  action  is  not  necessary  for  these  contractions,"  but  that 
they  may  be  excited  by  other  stimuli  (§  264,  475^,  476^  c,  498  e). 

But  the  special  object  of  this  section  is  to  refer  to  our  Author's  exper- 
iments upon  the  iris.  In  1847  he  disclosed  the  curious  fact  that  light 
may  act  as  a  direct  stimulus  upon  this  organ,  "so  as  to  produce  a  con- 
traction of  its  muscular  fibres,  manifested  by  a  constriction  of  the  pupil." 
Very  recently,  in  the  London  Philosophical  Transactions  (as  quoted  in 
the  London  Philosophical  Magazine),  he  announces  the  results  of  farther 
experiments,  which  show  that  the  pupil  of  an  exsected  eye  contracts  and 
dilates,  alternately,  according  to  the  degree  of  light.  "I  uniformly 
found,"  he  says,  "  that  the  yellow  part  of  the  spectrum  acted  as  well  as 
undecomposed  light,  and  that  the  other  parts  had  either  no  action  at  all, 
or  only  a  veiy  slight  one"  (§  188-|,  d)-  "From  these  experiments  it 
follows  thijt  it  is  not  the  chemical  or  calorific  rays,  but  the  illuminating," 
which  produces  the  phenomenon  ;  that  "  it  is  not  a  chemical  action,  but 
that  it  is  by  a  peculiar  dynamical  influence  that  light  produces  con- 
traction of  the  iris."  "The  power  of  the  iris  to  contract  when  stimu- 
lated by  light  lasts  extremely  long,  particularly  in  certain  animals.  In 
eels  it  lasts  sixteen  days  in  eyes  taken  out  of  the  orbit."  Muscular 
fibre-5,  therefore,  "may  be  stimulated  without  the  intervention  of  nerves. 
In  tlie  iris  of  the  eel  the  nerve-fibres  are  found  very  much  altered  a  few 
days  after  the  extirpation  of  the  eye,  and  they  are  almost  destroyed  iu 
twelve  or  fifteen  days  after  extirpation,  i.  e.,  at  a  time  when  muscular 
irritability  is  sometimes  still  existing." — London  Philosojyhical  Magazine, 
Supplement,  p.  520;  July,  1857. 

The  foregoing  experiments  go  with  a  multitude  of  others  in  showing 
that  the  power  by  which  motion  is  carried  on  is  implanted  in  all  parts, 
and  that  the  nervous  power  is  simply  a  stimulus  in  developing  motion, 
and,  therefore,  to  a  certain  extent,  on  common  ground  with  other  stimuli 
(§  205-215,  233,  259-265).  But  they  are  less  remarkable  in  this  re- 
spect than  some  other  examples  which  I  have  quoted  in  the  Iledical  and 
Physiological  Commentaries,  particularly  the  pulsation  of  an  extirpated 
heart  of  a  sturgeon  after  "  the  auricles  had  become  so  dry  as  to  imsile 
when  they  contracted  and  dilated"  (vol.  i.,  p.  17).* 

The  interesting  fact  relative  to  the  iris  of  an  extirpated  eye  is  its  obe- 
dience to  light,  while  it  is  not  aifected  by  mechanical  irritants.  We  may 
not  conclude,  however,  from  the  experiments,  that  light  has  any  direct 
action  upon  the  iris  in  the  natural  state  of  the  organ.  On  the  contrary, 
I  apprehend  that  Nature  has  not  adopted  any  such  multiplication  of 
causes,  but  that  she  has  placed  that  muscle  entirely  at  the  disposal  of 
the  nervous  influence,  and  by  which  the  direct  action  of  light  upon  it  is 
counteracted ;  nor  will  it  be  an  easy  matter  to  disprove  a  conclusion  so 
well  sustained  by  all  analogy  (§  500  /,  514  k,  1072  a).  Could  we,  how- 
ever, reason  in  this  case  from  analogies  supplied  by  plants,  the  phenom- 
enon would  be  readily  intelligible.     But  I  apprehend  that  it  is  merely  an 

*  This  extreme  case  is  related  circumstantiallj-  in  Dunglison's  Human  Plij-siology, 
vol.  ii.,  p.  148,  1836. 


Beflex  Action. — appendix. — Animal  Heat.  807 

incidental  result  of  the  organic  constitution  of  the  iris  in  its  relation  to 
light  as  a  remote  exciting  cause.* 

ANIMAL    HEAT   IN    CONNECTION   WITH   THE   NERVOUS    SYSTEM. 

§  1043.  Among  the  contributions  to  Physiology  made  by  Brown- 
Se'quard  few  are  more  interesting  than  those  relative  to  the  production 
of  Animal  Heat,  and  which  concur  in  demonstrating  (what  is  so  ex- 
tensively presented  in  these  Institutes)  its  dependence  upon  a  purely  vital 
process,  and,  therefore,  independence  of  any  chemical  agencies  (§  433- 
448).  Some  of  these  experiments  I  shall  state  briefly,  and  would  invite 
the  advocates  of  the  chemical  rationale  to  interpret  the  phenomena 
through  any  known  analogies  in  the  world  of  mere  matter,  if  they  can ; 
or  render  the  supposed  connection  between  the  Nervous  Influence  and 
the  forces  of  inorganic  bodies  in  the  production  of  animal  heat,  or  any 
other  result  of  life,  in  the  slightest  respect  intelligible.  But  let  us  hear 
our  Author. 

§  1044,  a.  In  his  experiment  of  dipping  a  hand  in  cold  water  two 
facts  are  farther  confirmed  through  which,  in  part,  I  had  endeavoured  to 
show  that  animal  heat  does  not  obey  the  laws  of  dead  matter,  and  that 
its  production  is  a  vital,  not  a  chemical  phenomenon.     Thus : 

"  I  have  found,"  says  Brown-Sequard,  "  that  the  chilling  of  one  hand 
plunged  in  water,  at  the  temperature  of  freezing-point,  acted  very  strong- 
ly on  the  temperature  of  the  other  hand.  But,  at  first,  there  is  no  regu- 
larity at  all  in  the  quantity  of  degrees  of  temperature  lost  by  the  hand 
which  remains  out  of  the  water ;  and,  secondly,  we  have  found  once 
that  this  hand  did  not  lose  any  fraction  of  its  temperature.  In  one  case 
we  have  observed  that  the  hand  kept  in  the  atmosphei'e  did  lose  22°  F. 
in  seven  minutes.  The  ordinary  loss  of  temperature  has  been  of  between 
6°  to  8°  F."  But  observe  that  "  the  greatest  diminution  of  the  temper- 
ature of  the  mouth  has  been  nearly  1°  F.,  and  this  only  in  one  case." — 
{Exp.  Researches,  &c.,  p.  33.) — Note  T  p.  1125. 

Now,  in  the  first  place,  is  seen  in  the  foregoing  paragraph  a  strong  ex- 
emplification of  reflex  nervous  action  in  its  relation  to  animal  heat,  and 
it  is  peculiarly  valuable  to  the  Vital  Physiologist,  since  it  is  the  same 
as  concerns  any  other  organic  product  (§  446,  a),  places  the  whole  on 
common  ground,  and  as  fully  pronounced  by  Bichat,  Hunter,  and  Phil- 
ip, and  as  set  forth  at  page  270,  §  447,  d,  &,c.  Secondly,  the  experiment 
is  not  less  important  in  showing  that  the  cooling  of  the  hand  in  the  at- 
mosphere was  not  at  all  owing  to  the  general  reduction  of  the  heat  of 
the  body,  and  therefore  effectually  contradicts  the  law  of  slow  commu- 
nication of  caloric  which  obtains  with  dead  matter,  as  applied  to  animal 
heat  by  Edwards,  Liebig,  Roget,  Billing,  and  others,  who  cultivate  the 
chemical  hypothesis  (§  438  a-c,  440  e).  It  is  also  an  exception  to  our 
Author's  doctrine  that  "  a  great  many  facts  prove  that  the  degree  of 
temperature  and  of  the  sensibility  of  a  part  is  in  close  relation  with  the 
quantity  of  blood  circulating  in  that  part."  {Eap.,  &c.,  p.  9.)  Indeed, 
our  Author  remarks,  that  "  Dr.  Tholozan  and  myself  have  observed  that 
the  greater  the  pain  felt,  the  more  the  tempei'ature  was  diminished  in 
the  hand  left  in  the  air''  (p.  34). 

§  1044,  b.  The  foregoing  experiment  Avas  reversed  by  immersing  the 

hand  in  water  at  a  temperature  of  108°  F.     But  our  Author  "  found  no 

evident  deviation  of  the  temperature  of  remote  parts,  as  the  mouth  and 

hand,  not  immersed  in  the  water." — {Ibid.,  p.  35.)     This  experiment 

*  When  PhysQstigma,  applied  on  the  ej-e  after  death,  produces  contraction  of  the 
iris,  it  must  be  through  the  motor  ciliarj-  nerve. — 1864. 


808  INSTITUTES    OP    MEDICINE, 

contributes  with  the  other,  by  its  failure  of  a  sympathetic  effect  upon  the 
opposite  hand,  in  illustrating  the  effect  of  the  nervous  influence  in  mod- 
ifying the  calorific  function,  through  the  well-known  fact  that  cold  is  of 
incomparably  greater  power,  in  this  respect,  than  heat ;  while  the  anal- 
ogy supplied  by  the  increase  of  urine  on  the  contact  of  cold  air  with  the 
surface  of  the  body  (as  related  to  the  sympathetic  reduction  of  tempera- 
ture in  the  hand  that  was  not  immersed  in  water,  §  1044,  ct),  goes  to  the 
proof  that  animal  heat  is  as  much  a  product  of  vital  action  as  any  of  the 
more  sensible  secretions.  But  all  this  is  entirely  allied  to  the  production 
of  pneumonia,  and  other  inflammations,  by  a  very  temporary  chilling  of 
the  surface  of  the  body,  and  is  mostly  interesting  to  the  Physician  by  its 
association  with  these  greater  phenomena,  since  it  is  of  no  little  import- 
ance in  practical  Medicine  whether  a  diminution  of  animal  heat  depend 
upon  a  mere  chemical  contingency,  or  some  profound  lesion  of  the  or- 
ganic functions  (^  1057  g). — ^Note  Aa  p.  1131. 

From  these  premises,  it  appears  that  when  the  temperature  of  the  body 
falls  from  the  application  of  cold  to  the  surface,  or  rises  from  that  of 
heat,  the  local  action  induced  on  the  sui'face,  and  mostly  so  the  reduc- 
tion or  elevation  of  its  temperature,  are  of  a  vital  nature,  and  that  the 
general  or  constitutional  effects  are  sympathetic,  as  set  forth  at  p.  246, 
§  440,  e,  and  shown  by  many  direct  facts,  some  of  Avliich  may  be  seen 
at  p.  253,  §  441,  d. 

§  1044,  c.  Farther  on  (ibid-,  p.  73-77),  our  Author  has  a  Chapter  on 
Experiments  showing  the  effect  of  injuries  of  the  nervous  system  upon 
animal  heat,  which  concur  with  the  foregoing  (§  1044,  a,  h)  in  their  only 
intelligible  import,  and  bear  a  general  correspondence  with  those  to 
Avhich  reference  is  made  in  these  Institutes,  but  which  are  examined 
more  particularly  in  the  Medical  and  Physiological  Commentaries,  in 
the  Essay  on  Animal  Heat.  But  the  modifications  of  animal  heat  by 
morbid  influences  upon  the  nervous  system,  of  which  our  Author  has 
but  little  to  say,  are  far  more  important  in  a  physiological,  as  well  as 
practical,  sense,  than  the  experiments  (§  446-447,  d). 

But  our  Author  is  far  from  being  alone  in  the  more  recent  experi- 
ments which  contribute  with  the  older  ones  in  illustrating  the  effects  of 
the  nervous  influence  upon  the  generation  of  animal  heat.  Bernard  has 
been  largely  in  this  field ;  and  Budge  and  others  have  followed  up  the 
inquiry.  As  all  these  observations,  however,  correspond  with  what  had 
been  before  ascertained,  and  only  go  with  the  earlier  to  confirm  the  doc- 
trine about  which  these  Institutes  have  been  interested,  their  statement 
would  be  superfluous. 

§  1045.  Sequard  has,  also,  many  observations  to  show  the  difference 
of  temperature  in  different  parts  of  the  body,  which  correspond  with 
those  of  Bichat,  Hunter,  Davy,  and  others  (p.  270,  §  447,  d,  &c.),  and 
which  I  have  employed  as  another  proof  that  there  is  no  analogy  between 
the  laws  which  regulate  the  temperature  of  warm-blooded  animals  and 
dead  matter ;  for  it  had  been  well  determined  that  every  part  has  not 
only  its  own  independent  heat,  but,  when  not  exposed  to  the  contact  of 
the  air,  the  temperature  is  without  change  in  the  several  parts  respect- 
ively, however  much  it  may  differ  in  any  two  contiguous  parts  (p.  270, 
§  447,  (/). 

This  very  palpable  proof  has  hithei'to  received  no  attention  at  the 
hands  of  the  Cliemist ;  but  its  accumulation  must  lead  to  a  recognition 
of  the  fact,  and  not  only  dispose  of  the  doctrine  of  free  interchange  of 


Reflex  Action. — APPENDIX. — Animal  Heat.  809 

heat  as  resulting  from  the  contiguity  of  parts,  but  present  an  equal  ob- 
stacle to  the  chemical  hypothesis  in  the  failure  of  the  blood  to  produce 
an  equilibrium  of  temperature,  as  would  of  necessity  be  the  case  were 
there  any  applicability  to  warm-blooded  animals  of  the  fundamental  laws 
of  an  interchange  of  caloric  which  obtains  in  dead  matter  (§  440  e,  No- 
14,  1034).     Nor  has  this  fact  ever  been  stated  as  an  objection. 

FARTHER   FACTS    RELATIVE  TO  ANIMAL  HEAT  FROM  THE  ARCTIC   ZONE. 

§  1046.  In  treating  of  the  function  of  Calorification  (p.  234-279)  I 
have  examined,  extensively,  Liebig's  philosophy  of  Animal  Heat,  and  I 
have  brought  up,  among  other  objections,  numerous  facts  which  contra- 
dict the  assumed  ratio  between  the  consumption  of  food  and  of  oxygen 
gas  as  the  main  element  of  a  uniform  temperature,  and  the  superadded 
contingency  of  clothing  as  one  of  the  subordinate  means  ;  and  have  fol- 
lowed him  into  the  Arctic  regions  to  inquire  into  the  accuracy  of  his 
facts.  It  is  now  my  purpose  to  extend  this  inquiry  by  consulting  the 
experience  of  a  late  Explorer  of  the  North,  from  which  it  will  be  seen 
that  food  and  clothing  are  even  less  important  to  animal  heat  than  to 
other  products  of  organic  life.  This  information  is  obtained  from  Dr. 
Kane's  late  Arctic  Explorations,  and  will  be  stated  in  a  rather  desultory 
manner.  I  might,  indeed,  appeal  for  similar  facts  to  other  explorers 
who  have  wintered  in  the  Arctic  Regions  since  this  work  was  published ; 
but  Di".  Kane  is  the  latest,  most  capable,  and  has  supplied  ample  mate- 
rials. I  shall  also  dispense  with  farther  comment,  w^hich  has  been  fully 
provided  in  the  earlier  pages.  But  I  shall  do  the  w^ork  thoroughly  in 
other  respects,  that  this  subject  may  be  taken  completely  out  of  the 
hands  of  Chemistry. 

It  may  be  farther  premised  that  Dr.  Kane  became  ice-bound  at  Rens- 
selaer Bay,  in  latitude  78^  58^,  in  September,  1853,  where  he  remained 
till  the  spring  of  1855,  and  that  the  following  observations  refer  to  that 
latitude,  or  to  his  more  northern  lointer  expeditions. 

§  1047.  In  the  first  place.  Dr.  Kane  presents  a  general  fact  which 
corresponds  with  what  I  have  said  of  acclimation  and  constitution,  in  their 
relation  to  organic  heat  and  vital  habit  (§  441  J-442  c,  443  c,  d,  447  g,  h, 
535-540,  615-619,  626  b,  &c.).     Thus,  our  Author : 

"  The  mysterious  compensations  by  which  we  adapt  oui-selves  to  cli- 
mate are  more  striking  here  than  in  the  tropics.  In  the  Polar  Zone,  the 
assault  is  immediate  and  sudden,  and,  unlike  the  insidious  fatality  of  hot 
climates,  produces  its  results  rapidly.  It  requires  hai'dly  a  single  win- 
ter to  tell  who  may  be  the  heat-making  and  acclimated  man.  Peterson, 
for  instance,  who  had  resided  for  two  years  at  Upernavick  (lat.  72°  40^), 
seldom  enters  a  room  ivith  a  fire.  Another  of  our  party,  George  Riley, 
with  a  vigorous  constitution,  established  habits  o^  free  exposure,  and 
active  cheerful  temperament,  has  so  inured  himself  to  the  cold,  that  he 
sleeps  on  our  sledge-journeys  icithoid  a  blanket  or  any  other  covering  than 
his  walking-suit,  while  the  outside  temperature  is  30°  Fahrenheit  below 
zero  (§  440  c,  No.  11,  442  a,  b).  The  half-breeds  of  the  coast  rival  the 
Esquimaux  in  their  powers  of  endurance.  The  North  British  Sailors, 
of  the  Greenland  seal  and  whale  fisheries,  T  look  upon  as  inferior  to  none 
in  capacity  to  resist  the  Arctic  Climate"  (§  1048,  b). — Kane's  Arctic 
Explorations,  vol.  i.,  p.  245. 

§  1048,  a.  We  will  now  come  to  the  subject  of  Food,  which  plays  so 
conspicuous  a  part  in  the  chemical  philosophy  of  Animal  Heat  (§  440,  a, 


810  INSTITUTES    OF    MEDICINE. 

Nos.  1-8),  though  there  will  be  something  more  about  clothing  (§  440  c, 
1047).  I  may  say,  however,  at  once,  that  Dr.  Kane  and  his  party  were 
capable  of  maintaining  their  natural  temperature  with  constitutions  im- 
paired by  disease,  and  when  often  nearly  destitute  of  food,  fuel,  and 
proper  clothing,  and  with  the  thermometer  ranging  for  months  from  60° 
to  90°  Fahrenheit  below  the  freezing  point. 

Our  Author  intimates  that  he  had  little  faith  in  alcohol  "  as  a  fuel  for 
the  furnace"  (§  SSOf  /,  438  b,  c,  440  hb,  No.  9,  441  b,  c).  He  had  three 
laws,  only,  for  the  government  of  his  party,  the  second  of  which  was, 
^^  Abstinence  from  all  spirituous  liquo7-s"  This  law  was  uniformly  en- 
forced, and  alcohol  was  "  burned"  for  cooking  purposes  alone. 

During  his  long  detention  at  Rensselaer  Bay  the  daily  journal  is  most- 
ly made  up  of  a  recital  of  hardships,  of  which  the  privation  of  food, 
want  of  fuel,  and  destitution  of  clothing,  form  the  most  appalling.  It  is 
this  feature  of  the  Narrative,  this  incessant  struggle  for  the  maintenance 
of  life,  which  forms  its  main  interest ;  and  the  development  which  is 
thus  afforded  of  a  very  extraordinary  man  constitutes  the  great  merit  of 
the  work,  and  reconciles  us  to  an  otherwise  fruitless  undertaking.  The 
fiction  of  "Kobinson  Crusoe"  is  no  match  for  our  Author's  realities. 
He  found,  it  is  true,  some  benevolent  sympathy  among  the  Esquimaux, 
but  encountered  in  the  Bears  a  foe  that  was  equally  struggling  for  life. 
They  devoured  the  food  at  the  sevei'al  depots,  and  it  became  often  ex- 
hausted on  shipboard. 

Under  these  circumstances  winter  expeditions  were  undertaken  into 
still  more  Northern  regions,  with  the  thermometer  fluctuating  from  40° 
to  60°  Fahrenheit  below  zero — often  90°  below  the  freezing  point.  In 
the  first  of  these  enterprises  they  were  cheered  on  by  the  depots  before 
them,  but  soon  to  suffer  the  chill  of  disappointment,  and  an  unsatisfied 
hunger.  Nor  did  Summer  bring  them  relief;  for,  in  its  veiy  midst,  only 
the  most  scanty  supplies  of  food  could  be  obtained.  On  the  8th  of  July, 
1854,  our  Author  records  in  his  journal  that  "we  have  neither  health, 
fuel,  nor  provisions."  (Vol.  i.,  p.  312.)  July  17th,  1854,  he  writes, 
"  The  young  ice  bore  a  man  this  morning.  It  has  a  bad  look,  this  man 
suspecting  August  ice.  It  is  horrible — yes,  that  is  the  word — to  look 
forwai'd  to  another  year  of  disease,  and  darkness,  to  be  met  without  fresh 
food  and  tvithout  fueV  '^  3foss  was  gathered  for  eking  out  our  winter 
fuel ;  and  willow  stems  and  stone-crops,  and  sorrel,  as  antiscorbutics, 
collected  and  buried  in  the  snow."    (Vol.  i.,  p.  343,  348.) 

The  party  entered  upon  the  second  winter  "a  set  of  scurvy-riddled, 
broken-down  men  ;  our  provisions  sorely  reduced  in  quantity,  and  alto- 
gether unsuited  to  our  condition ;"  and  the  Engraver  has  added  a  por- 
trait of  the  spectacle.    (Vol.  i.,  p.  349.) 

October  2Gth,  1854,  thermometer  66°  Fahrenheit  below  freezing. 
January  7th,  1855,  thermometer  had  been  ranging  since  from  70°  to  92° 
Fahrenheit  below  the  freezing  point.  At  this  time  he  also  writes, 
"  We  require  7neat,  and  can  not  get  along  without  it.  Our  sick  have  fin- 
ished the  dear's  head,  and  are  now  eating  the  abscessed  liver  of  the  animal, 
including  some  intestiiies  that  were  not  given  to  the  dogs.  We  have  now 
about  three  days'  allowance ;  thin  chops  of  raw  frozen  meat,  not  exceed- 
ing four  ounces  in  weight  for  each  man  per  diem"  (§  440  bb,  No.  9). 
A  few  days  later,  January  30th,  he  says,  "  I  gave  Wilson  one  raw  meal 
from  the  niasseter  muscle  which  adhered  to  another  old  bear's  head  / 
was  keepini/  jar  a  specimen^    (Vol.  ii.,  p.  17,  34.) 


Eeflex  Action. — appendix. — Animal  Heat.  811 

January  22d;  Dr.  Kane  and  Hans  went  on  a  dog-journey  of  91  miles 
in  pursuit  of  meat,  but  unsuccessfully.  His  outfit,  in  food,  consisted  of 
"  a  roll  of  frozen  meat-biscuit,  some  frozen  lady-fingers  of  raw  hashed 
fox,  and  twenty-four  pieces  of  ship-bread."  February  4th,  '*  I  made,"  he 
says,  "  a  dish  of  freshened  codfish  skin  for  Brooks  and  Wilson.  They 
were  hungry  enough  to  relish  it."  February  9th.  "  Still  no  supplies. 
Three  of  us  have  been  out  all  day  {night)  without  getting  a  shot.  Hans 
thinks  he  saw  a  couple  of  reindeer  at  a  distance."  "  I  have  not  permit- 
ted myself  to  taste  more  than  occasionally  an  entrail  of  our  last  half- 
dozen  rabbits."  February  10th.  "Hans  comes  in  with  three  rabbits. 
Distribution :  the  blood  to  Oleshen  and  Thomas,  and  to  the  other  eight 
of  the  sick  more  full  rations,  consuming  a  rabbit  and  a  half"  (§  440,  bb. 
No.  9).  "My  journal  tells  of  nothing  but  sick  men,  profitless  hunts,  re- 
lieved now  and  then  by  the  signalized  incident  of  a  rabbit  killed  or  a 
deer  seen,  and  the  longed-for  advent  of  the  solar  light."  (Vol.  ii.,  p.  21, 
37,41,42,43.) 

The  party  lived  on  much  in  the  foregoing  manner  till  March  10th, 
1855,  when  one  of  them  returned  from  a  distant  Esquimaux  hut  with 
some  walrus  meat.  Thermometer  now  at  72°  Fahrenheit  below  freez- 
ing. This  meat  was  soon  exhausted.  But,  March  24th,  there  had  been 
another  windfall,  of  which  he  says,  "  Our  ptarmigan  gave  the  most  sick 
a  raw  ration,  and  to-day  we  killed  a  second  paii",  which  will  serve  them 
for  to-morrow.  I  am  the  only  man  now  who  scents  the  fresh  meat 
without  tasting  it.  I  actually  long  for  it,  but  am  obliged  to  give  way  to 
the  sick"  {§  440,  bb,  No.  9).    Vol.  ii.,  p.  83. 

§  1048,  b.  Again,  as  to  the  effect  of  cold  in  reducing  the  heat  of  man 
(§  1047).  During  the  last  foregoing  period — March  15,  "  Hans  and  My- 
ouk  returned  at  eight  o'clock  last  night  without  game.  Their  sleep  in 
a  snow-drift  about  twenty  miles  to  the  northward,  in  a  temperature  54° 
Fahrenheit  below  zero  (86°  below  freezing),  was  not  comfortable,  as 
might  be  expected.  The  marvel  is  how  life  sustains  itself  in  such  circu7n- 
stances  of  cold.  I  have  myself  slept  in  an  ordinary  overcoat  without  dis- 
comfort, yet  without  fire,  at  a  temperature  of  52°  Fahrenheit  below 
zero,"  or  84°  below  freezing  (§  440,  c,  No.' 11).    Vol.  ii,,  p.  69. 

Again :  "  I  firmly  believe,"  he  says,  "  that  no  natural  cold  as  yet 
known  can  arrest  travel.  The  ivhole  stouj  of  this  winter  illusti-ates  it.  I 
have  both  sledged  and  walked  60  and  70  miles  over  the  roughest  ice,  in 
repeated  journeys,  at  fifty  degrees  below  zero ;  and  the  two  parties  from 
the  south  reached  our  Brig  in  the  dead  of  winter,  after  being  exposed  to 
the  same  horrible  cold." — Vol.  ii.,  p.  78. — Also  p.  257,  §  442  b. 

Extracts  of  the  foregoing  import  may  be  readily  multiplied.  But  I 
shall  only  add  our  Author's  remark  that  "  it  is  a  little  curious  that  a 
short  allowance  of  food  does  not  show  itself  in  hunger.  The  first  symp- 
tom is  loss  of  power  [not  loss  of  temperature],  often  so  imperceptibly 
brought  on  that  it  becomes  evident  only  by  an  accident." — Vol.  ii.,  p. 
284. 

§  1049.  Let  us  now  contrast  our  Author's  unprejudiced  experience  in 
Tea  with  the  speculations  of  Chemistry  upon  ^^  alcohol,  blubber  oil,  and 
talloiv  candles,"  in  their  aspect  of  "  fuel,"  as  set  forth  in  former  sections 
(§  440,  a-bb,  Nos.  7,  9,  &c.). 

"  Under  circumstances  of  most  privation,"  says  Dr.  Kane,  "  I  found  no 
comforter  so  welcome  to  the  party  as  our  great  restorative,  Tea.  We 
drank  immoderately  of  it,  and  always  with  advantage."     On  his  remark- 


812  INSTITUTES    OF    MEDICINE. 

able  retreat  homewards,  tliey  "  had  been  limited  for  some  days  to  three 
raw  eggs  and  two  breasts  of  birds  a  day ;  but  we  had  a  small  ration  of 
bread-dust  besides ;  and  when  we  halted,  as  we  regularly  did  for  meals, 
our  fuel  allowed  us  to  indulge  lavishly  in  the  great  panacea  of  Arctic  trav- 
el—Tex:'— Vol.  ii.,  p.  261,  282. 

This  Tea  acted  simply  as  a  stimulus  to  the  nervous  system,  and  among 
its  results  was  an  elaboration  of  heat,  just  as  is  explained  of  alcohol  and 
animal  food  in  §  440  h,  441  c. 

§  1050.  Not  a  little  has  been  assumed  of  the  voraciousness  of  the  Es- 
quimaux and  Samoyedes  in  proof  of  the  chemical  doctrine  of  animal  heat, 
and  there  has  come  to  be  a  settled  belief  that  they  would  perish  with  cold 
unless  forever  addicted  to  a  gluttonous  repast  upon  walrus  and  blubber 
(§  440,  bb^i  No.  9,  &c.).  Nothing  but  a  visit  to  their  settlements  could 
have  deprived  Chemistry  of  this  plausible  fallacy.  This  has  been  effect- 
ed by  Dr.  Kane,  who  found  the  habits  of  the  Esquimaux  near  his  own 
winter  quarters,  in  regard  to  food,  precisely  the  same  as  those  of  other 
savages  inhabiting  tropical  climates.     He  says  of  them,  that 

"However  gluttonously  they  may  eat,  they  evidently  bear  hunger 
with  as  little  difficulty  as  excess,"  as  I  have  endeavoured  to  show 
(§  441,  c).  And  again:  "Among  the  Esquimaux  generally,  the  coldest 
months  of  the  year,  January  and  February,  are  often,  in  fact  nearly  al- 
ways, months  of  privation."  {Ibid.,  vol.  i.,  p.  418  ;  vol.  ii.,  p.  131.)  Near 
our  Author's  station  they  Avere  as  destitute  as  his  own  party. 

If  we  now  consult  the  records  which  have  been  carefully  made  by  res- 
idents in  tropical  regions,  it  will  be  found  that  where  food  is  abundant, 
the  savages  gorge  themselves  far  more  habitually  than  the  wanderers  of 
the  polar  zone.  The  following  example  will  dispose  of  the  question  be- 
fore us.  Thus,  in  the  "Asiatic  Researches"  there  is  a  description  of 
the  Island  of  Nicobaras,  in  the  Bay  of  Bengal  (mean  annual  temperature 
70°  F.),  by  G.  Hamilton,  in  which  he  says  of  its  inhabitants,  that 

"They  are  veiy  fond  of  sitting  at  table  with  Europeans,  where  they 
eat  every  thing  that  is  set  before  them,  and  they  eat  most  enormously. 
They  will  drink  bumpers  of  rack  as  long  as  they  can  see.  A  great  part 
of  their  time  is  spent  in  feasting  and  dancing.  At  their  feasts  they  eat 
great  quantities  of  2^ork,  which  is  their  favourite  food.  Their  hogs  are 
remarkably/  fat,  and  they  eat  their  pork  almost  raiv"  (§  440  bb,  441  c). — 
Asiatic  Researches,  vol.  ii.,  p.  382.     London,  1799. — Note  Oo. 

"the  primordial  cell." 

§  1051,  a.  The  present  inquiry  refers  specifically  to  what  is  said  at 
pages  36-49  (§  03-81)  on  the  development  of  the  germ,  and  to  a  uni- 
versal characteristic  distinction  between  plants  and  animals,  at  §  11. 
The  former  subject  possesses  an  importance  both  in  a  physiological  and 
religious  sense,  since  there  are  many  Philosophers  who  assume  that 
there  is  but  one  primordial  cell  which  serves  as  a  foundation  for  all  or- 
ganic beings,  and  that  the  development  of  this  cell  into  a  plant  or  an 
animal,  or  into  a  particular  plant  or  a  particular  animal,  is  due  entirely 
to  the  special  physical  influences  that  may  act  upon  it,  and  not  at  all  to 
any  original  difference  in  the  sti-ucture  of  the  cells  or  their  endowments 
of  life ;  and  this  assumption  professes  to  be  predicated  of  the  revelations 
of  the  microscope  ;  though  it  is  not  difficult  to  understand  that  the  chem- 
ical doctrines  of  life  and  Lamarck's  transmutation  of  species  have  had 
their  share  in  the  project  (§  350f-350).     Upon  this  hypothesis,  there- 


Structure. — APPENDIX. — Primordial  Cell.  818 

fore,  the  only  reason  why  men  are  not  mushrooms  is,  that  in  one  case  the 
nucleus-cell  of  a  human  ovum  is  subject  to  physical  agents,  during  its  de- 
velopment, different  from  those  which  develop  a  mushroom.  Hence  it  is 
assumed,  that  if  it  were  possible  to  subject  the  germ  of  a  plant  to  the 
agents  which  unfold  the  human  ovum,  it  would  necessarily  grow  into  an 
intelligent,  responsible  being.  This  purely  speculative  assumption,  which 
^strikes  at  the  whole  foundation  of  organic  nature,  might  be  variously  ar- 
gued upon  physiological  grounds  (§  72-70,  121-123,  &c.)  ;  but  the  neces- 
sity of  this  is  superseded  by  continued  observations  with  the  microscope, 
which  has  been  lately  correcting  its  own  errors  (§  83,  131),  and  granting 
us  an  opportunity  to  again  believe  that  the  Almighty  created  the  germs 
of  every  species  of  animals  and  plants  with  a  rudimentary  structure  and 
organic  endowments  as  various  as  the  species,  so  that  each  one  should  be 
developed  by  special  physical  agents  alone,  and  the  progress  of  develop- 
ment result  in  the  particular  species,  and  in  nothing  else,  or,  at  least,  in 
a  near  approximation,  as  in  the  very  limited  hybrid  (§  190,  1052  h).*  The 
microscope,  indeed,  has  ascertained  that  even  a  cell  is  not  an  indispensa- 
ble requisite  in  the  germ  either  of  plants  or  of  animals.  To  this  effect 
I  shall  now  quote  a  late  able  writer,  who  is  thoroughly  conversant  with 
his  subject,  and  without  any  hypothesis  in  view: 

§  1051,  b.  "The  general  result,"  he  says,  "of  recent  microscopical 
investigation  in  regard  to  the  lowest  forms  of  vegetable  and  animal  life, 
seems  to  us  to  lead  to  this  conclusion — that  organisms  may  possess  an 
independent  existence,  may  go  through  all  the  phenomena  of  growth, 
multiplication,  and  reproduction,  and  may  even  possess  considerable 
power  of  spontaneous  motion  [involuntary],  without  having  advanced 
even  so  far  in  the  differentiation  of  their  powers  as  to  possess  those  at- 
tributes which  are  involved  in  the  ordinary  idea  of  a  '  cell'  (§  2G0-265). 
By  way  of  explaining  our  meaning,  we  shall  select  an  illustration  from 
each  kingdom  ;  and  the  comparison  of  the  two  will  enable  us  to  inquire 
in  wliat  lies  the  essential  difference  between  them. 

"  One  of  the  humblest  known  Protophytes,  the  PahnogloEa  macrococca, 
whose  multiplication  gives  origin  to  the  green  slime  tliat  is  found  on 
damp  stones  and  walls,  consists  of  isolated  particles  of  a  spheroidal  shape 
and  greenish  color,  commonly  imbedded  in  a  stratum  of  gelatinous  mat- 
ter, which  an  ordinary  observer  would  at  once  pronounce  to  be  vegetable 
cells.  But  a  careful  examination  shows  that  there  is  here  no  definite 
distinction  between  '  cell-wall'  and  '  cell-contents ;'  the  whole  particle 
being  composed  of  a  nearly  homogeneous  mass  of  '  protoplasm,'  through 
which  chlorophyll-granules  are  dispersed."  "  These  particles,  increasing 
in  size,  undergo  duplicative  subdivision  by  the  usual  process  of  elonga- 
tion and  constriction ;  and  it  is  observable  that  the  nucleus  gives  indi- 
cations of  the  commencement  of  this  subdivision  earlier  than  the  particle 
which  incloses  it.  Each  new  cell,  if  such  it  may  be  called,  then  begins 
to  secrete  from  its  surface  a  gelatinous  envelope  of  its  own  ;  so  that,  by 
its  intervention,  the  two  are  usually  soon  separated  from  one  another." 
"There  appears  to  be  no  definite  limit  to  this  kind  of  multiplication, 
and  extensive  areas  may  be  quickly  covered,  in  circumstances  favourable 
to  the  nutrition  of  the  plant,  by  the  products  of  the  duplicative  subdivi- 
sion of  one  primordial  cell.  This,  however,  is  simply  an  act  of  growth 
precisely  analogous  to  the  multiplication  of  cells  in  the  earliest  embryonic 
condition  of  the  higher  Plants  and  Animals,  before  any  differentiation 
of  organs  begins  to  show  itself"  "  Now,  for  such  a  mass  of  protoplasm 
*  See  Notes  Pp  p.  1142,  Q<j  p.  1345. 


814  INSTITUTES    OF    MEDICINE. 

to  become  converted  into  what  is  generally  regarded  as  the  type  of  the 
Vegetable  cell,  a  series  of  changes  must  take  place  in  it,  involving  a  dif- 
ferentiation between  the  cell -wall  and  the  cell-contents ;  and  this  involves 
a  greater  consolidation  of  the  external  layer  of  the  protoplasm,  in  a 
more  complete  liquefaction  of  its  internal  portion"  (§  64-65). 

*'  The  successive  stages  of  this  formation  may  be  best  traced  out  by 
careful  observation  of  the  process  of  cell-growth  in  the  higher  Algge  ;  but 
the  study  of  the  development  of  new  organs  in  Phanerogamic  plants  leads 
to  the  same  conclusions,  and  the  results  at  which  Mr.  Wenham  has 
lately  arrived,  from  observations  chiefly  made  on  the  newly-imported 
aquatic  weed,  Anacharis  akinastrum,  are  so  instructive  that  we  shall  sub- 
join a  brief  summary  of  them.  He  finds  that  when  a  new  leaf  is  being 
formed  from  the  main  stem,  it  commences,  not  as  is  commonly  supposed, 
in  a  single  cell,  but  in  the  simultaneous  development  of  some  hundred  at 
once,  tvhich  make  thev^  appearance  in  the  midst  of  a  mass  of  protoplasm  which 
is  inclosed  in  a  membrane  that  subsequently  seems  to  become  the  epi- 
dermis of  the  leaf.  This  mass  is,  at  first,  homogeneous ;  but  it  is  soon 
seen  to  contain  a  multitude  of  cavities  of  irregular  size  and  shape,  filled 
with  liquid,  while  the  protoplasm  between  them  becomes  more  viscid." 
"  These  cavities  are  next  observed  to  be  lined  with  a  definite  membrane ; 
and  within  this,  protoplasm,  chlorophyll,  and  cyclosis-currents  subse- 
quently become  indistinguishable." 

"  Turning  now  to  the  Protozoa,  we  find  in  the  Amaiba,  and  in  the  Ac- 
tinophrys,  types  of  animal  existence,  which,  in  so  far  as  we  are  yet  ac- 
quainted with  them,  may  be  legitimately  ranked  on  the  same  level  as  the 
Palmogla^a,  although  placed  on  the  other  side  of  the  boundary-line.  The 
body  of  each  of  these  creatures  is  a  minute  mass  of  a  substance  which 
long  since  received  from  Dujardin  the  appropriate  name  of 'sarcodc,' 
and  which  seems  to  be  the  equivalent  of  the  protoplasma  of  the  Proto- 
phyta ;  resembling  it  very  closely  in  chemical  composition  and  in  general 
attributes,  but  being  endowed  in  addition  with  a  high  degree  of  contrac- 
tility. The  body  is  not  inclosed,  in  either  of  these  beings,  by  a  distinct 
limitary  membrane,  although  the  outer  stratum  of  the  sai'code  obviously 
possesses  more  consistence  than  its  inner  part,  the  latter  being  semifluid. 
Vacuoles  or  clear  spaces  are  seen  in  various  parts  of  the  sareode-body ; 
and  in  these  are  very  commonly  observable  alimentary  particles,  intro- 
duced in  the  way  to  be  presently  described.  Besides  these  vacuoles,  a 
contractile  vesicle,  which  pulsates  at  tolerably  regular  intervals,  is  always 
to  be  distinguished,  sometimes  in  the  interior  of  the  body,  sometimes 
near  its  surface,  and  sometimes  projecting  above  its  siu-face." 

"In  these  creatures,  although  they  have  neither  digestive  cavity, 
mouth,  nor  anus — although  they  are,  to  all  appearance,  nothing  else  than 
jmrticles  of  animated  jelly  not  even  confined  ivithin  a  definite  membrane,  the 
prehension  and  ingestion  of  food,  the  extraction  of  its  nutritive  portion 
by  a  digestive  process,  and  the  rejection  of  what  cannot  be  thus  reduced 
by  an  act  of  defecation,  are  performed  as  characteristically,  and  in  real- 
ity as  perfectly,  as  in  the  highest  animaW  (§  14,  h).*  Continued  in  §  1052. 

*  Dakwin's  late  purely  speculative  yforlx.  On  the  Origin  of  Species  {an  offset  of  the 
Vestiges  of  the  Natural  History  of  Creation.,  p.  183-188),  in  whicli  the  Author  tLinks  that 
"in  a  distant  future  light  will  be  throtvn  on  the  ohigin  of  man"  !  and  whose  title  reveals 
its  object,  may  be  tried,  in  part,  by  the  foregoing  facts,  and  especiallj'  bj'  those  at  p. 
896-905,  911,  924,  927,  regardless  of  the  sheer  assumption  which  forms  the  essential 
basis  of  his  worlv.  His  difficulty  would  be  as  great  in  assigning  his  "owe  primordial 
form"  to  any  other  cause  than  "  a  Creator"  as  all  its  supposed  varietj^  of  develojiments. 
Ever}'  relative  fact  in  science,  of  anj'  importance,  contradicts  the  whole  of  this  violentl}' 
revolutionary  scheme.  See  Humboldt  and  Licwis  in  connection,  p.  922,  924. — 1860. 
Also  mj'  work  on  the  Soul,  and  Instinctivic  Puinciplk,  edition  1871. 


Animals  and  Plants. — APPENDIX. — Boundary-line.         815 

THE  GREAT  FUNDAMENTAL  DISTINCTION    BETWEEN  ANIMALS  AND    PLANTS, 
OR   THE    BOUNDARY-LINE. 

§  1052,  a  {Refers  to  §  1051).  It  will  now  be  interesting  to  the  student 
of  Physiology  to  observe  the  Universality  of  Nature's  laws  in  any  one  of 
her  great  departments,  in  the  manner  in  which  she  has  established  a  rad- 
ical distinction  between  the  vegetable  and  animal  kingdoms,  and  carried 
out  from  the  lowest  to  the  highest,  in  both  kingdoms  respectively,  the 
fundamental  plan  of  rendering  one  the  Producers  of  organic  compounds 
out  of  the  elements  of  matter,  and  the  other  Consumers  of  those  com- 
pounds, and  how  this  characteristic  will  readily  distinguish  the  lowest 
species  of  one  kingdom  from  the  lowest  of  the  other  (§  13-14,  18,  173, 
185,  298-303  ;  and  Index,  article  Plants).  By  this  brief  recurrence  to 
the  subject,  which  is  made  for  the  sake  of  the  following  quotation,  which 
brings  into  view  the  great  economy  of  life  as  manifested  in  the  boundary- 
lines  of  the  Animal  and  Vegetable  kingdoms,  and  which  confirms  the 
principles  expressed  in  this  work  (in  the  references  to  sections  just  made), 
we  shall  refresh  our  knowledge  of  the  wonderful  elaboration  of  living  be- 
ings, enlarge  our  conceptions  of  the  peculiar  properties  and  laws  by 
which  they  are  governed,  obtain  a  renewed  evidence  of  Creative  Power, 
and  be  quickened  in  our  adoration  (§  409,  493  a ;  and  Index,  articles 
Design  and  Creator).*  The  foregoing  Writer  (§  1051)  goes  on  as  follows: 

"If  we  now  compare  an  Amccba  or  an  Actinophijs,  in  its  quiescent 
state,  with  a  Palmoglcea,  or  an  equally  simple  Protophyte,  we  can  scarce- 
ly assign  any  structural  characters  by  which  one  could  be  differentiated 
from  the  other.  But  when  we  look  at  their  physiological  actions,  how 
wide  is  the  distinction.  The  Protophyte,  like  the  Phanerogamic  plant, 
obtains  the  materials  of  its  nutrition  from  the  air  and  water  that  sur- 
round it,  and  possesses  the  marvellous  power  of  detaching  oxygen,  hy- 
drogen, carbon,  and  nitrogen  from  their  previous  binary  combinations, 
and  of  uniting  them  into  chlorophyll,  starch,  albumen,  and  other  ternary 
and  quaternary  combinations ;  bvit  the  Protozoon,  in  common  with  the 
highest  members  of  the  Animal  kingdom,  is,  to  all  appearance,  destitute 
of  any  such  combining  power,  and  is  consequently  dependent  for  its  sup- 
port upon  organic  substances  previously  elaborated  by  other  beings ;  so 
that  it  must  in  the  end  derive  its  sustenance,  directly  or  indirectly,  from 
the  Vegetable  kingdom"  (§  13-14,  17,  303-304).  "Again,  the  Proto- 
phyte obtains  its  nutriment  by  the  absorption  of  liquid  and  gaseous  mole- 
cules which  penetrate  its  body  by  simple  imbibition  (§  289-295,  303  d, 
303^);  while  the  Protozoon,  though  destitute  of  any  permanent  mouth, 
stomach,  intestine,  or  anus,  extemporizes  (so  to  speak)  all  these  organs 
for  itself  whenever  there  is  occasion,  ingests  solid  particles  into  the  inte- 
rior of  its  body,  and  there  subjects  them  to  a  regular  digestive  process." 

"  Thus,  then,  by  attending  to  the  nature  of  their  food,  the  mode  of  its 
introduction,  and  the  character  of  their  respective  movements,  a  line  of 
distinction  may  be  drawn  between  the  Protophyte  and  the  Protozoon, 
scarcely  less  definite  than  that  which  separates  the  insect  from  the  plant 
whose  leaves  it  devours,  or  the  elephant  from  the  tree  on  whose  tender 
shoots  it  browses." — Medico-Chirurgical  Revieiv,  p.  3-7,  April,  1856  ; 
New  York  edition.     The  italics  are  generally  mine. — Note  Fff. 

And  now,  will  Orgftnic  Chemistry  pretend  that  there  are  only  "  inci- 
dental, casual  differences  between  living  and  dead  matter,"  and  that 
"  there  is  no  essential  difference  between  organic  and  inorganic  bodies," 

*  That  plants  subsist  upon  elements,  and  animals  upon  organic  compounds,  is  alone  fatal 
to  "one  primordial  cell"  (§  1083,  1085,  Notes,  P  p,  page  1142,  Q  q,  page  1145). 


816  INSTITUTES    OF    MEDICINE. 

and  that  "a  Chemist,  totally  unacquainted  with  organic  matter,  would 
u  priori  have  deduced  all  these  incidental  differences  of  matter  from  the 
doctrine  of  affinity  and  the  science  of  stoichiometry  evolved  from  dead 
matter"!  (§  1034,  Lehmann.)  Nay  more;  I  ask  the  Chemist  if  he  will 
even  hazard  an  assumption  as  to  the  "incidental  differences"  between 
the  fundamental  law  which  enables  the  Plant  to  exert  "  the  marvellous 
power  of  detaching  oxygen,  hydrogen,  carbon,  and  nitrogen  from  their 
previous  binary  combinations,  and  of  uniting  them  into  chlorophyll, 
stai'ch,  albumen,  and  other  ternary  and  quaternary  combinations,"  and 
that  other  fundamental  law  which  deprives  the  Animal  "  of  any  such 
combining  power,  but  renders  it  dependent  for  its  support  upon  organic 
substances  previously  elaborated  by  the  Vegetable  kingdom  ?"  And,  be- 
fore taking  leave  of  our  able  Chemist,  I  would  respectfully  ask  him  upon 
what  logical  ground  he  can  reconcile  the  doctrine  of"  simple  imbibition" 
(the  "lamp-wick"  doctrine,  §  289,  291,  350,  Nos.  21,  22x65,  23x66, 
231x67,  68,  69,  70,  25,  26,  26^,  27x71,  72,  73,  74,  75,  76,  11,  par- 
allel columns)  with  "  the  marvellous  power  possessed  by  Plants  of  detach- 
ing oxygen,  hydrogen,  carbon,  and  nitrogen  from  their  previous  binary 
combinations,  and  of  uniting  them  into  chlorophyll,  starch,  albumen,  and 
other  ternary  and  quaternary  combinations  f^  (§  13-18,  37-42,  48,  53, 
293-295,  303-304,  360,  409  c-411,  and  the  next  following  sections, 
1053, 1054.)    It  is  fatal,  also,  to  the  doctrine  of  unity  of  cells  (§  1051,  a). 

§  1052,  b.  And  now  a  word  upon  the  philosophy  of  hybrid  animals. 
Much  has  been  said  in  these  Institutes  upon  the  mutability  of  the  Proper- 
ties of  Life,  both  as  to  the  transient  and  permanent  nature  of  their  man- 
ifestations, and  much  as  to  the  influence  of  physical  agents  according  to 
the  nature  of  these  changes.  This  principle,  indeed,  lies  at  the  founda- 
tion of  physiology,  pathology,  and  therapeutics  {^  237-240),  is  deeply 
concerned  in  the  temperaments,  vital  habit,  hereditary  diseases,  and  in 
all  philosophical  medicine.     It  pervades  the  work  before  us. 

AVhen  the  reader  shall  have  considered  the  foregoing  in  connection, 
let  him  refer  to  what  is  said  of  the  permanent  changes  which  are  in- 
duced in  the  ovum  by  the  male  parent,  and  according  to  the  peculiari- 
ties of  his  physical  and  mental  constitution  (§  72-81),  and  also  to  the 
facts  attendant  on  vital  habit,  acclimation,  and  the  general  insuscepti- 
bility to  a  second  attack  of  small-pox,  measles,  &c.  (§  535-568,  650, 
653  b-d,  654  b,  659,  661,  664-666,  670.     Also  Index,  Vital  Pkoper- 

TIES). 

Now,  we  may  readily  discover  in  the  foregoing  facts  the  philosophy 
which  is  concerned  in  the  incapacity  of  hybrid  animals  to  propagate  their 
varieties ;  and  it  reflects  no  little  light  upon  our  general  philosophy  of 
life,  which  so  readily  offers  an  explanation.  This  incapacity  consists  in 
the  simple  element  that  the  pi'operties  of  the  hybrid  animal  have  under- 
gone such  a  mutation,  and  in  strict  conformity  with  the  foregoing  anal- 
ogies, that  the  semen  has  lost  its  impregnating  virtue  and  the  ovum  its 
susceptibility  to  the  action  of  semen.  Or,  if  hybrids  be  sometimes  ca- 
pable of  fruitful  intercourse  for  one  or  two  generations,  it  only  shows  a 
correspondence  in  the  ultimate  extinction  of  the  procreating  faculty, 
through  repeated  impressions  upon  the  constitution,  with  the  frequent 
necessity  of  repeated  vaccinations  to  extinguish  the  susceptibility  to  the 
farther  production  of  the  disease.  And  so  of  occasional  repetitions  of 
small-pox,  measles,  and.  scarlatina,  before  the  susceptibility  disappears 
(§  054  b,  064).     The  principle  is  a  profound  attribute  of  life. 


Alsorption. — appendix. —  Circulation.  b  1 7 

From  the  foregoing  premises  it  is  evident  that  any  general  failure  of 
animals  to  propagate  with  each  other  must  be  regarded  as  a  fundament- 
al test  of  species.  It  grows  out  of  a  law  implanted  in  the  constitution 
of  all  organic  nature,  and  a  law,  as  Ave  have  seen,  of  the  most  compre- 
hensive grasp.  For  the  same  reason,  therefore,  we  may  conclude  that 
the  varieties  which  may  ai'ise  from  the  intermingling  of  different  species 
cannot  propagate  themselves  beyond  a  few  generations.  All  this  may 
seem  peculiarly  Providential.  But  it  denotes  a  far  more  stupendous  pro- 
vision, in  being  an  integral  part  only  of  one  magnificent  system  of  Unity 
of  Design  (See  references  in  this  section  as  to  vital  habit  &c.). 

§  1052  c.  It  is  confidently  stated  that  about  nine  species  of  dioecious 
plants  have  been  known  to  yield  fruit  where  it  was  impossible  to  have 
had  any  communication  with  the  male.  We  shall  simply  place  this 
conclusion  in  the  category  involved  in  §  1051,  a.  AVe  are  not,  however, 
disposed  to  question  the  absence  of  the  male  plant,  but  to  assume,  in 
that  event,  the  certainty  of  at  least  one  male  blossom  or  one  hermaphro- 
dite having  been  developed  on  the  stem  of  the  female.  That  is  enough. 
And,  in  this  conclusion,  we  are  warranted  not  only  by  all  analogy  in 
both  organic  kingdoms,  but  by  the  specific  facts  which  often  occur  ex- 
tensively, as  in  the  conversion  of  certain  varieties  of  the  strawberry 
(fragaria),  the  ^^  Hovey^'  for  example,  into  exclusively  starainate,  and 
therefore  unproductive  flowers  (§  5^  ^,  c,  74,  p.  280,  §  449,  d). 

ABSORPTION   AND    CIRCULATION   IN   PLANTS. 

§  1053.  Although  the  laws  which  govern  absorption  and  circulation 
in  Plants  have  been  hitherto  variously  but  incidentally  considered  in 
this  work,  I  am  disposed  to  introduce  here  some  more  direct  observations 
on  account  of  the  immediate  bearing  of  the  subject  upon  absorption  and 
circulation  as  carried  on  in  animals,  and  to  thus,  also,  extend  the  anal- 
ogy to  the  philosophy  of  vegetable  heat,  indicate  the  harmony  in  the 
laws  which  govern  absorption  in  Plants,  the  circulation  of  sap,  and  the 
secreted  products  of  vegetable  organization,  and  the  analogy  between 
these  and  the  corresponding  phenomena  of  animals  (§  293-295,  381, 
445  d~g,  and  references  in  1052  a;  also  §  409  hh,  I,  493  cc,  893  a). 

§  1054.  Absorption  by  the  roots  of  Plants  is  considered  an  inadequate 
explanation  of  the  circulation  of  Sap  among  those  who  advocate  the 
doctrine  of  capillary  attraction.  To  interpret  the  process,  the  leaf,  or  its 
equivalent,  has  been  assumed  as  especially  instrumental ;  serving  either 
as  an  exhausting  apparatus  by  evaporation,  or  under  the  designation  of 
endosmosis,  or  contributing  its  aid  by  supposed  chemical  influences, 
through  the  operation  of  light,  upon  the  ascending  sap.  Some  one  of 
these  hypotheses  is  considered  an  indispensable  auxiliary  to  the  doctrine 
of  capillary  attraction  as  applicable  to  the  circulation  of  sap.  But,  in 
the  mean  time,  all  the  remarkable  facts  as  to  the  elective  power  of  the 
roots  of  Plants  in  their  function  of  Absorption  are  left  to  be  resolved 
by  "simple  imbibition"  or  the  "lamp-wick"  doctrine,  as  it  comes  to  us 
from  Liebig,  Carpenter,  and  others  (§  289-292,  1052,  and  inferences 
there.     Also  §  350,  Nos.  26,  26k,  27,  77). 

An  ingenious  application  of  the  Chemical  philosophy  has  been  pro- 
pounded to  satisfy  the  supposed  exigencies  of  capillary  attraction  not 
only  as  it  respects  the  ascent  of  sap,  but  as  affording  the  true  solution 
of  the  downward  motion;  but  it  touches  not  the  elective  power  of  the 
roots.     This  hypothesis  is  also  thought  to  be  a  new  obstacle  to  the  doc- 

Ffp 


818  INSTITUTES    OF    MEDICINE. 

trine  which  ascribes  life  to  a  Plant,  and  the  dependence  of  its  circulation 
and  unique  products  upon  vital  actions,  and  notwithstanding,  also,  that 
Plants  possess  a  far  greater  organizing  power  than  animals  (§11,  42, 
217,  298,  300,  1052);  have  exactly  the  same  organic  functions  as  ani- 
mals (§  249)  ;  and  generate  an  endless  variety  of  precise,  unique,  organic 
compounds  out  of  a  fluid  constituted  of  the  same  elements  as  the  blood 
(§  34-37,  41-48,  136).  The  hypothesis  derives,  also,  no  little  import- 
ancefrom  its  application  to  the  circulation  of  the  blood,  and  the  admis- 
sion that,  if  it  cannot  be  sustained  in  reference  to  Plants,  it  must  be 
equally  groundless  in  regard  to  Animals.  The  doctrine  comes  recom- 
mended to  our  attention  by  its  distinguished  Advocates. 

I  have  already  endeavoured  to  show  the  want  of  all  foundation  for 
the  more  comprehensive  principle  set  forth  by  Liebig,  and  of  which  the 
foregoing  is  a  corollary,  that 

"  The  Cause  of  the  state  o/"  Motion  is  to  he  found  in  a  series  of  changes 
ivhich  the  food  undergoes  in  the  organism,  and  these  are  the  rcsidts  of  pro- 
cesses of  decom2')osition,  to  which  either  the  food  itself  or  the  str-uctures  form- 
ed from  it,  or  jyarts  of  organs,  are  subjected'^  (§  350,  No.  1 ,  parallel  columns). 

This  summary  principle,  in  which  oxygen  gas  figures  conspicuously, 
is  the  combustive  doctrine  of  life.  The  Projector  held  it  to  be  applica- 
ble to  every  motion  and  to  all  the  phenomena  of  living  beings  in  health 
and  disease  (§  350,  Nos.  3,  7,  9,  10,  12,  15,  17^,  21,  73,  §  350^),  and  even 
in  death  (§  350,  No.  49,  383).  It  was  laid  as  the  foundation  of  Thera- 
peutics (§  350§).  It  was  also  made  to  explain  our  very  thoughts  and 
passions  ;  those  being  also  imputed  to  the  union  of  oxygen  with  the 
combustible  elements  of  the  brain  (§  349  e,  1076  a),  and  which  led  us  to 
the  demonstration  upon  "  The  Soul  and  Instinct."  It  is  the  circumstance, 
also,  of  these  fundamental  doctrines  being  still  the  current  Medical  Phi- 
losophy that  has  prompted  another  part  of  the  Appendix  (§  433,  1034). 

I  cheerfully  conceded  that  the  foregoing  "  summary  principle,  were  it 
true,  would  be  truly  beautiful."  I  therefore  felt  the  importance  of  show- 
ing that  it  was  not  only  deficient  in  every  necessary  element,  but  was 
contradicted  by  all  the  phenomena  of  Sympathy,  and  by  all  that  is 
known  of  Pathology  and  Therapeutics.  I  am  thus  provided  with  a  vast 
series  of  facts  in  advance,  which  must  be  taken  in  connection  with  what 
I  am  now  to  say  of  the  corollary  from  the  fundamental  doctrine.  This 
corollary  consists  in  the  application  of  the  general  doctrine,  above,  to  the 
circulation  of  the  sap  and  the  blood.     It  supposes  that 

The  movement  of  the  sap,  upward  and  downward,  is  generated  in  the 
leaf  by  the  action  of  light  in  promoting  the  decomposition  of  carbonic 
acid  gas,  that  ^^  marvellous  power  possessed  by  Plants"  (§  350,  Nos.  68, 
73,  74,  76,  §  1052).  The  imperfect  ascending  fluid  is  thus  converted  in 
the  leaf  into  perfect  sap,  and  the  change  is  supposed  to  institute  a  pro- 
pelling force  in  the  imperfect  juice,  by  which  the  perfected  sap  is  driven 
out  of  the  leaf  and  through  its  downward  course.  The  force,  generated 
in  the  leaf,  is  also  considered,  from  the  motion  which  ensues  in  that  part, 
as  the  most  essential  cause  of  the  ascent  of  the  sap,  or  that  the  fluid  is 
thus  lifted  from  the  roots  to  the  summit  of  the  most  lofty  trees.  Such, 
then,  is  the  ingenious  doctrine  which  it  has  been  found  necessary  to  sub- 
stitute for  capillary  attraction  in  expounding  the  circulation  of  Plants; 
as  the  illustration  drawn  from  a  "lamp-wick"  was  found  to  be  applica- 
ble only  to  the  radicles  in  their  supposed  office  of  "  simple  imbibition" 
(§  289-293). 


Absorption. — ^appendix. — Circulation.  819 

This  principle  has  the  merit  of  appearing  to  be  equally  applicable  to 
the  circulation  in  animals  as  to  that  of  plants  (§  350,  No.  73,  &c.),  and 
it  forms  a  remarkable  instance  of  consistency  in  a  somewhat  comprehen- 
sive range  of  a  purely  factitious  hypothesis,  though  it  is  regardless  of  all 
the  overpowering  facts  which  declare  its  artificial  character.  The  pul- 
monary circulation  is  said  to  depend  upon  the  union  of  the  oxygen  of 
the  air  with  the  carbon  of  the  venous  blood,  in  consequence  of  which 
this  blood  drives  the  decarbonized  into  the  left  auricle.  But,  in  the  case 
of  the  systemic  or  greater  circulation,  the  order  of  things  is  reversed  ;  for 
here  the  motion  is  supposed  to  be  generated  by  the  union  of  oxygen  with 
the  "structures  formed  out  of  the  food."  The  same  order  of  events  ob- 
tains in  the  livei' — all  referable  to  "  a  series  of  changes  which  the  food 
undergoes  in  the  organism,"  &c.  This  is  Liebig's  doctrine  of  the  circu- 
lation of  the  blood  and  sap,  as  expressed  in  the  foregoing  quotation,  and 
as  may  be  seen  farther  in  §  350,  Nos.  3,  5,  6,  8,  9,  10  15,  parallel  col- 
umns, and  §  383.  But  the  most  curious  facts  about  it  are,  as  I  formerly 
said,  that  it  "  considers  the  circulation  of  the  blood  due  to  the  agencies 
of  oxygen,  and  not  at  all  to  tlie  action  of  the  heart,"  and  that  it  "is  the 
chemical  substitute  for  the  medical  aphorism,  '  uhi  irritatio  ibi  affluxus,''  " 
and  that  it  is  made  the  grand  basis  of  all  Pathology  and  Therapeutics 
(§  350,  No.  10,  §  350^-3501).  The  latter,  indeed,  should  naturally  flow 
from  the  main  physiological  doctrine,  if  Nature  be  truly  represented  by 
this  (§  1  fl,  2  h,  383,  447^  a,  638,  1089). 

Doubtless,  this  remarkable  doctrine  of  the  circulation  of  the  blood 
might  have  been  left  to  itself  had  it  not  been  incorporated  in  the  lead- 
ing works  upon  Physiology,  as  in  Dr.  Carpenter's,  and  even  carried  into 
popular  systems,  as  by  Mrs.  Willard,  whose  appropriation  of  the  philos- 
ophy is  regarded  by  Dr.  Cartwright  (in  Boston  Medical  and  Surgical 
Journal)  as  singularly  ingenious  and  original  (§  349  d,  433). 

It  is  simply  my  remaining  object,  however,  to  inquire  into  the  sup- 
posed condition  of  the  circulation  in  plants,  as  in  all  other  relative  top- 
ics concerning  man  and  animals  the  ground  has  been  sufficiently  ex- 
plored, and  since,  also,  if  the  hypothesis  can  be  contradicted  here,  it  must 
equally  fail,  as  is  admitted,  in  respect  to  animals.  I  shall  also  endeav- 
our to  avoid  a  repetition  of  whatever  I  may  have  hitherto  said,  and  limit 
myself  to  the  statement  of  a  few  simple  facts. 

In  the  first  place,  then,  it  appears  to  me  that  the  hypothesis  contains 
a  fatal  element — the  prodigious  amount  of  force  which  is  said  to  be  gen- 
erated in  the  leaf,  as  well  as  in  the  lungs  and  other  soft  structures  of  an- 
imals. On  this  point  I  am  bound  to  abide  by  the  decision  of  the  Chem- 
ists, who  say  that  such  must  be  the  consequence  of  the  chemical  changes 
which  are  supposed  to  be  in  progress  for  the  production  of  motion.  '  As 
expressed  by  these  Philosophers,  who  designate  it  as  "  an  inexpressible 
force,"  or  compare  it,  like  Liebig,  to  a  "steam-engine"  (§  350,  No.  15), 
it  would  be  abundantly  sufficient  for  any  purposes  in  artillery  or  in  blast- 
ing rocks  (§  392,  c). 

In  the  next  place,  there  are  many  other  circumstances  attending  the 
circulation  in  Plants,  as  well  as  Animals,  not  hitherto  considered,  which 
it  would  not  be  easy  to  interpret  by  the  Chemical  doctrine,  but  which 
are  readily  explained  by  the  Vital.  Where,  for  example,  is  the  auxili- 
ary power  to  capillary  attraction  (if  the  latter  be  included) — where,  the 
l^ves,  or  even  buds,  when  vegetation  starts  from  its  hybemating  state 
in  northern  countries  ?     Observe  the  Acer  saccharimim — the  remarkable 


820  INSTITUTES    OF    MEDICINE, 

vigour  of  its  circulation  before  there  is  a  development  of  the  bud.  In- 
deed, the  harvest  of  maple-sugar  often  takes  place  in  the  Northern  States 
while  the  earth  is  covered  with  snow  to  the  depth  of  many  feet.  The 
circulation,  too,  is  most  vigorous  after  frosty  nights  succeeded  by  warm 
mornings  ;  and  when  the  temperature  of  the  air  rises,  for  a  night  or  two, 
to  some  40^  F.,  the  flow  of  sap  is  apt  to  be  greatly  diminished,  but  is 
restored  in  profusion  on  the  return  of  frost.  What  in  Chemistry  will 
explain  such  a  phenomenon  ?  And,  if  it  retreat  before  obstacles  of  this 
nature,  must  it  not  abandon  the  whole  ground?  Nay,  how  palpable  the 
force  of  a  single  fact,  when  it  is  considered  that  the  phenomenon  is  due 
to  the  effect  of  heat  as  a  vital  agent  on  the  irritability  of  vegetable  or- 
ganization, and,  singularly  enough,  as  admitted  by  Liebig  (§  350,  No. 
65) ;  and  whether  operating  at  the  higher  and  more  uniform  degrees,  or 
alternating  at  the  freezing  point,  the  exact  explanation  is  involved  in  the 
law  of  Vital  Habit,  as  set  forth  in  these  Institutes  at  pages  3G3-370. 

Such,  mainly,  is  also  true  of  the  Vitis  vinifcra,  which  was  the  subject 
of  many  ingenious  experiments  by  the  celebrated  Dr.  Hales,  as  appeared 
in  his  Vegetable  Statics.  And  this  brings  us  upon  the  fashionable  ground 
at  which  I  have  been  aiming — that  of  "  Experimental  Philosophy." 
These  experiments  are  allowed  to  have  been  ably  and  critically  conduct- 
ed, and  are  standard  references.  Let  us,  t'lerefore,  interrogate  some  of 
these  experiments,  and  see  how  far  they  correspond  with  Nature,  or  how 
far  they  contradict  her  and  bear  out  the  Chemist ;  and  let  us,  at  the 
same  time,  take  along  the  corroborating  testimony  of  other  eminent  ob- 
servers, who  were  obliged  to  conclude  that  "  the  sap  moves  with  such 
velocity  and  force,  that  it  must  be  propelled  by  vital  contractions  and 
dilatations  of  the  vessels"  (§  293).  Now,  in  some  of  Dr.  Hale's  experi- 
ments there  was  not  only  an  absence  of  leaves  and  buds,  but  the  stumj) 
alone  was  the  subject  of  observation.  There  was  wanting,  therefore, 
every  thing  that  could  contribute  to  the  fundamental  requisite  of  the 
Chemist,  and,  indeed,  I  may  say,  what  is  considered  indispensable  by 
all  the  physical  Philosophers  to  the  simple  doctrine  of  capillary  attrac- 
tion as  it  I'egards  the  ascent  of  sap.  ,  Take,  as  an  example,  Exj).  xxxvi. 
Thus : 

"  April  6th,  at  9  A.M.  I  cut  off  a  vine,  on  a  Southern  aspect,  two 
feet  nine  inches  from  the  ground.  The  remaining  stem  had  no  lateral 
branches.  It  was  seven  eighths  of  an  inch  in  diameter.  I  fixed  on  its 
top  the  mercurial  gauge;"  of  double  curve,  to  admit  the  flow  of  a  few 
inches  of  sap. 

For  several  days  the  mercury  was  more  or  less  pushed  up  by  the  sap, 
according  to  the  state  of  the  weather.  "  April  14th,  at  7  A.M.  the 
mercury  rose  to  20  inches  high.  At  9  A.M.  22  inches.  Fine  warm 
sunshine.  Here  we  see  that  the  warm  morning  gives  a  fresh  vigor  to 
the  sap."  "April  18th  (12th  day),  at  7  A.M.  mercury  32  inches  high, 
and  would  have  risen  higher  if  there  had  been  more  mercury  in  the 
gauge.  From  this  time  to  May  5th  the  force  gradually  decreased  [the 
life  of  the  plant  giving  way].  On  the  18th  of  April  the  force  of  the 
sap  was  equal  to  36  feet  height  of  water.  Here,  the  force  of  the  rising 
sap  in  the  morning,"  the  doctor  concludes,  '■'■  is  2^lainly  oiving  to  the  energy 
of  the  root  and  stem" 

In  another  and  similar  experiment,  at  the  same  time,  "  the  mercurial 
gauge  being  fixed  near  the  bottom  of  a  vine,  the  mercury  was  raised  by 
the  force  of  the  sap  38  inches,  equal  to  43  feet4-3  inches  +  i  height  of 


Absorption. — appendix. —  Circulation.  821 

water  ;  which  force  is  near  five  times  greater  than  the  force  of  the  blood 
in  the  great  crural  artery  of  a  horse  ;  seven  times  greater  than  the  force 
of  the  blood  in  the  like  artery  of  a  dog ;  and  eight  times  greater  than 
the  blood's  force  in  the  same  artery  of  a  fallow  doe,"  as  ascertained  by 
the  rise  of  the  blood  in  long  glass  tubes. 

In  these  experiments  it  is  sufficiently  manifest  that  all  the  physical 
hypotheses  fail,  since  all  of  them  assume  that  the  leaf,  or  its  equivalent, 
is  indispensable  to  the  progressive  rise  of  the  sap.  The  result,  I  say, 
shows,  what  all  organic  nature  teaches,  that  so  important  a  function  as 
the  circulation,  and  so  exceedingly  variable  as  in  plants,  yet  most  ex- 
actly suited  in  every  species  and  every  individual  (but  varied  in  all  the 
species),  to  the  methodical  steps  in  vegetation,  is  not  dependent  upon 
the  capricious  operation  of  any  chemical  or  physical  agencies,  and  that 
a  force  is  established  at  the  very  base  of  a  plant,  that  shall  not  fail  of 
the  exigencies  of  vegetable  life  according  to  its  progressive  changes 
(§  392  b,  394)  ;  and  the  same  general  principle  may  be  affirmed  of  every 
great  function  of  organic  life.  It  follows,  therefore,  that  the  sap  is 
moved  by  something  peculiar  to  living  beings,  and  this  is  called  a  vital 
action.  The  motion  which  we  have  seen,  however,  would  prove  utter- 
ly destructive  to  the  leaf,  and  even  to  all  delicate  branches,  without  a 
gradually  countervailing  influence  upon  that  action,  and  the  subdivision 
of  vessels  will  not  alone  explain  the  diminution  of  force.  We  must 
hence  infer,  what  is  denoted  by  other  important  facts,  that  the  reduction 
of  force  arises,  also,  from  a  modified  action  in  the  vessels  leading  to  the 
twigs  and  bud,  as  well  as  in  the  bud,  or  leaf,  itself.  Here  a  new  action 
is  set  up,  and  a  new  motion  of  the  sap  begins,  which  is  propagated  along 
its  downward  course  by  a  universal  action  of  the  vascular  system,  mod- 
ified in  different  parts  according  to  the  special  final  causes  of  each  part. 

Although  there  were  no  leaves  in  the  foregoing  experiments,  and,  in- 
deed, only  a  short  stump  of  the  vine,  the  results  were  not  unexpected 
to  the  Philosopher,  who  adopts  the  theory  that  the  circulation  of  sap  is 
owing  to  temperature.  But  temperature  could  not  be  always  made  to 
explain  the  phenomena,  Capillary  Attraction  was  little  understood,  and 
Chemistry  was  yet  unfledged.  Accordingly,  as  in  all  cases  where  genius 
departs  from  Nature,  even  the  acute  mind  of  Dr.  Hales  has  a  special  hy- 
pothesis for  each  apparent  difficulty ;  sometimes  borrowing  from  the 
theory  of  the  Vitalist,  though  less  so  than  most  Organic  Chemists,  and, 
like  the  latter,  actually  raising  hypotheses  in  direct  opposition  to  each 
other  (§  350,  &c.).  Take  the  following  examples,  where  the  leaves  had 
obtained  their  full  development,  and  which  will  farther  show  the  error 
of  the  physical  hypotheses.     Thus  : 

"July  4th,  at  noon,  I  cut  off  within  three  inches  of  the  ground  an- 
other vine  on  the  South  aspect,  and  fixed  to  it  a  tube  seven  feet  high, 
and  filled  it  with  water,  which  was  imbibed  by  the  root,  the  first  day, 
at  the  rate  of  a  foot  in  an  hour,  but  the  next  day  much  more  slowly ;  yet 
it  was  continually  sinking,  so  that  at  noonday  I  could  not  see  it  so 
much  as  stationary" — the  life  of  the  stump  now  giving  way. 

Here  are  two  important  facts.  There  Avas  no  apparent  upward  force, 
though  there  may  have  been  some  mingling  of  the  sap  with  the  water ; 
and,  secondly,  the  water  being  vitally  adapted  to  the  plant,  it  was  lit- 
erally carried  down  to  the  roots  from  the  tube  at  the  rate  of  a  foot  an 
hour.  There  was  no  chemistry  here  to  effect  or  in  any  manner  influ- 
ence the  descent ;  and  tlie  water  went  the  Avrong  way  for  capillary  attrac- 


822  INSTITUTES    OF    MEDICINE. 

tion.  The  hypothesis  of  gravity  would  be  absurd,  while  it  is,  also,  con- 
tradicted by  the  preceding  experiments ;  and  the  descent  of  the  sap  lias 
been  a  greater  problem  to  our  rival  friends  than  its  ascent.  The  import- 
ance and  compass  of  the  proof  will  be  at  once  perceived.  But  he,  who 
made  the  experiment,  seeing  the  want  of  agreement  with  the  preceding, 
thought,  like  a  great  many  other  Philosophers,  that  a  conflicting  fact 
would  justify  a  special  hypothesis.  Let  us  therefore  hear  the  doctor 
upon  this  troublesome  point.     Thus  : 

"Now,  since  the  flow  of  sap  ceased  at  once,  as  soon  as  the  vine  was 
cut  off  the  stem,  the  principal  cause  of  its  rise  must,  at  the  same  time, 
be  taken  away,  viz.,  the  great  perspiration  of  the  leaves.'' 

That  is  the  doctrine,  along  with  capillary  attraction,  of  a  large  section 
of  the  physical  school ;  but  it  supplies  no  aliment  to  Chemistry.  In  all 
the  cases,  the  blunders  arise  from  a  defective  observation  of  facts,  and 
from  an  ignorance  in  the  difference  between  the  physiological  condition 
of  the  vine  and  of  other  plants  before  and  after  leafing  (§  1034).  In  the 
experiments  first  recited,  the  vine  was  in  its  budding  season,  when  vege- 
table life  is  in  highest  activity,  and  hence  the  profusion  of  sap,  the  force 
of  its  circulation,  and  the  development  of  heat  (§  445,  e,f).  On  the  con- 
trary, in  the  last  experiment  Nature  had  accomplished  her  greatest  of 
objects  in  the  development  of  the  leaves  ;  and  Dr.  Hales  might  have  am- 
putated the  largest  limb,  with  all  the  other  leaves  remaining,  and  there 
would  have  been  no  bleeding.  The  same  descent  of  the  sap  would  have 
occurred,  and  prompted  a  different  hypothesis. 

And  now  contrast  the  foregoing  experiment  with  his  conclusion  as 
expressed  in  £ay9.  xxxviii.;  the  words  in  italics  being  designed  by  myself 
to  facilitate  the  hasty  reader.  It  is  a  hypothesis,  directly  opposed  to  the 
preceding,  for  the  purpose  of  expounding  another  fact : 

"  The  sap,"  says  the  doctor,  "  begins  to  rise  sooner  in  the  morning  in 
cool  weather  than  after  hot  days ;  the  reason  of  which  may  be,  because 
in  hot  weather  much  being  evaporated,  it  is  not  so  soon  supplied  by  the 
roots  as  in  cool  weather,  ivhen  less  is  evaporated."  In  Uxp.  xlvi.  he  says, 
"  It  was  found  that  the  trunk  and  branches  of  vines  were  always  in  an 
imbibing  state,  caused  by  the  g7'eat  p'^rspiration  of  the  leaves,  except  in  the 
bleeding  season"  when  there  are  no  leaves.  At  that  season  the  problem 
of  the  stump  led  him  to  conclude  that  "  the  force  of  the  rising  sap  is 
plainly  owing  to  the  energy  of  the  root  and  stem"  (Exp.  x.x\i.).  Will  the 
Chemist  explain  ? 

In  one  of  his  experiments  he  attributes  an  effect  to  the  "sun's  warmth," 
in  making  the  vessels  ^^  dilate  and  contract  a  little."  This  is  what  he 
means  by  "  the  energy  of  the  root  and  stem."  Had  he  adhered  to  that 
explanation,  and  had  he  a  competent  knowledge  of  the  physiological  laws 
of  vegetable  life,  he  would  have  had  no  difficult  problems  to  expound,  no 
conflicting  experiments,  no  contradictions  of  himself.  Few  Philosophers, 
however,  as  little  informed  in  the  philosophy  of  organic  life,  have  been 
as  accurate  in  their  experiments,  or  more  capable  of  reasoning  upon  the 
facts,  than  Dr.  Hales.  But  thus  it  ever  is  with  all  who  depart  from 
their  main  field  of  operations  to  build  up  the  difficult  parts  of  other  sci- 
ences. Hales  was  a  divine,  and,  although  adroit  in  experiments,  and 
better  qualified  by  impartial  habits  than  the  Chemist,  it  is  no  detraction 
from  his  (or  their)  exalted  merits  to  say,  that  he  knew  so  little  of  Phys- 
iology he  was  incapable  of  applying  or  even  perceiving  the  facts  which 
the  student  of  organic  nature  may  readily  seize  and  convert  to  the  phi- 


Absorption. — appendix. —  Circulation.  823 

losophy  of  life,  and  turn  against  the  conclusions  of  the  original  ob- 
server (p.  923-925,  Humboldt). 

Am  I  not,  therefore,  entitled  to  conclude,  from  these  few  observations 
alone,  that  organic  beings  are  contradistinguished  from  inorganic  by  what 
is  popularly  known  as  life,  or  vitality,  and  with  the  summary  remarks  of 
one  of  the  greatest  scientific  Botanists  of  the  age.  Professor  Lindley,  of 
the  London  University,  as  expressed  in  his  able  analysis  of  the  "  First 
Principles  of  Botany,"  that, 

1st.  "  The  movement  of  the  sap  depends  upon  a  vital  irritability,  and 
is  independent  of  mechanical  causes"  (§  185, 188, 188.^). 

2d.  "  The  proximate  principles  are  formed  by  the  vital  powers  of  the 
plant  acting,  in  conjunction  with  air  and  light,  upon  the  fluids  contained 
in  its  system." 

3d.  ^^  All  the  phenomena  connected  with  the  growth  of  plants  are  caused 
by  an  inherent  vital  action"  (§  293). 

§  1055,  I  shall  conclude  the  foregoing  subject  relative  to  the  circula- 
tion in  Plants  (§  1054)  by  a  quotation  from  Liebig's  '■'  Reseaixhes  on  the 
Chemistry  of  Food,  and  the  Motion  of  the  Juices  in  the  Animal  Bodyj'^ 
as  a  farther  justification  of  what  I  have  said  of  the  tampering  of  Chem- 
ists with  the  philosophy  of  organic  life,  in  former  sections  (§5,  276-i, 
676  b,  1006  or,  1034,  &c.),  and  that  it  may  be  compai-ed  with  §  350,  ^3ar- 
allel  columns,  and  §  350J  n.  It  will  be  seen  that  it  is  nearly  the  com- 
mon doctrine  relative  to  the  evaporation  by  leaves  in  explaining  the 
circulation  of  sap,  as  propounded  by  Dr.  Hales  (§  1054).  Professor 
Liebig  infers  the  principle  fi'om  experiments  made  upon  dried  mem- 
branes !  as  he  had  formerly  done  of  the  circulation  in  Plants  from  the 
action  of  "a  lamp-wick"  (§  289).  Having  found  the  membranes  pervi- 
ous to  water,  oil,  &c.,  he  proceeds  to  say,  in  a  letter  to  Professor  Hors- 
ford,  republished  in  the  '^  A^ner^ican  Journal  of  Science  and  Ar-ts'^  (May, 
1848,  p.  415),  and  which  I  quote  for  the  brevity  of  the  conclusion,  that 

"  The  employment  of  these  results  upon  the  processes  in  the  animal 
body  scarcely  requires  a  more  detailed  explanation. 

"  The  surface  of  the  body  is  the  membrane  from  which  evaporation 
goes  constantly  forward.  In  consequence  of  this  evaporation,  all  the 
fluids  of  the  body,  in  obedience  to  atmospheric  pressure,  experience  mo- 
tion in  the  direction  towards  the  evaporating  surface.  This  is  obviously 
the  chief  cause  of  the  passage  of  the  nutritious  fluids  through  the  walls 
of  the  bloodvessels,  and  the  cause  of  their  distribution  through  the  body.  We 
know  now  what  important  function  the  skin  fulfils  through  evaporation"  ! 
(§  350 1,  n-q.)  Our  Author  did  not  even  think  so  far  as  to  consider  the 
perpetual  vicissitudes  of  the  skin  in  that  respect,  nor  how  wonderfully 
the  blood  becomes  concentrated  in  the  great  internal  vessels  in  the  sweat- 
ing stage  of  the  malignant  cholera,  or  as  the  same  phenomena  distin- 
guish a  paroxysm  of  fear.  It  is  also  worthy  of  remark  that  this  distin- 
guished Leader  in  Physiology  here  loses  sight  completely  of  his  universal 
chemical  doctrine  of  motion,  which  had  been  put  forth  in  his  "  Animal 
Chemistry"  (§  1054).  It  forms,  therefore,  another  antagonism  for  the 
Parallel  Columns. 

If  we  may  have  sometimes  appeared  deficient  in  dignified  sobriety  on 
similar  occasions,  we  have  not  thought  it  necessary  to  render  an  apolo- 
gy, but  Jiave  relied  implicitly  upon  the  sympathy  of  intelligent  readers ; 
and  while  we  have  not  laughed  at  the  able  Chemists  who  have  taken 
upon  themselves  the  labour  of  persuading  Physicians  that  animals  are 


824  INSTITUTES    OF    MEDICINE. 

only  minerals,  but  rather  at  the  latter,  nor  have  been  offended  at  the  ar- 
rogance which  admits  no  penetration  of  the  most  hidden  recesses  of  Na- 
ture but  through  that  veil  of  ignorance  which  betrayed  the  Crispin  into 
the  immortal  rebuke  of  Apelles,  Ave  have,  nevertheless,  in  our  zeal  to 
save  something  from  the  wreck,  endeavoured  to  show  that  all  the  pre- 
cepts of  the  Laboratory  justify  our  application  of  that  rebuke;  nor  do 
we  feel  responsible  for  any  risible  consequences. 

EXPERIMENTS    BY    MYSELF    TO    ASCERTAIN   AVIIETHER    THE    QUANTITY    OF 
BLOOD  CIRCULATING  IN  THE   BRAIN  MAY  BE  REDUCED  ARTIFICIALLY. 

§  lOoG.  As  the  question  whether  the  bloodvessels  of  the  brain  may 
be  brought  under  the  influence  of  bloodletting  like  those  in  other  parts 
of  the  body  is  intimately  connected  with  the  philosophy  of  the  operation 
of  loss  of  blood,  as  set  forth  in  these  Institutes  (§  941,  950,  975,  &c.), 
and  has  an  important  bearing  upon  the  treatment  of  inflammatory  and 
congestive  affections  of  the  brain  (§  971-980,  «fcc.),  I  shall  now  introduce 
some  experiments  which  I  made  many  years  ago  in  reference  to  the  sub- 
ject before  us.  Whatever  may  be  thought  of  the  theoretical  conclusions, 
the  experiments  demonstrate  that  the  brain  is  on  common  ground  with 
all  other  organs  as  it  respects  the  "influences  of  bloodletting,"  and  that 
is  the  important  end  at  which  I  am  now  inviting  the  attention  of  the 
reader ;  nor  am  I  aware  that  the  experiments  have  been  invalidated. 
They  were  communicated  to  Dr.  James  Johnson,  Editor  of  the  Medico- 
Chirurgical  Revieu\  London,  in  1834,  who  published  an  abstract  of  the 
Article  in  the  April  Number  of  the  Review  for  that  year,  and  which  was 
introduced  by  the  following  prefatory  remarks : 

"  The  Editor  having  received  a  long  paper  from  Dr.  Paine,  of  New 
York,  is  unable  to  insert  it  in  the  Med.  Chir.  Revieio,  into  which  no  orig- 
inal articles  can  be  admitted,  excepting  some  short  cases  or  pieces  of  in- 
telligence. The  Editor,  however,  has  had  a  short  analysis  of  Dr.  Paine's 
paper  drawn  up,  &c.  J.  J." 

The  following  is  an  abstract  of  "  the  analysis :" 

"  Marked  and  conflicting  differences  of  opinion  prevail,  relative  to  the 
proximate  cause  of  cerebral  affections.  These  differences  we  may  truly 
ascribe  to  the  widely  opposite  conclusions  which  Physiologists  have  ar- 
rived at  as  to  the  functions  of  the  brain,  more  particularly  of  the  state 
of  its  circulation.  Dr.  Paine  instituted  a  suite  of  experiments  to  deter- 
mine, if  possible,  the  normal  state  of  the  brain,  so  far  as  information  so 
derived  might  be  connected  with  its  abnormal  changes. 

"  That  the  bi'ain  is  naturally  incompressible,  he  regards  as  an  estab- 
lished truth.  But,  with  reference  to  the  opinion  that  the  cranium  must 
always  be  filled,  he  thinks  '  the  spaces  which  exist  between  the  parietes 
of  the  ventricles,  between  the  membranes,  the  skull,  the  convolutions  of 
the  brain,  «S:c.,  are  not  necessarily  occupied  by  a  serous  fluid,  but  must 
be,  in  part,  pervaded  by  an  aqueous  vapour,  which  is,  of  course,  suscep- 
tible of  condensation,  not  only  from  the  decline  of  caloric,  but  by  any 
power  exceeding  its  force  of  expansion.  And  so,  on  the  other  hand,  the 
elasticity  of  the  vapour  will  promote  a  reduction,  by  loss  of  blood,  of 
the  contents  of  the  cerebral  bloodvessels  to  any  extent.  The  existence 
of  such  an  elastic  vapour  is  inferable  from  what  is  known  to  exist  in 
other  cavities  of  the  body,  and  from  what  is  respired  from  the  lungs.  It 
must,  therefore,  be  far  more  strongly  pronounced  in  the  cavity  of  the 


The  Brain. — appendix. — Experiments.  825 

cranium  in  consequence  of  the  exclusion  of  atmospheric  pressure,  except- 
ing so  far  as  this  operates  through  the  openings  in  the  skull.' 

"  To  get  rid  of  sources  of  ambiguity,  connected  with  the  otherwise  un- 
determined question,  whether  such  vapor  existed  naturally,  or  was  pro- 
duced during  changes  in  the  condition  of  the  brain,  experiments  were 
performed  (on  calves),  so  as  to  exhaust  the  system  of  its  blood.  With 
the  results  of  Ivellie's  experiments  Dr.  Paine  premises  a  statement  of  his 
unacquaintance,  but  hazards  a  supposition  that  the  animals  may  have 
been  so  bled  by  Kellie  as  to  occasion  fatal  syncope  '  before  the  body  was 
deprived  of  the  circulating  fluid ;  and  that,  as  condensation  of  the  vapour 
has  taken  place  after  the  death  of  the  animal,  the  blood  has  rushed  into 
the  brain  to  supply  the  vacuum.  Such,  indeed,  would  be  a  necessary 
consequence  of  vapour  so  condensed,  and  of  any  blood  remaining  in  the 
aorta,  the  cava,  or  the  great  branches  connected  with  those  of  the  head. 
For  this  reason  we  shall  always  find  the  cavity  of  the  skull,  in  the  hu- 
man subject,  fully  occupied  by  solid  and  fluid  matter,  to  whatever  extent 
depletion  may  have  been  carried,  unless  the  patient  may  have  been  tre- 
panned during  life,  or  before  any  reduction  of  the  natural  temperature. 
It  does  not,  therefore,  follow  that  vapour  cannot  have  existed  within  the 
cavity  of  the  skull  during  life  because  it  is  fully  occupied  by  incompress- 
ible matter  after  death.' 

"  The  calves  were  experimented  upon  in  this  way :  The  aorta  near 
the  heart,  or  the  descending  cava,  was  opened,  when  so  rapid  was  the 
hemorrhage  that  the  heart's  action  ended  only  on  the  vessels'  being  fully 
emptied.  Lest  condensation  of  vapour  should  possibly  have  arisen  from 
reduction  of  temperature,  the  head  was  instantly  removed  after  the  ani- 
mal died.  On  examination.  Dr.  Paine  ^  uniformly  found  the  vessels  of  tlie 
brain  and  of  the  membranes  nearly  deprived  of  their  contents,  and  the  organ 
perfectly  blanched.''  No  disproportion  in  the  quantity  of  the  blood  was 
observed,  whether  the  animal  had  been  trepanned,  or  the  external  air 
excluded.  The  serum-  exhibited  only  '  a  tinge  of  red'  when  the  brain 
was  opened  up,  and,  therefore,  there  could  be  but  very  little  blood  in  its 
vessels,  or  those  of  the  pia  mater.  Not  more  than  half  a  drachm,  and 
'always  quite  as  much  when  the  animal  had  been  trepanned,'  was  ob- 
served in  the  sinuses  of  the  dura  mater.  Calves  were  judiciously  select- 
ed in  preference  to  dogs,  being  less  troublesome,  and  probably  less  liable 
to  cerebral  excitement  during  '  an  operation  requiring  some  dissection.' 

"  The  cranial  contents  were  determined  by  comparing  their  weight 
with  a  bulk  of  distilled  water  equal  to  the  capacity  of  the  cavity.  The 
dura  mater  was  not  included,  and  its  sinuses  were  not  disturbed  so  as  to 
admit  of  the  entrance  of  water.     Here  are  the  results  : 

oz'5.  drs.  prs. 

1.  Brain — skull  trepanned 10  4  20 

Water — distilled 10  4  lo 

2.  Brain — skull  trepanned 9  4  25 

Water — distilled 9  2  0 

3.  Brain — skull  trepanned 10  3  26 

Water — distilled 10  2  'g 

1.  Brain — skull  entire 11  1  5 

Water — distilled 10  7  20 

2.  Brain — skull  entire 10  6  10 

Water — distilled 10  4  50 

3.  Brain — skull  entire 10  2  40 

Water — distilled 10  0  52 

"On  injecting  quicksilver  into  the  human  brain  an  equal  bulk  of 
bloody  serum  was  always  expelled.     The  average  quantity  of  quicksil- 


826  INSTITUTES    OF    MEDICINE 

ver,  on  injection  into  the  brains  of  animals  bled  to  death,  was  'two 
pounds  in  brains  weighing  ten  ounces'  (fx)  ;  the  sinuses  of  the  dura 
mater  admitted  the  maximum  of  this  proportion. 

"  If  these  experiments  be  correct,*  and  otherwise  trustworthy,  less 
blood  circulates  within  the  head  than  has  been  supposed  ;  and  the  amount 
of  sanguineous  effusion  has  probably  been  overrated,  unless  the  ratio  be 
higher  in  the  human  species. 

"  Independently  of  the  experiments,  Dr.  Paine  thinks  that  we  are 
authorized  in  believing  the  circulation  within  the  substance  of  the  brain 
to  be  slow,  and  the  quantity  of  blood  small.  As  the  organ  chiefly  fills 
the  cavity,  little  space  only  can  be  allotted  to  the  membranes,  and  still 
less  to  theh"  chief  vessels.  The  experiments  sustain  the  conclusions  de- 
rived from  anatomical  facts,  that  the  quantity  of  blood  is  much  more 
reduced  than  has  often  been  conjectured.  The  very  sparing  provision 
of  absorbents  with  which  the  brain  is  provided  is  '  a  negative  argument,' 
in  Dr.  Paine's  opinion,  '  that  the  brain  has  less  use  for  blood  ^han  other 
parts  of  the  system,  where  these  vessels  abound.'  '  To  obtain  a  slow 
circulation,  an  abundant  and  equable  supply  of  blood  was  required ;  we 
find  this  provision  made.  Are  not  those  vessels  large  and  powerful, 
which  convey  blood  from  the  aorta  to  the  confines  of  the  brain  ■?  And 
do  we  not  see  the  brain  carefully  protected  against  the  force  of  its  own 
circulation  V  Here  we  cannot  but  admire  the  philosophic  views  enter- 
tained by  Dr.  Paine,  which,  howevei',  the  necessary  limits  allotted  to  his 
Article  only  permit  us  thus  to  glance  at. — Kote  O  p.  1121. 

"  The  rate  at  which  the  blood  circulates  in  the  membranes  is  inferred 
to  be  much  more  active  than  that  within  the  proper  substance  of  the 
organ  ;  the  bulk  of  transmitted  blood  being  confined  to  the  membranes. 
Yet,  from  the  tortuous  coui'se  of  their  vessels,  the  circulating  fluid  must 
pass  slowly  compared  to  its  progress  in  other  great  organs.  It  is  prob- 
able, too,  from  such  considerations,  that  in  health  the  proportion  of  serum 
varies.  If  so,  a  variable  state  within  the  cranium  is  denoted ;  and  the 
normal  proportion  of  blood  being  ever,  probably,  nearly  the  same,  it  fol- 
lows, in  Dr.  Paine's  opinion,  that  '  any  preternatural  space  must  have 
been  occupied  by  vapour.'  In  accordance  with  the  results  of  our  Au- 
thor's experiments,  we  have  these  principles  deduced  for  practical  guid- 
ance, that 

'* '  Blood  may  be  abstracted  from  the  brain  in  the  same  manner  and 
to  the  same  extent  as  from  other  organs. 

"  '  That  there  takes  place  necessarily  an  active  contraction  of  the  blood- 
vessels of  the  brain,  as  the  exhaustion  of  their  blood  follows  equally  when 
the  external  air  is  not  admitted  within  the  cavity  of  the  cranium. 

" '  That  there  must  be  a  production  or  expansion  of  aqueous  vapour 
corresponding  in  bulk  and  elasticity  with  the  diminished  quantity  of 
blood  and  the  decrease  of  pressure  from  the  force  of  the  heart  and  blood- 
vessels. 

" '  That  the  natural  proportion  of  blood  found  in  the  brain,  after  its 
copious  abstraction  from  the  system,  arises  from  a  quantity  still  remain- 
ing in  the  vessels  connected  with  those  of  the  head,  and  which  rushes 
into  the  brain  after  death  to  supply  the  vacuum  produced  by  the  con- 
densation of  the  vapour  generated  during  the  contraction  of  the  cerebral 
vessels.' 

"  Dr.  Paine  argues  that  the  living  system  is  under  the  government  of 
uniform  laws.     Universal  contraction  of  the  bloodvessels — a  contrac- 


The  Brain. — appendix. — Experiments.  827 

tion  greater  in  the  extreme  vessels  than  what  is  explicable  by  the  mere 
loss,  is  observed  to  be  attendant  on  the  abstraction  of  blood  (§  746  a,  912, 
931,  935  b-e,  938  h,  944  a-c,  Sec).  Is  not  a  similar  contraction  ex- 
tended to  the  vessels  of  the  brain,  not  less  from  the  withdrawal  of  blood, 
than  likewise  '  through  the  influence  of  sympathy  with  the  vascular  ac- 
tion throughout  the  Ijody,  an  influence  rendered  still  more  probable  by 
the  propagation  of  the  sympathetic  nerve  along  the  arteries  of  the  brain ; 
that  the  topical  abstraction  of  blood  by  cupping  and  leeching,  if  not  also 
vesication,  operates  by  producing  a  sympathetic  contraction  of  the  ves- 
sels within  the  brain  ;  that  inflammation  of  the  brain  is  relieved  on  a 
common  principle ;  and  that  opposite  inferences  would  involve  the  re- 
markable exemption  of  a  part  from  the  operation  of  general  laws,  and 
a  violation  of  the  usual  simplicity  of  Design?'  (§  51C  d,  756  b,  893  a-i, 
915-921,  939,  974, 1039) Note  Q  p.  1122. 

"  The  varying  changes  in  the  circulation  of  the  brain  renders  proba- 
ble the  existence  of  an  elastic  vapor.  This,  it  is  inferred,  is  rendered 
yet  more  probable  from  the  rapid  production  of  vapor  when  the  temper- 
ature is  at  98^  F.,  atmospheric  pressure  being  removed,  which  must  be 
greatly  the  case  within  the  cranium,  and  allowing,  also,  for  '  the  resist- 
ance of  the  circulating  fluid,'  '  Equal  increments  of  temperature,  by  in- 
creasing in  geometric  progression  the  force  of  vapor,  would  tend  to  em- 
barrass the  functions  of  the  brain.  But  an  admii-able  provision  of 
Nature  guards  against  the  occurrence  of  such  casualties.'  As  the  bony 
inclosure  excludes  the  influence  of  atmospheric  pressure,  minus  the  open- 
ings at  the  base  of  the  skull,  '  the  generation  of  an  elastic  vapor  is  pro- 
vided, the  pressure  of  which  at  98°  F.  to  the  ratio  of  steam  at  212°,  is 
as  If  to  30.  It  will  therefore  admit  of  an  easy  condensation,  such  prob- 
ably as  would  be  produced  by  an  inci'eased  determination  of  blood  to 
the  head,  and  more  especially  by  blood  extravasated;*  and  however  the 
general  force  of  the  circulation  may  be  undetermined,  it  is  abundantly 
obvious,  from  the  tortuous  course  of  the  vessels,  and  their  minute  subdi- 
vision before  entering  the  substance  of  the  brain,  that  the  current  is  here 
sluggish  and  easily  resisted,  even  if  it  be  admitted  that  capillary  circu- 
lation depends  upon  the  vis  a  tergo,  as  it  does  not  (§  392,  c).  It  will  not, 
therefore,  be  difficult  to  imagine  that  there  exists  this  farther  harmoni- 
ous relation,  by  which  the  ordinary  force  of  the  circulating  fluid  is  ac- 
curately counterbalanced  by  an  aqueous  vapour.' 

"  The  minute  subdivision  of  vessels  before  entering  the  substance  of 
the  brain-^the  obstacles  checking  the  impetus  of  blood  from  the  heart's 
action — the  absence  of  valves  in  the  cerebral  veins — the  remarkable  dis- 
tribution of  the  sympathetic  rierre,  &c.,  are,  in  Dr.  Paine's  opinion,  so 
man^  powerful  motives  for  believing  that  the  circulation  in  the  brain  is 
especially  dependent  on  a  specific  action  of  the  vessels  themselves  (§  392  c, 
&c.).  The  experiments  tend  to  show  that,  if  vapor  exist  naturally,  its 
quantity  must  be  small.  A  small  quantity,  however,  is  quite  sufficient 
for  meeting  the  exigencies  of  its  purpose.  The  vapor  may  yet  be  found, 
it  is  supposed,  by  subsequent  inquii'ers,  to  enact  a  most  influential  part 
in  the  cerebral  economy,  its  great  compressibility  admitting  of  rapid 
changes  in  the  quantity  of  circulating  fluid  ;  and  by  which, '  in  severe  con- 
gestions, mechanical  pressure  is  partly  obviated,  and  the  circulation  less 
embarrassed  in  portions  of  the  organ  not  involved  in  disease.' 

"  If  the  production  of  vapor  under  the  most  probable  circumstances 
could  be  established,  '  the  uniformity  of  Nature,  upon  the  questions  be- 

*  In  no  other  way  can  the  largest  quantities  of  extravasated  blood  be  explaiqed. 


828  INSTITUTES    OF    MEDICINE. 

fore  us,  would  be  recognized.  No  longer  would  there  exist  any  neces- 
sity of  forming  new  doctrines  to  explain  analogous  changes  which  have 
acquired  the  force  of  established  laws  among  other  organs;  the  treat- 
ment of  cerebral  congestion  or  inflammation  will  be  again  placed  on  the 
broad  principle  which  determines  the  treatment  of  similar  affections  in  ev- 
ery part  of  the  body ;  and  when  the  organ  becomes  the  subject  of  venous 
plethora  or  of  high  vascular  action — when  the  carotids  are  beating  with 
a  violence  that  communicates  motion  to  the  head,  while  the  pulse  in  the 
extremities  is  low,  feeble,  and  oppressed  ;  when  also  the  skin  is  cold,  and 
the  blood,  which  may  not  be  determined  to  the  head,  is  accumulated 
about  the  abdominal  viscera,  and  the  heart  pulsates  with  exhausted  ef- 
forts, we  shall  be  no  longer  obliged  to  adopt  the  difficult  rationale,  that 
the  abstraction  of  blood  diminishes  the  violence  of  action  in  the  brain  by 
its  impression  on  the  vis  a  tergo.  We  shall  see  it  exerting  its  influence 
on  the  vessels  within  the  brain,  as  it  obviously  does  on  those  of  the  abdom- 
inal viscera  which  may  be  simultaneously  affected  by  congestion ;  we 
shall  not  doubt  that  it  equally  induces  a  change  of  action  in  the  vessels 
attended  by  their  contraction,  in  all  the  organs  that  may  be  involved 
in  analogous  affections ;  and  we  shall  the  more  readily  assent  -to  this 
proposition  and  abandon  the  notion  of  a  diminished  vis  a  tergo,  when  we 
find,  as  these  changes  progress,  the  pulse  rises  in  strength  and  fulness, 
and  the  heart  beats  with  moi'e  than  natural  energy;  which  now,  indeed, 
may  require  the  farther  abstraction  of  blood  to  lessen  its  violence  and 
remove  the  evil  it  originally  produced  ;  now,  indeed,  the  vis  a  tergo  may 
become  a  motive  for  continued  depletion'  (§  498/,  750  a,  801,  806,  811- 
813,  961  e,  965  h,  968,  969  c,  990  ?'). 

"  From  a  lengthened  paragraph  of  highly  ingenious  reasoning,  Dr. 
Paine  draws  a  corollary — that  the  force  of  the  momentum  of  the  circu- 
lation within  the  brain  may  be  determined  '  with  an  approach  to  accu- 
racy,' and  that  its  force  must  be  '  nearly  in  the  ratio  of  the  expansion 
of  vapor  at  98°  Fahrenheit,  removed  from  atmospheric  pressure.'  " 

Although  the  writer  of  the  abstract  is  pleased  to  say  that  "  with  one 
other  extract  we  must  reluctantly  conclude  this  notice,"  I  shall  not  re- 
peat it  here,  and  have  omitted  other  parts,  as  not  being  immediately  rel- 
ative to  my  present  objects. 

But  I  will  add,  in  conclusion,  that  Bonder  has  seen  the  arteries  of  the 
pia  mater  contract  when  the  cervical  sympathetic  nerve  is  irritated. 
The  brain  was,  of  course,  exposed  ;  but  if  contraction  take  place  undei' 
such  circumstances,  it  is  a  law  which  must  operate  in  the  natural  con- 
dition.— Bonder's  Physiologie  des  Menschen,  p.  138, 140. 

SEDATIVES. 

§  1057,0.  It  will  be  seen  in  these  Institutes,  that,  immediately  follow- 
ing the  general  subject  of  Therapeutics,  and  preceding  that  of  the  Modus 
Operandi  of  Remedies,  and  extending  from  page  563  to  660,  are  disqui- 
sitions upon  the  uses  of  various  groups  of  the  Articles  of  the  Materia 
Medica,  and  that  among  the  number  are  Narcotics,  which  are  considered, 
in  part,  in  their  aspect  as  Sedatives.  It  is  now  my  purpose  to  make 
some  general  comments  upon  the  virtues,  and  mode  of  operating,  of  the 
entire  group  of  Sedatives,  and  upon  the  differences  which  prevail  among 
the  several  members  of  the  group  (See,  particularly,  p.  583-593). 

I  understand  by  Sedatives  those  remedies  whose  general  tendency  is  to 
diminish  vascular  action  in  a  direct  manner ;  though  in  some  instances 


Tlierapeutics. — appendix. — Sedatives,  829 

they  may  at  first  produce  more  or  less  excitement,  which  is  followed  by 
diminished  action  as  an  ultimate  result  of  the  remedy  (§891,  q).  Nay 
more,  the  excessive  application  of  the  most  powerful  Sedatives — loss  of 
blood,  narcotics,  hydrocyanic  acid,  and  cold,  may  light  up  inflammation 
or  venous  congestion  in  the  brain,  whilst  they  simultaneously  exert  their 
general  sedative  eftects  upon  the  system  at  large  until  the  cerebral  affec- 
tion gives  rise  to  constitutional  excitement  (§  743,  817,  827  c7,  950,  974  h, 
1024).    The  various  aspects  of  the  modus  operandi  may  be  seen  in  ^  891-|-  k. 

These  opposite  effects,  however,  are  not  common,  nor  is  the  excite- 
ment ever  strongly  pronounced  unless  the  sedative  proves  morbific.  In 
the  extensive  class  of  Stimulants  and  Tonics  we  are  presented  with 
agents  which  illustrate,  by  their  opposite  virtues,  the  common  attributes 
of  the  Sedatives  ;  since  it  is  the  direct  and  equally  uniform  tendency  of 
the  former  to  increase  vascular  action  in  a  direct  manner.  As  examples 
of  the  two  Classes,  bloodletting,  antimonials,  hydrocyanic  acid,  and  cold, 
may  be  I'eckoned  as  standards  of  comparison  for  Sedatives,  and  alcoholic 
liquors,  spices,  mints,  the  vegetable  and  mineral  tonics,  animal  food,  and 
dry  heat,  as  representing  the  virtues  of  Stimulants. 

There  are  many  things,  however,  which  may  increase  vascular  action, 
and  induce  inflammation,  which  operate  in  virtue  of  some  irritation  they 
exert  (such  as  aloes,  scammony,  &c.),  but  whose  action  is  very  different 
from  that  of  stimulants.  Indeed,  tlie  most  powerful  Sedatives,  as  we 
have  seen,  may  become  irritants  in  excessive  amount,  and  excite  inflam- 
mation. But  they  can  never  act  as  Stimulants  in  the  proper  accepta- 
tion of  this  class  of  agents,  but  in  virtue  of  morbific  influences  of  an  irri- 
tating nature.  Irritants  produce  disease  when  Tonics  will  not(i5>  188-191). 

It  appears,  therefore,  that  Sedatives  are  liable  to  the  same  qualifica- 
tions as  we  have  seen  of  the  groups  of  other  remedies,  being  liable  to  be 
more  or  less  otherwise  unless  rightly  administered.  This  qualification 
is  more  strongly  manifested  in  morbid  than  in  healthy  states  of  the  body. 
There  must  be  a  pathological  condition  which  shall  be  in  relation  to  the 
peculiar  virtues  which  are  denominated  sedative,  or  no  sedative  effect 
may  arise  from  the  action  of  the  remedy,  and  even  an  opposite  result 
may  be  the  consequence,  as  often  witnessed  of  opium  when  administer- 
ed in  high  states  of  arterial  excitement.  And  I  am  now  led  to  remark 
that  the  tei'm  Sedative,  like  many  other  denominations  of  remedies,  is 
very  far  from  conveying  an  adequate  apprehension  of  the  effects  pro- 
duced ;  for  the  agents  so  called  not  only  reduce  the  properties  of  life, 
and  lessen  vascular  action,  but  they  exert  more  or  less  of  a  direct  alter- 
ative effect.  That  effect  is  most  distinctly  marked  when  they  aggravate 
or  produce  disease.     (See  Index,  Article  Alteratives.) 

§  1057,  b.  Again :  various  Sedatives  will  be  far  from  being  suited  to 
many  conditions  of  disease,  when  others  of  the  group  may  be  in  the  high- 
est degree  salutary.  Take  two  of  the  most  powerful.  Loss  of  blood, 
for  example,  will  often  save  life  where  opium  would  be  destructive  ;  and, 
vice  versa,  opium  will  relieve  the  subject  of  gastric  spasm  induced  by 
drinking  cold  water,  when  loss  of  blood  might  destroy  him.  Even  in 
some  conditions  of  inflammation,  remedies  which  are  commonly  stimu- 
lating and  tonic  will  prove  sedative  when  bloodletting  may  be  at  least 
useless.  Such  is  the  case  in  intermittent  inflammation,  after  suitable  de- 
pletion ;  since  Cinchona  may  then  succeed,  when  loss  of  blood,  antimo- 
nials, &c.,  have  ceased  to  be  curative  (§  G62  b,  675,  892  m-p).  This 
consideration  brings  up  the  importance  of  looking  well  at  the  patholog- 


830  INSTITUTES    OF    MEDICINE. 

ical  distinctions  among  closely-allied  diseases,  inasmuch  as  Cinchona, 
and  many  other  agents  of  active  tonic  virtues,  are  directly  sedative  (by 
their  alterative  action),  in  suitable  states  of  the  system,  in  intermittent 
fever,  Avhile  they  aggravate  all  other  fevers  at  the  same  early  stages ; 
and  it  is  only  the  intermittent  form  of  inflammation,  and  those  venous 
congestions  which  have  peculiar  miasmata  for  their  predisposing  causes, 
in  which  Cinchona  would  not  also  prove  stimulating.  So  far,  therefore, 
the  foregoing  tonics  belong  to  the  group  of  Sedatives  ;  and  they  show  us 
the  difficulties  of  artificial  arrangements  of  the  Materia  Medica.  These 
arise  mostly  from  the  compound  virtues  of  remedies,  and  often,  as  in  the 
case  before  us,  from  certain  important  virtues  being  developed  only  by 
special  pathological  conditions  ;  for,  it  is  not  the  tonic,  but  the  febrifuge 
virtue  of  Cinchona,  and  analogous  remedies,  which  does  the  service  in 
ihtermittents.  The  latter  is  then  so  completely  in  relation  to  the  spe- 
cial modifications  of  disease  that  it  transcends  or  counteracts  the  mor- 
bific action  of  the  former  (§  150-151,  and  references  there). 

§  1057,  c.  In  my  ^''  T her a2'>eutical  Arrangement  of  the  Materia  Medica^'' 
I  have  given  a  rather  different  import  to  the  group  of  Sedatives  than  is 
common,  having  placed  them  as  a  special  order  of  Antiphlogistics.  The 
group  is  composed  of  such  as  are  most  capable  of  subduing  general  arte- 
rial excitement  in  a  direct  manner,  though  some  of  them  may  be  little 
suited  to  the  relief  of  local  excitement.  Thus,  the  narcotics,  when  just- 
ly applied,  reduce  the  irritability  of  the  whole  system,  and  moderate 
general  excitement.  But  they  have  no  great  tendency  to  assuage  local 
inflammations,  but,  on  the  contrary,  their  tendency  is  more  frequently  to 
increase  them.  In  the  arrangement,  therefore,  of  the  Sedatives  accord- 
ing to  the  restricted  sense  in  which  I  have  employed  the  term,  I  have  es- 
timated their  therapeutical  value  according  to  their  greatest  usefulness 
in  allaying  morbid  irritability  and  sensibility,  particularly  the  former, 
in  their  appropriate  relations  to  certain  conditions  of  disease. 

§  1057,  d.  We  may  next  proceed  to  regard  Sedatives  under  five  ^xih- 
dW\^\ox\s,  r\^Ti\Q\y,  Sedatives  proper ;  Narcotics;  Cold;  Alteratives  capable 
of  nauseating,  but  without  producing  that  effect;  and  Nauseants. 

The  first  subdivision,  or  Sedatives  proper,  comprises  Loss  of  Blood, 
Plydrocyanic  Acid,  Cyanide  of  Potassium,  Cyanide  of  Zinc,  Ferro-cya- 
nide  of  Potassium,  Cherry  Laurel,  Bitter  Almonds,  Hydrosulphate  of 
Ammonia,  Foxglove,  Tobacco,  Indian  Tobacco. 

The  second  subdivision,  or  Narcotics,  embraces  Opium,  and  its  prepa- 
rations as  arranged  in  the  order  of  their  therapeutical  value,  Henbane, 
Poison  Hemlock,  Lupuline,  Lactucarium.  Add  also  the  '■'■  Senso-Para- 
lysants" — Belladonna,  Aconite,  Stramonium,  and  Delphinium.* 

The  third  subdivision  consists  of  Cold  only,  and  in  its  local  action. 

The  fourth  subdivision  consists  of  Tartarized  Antimony,  to  which  Ip- 
ecacuanha might  be  added. 

The  fifth  subdivision,  or  the  Nauseants,  refers  to  such  agents  as  are 
sedative  only  when  they  produce  nausea.  There  are  many  of  this  de- 
nomination, but  none  of  them  are  of  much  use  in  medicine  as  nauseants  ; 
but,  on  the  contrary,  they  arc  apt  to  produce  an  injurious  irritation  of 
the  gastro-intestinal  mucous  membrane  when  carried  to  the  extent  of 
nausea.     They  are,  therefore,  not  specified  in  our  group  of  Sedatives. 

§  1057,  €.  Now,  there  are  certain  well-marked  analogies  among  all 
the  foregoing  subdivisions,  yet  each  differs  from  the  others  in  some  very 
prominent  characteristics.     Indeed,  there  are  no  two  of  the  remedies, 
*  See  Note  Nn  p.  1141. 


Therapeutics. — ^appendix. — Sedatives.  831 

however  allied  os  Sedatives,  which  do  not  present  some  strong  peculiari- 
ties. Take,  for  example,  the  first  two  of  the  first  subdivision — loss  of 
blood  and  hydrocyanic  acid.  These  are  the  most  immediate  and  power- 
ful sedatives,  in  our  acceptation  of  the  term,  yet  each  has  its  own  pecu- 
liar mode  of  reducing  irritability  and  vascular  excitement,  nor  do  they 
modify  irritability  and  vascular  action  alike.  .Each,  however,  as  with 
all  other  Sedatives,  depresses  irritability  and  action,  and  this  is  the  only 
stronf  point  of  resemblance.  The  special  differences  consist  in  the  dif- 
ferent modes  in  which  each  Sedative  alters  irritability  and  action  in  their 
kind  (§  854,  895-901 ;  also  Indexes,  Alteratives).  It  is  an  ignorance  or 
neglect  of  this  philosophy,  and  too  often  a  contempt  of  all  inquiry  into 
the  modus  operandi  of  remedies  (shut  out,  indeed,  by  the  prevailing  chem- 
ical doctrines  of  disease),  which  leads  to  a  vast  amount  of  malpractice, 
and,  in  respect  to  the  most  important  of  the  agents  now  before  us,  which 
has  prompted  the  substitution,  in  otherwise  enlightened  quarters,  of  opi- 
um, digitalis,  tobacco,  aconite,  veratrum  viride  (§  891  c,  960  a,  1065) — 
ay,  even  stimulants  and  tonics,  for  loss  of  blood  and  tartarized  antimo- 
ny, and  often,  too,  where  bloodletting  is  indispensable  to  life. — Note  H. 

Besides  what  has  been  now  said  of  the  more  prominent  distinctions 
among  Sedatives,  there  are  others  less  distinctly  marked  among  such  of 
the  agents  as  are  most  nearly  allied,  as  the  Narcotics.  These,  however, 
have  been  already  indicated  under  the  subjects  of  Narcotics,  Therapeutics, 
Vital  Habit,  &c.  But  it  is  more  remarkable  that  some  of  the  Sedatives 
which  have  no  point  of  resemblance,  except  in  their  effects  upon  morbid 
conditions,  bring  about  alterations,  or  changes  in  kind,  of  a  con-espond- 
ing  nature ;  as  loss  of  blood  and  tartarized  antimony,  for  example,  in 
their  subversion  of  inflammation  and  fever.  But  the  same  remarkable 
characteristic  is  strongly  pronounced  among  many  other  remedies  ;  as  in 
the  control  which  Cinchona,  Arsenic,  and  Cobweb  exert  over  Intermit- 
tent Fever  (§  892  aa-c,  900,  904  c,  &c.).— See  Note  Ee  p.  1133. 

§  1057,/.  It  is  commonly  said  that  "  Sedatives  exert  their  effects  es- 
pecially upon  the  nervous  system."  But  this  is  far  from  being  the  case 
with  loss  of  blood  and  the  antimonials,  and  only  in  a  restricted  sense  as 
regards  those  agents  which  have  the  greatest  relation  to  the  nervous  sys- 
tem. The  nervous  power  is  certainly  involved  throughout.  But  this  is 
also  true  of  all  other  agents  whose  effects  reach  beyond  the  direct  seat  of 
their  operation.  All  exert  their  primary  action  upon  the  parts  to  which 
they  are  applied ;  and  when  the  nervous  power  is  brought  into  opera- 
tion, it  is,  as  extensively  set  forth  in  these  Institutes,  by  a  transmission 
of  the  remedial  influences  to  the  nervous  centres,  and  a  consequent  de- 
termination of  the  nervous  power  either  upon  the  organic  constitution 
of  the  brain  or  of  other  parts.  If  the  action  be  exclusively  local,  the 
nervous  system  participates  only  as  a  part  of  compound  tissues,  not  by  re- 
flex action  unless  through  local  centres  (§  746  c).  True,  this  doctrine  has 
no  relationship  to  those  physical  ones  which  render  the  Science  of  Medi- 
cine as  simple  and  mechanical  as  the  business  of  a  shoemaker. 

But,  do  not  some  of  the  Sedatives  affect  particularly  the  nervous  sys- 
tem, its  central  parts  especially,  just  as  other  agents  affect  particularly 
other  parts,  as  cantharides  the  bladder,  ergot  the  womb  ?  &c.  Certain- 
ly ;  and  this  is  especially  true  of  the  Narcotics.  In  excessive  doses  their 
main  fury  is  expended  upon  the  organic  constitution  of  the  brain,  and 
venous  congestion  of  that  organ  is  one  of  the  invariable  consequences. 
But  this  is  effected  through  a  very  different  process  from  what  has  been 


832  INSTITUTES    OF    MEDICINE. 

hitherto  supposed.  The  result  is  partly  due  to  the  reflex  action  of  the 
nervous  power,  in  a  modified  condition,  upon  the  capillary  vessels  of  the 
brain  and  spinal  cord,  but  also  more  or  less  upon  the  heart,  the  stomach, 
&c.  (§  228,  230,  508,  509,  &c.).  The  intensity  of  the  general  effects 
upon  the  system  at  large  will  often  depend  more  upon  the  determination 
of  the  nervous  power  uppn  important  organs  i-emote  from  the  brain,  than 
upon  the  amount  of  influence  exerted  by  the  nervous  power  upon  the 
organic  properties  of  the  brain  and  spinal  cord.  The  general  reflex  ac- 
tion may  be  so  sudden  and  violent,  as  in  the  case  of  hydrocyanic  acid, 
that  it  shall  destroy  the  life  of  the  heart,  the  lungs,  &c.,  without  leav- 
ing a  trace  of  its  influence  upon  the  brain ;  as  is  seen,  also,  in  sudden 
deaths  from  blows  upon  the  epigastric  region,  surgical  operations,  &c. 
(§  470^  h,  508-510,  828  c,  904  b).  At  other  times,  as  with  opium,  the 
remote  effects  may  depend  much  upon  the  morbid  change  which  the 
agent  may  establish  in  the  nervous  centres.  But,  in  its  ordinary  me- 
dicinal doses,  opium  exerts  no  such  morbific  effect  upon  the  nervous  sys- 
tem ;  when  it  rouses  and  modifies  the  nervous  power  in  degrees  of  in- 
tensity which  are  not  morbific  (if  the  remedy  be  properly  adapted  to  the 
pathological  conditions),  and  in  the  same  general  way  as  all  other  reme- 
dial agents,  but  in  a  way,  also,  both  as  to  degree  and  modification  of 
the  power,  peculiar  to  the  virtues  of  the  narcotic  (§  227-229,  and  refer- 
ences there).  It  is  this  special  modification  of  the  nervous  power,  and 
its  reflected  alterative  action  upon  various  parts,  which  lessens  and  oth- 
erwise modifies  the  irritability,  sensibility,  and,  of  consequence,  the  or- 
ganic actions,  of  all  parts  of  the  body  (§  891^  k^  893  o,  c,  904  a,  ft,  1059). 

§  1057,  (J.  Cold  is  generally  local  in  its  operation  so  long  as  it  is  con- 
fined to  a  limited  portion  of  the  surface  of  the  body,  and  it  is  scarcely 
beyond  this  local  elFect  that  its  operation  as  a  sedative  is  witnessed.  Its 
reflex  nervous  actions  are  mostly  of  a  stimulating  nature.  In  its  local 
aspect  it  operates  alone  upon  the  organic  constitution  of  the  part,  as 
seen  in  its  effects  upon  superficial  inflammations.  But  there  are  remark- 
able reflex  influences,  as  when  a  current  of  cold  air  striking  the  neck 
or  chest  occasions  rheumatism,  catarrh,  pneamonia,  &c.,  or  when  ex- 
posure of  the  feet  to  cold  arrests  menstruation.*  There  is,  also,  a  still 
more  remarkable  and  very  uniform  effect  of  this  reflex  nervous  action, 
but  not  of  a  moi'bific  nature,  in  suddenly  increasing  the  excretion  of 
urine ;  and  if  with  this  phenomenon  be  associated  the  powerful  effect 
of  fear  as  a  diuretic  (§  892  J  ft),  there  will  be  seen  a  display  of  results 
which  demonstrate  the  analogy  between  physical  and  mental  causes  and 
the  nervous  power,  and  how  the  latter  is  developed  by  the  former  and 
participates  as  an  exciting  or  modifying  cause  in  all  the  remote  effects 
(§  224-227,  233i,  475^,  493  cc).  Again:  Avhen  cold  operates  with 
great  intensity  upon  the  whole  surface  of  the  body  it  occasions  lethargy 
and  venous  congestion  of  the  brain.  The  pliilosopiiy  is  the  same  as  when 
liydrocyanic  acid  produces  cerebral  congestion.  (See  Essay  on  the  gi-eat- 
er  action  of  Cold,  in  Med.  and  Physiolog.  Comm.,  vol.  ii.,  p.  590-602.) 

The  great  variety  of  effects  which  Cold  is  capable  of  producing,  be- 
sides those  to  which  I  have  adverted,  such  as  its  invigorating  influences 
when  applied  in  the  form  of  a  shower-bath,  both  in  health  and  many 
chronic  maladies,  &c.,  are  among  the  plain  things  which  illustrate  the 
important  agency  of  the  nervous  power  in  transmitting  the  influences  of 
remedial  agenls  from  the  direct  seat  of  their  operation  to  distant  parts,  and 
show  us  how  readily  and  with  what  intensity  this  power  may  be  brought 

*  See  also  Brown-Suquard's  experiment  of  immersing  the  Land  in  cold  water,  p.  807, 
§  1044. 


Therapeutics. — appendix. — Ccistor  Oil.  833 

into  operation  bj  any  of  the  substantial  agents  of  the  Materia  Medica, 
or  by  morbific  causes,  while  its  universal  manifestations  in  healthy  states 
of  the  body,  or  as  disease  of  one  part  gives  rise  to  disease  in  other  parts, 
establish  the  philosophy  of  our  whole  subject  upon  one  common  physio- 
logical ground  of  alterative  reflex  actions  of  the  nervous  system. 

§  1057,  h.  I  have  placed  Tartarized  Antimony  in  a  subdivision  by 
itself,  though  many  would  probably  arrange  it  with  the  Nauseants.  But 
the  former  produces  very  powerful  sedative  effects  without  exciting 
nausea,  as  seen  in  the  manner  in  which  inflammations  and  fevers  yield 
to  its  quiet  influence.  But  the  principles  concerned  are  exactly  the 
same  in  all  the  cases  ;  thougli  great  vai'iety  arises  throughout  the  whole, 
even  in  respect  to  each  individual  agent,  and  according  to  its  dose,  the 
frequency  of  administration,  the  precise  pathological  condition,  the  na- 
ture of  the  organ  affected,  and  many  other  modifying  contingencies.  As 
it  respects  Tartarized  Antimony,  its  influences  involve  a  very  important 
modification  of  the  simply  sedative  principle.  This  is  its  alterative 
power,  and  by  which  it  is  rendered  of  the  highest  value  in  the  treatment 
of  diseases  (§  150-151,  841,  857,  863  d,  892|  g,  902  g,  904  hh,  476^). 

§  1057,  i.  Finally  :  the  group  of  Sedatives  is  designed  mainly  to  bring 
into  connection  a  number  of  remedies  Avhich  have  certain  important 
analogies,  but  variously  and  often  greatly  distinguished  from  each  other, 
that  they  may  be  considered  comparatively;  with  a  view  to  enlarging  our 
knowledge  of  the  relationship  of  remedies,  their  points  of  difference,  their 
modes  of  operating,  &c.  It  is,  however,  more  artificial  than  any  other 
group,  and  is  of  very  little  use  for  practical  purposes. 

The  Sedative  Effects  of  Cotton-wool  and  of  Castor  Oil- 

§  1057,  Ic.  In  connection  with  the  foregoing  subjects,  I  shall  briefly 
indicate  certain  apparently  sedative  virtues  belonging  to  common  Cotton 
and  Castor  Oil,  as  resulting  from  my  own  experience. 

In  the  edition  of  my  Materia  Medica  and  Therapeutics  of  1848,  I  re- 
marked that 

The  virtues  of  Cotton-wool  appear  to  be  more  than  of  an  ordinary  me- 
chanical nature.  It  is  evidently  alterative  as  well  as  quickly  sedative ; 
and,  doubtless,  these  remarkable  effects  are  owing  to  some  very  peculiar 
mechanical  influence.  The  Author  has  employed  it  with  the  happiest 
effect  in  poisoning  by  the  Rhus  toxicodendron ;  particularly  in  his  own 
person,  whei-e  the  hands  and  arms  were  severely  inflamed,  swollen,  and 
deeply  ulcerated.  The  relief  from  suffering  was  immediate,  and  the 
dressing  was  not  removed  till  restoration  had  become  complete.  The 
case  had  baffled  other  remedies. 

I  know  not  whether  the  remedy  has  been  submitted  by  others  to  trials 
beyond  its  well-known  uses  in  burns  and  scalds,  excepting  by  Mr.  Jones 
in  cases  of  ulcers,  who  appears  to  have  derived  the  same  benefit  from  it 
as  myself  (in  London  Lancet,  Dec,  1850). 

Very  lately  I  had  in  charge  an  obstinate  ill-conditioned  ulcer  upon  a 
highly  varicose  leg  of  a  lady  of  delicate  health,  attended,  also,  by  an  in- 
tense cutaneous  inflammation  surrounding  the  central  half  of  the  limb 
from  the  knee  to  the  ankle,  and  which  was  studded  over  with  a  crop  of 
suppurating  eruptions.  There  was  also  a  painful  sense  of  burning  and 
itching.  Failing  of  all  relief  from  the  usual  remedies,  excepting  a  mod- 
eration of  the  sense  of  burning  and  itching  from  cold  bread  and  milk 
poultices,  I  resorted  to  the  cotton- wool,  the  effect  of  which  was  rather 

Ggo 


b34  INSTITUTES    OF   MEDICINE. 

astonishing.  The  painful  sensations  were  immediately  removed,  and  the 
cure  completed  in  about  a  week,  though  a  dry,  thick,  hard  scab  had  then 
formed  uj^on  the  ulcer,  which  became  detached  in  five  days  afterward, 
when  an  elastic  silk  stocking  was  applied  to  the  varicose  limb.  This  oc- 
curred in  the  hot  weather  of  June. 

A  large  mass  of  the  wool  should  be  applied,  so  as  to  form  at  least  an 
inch  in  thickness  when  bound  down  by  a  bandage ;  and  thus  far  in  my 
experience  it  should  not  be  disturbed  till  there  is  reason  to  think  that 
it  has  fulfilled  its  purpose.  But,  having  never  been  in  pursuit  of  new 
remedies,  my  experience  in  this  particular  is  less  than  it  otherwise  would 
have  been.  I  think,  however,  that  there  can  be  no  doubt  of  the  great 
superiority  of  cotton-wool  to  other  means  in  the  foregoing  and  analo- 
gous affections,  even  if  it  be  necessary  to  remove  the  dressing  frequently, 
as  in  cases  of  inflamed  and  chapped  nipples.  But  even  in  these  cases 
the  cotton  should  be  closely  applied  by  means  of  a  bandage.  In  the 
case  of  ulcers,  it  appears  not  to  be  of  much  importance  that  they  should 
be  in  a  favorable  state  for  healing,  though  I  regret  that  I  have  not  tried 
the  remedy  in  any  of  an  eroding  or  malignant  nature.  It  should  be 
said,  however,  that  the  co-operation  of  constitutional  means  must  often 
be  necessary  in  the  unfavorable  cases  which  are  not  malignant,  and  that 
in  the  latter  we  may  hope  for  only  a  palliating  effect. 

§  1057, 1.  Of  Castor  Oil  I  remarked,  in  the  same  Avork,  that  the  Au- 
thor called  the  attention  of  the  Profession  to  the  special  alterative  influ- 
ences exerted  by  Castor  Oil  upon  the  Liver  in  his  Letters  on  tlie  Cholera 
Asphyxia  of  New  York,  and  again  in  the  Medical  and  Physiological  Com- 
mentaries, and  the  alterative  virtues  of  this  remedy  appear  now  to  be  ex- 
tensively appreciated.  I  also  said  that,  when  frequently  repeated  (as 
every  day,  or  every  other  day),  it  is  commonly  necessary,  and  pretty 
early,  to  reduce  the  quantity  from  one  or  two  table  spoonfuls  to  a  tea- 
spoonful,  or  even  to  a  fourth  of  a  teaspoonful,  the  remedy  being  remark- 
ably cumulative  in  its  effects.  This  is  greatly  owing,  however,  to  the, 
specific  action  of  Castor  Oil  upon  the  Liver,  and  the  consequent  in- 
creased production  of  bile.  It  is  often  peculiarly  efficacious  when  ex- 
hibited a  few  hours  after  calomel  or  blue  pill ;  is  very  useful  to  over- 
come habitual  constipation,  on  account  of  its  alterative  action  upon  the 
Liver,  when  it  should  be  given  in  small  doses  every  evening  (§  556  b, 
889  in,  mm).  Other  comments  follow  upon  its  important  uses  as  a  ca- 
thartic for  children,  and  for  pregnant  Avomen,  and  in  dysentery,  scarlet 
fever,  chronic  hepatic  affections,  &c.,  and  after  convalescence  from  acute 
diseases,  but  always  in  such  carefully  regulated  doses  as  shall  not  pro- 
duce intestinal  pain  and  mucous  discharges.  When  thus  regulated  in 
dose,  its  specific  action  upon  the  liver  in  inducing  a  free  secretion  of 
bile  is  greater,  in  a  general  sense,  than  calomel  or  blue  pill,  and  very 
often  more  usefully  alterative  (§  857).  It  cannot  be  too  strongly  insisted 
that  the  dose  should  be  accurately  adjusted  to  the  existing  condition  of 
the  intestines.  If  it  produce  griping,  or  frequent  or  mucous  discharges, 
the  dose  has  been  too  large,  and  the  useful  effects  of  the  remedy  will 
have  been  lost,  or  disease  may  be  aggravated,  especially  if  seated  in  the 
alimentary  canal. — See,  as  to  mercurials  and  the  liver  ^  1058  b. 

1  now  come  to  the  special  object  of  this  paragraph — the  soporific  vir- 
tue of  Castor  Oil,  and  this  I  shall  present  in  an  extract  from  my  Lectures. 
Thus : 

There  is  another  remarkable  peculiarity  about  Castor  Oil,  which,  like 


Therapeutics. — appendix. — Alteratives.  835 

its  special  action  upon  the  liver,  and  its  cumulative  effects,  you  will  not 
find  in  the  books.  It  is  that  of  exerting  a  soporific  wfluence ;  often  calm- 
ino-  restlessness,  both  in  children  and  adults,  soon  after  its  exhibition. 
Nor  does  it,  like  many  other  cathartics,  excite  the  general  circulation 
in  active  forms  of  inflammation  and  fever,  where  bloodletting  is  not  pre- 
mised, if  given  in  proper  doses  (§  871).  And,  on  account  of  its  anodyne 
and  soporific  effects,  I  often  exhibit  Castor  Oil  in  the  evening  in  cases 
where  I  should  delay  all  other  cathartics,  unless  the  mercurial,  till  morn- 
ing (§  863  f/,  889  n).  But  it  should  be  borne  in  mind  that  Castor  Oil,  in 
full  doses,  is  apt  to  operate  within  four  or  six  hours  after  its  exhibition, 
and  therefore,  if  given  early  in  the  evening  it  should  be  in  such  moderate 
quantities  as  may  not  be  likely  to  disturb  the  rest  of  the  patient  by  its 
cathartic  effect  before  morning  (§  889,  n).  Having  always  observed  this 
precaution  in  my  practice,  I  have  generally  left  instructions  to  repeat 
the  same  dose  if  necessary,  or  often  a  smaller  one,  at  some  hour  in  the 
morning,  or,  perhaps,  only  an  enema  of  warm  water.  I  have  thus  found 
the  dose  administered  in  the  evening  to  have  been  very  useful,  though  it 
have  not  operated  as  a  cathartic.  At  other  times,  both  in  acute  and  chron- 
ic diseases,  I  have  administered  small  doses  of  the  Oil  (as  a  teaspoonful 
or  less),  at  intervals  of  four  to  twelve  hours,  with  the  intention  of  delay- 
ing a  cathartic  effect  till  some  two  or  three  doses  shall  have  been  admin- 
istered— for  the  sake  of  its  slowly  alterative  action  upon  the  liver  and 
intestines  (§  857,  859  a,  b,  863  d,  873,  902  i,  905  a).  This  method  is  pur- 
sued in  susceptible  states  of  the  intestines,  and  often  in  the  advanced 
stages  of  all  diseases,  and  during  convalescence.  The  ultimate  result  is 
generally  a  copious  production  of  bile. 

ALTERATIVES. 

§  1057A.  It  will  be  seen,  by  referring  to  Indexes,  that  the  subject 
of  this  article  has  been  variously  discussed  in  its  relation  to  particular 
remedies ;  and  I  shall  now  make  some  general  remarks  upon  the  group 
of  Alteratives  as  assembled  in  the  Author's  Materia  Medica  and  Thera- 
peutics. 

Many  of  these  agents  are  derived  from  groups  that  bear  other  denom- 
inations ;  as  some  of  the  best,  for  example,  are  included  among  the  Ca- 
thartics and  Emetics.  But  many  of  them  belong  alone  to  the  group 
before  us ;  and  such  of  them  as  occur  among  remedies  of  other  denom- 
inations are  reduced  to  the  group  of  Alteratives  merely  by  their  dimin- 
ished doses  and  greater  frequency  of  exhibition.  And,  although  these 
last  are,  respectively,  the  same  substances  under  different  denominations, 
they  are  very  different  remedies,  in  certain  practical  respects,  as  they 
may  stand  in  one  group  or  another ;  though  they  may  act  upon  disease 
in  a  more  or  less  corresponding  manner  in  whatever  doses  they  may  be 
employed. 

But  there  is  a  general  characteristic  belonging  to  the  so  called  Alter- 
atives, as  intended  in  this  work,  which  assembles  them  into  a  group. 
That  characteristic  is  their  insensible  operation  compared  with  the  mem- 
bers of  other  groups  ;  and  their  action  is  to  be  appreciated  only  through 
certain  inconsiderable  phenomena,  and  through  the  subsidence  of  disease 
under  their  quiet  influence  —  as  when  arsenic,  or  quinine,  or  cobweb 
operate  in  the  cure  of  intermittent  fever.  When  other  remedies  belong- 
ing to  this  group  produce  some  j^rominent  local  effect,  or  are  more  ser- 
viceable in  their  operation  in  certain  large  therapeutical  doses,  they  are. 


836  INSTITUTES    OF    MEDICINE. 

in  such  cases,  ranked  under  other  denominations.  Such  is  the  case,  for 
example,  with  tartarized  antimony  and  ipecacuanha,  which,  in  certain 
therapeutical  doses,  operate  powerfully  as  emetics ;  whilst,  in  their  ac- 
ceptation as  Alteratives,  their  doses  are  comparatively  small  and  often 
repeated,  so  that  they  operate  in  an  insensible  manner,  though  their 
essential  influence  upon  morbid  states  may  be  the  same  in  whatever 
doses  employed.  In  one  case,  or  by  their  emetic  action,  they  may  pro- 
duce sudden  and  great  influences  upon  morbid  conditions,  alter  them 
very  speedily,  and  place  them  at  once  in  the  way  of  their  natural  return 
to  a  state  of  health.  In  the  other  case,  or  when  employed  in  their  small 
and  repeated  doses,  they  bring  about  the  same  salutary  changes  or  alter- 
ations without  exciting  even  any  nausea  (§  516  d,  No.  6,  §  902^).  It  is 
therefore  evident  that  these  substances,  like  many  others  of  the  group  of 
Alteratives,  may  be,  in  reality,  more  immediately  and  profoundly  alter- 
ative when  employed  in  full  doses,  as  Emetics  for  example,  than  in  their 
small  doses  under  the  denomination  of  Alteratives.  But  it  is  also  true 
that  both  tartarized  antimony  and  ipecacuanha  are  curative  of  a  vastly 
greater  range  of  diseases  in  their  small  and  frequently  repeated  doses 
than  when  administered  as  Emetics.  It  is  also  readily  apparent  that 
the  same  general  remarks  are  equally  applicable  to  calomel,  blue  pill, 
colchicum,  &c.,  which  are  cathartic  in  certain  doses,  but  powerfully, 
though  more  slowly  curative  in  such  small  doses  as  do  not  produce  purg- 
ing, and  which,  therefore,  in  these  small  doses,  I  call  Alteratives. 

There  are  many  things,  however,  which  are  as  insensible  in  their  op- 
eration as  our  group  of  Alteratives  that  are  not  included  in  this  group, 
particularly  the  Tonics  and  Astringents.  But  the  remedies  belonging 
to  these  denominations  are  very  peculiar  in  their  effects,  which  are  a 
good  deal  allied  as  the  remedies  may  belong  to  one  denomination  or  the 
other.  This  common  characteristic  serves,  therefore,  as  a  basis  of  ar- 
rangement for  either  group.  But,  in  the  case  of  the  Alteratives,  the 
want  of  any  general  correspondence  in  the  immediate  effects  of  its  sev- 
eral members  (with  certain  exceptions  which  are  grouped  into  subdivi- 
sions), and  the  absence  of  any  direct  and  well  pronounced  result,  have 
led  to  this  denomination. 

It  is  thus  seen  that  the  denomination  of  Alteratives  belongs  properly 
to  all  positive  remedies,  since  it  implies  the  absolute  effect  of  all  agents 
that  are  truly  remedial,  whether  physical  or  the  salutary  emotions.  That 
is  to  say,  they  produce  such  alterations  of  the  morbid  conditions  as  en- 
ables Nature  to  accomplish  the  cure,  or,  more  critically,  the  morbid 
organic  states  are  so  altered  to  a  condition  less  profoundly  morbid,  as 
enables  them  to  return  spontaneously  to  their  natural  type  (§  853-856, 
896-901). 

Although,  as  Ave  have  variously  seen,  all  agents  which  exert  effects 
upon  parts  remote  from  .the  seat  of  their  direct  operation  transmit  their 
influences  through  reflex  action  of  the  nervous  power,  the  Alteratives 
bring  it  into  action  somewhat  differently  from  those  agents  which,  like 
Cathartics,  and  Emetics,  and  Loss  of  Blood,  operate  suddenly  and  with 
gi'eat  power,  especially  when  the  Alteratives  are  administered  in  their 
usual  small  and  repeated  doses.  They  then  develop  the  nervous  influ- 
ence progressively  and  continuously,  and  therefore  bring  about  changes 
in  the  morbid  states  in  a  gradual  manner ;  while  in  the  other  cases  the 
changes  are  introduced  abruptly  (§  222-233^,  516  d,  No.  6,  §  551,  552, 
556,  841,  863,  867,  894-896,  002  e-f,  904  bb,  476^  /i.  905,  &c.). 


Therapeutics. — appendix. — Alteratives.  837 

It  will  be  seen,  therefore,  that  the  distinctions  which  are  made  of 
remedies  into  Cathartics,  Emetics,  Expectorants,  Astringents,  «fec.,  are 
merely  arbitrary,  and  for  the  sake  of  convenience.  As  we  have  various- 
ly seen,  also,  Cathartics,  Emetics,  &c.,  do  not  primarily  cure  by  the 
evacuations  they  produce,  but  essentially  through  their  alterative  action. 
The  evacuations  or  redundancy  of  the  secretions  are  only  consequences 
of  changes  which  the  remedial  agents  effect  by  their  alterative  action 
(§  863,  889  f-h) ;  and  while  Cathartics,  for  instance,  are  employed  in 
introducing  such  changes  in  the  functional  condition  of  the  intestinal 
mucous  membrane,  those  very  changes  lead  to  all  the  alterations  which 
take  place  in  diseased  parts  remote  from  the  intestinal  canal  (§  889,/). 
Whatever  part  the  redundant  products  may  contribute  towards  the  cure 
of  disease,  they  are  not  only  the  result  of  the  alterative  action  of  the 
remedies,  but  their  own  tributary  influences  are  of  an  alterative  nature, 
and  mostly  through  the  same  principle  of  sympathy  that  governs  the 
remote  action  of  the  agents  employed.     It  is  the  same  as  in  ^  944  c. 

Many  Alteratives,  in  the  sense  implied  by  the  group  now  under  con- 
sideration, are  remarkably  applicable  to  a  vast  range  of  diseases ;  but 
nearly  all  the  diseases,  to  which  any  of  the  members  of  this  extensive 
group  are  suited,  are  the  various  phases  of  inflammation  and  fever. 
Hence  the  group  forms  one  of  tlie  Orders  of  the  class  of  Antiphlogistics. 

Those  Alteratives  which  are  of  this  universal  nature  I  have  assembled, 
in  the  order  of  their  general  therapeutic  value,  under  the  denomination 
of  General  Alteratives  adapted  to  inflammatory  and  febrile  diseases  in  a  gen- 
eral sense.  They  are  more  or  less  suited  to  all  the  varieties  of  inflamma- 
tion, whether  acute  or  chronic. 

There  occurs  another  general  assemblage  which  are  more  especially 
adapted  to  specific  forms  of  inflammation  and  fever,  and  these  are  ar- 
ranged under  subdivisions  according  to  the  specific  forms  of  disease  for 
which  they  are  employed,  and  in  the  order  of  their  relative  value.  The 
following  are  the  subdivisions : 

1.  Adapted  to  scrofulous,  and  some  other  specific  chronic  inflamma- 
tions. 

2.  Adapted  to  syphilis,  and  certain  other  specific  chronic  inflamma- 
tions. 

3.  Adapted  to  syphilis  complicated  with  scrofula. 

4.  Adapted  to  rheumatism  and  gout. 

5.  Adapted  to  intermittent  fever,  intermittent  inflammation,  and  other 
intermitting  diseases. 

6.  Adapted  to  obstinate  and  chronic  cutaneous  diseases,  carcinoma, 
elephantiasis,  &c. 

Our  class  of  Antiphlogistics  embraces,  also,  a  group  of  Alteratives 
which  are  designated  as  local,  on  account  of,  particularly,  their  applica- 
tion to  the  surface  of  the  body.  This,  also,  is  an  extensive  group,  and 
is  divided  into  Constitutional  Alteratives,  or  such  as  extend  their  effects 
by  remote  sympathy,  and  of  which  there  are  but  few ;  and,  secondly. 
Limited  Alteratives,  whose  action  is  limited  to  the  part  to  which  they  are 
applied,  or  extended  only  by  continuous  or  contiguous  sympathy  (§  497- 
498,  8181,  893,  905,  &c.). 

As  all  this  practical  grouping  of  remedies  is  relative  to  principles  em- 
braced in  these  Institutes,  I  formerly  introduced  the  disposition  which 
I  have  made  of  the  Order  in  which  the  group  of  local  Alteratives  occurs. 
Unlike  the  Alteratives  which  are  employed  internally,  the  present  assem' 


838  INSTITUTES    OF    MEDICINE. 

blage  does  not  appear  as  an  order,  but  as  a  division  under  an  Order  of 
Cuicmeous  and  other  Local  Affections.     (See  p.  643,  644.) 

Tliese  Alteratives  (p.  643),  which  are  employed  locally,  may  operate 
either  constitutionally,  through  reflex  nervous  influence,  like  the  inter- 
nal alteratives,  as  the  mercurials,  or  in  a  more  cii'cumscribed  manner 
through  the  ganglia  or  other  centres  of  the  sympathetic  nerve,  or  only 
superflcially,  as  with  Suppurants,  Escharotics,  and  Sedatives  ;  but  Ves- 
icants, which  ai'e  embraced  in  the  group,  always  exert  useful  effects  upon 
internal  maladies  through  reflex  action  of  local  nervous  centres  (p.  642- 
648,  §  893  a-f,  p.  652-655,  §  893  m,  p.  657-659,  §  893^7,  p.  679-681, 
§  905  a).  Other  remedies  included  in  the  group  must  also  operate  upon 
internal  parts  through  local  centres  of  nervous  influence  (§  497,  1038), 
such  as  Aconite  in  the  relief  which  it  affords  to  neuralgia.  I  have  re- 
lieved a  very  painful  neuralgic  affection  of  the  whole  extent  of  the  sci- 
atic nerve  in  fifteen  minutes  by  rubbing  along  its  course  an  ointment 
of  aconitin,  which  had  refused  to  yield  to  other  remedies. — The  extens- 
ive subdivision  which  is  designed  for  diseases  of  the  skin  supplies  ex- 
amples of  a  purely  local  action  upon  the  organic  properties  of  the  part 
without  the  auxiliary  aid  of  nervous  influence  (§  658).  Some  of  them, 
however,  will  also  exert  constitutional  eflfects  through  reflex  nervous 
influence,  such  as  the  mercurial  ointments  (§  514  d,  826  d,  &c.).  Eem- 
edies  of  that  nature,  therefore,  are  arranged  also  in  another  subdivit^ion, 
indicating  their  extensive  constitutional  influences  through  the  medium 
of  the  skin  and  nervous  system  (§  89H^,  893  a,  1059,  1088  b,  904  b).* 

The  foregoing  details,  and  some  others  of  a  corresponding  nature,  are 
farther  designed  to  exhibit  the  advantages  of  the  Author's  system  of  a 
Therapeutical  Arrangement  of  the  Materia  IMedica. 

§  1057|-.  I  shall  now  introduce  a  series  of  important  remedies,  not 
only  for  the  purpose  of  examining  their  special  uses,  but  particularly  for 
a  farther  illustration  of  general  principles  in  Medicine,  and  the  Philoso- 
phy of  Organic  Life,  for  which  this  Avork  is  especially  designed  (§  1062^). 

CHLORIDE  OF  MERCURY,  AND  THE  BLUE  MERCURIAL  PILL. 

§  1058,  a.  I  shall  speak  mostly  of  Calomel  as  employed  in  full  doses 
for  its  cathartic  eflect ;  and  this  for  the  purpose,  especially,  of  indicating 
its  remedial  virtues.  Its  smaller  and  more  repeated  doses,  however,  will 
be  the  subject  of  remark ;  though,  in  whatever  doses  exhibited,  it  is  its 
alterative  action  which  bestows  the  service  (§  889,  a-g),  which,  indeed, 
is  true  of  most  other  remedial  agents  (§  516  d,  No.  6,  §  638,  863  d,  896, 
900,  902  g-m,  904  d,  905,  and  Indexes,  article  A Itercdires). 

I  need  not  say  that  Calomel  is  rarely  actively  purgative,  although  it 
occupies  the  first  rank  among  Cathartics  in  my  Therapeutical  Arrange- 
ment of  the  Materia  Medica,  or  that,  to  procure  a  cathartic  effect,  it  is 
commonly  associated  either  with  Jalap,  Aloes,  Rhubarb,  Podophyllum, 
Colocynth,  Scammony,  Gamboge,  or  Extract  of  Butternut,  or,  if  exhib- 
ited by  itself,  some  other  cathartic  is  generally  prescribed  within  a  few 
hours  afterward.  The  combinations,  too,  with  the  several  articles  are 
most  useful,  in  a  general  sense,  in  the  order  in  which  I  have  now  stated 
them.  Thus,  Calomel  and  Jalap  are  more  extensively  useful  than  Cal- 
omel united  with  any  other  cathartic.  Podophyllum  resembles  Jalap  in 
its  action,  but  is  much  inferior;  so  that  Aloes  is  the  next  adjunct  on  . 
account  of  its  adaptation  to  a  great  range  of  chronic  affections  of  the  di- 
*  NoTKs  Dn  p.  1132,  Eic  p.  -133. 


Therapeutics. — appendix. — Calomel^  Blue  Pill.  839 

gestive  organs,  and  next  Rhubarb,  and  so  on  ;  and  it  is  well  known  that 
it  may  be  often  useful  to  blend  two  or  more  of  these  together  along  with 
the  calomel.  But  the  merits  of  each  individual  case  should,  of  course, 
be  brought  to  bear  upon  the  right  combination  at  the  time  of  prescribing 
(§  150-151,  857,  870  a,  b,  872  a,  888  a-c,  1061). 

As  I  shall  soon  set  forth,  however,  it  may  be  often  most  useful  to  ex- 
hibit Calomel  uncombined,  and  to  administer  some  other  cathartic  at  an 
interval  of  some  hours  afterward.  For  this  purpose  Castor  Oil  generally 
surpasses  all  others  (§  1057,  I);  and,  next  to  this,  in  a  general  sense,  we 
may  reckon  Jalap  combined  with  Tartrate  of  Potash  (§  lOGO) ;  and 
next,  the  neutral  saline  cathartics  (§  1061);  and  next.  Rhubarb  along 
with  Calcined  Magnesia  and  the  Tartrate  of  Potash  and  Soda  (§  872  a, 
1061).  We  need  rarely  go  beyond  the  cathartics  which  I  have  now 
mentioned,  as  ultimate  aids  to  Calomel,  with  a  view  to  purgative  effects. 
But  it  should  be  always  considered  tliat  it  is  the  alterative  action,  the 
direct  influence  upon  disease,  that  is  to  be  chiefly  regarded  in  the  choice 
of  these  remedies,  and  of  none  is  this  so  true  as  of  Calomel.  Hence  it  is 
evident  that  the  precise  circumstances  of  the  disease  must  determine  the 
choice  (§  872  a,  883  a,  888  i). 

But,  though  Calomel  be  not  actively  purgative,  it  is  powerfully  alter- 
ative, and,  in  doses  that  are  felt,  it  is  never  negative  in  its  effects.  It 
alters  the  condition  of  disease  either  for  the  better  or  for  the  worse — too 
often  for  the  worse  (§  854).  There  is  no  other  remedy  that  requires 
more  skill  for  its  right  administration — none,  with  the  exception  of  loss 
of  blood  and  tartarized  antimony,  that  i-eaches  more  profoundly  diseased 
conditions,  or  which  will  so  often  turn  them  to  health,  when  wisely  em- 
ployed. And  so,  on  the  contrary,  it  is  capable  of  inflicting  great  injury 
if  not  suited  to  the  case. 

§  1058,  b.  Let  us  then  consider,  in  a  general  manner,  some  of  its  use- 
ful effects  when  employed  in  full  purgative  doses.  Its  action  is  mostly 
exerted  upon  the  stomach  and  duodenum.  Here  its  first  great  curative 
impressions  are  made,  and  from  these  parts  powerful  reflex  nervous  ac- 
tions radiate  over  the  whole  system,  though  more  so  upon  some  organs 
than  upon  others.  Its  effects  are  most  strongly  pronounced  in  some  of 
the  glandular  organs,  especially  the  liver;  and  hence  it  is  peculiarly 
suited  to  diseases  of  that  organ  in  many  of  their  phases.  But  its  action 
upon  this,  and  other  parts  remote  from  the  stomach,  will  depend  upon 
the  manner  in  which  they  may  be  affected  by  disease ;  for  we  have  va- 
riously seen  that  the  susceptibility  of  tissues  to  the  action  of  remedies  is 
not  only  increased  by  disease,  but  will  be  influenced  by  its  exact  con- 
dition— than  which  there  is  nothing  more  important  to  be  known  (§ 
129  h,  i,  134,  137  (Z-151,  240,  324,  556  c,  650,  662,  674  (/,  675,  854 
bb,  855,  859,  870  aa,  871,  888,  892  c,  892^  a,  b,  892^  d,  970  c,  1063  by 

When  the  Avhole  system  is  invaded  by  disease,  as  in  idiopathic  fever, 
we  may  anticipate  a  universally  favorable  impression  when  this  rem- 
edy is  rightly  applied ;  and  this,  too,  whether  employed  in  its  largest  or 
its  smallest  therapeutical  doses — though,  as  a  gradual  alterative  for  this 
purpose,  Tartarized  Antimony  is  much  better  (§  148,  557  a,  841,  892  c, 
900,  902  i;  and  Indexes,  Alteratives).  When  active  inflammation  affects 
any  part,  Ave  may  generally  calculate,  if  there  be  no  objection  to  its  use, 
that  a  few  grains  of  Calomel  will  reach  that  part  advantageously,  es- 
pecially if  Blood-letting  have  been  premised  (§  672,  868,  871,  889^). 
And  yet,  under  circumstances  of  health,  the  same  dose  might  have  no 

*  Calomel  and  blue  pill  rarely  increase  the  bile  in  health.  Hence  the  great  fallacy 
of  Dr.  Scott's  late  experiments  with  mercurials  upon  healthy  dogs  (§  694  6,  837  cc,  854  bb). 


840  INSTITUTES    OF    MEDICINE. 

effect  upon  the  same  organ.  This,  however,  is  constantly  more  or  less 
true  of  all  other  remedies. 

We  have  thus  before  us  two  great  leading  facts — that,  in  fevers,  and 
acute  inflammations,  especially  if  the  latter  affect  any  important  organs, 
the  next  great  curative  means  after  bloodletting,  if  the  latter  be  required, 
is,  in  a  general  sense,  Calomel,  in  at  least  one  dose,  with  a  view,  in  part, 
to  a  cathartic  effect,  though  carefully  regulated  as  to  quantity.  Wheth- 
er a  full  dose  should  be  repeated,  or  whether  in  any  dose,  and  with  what 
frequency,  will  then  depend  upon  the  peculiarities  of  each  case.  The 
general  affirmation  can  be  made  with  greater  certainty,  that  one  full 
dose  will  be  proper  and  useful  in  the  early  stages  of  disease,  than  we  can 
pronounce  upon  the  probable  advantages  of  its  repetition.  But,  it  is  a 
very  common  circumstance,  where  it  may  be  inexpedient  to  carry  this 
remedy  beyond  one  or  two  full  doses,  that  Blue  Pill  may  be  afterward 
exhibited  with  happy  effect,  when  the  continued  use  of  Calomel  would 
have  been  injurious. 

§  1058,  c.  This  correspondence  between  the  virtues  of  Calomel  and 
Blue  Pill  leads  me,  now,  to  speak  of  them  comparatively.  Notwith- 
standing their  affinities,  they  are  well  known  to  exert  effects  which  dis- 
tinguish them  from  each  other.  But  tliis  difference  consists  mostly  in 
the  effects  of  one  being  more  rapidly  produced,  and  more  strongly  pro- 
nounced than  those  of  the  other.  Calomel  is  more  irritating,  rapid,  al- 
terative, and  positive  in  its  action  than  Blue  Pill ;  while  in  other  re- 
spects, the  general  results  of  both  are  greatly  analogous.  The  resem- 
blances and  differences  in  their  effects  may  be  farther  illustrated  by  com- 
paring them,  respectively,  with  general  Bloodletting  and  Leeching  (§  925, 
927  a,  929,  939  e,  /,  95G-958,  966,  968,  &c.). 

From  these  analogies  in  their  useful  effects,  and  from  their  powerfully 
alterative  virtues,  it  is  evident  that  the  same  coincidences  Avill  be  likely 
to  obtain  in  their  bad  effects  (§  854  c  fZ,  857) ;  and  such  being  the  case, 
whatever  I  may  say  of  the  injurious  effects  of  Calomel,  and  of  the  pre- 
cautions which  should  attend  its  use,  will  be  equally  applicable,  though 
in  an  inferior  degree,  to  Blue  Pill. 

§  1058,  d.  It  is  a  well-ascertained  fact  that,  in  numerous  cases.  Calo- 
mel and  Blue  Pill  have  not  their  effects  increased,  beyond  a  certain  quan- 
tity, in  the  ratio  of  the  increase.  Ten  grains  of  either  Avill  often  pro- 
duce as  great  a  cathartic  effect  as  fifteen  grains  ;  or,  at  least,  this  is  in- 
ferable. Beyond  fifteen  grains  the  difference  is  still  less  manifest.  But 
below  ten  grains  this  ratio  is  less  likely  to  appear;  though  five  grains 
will  often  operate  with  greater  effect,  in  proportion  to  the  quantity,  than 
ten  grains.  Nevertheless,  the  difference  between  five  and  ten  grains,  and 
at  other  times  between  two  and  five  grains,  is  so  considerable  that  the 
smaller  quantity  may  be  very  beneficial  when  the  latter  would  be  very 
injurious  (§  857). 

But  there  are  occasionally  some  very  remarkable  peculiarities  in  the 
effects  attending  the  smallest  and  the  largest  doses  of  Calomel,  when  they 
are  regulated  according  to  the  repute  which  Calomel  holds  as  a  cathar- 
tic, and  which  are  but  little  observed  of  Blue  Pill.  When  employed,  for 
example,  in  very  large  doses,  even  far  exceeding  the  largest  in  common 
use,  the  cathartic  effect  is  wholly  counteracted  by  the  peculiar  nature  of 
some  present  intestinal  disease ;  or  the  dose  may  even  arrest  diarrhoea, 
as  Calomel  often  will,  also,  when  employed  in  the  minute  doses  of  a 
fourth  or  tenth  of  a  grain.    In  respect  to  the  large  doses,  I  will  quote  an 


Therapeutics. — APPENDIX. —  Calomel^  Blue  Pill.  841 

example  which  occurred  at  one  of  the  London  Cholera  Hospitals  in  1832, 
where  Mr.  Bennett  is  said  to  have  treated  successfully  17  of  18  cases  by 
exhibiting  to  each  patient,  as  soon  as  admitted,  120  grains  of  Calomel, 
and  afterward  60  grains,  every  hour  or  two,  until  some  relief  was  ob- 
tained. Several  of  the  patients  took  from  three  to  four  ounces.  Its  di- 
rect effect  was  that  of  restraining  the  vomiting  and  purging.  These  17 
patients  recovered,  and  the  record  so  far  is  undoubtedly  true ;  but,  from 
what  we  know  of  the  fatality  of  the  malignant  cholera  in  the  hands  of 
others,  after  the  accession  of  those  symptoms  which  are  diagnostic  of  the 
disease,  we  are  bound  to  believe  that,  in  most,  and  probably  in  all,  of 
these  cases  there  existed  only  the  premonitory  stage,  as  it  is  called, 
when  the  disease  is  always  very  easily  controlled,  and  by  much  milder 
treatment. 

It  has  been  long  known  that  large  doses  of  calomel — such  as  20  or 
30  grains —  Avill  ai-rest  vomiting  and  diarrhoea  attendant  on  particular 
pathological  conditions  of  the  intestinal  mucous  membrane.  This  it 
does  in  virtue  of  its  profound  alterative  power,  and  shows  us  that  it  is 
the  alterative,  and  not  cathartic,  operation  which  contributes  essentially 
to  the  cure.  It  equally  denotes,  also,  an  error  in  the  imputed  sedative 
effects  of  the  remedy,  as  will  be  more  distinctly  seen  in  the  entire  failure 
of  such  doses,  and  of  others  far  more  moderate,  in  the  ordinaiy  forms 
of  diarrhoea  and  vomiting,  and  in  cholera  morbus  and  cholera  infantum. 
But,  in  these  last  cases,  particularly  in  cholera  infantum,  and  often  in 
dysentery,  we  may  obtain  the  greatest  benefit  from  small  doses  of  Calo- 
mel— doses,  when  administered  in  cholera  infantum,  varying  from  the 
fourth  to  the  twentieth  part  of  a  grain.  All  of  this,  too,  goes  to  dem- 
onstrate that  it  is  not  the  cathartic,  but  the  alterative  virtues  of  Calo- 
mel which  impart  to  it  its  remedial  poAver. 

These  facts  admonish  us  that  we  must  study  the  virtues  of  remedies, 
and  their  doses  also,  in  their  relation  to  diseased  conditions,  and  that 
we  can  form  no  just  conclusions  as  to  their  remedial  capabilities  by  any 
other  methods  of  observation,  and,  above  all,  that  we  have  nothing  to 
hope  from  Organic  Chemistry  (§  1058  h,  note). 

§  1058,  e.  Although  Calomel  and  Blue  Pill  are  capable  of  profoundly 
morbific  effects  in  many  forms  of  disease,  unless  they  have  been  preceded 
by  other  remedies,  especially  in  miasmatic  congestions  of  the  liver  and 
intestinal  mucous  membrane,  where  nothing  may  follow  their  precipitate 
use  but  a  discharge  of  viscid  mucus,  and  an  aggravation  of  till  the  symp- 
toms, I  shall  not  prolong  this  article  by  analyses  which  would  involve 
so  great  an  amount  of  detail.  Nevertheless,  it  is  impossible  to  arrive  at 
any  just  conceptions  of  the  virtues  of  remedial  agents  without  referring 
to  their  effects  in  various  conditions  of  disease ;  nor  can  we  obtain  any 
correct  view  of  their  remedial  capabilities  by  considering  the  operation 
of  a  particular  remedy  abstractedly  from  other  means  which  may  be 
associated  with  it  in  the  treatment.  A  full  dose  of  Calomel,  for  exam- 
ple, may  be  very  salutary  in  some  given  form  of  disease,  if  it  have  been 
preceded  by  Bloodletting,  as  is  often  witnessed  in  congestive  fevers,  but 
without  which  it  may  be  very  pernicious.  At  another  time,  its  good 
effects,  or  at  least  its  best  effects,  can  be  secured  only  by  associating  with 
it  other  remedies,  or,  by  applying  others  after  its  administration.  The 
same,  also,  is  more  or  less  true  of  all  other  remedies  ;  each  one  influ- 
encing, more  or  less,  the  effects  of  the  others  (§  859  J,  863  e,  871,  872  a, 
889  k). 


842  INSTITUTES    OF    MEDICINE. 

§  1058,  /.  In  continuing  the  subject  of  Calomel,  I  shall  now  consider 
its  uses  in  certain  special  forms  of  disease,  when  employed  in  its  occa- 
sional and  full  doses : 

And  first  of  dysentery,  which  is  seated  particularly  in  the  lower  tract 
of  the  mucous  tissue  of  the  large  intestine,  though  all  the  digestive  or- 
gans are  more  or  less  involved  in  morbid  action.  But  the  burthen  of  the 
disease  is  upon  the  mucous  membrane,  where  it  probably  consists  at  all 
times  of  a  peculiar  modification  of  inflammation,  though  diffei'ing,  in 
different  cases,  according  to  the  nature  of  its  remote  causes  (§  644-666). 

Now,  the  treatment  of  this  disease,  not  only  by  Calomel,  but  by  other 
remedies,  will  be  influenced  by  the  nature  of  the  remote  cause;  and 
this  will  be  ascertained  by  the  phenomena,  and  by  tracing  up  the  his- 
tory of  the  patient  for  one  or  more  months  anterior  to  the  attack.  Its 
principal  cau.es  are,  mainly,  two :  1st,  crude,  indigestible  food,  acting 
in  conjunction  with  changes  of  weather,  and  other  common  atmospheric 
influences.     2d,  miasmata,  from  decaying  vegetable  matter. 

The  first  of  these  modifications  is  sporadic,  and  comparatively  mild. 
The  second  may  present  only  sporadic  cases,  but  is  apt  to  occur  more  or 
less  epidemically,  and  is  vastly  the  more  obstinate  and  fatal  form.  Each 
variety  demands  essential  differences  in  the  details  of  treatment,  though 
the  same  general  principles  are  applicable  to  all  the  modifications.  It 
should  I>e  also  premised  that  the  miasmatic  form  is  attended  with  a 
special  «;ondition  of  hepatic  congestion,  which  is  one  cause  of  the  greater 
obstinacy  and  fatality  of  this  variety  of  the  disease,  and  which  has  a  con- 
siderable bearing  upon  the  treatment  (§  650-652,  806-816). 

With  these  premises  before  us,  we  are  now  chiefly  interested  about 
the  adaptation  of  Calomel  to  dysenteric  disease,  with  a  view  especially 
to  its  local  effects.  But,  it  is  impossible,  as  I  have  said,  to  give  any  in- 
telligible account  of  the  proper  use  of  one  remedy,  especially  such  a  rem- 
edy as  Calomel,  without  speaking  of  it  in  connection  with  other  reme- 
dies which  may,  or  should  be,  associated  with  it.  We  have  formei'ly 
seen  that,  when  active  inflammation  is  seated  in  the  intestinal  canal, 
cathartics  are  hazardous  till  the  disease  has  been  more  or  less  subdued 
by  other  remedies,  especially  131oodletting.  Calomel,  however,  does  not 
irritate  in  the  same  way  as  other  cathartics.  But  it  will  often  do  Avhat 
is  much  worse  in  muco-intestinal  inflammation.  It  may  not  only  in- 
crease its  sevei-ity,  but  so  modify  its  character  as  to  render  it  very  ma- 
lignant, as  in  another  example  of  a  common  abdominal  affection  to  which 
I  have  adverted,  and  also  in  scarlet  fever.  In  such  circumstances,  it 
never  fails  to  affect  the  liver  injuriously  also.  It  has  been  therefore 
found,  in  the  best  experience,  to  be  the  most  successful  and  speedily 
curative  practice  to  abstract  blood  from  a  vein,  or  at  least  by  Leeches, 
as  the  first  remedy,  in  cases  of  dysentery  of  much  severity  (§  991,  b). 
But  this  is  not  commonly  done,  and  Calomel  is  apt  to  be  relied  upon  as 
the  principal  remedy.  It  is  a  prevailing  practice  to  exhibit,  at  the  on- 
set of  the  treatment,  from  10  to  even  20  grains  of  Calomel,  and  not  un- 
frequently  to  repeat  this  dose  from  time  to  time.  When  the  disease  is 
of  the  milder  variety,  if  other  things  go  right,  it  will  often  succeed  in  t4ie 
end ;  though  not  so  readily,  and  less  frequently  than  when  Calomel  is 
given  in  doses  of  two  to  five  grains  once  in  twelve  or  more  hours;  and, 
in  many  cases,  a  grain  or  less  of  Ipecacuanha,  also,  once  in  four  or  five 
hours,  with  more  or  less  of  some  preparation  of  opium.  A  large  medi- 
cation by  Calomel  in  any  condition  of  dysentery  is  not  a  reliable,  but 


Therapeutics. — APPENDIX. — Calomel^  Blue  Pill.  843 

often  an  injurious  practice.  Wiien  proper  bloodletting  has  not  been  em- 
ployed, if  the  inflammatory  symptoms  do  not  soon  yield,  all  internal 
means  should  be  suspended,  and  General  Bloodletting,  or  Leeches  to  the 
verge  of  the  rectum,  or  a  blister,  or  warm  poultices,  to  the  abdomen, 
should  be  applied,  and  perhaps  in  succession.  Alterative  doses  of  ipe- 
cacuanha may  often  -become  very  useful,  perhaps  Blue  Pill,  but  more 
probably  well-regulated  doses  of  Castor  Oil  (§  1057,  I). 

So  much  for  the  milder,  or  sporadic  form  of  dysentery.  Coming  to 
the  miasmatic  variety,  especially  when  prevailing  epidemically,  the 
Practitioner  who  does  not  regard  the  modifying  nature  of  the  remote 
predisposing  cause,  and  the  exact  pathology,  will  prescribe  empirically, 
and  be  apt  to  administer  large  doses  of  Calomel,  which,  in  this  condition 
©f  the  disease,  will  be  very  likely  to  destroy  the  patient.  Or,  if  he  de- 
pend upon  astringents,  or  administer  Rhubarb  as  is  often  done  (§  10G2), 
or  resort  to  Tonics  and  Stimulants,  nothing  but  disappointment  will 
await  him.  General  Bloodletting,  often  followed  by  leeching,  is  here 
the  great  remedy.  But,  however  we  may  subdue  the  morbid  condition 
by  loss  of  blood,  with  the  aid,  also,  of  blisters,  abstinence  from  food,  «&c., 
we  shall  generally  find  that  Calomel  must  be  managed  with  great  pru- 
dence, or  the  disease  will  not  only  be  aggravated  by  it,  but  rendered  more 
malignant. — Notes  Ff  p.  1135,  Go  p.  1138. 

As  to  Loss  of  Blood,  Nature  also  proclaims  in  this  variety  of  dysen- 
tery, more  distinctly  than  in  the  sporadic,  the  true  principles  of  treat- 
ment, for  here  the  eft'usion  of  blood  from  the  intestinal  mucous  membrane 
is  greater ;  and  this  is  plainly  the  remedy  which  Natui'e  institutes  for 
her  own  relief  (§  805,  862,  8G3  e,/,  890  d-g,  1019).* 

§  1058,  g.  In  respect  to  fever,  most  of  its  varieties  derive,  at  their  early 
stages,  great  benefit  from  a  full  dose  of  Calomel  combined  with  Jalap 
and  a  grain  or  two  of  Ipecacuanha ;  or  it  may  be  most  useful,  in  many 
cases,  to  exhibit  the  Calomel  uncombined,  and  to  administer  Castor  Oil, 
or  a  combination  of  Jalap  and  Tartrate  of  Potash,  a  few  hours  after- 
ward. If  an  emetic  be  also  indicated,  a  full  dose  of  Ipecacuanha,  per- 
haps with  Tartarized  Antimony,  may  be  preferable  to  the  latter  reme- 
dies ;  so  that  when  vomiting  begins,  purging  will  generally  take  place 
simultaneously.  In  this  way  prodigious  alterative  influences  will  be 
exerted,  and  if  employed  near  the  invasion  of  disease  it  may  be  arrested 
at  once  (§  557  a).  But  it  often  happens,  as  has  been  variously  stated  in 
this  work,  that  bloodletting  should  be  premised,  and  this,  especially,  if 
there  be  any  local  inflammations  or  venous  congestions,  which  are  often 
present  at  the  invasion  of  the  constitutional  malady. 

§  1058,  h.  When  Calomel  is  employed  in  the  treatment  of  Scarlet  fe- 
ver, it  should  be  with  great  caution  after  the  disease  has  advanced  some- 
what into  the  eruptive  stage.  At  this  period,  Calomel,  Senna,  and  Rhu- 
barb have  done  a  vast  amount  of  mischief  At  or  near  the  invasion  of 
Scarlatina,  when  the  symptoms  are  severe,  a  moderate  dose  of  Calomel 
may  be  useful.  Nevertheless,  severe  forms  of  this  disease  not  unfre- 
quently  occur  in  which  Calomel,  administered  at  the  very  onset  of  the 
attack,  proves  detrimental.  If  doubt  exist  as  to  the  propriety  of  the 
remedy,  Castor  Oil  should  be  substituted,  and  perhaps  little  else  should 
be  done  (§  858,  8G1).  It  may  be  also  safely  affirmed  that  Calomel 
should  be  rarely  exhibited  after  the  disease  has  run  its  course  for  some 
two  or  three  days  ;  not  often,  indeed,  when  the  eruptive  stage  has  existed 
for  twenty-four  hours.     It  will  then  aggravate  the  abdominal  conges- 

*  In  mild  forms  of  dj-senterj-  there  may  be  an  absence  of  blood,  or  the  mucus  only 
tinged. 


844  INSTITUTES    OF    MEDICINE. 

tions,  and  often  convert  a  mild  into  a  malignant  form.  And  liere,  too, 
when  Calomel  affects  the  digestive  organs  perniciously,  the  salivary 
glands  often  swell  up  suddenly  from  sympathy,  and,  not  unfrequently, 
the  throat  becomes  ulcerated,  gangrenous,  &c.  But  these  are  only 
secondaiy  results  of  a  far  more  alarming  condition  of  disease  in  the  ab- 
dominal organs.  The  swelling  of  the  glands,  in  these  cases,  is  not  at  all 
owing  to  the  direct  specific  eftect  of  mercury  upon  them,  as  in  cases  of 
salivation,  nor  is  there  any  attendant  flow  of  saliva ;  but  it  is  the  result 
of  a  highly  aggravated  state  of  the  morbid  condition  of  the  abdominal 
organs,  inflicted  upon  them  by  this  remarkable  agent.  The  glandular 
swelling  which  often  occurs  spontaneously  from  the  same  visceral  cause, 
presents  a  far  milder  form.  There  is  not  generally,  however,  much 
danger  from  the  swollen  glands,  or  from  the  sphacelus  of  the  fauces,  sb 
only  they  be  not  allowed  to  remain  a  source  of  constitutional  irritation. 
One  may  be  relieved  by  a  stick  of  lunar  caustic,  and  the  other  moderated 
by  leeches  and  warm  fomentations.  What  is  thus  witnessed  about  the 
throat  is  only  an  index  of  a  far  more  fearful  evil  in  the  great  organs  of 
life.     In  these  cases  Nature,  mainly,  must  work  out  the  cure  (§816  b.) 

For  the  grave  forms  of  Scarlatina,  I  am  apt  to  prescribe  a  small  dose 
of  Calomel  at  the  beginning  of  the  disease,  but  never  repeat  it ;  and  as 
for  the  rest,  I  depend  upon  cautious  doses  of  Castor  Oil,  as  far  as  may 
be  indicated  by  the  state  of  the  abdominal  viscera  (§  1057, 1). 

I  may  finally  add  that,  in  all  mild  cases  of  scarlet  fever,  no  risk  should 
be  taken  from  Calomel.  It  is  not  then  wanted ;  and  I  have  seen  the 
mildest  converted  into  malignant  cases  by  imprudent  doses  of  Calomel, 
and  by  Senna,  Rhubarb,  and  the  Saline  Cathartics.  Indeed,  so  suscept- 
ible is  the  alimentary  mucous  tissue  in  this  disease,  and  so  peculiar  is 
its  morbid  condition,  that  solid  food,  even  bread,  will  sometimes  convert 
the  mildest  into  the  severest  cases,  merely  by  its  mechanical  irritation. 
It  should  be  also  borne  in  mind  that  in  this,  as  in  all  other  strictly  self- 
limited  diseases,  we  cannot  establish  any  modification  of  the  pathologi- 
cal cause  which  will  prevent  its  running  a  regularly  ordained  course. 
The  natural  state  of  tliese  affections,  in  all  favourable  cases,  is  most  likely 
to  result  in  their  cure  (§  858,861).  In  the  graver  forms,  art  can  only 
moderate  their  violence,  or  meet  with  appropriate  remedies  any  incident- 
al local  inflammations  that  may  spring  up  in  the  progress  of  the  specific 
maladies  (§  137  c,  524  (/,  847,  858,  870fla).— ^ee  P.S.  1860,  p.  B72. 

§  1058,  {.  As  to  the  treatment  of  measles  and  small-pox,  I  do  not  recol- 
lect to  have  witnessed  any  injurious  eftects  from  the  use  of  Calomel,  nor 
do  I  find  them  stated  by  Authors.  Perhaps  one  reason  is,  that  Nature 
has  been  more  allowed,  in  these  self-limited  diseases,  than  in  scarlatina, 
to  have  her  own  way.  But  here  the  danger  from  Calomel  is  certainly 
far  less  than  in  scarlet  fever. 

§  1058,  k.  In  ivhoopivg-cough,  Calomel,  as  a  cathartic,  or  rather  for  its 
alterative  effects  upon  the  abdominal  organs,  is  often  very  salutary ;  and 
this  especially  so  when  the  alvine  evacuations  present  a  morbid  appear- 
ance. Blue  Pill,  however,  is  often  better.  Bloodletting  should  come  in 
the  moment  that  pneumonia  may  supervene,  as  it  often  does,  and  is  the 
great  cause  of  the  fatality  of  whooping-cough  (§  870,  aa).  But  here,  as 
in  other  acute  diseases,  great  moderation  as  to  food  is  powerfully  cura- 
tive (§  856). 

§  1058, 1.  In  the  ordinary  forms  of  jaundice,  whether  complicated  with 
a  gall-stone  in  the  liver,  or  owing  alone  to  hepatic  disease,  Calomel  dis- 


Therapeutics. — APPENDIX. —  Calomel,  Blue  Pill  845 

plays  some  of  its  brightest  advantages,  and  may  be  given,  if  apparently 
indicated,  in  doses  of  10  to  20  grains,  two  or  three  times  a  day,  with 
jalap,  or,  perhaps,  aloes,  or  the  resinous  cathartics,  at  intervals,  till  the 
difficulty  is  more  or  less  surmounted.  But  Jaundice  is  often  of  too  grave 
importance  to  be  always  intrusted  to  those  remedies;  and  Bloodletting 
must  then  be  the  principal  remedy,  followed,  perhaps,  by  a  blister  eight 
or  ten  inches  square  over  the  epigastric  region.  If  there  be  gall-stones, 
Cicuta  may  be  useful  in  relieving  spasm  of  the  biliary  duct. 

§  1058,  m.  Calomel  is  an  admirable  remedy,  as  it  respects  its  transient 
effect,  in  eri/sijjelas,  a  disease  which  is  often  sadly  managed  by  tonics 
and  stimulants  (§  1005,  j).  The  least  important  part  of  the  disease  is 
also  generally  considered  the  most  important,  since,  in  all  severe  cases, 
the  inflammation  of  the  skin  is  comparatively  of  little  moment.  Now 
and  then,  however,  when  erysipelas  springs  up  epidemically,  tlie  super- 
ficial inflammation  puts  on  the  phlegmonous  character,  when  ulceration 
and  sloughing  are  apt  to  follow ;  and  these  conditions,  as  well  as  the 
antecedent  and  remaining  inflammation,  form  an  important  part  of  the 
pathological  complications.  But  of  the  pathology  of  this  disease  I  have 
spoken  sufficiently  (§  970  c,  1005  /),  and  therefore  come  to  the  treatment. 

The  great  curative  means,  in  all  severe  cases,  is  early  and  full  Blood- 
letting, followed  by  five  to  fifteen  grains  of  Calomel,  and  this  in  six  or 
eight  hours  afterward  by  Jalap  and  Soluble  Tartar,  or  by  Castor  Oil. 
If,  by  these  means,  a  blow  be  struck  at  the  abdominal  disease,  the  in- 
flammation of  the  skin  will  begin  to  give  way,  and  nothing  more  may 
be  necessary  than,  perhaps,  a  moderate  dose  of  Calomel,  or  of  Blue  Pill, 
or,  more  probably,  Castor  Oil,  or  Leeches  to  the  inflamed  surface.  Or, 
Nitrate  of  Silver,  pure  and  concentrated,  or  dilute  Iodine  may  now  be 
pencilled  over  the  whole  inflamed  surface.  But,  for  subduing  the  re- 
maining inflammation.  Leeches  are  the  best  local  application,  in  my  ex- 
perience, and  they  are  dictated  by  the  soundest  pathological  principles. 
Nevertheless,  whatever  is  done  in  severe  cases  should  be  done  quickly ; 
and,  if  the  treatment  have  failed,  at  the  onset,  to  sensibly  mitigate  the 
symptoms,  especially  the  cutaneous  inflammation,  which  is  only  symp- 
tomatic of  abdominal  disease,  we  may  depend  upon  it  that  the  latter  con- 
dition calls  for  farther  general  Bloodletting,  and  probably  for  another 
dose  of  Calomel,  or  at  least  of  Blue  Pill,  and  more  or  less  of  Castor  Oil. 
If  cerebral  symptoms  (which  are  also  sympathetic  of  the  abdominal  con- 
gestion) spring  up,  a  large  abstraction  of  blood  will  be  indispensable. 

I  have  never  known  Calomel  injurious  in  erysipelas ;  but  it  must  be 
added  that  I  have  almost  always  begun  the  treatment  by  abstracting 
blood,  which,  as  I  have  said,  is  a  great  means  of  preventing  the  morbific 
effects  of  Calomel  and  Blue  Pill ;  and  no  fatal  case  has  occux'red  in  my 
practice  (§  1005,  j?'). 

§  1058,  n.  And  now,  as  to  acute  rheumatism.  Here,  too,  in  all  severe 
cases,  especially  of  articular  rheumatism,  there  is  much  attendant  dis- 
ease of  the  abdominal  organs,  which  contributes  powerfully  to  maintain 
the  rheumatic  affection ;  and  it  commonly  happens,  in  such  cases,  that, 
after  the  inflammatory  condition  is  subdued,  there  will  be  still  remaining 
a  considerable  amount  of  visceral  disease,  which  will  require,  at  least, 
great  simplicity  of  diet.  In  all  severe  cases,  it  will  be  often  observed 
that  the  abdominal  affection  precedes  the  rheumatic,  but  becomes  much 
aggravated  as  soon  as  the  latter  supervenes. 

Calomel  is  a  very  useful  remedy  in  acute  rheumatism,  in  one  or  more 


846  INSTITUTES    OF    MEDICINE. 

full  doses,  or  yielding  soon  to  Blue  Pill,  or  Castor  Oil,  and  rarely  does 
any  harm.  But,  in  all  severe  cases,  a  free  abstraction  of  blood  should 
be  the  fii'st  remedy ;  and  one  or  more  repetitions  of  venesection,  along 
with  leeches  perhaps,  are  often  important  to  a  speedy  removal  of  the 
disease,  and  a  fluid  farinaceous  diet  is  jiext  in  importance.  Any  other 
practice  which  excludes  Bloodletting  in  severe  cases  will  be  more  profit- 
able to  the  Physician  than  to  the  Patient.  The  next  great  remedy  for 
acute  rheumatism,  and  often  for  chronic,  is  Tartarized  Antimony,  fre- 
quently administered  in  augmented  doses  to  just  short  of  nausea.  If  the 
heart  he  affected,  the  Loss  of  Blood  Avill  be  so  much  the  more  important. 
In  a  large  proportion  of  cases,  the  disease  will  yield  to  this  practice  with- 
in a  week.  But,  however  exact  the  treatment  may  be  in  other  respects, 
an  allowance  of  solid  food,  even  bread,  or  of  animal  broths,  may  prolong 
the  disease,  especially  the  abdominal  derangement,  for  many  weeks. 
Colchicum  should  not  be  necessary  in  the  declining  stages,  nor  should 
opiates  be  employed  (§  870,  b). 

§  1058,  9171.  The  same  general  principles  of  treatment  apply  to  acute 
gout  as  to  acute  rheumatism  (§  1058,  n),  though  in  a  moderated  degree. 
A  full  dose  of  Calomel,  or  of  Blue  Pill,  is  generally  useful  at  the  onset 
of  the  treatment,  one  or  the  other,  according  to  the  derangement  of  the 
abdominal  organs.  But  here,  if  the  paroxysm  be  at  all  severe,  and  we 
would  most  speedily  relieve  the  patient,  he  should  be  first  bled.  La^ly, 
if  necessary,  and  often  pretty  early,  Colchicum  may  be  exhibited. 

§  1058,  0.  In  pneumonia,  Calomel  or  Blue  Pill,  in  one  or  more  full 
doses,  at  or  near  the  beginning,  is  generally  useful,  rarely  injurious.  But 
it  is  sometimes  a  better  practice  to  obtain  more  of  their  constitutional 
influence  by  exhibiting  from  one  to  four  grains  of  either  (to  adults)  once 
in  four  to  six  hours ;  though  this  is  by  no  means  recommended  as 
a  general  practice.  It  is  better  suited  to  advanced  stages  of  pneu- 
monia. If  complicated  with  abdominal  disease  in  the  form  of  bilious 
pneumonia,  they  are  still  more  indicated,  but  unless  cautiously  adminis- 
tered are  liable  to  do  injury.  Bloodletting,  however,  is  the  great  rem- 
edy for  all  forms  of  pneumonia,  and  next  to  that  Tartarized  Antimony, 
in  increased  alterative  doses  every  hour  or  two,  but  kept  below  the  point 
of  nausea  (§  904  bb,  1005  k,  1068  c).  Leeches  and  Blisters  may  ulti- 
mately be  wanted,  and  perhaps  more  or  less  opium  to  tranquillize  the 
cough,  as  appears  in  other  places  (§  892^^,  1005  h,  Ic,  1017  c). 

§  1058,  ;).  In  the  treatment  of  croup,  which  is  apt  to  be  complicated 
with  abdominal  disease,  a  dose  of  Calomel  is  generally  useful,  often  very 
important.  I  generally  exhibit  it,  in  a  moderate  dose,  along  with  suffi- 
cient Ipecacuanlia  to  produce  vomiting.  If  the  symptoms  do  not  then 
yield,  I  take  no  risk,  but  proceed  at  once  to  the  abstraction  of  blood  from 
the  arm  (§  576  e,  1009-1013).  There  is  no  danger  from  the  ordinary 
forms  of  croup  when  Blood-letting  is  applied  early.  But  the  disease 
advances  with,  great  rapidity,  and  may  quickly  reach  a  stage  when  all 
remedies  will  fail.  If  late  in  the  disease  an  emetic  be  the  first  remedy, 
it  will  certainly  fail  if  blood-letting  will  not  succeed  ;  or,  if  the  latter,  in 
being  first,  will  effect  a  cure,  it  would  be  probably  baffled  by  the  pros- 
trating effect  of  a  preliminary  emetic  (§  576  e,  869).  I  may  add  that 
I  have  lost  but  one  patient  of  croup,  and  that  in  the  early  part  of  my 
professional  life.  It  is  of  greater  interest,  however,  that  the  child  was 
rather  the  victim  of  the  purgative  action  of  Tartarized  Antimony,  ad- 
ministered in  cautious  doses  about  once  in  twenty  minutes.*  The  croupy 
*  See  Not K  Ggg  p.  1151. 


Therapeutics. — appendix. —  Calomel.,  Blue  Pill.  847 

• 

symptoms  vanished  under  this  effect ;  for  there  was  no  vomiting.  I  have 
also  witnessed  the  death  of  two  adult  patients  in  the  hands  of  other 
Physicians  from  the  same  cause,  and  where  the  doses  given  were  but 
three  grains.  There  was  no  vomiting,  but  an  uncontrollable  watery 
puro-ing,  no  abdominal  pain,  pulse  extremely  rapid  and  so  small  as  to 
be  scarcely  sensible  to  the  touch  when  there  was  much  remaining  mus- 
cular strength,  and  entire  preservation  of  the  mind  (§  863,  d).  Never- 
theless, this  has  not  deterred  me  from  the  occasional  use  of  Tartarized 
Antimony  in  emetic  doses,  especially  in  conjunction  with  Ipecacuanha 
(§  675,  857,  902  <;,  &c.) ;  and  as  an  alterative  in  small  and  frequently- 
repeated  doses  it  transcends  the  Mercurials  in  fevers,  and  is  scarcely  in- 
ferior in  all  acute  inflammations  excepting  of  the  intestinal  canal. 

§  1058,  q.  And  how  is  it  with  Calomel  in  acute  injiammation  of  the 
brain  ?  Certainly  important.  But  after  one  full  dose  it  becomes  most 
useful  in  doses  of  two  to  four  grains  once  in  four  to  ten  hours.  This, 
however,  is  more  of  the  gradually  alterative  plan,  and  when  more  of  the 
constitutional  influence  of  the  remedy  is  intended  than  we  arc  now  con- 
sidering, especially  if  all  purgative  effect  be  restrained  (§  51G  d,  860, 
863  d,  890  /,  902  {).  There  should  be  no  active  purging  in  cerebral  in- 
flammation by  irritating  cathartics,  as  is  often  recommended  in  the  books. 
They  will  propagate  a  pernicious  nervous  influence  upon  tlie  brain. 
Calomel,  Blue  Pill,  Jalap,  and  Castor  Oil  are  alone  wanted,  so  far  as 
cathartics  are  concerned.  The  Drastics  have  been  commended  upon  the 
fearful  doctrine  o? counter-irritation,  supplying  an  impressive  contrast  with 
the  objections  alleged  against  Bloodletting  (^  889  g,  893  n,  1065  d). 

But,  as  I  have  hitherto  said,  Loss  of  Blood  is  our  chief  remedy  in 
acute  cerebral  inflammation.  So  long  as  the  symptoms  continue  to  re- 
cur, they  should  be  promptly  met  by  General  Bloodletting.  Set  the 
patient  erect,  and  bleed  him  to  the  point  of  syncope.  There  is  nothing 
to  fear  from  the  remedy,  but  every  thing  from  the  disease  (§  974-975). 

Leeching,  and  Tartarized  Antimony  in  its  small  doses,  which  are  so 
valuable  in  other  acute  inflammations,  are  of  little  or  no  use  here ;  and 
Blisters  should  be  avoided  till  at  least  a  decisive  ascendency  is  obtained 
over  the  disease.  The  latter  remedy  should  never  be  applied  to  the 
head,  but  to  the  neck  and  shoulders,  unless  the  abstraction  of  blood  have 
been  carried  to  a  great  extent.  In  some  four  or  five  cases,  after  having 
bled  the  patients  till  the  remedy  became  unavailing,  I  have  rescued  them 
by  covering  the  entire  scalp,  neck,  and  upper  part  of  the  shoulders  with 
a  Blister.  The  effect  Avas  truly  wonderful,  as  hope  was  nearly  exhaust- 
ed. But  the  Loss  of  Blood  had  been  very  great.  I  may  add  that  the 
head  should  be  shaved  early  and  kept  covered  with  ice  (§992, 1056). 

Nor  may  we  refrain  from  general  bloodletting  in  venous  congestions 
of  the  brain,  and  at  all  ages,  though  generally  in  a  very  moderated  de- 
gree (§  576  e,  925  c,  976  b,  978, 1010.     Also  p.  872  P.S.  1860), 

§  1058,  r.  In  respect  to  diseases  of  the  serous  tissues,  they  are  probably 
less  influenced  by  the  mercurials  than  of  most  other  parts.  Neither 
pleurisy  nor  peritonitis  are  very  sensibly  benefited,  nor  are  they  apt  to  be 
aggravated  by  full  doses  of  Calomel,  unless  it  be  inflammation  of  the 
serous  coat  of  the  intestines  ;  and  hei-e  there  is  but  little  chance  for  other 
remedies  until  the  disease  has  been  broken  down  by  loss  of  blood  (§  960  J", 
995, 1005  e).— Note  H  p.  1117. 

§  1058,  s.  Next,  as  to  the  kidneys.  These  and  the  renal  capsules  have 
become  specialties  with  many,  who  are  apt  to  mistake  what  is  merely 


848  INSTITUTES    OF    MEDICINE. 

symptomatic  for  some  positive  disease  of  tliose  organs.  The  urine  is  an- 
alyzed, and  a  variety  of  pathological  conditions  are  detected  in  the  re- 
sults, or  some  remote  symptom  is  associated  along  (§  42G,  427,  691, 
905|  b,  9G0  c,  d,  1029,  1032  a).  Hospitals  supply  the  bulk  of  disorgan- 
ized conditions.  Other  affections  of  the  kidneys,  especially  such  as  are 
acute,  derive  more  or  less  benefit  from  the  moderate  use  of  Calomel ;  but 
Blue  Pill  is  commonly  to  be  preferred,  particularly  in  diabetes  mellilus. 

§  1058,  t.  Where  inflammation  of  any  of  the  tissues  of  the  eye  is  com- 
plicated with  gastric  and  hepatic  disease,  as  is  often  the  case,  especially 
in  epidemic  ophthalmia,  the  occasional  exhibition  of  Calomel,  in  a  deci- 
sive dose,  along  Avith  Jalap,  or  followed  by  Castor  Oil,  if  necessary  to  a 
full  cathartic  effect,  is  generally  very  useful ;  and  especially  so  if  the  ca- 
thartic have  been  preceded  by  general  or  local  bloodletting. 

§  1058,  u.  Next  to  bloodletting.  Calomel,  in  full  doses,  is  the  most  im- 
portant remedy  for  apoplexy,  along  with  Jalap,  «S;c.  But  there  is  great 
variety  here.  There  are  cases  in  which  no  cathartic  is  admissible,  and 
others  where  none  but  Croton  Oil  will  rouse  the  intestines.  For  the 
rest,  I  refer  to  §  990-990^. 

§  1058,  V.  Calomel,  in  one  or  more  full  doses,  is  indicated,  generally, 
in  epilepsy,  if  bloodletting  be  also  necessary.  But,  if  loss  of  blood  be  not 
required,  Blue  Pill  is  entirely  preferable.  Much  will  depend,  in  these 
respects,  upon  the  condition  of  the  abdominal  organs.  If  there  be  much 
derangement  here,  a  large  blister  over  the  epigastric  region  yields  much 
relief,  though  these  are  cases  which  are  often  greatly  benefited  by  Loss 
of  Blood.  A  rigid  attention  to  diet,  and  other  natural  habits,  are  the 
great  preventive  means.  But  a  reliance  is  apt  to  be  placed  upon  some 
fancied  specific,  and  when  the  paroxysms  come  on  the  symptom  is  often 
in  the  ascendant  (§  163,  884,  887,  891|  e).  I  see,"however,  by  a  late  Re- 
port of  the  Chairman  of  a  "  Committee  on  the  effects  of  Bloodletting  in 
Epilepsy,  Convulsions,  &c.,"  embraced  in  the  able  "  Transactions  of  the 
Indiana  State  Medical  Society,"  that  a  new  view  appears  to  be  enter- 
tained of  the  pathology  of  Epilepsy,  which  brings  the  disease,  theoreti- 
cally and  practically,  under  the  prevailing  Brunonian  philosophy  (§  1068, 
a) ;  and,  as  the  document  is  brief,  and  is  regai'ded  by  the  Publishing  Com- 
mittee as  a  "  Model  Report,"  and,  moreover,  shows  us  what  are  the  grow- 
ing prospects  of  "  Bloodletting,"  I  shall  quote  it  without  abridgment : 

"  Having  examined,"  says  the  Report,  "  the  literature  of  the  subject, 
I  find  that  none  of  our  recent  Authorities  have  any  confidence  in  Blood- 
letting as  a  remedy  for  Epilepsy,  but,  on  the  contrary,  an  opposite  mode 
of  treatment  is  advised,  the  disease  being  one  of  debility  instead  of  pleth- 
ora. The  question  being  altogether  a  negative  one,  and  unsuitable  for 
a  report,  I  wish  to  be  discharged  from  farther  duty." — TRANSAcnONS, 
&c.,  p.  8,  40,  IndianajMlis,  May,  1857.— See  p.  591,  ^  891^  e. 

§  1058,  w.  Asthma  supplies  another  example  of  greatly  modified  con- 
ditions ;  and  it  is  only  in  the  congestive  form  in  which  either  Calomel  or 
Blue  Pill  are  wanted.  But  nothing  affords  such  prompt  relief  in  con- 
gestive asthma  as  General  Bloodletting  (§  891^-,/). 

§  1058,  X.  As  in  epilepsy,  asthma,  and  hysteria,  so  in  chorea,  the  treat- 
ment is  apt  to  be  suggested  by  the  prominent  symptom,  and  the  patient 
accordingly  treated  by  antispasmodics.  liut  they  are  rarely  of  any  use, 
and  generally  injurious  in  these  diseases,  Avhich  are  constantly  supplying 
instances  of  the  importance  of  addressing  our  remedies  to  the  exact  path- 
ological conditions  (%  668,  672,  673,  675,  681  c,  685,  891^  ^,  d). 


Therapeutics. — appendix. —  Calomel^  Antimony ^  &c.        849 

Cathartics,  also,  have  been  especially  recommended  by  others  for  cho- 
rea, and  so  exclusively  by  some  as  to  render  the  practice  empirical. 
But  no  two  successive  cases  are  alike ;  one  may  be  greatly  benefited  by 
repeated  cathartics,  and  the  next  may  admit  of  only  their  very  moderate 
use,  or  not  at  all.  '  But  it  is  my  main  purpose  now  to  express  my  opin- 
ion of  the  salutary  effects  of  occasional  doses  of  Calomel  or  Blue  Pill  in 
those  cases  where  cathartics  are  indicated. 

§  1058,  y.  A  full  dose  of  Calomel,  probably  along  with  Jalap  or  Cas- 
tor Oil,  is  generally  useful  in  delirium  tremens,  as  preliminary  to  the  use 
of  morphia ;  though  opiates  ai-e  inferior  to  small  doses  of  tartarized 
antimony.  If  there  be  high  arterial  action,  or  much  attendant  disease 
of  the  abdominal  organs,  or  any  important  local  inflammation.  Blood- 
letting should  be  premised  in  many  of  the  cases.  But  this  requires  much 
good  judgment.  In  a  large  proportion  of  cases  this  remedy  is  not  want- 
ed, and  in  many  it  would  be  seriously  injurious.  Where  doubt  exists,  it 
should  be  avoided,  and  the  main  dependence  placed  upon  the  foregoing 
antiphlogistic?,  and  perhaps  a  Blister  to  the  nape  of  the  neck.  If 
Bloodletting  be  practised,  the  patient  should  be  in  a  sitting  posture,  and 
its  effects  should  be  carefully  observed  while  the  blood  is  flowing  from 
the  arm.  I  bled  a  very  athletic  man,  with  a  bounding  pulse,  florid  skin, 
and  furious  delirium,  to  the  extent  of  twelve  ounces,  from  a  large  ori- 
fice, when  syncope  came  on  in  an  instant  of  time,  and  tumbled  him  from 
his  chair.  But  it  completely  carried  off  the  delirium,  though  there  re- 
mained much  abdominal  disease  to  be  subdued  by  other  means,  of  which 
a  dose  of  Calomel  and  Jalap  was  one  (^  662  c). — See  Note  p.  425. 

In  another  case  of  a  robust  subject,  which  was  complicated  with  in- 
tense pleurisy,  I  bled  the  patient  pretty  freely;  but  he  got  no  relief  from 
this  or  any  other  remedy.  I  advert  to  this  instance,  particularly,  as 
simple  pleurisy  yields  readily  to  an  early  abstraction  of  blood  {^  624). 

§  1058,  z.  In  puerperal  fever,  Blue  Pill,  whatever  may  be  the  dose,  is 
more  or  less  useful  for  its  local  effects,  and  much  preferable  to  Calomel, 
which  is  liable,  in  this  disease,  to  irritate  the  abdominal  organs  injuri- 
ously (§  1058, y).  But  a  prompt  and  large  abstraction  of  blood,  as  w^e 
have  already  abundantly  seen,  is  the  only  reliable  means  (§  1005,  h-rj). 

The  relative  value  of  Calomel,  Blue  Pill,  Tartarized  Antimony,  and  Ipecac- 
uanha, as  gradual  Alteratives  in  the  Treatment  of  Inflammations  and 
Fevers. 

§  1059.  Much  has  been  said  in  these  Institutes  of  the  foregoing  reme- 
dies, as  employed  in  small  doses  with  a  view  to  their  gradually  altera- 
tive effects,  but  mostly  for  the  purpose  of  illustrating  principles.  They 
have  been  regarded  also,  with  the  same  intention,  as  employed  in  their 
full  cathartic  or  emetic  doses ;  and  it  has  been  seen  that,  in  whatever 
doses  administered,  they  operate  upon  one  common  principle — that  of 
altering  or  changing  the  pathological  conditions.  By  that  alterative  vir- 
tue the  profound  action  of  Calomel  as  a  cathartic,  or  of  Tartarized  An- 
timony, or  Ipecacuanha,  as  an  emetic,  may,  by  a  single  blow,  as  it  were, 
overthrow  a  fever,  or  pneumonia,  or  croup,  &c.,  when  the  same  diseases 
would  subside  only  slowly  under  those  minimum  doses  which  may  dis- 
play no  other  remarkable  effect  than  the  substitution  of  healthy  for  mor- 
bid actions.  But,  however  great  may  sometimes  be  the  curative  influ- 
ences of  the  maximum  doses,  the  minimum  are  by  far  the  greater  auxili- 
aries to  Nature.     Such  is  an  abstract  view ;  for,  in  either  case,  it  may 

Hh  h 


B50  INSTITUTES    OF    MEDICINE. 

be  indispensable  that  other  remedies  should  have  prepared  the  way  for 
their  favorable  operation,  as  bloodletting  to  secure  their  salutary,  or  to 
prevent  their  morbific,  effects  either  as  cathartics,  or  emetics,  or  gradual 
alteratives;  or  a  preliminary  cathartic  to  render  useful  the  emetic  or 
the  slowly  progressive  altei-ative  (§  672,  867,  871,  «fec'). — Note  Ee. 

To  enable  us  to  comprehend  the  better  how  these  agents  quietly  re- 
move, in  small  and  repeated  doses,  profound  conditions  of  disease,  it 
should  be  considered  how,  also,  they  will  sometimes  overcome  the  same 
by  a  single  powerful  impression — how  Calomel  will  then  display  its  pow- 
er as  a  cathartic  and  unlock  the  liver,*  or,  at  another  time,  calm  the  whole 
gastric  and  intestinal  tumult  of  the  epidemic  cholera^ — or  yet  again,  in 
the  same  full  dose,  will  rouse  the  irritability  of  the  stomach  from  apparent 
torpor,  and  set  in  motion  the  whole  mechanism  of  vomiting — besides  nu- 
merous other  potent  influences  which  Calomel  is  capable  of  exerting  in 
its  higher  doses.  And  turning  next  to  the  agents  of  emetic  virtues,  we 
may  trace  out  their  unperceived  operation  as  gradual  alteratives  by  con- 
sidering what  has  been  said  of  the  emetic  effects  of  Tartarized  Antimo- 
ny in  ^  902,  e-g,  and  by  a  reference  to  that  philosophy  of  the  operation 
of  all  these  agents,  through  reflex  action  of  the  nervous  system,  as  vari- 
ously set  forth  in  this  work,  and  a  glance  at  which  may  be  obtained  by 
simply  referring  to  §  150,  151,  228-233|,  500,  506,  514,  516  d,  No.  6, 
§  549-557,  841,  854,  857,  863  d,  873,  889  b,  892|  g,  902  e-h,  904  hb. 
But  before  leaving  this  subject  of  the  modus  operandi  of  remedies  I 
shall  employ  the  constitutional  influences  of  the  mercurials  in  farther 
demonstration  of  the  doctrine  which  I  have  propounded,  that  remedies 
of  positive  virtues  contribute  to  the  removal  of  disease  by  substituting 
for  the  more  profoundly  morbid  other  pathological  conditions  that  sub- 
side spontaneously,  and  this  whether  the  action  be  exerted  directly  upon 
the  part  affected,  or  upon  distant  parts  through  alterative  influences  of 
reflex  nervous  action.  The  principle  was  exemplified  in  all  its  local  and 
constitutional  aspects  when  speaking  of  the  modus  operandi  of  Counter- 
irritants,  the  Seton,  &c.  ;  but  the  constitutional  action  of  the  mercurials 
supplies  another  apt  illustration.  That  effect  as  displayed  in  the  sali- 
vary glands  and  about  the  tissues  of  the  mouth  is  strictly  inflamma- 
tory. It  also  subsides  spontaneously.  But  the  disease  for  which  the 
mercurial  had  been  employed,  especially  if  acute,  will  have  probably 
disappeared  long  before  the  artificial  inflammation.  And  so  of  pleurisy 
after  the  application  of  vesicants.  Now,  what  should  be  inferred  from 
these  facts  t  Certainly  that  the  mercurial  had  altered  the  condition  of 
the  parts  that  were  primarily  diseased  more  or  less  according  to  the 
manner  in  which  it  had  altered  the  condition  of  the  salivary  glands  and 
mouth — perhaps  only  less  intensely — only  changing  the  already  morbid 
states  to  other  conditions  less  profoundly  morbid,  and  thus  substituting 
a  pathological  state  which  will  subside  more  immediately  than  the  tran- 
sitory one  instituted  in  the  salivary  glands.  This,  too,  is  farther  seen 
in  the  correspondence  in  the  increased  secretion  of  bile  in  hepatic  dis- 
eases as  induced  by  the  transient  or  more  profound  effects  of  the  mer- 
curials and  the  increase  of  saliva  incident  to  salivation.  The  same 
principle  is  shown  by  cantharides — externally  or  internally.  The  in- 
flammation it  induces  in  the  skin  or  bladder  subsides  quickly,  but  be- 
fore it  shall  have  disappeared  from  the  surface  it  may  have  removed  a 
pneumonia  or  a  pleurisy ;  and  this  result  demonstrates,  in  itself,  the  de- 
*  See  p.  839,  §  1058  h,  note. 


Therapeutics. — appendix.  — Jalap.  851 

pendence  of  the  cure  upon  a  reflected  alterative  nervous  action  upon 
the  thoracic  organs,  which  is  as  completely,  but  less  intensely  and  ti'an- 
siently,  morbific  as  when  cantharides  cures  erysipelas  by  its  direct  ap- 
plication to  the  affected  surface  (§  854-860,  S^l^g,  893  a,  c-i,  L  894- 
901,  905).  And  so  of  the  constitutional  action  of  the  unguentum  hy- 
drargyri  as  applied  to  the  skin  (§  827  e,  904  c,  1088  b).  Fi'om  these 
analogies  we  pass  along  the  gradations  that  are  supplied  by  cathartics 
and  emetics  till  we  reach  the  less  appreciable  ones  as  manifested  by  io- 
dine, quinine,  &c.  (§  892^-  c,  893  q),  and,  taking  along  the  acrids  in  § 
1065  a,  we  find  that  a  common  modus  operandi  appertains  to  the  whole. 
Tartarized  Antimony. — Kanks  here  after  Blue  Pill.  Others  would 
place  it  as  the  first  of  the  alteratives,  from  its  almost  universal  adapta- 
tion to  fevers  and  inflammations,  and  its  great  curative  power.  But, 
though  far  more  unexceptionably  applicable  to  these  affections  than  the 
mercurials,  it  will  not,  in  like  manner,  suddenly  arrest  continued  fever, 
or  acute  inflammations,  and,  although  gradually  succeeding  where  the 
mercurials  may  fail,  the  latter  not  unfrequently  have  the  same  advant- 
age over  the  Antimonial.  But  this  comparison  holds  more  with  Calo- 
mel than  with  Blue  Pill.  Again,  the  mercurials  exert  a  profound  in- 
fluence upon  chronic  inflammations,  of  which  Tartarized  Antimony  is 
far  less  capable,  though  sometimes  greatly  more  so,  as  in  chronic  rheu- 
matism. The  proper  rank  of  Tartarized  Antimony  is  probably  imme- 
diately after  Calomel,  as  gradual  alteratives  (§510  d,  no.  G,  904  hb). 

Ipecacuanha. — Dose,  gx".  J  to  gr.  1,  once  in  four  to  six  hours.  The 
repetition  of  one  grain  oftener  than  once  in  four  hours  will,  in  a  majority 
of  cases,  soon  produce  vomiting  (§  549-559,  841,  873  a).  Ranks  after 
Tartarized  Antimony.  Is  adapted  to  all  the  inflammatory  affections  to 
which  the  antimonial  is  suited,  but  is  much  less  efficient  in  most,  though 
far  more  so  in  a  few,  as  in  dysentery,  where  Tartarized  Antimony,  in- 
deed, is  inadmissible.  May  be  also  employed  in  many  irritable  condi- 
tions of  the  alimentary  canal  in  which  the  antimonial  cannot.  It  is  of 
comparatively  little  use  in  chronic  inflammations,  excepting  of  the  lungs ; 
and  renders  very  little  service  in  idiopathic  fever.  Its  advantages  in 
some  cases  of  indigestion  have  procured  for  it  a  place  among  the  tonics. 
But  it  has  no  shade  of  a  tonic  virtue,  though  it  will  sometimes  bring 
about  corresponding  results  by  its  peculiar  alterative  action  (§  89O2-,  d). 

JALAP. 

§  1060.  In  the  work  on  Materia  Medica  and  Therapeutics,  I  have  given 
to  Jalap  in  conformity  with  the  results  of  general  experience,  the  third 
rank  among  the  cathartics.  There  is  no  other,  excepting  Calomel  and 
Blue  Pill,  that  is  so  powerfully  alterative  in  inflammations  and  fevers, 
and  none  so  safe  in  connection  with  the  curative  virtues  which  are  re- 
quired in  the  early  stages  of  these  affections,  and  it  is  an  early  stage  of 
acute  diseases  to  which  I  always  refer.  This  comparative  exemption 
from  objection  is  rather  remarkable,  when  it  is  considered  that,  like 
Scammony,  the  active  principle  resides  considerably  in  a  resinous  sub- 
stance, and  that  the  resin  of  Jalap  is  an  acrid  cathartic.  But  this  only 
shows  us  that  we  must  consult  the  direct  effects  of  remedial  agents  upon 
morbid  conditions  to  ascertain  their  actual  virtues  as  remedies  (§  5^  a, 
675,  686,  837  cc,  854  bb,  c,  904  c).  All  that  is  of  any  value  in  this 
respect  has  been  the  result  of  experimental  observation — observation 
limited  to  effects  upon  diseased  states  of  the  body  (§  137,  d).     And  what 


852  INSTITUTES    OF    MEDICINE. 

a  rebuke  is  this  to  the  pretensions  of  Organic  Chemistry !  Doubtless, 
it  is  greatly  owing  to  analogical  conclusions  from  the  apparent  coinci- 
dence in  the  resinous  principles  of  Jalap,  Scammony,  &c.  (§  10G3),  that 
many  have  considered  Jalap  as  unsuited  to  the  acute  stages  of  inflamma- 
tion and  fever  as  the  other  resinous  cathartics.  But  experience  shows 
it  otherwise. 

In  making  this  discrimination,  however,  in  favour  of  Jalap,  it  must 
not  be  entertained  that  it  will  supersede  the  necessity  of  Bloodletting  in 
acute  inflammations  of  important  parts,  and  in  numerous  cases  of  fever, 
especially  of  all  the  congestive  varieties,  or  that  all  the  favourable  cflTects 
of  Jalap,  like  those  of  other  cathartics,  will  not  be  as  often  promoted  by 
previous  Bloodletting  in  these  affections ;  though  it  may  be  less  morbific 
without. — See  Note  Ff  p.  1135,  as  to  Yelloio  Fever. 

When  acute  inflammation  affects  the  intestinal  canal,  neither  Jalap 
or  any  other  cathartic  can  be  employed  till  the  disease  is  essentially 
overcome  by  other  remedies.  But  even  in  these  conditions  it  will  pro- 
duce less  injurious  irritation  than  any  other  active  cathartic,  excepting 
Castor  Oil ;  and  it  may  be  a  good  deal  divested  of  its  irritating  effects 
by  combining  with  it  some  proportion  of  Tartrate  of  Potash. 

With  the  exception  of  the  Saline  and  Mercurial,  it  is  the  effect  of 
most  cathartics,  especially  of  such  as  ai'e  called  Resinous,  and  of  Rhu- 
barb, and  Senna,  to  excite  the  general  circulation  during  their  direct  op- 
eration ;  and  this  particularly  if  acute  inflammation  or  febrile  excitement 
be  present.  But  the  usual  effect  of  Jalap  is  the  reverse,  if  any  pi-esent 
artei'ial  excitement  be  not  very  high,  and  the  intestine  be  not  in  a  mor- 
bidly irritable  state.  Under  these  circumstances,  the  action  of  the  heart 
and  bloodvessels  diminishes  in  force  and  decreases  in  frequency  during 
the  direct  action  of  Jalap,  which,  in  respect  to  uniformity,  is  a  remark- 
able property  of  this  cathartic,  though  frequently  witnessed  of  Castor 
Oil  (§  1057,  /). 

But  Jalap  is  recommended  in  the  early  stages  of  acute  inflammations 
and  fevers,  with  the  qualification  already  made,  not  only  by  its  compar- 
atively unirritating  effects,  and  its  depressing  influence  upon  the  organs 
of  circulation,  but  by  its  direct  alterative  effects  upon  diseases  of  all 
parts,  under  appropriate  circumstances.  Indeed,  its  alterative  action  is 
not  especially  manifested  in  any  one  organ  ;  but  it  appears  to  distribute 
its  effects  more  equally  than  any  other  active  purgative  upon  all  parts 
that  may  be  the  seat  of  disease.  So  far,  it  is  singularly  adapted  to  idio- 
pathic fever,  and  to  inflammation  of  all  parts,  excepting  of  the  intestines. 
The  copious  secretion  Avhich  it  determines  from  the  intestinal  mucous 
membrane,  and  quite  freely  from  the  liver,  is,  also,  another  recommend- 
ation of  this  remedy  in  the  diseases  under  consideration  (§  143  h,  c,  148, 
163,  847  (J,  863  d,  e,  871,  889/,  h,  i,  n,  900,  902  g,  i). 

But  Jalap  is  rarely  given  uncombined.  It  has  not,  as  I  have  said, 
any  remarkably  greater  effect  upon  one  organ  remote  from  the  aliment- 
ary canal  than  upon  another ;  but  by  combining  other  remedies  with  it, 
we  may  not  only  increase  its  own  remedial  influences,  but  produce  spe- 
cial effects  upon  particular  organs.  For  this  purpose  Calomel  is  gener- 
ally the  best  adjunct.  The  effects  of  this  combination,  when  appropriate, 
are  Avell  known  to  be  remarkably  great,  each  remedy  contributing  to  the 
effects  of  the  other,  extending  them  with  greater  force  than  either,  indi- 
vidually, to  every  organ  of  the  body,  and  exerting  a  more  special  sway 
over  the  liver,  breaking;  down  disease  wherever  it  exists  in  a  direct  man- 


Therapeutics. — ^appendix. — Saline  Cathartics.  853 

ner,  and  indirectly  by  influences  that  are  exerted  upon  organs  that  are 
not  diseased,  through  salutary  sympathetic  impressions  reflected,  through 
the  nervous  power,  from  these  parts  (as  the  skin  for  example)  upon  or- 
gans that  are  diseased  (§  143  c,  514  //,  674  d,  676,  889  n,  902  g,  m). 

This  knowledge  of  the  virtues  of  Jalap  enables  us  to  understand  ho\r 
it  is  that  the  addition  of  a  grain  or  two  of  Ipecacuanha  often  improves 
its  excellent  qualities,  especially  when  Calomel  is  also  associated  in  the 
compound.  Ipecacuanha  is  not  less  remarkably  universal  in  its  influ- 
ences, though  determining  a  more  special  action  upon  the  skin,  and  upon 
the  lungs  in  their  inflammatory  conditions  (§  2b,  143  c,  148-151,  855, 
895,  902  /),  contra-stimulant,  powerfully  alterative,  especially  when 
thus  appointed,  and  tributary  to  the  purgative  eftect.  When,  therefore, 
brought  into  union  with  Jalap  and  Calomel  in  the  dose  of  a  grain  or 
two,  or,  if  a  more  powerful  etfect  as  a  cathartic,  depressant,  and  alter- 
ative be  wanted  (§  227),  then  the  Ipecacuanha  in  the  dose  of  five  or  more 
grains  forms  a  compound  which  is  truly  wonderful  in  its  curative  effects, 
so  only  the  remedy  be  suited  to  the  exigencies  of  the  disease. 

In  all  that  I  am  now  saying  of  the  uses  of  cathartics,  or,  indeed,  of 
any  remedy,  the  remarks  must  not  be  taken  in  an  abstract  sense,  but 
they  suppose  that  other  remedial  agents  have  been  already  employed, 
whenever  necessary,  to  place  the  disease  in  a  proper  condition  for  the 
remedy  under  consideration  (§  1058,  e). 

I  have  now  stated  the  most  useful  combinations  which  Jalap  is  capa- 
ble of  forming  with  other  remedies.  The  only  other  of  much  import- 
ance is  its  union  with  Tartrate  of  Potash  (the  bitartrate  being  often 
injurious  by  the  excess  of  acid).  This  and  Castor  Oil  are,  in  a  general 
sense,  the  most  useful  adjuvants  to  Calomel,  when  the  latter  is  admin- 
istered in  advance  (§  1057,  I). 

THE  'SALINE    CATHARTICS. 

§  1061.  In  the  Author's  Therapeutical  Arrangement  of  Remedies  Cas- 
tor Oil  and  Aloes  follow  successively  after  Jalap,  and  then  appear  five 
saline  cathartics  in  the  following  order:  1.  Tartrate  of  Soda  and 
Potash.  2.  Sulphate  of  Magnesia.  3.  Sulphate  of  Soda.  4.  Phos- 
phate OF  Soda.  5.  Tartrate  of  Potash.  This  order  of  arrangement 
is  intended,  as  throughout  the  whole  plan,  to  indicate  their  supposed 
general  relative  usefulness.  I  Avill  here  remark  that  Podophyllum  is 
placed  as  the  fourth  in  order  on  account  of  its  analogies  to  Jalap ;  but 
it  should  go  down  below  the  Juglans,  as  it  is  so  fully  superseded  by 
Jalap.     It  yields,  however,  a  useful  extract,  which  Jalap  does  not. 

The  virtues  of  these  saline  cathartics  are  very  analogous,  yet  each  one 
is  marked  by  certain  peculiarities,  but  less  individually  characteristic 
than  such  as  distinguish  most  of  the  other  members  of  this  family  of 
medicines.  In  a  general  sense  they  are  also  distinguished  from  other 
cathartics,  excepting  Jalap,  by  often  directly  lessening  any  general  ar- 
terial excitement  which  may  exist  at  the  time  of  their  exhibition,  and 
they  have  obtained,  in  consequence,  the  appellation  of  Antiphlogistic 
Catliartics.  And  yet  their  range  of  influence  over  severe  forms  of  inflam- 
mation and  fever  is  greatly  less  than  that  of  the  Mercurials,  and  Jalap, 
and  Castor  Oil.     All  these  things  illustrate  ^  500  m,  900,  902  g,  h,  904  a. 

But  their  adaptation  to  a  vast  range  of  mild  fevers  as  ultimate  reme- 
dies, and  to  inflammations  of  comparatively  unimportant  parts,  gives  to 
them  the  relative  value  which  I  have  assigned  them  in  the  Systematic 


854  INSTITUTES    OF    MEDICINE. 

Arrangement.  But,  in  all  inflammatory  and  irritable  conditions  of  the 
intestines,  these  cathartics  rarely  fail  of  being  injurious.  Nor  should 
they,  as  a  general  rule,  be  exhibited  as  a  primary  remedy  in  any  disease 
of  much  importance  ;  for,  although  they  moderate  general  arterial  excite- 
ment, they  are  but  feebly  alterative,  and  are  liable,  by  an  irritative  action, 
to  aggravate  severe  conditions  of  disease.  Examples  of  this  nature  are 
often  presented  to  our  observation  in  cases  where  some  one  of  these  salts 
has  been  administered  before  summoning  the  attendance  of  a  physician. 
These  are  particularly  the  cathartics  which  render  much  of  their  service 
by  the  secretion  which  they  elicit  from  the  intestinal  mucous  membrane 
(§  863)  ;   but  least  of  all  do  they  reach  the  function  of  the  liver. 

It  is  seen,  therefore,  to  be  a  peculiarity  of  these  cathartics  to  irritate 
the  intestinal  mucous  membrane  without  propagating  an  irritation  to 
the  general  circulatory  organs,  even  in  their  excited  conditions,  so  long 
as  they  produce  no  injurious  irritation  of  the  intestines.  On  the  con- 
trary, if  the  disease  be  not  intestinal,  they  will  often  gi-eatly  moderate 
arterial  excitement  during  their  direct  operation  ;  and  it  is  this  circum- 
stance which  has  given  them  a  factitious  importance  in  the  treatment 
of  severe  forms  of  disease.  But  the  reduction  of  arterial  action  and  of 
heat  is  mostly  due  to  the  free  elaboration  of  intestinal  fluids,  and  the 
absence  of  irritative  virtues  in  the  remedies.  There  is  little  or  no  alter- 
ative action  exerted  upon  the  immediate  instruments  of  disease,  where 
disease  is  at  all  profound.  There  is  but  little  of  that  alterative  reflect- 
ed nervous  influence  instituted  through  the  alimentary  canal  which  con- 
stitutes the  most  valuable  effect  of  remedial  agents  (§  150-151, 163,  228, 
526  a,  714,  716,  854  c,  859  5,  860,  870  a,  aa,  902,  904  a).  Although, 
then  fore,  the  heat  of  the  skin,  and  the  excited  state  of  the  pulse,  be 
moderated  by  the  saline  cathartics,  it  is  often  so  only  to  return  soon  with 
equiil  or  increased  intensity.  The  remedy  has  not,  in  such  cases,  estab- 
lished salutary  impressions  ;  and,  in  this  way,  the  days  steal  on,  but  each 
succeeding  day  bringing  some  ascendency  of  disease  over  what  is  gained  by 
the  illusory  "cooling  effects,"  as  they  are  called,  of  the  saline  cathartics. 

Those  who  depend  upon  their  cooling  effects  are  also  apt  to  employ 
lemonade  and  oi*anges  to  aid  in  the  cooling  process ;  and,  although  these 
vegetable  acids  are  set  down  in  the  books  under  the  hypothetical  denom- 
ination of  refrigerants  (^  819,  a,  Mottoes),  and  are  strongly  recommend- 
ed for  the  purpose  of  cooling  down  inflammations  and  fevers,  it  is  not 
less  certain  that  it  is  only  an  old  relic  of  the  humoral  pathology,  and  that 
these  acids  have  not  the  slightest  tendency  to  diminish  febrile  or  inflam- 
matory action ;  but,  on  the  contrary,  they  rarely  fail  to  aggravate  and 
prolong  both.  They  produce  an  injurious  irritation  of  the  gastro-intes- 
tinal  mucous  membrane,  thus  inflicting  a  direct  injury  upon  those  organs 
through  which  we  endeavour  to  convey  relief  to  others. 

Such,  then,  is  the  deceptive  nature  of  the  whole  of  this  refrigerant 
system.  Thousands  are  its  victims ;  when  one  good  Bloodletting,  and 
a  dose  of  some  suitable  cathartic,  at  the  beginning,  would  effectually 
cool  down  the  patient,  and  probably  save  the  necessity  of  any  forther 
active  treatment  in  a  great  proportion  of  the  cases.  It  is  comparatively 
a  small  evil,  however,  with  that  which  arises  from  an  indiscriminate  and 
excessive  medication. 

All  this  comes  from  the  want  of  sound  principles  in  physiology  and 
pathology — the  want  of  medical  philosophy — and  a  consequent  leaning 
upon  the  impracticable  and  visionary  doctrines  of  the  physical  schools. 


Therapeutics. — appendix. — Rh  ubarh.  855 


RHUBARB. 


§  1062.  llhubarb  follows  next  in  our  Therapeutical  Arrangement,  and, 
doubtless,  there  are  many  who  think  it  entitled  to  a  higher  rank.  But, 
■with  all  its  reputation,  its  uses  are  comparatively  circumscribed.  It  is 
not  suited  to  any  conditions  of  acute  inflammation  or  fever,  till,  at  least, 
they  are  far  on  the  decline  (§  872,  a) ;  nor  is  it,  at  any  time,  a  proper 
purgative  when  an  active  effect  is  required.  Indeed,  the  real  advantages 
of  Khubarb,  as  a  cathartic,  are  limited  almost  to  cases  of  diarrhoea  un- 
attended with  intestinal  inflammation,  to  indigestion,  and  to  the  stage  of 
convalescence  from  most  diseases,  whether  acute  or  chronic ;  and,  I  may 
also  add,  to  scrofulous  subjects  when  affected  by  indolent  conditions  of 
inflammation.  I  am  speaking  of  it  in  its  relations  to  disease  as  a  cathar- 
tic, though  it  may  exert  simultaneously  other  veiy  desirable  effects.  In 
smaller  doses,  other  objects  are  in  view,  and  they  can  have  no  participa- 
tion in  assigning  the  rank  as  a  cathartic  (§  890,  b). 

Now,  the  reasons  of  this  limitation  are  rendered  obvious  by  consider- 
ing the  effects  of  Rhubarb  upon  certain  diseased  states  of  the  body. 
When  exhibited  in  fevers  and  acute  inflammations,  which  make  up 
the  great  amount  of  diseases,  it  aggravates  them  like  stimulants  and 
tonics;  and  it  is  also  well  known  that  it  exerts  the  useful  effects  of 
tonics  where  these  remedies  are  appropriate,  as  in  dyspectic  affections 
(§  10G5).     Aloes,  scammony,  &c.,  increase  them  by  irritant  virtues. 

Whilst,  therefore,  we  thus  learn  that  Rhubarb  is  not  suited  to  febrile 
and  inflammatory  conditions  of  an  active  nature,  the  objections  show 
us  that  it  is  well  adapted  to  the  periods  of  convalescence  from  those 
affections.  Its  mild  tonic  and  cathartic  virtues,  as  then  manifested  in 
small  doses,  give  to  it,  under  those  circumstances,  a  high  value  as  an 
auxiliary  to  Nature  in  her  recuperative  efforts.  But  in  these  cases, 
even,  it  should  not  be  given  uncombined  (§  872  a,  1064). 

By  its  frequent  effect  in  arresting  diarrhosa,  it  is  known  to  possess, 
also,  what  is  called  an  astringent  property.  But  of  this  I  have  already 
spoken  (§  890,  h). 

We  have  now  seen  that  Rhubarb  is  cathartic,  tonic,  stimulant,  and 
astringent ;  a  combination  of  virtues  which  distinguishes  it  remarkably 
from  all  other  cathartics.  These  united  virtues  impart  to  it  a  high  value 
as  a  cathartic  in  certain  conditions  of  disease,  and  a  good  substitute 
could  not  be  supplied  for  it  in  those  conditions.  It  enables  us,  also,  to 
employ  rhubarb  most  advantageously  in  many  forms  of  disease  where 
we  do  not  desire  its  cathartic,  but  only  its  laxative  effect  that  arises 
from  small  doses.  In  these  small  quantities,  too,  as  a  grain  to  five 
grains,  the  tonic  effect  of  the  remedy,  which  is  then  commonly  desirable, 
is  more  strongly  pronounced  than  in  large  doses. — Note  Ee  p.  1133. 

On  account  of  these  numerous  virtues  of  Rhubarb,  according,  in  part, 
to  the  quantity  administered  and  the  nature  of  the  disease,  I  have  ar- 
ranged it  not  only  among  the  cathartics,  but  among  the  alteratives,  and 
tonics,  and  astringents.  For  the  first  of  these  purposes  it  is  most  useful 
when  combined  with  Calomel,  or  Calcined  Magnesia,  or  the  Tartrate  of 
Soda  and  Potash,  or  the  Sulphate  of  Potash  ;  as  an  alterative  it  is  often 
useful,  in  small  doses,  in  chronic  inflammations,  on  account  of  its  useful 
effect  upon  the  alimentary  canal  and  liver ;  as  a  tonic  in  dyspeptic  cases, 
and  in  convalescence  from  acute  diseases,  when  its  action  upon  the  liver, 
and  its  laxative  effect,  are  also  tributary  to  the  cure ;  and,  as  an  astrin- 


856  INSTITUTES    OF    MEDICINE. 

gent,  in  cases  of  diarrhoea  unattended  by  intestinal  inflammation,  and  in 
large  or  small  doses  according  to  the  precise  nature  of  the  disease. 

Great  mischief  is  done  by  the  exhibition  of  Rhubarb  in  dysentery 
and  scarlet  fever.  It  is  employed  theoretically  in  the  treatment  of  the 
former  disease,  on  account  of  the  astringent  as  well  as  cathartic  virtue 
of  this  remedy,  while  the  tonic  and  stimulating  are  completely  neglected, 
as  well  as  its  pernicious  effects  (§  892^,  g). 

SCAJUMONY,  ALOES,  COLOCYNTH,  SENNA,   COLCHICUM. 

§  1062^.  Three  of  the  foregoing  remedies,  Scammony,  Senna,  and  Col- 
chicum,  are  produced  here,  not  only  for  the  purpose  indicated  in  §  1057^, 
but  to  exemplify  the  manner  in  which  remedial  agents  of  powerful  mor- 
bific virtues  arc  commended  to  an  indiscriminate  use  in  those  enlight- 
ened quarters  where  Bloodletting  is  nearly  or  altogether  proscribed,  and 
to  thus  institute  a  farther  contrast  between  the  abuse  of  the  Materia 
Medica  and  the  neglect  or  denunciation  of  the  '■'■  Remedium  Priricipale" 
(§  819  b,  891  c,  954  b,  960  a-h,  1000,  1001,  1003,  1005-1006,  1007  b). 

SCAMMONY,  ALOES,  AND    COLOCYNTH. 

§  1063,  a.  The  cathartics  following  Ehubarb  (§  1062)  in  our  Thera- 
peutical Arrangement  are,  respectively.  Calcined  Magnesia,  Carbonate 
of  Magnesia,  Colocynth,  and  Scammony,  the  last  of  which,  therefore, 
occupies  the  15th  rank  as  a  cathartic  of  general  usefulness,  Aloes  hold- 
ing the  5th,  or  next  after  Castor  Oil. 

Scammony  is  a  more  irritating  cathartic  than  Aloes  or  Colocynth,  to 
which  it  is  a  good  deal  allied  in  its  effects  upon  morbid  conditions,  al- 
though, unlike  the  latter  it  contains  a  large  proportion  of  resin,  which 
is  the  active  principle  (§  1060).  It  operates  with  energy  upon  the  whole 
intestinal  canal,  and  exerts  an  alterative  reflex  nervous  effect  upon  the 
liver,  often  inducing  a  redundant  flow  of  bile  in  the  inactive  conditions 
of  that  organ.  It  is  well  suited,  therefore,  when  properly  combined,  to 
habitual  and  obstinate  constipation,  where  no  intestinal  inflammation  is 
present.  It  is,  for  like  reasons,  and,  like  Aloes  and  Colocynth,  curative 
of  chronic  diseases  of  organs  situated  remotely  from  the  abdominal  vis- 
cera, and  which  owe  their  origin  to  those  abdominal  affections  of  which 
I  am  speaking,  or,  having  a  different  origin,  become  complicated  with 
them  (§  905,  a).  These  three  remedies,  indeed,  are  generally  adapted 
to  like  conditions ;  though  Aloes  is  much  the  best,  and  Colocynth  is 
more  alterative  and  remedial,  and  less  irritating  than  Scammony.  Each 
is  pernicious  in  all  inflammatory  and  irritable  states  of  the  intestinal 
canal,  as  well  as  injurious  in  all  fevers,  and  in  all  acute  inflammations 
of  important  organs.  Nevertheless,  Scammony,  like  Aloes  and  Colo- 
cynth, is  more  or  less  adapted  to  mild  inflammations  of  the  mucous  tis- 
sue remote  from  the  abdomen,  as  in  catarrhal  affections  (^  904  a). 

§  1063,  b.  An  important  error  prevails  in  regard  to  the  action  of 
Scammony  and  Aloes  upon  the  intestinal  canal,  it  being  supposed  that 
they  exert  their  effects  (particularly  Aloes)  upon  the  lower  tract  of  the 
large  intestine.  This  conclusion  has  grown  out  of  the  irritation  of  the 
anus  which  often  attends  the  operation  of  Aloes ;  but  it  is  mostly  due 
to  the  morbid  bile  which  Aloes  elicits  from  the  liver.  The  Mercurials 
and  Castor  Oil  have  often  the  same  effect  in  hepatic  congestions,  and  it 
often  occurs  when  no  cathartic  has  been  exhibited.  Either  for  this 
reason,  or  because,  perhaps,  Aloes  contains  no  resin,  Pereira  remarks^ 


Therapeutics. — appendix. — Aloes^  Senna.,  &c.  857 

in  his  great  work  on  the  Materia  Afedica,  that  "Aloes  irritates  less  pow- 
erfully than  Jalap" !  The  misapprehension  has  led  to  a  great  extent  of 
malpractice,  particulai'ly  to  the  administration  of  this  cathartic  in 
fevers  and  acute  inflammations,  and  even  in  morbidly  irritable  states  of 
the  small  intestines.  Aloes  is,  also,  for  the  same  reason,  in  part,  with- 
held from  pregnant  women,  lest  its  supposed  action  upon  the  rectum 
should  give  rise  to  abortion,  a  result  which  was  denied  by  Denman, 
while,  also,  Aloes  is  an  emmenagogue  of  some  pretensions.  As  to  the  lat- 
ter fact,  it  restores  menstruation  in  two  pi'incipal  ways:  1st,  by  its  spe- 
cial sympathetic  action  upon  the  mucous  tissue,  remote  from  the  intes- 
tine, in  its  morbidly  susceptible  conditions,  as  witnessed  in  catarrh  and 
gonorrhoea ;  and,  2d,  by  its  removal  of  indolent  hepatic  troubles  and  con- 
stipation, of  which  amenorrhoea  is  so  often  merely  symptomatic. 

The  simple  fact  that  Aloes  affects  readily  and  powerfully  the  hepatic 
function  in  its  morbid  states  should  leave  no  doubt  of  its  special  action 
upon  the  upper  portion  of  the  intestinal  canal ;  but,  that  this  is  truly 
so  may  be  rendered  evident,  and  Pereira's  comparison  of  Jalap  and 
Aloes  contradicted,  by  the  following  experiment,  which  may  be  readily 
tried  by  the  advocates  of  Aloes  and  Scammony,  bearing  in  mind  that, 
when  constitutional  excitement  ensues,  or  when  allayed,  by  the  opera- 
tion of  cathartics,  it  is  mostly  in  consequence  of  their  action  upon  the 
small  intestine  (§  718,  889  i). 

Let  us,  then,  regard  two  patients,  affected  as  nearly  alike  as  may  be 
with  remittent  fever.  The  skin  of  both  is  preternaturally  Avarm,  the 
pulse  moderately  full,  and  100  beats  in  a  minute.  This  is  so  far  their 
corresponding  state  ;  the  disease  in  its  incipient  stage,  and  there  has  been 
no  treatment.  Now,  to  one  we  will  give  30  grains  of  Jalap,  to  the 
other  12  grains  of  Aloes;  and  let  us  take  an  observation  of  their  symp- 
toms at  the  time  of  the  second  alvine  evacuation.  The  pulse  of  him  who 
is  purged  by  the  Jalap  has  descended  in  frequency  from  100  to  80  beats 
in  a  minute ;  while  the  Aloes  has  carried  it  up  in  the  other  to  120,  be- 
ing a  difference  of  40  beats.  The  skin  of  the  former  patient  has  become 
cool,  and  soft  Avith  an  insensible  perspiration.  This  patient  is  also 
placid,  and  feels  himself  relieved.  On  the  contrary,  the  skin  of  the  other 
is  ardent  and  dry,  his  face  flushed,  his  eyes  wild,  his  head  annoyed  with 
pain,  and  his  whole  system  in  an  agitated  and  harassing  state.  This  is 
the  test,  and  by  this  should  we  be  governed  both  in  practice  and  in 
theory.     It  illustrates  also  the  principles  in  ^  500  m,  863  d,  904  a,  kc. 

§  1063,  c.  The  objections  which  I  have  made  to  Scammony  as  an  ii*- 
ritating  cathartic  lead  me  now  to  fulfil  the  purpose  expressed  in  §  1062^, 
as  I  shall  have  occasion  to  do,  also,  when  I  come  to  the  merits  of  those 
popular  remedies,  Senna  and  Colchicum.  For  this  object  I  shall  look 
into  Pereira's  elaborate  and  standard  work  upon  the  Materia  Medica  (as 
I  have  done  on  former  occasions,  §  891  c,  960  a),  as  one,  among  others 
quoted  to  the  same  effect,  which  represents  the  opinion  of  many. 

'^  Scammon?/,"  says  Pereira,  "  w  prmcipally  valuable  as  a  smart  2)urga- 
tivefor  children,  on  account  of  the  smallness  of  the  dose  necessaivj  to  produce 
the  effect,  the  slight  taste,  and  the  energy,  yet  safety,  of  its  operation." 

I  shall  not  speculate  upon  the  probable  consequences  of  this  eulogium 
upon  one  of  the  most  irritating  and  drastic  of  the  purgatives  that  are 
entitled  to  a  reputable  place  in  the  Materia  Medica,  nor  inquire  how  far 
it  may  have  contributed  to  the  success  of  homoeopathy  (§  878).  But  I 
am  entitled  to  assert,  in  the  first  place,  that  such  is  the  great  liability 


858  INSTITUTES    OF   MEDICINE. 

of  Scammony  to  produce  constitutional  irritation,  and  excite  intestinal 
inflaramation  in  Children,  that  it  should  never  be  exhibited  to  them  un- 
der any  circumstances  (§  576  d-577) ;  and  for  the  ordinary  purpose  of 
cathartics  it  is  entirely  unsuitable  at  any  age. 

Again  :  as  to  the  attractive  "  taste"  of  medicines,  which  appears  to  be 
often  of  paramount  consideration.  Calomel,  even,  is  recommended  for 
Children  upon  this  worse  than  mere  empirical  ground ;  and,  of  one  of 
the  most  valuable  remedies,  and  most  appropriate  for  Children,  Fereira 
says,  that,  "  As  a  purgative  for  Children,  Castor  Oil  has  been  used  on 
account  of  its  mildness ;  but  its  unpleasant  taste  is  a  strong  objection  to  its 
use."  Compare  this  with  what  he  says  of  Tobacco  at  §  900,  a.  Nei- 
ther is  the  "  small/less"  of  a  requisite  dose  to  be  for  a  moment  weighed 
against  the  virtues  of  a  better  remedy. 


§  1064.  The  popularity  of  Senna  as  a  domestic  medicine,  and  the  ex- 
tensive use  of  it  by  the  Profession,  lead  me  to  some  comments  Avhich 
would  not  be  otherwise  made.  If  Bloodletting,  in  the  treatment  of  in- 
flammations and  fevers,  is  to  receive  no  quarter  from  those  who  build 
their  hopes  upon  a  more  popular  practice,  or  lose  sight  of  pathology  in 
the  novelties  and  promises  of  Organic  Chemistry,  let  us  see  to  it  that 
they  do  not  escape  without  rebuke  for  their  lavish  use  of  the  violent  ar- 
ticles of  the  Materia  Medica  (§  819,  b). — Note  H  p.  1117. 

Pereira,  in  his  able  work  upon  the  Materia  Medica,  supplies  the  best 
authority  as  to  the  general  estimation  in  which  Senna  is  held.  "Taken 
by  the  stomach,"  he  says,  "  Senna  acts  as  a  sure  and  safe  purgative ;" 
and  again  he  repeats,  "  It  is  a  very  safe  purgative,  and  may  be  given  to 
Children,  Females,  and  Elderly  persons  ivith  great  security." 

That  Senna  is  a  "  sure  purgative"  is  as  true  as  the  same  affirmation 
by  our  Author  of  Scammony  (§  1063,  c) ;  but  it  is  nearly  as  far  as  Scam- 
mony from  being  entitled  to  the  same  general  commendation  of  being 
"  very  safe."  On  the  contrary,  in  my  judgment,  there  is  no  other  ca- 
thartic, in  the  hands  of  Physicians,  which  has  been  more  extensively  in- 
jurious than  Senna ;  and  this  being  so,  I  shall  indicate  its  bad  qualities 
before  speaking  of  its  good. 

In  the  first  place.  Senna  is  rarely  capable  of  any  very  salutary  effect 
upon  inflammations,  either  acute  or  chronic,  or  upon  fevers.  By  its  ir- 
ritative virtue,  it  excites  the  general  circulation ;  and  as  it  is  profoundly 
irritating  to  the  whole  mucous  tract  of  the  bowels,  it  rarely  fails  to  ag- 
gravate idiopathic  fever,  or  to  exert  injurious  reflex  nervous  influences 
upon  any  inflamed  organs.  We  have  already  seen  how  Rhubarb  is  mis- 
applied in  this  manner,  especially  in  dysentery  (§  1062).  But  that  rem- 
edy inflicts  its  injuries  in  active  forms  of  inflammation  and  fever  by  its 
tonic  and  stimulating  properties — Senna,  by  its  irritating  (§  889,  a). 
And  here,  by  the  way,  it  is  apropos  of  the  Author  to  Avliom  we  are  now 
paying  our  respects,  that  he  says  of  Rhubarb  that,  "Given  at  the  corn- 
viencement  of  disease,  it  is  a  very  popular  remedy  ;  and  though  doubtless 
it  is  often  employed  unnecessarily,  it  rarely  if  ever  does  harm."  True,  he 
also  says  that  "  it  is  not  fitted  for  inflammatory  or  febrile  cases." 

But,  as  to  this  Senna,  it  may  be  safely  said,  that  it  should  never  be 
employed  but  with  a  simple  view  to  its  purgative  effect,  and  then  only  in 
constipated  states  of  the  bowels  when  unattended  with  any  inflammation 
of  those  organs.     The  griping  of  Senna  is  proverbial ;  and  Physicians 


Th^apeutics. — appendix. — Colchicum.  859 

have  vainly  flattered  themselves  that  this  effect  may  be  counteracted  by 
uniting  Manna,  or  the  Saline  Cathartics,  or  a  purgative  Tincture,  or 
some  carminative,  like  Coriander  or  Anise,  with  an  infusion  of  Senna ; 
nor  does  a  moderated  heat  in  its  preparation  lessen  the  evil.  What, 
then,  does  that  griping  imply,  considering  its  universality?  Certainly, 
an  excessive  irritation  of  the  intestinal  mucous  membrane,  and  such,  too, 
as  is  very  likely  to  result  in  disease  of  the  intestines,  if  these  organs  be 
in  a  morbidly  irritable  state.  If  any  disposition  to  inflammation  be 
present  in  any  one  of  the  tissues  of  the  intestines,  the  action  of  Senna 
will  be  very  likely  to  develop  an  attack  of  that  disease.  If  any  venous 
congestion  affect  the  liver,  it  will  be  aggravated  by  the  irritating  prop- 
erties of  Senna.  And,  as  it  regards  inflammations  of  other  parts,  and 
idiopathic  fever,  it  is  very  likely,  as  is  known  in  the  best  experience,  to 
send  its  morbific  influences  abroad  from  the  abdominal  organs  over  those 
affections.  Among  the  worst  and  most  common  manifestations  of  this 
are  the  sad  effects  of  Senna  in  the  treatment  of  scarlet  fever. 

The  objections  to  Senna  grow  out  of  its  radical  fault  of  possessing 
very  little  alterative  virtue  of  a  useful  nature,  and  a  great  deal  of  a  mor- 
bific (§  854,  d).  But  a  difference  in  this  respect  obtains  in  difterent  cli- 
mates ;  which  applies,  also,  more  or  less,  to  other  irritating  cathartics, 
and  to  Tartarized  Antimony  in  emetic  doses.  In  latitudes  north  of  about 
40°  these  remedies  are  better  borne  than  in  the  more  southern  ;  the  rea- 
son of  which  is,  that  in  New  York  and  South  there  either  exist  in  most 
complaints,  or  there  is  a  great  tendency  to,  derangements  of  the  abdom- 
inal viscera. 

Having,  therefore,  so  little  to  say  in  commendation  of  this  notorious 
member  of  the  Materia  Medica,  and  having  dwelt  sufficiently  long  upon 
its  demerits,  it  only  remains  to  be  added,  that  it  is  most  salutary  when 
it  takes  along  some  one  of  the  meritorious  neutral  salts. 

COLCHICUM. 

§  1065,  a.  The  most  obvious  effect  of  Colchicum,  in  small  and  repeat- 
ed doses,  is  that  of  irritating  the  intestinal  mucous  membrane,  as  evinced 
by  a  purgative  effect.  In  larger  doses  it  produces  nausea,  vomiting,  and 
hyper-catharsis.  Indeed,  this  remedy  is  commonly  arranged  with  the 
cathartics,  though  it  is  rarely  employed  with  the  usual  intentions  of  a 
purgative.  I  am  quite  satisfied,  however,  that  it  will  not  often  afford 
much  relief  in  gout  or  rheumatism  (to  which  its  uses  are  mostly  restrict- 
ed) till  it  produces  some  purgative  or  laxative  effect.  For  this  reason, 
particularly,  I  have  given  it  a  low  rank  among  the  Cathartics  in  the 
Therapeutical  Arrangement  of  the  Materia  Medica.  This  effect,  indeed, 
is  what  we  are  to  carefully  watch  ;  since,  when  it  begins,  if  the  dose  have 
been  large,  or  the  intestines  unusually  susceptible,  the  purging  is  liable 
to  be  excessive  and  injurious. 

Various  incidental  results  are  stated  by  Authors  as  following  the  use 
of  Colchicum,  such  as  occasional  sweating,  occasional  increase  of  the 
flow  of  urine,  &c.  But  these  are  only  contingencies  to  which  almost  all 
remedies  may  lead,  under  particular  circumstances  of  disease,  and  are  of 
very  little  importance  in  an  abstract  sense  (§  422  b,  863  d,  e,  892f ).  It  is 
worthy  of  remark,  however,  that  Colchicum  often  reduces  the  frequency 
of  the  pulse,  though  at  other  times  it  exerts  an  opposite  effect.  But  the 
interesting  fact  relates  to  the  diminished  frequency,  which  has  been  taken 
hypothetically  as  a  ground  for  the  administration  of  Colchicum  as  a 


860  INSTITUTES    OF    MEDICINE, 

remedy  for  all  kinds  of  inflammation,  and  is  one  of  the  expedients  that 
have  been  devised  for  getting  rid  of  Bloodletting.  This  brings  me  to 
one  of  the  objects  set  forth  in  §  1062^. 

"  J/r.  Haden^''  says  Pereira,  '■'■xoas,  the  first  to  direct  attention  to  the  advan- 
tages to  be  taken  of  this  effect  in  the  treatment  of  inflammatory  diseases  {ut 
cit,  §  1063,  c).— Note  I  p.  1 118. 

I  know  not  to  what  extent  this  very  limited  view  in  Therapeutics 
may  have  prevailed  ;  but  it  has  been,  probably,  the  occasion  of  an  effort 
now  making  in  the  United  States  to  substitute  for  Bloodletting  that  very 
violent  agent  the  Veratrura  Viride,  which  has  been  long  known  to  less- 
en the  frequency  of  the  pulse  by  an  acrid  narcotic  virtue  which  it  pos- 
sesses, and  which  belongs  to  some  of  the  acrid  cathartics.  The  whole  of 
this  practice  appears  to  have  been  suggested  by  a  similar  error  in  respect 
to  Digitalis,  and  by  the  attempts  that  have  been  made  to  substitute  To- 
bacco and  Aconite  for  Loss  of  Blood  (§500  m,  826  cc,  893i,  960  a). 

Neither  Colchicum  nor  Veratrum  exert  any  antiphlogistic  effect  ex- 
cepting upon  those  specific  forms  of  inflammation  which  constitute  rheu- 
matism and  gout ;  and  both  of  them  will  aggravate  these  diseases  in 
their  acute  condition  till  they  are  effectually  moderated  by  Bloodletting, 
Tartarized  Antimony,  or  other  direct  Antiphlogistics.  In  that  respect 
they  are  upon  common  ground  with  quinine  in  its  relation  to  intermit- 
tent inflammation,  and  with  iodine  to  the  scrofulous.  They  are  very 
remarkable  exceptions  to  all  the  general  antiphlogistic  means  which  are 
alike  adapted  to  the  early  stages  of  the  specific  and  common  forms  of 
inflammation,  and  which  are  indispensable  at  that  stage,  as  preliminary 
remedies,  to  the  favorable  action  of  the  specific  ones  upon  the  special 
modifications  of  inflammation  to  which  they  are  alone  adapted  (§  662, 
671,  892  m,  p,  892i^  c,  e,  ti).  More  remarkable  exceptions  occur  in 
guaiacum  and  other  substances  of  allied  virtues  Avhich  are  peculiarly 
suited  to  chronic  rheumatism,  while  they  aggravate  any  other  form  of 
inflammation.  Nor  is  it  an  uninteresting  fact,  that  all  these  things, 
Colchicum,  Guaiacum,  Veratrum,  Asagrtea,  Delphinium,  Xanthoxyl- 
lum,  Aconite,  Mezereon,  Savin,  are  acrids  (^  892  b,  892-|-  r,  904  a). 

§  1065,  b.  These,  however,  are  only  strongly  pronounced  character- 
istics ;  for  the  critical  observer  will  find  the  same  distinctions  prevailing 
in  various  degrees  throughout  the  Materia  Medica,  and  they  show  us 
that  experience,  and  not  theory,  is,  or  should  be,  at  the  foundation  of  all 
our  knowledge  of  the  virtues  of  remedies  (§  2,  c)  ;  and  not  only  so,  but 
that  we  can  have  no  just  apprehension  of  their  relations  to  disease  with- 
out a  long  series  of  trials  in  the  endless  variety  of  pathological  condi- 
tions, their  fluctuations,  their  localities  and  sympathetic  influences,  or  as 
they  may  involve  the  universal  body,  according  to  the  range  of  inquiry 
which  pervades  these  Institutes ;  and  when  the  student  shall  have  ex- 
amined its  details  and  principles,  and  seeing  that  there  is  not  a  conflict- 
ing fact  or  induction,  but  that  it  is  a  perfectly  consistent  and  harmoni- 
ous whole  (§  1,  a),  let  him  interrogate  himself  as  to  whether  he  can  sum- 
mon a  fact  or  a  doctrine  from  Organic  Chemistry  that  will  disturb  that 
relationship,  or  withstand  its  united  force. 

§  1065,  c.  But,  however  this  may  be,  so  long  as  the  Chemical  doc- 
trines are  in  the  ascendant,  we  may  not  hope  that  experiments  of  the 
foregoing  nature  will  cease  to  occupy  the  place  of  rational  Medicine. 
*Nay  more ;  failing  in  these,  and  considering  the  unpopularity  of  anti- 
phlogistic remedies  and  the  acceptable  nature  of  the  invigorating,  we 


Therapeutics. — appendix. — Colcliicum.  861 

need  not  be  surprised  that  the  Chemical  treatment  of  disease  is  so  ex- 
tensively governed  by  the  Brunonian  philosophy.  Of  that  philosophy  I 
have  said  something  in  these  Institutes,  and  adduced  an  example  of  its 
prevalence  in  the  British  Army  when  Robert  Jackson  undertook  to 
demonstrate  its  real  merits  (§  621a,  890^/,  960a,  p.717,  §569 e,  1006/, 
1068).  But  how  little  would  this  Reformer  rely  upon  human  efforts 
could  he  how  read  the  brief  paragraph  which  follows : 

^^ Costly  3Iedicine. — A  London  (Eng.)  paper  says:  'The  consumption 
of  Avines  in  our  public  hospitals  constitutes  one  of  the  heaviest  items  of 
their  expenditure.  The  wine  account  at  Guy's  Hospital  last  year,£l083 ; 
the  spirit  account,  £376 — total,  £1459  ($7295).  At  St.  Thomas's,  the 
wine  account  was  £629  ;  spirit  account,  £521 — total,  £1150 ;  or  £2609 
($13,045)  in  one  year  in  the  (two)  borough  hospitals  alone.'  " — Boston 
Med.  and  Surg.  Journal,  July  2,  1857,  p.  448. — Note  F  p.  1114, 

§  1065,  rf.  Again,  as  to  Colchicum.  This  is  also  one  of  the  many  vio- 
lent remedies  that  have  been  employed  not  only  as  a  substitute  for 
Bloodletting,  but  commended  in  doses  at  which  Bloodletting  revolts 
(§960,  a,  p.  717).     Thus: 

"  In  some  experiments,"  says  Pereira,  ut  cit.  (made  with  Colchicum  on 
a  healthy  individual  by  Dr.  Levvins),  "  debility,  a  feeling  of  illness,  and 
headache  were  experienced.  This  feeling  of  debility  is  not,  however,  to 
be  referred  to  the  evacuations  produced,  for,  as  Dr.  Barlow  has  observed, 
the  number  of  motions  is  sometimes  considerable  without  any  propor- 
tionate diminution  of  strength.  I  have  known,  says  Dr.  Barlow,  even 
twenty  stools  occasioned  by  a  single  dose  of  Colchicum,  the  patient  not 
complaining  of  the  least  debiHty." — Note  G  p.  1116.     Also,  p.  656. 

Now  here  is  something  of  which  we  have  a  right  to  complain.  In 
the  first  place,  that  Dr.  Barlow  should  isolate  a  case  of  this  nature,  and 
put  it  forth  to  show  that  we  have  nothing  to  fear  from  "  twenty  stools" 
by  a  single  dose  of  this  most  violent  substance ;  and,  secondly,  that  Pe- 
reira should  quote  it  for  the  same  purpose,  and  in  opposition,  even,  to 
Dr.  Lewin's  experiment  upon  a  healthy  individual. 

Having  done  this  mischief,  Pereira  ultimately  relates  instances  of 
death  from  over-doses  of  this  medicine,  and  remarks  that,  "in  poisonous 
doses,  Colchicum  acts  as  a  powerful  poison."  Now,  to  my  apprehension, 
when  "a  single  dose"  of  any  "powerful  poison"  pi'oduces  "twenty 
stools,"  it  is  verging  very  closely  upon  its  poisonous  effects;  and  when- 
ever Colchicum  may  treat  our  patients  in  that  reckless  manner,  we  may 
fear,  at  least,  some  troublesome  intestinal  inflammation  as  a  consequence. 
There  never  was,  and  never  will  be  a  patient  purged  twenty  times  by  "a 
single  dose"  of  any  cathartic,  without  being  the  worse  for  the  violence 
inflicted  upon  his  intestines  (§  960,  a,  p.  717).  There  can  be  no  topic 
more  worthy  of  professional  criticism. 

But  I  have  been  actuated  in  this  disquisition  only  by  a  sense  of  the 
importance  of  considering  well  how  the  violent  agents  of  the  Materia 
Medica  are  often  commended  to  our  rash  and  indiscriminate  use ;  and 
in  so  doing,  to  show,  also,  how  probable  it  is  that  the  same  inconsider- 
ate view  of  the  subject  has  led  to  protestations  against  the  most  import- 
ant of  all  remedies  in  the  treatment  of  inflammations. — Note  Hp.  11 17. 

§  1065,  e.  There  can  be  no  doubt  that  Colchicum  manifests  a  much 
greater  control  over  gout  than  rheumatism ;  and,  although  this  is  gen- 
erally conceded,  all  practitioners  do  not  agree  as  to  the  extent  of  its  in- 
fluence.    Some  of  .the  most  able  and  accurate  observers,  such  as  Sir  E. 


862  -  INSTITUTES    OF    MEDICINE. 

• 

Home,  and  Dr.  Paris,  pronounce  it  a  specific  for  the  disease;  while 
others,  like  Sir  C.  Scudamore,  consider  it,  at  best,  only  a  palliative.  In- 
deed, Scudanaore,  in  his  treatise  on  the  gout,  is  disposed  to  look  upon 
Colchicum  with  great  suspicion,  believing  that,  although  it  be  a  present 
means  of  relief,  it  increases  the  tendency  to  a  repetition  of  the  paroxysms. 
He  thinks,  also,  that  it  loses  its  remedial  eft'ects  by  frequent  use,  al- 
though considerable  intervals  intervene  between  the  attacks.  Very 
much,  however,  will  depend  upon  the  particular  circumstances  of  the 
case  when  the  remedy  is  exhibited.  If  given  at  the  onset  of  acute  gout 
without  antecedent  Bloodletting,  or  when  the  abdominal  organs  are  in 
a  morbid  state,  we  may  look  for  disappointment. 

ON  THE  ACTION  OF  CHLOROFORM,  AND  ANALOGOUS  AGENTS  IN  PRODUCING 
INSENSIBILITY  WHEN    INHALED.* 

§  1066,  a.  The  general  prevalence  of  the  Chemical  or  other  physical 
doctrines  of  life,  and  the  consequent  interpretation  of  Pathology  and 
Therapeutics  upon  the  same  principles,  has  necessarily  led  to  as  exten- 
sive a  revival  of  Humoralism,  and,  as  one  of  its  dicta,  that  the  causes 
of  disease,  and  the  curative  means,  so  far  as  the  nature  of  things  will 
admit,  are  absorbed  into  the  circulating  mass  of  blood,  where  they  effect 
their  results  in  the  blood  or  the  solids  through  some  chemical  process 
(§  40-46,  350,  3501-3501,  821  c,  828  d,  830,  837  a,  840,  893  e,  904  b, 
905  a,  1034).  All  but  Setons,  Cold,  Mental  Emotions,  &c.,  are  carried 
to  this  account  (see  Indexes)  ;  and  even  some  of  the  soundest  Physiolo- 
gists in  other  respects  maintain  that  the  poison  of  the  Viper,  Hydrocyanic 
Acid,  and  the  spirituous  extract  of  Nux  Vomica  are  absorbed  when  the 
last  two  destroy  life  in  a  second  of  time,  notwithstanding,  also,  it  is  pal- 
pable that  their  fatal  action  must  begin  on  the  instant  of  their  contact 
with  the  lungs  or  the  mouth  (§  350^ 7?,  441/,  487  g,  h,  494,  826,  827, 
828  a-e,  829,  904  b,  &c.). 

And  so,  to  question  the  assumption  that  chloroform  and  analogous 
agents  produce  their  effects  only  after  being  combined  with  the  circu- 
lating mass  of  blood,  according  to  Liebig's  or  some  kindred  hypothesis 
(§  350|,  n,  p),  is  held  to  be  an  evidence  of  ignorance  in  Physiology,  and 
unworthy  a  moment's  consideration.  But,  before  this  doctrine  can  be 
sustained,  the  facts  in  the  foregoing  references,  and  a  multitude  of  others 
contained  in  this  Volume,  must  be  disproved.  True,  the  blood  is  said 
to  be  changed  in  its  colour,  but  that  Avould  necessarily  arise  not  only 
fi'om  the  exclusion  of  atmospheric  air,  but  from  the  morbific  action  of 
the  anaesthetic  through  the  ordinary  laws  of  sympathy,  and  is  upon  the 
same  ground  as  the  supposed  absorption  of  Carbonic  Acid  Gas  (§  419, 
827  b).  Again :  some  may  have  supposed  that  they  have  smelt  those 
agents  in  the  blood  (§  282).  But  the  sense  of  smell  is  apt  to  be  fallacious, 
especially  when  in  pursuit  of  some  particular  odour  or  some  favourite  hy- 
pothesis, and  it  is  difficult  to  contradict  it.  But  this  would  prove  noth- 
ing as  to  their  mode  of  operating ;  since,  especially,  others  have  failed 
of  detecting  the  odour  of  the  most  fragrant  and  fatal  (§  494,  827  d,  904 
I),  c).  Moreover,  the  odour  of  chloroform  and  of  sulphuric  ether  is  very 
diffusive  and  impressive,  so  that  if  even  a  minute  quantity  of  either  sub- 
stance entered  the  circulation,  it  should  be  detected  without  the  aid  of 
the  imagination.  A  drop  of  ether  will  impregnate  the  air  of  a  large 
room.  We  have  had  reports  of  alcohol  having  been  thus  observed,  and 
they  have  been  appropriarted  by  the  Chemist  accordingly  (§  440  bb,  No. 

*  I  will  not  forego  this  opportunit}'  of  expressing  mj'  full  conviction  that  the  honor 
of  this  discovery,  and  of  its  lirst  practical  application,  belongs  to  Dr.  Houack  Wklls. 


Anoesthetics. — appendix. —  Chloroform^  dc.  863 

9,  §  441  c,  104S-1049) ;  nay  more,  of  the  blood  burning  like  a  flaming 
current  as  it  issued  from  a  vein,  and  even  of  the  spontaneous  combus- 
tion of  inebriates.*  (See  all  the  reported  cases  in  3Ied.  and  Physiolog. 
Comm.,  vol.  i.,  p.  576-581,  where  each  one  is  shown  to  be  without 
foundation.)  But  alcohol  is  not  absorbed  (Liebig,  p.  172,  §  350,  no.  94). 
The  veins  of  different  organs  have  been,  also,  found  congested  after 
respiring  the  Antesthetics,  but  less  frequently  of  the  brain  than  of  some 
other  parts.  But  this,  too,  proves  nothing  of  absorption  ;  for  the  same 
is  the  case  Avhen  Hydrocyanic  Acid,  and  the  spirituous  extract  of  Nux 
Vomica,  whether  taken  by  the  stomach,  or  applied  to  the  mucous  mem- 
brane of  the  eyes,  or  nose,  or  mouth  of  rabbits,  destroy  life  in  a  second 
of  time  (p.  675,  §  904  b,  494  dd,  826  d),  or  the  virus  of  a  snake  in  a 
minute  (§  828  c).  And  let  these  observations  be  taken  in  connection 
with  Girtanner's  experiments  and  those  of  others  (§  494  b-dd),  and  with 
the  remarkable  results  from  pricking  the  floor  of  the  fourth  cerebral  ven- 
tricle (§  1032  d)  and  with  the  respiration  of  ammonia,  &c.  (§  827  c). 

But  the  question  is  not  whether  Anaesthetics  or  Isitrous  Oxide  be  ab- 
sorbed, as  very  possibly  they  are  more  or  less,  but  whether  they  produce 
their  eflfects  through  the  medium  of  the  blood,  or  by  reflex  actions  of 
the  nervous  system.  (See  §  284,  1088  d.  This  distinction  is  fully  con- 
sidered in  various  places.     See  Index  ii.) 

As  the  whole  of  this  ground,  however,  has  been  gone  over  extensive- 
ly in  these  Institutes,  it  is  mostly  the  purpose  of  the  present  Article  to 
bring  the  question  under  the  ti-ial  of  facts  embraced  in  the  foregoing  sec- 
tions, and  others  to  which  they  refer,  along  with  our  demonstrations  of 
the  nervous  power  and  its  laws  of  reflex  action  ;  though  the  subject  might 
have  been  left  to  a  single  consideration,  which  appears  to  me  to  be  con- 
clusive against  the  doctrine  of  operation  by  absorption,  and  which  I  shall 
now  address  to  the  Physiologist. 

§  1066,  b.  In  the  first  place,  then,  it  is  conceded  that  the  blood  is 
from  one  to  two  minutes,  at  least,  in  going  the  round  of  the  circulation 
(§  904,  b).  It  should,  therefore,  occupy  nearly  that  time  after  the  res- 
piration of  the  Anesthetics  is  begun  before  insensibility  takes  place, 
which  is  equally  true,  also,  of  Hydrocyanic  Acid  and  the  extract  of  Nux 
Vomica  (the  latter  of  which  is  not  volatile,  §  494  dd.,  826  d),  which  have 
been  known  to  destroy  animals  in  a  second  of  time  (§  904,  b).  But  this 
is  not  the  specific  fact  to  which  I  have  adverted,  though  it  should  be 
taken  in  connection. 

I  say,  then,  if  insensibility  depend  upon  the  absorption  of  the  Anaes- 
thetic agents  there  should  be  no  necessity  for  their  unceasing  respiration, 
or  quick  repetition,  to  maintain  their  eflfects.  The  blood  once  charged, 
or  however  modified,  should  be  capable  of  prolonging  insensibility  far 
beyond  any  thing  that  is  observed  in  experience.  But  if,  on  the  con- 
trary, the  efi^ect  arise  from  the  influence  of  the  agent  upon  the  pulmonary 
mucous  membrane,  and  be  thence  propagated  by  the  nervous  system,  it 
would  be  quite  likely  to  subside  soon  after  atmospheric  air  is  freely  ad- 
mitted to  the  lungs,  as  in  §  481,  a-h.  Precisely  the  same  peculiarities 
attend  the  respiration  of  the  nitrous  oxide  gas  (§  827,  c).  The  subject 
is  quickly  brought  under  its  power,  and  his  faculties  are  often  fully  re- 
stored in  less  than  half  a  minute  after  atmospheric  air  is  substituted. 
This  is  as  true  oi  Amylene  as  of  chloroform  and  sulphuric  ether.  Thus, 
Dr.  Orton,  of  Binghamton,  N.  Y.,  on  administering  siij.  of  amylene, 
produced  '■'■  complete  insensibility  in  about  two  mimites."  "Just  as  I  was 
*  It  has  been  lateh'  reaffirmed  bj'  French  chemists  that  alcohol,  chloroform,  &c.,  occur 
within  the  body,  after  their  ordinar}'  use,  in  a  free  state.     See  §  350,  nos.  43,  94. — 1861. 


864  INSTITUTES    OF    MEDICINE. 

about  to  perform  the  surgical  operation  intended,  the  flexible  tube  with 
mouth-piece  separated  from  the  inhaler,  and  before  I  could  adjust  it  my 
patient  had  completely  recovered  her  usual  sensation."  The  inhalation 
was  repeated,  and  "  the  larger  nail  torn  from  the  toe  without  the  slightest 
uneasiness."*  {New  York  Journal  of  Med.,  Sept.,  1857,  p.  2S6.)  Now, 
will  any  one  believe,  with  his  logical  powers  awake,  that  such  a  sudden 
transition,  in  either  of  the  cases,  could  ppssibly  happen  were  the  phe- 
nomena owing  to  an  incorporation  of  these  substances  with  the  circu- 
lating mass  of  blood  !  Give  to  the  Chemical,  or  any  other  physical  hy- 
pothesis, the  greatest  possible  latitude  of  construction,  or  expound  the 
results  upon  the  vital  theory,  it  is  plain  that  when  these  agents  are  once 
circulating  in  the  labyrinth  of  the  organism,  and  in  sufficient  quantity  to 
produce  the  astonishing  momentary  effects,  they  would  continue  to  do 
so,  in  gradually  diminishing  degrees^  until  ample  time  should  have  elapsed 
for,  at  least,  their  elimination  by  the  emunctories. 

Again  :  the  doctrine  of  absorption  is  contradicted  by  the  necessity  of 
diluting  the  ansesthetics  with  atmospheric  air  to  prevent  immediate 
death,  which  may  happen  so  quickly  as  to  preclude  the  hypothesis.  This 
necessity  of  dilution  supposes,  therefore,  the  action  of  the  Anaesthetics 
upon  the  nervous  system  of  the  lungs,  and  their  transmitted  influence 
over  the  entire  organism  by  the  reflex  action  of  the  nervous  power ;  and 
this  is  farther  seen  in  the  fact  that  a  greater  amount  would  be  absorbed 
during  a  long-continued  respiration  of  the  diluted  agents  than  could  hap- 
pen when  only  momentarily  exhibited  in  a  concentrated  state,  and  there- 
fore death  should  as  certainly  follow  in  the  former  case.  Moreover,  all 
the  earliest  phenomena  denote  the  direct  action  of  the  agents  upon  the 
lungs.     Why  are  the  effects  so  difterent  when  taken  by  the  stomach  ?! 

The  whole  philosophy,  therefore,  is  perfectly  explicable  through  what 
is  known  of  the  different  susceptibilities  of  the  various  tissues,  and  in 
their  various  parts  to  the  action  of  external  and  internal  causes,  and  the 
wonderful  attributes  of  the  nervous  system ;  and  which  enable  us  to 
comprehend  the  reason  why  the  Ansesthetics  so  rarely  affect  the  organs 
of  organic  life  (§  233|,  422,  425  d,  no.  7,  481  a-h,  487  h,  500  g,  m,  891^ 
g,  k,  893^,  1088  c,  and  Indexes,  Art.  Structure,  Nervous  Power). 

By  the  same  philosophy  we  as  readily  comprehend  the  reason  why 
the  respiration  of  the  fumes  of  Hyosciamus  and  of  Opium  establishes 
profound  effects  upon  the  whole  organism,  when  no  such  result  arises 
from  smoking  tobacco  (§  904  h).  But  what  is  very  exact  and  compre- 
hensive is  the  effect  of  ammonia  when  respired  as  a  counter-poison  for 
hydrocyanic  acid.  Here  can  be  no  relief  from  absorption,  for  hydrocy- 
anate  of  ammonia  is  an  active  poison. 

*  I  have  introduced  this  case  for  the  purpose,  particular!}-,  of  referring  to  the  remarlc- 
able  fact  that  "  the  e3-es  of  the  patient  were  not  closed  at  any  time  during  the  operation, 
but  she  seemed  to  amuse  herself  with  an  examination  of  the  apparatus.  She  answered 
questions  put  to  her  with  considerable  promptness,  and,  in  fact,  conversed  with  m}'  as- 
sistant during  the  period  of  insensibilitj-,"  nor  "was  she  aware  that  the  nail  had  been 
removed  when  she  recovered  her  sensibilitj-.     The  pulse  was  but  slightlj'  accelerated." 

There  is  no  contradiction  between  this  statement  and  that  "complete  insensibility" 
was  effected.  The  latter  refers  to  common  sensibilit}-,  the  source  of  pain  ;  and  the  ex- 
periment illustrates  admirably  the  distinction  between  common  and  specific  sensibility- 
(§  197-201).  The  experiment,  in  thus  sliowingthe  limitation  of  the  anesthetic  influence 
to  the  nerves  of  common  sensation,  and  in  leaving  the  mind  unaffected,  as,  also,  the  ac- 
tion of  the  heart,  goes  with  our  other  facts  in  disproving  operation  b}'  absorption. 

The  anah'sis  which  the  experiment  has  supplied  as  to  the  modification  of  sensibility 
may  be  carried  analogicall}-  to  the  organic  properties,  and  be  thus  emploj-ed  in  corrob- 
orating our  analysis  of  those  properties  (§  170  a,  172,  175  «,  6,  183-193,  205-221). 

f  That  death  is  owing,  as  surmised  bj-  some,  to  the  exclusion  of  atmospheric  air,  is 
contradicted  by  the  phenomena,  and  by  the  failure  of  restoratives  (§  634). — See  Note 
M  p.  1120. 


Remedial  Action. — APPENDIX. — Mental  Emotion.  865 


THE  INFLUENCE  OF  THE  MINB  UPON  THE  ACTION  OF  REMEDIAL  AGENTS. 

§  1067,  a.  Much  has  been  said  in  this  work  upon  the  influence  of  the 
Mind  in  the  production  and  cure  of  diseases ;  and  it  is  now  my  purpose 
to  extend  this  inquiry,  very  briefly,  to  the  influences  of  the  mind  upon 
the  action  of  physical  agents,  both  as  predisposing  the  body  to  the  action 
of  foreign  morbific  causes,  and  as  modifying  the  operation  of  remedies. 
It  will  thus  form  an  Appendix  to  what  is  said  of  the  "General  Philos- 
ophy of  the  Modus  Operandi  of  Remedial  Agents,"  or,  rather,  a  group- 
ing of  many  relative  observations  that  are  disseminated  through  the  In- 
stitutes. (See  Indexes,  Articles  Remedial  Action,  Remedies,  Mental  Emo- 
tions, Mind,  and  Will-)  The  subject  is  practically  important,  and  goes 
far  in  denoting  the  laws  which  govern  the  operation  of  physical  agents 
upon  the  body,  and  in  drawing  a  broad  line  of  distinction  between  Chem- 
istry and  Physiology. 

I  say  practically  important ;  for  who,  indeed,  of  the  Medical  Profes- 
sion has  not  suffered  the  experience  of  seeing  the  useful  effects  of  reme- 
dies defeated  by  the  despondency  of  his  patient,  or  by  some  saddening 
emotion  awakened  by  the  indiscretion  of  friends,  and  often  by  a  brief  at- 
tention to  business  engagements,  or  by  far  simpler  occupations  of  the 
mind?  But  there  is  great  variety  in  these  respects,  according  to  the 
pathological  conditions  and  the  mental  influences.  The  differences  in 
results  coincide,  also,  with  such  as  are  witnessed  of  physical  agents ;  the 
same  philosophy  interprets  the  operation  of  both ;  and  the  same  careful 
regulation  of  one  is  often  as  important  as  that  oPthe  other. 

It  is  a  matter  of  daily  observation,  in  acute  diseases,  that  the  casual 
visits  of  relatives  and  friends,  however  much  enjoyed  by  the  sick,  leave 
them  for  the  worse ;  an  effect  entirely  the  reverse  of  what  is  witnessed 
of  the  same  excitements  in  chronic  forms  of  disease.  But  this  corre- 
sponds with  what  is  seen  of  the  difference  in  the  results  of  bodily  exer- 
cise and  tonics  and  stimulants  in  acute  and  chronic  maladies.  On  the 
other  hand,  however,  the  subject  of  acute  disease  may  be  essentially  ben- 
efited by  the  subdued  cheerfulness  of  an  habitual  attendant.  He  may 
be,  in  like  manner,  seriously  disturbed  by  listening  to  a  page  from  a  Ro- 
mance, when,  on  the  contrary,  he  would  derive  an  advantage  from  an 
appropriate  Chapter  of  the  Bible  ;  and  yet  both  of  these  are  remedial  in 
chronic  diseases.  Nevertheless,  there  is  a  perfect  consistency  in  the  phi- 
losophy which  attends  the  effects  of  those  causes  in  the  two  cases — 
whether  Nature  be  embarrassed  by  mental  troubles  and  pleasurable  ex- 
citements, or  aided  by  placid  cheerfulness  a;nd  buoyant  hope.  The  moody 
dyspeptic  is  invigorated  in  his  digestion  by  every  kind  and  degree  of  men- 
tal enjoyment,  and  his  laxative  and  tonic  medicines  are  sure  to  serve  him 
best  when  his  constipating  melancholy  is  occasionally  broken  by  hilarity 
of  mind ;  while  the  subject  of  fever,  though  lacerated  by  exhilarating 
emotions,  is  started  along  by  every  smile  of  his  Medical  Attendant,  and 
every  remedy  yields  a  boon  to  Nature  under  the  influence  of  that  smile, 
when  a  solemn  countenance  may  make  all  the  odds  between  recovery 
and  death.  In  acute  diseases,  it  is  the  tranquil  emotions  that  do  the 
service,  while  all  of  a  joyful  nature  are  scarcely  less  embarrassing  to  art 
than  they  are  instrumental  in  the  cure  of  chronic  maladies.  So  nicely 
graduated  is  this  principle  in  its  operation,  that  it  often  happens  that  the 
subject  of  fever  will  make  greater  improvement  in  the  hands  of  a  com- 
mon nurse  than  in  those  of  a  sympathizing  friend.    And  yet  there  never 

In 


866  INSTITUTES    OF    MEDICINE. 

fell  from  the  lips  of  the  Medical  Attendant  a  word  of  encouraging  pity 
that  did  not  tell  favourably  on  his  Castor  Oil  or  his  Narcotic. 

It  is,  of  course,  impossible  to  analyze  the  precise  influences  of  the  mind 
upon  the  action  of  remedies  in  mitigating  or  aggravating  disease.  The 
principle  is  abundantly  pronounced  in  morbific  effects  of  the  mind,  that 
are  independent  of  other  causes,  in  embarrassing  the  favourable  action  of 
remedies ;  and  it  not  unfrequently  happens  that  the  mental  condition 
may  bafile  the  best  efforts  of  art,  not  only  as  a  fundamental  evil,  but  as 
crippling  the  curative  means ;  while,  on  the  other  hand,  when  the  same 
mental  trouble  is  supplanted  by  happier  thoughts,  its  baneful  conse- 
quences not  only  yield  as  a  spontaneous  effect,  but  are  hastened  in  their 
decline  by  the  new  mental  influences.  From  these  premises  we  may 
reason  to  all  the  transient  and  infinitely  diversified  affections  of  the  mind 
that  spring  up  in  the  progress  of  diseases  which  have  their  origin  in  phys- 
ical causes  alone,  and  calculate,  with  much  exactness,  the  effect  of  one 
passion  or  another  in  aggravating  or  moderating  disease,  and  how  far 
they  may  embarrass  or  facilitate,  through  those  modifying  influences,  the 
effects  of  remedial  agents.  But,  to  carry  this  analysis  into  practical  ef- 
fect in  the  treatment  of  acute  diseases,  there  must  be  the  same  reference 
to  their  nature  and  fluctuations  that  is  demanded  for  the  right  applica- 
tion of  the  Materia  Medica,  though  it  may  be  comparatively  unim- 
portant (^  167/,  note,  476  c,  476^,  500  k-p,  509,  891i/c,  892f  h,  951  c)- 

We  have  variously  seen  how  the  susceptibilities  of  organs  to  the  ac- 
tion of  physical  agents  are  increased  by  morbid  states,  and  it  is  exactly 
tlie  same  with  mental  "emotions  as  with  the  physical  causes;  and  with 
what  prodigious  power,  especially  in  acute  diseases,  the  latter  may  oper- 
ate, can  be  readily  inferred  by  considering  how,  in  healthy  states  of  the 
body,  one  passion,  as  fear,  will  agitate  the  voluntary  muscles,  depress 
the  circulation,  but  impart  a  bounding  motion  to  the  heart,  give  rise  to 
vomiting,  open  the  floodgate  of  the  kidneys,  expel  the  contents  of  the 
bladder,  protrude  the  eyeballs,  drive  the  blood  from  the  face,  and  bathe 
the  skin  with  perspiration  ;  or,  how  anger  braces  up  the  voluntary  mus- 
cles, rouses  a  vehement  circulation,  «fec. ;  or,  how  shame  strikes  at  the 
capillaries  of  the  face  and  injects  them  with  blood ;  or,  how  marvellous- 
ly love  plays  Avith  its  shafts  ;  or,  how  hope  ever  gladdens  the  heart ;  or, 
how  joy  and  anger  may  be  instantly  fatal. 

So  fixr,  therefore,  as  the  mind  can  have  a  bearing  upon  the  action  of 
remedies,  it  is  by  its  direct  influences  upon  the  pathological  states, 
through  Avhich  it  renders  them  more  susceptible  of  either  salutary  or 
morbific  impressions  from  physical  agents,  or  renders  them  inoperative ; 
while,  also,  it  co-operates  simultaneously,  as  an  independent  means  of 
cure,  or  proves  a  direct  morbific  cause  (^  233f,  500  k,  647^,  903). 

If  the  inquiry  be  extended  to  many  of  the  familiar  phenomena  of  the 
organic  life  of  man,  it  will  be  seen  that  the  mind  is  more  or  less  in- 
terested in  all  the  healthy  functions ;  and  it  goes  to  supply  more  delicate 
illustrations  of  the  influence  of  the  spiritual  part  upon  morbid  states  of 
the  body.  This,  for  example,  is  habitually  seen  in  the  improved  appe- 
tite and  more  vigorous  digestion,  on  occasions  of  festivity.  Nor  is  it 
alone  the  unflinching  manner  in  which  the  stomach  meets  its  unwonted 
task  (and  much  to  the  admiring  wonder  of  the  chemical  philosopher), 
but  it  yearns  for  the  multitudinous  variety  as  the  odour  regales  the  nose, 
or  the  clattering  of  dishes  delights  the  ear,  and  under  the  influence  of 
which  the  mouth  overflows  with  saliva.     And  now,  if  we  reverse  the 


Berriedial  Action. — appendix. — Mental  Emotion.       867 

case,  and  suppose  the  Party,  as  soon  as  completing  the  repast,  to  be 
thrown  into  a  paroxysm  of  fear  of  a  few  hours'  duration  by  some  im- 
pending catastrophe,  it  is  certain  that  digestion  would  have  made  but 
little  or  no  progress.  Observe,  again,  hoAV  some  remedies  of  active  vir- 
tues are  more  or  less  governed  in  their  effect  upon  comparatively  healthy 
individuals  by  the  varying  conditions  of  the  mind,  as  seen  in  the  sus- 
pended or  defeated  operation  of  cathartics  by  any  close  attention  to  the 
daily  atFairs  of  life,  and  how,  on  the  other  hand,  their  effect  is  promoted 
by  giving  the  attention  to  the  anticipated  results  (§  500  e,  7m,  902  /). 

§  1067,  aa.  A  well-marked  example  will  illustrate  the  complex  in- 
fluences of  physical  agents  and  of  the  will  and  mental  emotions  when  in 
simultaneous  operation.  Thus,  when  the  voluntary  muscles  are  slight- 
ly affected  by  nux  vomica  an  aggravation  of  the  spasm  is  often  produced 
by  any  sudden  alarm.  A  lady  to  whom  I  had  administered  a  few  very 
small  doses  of  strychnia  suffered  some  twitchings  in  the  muscles  of  the 
legs  when  she  walked  in  a  careless  manner,  but  was  able  to  govern  her 
limbs  steadily  by  a  careful  effort  of  the  will.  In  this  condition  she 
walked  into  Broadway,  when,  on  being  a  little  jolted  by  an  uneven 
stone,  she  began  to  stagger,  and,  struck  with  alarm  lest  she  should  be 
considered  intoxicated,  she  fell  upon  the  pavement.  This  is  not  an  un- 
common example  ;  and  now  for  the  rationale.  That  the  spasmodic  ef- 
fects of  nux  vomica  are  owing  to  influences  transmitted  by  the  organic 
nerves  of  the  gastro-mucous  tissue  to  the  cerebro-spinal  axis,  and  a  con- 
sequent development  of  the  nervous  influence  and  its  reflection  upon  the 
voluntary  muscles  through  cerebro-spinal  nerves,  needs  no  farther  dem- 
onstration. The  will  was  capable  of  surmounting  that  development  by 
its  own  forcible  excitation  of  the  nervous  power  that  gives  rise  to  vol- 
untary motion  (§  893^)  ;  but  the  sudden  alarm  not  only  arrested  the  op- 
eration of  the  will  and  allowed  the  tetanic  its  unrestrained  action,  but  the 
alarm  generated  an  exciting  nervous  influence  which  concurred  power- 
fully with  that  of  the  physical  cause.  The  philosophy  as  to  the  will  is 
the  same  as  when  conia  counteracts  the  spasmodic  influence  of  strych- 
nia, or  as  when  coffee  increases  it  (§  891^  g,  k,  984  b,  note),  only,  in  the 
case  of  the  mind  the  excitation  of  the  nervous  influence  is  direct,  in  that 
of  physical  causes  reflex.  And  so  of  the  will  and  sea-sickness  (§  113- 
117,  222-2331,  245,  266,  476  e,  500  c,  6381,  647^,  893,  893^,  1077). 

§  1067,  b.  Upon  what  principles,  then,  are  we  to  interpret  all  the  va- 
riety of  effects  which  the  different  mental  emotions  display  in  the  or- 
ganic life  of  man?  Simply,  as  already  explained,  by  their  operation 
thi'ough  the  medium  of  the  nervous  power,  and  the  modifications  which 
they  bestow  upon  that  power  according  to  the  nature  of  each  passion. 
There  is  thus,  throughout,  a  perfect  coincidence  between  the  operation 
of  the  mental  and  physical  causes,  since,  whenever  the  latter  give  rise 
to  effects  beyond  the  direct  seat  of  their  operation,  and  thus  bring  the 
nervous  power  into  action  (§  1039-1041,  and  references  i\\Gve),  their  re- 
sulting influences  will,  as  in  the  case  of  the  passions,  depend  upon  their 
precise  nature,  and  the  special  manner  in  which  they  modify  the  nerv- 
ous power,  as  set  forth  in  the  foregoing  sections  (§  227-232,  500  k-p^ 
503-505,  647i,  649  b,  c,  657,  892  b,  892f,  893  e,  894  b,  902  g-l). 

§  1067,  c.  From  what  has  been  now  said  of  the  coincidences  between 
the  effects  of  the  mental  emotions  and  remedial  and  morbific  agents,  and 
that  they  all  operate  upon  a  common  principle  (§  854c-857,  859  5-860, 
894-905),  and  as  the  former  are  in  perpetual  operation,  either  for  good 


SOS  iNsrrnrKs  ok  mkohink, 

or  for  ovil,  it  booomos  oviilont  that  tho  rruv>titionor  inuv  bo  as  u\tolli)^i 
blj  :uul  as  imioh  intoivstoil  in  ivgulatii\>;'  thouvouttil  us  tho  plivsioal  troat- 
mont  of  ilisoa!?o.  Tlio  h»ttoi"  jivnorallv  propoiuloralos,  oftou  }.!;iv'utlv,  in 
iuiportanoo;  but  oirat^ions  arc  oonstMutlv  arij*iu^^  in  whioh  (ho  forunT 
should  tako  tho  h\ul,  \vhih>  it  has  at  all  tituos  tho  atlvaulaf^o  of  briui* 
oonvortod  to  tho  salutary  otVoots  of  physioal  r»n»u"ilios. 

Would  our  limits  admit,  wo  oouUl  tiraw  \\\hh\  (ho  historios  ol  luiuvoy 
for  a  vast  amoiu\t  t>f  matorials  (o  illustralo  (ho  |)hih>;H>|tliv  and  pnuMioul 
importanoo  of  our  subjoot,  l>u(  all  (his  will  nwulilv  su(',|!,»'st  ilsolf  to 
those  Avho  may  study  tho  i>houi>moua  of  iusaiiiiy  in  o(>iuu>o(ii>u  wi(h  (ho 
philosophy  of  (ho  mind  in  its  rolatious  (o  or^jauio  lito. 

§  1007,  (/.  What  >vo  havo  ni)w  and  hidiorto  s»<on  «>r  (h(>  pn^oino  oorro- 
spondence  betwoou  tho  olloots  i>f  tho  passions  and  of  physiorti  aj^ontu  in 
the  or<:;anic  lifa  of  man  may  bo  carried  wi(h  (ho  olfoot  ol"  (hit  ch^iirost 
demonstration  in  proof  of  (ho  subs(an(iv»>,  s*'lf-ao(inj;  naluro  of  tlu>  Soul 
(§  10(!!)-1077).  'i'his  must  bt^  oouccdod  by  IMiilosophiMs  of  (U'ory  si'hool  i 
and  those  who  nj!;roo  with  (ho  pri-sonl.  wiidM'  in  his  (•ons(ruoli(in  of  (ho 
operation  of  the  nervous  power  will  se»t  how  j;reM(ly  (he  deinoiiiU radon 
is  extended  by  re<2;Mrdin}.!;  (ha(.  pow(M'  as  (ho  mediinn  (hron^di  whh'li 
physical  agents  cxer(  (heir  elfocts  upon  parls  n^mote  from  (he  direcl  sent 
of  their  oj)eration.  Here  wo  have  a  conunon  oxeitinj*  cunso  lor  (ho  com- 
nion  phenomcnn.  Tho  mental  (Muotions,  in  on(t  casi^,  Itring  th(«  norvouN 
power  into  action  by  their  dinuit  inllnenee  upon  (ho  (,';rea(.  jiervouM  cen- 
tre, while  physical  causes,  in  tlio  chhoh  Hiipposod,  develop  the  power  in- 
directly, and  in  all  (he  cases  ea(rh  nffcnt  modillen  (ho  povvej-  lUMMtrdinj/  (o 
its  own  siM^cial  nature,  and  dircicis  it  in  ho  compliealed  n  nauna^r,  and  ne- 
cordiiif!;  to  an  incalenlabh!  anioinil,  of  c(tntinf.^(!nt  cireuniMdineeM,  lhr'(Hi;<li 
a  la])yrinth  of  nerv(;s,  as  to  form  tla;  most  dilllcnlt  problem  in  riiyMJolii- 
gy  (§  2.*].").^,  47 ry-};,  r>()()  r-p,  (i47i,  H!M,  !)()ti  /). 

IJut  to  the  mere  practical  imui,  who  aspircH  beyond  (he  walKn  of  em 
piricism,  the  eflirct  of  the  piiHsions  in  the  production  t\.\n\  cine  of  dirteiiMo, 
and  their  nndenialjh-,  operation  (lii'on;.di  tli(;  ni^rvourt  \towci;  Kiipply  a 
ready  apprelKinsion  of  those  analo;_M)UH  problems  which  n,t(,eiid  the  openi,' 
tion  of  morbific  and  remedial  n<ry.niH  of  a  phyHi(t»d  natun^,  and  a  fniitful 
means  for  contesting  with  the  (JlHimist  the  field  of  I'hyMiolo^'y,* 

HAVE  DISEASES  UNnKJtOONK  OMANOKH  OK  TVI'K   W/TIIIN    IMK   I.AK'I'   I'Oirl  V 
YKAKH,  OU  IIAVK   NKW  ONKH    AI'I'KA  UKO  "if 

§  10G8,  a.  Vy  change  of  type  F  mean  that  radical  chanj/e  vvliich  In 
supposed  to  justify  the  Kubstitution  of  the  Ktiuudjiting  iov  (Im!  antiphlo- 
gistic treatment  of  inflammatrwy  and  feld'ile  djfteaMen.  In  (hi/i  accepta- 
tion I  answer  the  interrogatory  as  it  haw  been  in  ail  pact  time  by  every 
truly  enlightened  and  impartial  obwirver.  .John  lirovvn,  tlie  gn;at  An- 
tagonist of  Nature,  and  who  lefwls  a  lio«t  in  liix  train,  i«  in  no  re«f»ect  an 
exception  ;  for,  whatevcT  may  have  been  biw  geniuH,  be  bjwl  vf.ry  little 
practical  knowlwlge,  waH  intemperate  in  li'in  })af<if«,  and  the  revolntio/i 
which  he  achieved  was  prompt/;d  by  Sift'ifito'/tly  towardn  (lullen  and  oth«;r 
early  friends.  As  it  is  important  to  nnderntand  the  ground  (if*on  whieb 
this  School  originally  stood,  I  shall  intrr;<Jijc^;  u  brief  ><,k etch  of  itM  origin 
from  the  ^'ArruirvMn  J'Jnc>/c/y//Mdia.'*     'i'buH: 

"  lirown  wa.s  suhnhtf-A,  a»  an  indigent  Kcholar,  to  a  i/ndii'itoun  tdU-.iul' 
ance  on  the  \f-j:X\xT(:n  Hvlinburgb),  and  (AdiuntA  the  (patronage  hi  l)i.  Cul- 
len,  who  (:mp]oy<A  birn  an  a  iuUtr  in  bi«  ov/n  family,  huiiini  lUiti  <:<ntrm 
*  Se*:  rnv  work  ori  tti*  ^>f;i.  ami>  Inwtfu.tivy.  l'nint,ii'i,K,  t-AitU/n  i'/'/IS, 


Dimlhi^H,       AI'I'KHUIrt.        ('Iniii'ii    iij   'I'lliir.  MOO 

nC  hi  inly,  liii  iiiiii'rioil,  mill  m<^I/  ii|i  ii  lioiinliii^-lionHK,  hiil.  Iiulnl,  iiinl  ln'catrto 
lHiiiKrii|il,  Aliniil,  lliiu  liiiit<,  liy  ii  luiif/  rtiiiiHti  iW'iim«IiIiiIIoii  on  llic  uii)- 
iiimI  (lyMlMin,  iiilil  lli«  vigour  ol' liin  nwii  iitlml,  tWywlM  hy  hniiid  i'iuiiliii|j;, 
IhiI'  Ht^«'uiii|)^il  hy  III  lit)  or  no  <ii«l  Iroiii  |iiiit'|)('ul  olmcrvalioti,  Jut  (f|uhoruU:<l 
II  imw  lliMory  of  iiiMilirJiiu,  'I'liti  iit»ull<  wiih,  Uik  |Mtl»li<'i(l.ioit  ol' liiu  hlla- 
nimilK,  Mt'iliiHiiii',  wlih'li  lio  (iii'll)«ir  «tM|tliiiMi'(|  in  n  coni'Hft  of  priviiUi  l«t> 
hnim,  Iti'own  f^rrupit'tl  nl  no  int<iin»  l.o  jmikIi  IiIh  ilorlrintM.  A  m^w  ini'il' 
ii'iil  liin^iiiijjii  wiM  liili'oiliii'.fil  (  Itlitiin  loliilly  iiJ<  viu'innrit  willi  ioi'inui* 
iiliinionn  vvim  niiiinliiini'il  (  iuhI  IIim  nionl.  viinlttnl.  nlMirtc.  ol'  ijic  ri^giiliu' 
I'i'iili'MHuirt  ol' llm  I  Iniviii'ttily  wiim  pi'ihiVKi  lH|/ly  MllfTid,  Al,  jtiifylli,  ru» 
iiitui  in  rt'|Milulion,  Iim  i'*<|)iiii'ti<l,  in  IVHI),  lo  Lonilon.  IIiim  lie,  t'ni|tiiiv« 
oih'imI  1)1  (tHi'iltt  lUlciilJon  l)y  liii^  ( )|iMi'i'viilionM  on  lliti  ( )|(|  MynliniH  oC 
I'liywiis  linl,  willionl.  unfctiMw.''- 'I'liti  diiy  oCwncciHM,  liovvcvi'i',  w/i«  nol.  \(>\\^ 

•  liijiiyi'ij.  'I'lm  I'llvinnifH  nf  flti'diniin  liinl  IIim  ii(lviinliij/M  id' litiin}^,  wi'ill.«'U 
In  liiiUni  nn<l  ua  l\n\  Hiniplirily  of  iln  iloi^Mint^H,  itml  iJiti  prnrljcti  inrnN 
i'iiIchI,  w«irii  noviO  timl  ruMciniilinfy,  nil  IOiu'o|i(i  hook  lH*i^iinui  i^nHniti'iiil  hy 
llm  rlninn  (8  (1^1  /^  HIIOA /,  IMIO  </,  p.  717,  71!),  <l  HMMiy,  KMlA  r). 

ii  iDiiH,  //.  Ilniliir  my  own  oliMt^rviiUon  iJifiut  Ihih  hi'«n  no  rhiingM  lu 
llm  ('jiiniu'irr  ol'iliMniiHuH,  vvilli  Mil*  hiniplx  «<H<'i'|ilion  llnil.  Honm  loi'lnii  Inivii 
Jint'n  \t<M  nnyiiililin(i,  williin  I  In*  liihl  Iwtuily  y*-m'H  llimi  dining,  lint  pit" 

•  iMlin^  Iwi'niy.  Ilnl.  Iliin  ipnililli-nlion  Ih  nnmlly  liniili'<|  lo  lint  ronnnon 
lorniM  ol' lonil  vi'iionrt  rmiyyuihtun  lonl  ninfiCMliv**  I't-vi'i'tt  (ii  7^7  7HA,  7Hli 
MIH,  Mill  ir/O),  'i'liithit  iillt'i'lionti  linvit  yir|i|i-i|,  iluriii^,  lint  liillci'  pt'l'ioil, 
lo  riillnti'  Nnnilh'r  nliHlindionis  ol'  MoimI,  nml  hnnilli  r  «Io>ii'm  ol  nn'ilii'im*, 
purlicnlnrly  rtillnii'lii'H  Itiil  pii'iimtly  ||nt  t^iinnt  (iitnnriij  nnxlit  ol'litnil,* 
iMinl.  IniM  Ititcn  iiniinpt^nHiililn  lo  mi  t-nily  r<tfovitry,  or  lo  ii,  ooniplt'lti  r(*> 
iriuvnl  III  lint  tliiii'iir-it,  or  lo  llni  pi'i'hfrviilion  ol' lil'ti  (  wliild,  on  Mm  con* 
irmy,  llm  pi'tiviiilini?;  Kninonlmi  li'ttii|,iiiiiii|,  Imu  htutii  illHliii{iiiieln*(|  hy  llM 
loi'iiMti' tliHMhIi'oiiH  (tItiti'iH  (ii  lOllH,  (/),     In  pi'ool' ol' l.liiiH,  I  ncttil  only  nilvcrl 

10  |,|iu  ttHiuiHHivtf  inoi'Liillly  wliiuli  Iimm  iillitinlttil  llm  yellow  I'cvi'i'  williin  iv 
It'W  liilit  yttni'M,  mill  in  llm  Irttiitnutnl.  of  wliidi  lint  Mliniiilalin^,  pliiii  Iihm 
liiutn  ^i'liiti'iilly  pi'iii'litiitil  (  |nimi;xi.h,  mlicltt  /.imti  n/'  ll/ntul).  Ah  mi  t')itun« 
|iln  of  lint  nioi'liilily,  inn|><r  lli't  hiiiiiiiliilinf,  niitlliod,  i|.  itt  hIiiUhI  in  llm 
nliitt  Wi'poir  ol'  II  ( !oiiiinill('tt  olntix  I'liyhicimm  oii  iIm'  "  ^  illuw  ji'i'ver  ii|, 
Noil'ollt,  Virpjniii,  in   IM/Wi,"  lliiil, 

"'lint  niiiiili<t|'  oriliMilliii  wiiH  iilioiil.  VOOII,  or  <iint  lonilli  ol'llnt  tmliiM 
popniiilion  iitiniiiniiif/  in  llm  cily.  VVIn'ii  wtt  roiihidi'i'  lliiil  linU' ol'  IIiIh 
|iopnlMlioii  wiiH  liliD'K,  miioti|/  wlioiii  llniit  wi*rit  I'ltw  <l<tiillih,  il<  Hci'inti 
proliilliltt  iJiiil,  moi'ii  lliiui  oint  lliii'il  ol'  nil  lint  wliilrn  itMinKtttl,  tlieil."  - 
Ui^fnirf,  &,(i.,  |),  JIM  I   IMitli I,  ViiKiiiiii,  IM[,7.*      Nmtmm  I'',  I'r,  C.i,  li, 

'*'   III  lli<i  MHiiin  l(u|iiirl  II  JH  hliili'ij  ihiil  Him  yt'll'ivv  Ikvi  "  in  IIn  hviiijil »  wim  miiikIi 

IliM  niillKi  MM  nil  llm  ({iMiil  i>|ili|>  lull  n  lliill   lliivii  tni  iiiliwl  kIIIiih   Ii«i>'  hi  iiltinu  Iii'I  i>"  (  |i.  IIM), 

11  Willi  iHiilv  ill  llii»  I'lilili'iiiii    Hull  Miiiiii  |ili\Mii'iiiiiH  i<iili<iliiliM<i|  llm  liii|M<  Hull   Hill  Mini' 

•  iliiil  I'linliii'it  of  linn  vviiiilil  |)iMvii  II  »/ii'ii(//ii  I'm  lliu  illHiiiitiii. 

Ilni'ii,  mIhii,  vvti  iiitini,  loiiiiiiu  iiIImii'  lni|iiiiliiiil  nlMliiiinuilH,  wllli  iiii  iilmnrMiliuii  iiI'i'iiihIi. 

llIu   Wi<l|{lll  III  llm  iliinllilio  til   riiMlil({iiil|nl|tir'n  III' vt'll'iW  t'l'VUI.      Tlllin  ' 

''  hi  IIII  luiHM  IIihI  «v<t  liMVii  liiniwii  III  liKiinl  iif  tviin  Hmiii  llm  Iniinl  rniiHiiii  In  MiiH|Mirl  Hint 
llm  ilJMiiiiMu  vviiH  i'iiiilii|(liiiin      Miiiii/  liiiiiilinl.i  III  iMii'  |iiiiijilii,  llyliiK  fi'iiiii  llm  iiuhHIiiiioii, 

Kliimiil  mill  ill,, I  III  Hm  iii>l|ililiiillii|{  i iIIi'm  iiikI  I'llii'rt,  In  Inililn  iiinl  |iilviili<  limimin,  III 

liiliriiKiiliui  iiinl  Iiiim|iI|iiIh,  nmli  r  nil  |iiihtilli|i<  viiiii'liin  nl  jilin  i>  iiml  i  li<  iini'iliimo,  iiinl  )  i>l, 
vvii  liiivii  mil  IikiimI  iir  II  «M».i//ii  iimliiino'  In  tvlilrli  II  tviia  nvnr  iillii|j«i|  llnil  llm  illtmii^u  witN 
I  •iliiniiinliiiliMl  III  Hill  iilliniitiiiili  III' I'lli'iiiln"  ( |i    IIH  I. 

'llm  fiii«i{iilii|^  n)i|ii<iiiiul  ill  llm  finiiili  nitllliiii  nflliiti  wnrli,  iiinl  n  U  |ili<iniiMil,  In  tinitiN 
iinnilM  III  llilii  tiUtli  kiIiiImii  llm  InllnwIiiH  i«i<iiliiliiiii,  iiiihmihI  iiy  llm  "  AdimIiwiii  giiui'uiu 
llim  iiml  Hiiiilliin   »iiiii\.'iill.iii,"  III  llM  liHiiHi  iiiiiiiinl  tii'ttnlnii,  Imlil  .liiiin,  iHlHIi 

'•  ll,n„ll>,>,l,    riiiil    llio  III  linn   111'  llm   liinl.  I'lilivi'llll I  llm  i|lliihliiill  nl'  llln  mU-WnUt- 

^Ihrnmumi  nf  y»ll<iw  I'nviii'  In  Im  rniiinl  nil  jhikk  Hi  nl  IIh  'rriiiiain'llniiM,  tin  iiinl  In  litiriiliy 
ruulllliiiuil"     It  i|iiuHltnii  In  liiivii  liiiuM  nnllliiil  ii|iiiii  Hm  |ilittnan|i|ili>al  ((iniihiln  i<iiiliiiii'tu| 


870  INSTITUTES    OF    MEDICINE. 

As  to  the  acute  and  chronic  forms  of  intiammation,  I  have  observed 
sitill  less  of  the  modifying  etfects  of  remote  causes  (§  64-4-67G,  710-756). 
In  the  acute  form,  as  aifecting  all  great  organs,  the  same  amount  of 
bloodletting,  the  same  cathartics,  though  in  smaller  doses,  the  same  alter- 
ative antimonial  treatment,  &c.,  have  been  either  necessary  to  life,  or  to 
an  early  and  perfect  recovery.  In  all  these  respects,  pneumonia,  pleuri- 
sy, intiammation  of  the  brain,  peritoneal  intiammation  of  the  intestines, 
puerperal  peritonitis,  rheumatism,  c\:c.,  have  remained  without  modifica- 
tion, or  with  the  exception  only  that  Cathartics  require  a  more  careful 
regulation  of  their  doses  (§  857,  ttc).  In  these  conclusions  I  am  also 
sustained  by  what  I  have  learned  of  the  histories  of  disease  throughout 
the  United  States  (§  969  d,  1005  /,  1005^,  1006/,  g). 

All  this,  however,  is  inferable,  as  it  respects  my  own  experience,  from 
what  appears  in  this  work,  which  was  published  originally  as  late  as  the 
year  1847,  and  continued  in  repeated  editions  without  modification  ;  and 
I  advert  to  the  subject  now,  that  I  may  not  be  misapprehended  (§  1004, 
1005A).  It  may  be  also  proper,  in  consideration  of  the  preference  which 
I  have  hitherto  given  to  the  experience  of  others  as  being  of  greater 
weight  than  my  own,  to  repeat  (§  1025),  that  I  have,  doubtless,  seen  as 
much  of  the  etfects  of  Bloodletting  in  private  practice  as  has  been  wit- 
nessed by  any  other  Physician  during  my  professional  life,  which  ex- 
tends over  a  period  of  more  than  forty  years,  while  also  I  have  been  al- 
ways unremittingly  and  actively  engaged,  up  to  the  present  time,  in  the 
practical  duties  of  Medicine. — yhte  p.  763,  Notes  Ff  p.  1135,  Gg,  Hh,* 

§  1068,  c.  Moreover,  haying  adverted  in  this  work  to  the  treatment 
which  I  pursued  in  a  case  of  inflammation  aft'ecting  one  of  my  own  fam- 
ily (§  992,  (T),  and  a  case  of  remittent  fever  of  which  another  member 
was  the  subject  (§  870,  aa),  I  shall  state  briefly  the  practice  which  was 
piir>ued  in  one  of  simple  pneumonia  with  which  I  was  seized  in  March, 
1847,  as  supplying  evidences,  at  least,  of  my  profound  convictions  upon 
all  the  questions  before  us.  The  first  remedy  adopted  was  the  loss  of 
blood  to  the  extent  of  about  two  pounds.  This  was  followed  by  five 
grains  of  Blue  Pill,  and  in  a  few  hours  afterward  by  about  two  drachms 
of  Castor  Oil.  Some  ten  hours  after  the  Bloodletting,  the  symptoms 
having  recurred,  I  was  again  bled  to  the  extent  of  about  24  ounces.  I 
now  took  at  intervals  of  about  four  hours,  half  a  grain  of  Ipecacuanha 
and  two  grains  of  the  compound  powder,  the  latter  to  allay  the  cough. 
Alterative  doses  of  Tartarized  Antimony  were  also  employed  at  intervals 
of  two  or  three  hours,  but  not  to  the  extent  of  producing  nausea.  About 
twelve  hours  after  the  last  Bloodletting,  the  symptoms  having  again  re- 
turned, though  in  a  diminished  degree,  twelve  large  leeches  were  applied 
to  my  chest,  and  the  bleeding  maintained  for  several  hours  (§  925,  a). 
This  was  towards  the  decline  of  the  day.  The  Alteratives  were  con- 
tinued, and  a  Blue  Pill  of  about  five  gi-ains  was  taken.  On  the  follow- 
ing morning,  the  symptoms  having  again  increased,  I  desired  my  medical 
friend,  Dr.  James  C.  Bliss,  to  bleed  me  again.  It  was  his  opinion,  how- 
ever, that  I  might  recover  with  tlie  aid  of  the  other  means  alone.  I  re- 
plied that  I  did  not  fancy  the  risk  when  I  had  so  sure  and  safe  a  remedy 
in  the  farther  loss  of  blood,  and  expressed  a  wish  that  he  would  '•  carry 
out  upon  myself  the  practice  which  I  liad  inculcated  in  my  medical 
writings,  and  which  I  taught  my  Medical  Class."     I  had  then  in  mind, 

in  §  C5U-6o3  a-<l.     The  result  shows  the  distinction  between  the  instant  application  of 
sound  principles  and  the  tardv  conclusions  from  complicated  facts. 
*  Also  N..TK  GciG  p.  1151.' 


Diseases. — appendix. —  Change  of  Type.  871 

also,  the  experience  which  prompted  the  remarks  just  antecedently  pub- 
lished in  §  8924  7,  1006  h,  c.  I  was  accordingly  bled  to  the  extent  of 
about  20  ounces,  when  the  symptoms  vanished  entirely  and  permanently 
(§  955,  by 

On  the  ninth  day  after  the  last  Bloodletting,  when  my  medical  friend 
called  in  the  morning,  he  found  me  outside  of  the  house,  at  my  early 
morning  exercise  of  sawing  wood  (§  992,  b,  c).  So  other  medicine  was 
taken,  and  no  blister  was  required.  It  should  be  said,  also,  that  my 
disestion  had  been  impaired  for  a  long  time  antecedently,  and  that  it 
became  subsequently  much  improved  (§  1007,  b). — Note  Hh  p.  1138. 

§  1068,  d.  One  case  more,  as  farther  illustrating  the  object  of  this 
Section.  It  may  be  interesting,  also,  on  account  of  the  usual  fatality 
of  the  disease,  and  the  embarrassing  circumstances  by  which  the  case 
Avas  surrounded ;  while  it  will  go  to  show  what  have  been  the  practical 
habits  of  the  writer,  and  that  he  has  inculcated  nothing  upon  Ae  subject 
of  Bloodletting  that  has  not  been  warranted  by  his  own  experience.  The 
patient  was  one  of  our  medical  students,  E.  P.  .Johnson.  M.  D.  of  the 
Class  of  1850-51.  I  found  the  fauces  of  an  intense  redness,  tumefied, 
and  attended  with  a  complete  inability  to  swallow.  Any  effort  at  deg- 
lutition was  arrested  at  once  by  the  suffering  which  it  produced.  There 
w^as  great  constitutional  imtation,  much  restlessness,  pulse  rapid,  hard, 
and  small.  Strength  prostrated.  No  ditnculty  in  respiration  (§  140, 
525-530,  689  /,  718). 

There  was,  at  this  time,  a  great  deal  of  clamour  in  the  Profession 
against  Bloodletting  under  any  circumstances ;  and  as  this  case  would 
be  well  known  to  the  Class,  I  felt  some  regret  that  it  had  fallen  into 
my  hands,  particularly  as  I  apprehended  a  fatal  issue,  and  that  discredit 
would  be  brought  upon  the  principal  remedy  upon  which  I  saw  that  I 
must  rely.  Nevertheless.  I  sat  the  patient  half  erect  in  his  bed,  and  bled 
him  till  syncope  began  to  approach.  The  quantity  of  blood  taken  was 
about  40  ounces  ;  an  extent  of  the  remedy  which  I  practice  only  in  severe 
forms  of  inflammation. 

In  a  few  minutes  afterward  the  patient  was  able,  after  repeated  and 
painful  efforts,  to  swallow  a  dose  of  Calomel  and  Jalap — about  10  grains 
of  the  former  and  20  of  the  latter.  This  operated  within  a  few  hours, 
but  brought  no  relief.  '  The  throat  remained  of  the  same  intense  redness, 
and  the  patient  could  no  longer  swallow.  Accordingly,  on  the  same 
day,  I  bled  him  again  to  approaching  syncope,  when  I  abstracted  about  32 
ounces  more  of  blood,  the  head  and  shoulders,  according  to  my  habitual 
practice,  being  elevated.  Nothing  more  was  done  till  the  day  following, 
when,  finding  the  patient  no  better,  I  directed  the  application  of  twelve 
large  Leeches  to  the  anterior  part  of  the  neck.  They  executed  theu*  of- 
fice well,  and  the  bleeding  was  kept  up  for  some  four  hours,  but  the  pa- 
tient was  apparently  worse  in  the  evening.  But,  having  done  so  much 
in  so  short  a  time,  I  concluded  to  await  the  issue  of  the  last  remedy  till 
morning.  Nothing  could  be  swallowed,  and  the  inflammation  was  too 
intense  for  a  blister  (§  893,/*).  Curiosity  was  now  on  tiptoe  about  the 
bleeding,  and  the  general  merits  of  this  remedy  were  to  be  judged  by  the 
issue  of  the  case.  I  supposed,  indeed,  that  it  had  been  already  con- 
demned. Added  to  this.  I  felt  an  extreme  degree  of  anxiety  to  save  the 
life  of  my  patient.  So,  on  the  following  morning,  one  of  the  coldest  in 
the  "Winter,  I  arose  at  four  o'clock,  and  walked  to  the  house  of  the  pa- 
tient, about  a  mile.     "What  then  happened  I  shall  relate  circumstantially, 


872  INSTITUTES    OF    MEDICINE. 

as  it  may  be  of  benefit  to  some  others  under  similar  exigencies,  and,  as 
I  trust,  tor  many  generations  to  come. 

The  scene,  when  I  entered  the  room,  was  in  every  respect  of  the  most 
dispiriting  nature.  Johnson  was  apparently  moribund.  His  mind  was 
abolished,  the  fauces  as  red  and  tumid  as  ever,  and  a  thread-like  pulse 
running  with  almost  countless  rapidity.  I  stated  to  his  nurse  and  class- 
mate, the  now  Dr.  Oliver,  that  the  only  remaining  chance  was  from  a 
farther  abstraction  of  blood,  but  that  the  probability  of  immediate  death 
was  so  great  that  it  was  inexpedient  to  risk  any  farther  the  reputation 
of  this  important  remedy.  Tliat  something,  however,  might  appear,  at 
least,  to  be  done,  I  directed  a  large  blister  to  be  applied  to  the  nape  of 
the  neck  and  shoulders,  and  left  the  patient  with  the  expectation  of  find- 
ing him  dead  at  my  next  visit. 

No  sooner,  however,  had  I  left  the  door  of  the  house  than  I  was  be- 
set by  a  painful  consciousness  that  I  had  been  in  some  measure  deterred 
from  a  repetition  of  bloodletting  by  a  fear  that  the  patient  might  die  un- 
der the  operation,  while,  on  the  contrary,  one  more  application  of  the 
remedy  might  save  his  life.  In  any  event,  it  could  but  shorten  it  a  little. 
This  train  of  thought  continued  till  I  had  walked  some  quarter  of  a  mile 
on  my  return  home,  when  I  found  myself  almost  unconsciously  return- 
ing to  carry  out  the  practice  which  my  judgment  prompted. 

I  then  stated  to  Oliver  that  I  had  returned  for  the  purpose  of  giving 
to  Johnson  his  last  chance,  and  that  if  he  died  in  my  hands  it  was  a 
sad  responsibility  to  which  all  should  be  willing  to  submit,  irrespectively 
of  any  consequences  to  themselves,  or  to  practical  medicine ;  that  it  was 
our  duty  to  give  to  the  patient  the  only  remaining  chance  for  life,  even 
though  the  means  employed  might  be  likely  to  hasten  a  death  which 
would  be  otherwise  certain. 

The  head  and  shoulders  of  the  patient  were  raised,  and  about  twenty 
ounces  of  blood  were  abstracted  (§  973-980).  The  relief  from  the  last 
bleeding  was  such  that  the  patient  could  swallow  water  within  an  hour 
afterward ;  and  from  that  time  his  convalescence  went  forward  steadily 
and  rapidly  (§  955  b,  994,  1000-1001,  1005). 

The  circumstances  of  the  foregoing  case,  particularly  the  nature  of  the 
disease  and  attending  symptoms,  rather  than  the  quantity  of  blood  ab- 
stracted, impart  to  it  its  principal  interest.  In  Several  cases  of  inflam- 
mation of  the  brain  and  lungs,  where  I  have  had  the  same  successful 
conflict  with  disease,  the  bleedings  have  been  much  more  numerous,  es- 
pecially in  phrenitis,  and  the  quantities  of  blood  abstracted  have  av- 
eraged a  greater  amount  at  each  application  of  the  remedy.  There  has 
been,  also,  in  the  cases  to  which  I  refer,  the  same  exigency  for  the  last 
bleeding,  aud  the  same  apprehension  that  it  might  hasten  death  (§  756  h). 

P.S.  1860. — Finall}',  as  nothing  carries  conviction  lilte  reliable  statistics,  and  as  no 
city  has  a  more  salubrious  climate  than  New  York,  and  to  place  its  excess  of  mortality 
on'tbe  prevailing  "stimulating  plan,"  let  us  loolc  at  the  statistics  for  Januarj-,  Februarj-, 
March,  and  April,  1860,  as  obtained  from  the  City  Inspector's  Report.  During  those  four 
months  there  were  8283  deaths,  of  which  the  following  are  some  of  the  startling  details : 
PsicuMONiA,  602;  Bkonchitis  {pneumonia'?),  no ;  0i£oup,312;  Consumption,  1159; 
ScARi.KT  Fkvicr,  1000.  Probabl}-  about  1  in  11  from  Pneumonia  of  all  the  deaths  (see 
note,  p.  760). — Of  London  it  is  said  by  the  Dublin  Medical  Press — "  that  the  deaths  from 
pneumonia  in  London  number  froml.SO  to  150  weekly,  [about  the  same  proportion  as  in 
the  citv  of  New  York]  ;  but  that  in  Dublin  a  death  from  that  disease  is  of  rare  occur- 
rence.'"'—(Boston  Med.  and  Surg.  Journ.,  May  31, 1860.)  The  "stimulating  plan"  pre- 
vails in  London,  the  lancet  is  used  in  Dublin.— See  Notks  F  p.  1114,  Mm  1141. 

A  Note  which  has  stood  in  this  place  since  1860  is  now  incorporated  with  other  re- 
marks in  NoTK  Ggg  p.  1151. 


The  Soul. — APPENDIX. — Instinct  873 


PHYSIOLOGY  OF  THE  SOUL  AND  INSTINCT. 

DEMONSTRATION    OF    THE    SOUL. 

§  1069.  In  the  year  1848  I  published  an  Essay  on  the  "  Soul  and 
Instinct,  physiologically  distinguished  from  Materialism."  As 
this  is  the  only  attempt  made,  so  far  as  I  am  aware,  to  demonstrate  the 
substantive  existence  of  the  Soul  and  Instinctive  Principle  upon  physio- 
logical grounds,  but,  on  the  contrary,  has  been  evaded  (§  350|,  gg),  and 
as  the  question  is  intimately  connected  with  many  of  the  great  topics 
embraced  in  these  Institutes,  and  forms  an  important  subject  in  Physiol- 
ogy, I  shall  incorporate  with  them  the  essential  parts  of  the  demonstra- 
tion contained  in  the  Essay.* 

§  1070.  The  evidence  turns  wholly  upon  physiological  facts;  my  es- 
sential premises  are  relative  to  the  Nervous  System,  and  are  admitted  by 
all.  They  are  variously  presented  in  this  work,  but  must  be  now  stated 
briefly  to  render  the  argument  at  once  intelligible,  and  that  it  may  ap- 
pear a  consistent  whole.  This  involves,  necessarily,  a  recapitulation  of 
facts  which  have  been  hitherto  presented  in  different  parts  of  this  work. 

§  1071.  1.  The  brain,  or  an  equivalent  ganglion,  is  the  or'gan  of  in- 
tellectual, instinctive,  and  all  perceptive  functions  (§  197-199-2-,  455). 

2.  The  spinal  cord,  and  the  nerves  which  depart  from  it,  are,  among 
other  uses,  the  organs  through  which  the  Will  transmits  its  influences  to 
the  voluntary  muscles  (§  227,  233,  258,  473-475,  476  c,  500  dd). 

3.  The  ganglionic  or  sympathetic  nerve  is  designed,  in  part,  to  con- 
nect together,  in  harmonious  action,  the  involuntary  organs,  or  those  upon 
which  life  essentially  depends.  It  is  also  through  this  nerve,  especially, 
that  the  passions  display  their  effects  (§  96-108,  113-117,  126-130, 
455,  523-524,  and  references  there,  and  Index  II.,  art.  Mental  Emotions). 

4.  The  cerebro-spinal  and  sympathetic  systems  of  nerves  are  intimate- 
ly blended  with  each  other,  so  that  the  brain,  or  its  equivalent,  is  the 
great  centre  of  both  systems,  and  the  spinal  cord  a  less  general  centre, 
while  the  ganglia  of  the  sympathetic  nerve  are  now  well  ascertained 
to  be  local  centres  to  that  nerve.  Of  this  character,  also,  are,  doubtless, 
the  semilunar  and  other  plexuses,  while,  in  very  recent  times,  it  is  render- 
ed probable  that  certain  nerves  are  special  centres  of  nervous  influence 
(§  1037,  a) ;  all  of  which,  however,  are  more  or  less  subordinate  to  the 
brain  (§  487  g,  497,  499  a,  516  d,  No.  9,  §  520-523,  524  d,  No.  4,  §  1038). 
Whatever,  however,  may  be  true  of  these  local  centres,  it  is  of  no  im- 
portance to  my  demonstration. 

In  consequence  of  the  foregoing  union  of  the  two  systems  of  nerves, 
the  cerebro-spinal  system  has  certain  organic  influences  upon  the  es- 
sential organs  of  life  (§  110-117).  Physical  irritation  of  the  brain  and 
spinal  cord  may  be  thus  transmitted  directly  to  the  voluntary  and  in- 
voluntary organs  (§  473-494,  1039)  ;  and  the  Passions,  but  not  the  Will, 
by  their  direct  action  upon  the  brain,  may  readily  affect  these  essential 
or  involuntary  organs  through  the  sympathetic  nerve  (Index  II.,  J/ew- 
tal  Emotions). 

The  influence  of  irritations  of  the  expanded  extremities  of  the  sympa- 
thetic nerve  may  be  also  transmitted  to  the  voluntary  organs  through 
thfc  circuit  of  .this  nerve  and  the  great  nervous  centres,  as  seen  in  the 

*  Some  things  that  I  have  said  of  Instinct  lead  me  to  state  that  the  original  edition 
was  distributed  extensively,  and  aclcnowledged  in  the  literar}-  journals  in  1848.  A  ki£- 
WKirxEN  AND  I'iNLAKGED  EomoN  will  sooii  he  published — 1870. 


874  INSTITUTES    OF    MEDICINE. 

convulsions  of  children  arising  from  dentition,  intestinal  irritation,  &c. 
So,  too,  on  the  other  hand,  from  the  same  intercommunication  of  the 
cerebro-spinal  and  sympathetic  systems,  irritations  or  other  affections  of 
the  voluntary  organs  may  be  felt  by  the  involuntary  through  influences 
transmitted  by  the  sympathetic  nerve  (§  454-475i  500-524,  891i,  g,  k). 

5.  The  familiar  fact  must  be  next  stated,  that  the  nerves  are  composed 
of  two  kinds,  one  of  which  transmits  the  influence  of  the  Will  and  of 
the  Passions,  and  the  effects  of  other  causes,  from  the  nervous  centres 
towards  the  circumference,  while  the  other  kind  transmits  impressions 
from  the  circumference  to  the  nervous  centres.  The  first  of  these  two 
orders  of  nerves  is  concerned  in  the  development  of  voluntary  and  many 
involuntary  motions,  and  are  hence  called  exciio-motoi^  nerves.  The 
second  order  are  nerves  of  sensation,  or  sensitive  nerves,  though  the  in- 
fluences transmitted  by  them  to  the  nervous  centres  are  felt,  in  the  nat- 
ural state,  only  Avhen  propagated  through  the  nerves  which  supply  the 
organs  of  sense  (§201-204,  227,451-453,  462-4754-,  500,  1037  b).  It 
should  be  also  remarked  that,  while  some  of  the  two  orders  of  nerves  are 
wholly  or  mostly  of  one  kind  or  the  other — either  excito-motory  or  sensi- 
tive— a  very  large  proportion  of  the  nerves  are  composed  of  fibres  of  both 
orders,  though  perfectly  distinct  from  each  other  in  arrangement  and 
function.  This  double  order  pervades  the  entire  body,  and  has  brought 
the  physiology  of  the  nervous  system  within  the  range  of  the  most  ex- 
act experiment,  and  has  become  the  foundation  of  many  important  laws, 
which  are  as  clearly  ascertained  as  any  in  astronomy.  The  two  orders 
of  nerves,  or  fibres  of  compound  nerves,  never  interchange  their  func- 
tions, one  of  them  being  always  employed  in  transmitting  impressions  to 
the  brain  and  spinal  cord,  and  the  other  as  purely  centrifugal  in  its 
oflice  (^  466). 

It  is  also  important  to  understand  that  my  demonstration  is  concerned 
particularly  with  the  system  of  excito-motory  nerves,  both  voluntaiy  and 
involuntary,  or  those  nerves  or  fibres  of  compound  nerves  which  trans- 
mit influences  from  the  brain  towards  the  circumference.  Nevertheless, 
many  examples  of  nervous  influence  will  be  introduced,  in  which  the 
other  kind,  or  sensitive  nerves,  are  equally  engaged  along  with  the  excito- 
motory,  as  contributing  to  the  demonstration.  It  may  be  said,  too,  that 
when  the  latter  are  alone  concerned,  as  in  all  acts  of  the  Will,  or  when 
the  Passions  operate,  or  when  motions  follow  in  the  voluntary  or  invol- 
untary organs  from  mechanical  or  other  physical  irritations  of  the  nerv- 
ous centres,  the  projection  of  the  nervous  influence  is  in  a  direct  line  from 
the  central  parts  of  the  nervous  system  towards  the  circumference,  and 
generally  terminates  there  (§  245) ;  but  that,  when  both  orders  of  nerves 
are  interested,  the  influences  are  circuitous.  With  these  last,  however,  I 
shall  be  employed  only  for  supplying  illustrations  in  proof  of  the  sub- 
stantive existence  of  the  Soul  and  Principle  of  Instinct,  and  of  their  mo- 
dus operandi  through  the  excito-motory  nerves  (^  500  dd,  i,  k). 

§  1072,  a.  Having  thus  stated  our  anatomical  and  physiological  prem- 
ises, I  shall  next  endeavour  to  render  the  demonstration  of  ready  compre- 
hension by  the  uninstructed  in  the  physiology  of  the  nervous  system  by 
stating  many  illustrations  derived  from  the  operation  of  physical  causes 
to  serve  as  parallel  examples  with  the  operation  of  the  Soul  and  In- 
stinctive Principle. 

We  have  seen  that  influences  may  be  transmitted  from  the  brain  and 
spinal  cord  towards  the  circumference  by  impressions  made  directly  upon 


The  Soul. — APPENDIX. — Instinct.  875 

those  centres,  as  when  they  are  irritated  by  mechanical  or  other  agents, 
or  when  the  Will  or  Passions  operate  (§  1071,  No.  4).  We  have  seen, 
also,  that  impressions  may  be  made  upon  these  centres  through  irritations 
produced  in  distant  organs,  and  then  reflected  from  the  nervous  centres 
upon  other  distant  parts,  and  even  upon  the  parts  from  which  the  irrita- 
tions proceeded  originally  (§  512-524,  1071,  Nos.  4,  5).  This  transmis- 
sion of  influences  from  remote  parts  to  the  nervous  centres,  and  which 
is  perpetually  going  forward  between  those  centres  and  all  other  parts, 
in  natural  states  of  the  body  (§  111-113,  455-458,  500),  evinces  the 
great  and  inscrutable  susceptibility  of  the  brain  and  spinal  cord,  and  en- 
ables us  the  better  to  comprehend  the  action  of  an  Immaterial  Substance 
upon  the  brain,  and  its  transmission  of  influences  to  all  parts  of  the  body. 
An  immense  proportion  of  the  natural  influences  upon  the  great  nervous 
centres  (and  they  are  unceasing  and  manifold  beyond  the  compass  of 
imagination)  proceed  from  distant  parts,  and  are  circuitous  in  their  ulti- 
mate destinations.  They  begin  in  the  expanded  extremities  of  the  sen- 
sitive nerves,  or  sensitive  fibres  of  compound  nerves,  in  all  parts,  by  which 
they  are  transmitted  to  the  nervous  centres,  where  they  make  their  won- 
derful, and,  as  it  were,  infinitely  complex  but  unfelt  impressions,  Avhich 
are  then  reflected  from  those  centres  upon  other  parts  througli  excito-mo- 
tory  nevves  or  the  motor  fibres  of  compound  nerves  (which  are  also  called, 
in  such  cases,  nerves  of  rfiflexion).  The  palpable  exceptions  to  these  re- 
flected influences,  and  wliere  the  transmitted  impressions  terminate  in 
the  central  parts  of  the  nervous  system,  are  normally  confined  to  the  im- 
pressions transmitted  from  the  organs  of  special  sense,  as  in  seeing,  smell- 
ing, &c.,  and  when  no  mental  emotions  are  excited  (§  194-204,  450-451). 

We  will  now  come  to  our  examples  of  transmitted  and  reflected  influ- 
ences, which  are  clearly  exhibited  in  respiration,  in  vomiting,  in  con- 
tractions of  the  iris,  in  the  permanent  contraction  of  the  sphincter  mus- 
cles, in  spasms  from  teething,  or  from  irritations  of  the  intestines,  &c. 

In  breathing,  for  instance,  two  principal  nerves  are  concerned,  and  the 
diaphragm  is  the  principal  muscle  which  is  moved.  The  sensitive  fibres 
of  the  pneumogastric  nerve,  and  more  or  less  of  the  sympathetic,  are  the 
parts  through  which  an  impression,  arising  from  want  of  atmospheric 
air,  is  transmitted  to  the  nervous  centres,  which  is  then  reflected  upon 
the  diaphragm  through  the  phrenic  nerve,  and  calls  it  into  action.  Now, 
the  lihrenic  nerve  is  also  the  excito-motory  nerve  through  which  the  Will 
operates  upon  the  diaphragm  in  voluntary  respiration.  The  other  res- 
piratory muscles  have  similar  relations  to  the  pneumogasti'ic  and  to 
other  excito-motory  nerves,  and  the  Will  operates  as  readily  upon  the 
intercostal  muscles  as  upon  the  diaphragm.  But  the  diaphragm  is  con- 
spicuously marked  in  this  respect,  and  its  importance  is  inferior  only  to 
that  of  the  heart.  For  farther  details  relative  to  the  coincidences  be- 
tween voluntary  and  involuntary  respiration,  and  voluntary  and  invol- 
untary coughing,  &c.,  I  would  refer  the  reader  to  §  500,  c-7j??;  and  to 
§  902,  b-g,  for  the  physiology  of  vomiting,  its  various  modes  of  produc- 
tion by  physical  causes,  and  the  exact  coincidences  (as  in  involuntary 
and  voluntary  respiration)  between  their  effect  and  vomiting  brought  on 
by  Mental  Emotions. 

In  seeing,  there  occurs  the  very  complex  example  of  the  motions  of  the 
iris,  which  are  entirely  of  an  involuntary  nature ;  while  the  iris  stands 
in  the  same  relation  to  perfectly  distinct  nerves  as  does  the  diaphragm. 
In  the  former  case,  the  optic  nerve  not  only  conveys  the  impression  to 


876  INSTITUTES    OF    MEDICINE. 

the  brain  which  is  recognized  by  the  mind,  but  it  is  also  the  sensitive 
nerve  for  the  iris,  by  which  the  pupil  is  exactly  adjusted  to  the  degree 
of  light,  while,  according  to  some,  the  excito-motory  nerve  of  the  iris 
goes  from  the  ciliary  branches  of  the  lenticular  ganglion  through  its 
communication  with  the  third  pair  of  cerebral  nerves ;  but,  according 
to  other  and  later  observations,  "  the  cervical  sympathetic  is  one  of 
the  motor  nerves  of  the  iris,  and  the  spinal  cord  is  the  origin  of  the 
nerve  fibres  going  from  the  sympathetic  to  the  iris."*  The  brain  is 
the  bond  of  union  in  all  the  cases ;  but,  for  an  obvious  final  cause,  the 
iris,  unlike  the  diaphragm,  is  withdrawn  from  the  Will  (§  514,  k).  As 
the  stimulus  of  light,  however,  is  indispensable  to  the  natural  contx-action 
of  the  iris,  and  is  so  far  unobserved,  it  will  be  readily  understood  by  the 
uninformed  how  a  similar  impression  upon  the  pneiimogastric  nerve  in 
the  lungs  is  necessary  to  the  involuntary  motions  of  the  diaphragm  ;  and 
since  the  transmitted  impressions  to  the  brain  excite  no  sensation,  either 
in  the  foregoing  cases,  or  in  all  the  endless  variety  of  reflex  actions  in 
which  physical  causes  institute  the  movements,  it  becomes  evident  that  it 
is  no  objection  to  the  supposed  action  of  an  immaterial  substance  upon 
the  brain  that  it  is  not  felt. 

We  have  now  seen  that  the  principle  is  exactly  the  same,  whether  im- 
pressions made  directly  upon  the  nervous  centres  give  rise  to  motion  in 
parts  that  are  voluntary  or  involuntary  (§  1071,  No.  4,  and  references 
there),  or  whether  the  impressions  upon  those  centres  be  occasioned  by 
influences  transmitted  to  them  from  remote  parts,  and  which,  by  reflexion, 
equally  give  rise  to  motions.  But,  in  all  the  latter  cases,  the  resulting 
motions  are  involuntary,  as  are  all  in  the  other  cases  excepting  such  as 
arise  from  the  operation  of  the  Will-  But,  in  the  case  of  the  direct  im- 
pressions, it  is  particularly  important  to  remember  that  the  motions 
which  are  produced  by  tlie  Passions  are  essentially  involuntary,  and,  there- 
fore, so  far  exactly  coincident  with  such  as  arise  from  irritating  the  brain 
mechanically  (§  1071,  No.  4),  and  by  our  demonstration,  the  same,  also,  ' 
with  any  reflex  movements  that  ai'ise  as  the  eflTect  of  impressions  propa- 
gated from  distant  parts  upon  the  nervous  centres. 

Itmay  be  finally  added  that  the  twonervous  systems,  and  So^/iorders 
of  nerves,  co-operate  together  in  giving  rise  to  motion  in  the  organs  of 
organic  life,  so  far  as  organic  actions  depend  upon  the  nervous  system 
(§  172,  176,  177,  226-233f,  1041);  while  only  the  brain  and  spinal 
cord  and  the  excito-motouj  nerves  are  concerned  in  developing  the  mo- 
tions Avhich  are  brought  about  by  the  Mind,  or  the  Instinctive  Principle, 
or  by  Mechanical  or  other  direct  physical  irritations  of  the  brain.  In 
ordinary  respiration,  for  example,  the  sensitive  fibres  of  the  pneumogastric 
nerve  are  indispensable  for  the  transmission  of  an  exciting  influence  from 
the  lunss  to  the  nervous  centres ;  but  in  voluntary  respiration  the  pneu- 
moo'astric  nerve  is  not  concerned,  but  only  the  nenvns  centres  and  the 
excito-motory  nerves  of  the  respiratory  muscles.  In  the  former  case,  the 
irritation  of  the  nervous  centres  proceeds  from  the  lungs,  and  therefore 
does  not  originate  in  the  brain  or  spinal  cord,  and  so  of  all  reflex  actions  ; 
in  the  latter  case,  those  centres  are  directly  irritated  by  the  Will  In  the 
former  case,  also,  a  cause  totally  distinct,  and  originally  remote  from  the 
nervous  centres,  makes  its  impression  upon  them,  and  calls  the  nervous 
power  into  operation ;  while  in  the  latter  case,  or  that  of  voluntary  res- 

*  Brown-8equard  remarks  that  "  this  fact  is  well  established  by  Budge  and  Waller." 
^Exp.  Research.,  p.  10,  1853 ;  also,  §  1042. 


The  Soul. — ^APPENDIX. — Instinct.  877 

piration,  precisely  the  same  nervous  influence  is  brought  into  action,  and 
through  the  same  nervous  channel,  by  the  Will,  and  therefore,  by  parity  of 
reason,  by  a  cause  as  distinct  from  the  brain  and  spinal  cord  as  is  the  cause 
of  the  irritation  in  the  former  case.  The  first  is  true  of  all  involuntary  mo- 
tions when  the  nervous  centres  are  irritated  by  impressions  propagated  from 
other  parts ;  and  the  last  is  true  of  all  voluntary  motions,  and  of  all  the  in- 
voluntary, when  tlie  irritating  cause  is  applied  immediately  to  the  centres. 

These  coincidences  in  results  of  irritations  of  the  brain  and  spinal  cord 
as  brought  about  by  irritations  of  parts  remote  from  those  centres  with 
such  as  follow  their  direct  irritations  by  mechanical  causes,  and  the  coin- 
cidences between  the  effects  of  indirect  irritation  of  the  nervous  centres, 
as  in  involuntary  respiration  and  vomiting  by  emetics,  with  the  same  ef- 
fects of  the  mind  in  voluntary  respiration  and  vomiting  occasioned  by 
disgust,  and  the  coincidences,  also,  between  the  efl^ects  of  mechanical  irri- 
tations of  the  brain  with  such  as  ensue  upon  the  operation  of  the  mind 
and  its  passions,  and  a  general  concurrence  of  the  coincidences,  through- 
out, as  to  a  manifest  cause  irritating  the  nervous  centres,  as  well  as  a  gen- 
eral coincidence  in  results,  form  the  groundwork  of  this  demonstration 
(227,  228,  233|,  475-^,  476  c,  500  c-p,  647^,  844,  902  I,  1067  aa). 

§  1072,  b.  Let  us  now  be  critically  understood,  both  here  and  in  for- 
mer places  in  this  work,  when  speaking  of  the  Passions  as  elements  of 
the  mind,  and  as  producing  involuntary  effects.  It  certainly  is  not  in- 
tended to  be  implied  that  they  are  not  more  or  less  associated  with  acts 
of  intellection,  and,  perhaps,  always  brought  into  operation  by  some  act 
of  the  Mind  properly  so  called.  This  is  also  doubtless  true  of  the  Will, 
which  appears  to  depend  more  or  less  upon  the  previous  exercise  of  re- 
flection, comparison,  and  judgment,  in  man,  but  moved  into  action  in 
greater  independence  in  animals — that  is,  instinctively.  This  remark 
may  apply,  also,  to  the  Understanding  (§  241  b,  243).  If,  however,  the 
Passions  and  the  Will  be  the  results  of  intellectual  processes,  the  former, 
by  their  great  variety  and  their  peculiar  operation  in  organic  life,  while 
the  latter  and  all  the  higher  faculties  of  the  mind  are  excluded  from  that 
department  of  life,  and  the  sameness  of  the  Will,  throughout,  in  princi- 
ple and  results,  evince  an  individuality  that  renders  them  equivalent  to 
elements  or  properties  of  the  Soul  and  Instinctive  Principle.  They  are 
as  precise  and  peculiar  in  their  phenomena  as  any  admitted  faculties, 
and  their  results  are  far  more  strongly  pronounced.  They  must,  there- 
fore, be  taken  as  equivalents,  and  as  the  only  practical  ground  of  discus- 
sion.    All  beyond  is,  at  least,  metaphysical  (§  243-246,  903,  1067). 

But  the  question  which  is  thus  raised,  in  anticipation  of  any  caviling, 
has  no  bearing  upon  our  demonstration,  nor  upon  any  of  the  topics  dis- 
cussed in  these  Institutes.  It  is  equally  immaterial  whether  the  Pas- 
sions and  the  Will  be  distinct  elements  of  the  Soul  and  Instinctive  Prin- 
ciple, acting  independently,  or  summoned  into  operation  by  the  higher 
faculties,  or  whether  they  be,  respectively,  the  concurrent  results  of  those 
faculties.  In  the  latter  case,  they  would  be  employed  in  a  collective 
sense ;  and,  as  the  results  are  the  same  as  if  they  were  distinct  entities, 
and  entirely  different  from  other  manifestations  of  Reason  and  Instinct, 
they  are  as  properly  designated  by  the  specific  names  of  Passions  and 
Will,  and  the  former  resolved  into  Love,  Hatred,  Anger,  &c.,  as  any  of 
the  Faculties  upon  which  they  may  depend  are  known  by  other  names. 
They  may  be  called  mere  Emotions ;  but  still  they  would  belong  to  men- 
tal processes,  and  that  is  enough  for  all  the  purposes  that  can  bear  any 


878  INSTITUTES    OF    MEDICINE. 

relation  to  physiological  inquiries,  or  to  our  present  objects.  It  would 
be,  indeed,  equally  to  our  purpose,  were  it  conceded  that  the  stimulus 
which  gives  rise  to  the  Passions  emanates  from  other  organs  than  the 
brain,  since  they  operate  through  the  medium  of  the  nervous  system,  are 
under  the  control  of  the  mental  faculties,  and  are  palpably  associated 
with  them  either  as  co-ordinate  elements  or  as  resulting  emotions.  The 
remote  stimulus,  upon  this  hypothesis,  simply  rouses  the  mind  into  ac- 
tion. The  conclusions,  therefore,  which  I  shall  have  predicated  of  them 
can  not  be  affected  by  any  hypothesis  of  a  metaphysical  nature,  nor  by 
any  supposed  involutions  of  other  organs  with  the  brain  (§  167/,  175  h, 
183,  188  a,  227,  230,  232,  241-245,  476  c,  oOO  f-p,  902  1, 1067.  Also 
Indexes,  article  Will)- — ^Note  Hh  p.  1138. 

Having  thus  disposed  of  this  question  to  meet  any  subtleties  of  the 
speculative  philosopher,  I  shall  now  interrogate  the  physiological  facts 
as  to  the  individuality  of  the  Will  as  a  property  of  the  Soul  and  Instinct, 
when  it  will  be  found  that  it  is  in  no  respect  the  same  complex  emana- 
tion of  either  as  the  Passions.  It  is  not  obedient  to  any  analogous  laws, 
nor  does  it  operate  through  the  same  mechanism  as  the  Passions.  It  is 
distinguished  from  the  Passions  by  the  simplicity  and  precision  of  its  re- 
sults, by  its  great  final  cause,  by  its  operation  in  animal  life,  and  through 
the  cerebro-spinal  system,  while  the  Passions  operate  mostly  in  organic 
life  and  through  the  sympathetic  system.  In  all  these  respects  the  Will 
is  on  common  ground  with  Judgment  and  Reflection,  while  it  is  the  most 
important  and  uniform  characteristic  of  the  Instinctive  Principle  through- 
out the  animal  tribes  (§  476  c,  500  h). 

§  1073,  a.  It  is  allowed  by  all  that  some  invisible,  intangible  principle 
exists  in  the  Nervous  System,  commonly  known  as  the  Nervous  Power, 
which  is  extensively  concerned  in  the  processes  of  animal  organization; 
and  I  have  endeavoured  to  show  that  this  power  is  a  vital  agent,  which 
is  very  vai'iously  brought  into  action  either  by  physical  or  mental  causes, 
and  that  when  motion  is  produced  by  direct  or  indirect  physical  irrita- 
tions of  the  brain,  or  by  the  Will  or  the  Passions,  it  is  in  consequence  of 
the  development  of  this  nervous  power,  and  the  direction  of  its  influence 
upon  the  organic  properties  of  the  parts  that  are  brought  into  motion. 
It  operates  equally  in  organic  and  animal  life,  but  through  very  different 
channels  and  with  very  different  results.  It  is  most  important  in  the 
organic  life  of  animals,  though  its  greatest  final  cause  is  relative  to  ani- 
mal life.  Its  transmission  to  the  former  is  through  involuntary  nerves, 
whether  it  be  consequent  on  the  operation  of  physical  causes,  or  when 
the  Passions  disturb  the  organs  in  that  department  of  life ;  and  it  is 
through  the  cerebro-spinal  or  voluntary  nerves  that  the  Will  operates 
upon  the  organs  of  animal  life,  and  when  injuries  of  the  brain  or  spinal 
cord,  or  when  the  Passions  affect  these  organs.  Such  are  the  general 
facts  (§  1072,  a).  When  the  Will  produces  muscular  motion,  it  is  by 
developing  the  nervous  power,  and  transmitting  it  to  the  voluntary  mus- 
cles, when  it  stimulates  the  muscles,  and  brings  them  into  action  through 
their  own  inherent  power.  And  just  so  of  the  Passions,  and  of  physical 
causes.  There  is  no  wandering  of  the  Will  or  of  the  Passions  into  the 
organs  which  they  affect,  as  has  been  always  vaguely  supposed,  no  more 
than  of  physical  agents  when,  on  being  applied  to  the  nervous  centres, 
they  excite  analogous  motions  (§  233).  It  is  also  important  to  under- 
stand that  the  nervous  power,  by  whatever  cause  developed,  is  liable  to 
act  with  intensity  upon  the  brain  (§  230,  509,  950,  1040).     I  have  also 


The  Soul. — APPENDIX. — Instinct.  879 

endeavoured  to  show  that  the  nervous  power  is  developed  by  the  mind  in 
all  acts  of  intellection,  and  that  there  is  then  an  associate  action  between 
this  power,  the  brain,  and  the  mind ;  though  beyond  the  analogies  sup- 
plied by  the  Will  and  the  Passions  this  may  be  hypothetical  (§  234). 

But  all  that  is  embraced  in  this  Section,  whether  as  to  the  nature  of 
the  nervous  power,  or  its  mode  of  development  and  action,  or  whether  it 
have  any  existence,  is  unimportant  to  my  demonstration  (§  234,  e-h). 
It  simply  facilitates  an  understanding  of  the  phenomena  upon  which  the 
demonstration  depends.  (See  Indexes,  Articles  Nervous  Power,  Sym- 
pathy, Remedial  Action,  Oi-ganic  Life,  &c.), 

§  1073,  b.  I  may  say,  also,  that  in  the  Medical  and  Physiological  Com- 
mentaries I  have  endeavoured  to  show  that  the  Nervous  Power  forms  a 
bond  of  union  between  the  Soul,  the  Principle  of  Instinct,  and  the  Brain, 
and  that  this  Principle  is  instrumental  not  only  in  the  results  of  Sensa- 
tion as  set  forth  in  the  present  work,  but  in  the  acts  of  Intellection.  The 
phenomena  of  the  Nervous  Power  in  developing  voluntary  motion  when 
the  Will  operates,  and  of  the  Passions  in  their  demonstrations  in  Organic 
Life,  supply  many  forcible  evidences  of  the  instrumentality  which  I  as- 
sign to  the  Nervous  Power  in  the  concerted  action  between  the  Soul,  the 
Principle  of  Instinct,  and  the  Brain.  (See  Indexes,  Articles  Will  and 
Mental  Emotions.) 

§  1074.  From  what  has  been  now  said  of  the  ground  of  my  reason- 
ing, you  begin  to  perceive  the  consequences  which  must  logically  follow. 
You  begin  to  discern  the  force  of  the  analogy  between  the  eiFects  of  those 
elements  of  the  mind  (or  emotions,  if  it  be  preferred,  §  1072,  h),  the  Will 
and  the  Passions,  and  of  mechanical  and  other  physical  agents  when  ap- 
plied to  the  brain.  You  see,  already,  that  if  the  brain  be  influenced  by 
SOMETHING  Avhen  physical  agents  acting  upon  it  give  rise,  in  consequence, 
to  motion  in  the  voluntary  muscles,  and  in  the  heart,  bloodvessels,  stom- 
ach, «&;c.,  SO  must  it  be  equally  influenced  by  something,  and  that  something 
must  be  equally  an  exciting  and  analogous  cause,  when  the  Will  gives 
rise  to  voluntary  motion,  or  when  the  Passions  affect  the  action  of  the 
heart,  produce  blushing,  or  excite  vomiting,  &c.  From  the  exact  iden- 
tity of  effects  in  the  two  cases,  there  must  be  an  analogy  among  the 
causes  and  their  modus  operandi ;  and  therefore  the  Soul  and  Principle 
of  Instinct  (of  which  the  Will  and  the  Passions  are  prominent  character- 
istics) are  as  much  distinct  causes  as  are  the  mechanical  ii-ritants  or  other 
physical  agents  which  determine  the  corresponding  movements.  I  say, 
that  such  is  your  mental  constitution  you  cannot  resist  this  conclusion, 
however  prone  you  may  be  to  materialism.  Here  is  an  animal  Avhose 
brain  is  shocked  by  a  blow  or  irritated  mechanically,  and  spasms  follow 
in  the  voluntary  muscles ;  and  you  see  that  the  Will  is  even  capable  of 
imitating  that  convulsive  affection.  Here  is  another  whose  brain  is  ir- 
ritated by  the  application  of  alcohol,  and  you  see  the  heart  beating  more 
actively  as  a  result ;  and  here  is  a  third  whose  heart  is  as  quickly  enfee- 
bled in  action  by  the  application  of  tobacco  to  the  brain,  just  as  it  is 
excited  by  joy  and  anger  in  the  one  case,  or  depi*essed  by  grief  and  fear 
in  the  other  (§  481  a-h,  487,  &c.).  You  also  witness  the  same  spasms 
in  the  voluntary  muscles  from  the  operation  of  the  Passions  as  arise  from 
mechanical  causes  when  affecting  the  brain  (§  486,  487  g).  Consider, 
for  example,  a  paroxysm  of  hysteria,  where  convulsions  of  the  voluntary 
muscles  are  brought  on  by  some  mental  irritation,  and  where  they  are  ex- 
actly the  same  as  when  produced  by  disturbing  the  brain  mechanically. 


880  INSTITUTES    OF   MEDICINE. 

Consider,  also,  how  greatly  analogous  are  these  mental  pai'oxysms  to  the 
convulsions  that  proceed  from  teething  and  intestinal  troubles  ;  and  how 
exactly  alike  are  the  voluntary  and  involuntary  acts  of  respiration,  one 
of  them  being  determined  by  the  direct  action  of  theil/md  upon  the  brain, 
and  the  involuntary  act  by  an  impression  transmitted  from  the  lungs  to 
the  brain.  How  precisely  the  same,  also,  the  involuntary  contraction  of 
the  sphincter  ani  and  its  contraction  as  effected  by  the  Will,  and  where 
the  same  philosophy  is  concerned  in  respect  to  causation  as  in  the  vol- 
UHtary  and  involuntary  acts  of  respiration  (§  500  o,  514/,  g).  Consid- 
er, too,  among  the  inexhaustible  examples,  the  variety  of  effects  which 
result  from  the  operation  of  an  emetic,  as  set  forth  in  §  902,  g,  and  the 
same  effects  as  produced  by  a  blow  upon  the  head — all  consequent  upon 
an  irritation  of  the  nervous  centres — and  then  compare  them  with  the 
same  results  which  ensue  when  vomiting  is  produced  by  disgust,  and  even 
by  its  recollection  ;  and  compare  many  of  these  results  with  the  effects  of 
Fear — the  bounding  action  of  the  heart,  the  small  and  rapid  pulse,  the 
half-suspended  respiration,  the  pallor  of  the  skin  and  the  copious  perspi- 
ration, the  flood  of  urine,  the  hurried  movements  of  the  intestinal  canal, 
the  ghastly  countenance  and  frightful  eyeballs,  the  trembling  of  the  vol- 
untary muscles  and  the  prostration  of  their  power ;  or,  compare  the  re- 
sults of  many  physical  causes,  such  as  constipation  of  the  bowels,  with 
the  effects  of  Grief,  either  so  influencing  the  nervous  centres  as  to  un- 
dermine digestion,  or  so  acting  upon  the  brain  as  to  overthrow  the  men- 
tal faculties ;  or  consider  how  Hope,  succeeding  to  Grief,  will,  like  ton- 
ics, cathartics,  shower-bath,  change  of  climate,  &c.,  influence  the  nervous 
centres  in  yet  another  manner  so  as  to  restore  that  digestion  which  Grief 
had  impaired.  And  what  makes  the  tears  flow,  when  Grief,  or  Love,  or 
Joy,  or  Anger,  is  in  the  ascendant,  just  as  they  do  when  snuff  or  other 
physical  agents  irritate  the  nose?  Why  does  the  mouth  water  at  the 
sight  of  a  bountiful  feast,  or  on  scenting  its  odour,  or  from  its  expecta- 
tion alone,  just  as  it  will  on  chewing  horseradish  or  tobacco?  Why  will 
the  sight  of  a  pill-box,  or  offensive  odours,  or  startling  or  other  unpleas- 
ant sounds,  operate  upon  some  after  the  manner  of  cathartics  (§  514  m, 
844  a,  892f  h,  944  h,  951  c)*?  It  is  palpable  enough,  that,  in  one  series 
of  the  cases  the  effects  are  owing  to  some  physical  cause  irritating  the 
brain  and  spinal  cord,  and  which  is  totally  distinct  and  different  from 
those  nervous  centres ;  and,  can  any  one  be  so  regardless  of  the  plainest 
rule  of  pliilosophy  as  to  suppose  that  the  corresponding  results,  in  the 
other  series,  are  not  equally  due  to  some  cause  which  is  alike  distinct 
and  different  from  the  nervous  centres?  All  of  them  are  the  most  fa- 
miliar facts  that  engage  our  attention ;  but  such  as  are  relative  to  the 
mind  have  engaged  us  only  as  facts. 

§  1075,  a.  We  now  revert  to  our  statement  relative  to  the  nervous 
power  (§  1073)  in  pui'suit  of  a  common  exciting  cause  by  which  all 
the  endless  but  analogous  phenomena  to  which  we  have  adverted  are 
brought  about.  It  is  readily  granted  that  the  mechanical  and  other 
physical  causes  are  not  transmitted  to  the  parts  which  they  influence 
through  the  medium  of  the  nervous  system,  and  we  must  therefore  look 
for  some  intermediate  cause  by  which  the  remote  effects  are  produced. 
It  is  of  no  importance  to  our  present  objects  whether  this  cause  be  gal- 
vanism, or  a  nervous  fluid,  or  nervous  power,  or  a  vibration  of  the  nerv- 
ous fibres,  «&c.  (§  184  h,  234  a) ;  and,  from  the  analogy  in  the  effects  of 
the  Will  and  Passions,  it  is  equally  clear  that  these  elements  or  eraana- 


The  Soul. — ^.^PPENDix. — Insiinct.  881 

tions  of  the  IMind  are  not  transmitted  to  the  parts  affected,  but  that  they 
must  operate  through  the  same  intermediate  exciting  cause  as  the 
physical  agents.  These  unquestionable  coincidences,  therefore,  not  only 
place  the  external  and  internal  primary  causes  upon  common  ground  as 
substantive  agents,  but  are  demonstrative  of  their  operation  through 
some  common  cause  appertaining  to  the  nervous  system.  This  is  also 
farther  sustained  by  the  simplicity  and  consistency  of  Nature  in  her  fun- 
damental institutions,  especially  where  the  mechanism  is  the  same,  al- 
though there  be  great  diversity  in  the  remote  causes  and  results. 

Nor  do  I  entertain  any  doubt,  however  much  the  physical  school  may 
look  upon  this  question  as  an  affair  of  "spiritualism"  (§  1034),  that  the 
facts,  which  are  of  such  an  endless  variety,  so  distinctly  pronounced,  and 
so  perpetually  before  us,  will  be  universally  allowed  to  establish  the  in- 
terpretation rendered  in  these  Institutes  of  the  modus  operandi  of  the 
nervous  power.  There  is  not  a  phenomenon  relative  to  the  nervous  sys- 
tem which  the  doctrine  will  not  explain,  nor  is  there  one  which  can  be 
consistently  or  intelligibly  explained  by  any  otner.  (See  Indexes,  Articles 
Nervous  Power,  Sympathy,  Itemedial  Agents,  Will,  and  Mental  Emotions.) 

It  is  also  evident  from  my  premises,  that,  if  the  movements  Avhiclf  are 
excited  by  the  action  of  physical  causes  upon  the  brain  be  only  remotely 
due  to  those  causes,  and  not  to  any  primary  change  in  the  brain  (which 
includes  the  transmitted  as  well  as  direct  impressions),  it  must  equally 
follow  that  the  effects  of  the  Will  in  developing  voluntary  motion,  and 
of  the  Passions  in  modifying  the  action  of  the  heart  and  bloodvessels, 
and  other  organs,  cannot  be  due  to  any  original,  primai^  changes  in  the 
condition  of  the  brain,  but,  of  necessity,  to  some  causes  as  distinct  from 
the  brain  as  are  the  physical.  But,  as  this  is  the  great  point  in  material- 
ism,, and  forms  the  chemical  doctrine  of  intellection,  let  us  admit  that 
the  remote  effects  brought  about  by  physical  impressions  upon  the  brain 
are  due  to  simply  some  physical  change  in  the  organ,  and  that,  there- 
fore, the  corresponding  manifestations  of  the  Will  and  the  Passions  are 
equally  owing  to  simply  physical  changes  in  the  great  nervous  centre, 
it  will  still  follow  just  as  logically  that  there  must  be  in  the  latter  case 
as  much  an  efficient  cause  for  the  cerebral  changes  as  there  is  allowed 
to  be  in  the  former. 

§  1075,  b.  So  far,  then,  the  analogy  is  complete.  But,  in  the  case  of 
the  physical  agents  the  causes  are  of  a  passive  nature,  and  require  other 
agencies  to  bring  them  into  operation.  How  different,  on  the  other 
hand,  with  the  Will  and  the  Passions!  Plere  the  causes  are  entirely 
self-acting,  originating  their  own  actions  in  the  Sensorium  Commune. 
This,  in  itself,  establishes  a  radical  distinction  between  the  nature  of  the 
Soul  and  Instinctive  Principle,  and  of  all  physical  causes,  and  is  utterly 
fatal  to  materialism.  The  self-acting  nature  of  the  Soul  and  of  Instinct, 
and  especially  of  the  rational  faculty,  transcends  greatly  tlie  Principle 
of  Organic  Life,  which  requires  the  operation  of  stimuli  to  rouse  it  and 
maintain  it  in  action  (§  75,  136,  188^).  Nay  more,  the  Will  and  the 
Passions  are  among  the  most  efficient  causes  in  calling  into  action  the 
Principle  of  Life  ;  and  being,  in  this  respect,  upon  common  ground  with 
all  vital  stimuli,  the  materialist  will  see  in  this  analogy  an  insuperable 
proof  of  the  substantive  existence  and  self-acting  nature  of  the  Soul,  and 
how,  also,  the  same  analogy  distinguishes  the  Soul  completely  from  the 
Principle  of  Life,  with  which  it  has  been  confounded  even  by  eminent 
Vitalists.     The  group  of  the  facts  is  here  so  very  comprehensive,  and 

Kkk 


882  INSTITUTES    OF    MEDICINE. 

80  demonstrative  of  the  two  most  important  problems  in  intellectual  and 
organic  philosophy,  that  I  pause  in  this  manner  upon  the  subject.  But 
so  far  as  action  is  immediately  concerned  in  the  two  cases  an  analogy 
obtains,  and  we  may  reason  upon  that  analogy  from  the  self-acting  Soul 
to  the  existence  of  an  active  Principle  of  Life  upon  which  organic  mo- 
tions depend  (§  234,  1034).  But,  we  shall  seek  in  vain,  throughout  the 
wide  range  of  Nature,  for  any  direct  similitude  with  the  manifestations 
of  Reason  or  of  Instinct;  though,  if  we  pass  the  limits  of  Nature,  we 
may  discover  in  the  results  of  Creative  Energy  that  analogy  with  the 
Soul  which  shadows  foi-th  the  Image  of  God  (§  234,  a-h). 

§  1076,  a.  What  has  now  been  said  is  equally  applicable  to  material- 
ism, whether  it  regard  the  manifestations  of  mind  as  a  chemical  phenome- 
non, or  as  elaborated  from  the  blood ;  and  these  are  the  only  hypotheses 
which  have  any  intelligible  foundation.  They  must,  therefore,  be  now 
considered  more  specifically. 

The  chemical  supposes  that  all  acts  of  intellection,  all  manifestations 
of  the  Will  and  the  Passions,  all  the  impulses  of  Conscience,  and  all 
Ad^'ation  of  the  Deity,  are  results  of  "  the  chemical  action  which  the  ele- 
m,ents  of  the  food  and  the  oxygen  of  the  air  mutually  exercise  on  each  other''' 
(§  349  e,  500  n,  1054).  This  is  the  hypothesis  of  combustion.  But 
enough  has  been  said  to  show  the  impossibility  of  referring  the  phenom- 
ena to  a  chemical  process  without,  at  least,  an  attendant  cause  to  insti- 
tute the  process.  This,  however,  is  farther  examined  at  §  500,  nn,  o,  to 
which  I  would  refer  the  reader ;  and  what  will  soon  be  said  of  the  doc- 
trine of  mental  secretion  will  be  alike  applicable,  in  principle,  to  the 
chemical  hypothesis,  and  will  cover  the  whole  ground. 

§  1076,  h.  But  there  is  a  class  of  Philosophers  who  have  endeavoured 
to  render  the  chemical  doctrine  acceptable  by  admitting  something  like 
a  Soul,  which  is  supposed  to  act  as  a  predisposing  cause  of  that  com- 
bustive  process  upon  which  tlie  phenomena  of  Reason  and  Instinct  are 
said  to  depend.  But  it  may  be  readily  seen  that  the  hypothesis  is 
illusory. 

In  the  first  place,  the  supposition  of  the  dependence  of  thought,  &c., 
upon  any  chemical  process  necessarily  places  the  agency  of  the  supposed 
principle,  in  its  relation  to  the  phenomena  of  Mind  and  of  Instinct,  upon 
exactly  the  same  ground  as  the  simple  chemical  hypothesis ;  for  the  re- 
sults would  still  be  chemical  and  nothing  more.  If  oxygen  unite  with 
another  element,  and  result  in  combustion,  it  takes  place  under  a  special 
law,  and  an  exact  chemical  product  ensues,  which  neither  the  Soul  can 
alter,  nor  imagination  aiFect.  The  only  part  which  the  Soul  would  take, 
according  to  any  analogies  borrowed  from  Chemistry,  and  which  is  neces- 
sarily the  part  supposed,  would  be  that  of  exerting  merely  a  predisposing 
affinity  among  the  elements.  This  predisposing  influence  is  meant  to 
embrace  whatever  may  be  supposed  to  result  from  its  action  upon  the 
doctrine  of  catalysis  (§  409  7,  350  J  a-e).  In  this  only  view  of  the  sub- 
ject, the  chemical  tendency  of  the  Soul  would  no  more  react  upon  itself 
than  that  o? platinum,  and  the  only  result  would  be  (in  chemical  phrase- 
•Dlogy),  a  combustion  of  the  elements  of  the  brain,  just  as  when  hydrogen 
and  oxygen  gases  are  submitted  to  the  catalytic  action  of  the  metal. 
And  so  of  any  other  given  chemical  change.  It  always  terminates  in 
one  way. 

Whenever,  therefore,  oxygen  unites  with  the  phosphorus  of  the  brain, 
according  to  the  material  doctrine  of  intellection,  whether  chemical  or 


The  Soul. — APPENDIX. — Instinct.  883 

chemico-spiritual,  it  can  form  no  other  compound  than  phosphorous  or 
phosphoric  acid,  whatever  the  supposed  activity  of  the  combustion ;  or, 
if  it  unite  Avith  those  other  combustible  elements  of  the  organ,  carbon 
and  hydrogen,  the  resulting  compounds  must  be  carbonic  acid  in  one 
case,  and  water  in  the  other ;  or,  at  most,  a  special  triple  compound  of 
those  elements.  An  exciting,  or  predisposing,  or  any  other  agency  of 
the  Soul,  even  were  the  soul  a  material  substance,  would  in  no  respect 
affect  these  results  ;  and  to  imagine  that  the  Soul  enters  into  either  com- 
bination, and  is  yet  in  perpetual  operation,  per  se,  would  be  a  chemical 
absurdity.  Whatever  consideration,  therefore,  may  be  given  to  chemical 
processes  thus  instituted  as  the  source  of  ideas,  &c.,  it  can  be  in  no  re- 
spect different  from  that  which  attributes  them  to  one  of  an  uncompli- 
cated nature,  whether  the  soul  be  immaterial  or  material. 

The  difficulty  will  be  readily  appreciated,  both  here  and  in  regard  to 
organic  products,  which  are  equally  ascribed  to  a  chemical  process  (for 
these  doctrines  are  essentially  alike),  should  it  be  attempted  to  call  in 
the  aid  of  the  Soul,  or  the  Principle  of  Life,  in  any  of  the  manipulations 
of  the  Laboratory.  They  are  so  far  on  common  ground  ;  and,  if  the  Soul 
can  promote  combustion  in  the  brain,  or  in  any  way  modify  its  results, 
or  the  Principle  of  Life  subserve  the  chemical  hypothesis  of  organic  re- 
sults (according  to  Liebig),  they  should  be  equally  competent  out  of  the 
body,  so  only  they  could  be  brought  into  external  operation.  But  no 
imagination  can  surmise  the  possibility  of  applying  them  in  a  chemical 
manner,  and,  least  of  all,  eliciting  by  the  aid  of  the  Soul  the  phenomena 
of  mind  from  the  most  ingenious  devices  of  Organic  Chemistry.  On  the 
other  hand,  however,  there  is  no  difficulty  in  regarding  the  Soul  as  a  cause 
acting  through  the  vital  constitution  of  an  organ,  and  thus  originating 
all  the  phenomena  of  mind  ;  while,  in  so  doing,  we  get  rid  of  an  unneces- 
sary, as  well  as  an  unmeaning  and  mischievous  multiplication  of  causes 
(§  171-221). — See  ^455  a  as  to  final  causes  of  the  union  of  Soul  and  Brain. 

The  Chemico-Spiritualist  is  thus  coerced  to  the  alternative  of  ascrib- 
ing all  intellectual  and  instinctive  functions  to  the  immaterial  principles 
in  their  co-operation  with  the  vital  constitution  of  the  brain,  or  to  deny 
the  existence  of  those  principles  (whether  immaterial  or  material),  and 
throw  himself  exclusively  upon  the  simple  chemical  rationale.  If  the 
doctrine  stand,  it  must  be  upon  its  own  merits,  and  not  through  any 
sophistry  that  may  seem  like  a  leaning  towards  the  common  faith  of 
mankind  —  no  gilding  the  material  device — no  concession  to  what  may 
be  considered  the  innocent  but  obstinate  belief  of  the  spiritual  theorist, 
in  the  trbst  that  he  may  finally  discern  the  reality  of  his  delusion. 

Again,  farther :  the  Organic  Chemist  maintains  that  all  the  processes 
of  life  are  owing  to  the  same  combinations  of  oxygen  with  phosphorus, 
carbon,  hydrogen,  and  nitrogen,  as  are  supposed  to  give  rise  to  intellec- 
tion. The  brain  is  thus  placed  on  common  ground  with  all  other  parts. 
Why,  then,  are  there  no  manifestations  of  mind  or  instinct  in  the  liver, 
intestines,  or  in  the  bones  where  phosphorus  abounds?  Or,  turning  to 
the  accommodating  Chemico-Spiritualist,  I  may  ask,  if  the  Soul  or  Instinct 
make  all  the  difference  as  regards  intellectual  and  instinctive  manifesta- 
tions, what  makes  the  difference  in  respect  to  the  corporeal  phenomena  ? 
Nor  is  that  all.  If  the  brain  be  considered  the  source  of  intellection  in 
its  organic  condition  alone,  how  are  facts  treasured  up,  and  ever  present 
from  childhood  to  decrepit  age  ?  As  the  brain,  like  all  other  parts,  is 
constantly  subject  to  renewals,  the  facts  should  go  with  the  parts  upon 


884  INSTITUTES    OF   MEDICINE. 

which  they  are  impressed,  if  the  organ  alone  be  their  receptacle.  Why, 
again,  are  the  events  of  childhood  fresh  to  the  Octogenarian,  when  those 
of  the  day  are  speedily  forgotten?  Why  may  memory  be  trained  with 
a  special  reference  to  particular  subjects,  and  to  a  forgetfulness  of  others, 
or  disciplined  to  a  general  compass  of  knowledge?  Materialism  must 
here  be  consistent  and  stand  on  its  own  philosophy.  But  the  Soul,  on 
the  other  hand,  as  also  the  Instinctive  Principle,  being  one  of  an  un- 
changing nature  (as  proved  by  these  very  facts),  holds  fast  the  treasury 
of  knowledge,  or  the  improvements  it  may  gain  (§  180). 

And  here  we  come  upon  a  demonstration  which,  were  there  no  other 
objection,  would  be  fatal  to  materialism  in  either  of  its  shapes  ;  for  one 
hypothesis  supposes  that  intellection,  &c.,  is  the  result  of  the  combustive 
process,  and  the  other,  of  secretion.  In  either  case,  therefore,  all  ideas 
should  be  as  evanescent  as  the  processes  themselves. 

Finally,  such  as  are  disposed  to  follow  the  Author  any  farther  upon 
this  particular  question  will  find  in  former  parts  of  this  work  many  sug- 
gestions which  have  a  direct  bearing  upon  it,  as  in  §  350|  e-n,  p.  180- 
192. 

§  1076,  c.  And  now,  as  to  the  other  branch  of  materialism,  or  that 
which  regards  the  phenomena  of  mind,  &c.,  as  the  products  of  secretion. 
This  question  has  been  incidentally  discussed  in  these  Institutes,  but  with 
other  objects  than  are  now  contemplated.  As  it  bears,  however,  as  well 
upon  the  chemical  as  the  functional  doctrine,  and  as  it  is  desirable  to 
amplify  the  argument,  and  that  it  may  appear  as  an  integral  part  of  the 
pi'esent  demonsti-ation,  I  shall  introduce  it  here  (§  175,  c). 

I  have  there  said  that  in  former  works  I  have  presented  certain  facts 
which  go  to  the  conclusion  that  the  Soul  is  a  distinct,  immaterial  sub- 
stance, and  that  the  Instinctive  Principle  of  animals  is  equally  a  distinct 
substance  from  the  brain.  I  then  proceeded  to  comment  upon  the  main 
argument  of  the  Materialists,  drawn  from  analogy,  that  the  mind,  like 
the  gastric  juice,  bile,  &c.,  is  only  a  product  of  the  organic  functions  of 
the  brain.  I  have  there  shown,  also,  that  the  supposed  analogy  is  desti- 
tute of  foundation.  It  might  be  sufficient,  in  proof  of  this,  to  simply 
say  that  the  Mind  and  Instinct  are  wanting  entirely  in  every  known 
attribute  of  the  products  of  other  organs,  and  are  sui  generis  in  all  their 
chai'acteristics.  But  there  are  other  more  absolute  characteristics  which 
completely  destroy  the  supposed  analogy.  What,  for  example,  is  tlie  ef- 
ficient cau§e  of  the  production  of  bile,  saliva,  &c.  1  Certainly  the  blood, 
in  connection  Avith  organic  structure  and  organic  actions — chemical,  if 
you  please.  While  these  processes  go  on,  bile,  saliva,  &c.,  are  produced 
uninterruptedly;  or,  if  arrested,  it  is  from  the  failure  of  the  organic  pro- 
cesses. But  it  is  just  otherwise  in  respect  to  the  Mind  and  the  Instinct- 
ive Principle.  All  their  manifestations  are  completely  suspended  during 
sleep,  and  often  with  great  instantaneousness,  or,  to  meet  any  sophistry 
about  dreams,  I  might  say  half  suspended  ;  and  yet  the  organic  functions 
of  the  brain  continue  to  move  on  as  perfectly  as  those  of  the  liver,  the 
lungs,  &c.  Indeed,  were  any  change  of  this  nature  to  befal  the  brain,  it 
would  be  particularly  manifested  by  some  consequent  modification  of  all 
the  organic  actions,  especially  as  those  of  the  Mind  and  Instinct  undergo 
complete  suspension.  The  continuance  of  all  tlie  organic  results  proves 
that  organic  life  is  every  where  in  perfect  operation ;  while,  by  equality 
of  reason,  the  suspension  of  all  results  in  animal  life  proves  that  an 
agent,  upon  which  these  results  depend,  has  ceased  to  operate.     In  one 


The  Soul. — APPENDIX. — Instinct.  885 

case,  organic  functions  must  go  on  without  interruption,  and  therefore 
the  moving  causes  upon  which  they  depend  must  be  in  perpetual  action. 
In  the  other,  it  is  ordained  that  the  organs  peculiar  to  the  division  of 
animal  life  shall  have  periodical  repose  (though  only  as  it  respects  mere 
animal  life),  and,  therefore,  by  parity  of  reason,  their  spring  of  action  is 
constitutionally  fitted  for  quiescence  as  well  as  action,  and  this,  as  it  re- 
spects sleeping  and  waking,  corresponds  with  the  alternations  of  thinking 
and  not  thinking  during  the  waking  time.  The  various  gradations  in  the 
suspension  of  mental  and  instinctive  functions  from  their  quiescence  in 
the  waking  state  to  profound  slumber  concur,  also,  in  this  pai't  of  our 
demonstration.  Nor  is  it  at  all  important  to  our  purpose  whether  there 
ever  be  a  complete  suspension  of  the  intellectual  or  instinctive  functions. 
But  again  :  suppose  some  change  in  the  oi'ganic  condition  of  the  brain, 
as  the  cause  of  sleep  (§  500,  n)  ;  what  is  it,  I  say,  that  so  instantly  rein- 
states its  organic  functions  when  we  pass  from  the  sleeping  to  the  wak- 
ing state "?  What  arouses  the  organ  to  its  wonted  secretion  of  Mind,  or 
what,  in  the  other  case,  restores  the  combustive  process  %  Certainly  not 
the  blood.  Are  there  any  analogies  supplied  by  the  liver,  or  by  any  other 
organ  ?  Do  you  assume  that  some  imaginary  stimulus  is  propagated  upon 
the  brain  from  other  organs?  Then  I  ask  what  brings  this  into  operation, 
and  under  such  an  infinite  variety  of  unique  circumstances'?  In  what 
conceivable  manner  does  it  modify  the  organic  functions  of  the  brain  so 
as  to  excite  the  secretion  of  Mind,  or  how,  in  the  other  case,  does  it  start 
the  combustive  process '?  Do  the  functions  of  any  other  organ  supply 
the  slightest  ground  for  such  a  conjecture  ?  Will  it  interpret  the  reason 
why  sleep  is  so  prolonged  in  the  habitually  indolent,  or,  contrasted  with 
this,  why  the  laborious  and  exhausted  student  often  sleeps  less  than  others, 
whatever  their  occupation "?  Is  it  said  that  this  is  the  i-esult  of  habit,  or 
of  self-discipline  ?  In  either  case  it  is  an  admission  of  a  self-acting  Prin- 
ciple, which  brings  itself  and  the  brain  under  these  influences,  and  there- 
fore it  is  necessarily  that  Principle  which  rouses  the  brain  from  its  state 
of  suspended  animal  functions.  It  is  a  case,  too,  very  strongly  to  our 
purpose,  for  it  denotes  a  remarkable  cviltivation  of  the  spiritual  part, 
which  enables  it  to  spi'ing  into  active  operation  from  a  dormant  condi- 
tion in  habitually  exhausted  states  of  the  body,  while  the  brain,  accoi'd- 
ing  to  materialism,  should  resist  all  wakefulness  till  that  organ,  and  all 
other  parts,  are  fully  recruited  by  repose  (p.  329-332,  §  500,  ?t-p,  Liebig). 
But  the  Materialist-  is  not  convinced  by  the  difficulties  attendant  upon 
sleeping  and  waking ;  and  again,  therefore,  I  ask  him.  What  is  it  that 
directs  the  special  combustive  or  secreting  process  in  all  the  acts  of  voli- 
tion, in  all  the  acts  of  intellection  ;  or  what  brings  them  into  operation? 
What  are  your  conceptions  of  Creative  Energy"?  Are  not  the  results 
of  Mind,  however  separated  from  Infinitj'^,  precisely  analogous  to  those 
which  are  everywhere  seen  as  the  offspring  of  an  Infinite  Intelligence  ? 
But,  if  you  admit  a  God,  you  Avill  not  reason  from  your  debasing  doc- 
trines of  the  human  mind  to  the  Attributes  of  your  Maker "?  And  I  ask 
the  Materialist  what  answer  he  will  make  as  to  the  condition  of  our  Loi'd 
before  His  appearance  upon  the  earth,  and  as  He  was  "  manifest  in  the 
flesh?"  Was  there  no  Spirit  there?  Nothing  but  material  eliminations 
of  Mind  from  the  blood,  or  a  conflagration  of  the  elements  of  the  brain  ? 
For  so  you  must  have  it,  and  so  it  is  meant,  whei'e  the  same  mental 
phenomena  are  so  interpreted  in  man.  Nay  more ;  so  complete  is  the 
analogy  between  the  acts  of  ratiocination  and  those  of  the  Creator,  as 


886  INSTITUTES    OF    MEDICINE. 

geen  in  the  humble  designs  which  are  devised  and  executed  by  man,  and 
which,  indeed,  is  all  that  we  know  of  Him  except  from  Revelation,  it 
would  unavoidably  follow,  upon  the  doctrines  of  materialism,  that  all 
the  Designs  of  the  Almighty  Being  were  equally  the  results  of  chemical 
or  organic  processes !    Or  is  this  to  be  excluded  from  the  pale  of  "  science^''  ? 

The  questions  and  arguments  now  propounded  must  be  answered 
consistently,  and  in  some  conformity  with  the  hypotheses  drawn  from 
analogy.  If  that  can  be  done  (this  simple  physiological  requisite  alone), 
then  it  must  be  conceded  that  the  analogy  is  entitled  to  the  gravest 
consideration.  So,  on  the  other  hand,  should  the  hypotheses  fail  in  this 
indispensable  requisite,  materialism  must  stand  convicted  of  sophistry, 
insincerity,  and  a  leaning  to  infidelity. 

Here  we  might  bring  our  demonstration  to  a  close  as  it  respects  the 
existence  of  the  Soul,  and  its  power  of  instituting  actions  in  connection 
with  the  material  fabric.  But  there  may  be  some  who  may  be  inclined 
to  follow  us  in  a  more  extended  inquiry  than  has  now  been  presented, 
especially  as  the  demonstration  will  continue  to  be  predicated  of  admitted 
facts  and  principles,  as  set  forth  in  these  Institutes. 

§  1077.  What  will  be  presented  in  the  present  section  is  mostly  a 
series  of  physiological  examples  which  concur  with  the  foregoing  in 
enforcing  the  conclusions  at  which  we  have  already  arrived. 

It  has  been  seen,  extensively,  that  impressions  upon  the  nervous  centres, 
by  which  the  nervous  influence  is  developed  and  detei-mined  with  various 
effects  upon  distant  parts,  are  all  upon  a  par,  in  principle,  whether  tliey 
result  from  agents  applied  directly  to  the  centres  themselves,  or  be 
transmitted  to  them  through  the  medium  of  parts  remotely  situated,  or 
whether  the  Will  and  Passions  make  their  demonstrations.  Take  some 
of  the  examples  among  the  muscles  which  are  botli  voluntary  and  invol- 
untaiy.  Let  these  be,  again,  the  respiratory  muscles,  including  those  of 
the  face.  Now,  their  several  movements  are  liable  to  numerous  modifi- 
cations, some  of  which  are  natural,  as  in  sneezing,  coughing,  yawning, 
laughing,  and  others  more  or  less  morbid,  as  asthma,  hiccough,  &c.  In 
all  but  two  of  these  cases  the  movements  depend  upon  the  excitement 
of  the  nervous  power  through  some  sensitive  nerve,  which  are  generally 
the  sensitive  fibres  of  the  pneumogastric,  and  the  reflection  of  that  power 
from  the  brain  and  spinal  cord,  through  motor  nerves,  upon  a  part  of  or 
upon  the  whole  of  the  respiratory  muscles.  In  each  process  there  is  a 
special  irritation  of  the  nervous  centres,  and  in  each  the  nervous  influence 
is  brought  into  operation  in  a  peculiar  manner,  and  according  to  that 
manner  is  the  nature  of  the  movement.  In  Asthma,  a  stronger  irrita- 
tion is  propagated  from  tlie  lungs  to  the  nervous  centres,  and  a  more 
intense  motor  excitement  is  reflected  from  the  centres  upon  all  the  mus- 
cles of  respiration  (often  including  those  of  the  face),  than  in  ordinary 
breathing,  and  in  some  cases  the  Will  comes  to  the  aid  of  the  irritation 
propagated  from  the  lungs.  Here,  then,  it  is  seen  that  a  prompting  of 
the  Mind  and  the  pliysical  causes  are  brought  into  immediate  co-operation 
in  rousing  the  brain  and  spinal  cord.  The  physical  cause  is  insufficient 
io  excite  the  requisite  movements  of  the  respiratory  muscles,  and  there- 
fore the  Mind  lends  its  assistance.  Both  act  in  perfect  harmony  togeth- 
er ;  nor  can  the  slightest  difference  be  observed  in  tlie  results  of  either, 
excepting  as  the  Mind  acts  with  greater  energy,  and  brings  the  respira- 
tory muscles  of  the  face  into  action. 

Now,  upon  the  physical  hypotheses   of  intellection,  what  is  it  that 


The  Soul. — APPENDIX. — Instinct.  887 

superadds  to  the  respiratory  movements,  in  the  foregoing  case,  a  cause 
perfectly  distinct  from  such  as  naturally  governs  the  process?  If  it  be 
said,  fluctuating  conditions  of  the  brain,  what  is  the  cause  of  those  fluc- 
tuations? AVhy  is  there  at  one  moment  only  a  moderate  degree  of  the 
supposed  combustive  or  secretory  process,  and  at  the  next  a  greatly 
increased  amount  of  one  or  the  other,  and  this  requiring  as  much  a 
cause  as  the  excitement  of  the  brain  in  the  involuntary  act?  And  here 
we  may  again  advert  to  the  sphincter  muscles  as  supplying  a  parallel 
example. 

Take  another  illustration  —  the  acts  of  voluntary  and  involuntary 
laughing.  When  the  feet  or  arm-pits  are  tickled,  laughing  follows  irre- 
sistibly in  many,  as  the  effect  of  an  irritation  propagated  to  the  nervous 
centres  by  sensitive  nerves  supplying  the  skin  of  those  parts  (§  514  ci, 
649  b).  The  phenomena  are  the  same  as  witnessed  in  ordinary  laugh- 
ing, where  the  Will  and  agreeable  Emotions  are  the  exciting  causes. 
The  former  soon  becomes  painful,  and  then  goes  on  in  direct  opposition 
to  the  Will.  A  man,  for  example,  bound  the  limbs  of  his  wife  and 
tickled  her  feet  till  she  died  of  laughing,  just  as  some  die  suddenly  of  a 
strong  mental  emotion,  "  which,"  as  Shakspeare  says,  "  is  as  bad  as  die 
with  tickling."  And  here  1  would  ask  the  Materialist  what  other  con- 
struction he  can  apply  to  the  cases  of  sudden  death  from  jotj  and  anger 
than  the  powerful  operation  of  some  unseen  cause  upon  the  brain,  and 
through  that  organ  upon  organic  life?  What  other  condition  than  a 
violent  shock  of  the  brain  from  a  cause  as  distinct  in  its  nature  from  the 
organ,  as  the  hammer  whose  blow  upon  the  head  is  fatal  through  pre- 
cisely the  same  physiological  influences?  (§  230,  455,  476 J  A,  478,479, 
500/-nn,  507-509,  634,  902  /,  951  c,  d.) 

A  case  precisely  parallel  in  its  physiological  rationale  with  death  from 
mental  emotions  {last  references)  occurs  in  syncope,  when  it  arises  from 
seeing  or  hearing  something  offensive,  or  from  the  sight  of  a  lancet. 
Here  the  immediate  cause,  as  in  the  case  of  death  from  joy  or  anger,  is 
the  instant  and  powerful  determination  of  the  nervous  influence  upon  the 
brain,  heart,  stomach,  &c.  (§  230,  479,  507-509,  634,  951).  But  there 
must  be  something  to  develop  that  nervous  influence  in  the  brain,  and  the 
common  sense  of  every  one  assures  him  that  it  is  a  conscious  agent  which 
does  the  work.  But,  for  the  fullest  illustration  of  this  subject,  let  us 
analyze  the  physiological  rationale  of  syncope  as  produced  by  offensive 
odours.  Here  the  Mind  may  have  but  little  participation  in  the  pros- 
tration of  the  heart,  &c.,  but  the  eflfect  be  mainly  due  to  the  physical 
impression  propagated  to  the  brain  through  the  olfactory  nerve,  and  per- 
haps, also,  the  nasal  branches  of  the  fifth  pair  (§  514,  m),  which  impres- 
sion, in  itself,  develops  greatly  the  nervous  influence.  But  the  Mind 
may  also  contribute  to  that  development ;  for,  if  the  odour  Avcre  not  per- 
ceived, no  syncope  might  follow.  Thus,  again,  are  associated  the  phys- 
ical and  mental  causes  in  producing  a  common  effect,  while  in  the  case 
of  the  lancet  it  is  purely  a  mental  emotion  which  determines  the  par- 
oxysm. But,  in  respect  to  the  odour,  the  Mind  generally  endeavors  to 
resist  its  effects,  and  as  syncope  may  happen  in  spite  of  the  effort,  it  is 
evident  that  the  depressing  influence  may  be  mostly  due  to  the  direct 
action  of  the  physical  cause  upon  the  brain,  just  as  we  shall  soon  see 
how  a  strong  light  acting  upon  another  pure  nerve  of  sensation  may  pro- 
duce sneezing ;    but  I  think  more  the  mental  emotion  (p.  79,  note). 

Let  us  now  connect  with  the  foregoing  facts  the  syncope  v/hich  follows 


888  INSTITUTES    OF    MEDICINE. 

blows  upon  the  head,  and  it  will  be  seen,  as  plainly  as  we  see  that  the 
physical  blow  upon  the  brain  is  the  cause  in  one  case  and  the  odours  in 
others,  that  the  Mind  inflicts  the  blow  in  the  remaining  series,  or  that 
of  joy,  anger,  the  lancet,  «&;c.  The  physiological  effects  prove  conclu- 
sively, both  in  their  nature  and  coincidence,  that  one  cause  is  as  much 
an  agent  acting  upon  the  brain  as  the  other,  and  that  both  are  equally 
distinct  from  the  organ  (§  514  m,  844  a,  892 J  h,  944  h,  951).  In  all  the 
cases  where  the  physiological  effects  are  consequent  upon  mental  pro- 
cesses the  Mind  and  the  effects  stand  in  the  same  relation  as  do  the 
physical  causes  and  their  effects  in  the  other  cases,  and  where  the  effects 
are  precisely  the  same  in  both  series.  To  suppose  the  absence  of  a  cause 
in  the  former  is  a  physiological  absurdity,  and  to  suppose  any  other 
primary  cause  than  the  Mind,  as  a  self-acting  Agent,  is  a  greater  absurd- 
ity. Nay  more,  the  Mind,  the  brain,  and  the  cerebro-spinal  nerves  are 
absolutely  indispensable  to  all  voluntary  movements,  however  true  it  be 
that  the  power  by  which  the  movements  are  accomplished  is  implanted 
in  the  muscles  (§  258-267,  &c.)  ;  while  the  motions  of  organs  in  organic 
life  may  go  on  without  Mind,  or  brain,  and  even  without  cerebro-spinal 
nerves  (§261,  264,  455  a,  46H  «.  478  b,  490,  1042). 

I  have  said  that  in  the  several  modified  movements  of  the  respiratoiy 
muscles  mentioned  at  the  beginning  of  this  section,  all  but  two  depend 
upon  irritations  of  the  nervous  centimes  propagated  through  sensitive 
nervous  fibres  from  the  lungs  or  other  parts,  and  that,  in  all  the  cases, 
the  same  excito-motory  nerves  bring  the  muscles  into  action.  The  two  ex- 
ceptions are  voluntary  laughing  and  yawning.  In  the  former  case,  the 
Mind,  unlike  involuntary  laughing,  rouses  the  brain  without  the  inter- 
vention of  any  sensitive  nerves,  and  determines  the  nervous  influence  di- 
rectly upon  the  muscles  of  the  face  through  the  excito-motory  nerves ; 
which  is  also  true  of  the  bloodvessels  of  the  face  in  blushing,  and  of  the 
production  of  tears  in  weeping,  though  in  the  latter  instances  the  nervous 
influence  is  propagated  upon  the  face  and  gland  through  motor  fibi'es 
of  the  sympathetic  nerve. 

In  ordinary  yawning,  which  is  exactly  a  modified  form  of  respiration, 
the  Mind  may  have  but  little  or  no  participation  in  the  act,  but  it  may 
depend  alone  upon  a  physical  impression  transmitted  from  the  lungs  to 
the  nervous  centres,  along,  perhaps,  with  a  concurring  sense  of  uneasi- 
ness propagated  from  the  voluntary  muscles ;  or,  if  the  Mind  participate, 
as  in  its  efforts  to  relieve  a  sense  of  weariness,  the  physical  and  mental 
causes  act  in  co-operation,  just  as  happens  in  severe  cases  of  asthma. 
At  other  times,  a  very  different  chain  of  causation  may  be  observed,  and 
where,  also,  the  mental  and  physical  causes  appear  to  identify  them- 
selves, as  it  were,  with  each  other,  as  in  sympathetic  yawning,  where  one 
yawns  on  seeing  or  hearing  another  yawn,  or  in  talking  about  it;  for, 
in  one  case,  an  irritation  is  propagated  both  to  the  brain  and  Mind 
through  the  optic  nerve,  and  in  the  other  case  through  the  auditory 
nerve,  and  simultaneously  the  Mind  conspires  with  the  physical  irrita- 
tions in  exciting  the  nervous  influence,  and  directing  it  upon  the  muscles 
of  respiration.  But  a  paroxysm  of  yawning  may  be  readily  consequent 
upon  simply  thinking  about  it,  as  will  probably  be  the  case  with  many  on 
reading  this  statement ;  when  the  reader  will,  doubtless,  feel  quite  assured 
that  his  mind  is  as  exclusively  the  cause  in  this  instance,  as  the  physical 
irritation  commonly  is  in  ordinai'y  yawning. 

Just  so,  too,  in  respect  to  offensive  odours,  when  they  produce  vomit- 


The  Soul. — APPENDIX. — Instinct.  889 

iiig  instead  oi  syncope.  In  the  former  case  the  Mind  may  be  more  inter- 
ested in  the  physiological  effects  than  in  the  case  of  syncope  from  analo- 
gous odours ;  since  the  odours  may  be  so  far  different  in  the  two  series 
that  disgust  is  in  operation  in  one,  but  not  in  the  other.  A  rose  may 
occasion  syncope  when  just  plucked  from  the  bush,  but  vomiting  only 
when  in  a  decaying  state.  The  Mind,  therefore,  in  the  case  of  vomiting, 
and  the  nervous  influence,  are  brought  into  simultaneous  operation  by 
the  transmitted  impression,  and  the  Mind  then  co-operates  with  the 
physical  impression  and  occasions  a  farther  development  of  the  nei'vous 
power,  and  thus  increases  the  intensity  of  that  degree  which  is  created 
by  the  physical  impression.  But  the  odours  may  produce  either  vomit- 
ing or  syncope,  as  also  purging,  by  their  own  independent  influence,  and 
in  opposition  to  all  resistance  of  the  Mind ;  or,  on  the  other  hand,  the 
Mind,  as  in  breathing,  yawning,  and  coughing,  may  be  adequate  to  the 
entire  effect,  for  it  will  produce  vomiting  by  reflecting  upon  the  former 
action  of  the  odour,  and  which  may  have  happened  years  antecedently. 
Sympathetic  vomiting,  on  seeing  or  hearing  another  vomit,  is  mostly  of 
this  nature;  but  here,  too,  as  in  the  case  of  the  odours,  the  mind  alone 
may  determine  an  act  of  vomiting  by  simply  reflecting  upon  a  disgusting 
spectacle  which  had  at  a  former  time  upset  the  stomach  (^  230-233*, 
475i   500  c-2h  514  b,  c,  I,  m,  647i,  844,  892f,  902  I,  1066). 

To  render  the  foregoing  readily  intelligible  to  the  student,  farther  ex- 
planations will  be  made.  He  has  become  sufficiently  enlightened  by  the 
demonstration  to  see  that,  in  all  the  examples,  the  Mind  is  necessarily 
a  substantive  agent,  acting  of  itself  upon  the  brain.  The  nervous  influ- 
ence which  it  develops,  in  the  cases  of  vomiting,  is  exactly  equivalent 
to  that  which  arises  from  the  action  of  an  emetic  upon  the  stomach. 
There  is,  however,  one  more  link  in  the  chain  of  causation  in  the  former 
than  the  latter  case  ;  for  when  the  Mind  is  the  exciting  cause,  the  nerv- 
ous power  is  first  projected  upon  the  raucous  coat  of  the  stomach,  where 
it  irritates  the  organ  after  the  manner  of  an  emetic.  This  irritation  is 
then  reverberated,  as  in  the  case  of  the  emetic,  upon  the  nervous  centre, 
and  thence  reflected  upon  the  abdominal  muscles,  diaphragm,  and  mus- 
cular coat  of  the  stomach,  by  which  they  are  brought  into  spasmodic 
action.  When  vomiting  is  produced  by  tickling  the  throat,  the  Mind  has 
no  connection  with  the  effects,  but  the  physiology  is  so  exactly  coinci- 
dent with  that  which  is  relative  to  the  Mnd,  that  it  goes  with  the  rest 
in  showing  how  the  Mind  is  necessarily  a  substantive,  self-acting  cause. 
The  chain  of  causation  is  the  same  here  as  In  the  case  of  the  Mind,  only 
the  flrst  development  of  the  nervous  power  is  produced  by  the  irritation 
of  the  throat  (§  233f,  500  e-k,  514  b,  c,  894-896,  902  e-^).— Note  D. 

Whenever  vomiting  springs  from  disturbance,  or  disease,  or  any  novel 
conditions  of  organs  remote  from  the  stomach  and  brain,  the  same  chain 
of  causation  obtains  as  in  irritating  the  throat ;  the  point  of  departure 
being  the  affected  part,  and  the  nerves  supplying  it  are  the  organs  of 
transmission  to  the  nervous  centres.  When  the  irritation,  in  these 
physical  cases,  is  thus  made  upon  those  centres,  it  is  exactly  equivalent 
to  the  mental  irritation  when  the  Mind  is  the  remote  cause  of  vomiting, 
and  the  subsequent  steps  in  the  process  are  exactly  the  same  in  all  the 
cases.  The  sickness  and  vomiting  which  spring  from  sailing,  whirling, 
riding,  &c.,  depend  upon  the  same  chain  of  influences.  In  these  exam- 
ples, the  remote  impressions  which  are  propagated  to  the  brain  arise,  in 
part^  from  mechanical  effects  upon  different  organs,  and  they  are,  in 


890  INSTITUTES    OF    MEDICINE. 

part,  exerted  directly  upon  the  brain  itself.  In  these  instances,  howevei*, 
the  Mind  often  participates  in  developing  the  nervous  influence,  through 
some  emotion  that  grows  out  of  the  physical  influencee  ;  as  may  be  known 
from  the  fact  that  a  strong  determination  of  the  Will  to  resist  sea-sick- 
ness will  often  prevent  its  occurrence,  especially  the  act  of  vomiting ; 
while,  on  the  other  hand,  if  one  has  made  up  his  mind  to  be  sick,  he 
will  surely  be  so,  though  in  the  midst  of  a  calm.  In  the  former  case,  the 
development  of  the  nervous  influence  by  the  motion  of  the  vessel  falls 
short  of  the  intensity  necessary  to  vomiting.  And  so  of  other  analogous 
causes  ;  and  so,  too,  when  offensive  odours,  disgusting  sights,  &c.,  operate, 
or  Avhen  memoi^  turns  them  again  upon  the  stomach.  In  all  such  cases, 
and  in  various  conditions  of  disease  (§  1067),  the  Mind,  by  resolving 
not  to  co-operate  with  the  physical  causes,  or  keeping  down  fear  and 
other  depressing  emotions,  may  often  yield  no  little  protection  to  the 
stomach.  In  this  counteracting  influence  of  the  Mind  we  have,  also, 
another  exemplification  of  its  substantive  existence  and  self-acting  nature, 
as  contrasted  with  its  co-operation  Avith  the  same  physical  causes  in 
other  cases  (p.  78,  §  167/,  note,  1067  ad). — Note  D  p.  1114. 

In  section  514,  Z,  an  example  occurs,  corresponding  with  the  foregoing, 
in  which  the  physiology  of  sneezing  is  shown  when  occasioned  by  the 
Sun's  light  impinging  upon  the  retina.  Here  the  circuit  of  nervous  in- 
fluence is  very  complex.  And  now  observe  hoAV  perfectly  the  Mind  will 
do  the  same  thing  ;  since,  by  thinking  intently  upon  a  former  paroxysm, 
the  mind  will  develop  the  nervous  influence  by  its  own  direct  action  upon 
the  brain — will  determine  that  influence  upon  the  lining  membrane  of  the 
nose,  and  give  rise  to  the  same  irritation  as  the  light  of  the  Sun,  or  as 
in  the  case  of  snuff;  when  the  subsequent  steps  become  alike  in  the  sev- 
eral examples.  The  only  apparent  difference,  so  far  as  effects  are  con- 
cerned, between  the  physical  and  mental  causes,  consists  in  the  self-acting 
nature  of  the  latter.  The  Mind,  the  nervous  influence,  and  physical 
agents  are  all  on  a  par  in  principle,  as  it  respects  their  character  of  sub- 
stantive causes  in  relation  to  effects  (§  234,  f,  475^,  647-^,  500  h-p). 

Such  are  plain  examples  among  a  multitude  of  analogous  ones.  But 
we  must  consider  others  less  obvious,  that  Materialism  may  not  oppose 
us  with  specious  problems  in  organic  philosophy.  It  may  be  asked,  for 
instance.  How  will  you  explain  the  movement  of  the  limbs  during  sleep 
upon  your  doctrine?  The  ready  answer  is,  exactly  upon  that  doctrine, 
since  the  facts  are  of  the  same  nature  with  those  already  stated.  In 
these  cases  the  act  may  be  either  voluntary  or  involuntary  ;  but,  through- 
out, it  arises  from  some  impression  made  upon  the  nervous  centres. 
Sleep  may  not  be  so  profound  as  to  suspend  entirely  the  action  of  the 
Will ;  or,  in  other  cases,  the  motion  is  owing,  remotely,  to  some  impres- 
sion propagated  from  the  limbs  to  the  nervous  centres.  These  remote 
impressions  arise  from  some  constrained  position,  or  analogous  cause, 
and  may  not  awaken  perception,  or  call  the  Will  into  exercise ;  though, 
doubtless,  in  most  cases  the  Will  is  roused  into  action.  If  involuntary, 
the  phenomenon  is  then  coincident,  both  as  to  cause  and  effect,  with  the 
motions  of  decapitated  animals,  as  when,  for  example,  a  decapitated  tur- 
tle draws  up  its  leg  on  being  pricked,  or  as  a  bird  flutters  or  runs  on 
striking  off  its  head.  Here  the  nervous  influence  proceeds,  of  course, 
from  the  spinal  cord  alone  ;  and  the  example  is  another  clear  illustration 
of  the  substantive,  self-acting  nature  of  the  Mind  (§  451,  c,  d). 

Let  us  next  suppose  that  the  Materialist  will  demand  of  us  an  expla- 


The  Soul. — APPENDIX. — InsiincL  891 

nation,  upon  our  general  facts,  of  the  influences  which  are  concerned  irf 
sleeping  in  the  erect  posture,  which  is  common  to  many  animals.  The 
physiology  of  voluntary  and  involuntary  respiration,  and  jp,rticularly  of 
the  action  of  the  constrictor  muscles,  and  the  exact  coincidences  between 
the  voluntary  and  involuntary  acts  ^n  either  case,  supply,  respectively, 
an  answer  to  the  interrogatory.  It  is  evident,  therefore,  that  in  sleeping 
in  the  erect  posture,  the  muscles  are  placed  by  the  Will  in  a  state  of 
tension  which  determines  upon  them  an  unceasing  nervous  influence  af- 
ter the  action  of  the  Will  is  suspended,  and  in  a  manner  analogous  to 
that  which  holds  the  sphincter  muscles  in  a  state  of  permanent  contrac- 
tion (§  514  ^,  516  d,  No.  G,  §  902  k).  Indeed,  there  is  always,  as  in  the 
case  of  the  latter,  a  certain  degree  of  involuntary  nervous  influence  oper- 
ating upon  the  voluntary  muscles,  by  which  their  antagonism  is  balanced. 
This  is  shown  by  the  division  of  nerves,  as  when  those  of  one  side  of 
the  face  are  divided,  or  paralyzed,  the  muscles  lose  their  relation  to  those 
of  the  opposite  side.     Another  example  occurs  in  the  wry-neck. 

The  same  explanation  is  applicable  to  the  contracted  leg  of  the  bird, 
in  roosting.*  The  whole  principle,  in  all  its  variety  of  manifestations, 
according  to  the  nature  of  the  animal  and  the  uses  of  parts,  has  its  foun- 
dation in  consummate  Design.  The  modifications  in  diiferent  species  of 
animals  correspond  with  those  of  Instinct,  and  are  full  of  instruction  to 
the  contemplative  mind.  Their  final  cause  belongs  to  the  same  inscru- 
table system  of  Designs  as  the  varieties  in  Instinct  itself;  and,  if  we 
may  not  trace  out  the  exuct  mechanism,  or  the  remote  causes  in  all  the 
cases,  there  are  a  multitude  of  analogous  facts  which  have  been  clearly 
ascertained,  and  which  as  clearly  interpret  the  less  demonstrable  prob- 
lems to  every  right  thinking  mind  (§  234,  a-h).  The  route  of  the  nerv- 
ous influence  among  the  organic  viscera,  and  even  among  the  voluntary 
muscles,  is  often  eluding  the  knife  of  the  anatomist  (§  233|) ;  and  well 
may  he  sometimes  despair  of  success,  yet  rest  in  the  conviction  that  Na- 
ture operates  by  general  laws,  when  he  considers  the  fact  that  the  Will 
determines  its  influence  upon  whatever  voluntary  part  it  chooses,  isolat- 
ing many  intermediate  nerves,  or  electing  one  only  and  far  remote  from 
its  own  seat  of  operation.  And  so  he  shall  equally  find  it  in  organic 
life,  where  the  Passions  play  their  part,  at  one  moment  upon  the  heart, 
at  another  upon  the  skin,  or  kidneys,  or  genital  organs,  or  raise  the  blush 
of  modesty  in  the  capillaries  of  the  face,  or  strike  us  dead  in  an  instant ; 
and  he  may  witness  far  greater  demonstrations  of  the  same  principle  in 
the  operation  of  remedial  agents  (§  852-888,  894-905). — Note  A. 

We  draw  to  a  close.  If  the  discussion  have  been  proti-acted,  it  has 
been  due  to  the  magnitude  and  the  novelty  of  the  subject.  We  might 
have  rested  the  demonstration  upon  the  operations  of  the  Mind  in  its 
function  of  willing  alone,  were  there  a  ready  acquiescence  in  the  logic  of 
facts.  Through  these  endless  manifestations  we  almost  see  the  Thinking 
Being  enthroned  upon  the  great  centre  of  the  nervous  system,  wielding 
at  its  inexpressible  pleasure,  and  through  the  instrumentality  of  its  or- 
gan, that  amazing  power  which  as  far  surpasses  electricity  in  the  com- 
pass and  variety  of  phenomena,  as  the  effulgence  of  Reason  transcends 
the  glimmerings  of  Instinct.  The  Will  but  commands  (§  1072,  b),  and 
Reason  may  be  chained  for  hours  to  some  abstract  process,  or  tumultu- 
ous passion  settles  down  in  tranquil  submission.  With  inconceivable 
rapidity  of  action  it  directs  all  the  muscular  movements  which  form  the 
various  feats  of  dexterity,  the  flight  of  animals,  and  the  melody  of  song. 
*  See  §  500  dd,  and  Article  Roosting,  Index  II. 


892  INSTITUTES    OF    MEDICINE. 

^nd  let  us  consider,  also,  as  we  ponder  upon  these  things,  how  exactly 
the  mind  graduates  the  force  of  every  muscle  which  it  brings  into  action, 
varying  through  every  imaginable  degree  from  the  slightest  touch  to  the 
death-struggle  of  the  combatant  (§  234  c-h,  235). 

Who,  then,  shall  be  so  unjust  to  his  Keason  as  to  imagine  that  all  this 
wonderful  display  of  a  single  function  of  the  Mind  is  the  material  prod- 
uct of  chemical  mutations  of  the  brain,  or  of  any  organic  function  of 
that  organ,  and  without  a  conceivable  cause  of  the  cerebral  process ! 

DEMONSTRATIOK    OF    INSTINCT,  AND    ITS   DISTINCTION    FROM   THE    SOUL.* 

§  1078,  a.  In  what  I  have  said  in  the  former  part  of  this  work  of  the 
distinct  nature  of  the  Soul  and  Instinctive  Principle,  and  of  their  connec- 
tion with  the  main  central  part  of  the  nervous  system,  my  remarks  have 
referred  to  their  immediate  relations  to  the  body,  as  established  through 
the  cerebro-spinal  and  ganglionic  systems  (§  234/,  241,  500,  &c.).  At 
section  500,  p,  the  deductions  are  made  from  a  variety  of  facts,  though 
not  altogether  susceptible  of  direct  proof.  They  involve  a  critical  anal- 
ysis of  the  various  phenomena  of  which  they  are  predicated,  both  in  their 
relations  to  Reason  and  to  the  mere  Principle  of  Instinct.  But,  however 
some  acts  of  intellection  in  man  may  require  the  co-operation  of  the 
brain  more  than  other  mental  processes,  thei-e  can  be  no  doubt  that  every 
act  of  the  Mind  and  of  Instinct  is  the  result  of  an  inscrutable  concur- 
rence between  the  self-acting  cause  and  the  organ  over  which  it  presides. 
It  may  be  now  said,  also,  that  the  brain  is  subservient  to  the  Soul,  inde- 
pendently of  its  relations  to  the  body,  in  all  its  higher  functions,  while  it 
manifests  no  such  subserviency  in  animals ;  nor  have  I  any  doubt  that 
all  the  facts  warrant  the  conclusion  that  the  nervous  power  is  as  well 
concerned  in  the  functions  of  the  higher  faculties  as  it  demonstrably  is 
in  the  acts  of  the  Will  and  the  Passions.  The  instrumentality  of  the 
brain  in  the  former  case  comes  through  the  property  of  the  Soul  which 
is  known  as  j^crception,  and  to  which  the  senses  are  subordinate.  The 
same  property  belongs,  also,  to  animals ;  and  so  far  as  mere  sensation  is 
concerned,  or  as  it  may  give  rise  to  volition  in  its  simple  relation  to  ani- 
mal life,  the  results  are  apparently  the  same  in  man  and  animals.  But 
it  goes  no  farther  in  animals,  though  in  man  Perception,  as  resulting  from 
sensation,  is  the  great  fulcrum  of  Reason,  and  the  fountain  of  intellectual 
knowledge.  But  that  knowledge  garnered  up,  every  avenue  to  the  Mind 
may  be  shut,  and  the  harvest  of  facts  remains,  and  may  be  now  multi- 
plied, cultivated,  embellished  by  the  exercise  of  Reason  alone  upon  the 
organ  through  which  the  elementary  knowledge  had  come.  It  may  now 
summon  a  host  of  intellectual  images,  and  render  them  tributary  to  those 
abstruse  processes  by  which  the  laws  of  the  Universe  are  scanned,  and 
Mind  itself  analyzed  and  understood.  This  is  abundantly  manifested  in 
the  early  displays  of  genius,  where  knowledge  from  external  sources  is 
just  in  its  dawn.     It  is  fatal  to  the  doctrine  of  cerebral  images. 

But  no  such  phenomena  ever  marked  the  highest  cultivation  of  Instinct. 
It  is  all  Instinct  with  animals,  while  this  Principle  is  only  feebly  shadowed 
forth  in  man  (§  241).  And  this  leads  me  to  indicate  the  most  fundamental 
distinction,  in  a  physiological  sense,  between  the  Soul  of  man  and  the 
Instinct  of  animals ;  nor  am  I  aware  of  any  well-founded  exception  to 
the  distinction  which  I  make.  Among  the  latter,  the  whole  sum  of  in- 
stinctive processes  is  limited  exclusively  to  the  ivants  and  the  uses  of  the  bodjj. 
Whatever  may  be  the  fundamental  cause,  it  is  in  complete  operation  at 

*  See  Note  at  p.  873. 


The  /Soul. — ^APPENDIX. — Instinct.  893 

the  moment  of  birth,  when  its  dawning  has  scarcely  begun  in  the  human 
race  (§  241,  c).  It  is  as  perfect  and  comprehensive  in  the  Ant  as  in  the 
Chimpanzee.  Each  species  of  animal,  and  all  the  individuals  respectively, 
carry  out  an  ordained  plan  of  existence,  and  this  is  the  compass  of  their 
knowledge.  From  that  particular  path  Instinct  never  diverges.  It  has 
no  higher  aim  in  the  brute  than  the  mere  perpetuity  of  organic  life,  and 
it  never  operates  without  manifesting  effects,  either  active  or  passive,  in 
t/ie  mechanism  of  animal  life.  That  is  its  grand  characteristic,  and  its 
broadest  contradistinction  from  the  Mind  of  man.  It  terminates  there  ; 
and  Reason,  therefore,  must  prompt  the  conclusion  that  the  Instinctive 
Principle  perishes  with  the  body.  But  how  different  with  the  Soul, 
which  spans  the  sciences,  rolls  up  its  vast  acquisitions  through  all  gener- 
ations, and  sees  in  itself  the  "Image  of  God."  All  its  noblest  functions 
have  no  relation  whatever  to  the  uses  of  the  body.  The  untutored  Savage 
has  all  the  perfection  of  life  that  is  enjoyed  by  a  Newton,  and  greater 
instinct.  He  may  become  a  Newton  without  a  gain  to  his  physical 
wants,  but  with  some  loss  of  his  well-disciplined  instinct.  Here,  in  the 
exercise  of  Reason,  all  physiological  analogies  fail,  while  every  impulse 
of  Instinct  demonstrates  its  subordination  to  physiological  laws.  When 
Reason  operates,  there  is  no  participation  of  the  nerves,  as  in  the  case 
of  Instinct,  no  influences  seen  upon  any  part  of  the  organism.  We  look 
upon  its  manifestations  as  emanating  apparently  from  itself  alone.  And 
since  there  is  nothing  in  the  manifestations  of  the  Will  when  it  operates 
alone  in  the  processes  of  Reason  that  denotes  any  influence  upon  the 
animal  mechanism,  as  is  always  the  case  in  animals,  and  since,  also, 
that  influence  is  strongly  displayed  in  man  Avhen  the  action  of  the  Will 
refers  to  the  organs  of  volition,  this  distinction  between  its  intellectual 
and  physical  functions  corresponds  exactly  with  my  inductions  in  regard 
to  the  general  constitution  of  the  Soul,  and  the  relation  which  it  bears 
in  other  aspects  to  the  body.  Hence,  we  may  again  conclude  incident- 
ally that,  by  parity  of  reason  as  it  respects  the  uses  of  Instinct,  the  Soul, 
which  in  its  highest  faculties  is  useless  to  the  body,  will  continue  to 
exist  without  the  aid  of  organic  life.  And,  if  I  may  deviate,  for  a  mo- 
ment, from  my  physiological  ground,  to  final  causes  of  a  moral  nature, 
I  would  refer  to  the  manifest  design  of  animals  for  the  husaan  race,  as 
a  farther  proof  of  their  absolute  extinction  when  those  ends  are  fulfilled ; 
and,  on  the  other  hand,  to  the  noble  and  sublime  objects  of  man  in  his 
no  less  obvious  companionship  with  God,  as  equally  conclusive  of  the 
perpetuity  of  his  being. 

Nevertheless,  the  analogies  between  the  Soul  and  the  Principle  of  In- 
stinct are  such  (§241,  b),  that  if  one  be  a  distinct,  substantive,  self-acting 
agent,  so  must  be  the  other.  But  their  great  practical  final  causes,  inde- 
pendently of  our  other  facts,  are  broad,  fundamental  distinctions  between 
them ;  nor  have  these  distinctions,  within  my  knowledge,  been  hitherto 
indicated.  It  is  only,  however,  a  display  of  the  common  law  of  analogies 
which  prevails  throughout  organic  nature.  The  coincidences  and  distinc- 
tion between  Reason  and  Instinct  are  far  less  remarkable  than  the  cor- 
responding analogies  and  distinctions  which  are  supplied  by  organic  life 
in  its  greatest  extremes ;  for  there  is  not  a  single  organic  function  of  a 
comprehensive  nature  performed  by  man  that  is  not  equally  so  by  the 
lowest  plant.  With  greater  reason,  therefore,  should  we  argue  the  iden- 
tity of  Man  and  Plants  than  of  the  Soul  and  Instinct*  (See  JVoie  p.  873). 

*  As  an  example  of  the  assumptions  and  sophistrj-  of  those  who  reject  the  Soul,  take 


894  INSTITUTES    OF    MEDICINE. 

§  1078,  h.  I  am  finally  conducted  to  other  and  still  more  definite  con- 
tradistinctions between  the  Soul  and  the  Instinctive  Principle,  and  where 
it  Avill  probably  appear,  also,  that  the  brain  co-operates  less  in  the  higher 
acts  of  intellection  than  has  been  commonly  supposed.  But  the  Mind, 
in  all  its  functions,  is  not  only  more  or  less  dependent  upon  its  associate 
organ,  but  the  influences  which  it  is  capable  of  exerting  upon  it  in  con- 
sequence, and  thence  upon  the  whole  organism,  are  among  the  facts 
which  foi'm  a  broad  distinction  between  the  Soul  and  the  Instinctive 
Principle.  Nor  can  it  be  doubted  that  the  full  exercise  of  the  Mental 
Faculties,  as  well  as  of  Instinct,  requires,  in  a  general  sense,  a  natural 
condition  of  the  brain  or  its  equivalent ;  and  the  greatest  displays  of  the 
former  are  apt  to  be  seen  where  the  organ  is  developed  beyond  the  com- 
mon standard.  To  these  general  facts,  however,  there  are  important 
exceptions,  several  examples  of  which,  as  arising  from  organic  disease 
and  injuries,  may  be  seen  in  Medical  and  Physiological  Commentaries,  vol.  ii., 
p.  139,  note.  Equally  true  is  it,  also,  that,  from  the  co-operation  of  the 
Soul  and  the  brain  in  the  processes  of  Reason,  excessive  exercise  of  the 
Mind  is  felt  injuriously  in  the  organs  of  organic  life,  and  too  often  per- 
manently felt.  The  proper  development  of  the  brain  is,  also,  arrested ; 
and  thus,  in  its  turn,  the  Mind  suffers  a  corresponding  injury.  Our  gen- 
eral premises  lead  to  this  conclusion,  and  our  primary  schools  confirm 
the  principle  in  a  lamentable  amount  of  broken  constitutions  and  smoth- 
ered intellect.  This,  too,  is  one  of  our  evidences  of  the  substantive,  self- 
acting  nature  of  the  Soul ;  and  although  the  Instinctive  Principle  is 
equally  self-acting,  we  here  come  upon  the  remarkable  distinction  that 
nothing  like  the  foregoing  has  ever  been  witnessed  from  the  severest  dis- 
cipline of  Instinct.  The  Soul  alone  supplies  these  phenomena ;  and,  from 
its  incessant  operation  in  undermining  health,  or  disturbing  the  natural 
action  of  the  organic  viscera,  it  must  be  regarded  as  separating  the  Soul 
and  Instinct  widely  from  each  other. — Note  Hh  p.  1138. 

And  this  leads  us  to  observe  another  and  greater  distinction  ;  for, 
while  the  development  of  the  Mental  Faculties  is  retarded  by  overtask- 
ing the  Mind  in  early  life,  just  the  contrary  effect  obtains  in  animals. 
By  untiring  zeal,  and  the  lash  of  instruction,  Instinct  is  often  suscepti- 
ble of  influences  in  the  infancy  of  animals,  and  only  then;  but  here,  again, 
it  is  just  the  reverse  with  Reason  in  the  infancy  of  man.  This  distinc- 
tion is  also  of  a  radical  nature  when  compared  with  the  improvements 
of  Reason  at  later  periods  of  life ;  for  what  has  been  supposed  to  be  a 

the  following,  from  the  '''■Lectures  on  Physiology,'^  bj'  the  able  and  eminent  Mr.  Law- 
rence : 

"If  the  intellectual  phenomena  of  man  require  an  immaterial  principle  superadded 
to  the  brain,  we  must  equallj'  concede  it  to  those  more  rational  animals  which  exhibit 
manifestations  differing  from  some  of  the  human  famih'  onh'  in  degree.  If  we  grant  it 
to  these,  we  cannot  refuse  it  to  the  next  in  order,  and  "so  on  in  succession  to  the  whole 
series — to  the  oj'ster,  the  sea-anemone,  the  polypi,  the  microscopic  animalcules.  Is  any 
one  prepared  to  admit  the  existence  of  immaterial  principles  in  all  these  cases?  If  not, 
he  must  cquallj'  reject  it  in  man." 

This  argument  is  often  staring  us  in  the  face,  and  it  is  quite  time  that  it  should  be 
silenced,  although  "prepared  to  admit  the  existence  of  immaterial  principles  in  all  the 
cases."  But,  waiving  the  assumptions  upon  which  the  conclusions  are  founded,  it  is  evi- 
dent that  the  analog}'  fails  as  soon  as  we  reach  those  animals  which  exhibit  no  rational 
manifestations.  So  Ihe  argument  falls  upon  its  own  ground.  Nor  is  that  all ;  for,  as  in 
most  cases  where  an  author  is  at  fault  about  principles,  Mr.  Lawrence  contradicts  him- 
self.   Thus,  in  another  place  he  sa^-s  that 

"Although  the  external  senses  of  brute  animals  are  not  inferior  to  our  own,  and  though 
we  should  allow  some  of  them  to  possess  a  faint  datcning  of  comparison,  reflection,  and 
judgment,  it  is  certain  that  they  are  unable  to  form  that  association  of  ideas  in  which  alone 
the  essence  of  thought  consists." 


The .  Soul. — ^APPENDIX. — Instinct.  895 

"  cultivation  of  Instinct"  is,  in  reality,  no  such  thing,  since  it  subserves 
no  useful  purpose,  and  manifests  itself  only  under  the  special  influences, 
respectively,  by  which  the  several  impressions  were  originally  produced. 
The  "  tricks,"  &c.,  of  the  animal,  whenever  there  is  a  deviation  from  the 
natural  operation  of  Instinct,  require  suggestions  from  the  associate  causes. 
Unlike  the  improvements  of  the  Rational  Faculty,  the  artificial  conditions 
of  Instinct  do  not  operate  without  the  excitements  of  the  primary  causes, 
or  their  equivalents,  and  then  always  in  exact  conformity  with  the  nature 
of  the  external  cause.  In  other  words  (for  the  distinction  is  important). 
Reason  acts  independently  of  remote  causes ;  the  artificial  conditions  of 
Instinct  require  the  agency  of  such  causes  to  bring  them  into  renewed 
manifestations.  In  the  former  case  the  senses  may  not  be  interested ;  in 
the  latter,  impressions  must  always  be  made  upon  sense  (as  in  seeing  and 
hearing),  and  transmitted  to  the  brain,  or  some  equivalent  nervous  cen- 
tre, when  Instinct  will  operate  in  an  automatic  manner.*  It  is  only  a 
display  of  those  low  analogies  between  Instinct  and  the  Soul  to  which  I 
have  referred.  Imitation,  in  a  higher  sense,  as  seen  in  parrot-talking, 
belongs  to  the  same  principle.  But  in  these  cases  it  is  more  constitu- 
tional, on  account  of  the  natural  prating  of  the  bird.  It  thus  becomes 
ingrafted  upon  its  notes,  and  will  therefore  display  itself  as  an  offspring 
of  nature,  and  as  a  matter  of  habit,  and  without  any  extraneous  prompt- 
ing. What  is  thus  acquired  from  man  by  the  parrot  and  magpie,  and 
which  has  been  supposed,  even  by  Mr.  Locke,  to  evince  a  Rational  Fac- 
ulty, is  derived  by  other  birds  from  other  songsters,  particularly  by  the 
American  mocking-bird  and  cat-bird,  who  appropi-iate  the  notes  of  many 
other  warblers.  Now,  there  is  nothing  more  in  parrot-talking  than  in 
these  last  examples,  and  the  latter  is  just  as  much  an  evidence  of  a 
rational  faculty  as  the  former.  The  examples  go  towards  the  illustra- 
tion of  our  subject  in  showing  how  Instinct  is  adapted  to  the  peculiari- 
ties of  organization  in  different  animals,  while  man,  through  his  Rational 
Faculties,  may  originate  an  endless  variety  of  vocal  music,  and  construct 
languages  for  himself  (§  241,  b). 

§  1078,  c.  Even  the  promptings  of  Instinct,  which  impel  animals  to 
search  after  food,  whether  for  present  or  future  use,  have  their  origin  in 
present  sensations.  What  is  prospective  in  this  respect  is  just  as  impul- 
sive as  migration,  and  as  little  allied  to  the  course  of  Reason.  The 
same  physiological  influences  of  hunger,  in  regard  to  immediate  wants, 
operate  in  the  infiincy  of  man,  though  with  none  of  that  discrimination 
which  distinguishes  the  infant  animal ;  for  the  human  infant  will  as 
readily  suck  at  all  things  else  as  at  the  breast.  Its  apparent  instinctive 
impulses  go  no  farther  than  the  movement  of  the  mouth  ;  and  that  is  all 
the  display  of  instinct  it  evinces,  unless  farther  shown  by  its  cries  Avhen 
hunger  is  unappeased. 

Again  :  as  soon  as  Reason  obtains  its  development,  it  displays  an  end- 
less variety  of  inventions  for  the  sustenance  of  life,  which  are  wholly  irre- 
spective of  associations  with  the  original  physiological  incitements,  but 
which  must'be  forever  a  recurring  cause  to  the  animal.  Whatever  simili- 
tude may  seem  to  exist  between  the  acts  of  Reason  and  the  acts  of  In- 
stinct in  procuring  food,  or  in  providing  for  the  future,  organic  influ- 
ences are  interested  in  the  latter  as  often  as  hunger  returns ;  and,  so  far 
as  the  processes  are  dependent  in  animals  upon  the  inscrutable  constitu- 
tion of  Instinct,  they  are  contradistinguished  from  all  the  analogous  man- 
ifestations in  man  by  their  undeviating  uniformity  in  animals,  and  ac- 

*  Rare5''s  sj'stem  of  horse -taming  is  a  comprehensive  illustration  of  the  principle.  All 
horses  j'ield  at  once,  and  alike,  to  the  foot-strap,  as  would  a  machine. — 1861. 


896  INSTITUTES    OF    MEDICINE. 

cording,  also,  to  the  species  of  animals,  while,  also,  all  the  individuals  of 
a  species  pursue  a  common  and  uniform  way.  Thus,  many  species  lay 
wait  to  entrap  their  food,  and  although  variously  according  to  the  na- 
ture of  the  species,  all  the  individuals  of  a  species  act  exactly  in  a  certain 
way,  while  others  pursue  a  different  course,  and  neither  takes  forecast  be- 
yond the  present  sensation  of  hunger ;  while  in  some  species  which  sub- 
sist on  vegetable  food,  the  principle  operates  seemingly  after  the  sagacious 
manner  of  Reason  in  providing  for  their  future  wants. 

§  1078,  d.  And  here  we  come  upon  another,  and  very  broad  distinc- 
tion between  the  Soul  and  Instinctive  Principle ;  for,  as  admitted  by  all, 
the  greater  the  development  of  the  brain  in  man,  so,  in  a  general  sense, 
are  the  manifestations  of  Eeason,  and  therefore  a  forecast  in  animals 
in  laying  up  food,  if  at  all  allied  to  Reason,  should  predominate  in  those 
which  have  the  greatest  amount  of  brain ;  and  here,  if  in  any  respect, 
there  should  be  the  greatest  display  of  Reason.  But  it  is  just  otherwise 
with  all  the  superior  animals,  who  take  no  thought  for  the  morrow,  what 
they  shall  eat ;  while  in  the  bee  and  ant,  where  there  are  only  ganglia 
for  the  nervous  centres,  there  is  an  anticipation  of  the  future  in  providing 
for  the  young  which  surpasses  any  thing  known  of  the  human  race. 
What  variety,  too,  in  the  structures  which  they  rear  for  their  progeny, 
according  to  the  particular  species  in  each  genus,  but  always  the  same 
with  each  species.  And  then  the  food — just  as  methodically  of  a  precise 
kind  as  the  act  of  providing  it.  The  whole  history  of  the  instinctive  acts 
of  the  elephant  or  the  lion  may  be  written  in  an  hour ;  but  Huber  found 
a  good-sized  book  necessary  for  the  amazing  operations  of  the  common 
honey-bee.  He  described  the  doings  of  a  hive,  and  that  description  tells 
the  precise  history  of  all  past  and  of  all  future  hives.  The  diversified 
acts  of  this  insect,  and  according  as  it  may  be  queen,  male,  or  drone,  seem 
like  the  complex  movements  of  some  elaborate  machinery,  which,  when 
wound  up,  runs  on  in  one  precise  way  till  it  runs  down.  And  still  more 
estranged  from  Reason,  and  utterly  beyond  its  grasp,  is  the  return  of  the 
bee  to  its  hive  through  miles  of  trackless  air,  and  the  unerring  flight 
of  the  carrier  pigeon  ;  nor  are  any  of  the  higher  animals  capable  of  this 
amazing  achievement,  which,  also,  grows  immediately  out  of  the  physio- 
logical arrangements  for  acquiring  food. 

§  1078,  e.  The  correspondence  between  the  peculiarities  of  Instinct 
and  the  mechanism  in  animal  and  organic  life  is  so  remarkably  full  and 
pex'fect  in  its  design,  and  so  unlike  any  of  the  manifestations  of  the  Hu- 
man Mind  in  their  connection  with  the  organs  and  functions  of  either 
division  of  life,  that  a  glance  at  the  former  will  contribute  farther  aid  in 
distinguishing  the  Soul  from  the  Instinctive  Principle,  and  in  proving 
the  absolute  existence  of  Instinct  as  a  distinct  essence  of  the  brute  crea- 
tion. If  we  may  any  where  detect  the  Rational  Faculty  among  ani- 
mals, it  should  be  found  in  the  phenomena  that  are  relative  to  their 
means  and  modes  of  subsistence. 

Now  it  will  be  found  that,  in  eveiy  species  of  animal,  the  promptings, 
of  Instinct  in  the  pursuit  of  food  have  a  direct  relation  to  the  peculiari- 
ties that  exist  in  the  organization  of  the  stomach,  and  the  modifications 
of  the  special  endowments  of  the  gastric  juice  in  each  of  the  species  (as 
set  forth  in  section  353),  by  which  one  species  is  enabled  to  convert  flesh, 
another  nuts,  another  hay,  &c.,  into  one  homogeneous  substance  called 
chyme,  and  which,  from  man  to  the  lowest  tribes  of  warm-blooded  ani- 
mals, at  least,  is  apparently  alike  in  all,  whatever  the  nature  and  the 


The  Soul. — APPENDIX. — Instinct.  897 

variety  of  the  food.  But  the  agreement  between  man  and  animals  is 
limited  to  that  result  in  its  connection  with  the  digestive  apparatus,  and 
as  it  relates  to  the  maintenance  of  organic  life.  What  is  true  of  the 
precise  adaptations  of  Instinct  to  the  organic  conditions,  and  its  invaria- 
ble operation  in  one  way,  according  to  the  nature  of  the  animal,  is  in  no 
way  true  of  the  Human  Mind ;  for  the  latter  operates,  in  this  respect, 
according  to  acts  which  involve  the  exercise  of  judgment,  reflection,  com- 
parison, t&c,  and  very  variously,  also,  according  to  individual  suggestions 
of  Reason,  Passion,  love  of  sensual  gratifications,  the  exigencies  of  dis- 
ease, &c. 

Since,  therefore.  Instinct  has  its  special  constitution  conforming  to  the 
organization  of  the  stomach  and  the  peculiarities  of  the  gastric  juice,  we 
shall  see  how  far  it  is  related  in  its  peculiarities  to  other  varieties  in  the 
mechanism  of  organic  life,  by  considering  how  all  these  varieties  in  every 
species,  respectively,  have  an  equally  direct  reference  as  the  peculiarities 
of  Instinct,  to  the  special  organization  of  the  stomach,  and  special  con- 
stitution of  the  gastx'ic  juice.  If,  therefore,  such  be  the  relation  of  the 
whole  mechanism  of  animals,  both  organic  and  animal,  to  the  special 
condition  of  the  stomach  and  gastric  juice  in  their  adaptations  to  the 
varieties  of  food  in  the  several  species,  it  is  obvious  that  Instinct  in  all 
the  species,  respectively,  must  be  constituted  with  a  corresponding  refer- 
ence to  every  part  of  the  organic  whole.  Now,  an  intestine,  claw,  hoof, 
tooth,  or  any  bone  of  an  unknown  animal  being  given,  we  may  construct 
a  skeleton,  say  from  the  bone,  that  shall  be  true  to  nature  in  all  its  parts. 
We  may  thus  proceed  to  cover  it  with  muscles,  provide  it  with  claws  or 
hoofs,  and  special  kinds  of  teeth,  «&;c.,  and,  lastly,  we  can  tell  from  that 
tooth,  or  claw,  or  hoof,  or  other  bone,  what  was  the  structure  of  the  di- 
gestive apparatus,  and  to  what  kind  of  food  the  gastric  juice  was  specif- 
ically adapted,  and  what  were  the  peculiar  Instinct  and  habits  of  the 
animal ;  so  special  is  the  adaptation  of  all  other  parts  of  the  organism, 
both  in  animal  and  organic  life,  to  the  peculiarities  of  the  stomach  in 
every  species,  and  so  exactly  conformable  are  the  Instincts  and  habits  of 
animals  to  all  that  vast  range  of  physical  peculiarities  in  the  several 
species  respectively. 

The  foregoing  is  also  true  of  man  as  it  relates  to  organization.  But 
who  could  surmise  from  any  part,  or  from  the  whole  of  his  organism, 
that  he  is  endowed  with  Rational  Faculties,  or  with  any  thing  more 
than  what  is  common  to  brute  animals  ?  Here  begins,  abruptly,  a  total 
distinction  between  man  and  animals — nothing  whatever  in  the  mechan- 
ism of  either  to  denote  the  ending  of  one  or  the  beginning  of  the  other. 
Nothing,  indeed,  but  analogy,  founded  upon  observation,  enables  us  to 
affirm  with  certainty  the  same  principles  of  extinct  species  of  animals. 
Nothing  but  observation  informs  us  of  either  the  physical  or  mental  func- 
tions ;  for  neither  could  have  been  deduced  from  structure  alone.  And 
yet  analogy  is  so  perfect  a  guide  where  the  continuity  of  the  chain  is 
unbroken,  that  no  error  can  arise  in  scanning  the  Designs  of  Infinite 
Wisdom,  so  far  as  they  are  submitted  to  human  inquiry.  But  analogy 
in  relation  to  Instinct  snaps  in  man.  This  might  render  it  difficult,  if 
not  impossible,  to  know  the  great  fact,  had  all  the  species  of  quadruma- 
nous  animals  become  extinct  before  man  began  his  observations  in  nat- 
ural history.  The  subsequent  discovery  of  the  skeleton  of  a  chimpanzee 
would  doubtless  have  been  regarded  as  an  unanswerable  proof  that  there 
had  been,  at  least,  other  beings  upon  earth  besides  the  human  race  who 

L  L  L 


898  INSTITUTES    OF    MEDICINE. 

had  enjoyed  the  prerogatives  of  Reason,  and  so  a  descending  analogy 
imagined  down  to  the  polypi.*  But,  the  chimpanzee  is  a  thousand  times 
less  endowed  with  Instinct  than  the  honey-bee ;  and  we  have  seen  that 
the  sense  of  instinctive  promptings  throughout  all  animal  tribes  is  con- 
cerned about  objects  which  Reason  regards  as  only  tributary  to  those 
immeasurably  higher  occupations  of  the  Soul  which  have  no  relation 
whatever  to  those  of  the  Instinctive  Principle. — Note  Pp  p.  1142. 

§  1078,/.  However  the  foregoing  branch  of  our  inquiry  (§  1078,  e) 
may  be  pursued,  it  will  always  result  in  the  same  uniform  way.  Con- 
sider, for  example,  the  correspondence  between  the  Instincts  of  animals 
and  their  weapons  of  offence  and  defence ;  each  species  of  animals,  and 
all  the  individuals  of  a  species,  acting  defensively  or  offensively  accord- 
ing to  the  special  weapons  with  which  they  are  provided.  These  means 
of  preservation  have  a  direct  reference  to  organic  life,  and  Instinct,  there- 
fore, is  adapted  to  the  nature  of  the  means.  The  various  provisions  are 
not  only  such  as  are  actively  employed,  both  for  the  purpose  of  procuring 
food  and  for  self-preservation,  like  the  weapon  of  the  sword-fish,  claws, 
the  poison  of  serpents,  &c.,  but  others  for  the  simple  object  of  self-pro- 
tection, such  as  horns,  the  quills  of  the  porcupine,  the  armour  of  the 
rhinoceros,  the  sting  of  bees,  the  galvanism  of  the  electrical  eel,  the  ink 
of  the  cuttle-fish,  &c.  Again,  certain  animals,  and  many  of  them  of 
inferior  orders,  as  some  species  of  cockroaches,  some  of  worms,  often  af- 
fect the  appearance  of  death  when  closely  pursued ;  and  when  this  is 
seen  in  one  animal,  it  is,  as  in  the  preceding  cases,  common  to  all  the 
individuals  of  the  species.  Many  other  animals  that  keep  near  the 
ground  are  protected  by  their  colour,  and  the  animal,  when  alarmed,  lies 
close.  In  all  the  cases  there  is  a  manifest  unity  of  designs  which  con- 
spire together  for  the  well-being  of  organic  life.  "Whatever  may  be  the 
means  of  defence,  of  offence,  of  flight,  or  of  whatever  variety  or  modifi- 
cation, they  are  adapted  to  all  the  mechanism  in  animal  life,  to  special 
sensation,  &c.,  and  according  to  the  whole  will  be  the  special  prompt- 
ings of  Instinct. — Note  C  p.  1113. 

§  1078,  g.  Fear,  therefore,  operates  in  animals  impulsively,  while  in 
man  it  is  the  result  of  judgment,  reflection,  comparison,  and  his  modes 
of  defence  are  suggested  accordingly.  Observe,  also,  another  fact  rela- 
tive to  fear,  which  equally  separates  Instinct  from  the  Soul.  The  young 
animal  will  turn  from  danger  about  as  impulsively  as  the  adult,  while 
the  human  infant  will  thrust  its  hand  into  the  blaze  of  a  candle  sooner 
than  it  will  seize  the  nourishment  that  is  simultaneously  offered.  In  ani- 
mals, indeed,  the  most  exquisite  sensitiveness  to  danger  prevails,  transcend- 
ing even  the  promptings  of  hunger.  Its  predominance  is  designed  alone 
for  the  preservation  of  organic  life,  and  such  are  their  exposures,  and  so 
limited  their  conceptions,  that  it  is  made  to  operate  with  great  uniform- 
ity and  instantaneousness.  In  man,  on  the  contrary,  its  impulses  are 
comparatively  feeble  and  slow,  and  so  far  as  it  obtains,  it  aims  at  a  va- 
riety of  objects  which  are  determined  by  the  decisions  of  Reason.  The 
principle,  in  animals,  is  evidently  allied  to  that  characteristic  Avhich  di- 
rects their  migrations,  and  the  homeward  flight  of  the  bee. 

The  manifest  dependence,  in  man,  of  a  sense  of  danger,  and  his  expe- 
dients for  self- protect! on,  upon  the  Rational  Faculties,  has  led  to  compar- 
isons of  certain  Instinctive  perceptions  of  danger  in  animals,  with  a  view 
to  the  identity  of  Instinct  and  Reason,  of  which  one  of  the  strongest  is 
often  seen  in  the  elephant  on  crossing  a  bridge,  or  embarking  on  a  steam- 

*  Who  will  doubt  this,  now  that  the  much-lauded  work  of  Darwin  On  the  Origin  of 
Soecies  has  made  its  apoearance?     See  d.  814.  7iote. — 1860. 


The  Soul. — APPENDIX. — Instinct.  899 

boat,  as  he  first  presses  the  bridge  or  the  boat  with  a  single  foot  to  learn 
their  stability.  But  this  example  is  peculiarly  adapted  to  our  purpose, 
since  Instinct  is  here  constituted  with  a  reference  to  the  weight  of  the 
animal,  who  would  be  otherwise  exposed  to  frequent  injuries;  and  the 
associations  that  are  indispensable  to  safety  are  early  formed.  But  they 
go  no  farther,  and  this  particular  demonsti-ation  is  seen  only  in  animals 
that  may  break  a  bridge  or  sink  a  boat.  It  is,  therefore,  only  an  instance 
of  the  ordinary  impulsive  associations  which  are  always  in  operation  in 
cases  of  danger,  and  is  exactly  similar  to  the  careful  tread  of  the  smooth- 
shod  horse  when  about  stepping  upon  ice,  or  the  wariness  of  the  fox  and 
the  rat  in  eluding  the  trap,  or  the  various  expedients  of  the  squirrel  in 
dodging  the  sportsman,  or  the  cautious  nibble  of  the  fish,  &c.  The  va- 
rieties in  these  examples  are  almost  as  great  as  the  species  of  animals, 
and  they  all  belong  to  the  exquisite  intuitive  principle  which  warns  them 
of  approaching  danger.  It  is  often  seen,  indeed,  in  the  aspect  of  mutual 
protection  among  animals  of  the  same  species,  when  it  always  operates 
according  to  the  nature  of  the  species.  The  crow  has  his  sentinel,  and 
the  affi'ighted  ant  communicates  its  alarm  by  a  peculiar  touch  of  its 
companion,  which  spreads  with  rapidity  from  one  to  another,  till  the 
whole  hive  is  quickly  thrown  into  this  paroxysmal  movement.  And 
now,  if  this  analysis  be  pursued  through  an  obvious  series  of  analogies, 
it  will  be  found  that  the  habits  of  bees  in  relation  to  their  queen,  and 
many  other  remarkable  problems  in  the  history  of  Instinct,  are  flllied  to 
the  principle  which  I  have  just  considered. 

§  1078,  h.  Another  shade  of  difference  in  the  general  principle  occurs 
in  an  example  which  has  been  presented  by  Metaphysicians  to  illustrate 
the  supposed  identity  of  Instinct  and  Reason.  It  is  that  of  a  dog,  Avho 
has  appeared,  when  making  for  a  drifting  boat,  to  lay  out  the  plan  of 
first  ascending  the  bank  of  a  stream  above  the  boat,  that  the  distance 
between  himself  and  the  object  may  compensate  for  the  motion  of  the 
water,  which  would  otherwise  carry  him  below  his  destination.  I  pre- 
sent the  example  in  its  strongest  light,  and  as  implying  all  that  can  be 
surmised  of  a  rational  process  in  animals.  But,  with  all  instances  of  a 
similar  nature,  it  falls  within  the  common  laws  of  the  Instinctive  Princi- 
ple, which  are  just  so  far  operative,  according  to  the  species  of  animal, 
as  shall  subserve  the  exigencies  of  life.  In  the  case  of  the  dog,  this  ani- 
mal is  more  or  less  addicted  to  the  water  (especially  the  individual  in 
question),  and  his  Instinct  is  therefore  adapted  to  the  emergencies  that 
may  attend  that  temporary  mode  of  life.  He  early  acquires,  in  conse- 
quence, an  impulsive  apprehension  of  the  effects  of  strong  currents  of 
water,  and  is  so  far  capable  of  forming  associations  as  may  be  necessary 
to  his  safety,  or  to  his  natural  wants.  The  instance  of  the  boat  is  one 
of  safety  and  of  want,  and  is  exactly  parallel  with  that  where  all  dogs 
will  elect  a  bridge  of  500  feet  in  preference  to  swimming  the  width  of  a 
dozen.  The  knowledge  of  the  effects  of  a  current  of  water  exceeds  but 
little  that  of  its  quality  of  wetting ;  and  when,  therefore,  a  dog  is  moved 
by  the  desire  of  bathing,  he  neglects  the  bridge  and  takes  to  the  water. 

Various  prejudices  and  misapprehensions  relative  to  supposed  instinct- 
ive acts  abound  in  the  community,  who  are  prone  to  the  most  favourable 
comparison  of  the  brute  with  his  lordly  associate.  The  rarity  of  appa- 
rent evidences  of  Reason  in  brutes,  and  the  enjoyment  of  what  is  thus 
unexpected  and  wonderful,  lead  the  multitude  to  seize  upon  what  is  ac- 
cidental and  carry  it  to  the  account  of  Instinct.     An  example  of  this, 


900  INSTITUTES    OF    MEDICINE. 

which  has  often  gone  the  round  of  the  public,  is  that  of  the  elephant  and 
the  apple,  where  the  tempting  morsel,  being  just  beyond  the  grasping 
range  of  the  animal's  trunk,  was  made,  by  a  forcible  projectile  blow,  to 
rebound  within  its  reach  from  an  opposite  wall.  This  has  been  thought 
to  be  but  little  inferior  to  a  game  at  billiards.  But  it  was  simply  an 
act  of  irritation,  the  blow  being  designed  in  the  same  resentment  as 
when  an  angry  man  loses  all  reason  and  castigates  a  stone  that  has 
caused  him  an  injury.;— Note  P  p.  1121. 

§  1078,  i  The  Speculatist  points  to  the  care  with  which  animals  pro- 
vide for  their  young,  and  the  great  resemblance  between  them  and  man 
in  parental  attachments,  as  an  evidence  of  the  supposed  identity  of  Rea- 
son and  Instinct.  But  I  answer  that  this  is  much  more  seeming  than 
real,  and  that  however  the  principle  may  have  an  ultimate  reference  to 
the  well-being  of  organic  life  in  the  infancy  of  man,  it  embraces  in  him 
far  loftier  objects,  and  prompts  to  an  endless  variety  of  useful  purposes 
in  the  care  of  his  progeny  which  have  not  the  least  connection  with  the 
exigencies  of  life,  but  which,  on  the  contrary,  are  relative  to  the  culture, 
the  enjoyments,  the  morality,  the  Religion,  the  eternal  welfare  of  the 
Spiritual  part.  It  follows  them  through  all  the  stages  and  vicissitudes 
of  life,  rejoices  in  their  happiness,  and  grieves  for  their  adversities. 
When  intercourse  fails,  every  expedient  is  devised,  from  the  tardy  mes- 
senger to  the  electric  telegraph,  to  impart  renewed  expressions  of  affec- 
tion, and  fresh  hopes  of  prosperity.  And  how  is  it  on  the  part  of  the 
offspring?  Does  not  every  heart  beat  responsively  to  the  Divine  com- 
mand to  "  honour  thy  father  and  thy  mother "?"  And  can  there  be  a 
broader  distinction  between  the  attachments  of  animals  and  of  mankind 
than  what  Scripture  implies  and  what  man  pursues  1  The  very  attach- 
ments which  man  contracts  for  favourite  animals  flow  from  the  Divine 
sentiment  which  is  impressed  upon  his  Soul.  And  then  all  that  display 
of  sympathy  and  friendship  among  companions  of  mutual  thoughts,  or  of 
heartfelt  kindness  towards  the  faithful  and  trusty  servant,  or  the  univer- 
sal characteristic  known  as  the  sentiment  of  humanity — where,  I  say, 
shall  we  look  for  the  dawning  of  these  mental  attributes  in  the  constitu- 
tion of  Instinct  ?  And  wherein  are  the  instinctive  movements  of  ani- 
mals towards  their  offspring  related  to  human  affections?  Simply  for 
the  preservation  of  life,  and  thus  incidentally  for  the  perpetuation  of  the 
species,  as  conclusively  shown  by  the  total  and  abrupt  disappearance  of 
brute  attachments  as  soon  as  the  offspring  can  provide  for  and  protect 
themselves,  and  this,  too,  at  ordained  times  according  to  the  species  of 
animal.  Nay  more ;  parents  and  offspring  mutually  abandon  each  other 
at  allotted  times,  and  turn  upon  each  other.  The  principle  is  seen  in 
full  operation,  and  in  its  largest  extent,  in  the  bird  while  hatching  her 
eggs.  She  may  be  in  expectation,  though  she  may  have  had  no  more 
experience  in  the  final  result  than  the  bee  on  its  return  after  its  first 
wandering  from  the  hive ;  nor  is  there  any  more  similitude  with  the  ope- 
rations of  reason  in  the  one  case  than  the  other ;  she  will  as  readily  sit 
upon  counterfeit  eggs  as  her  own  till  her  time  of  "  reckoning"  is  up,  and 
then  abandon  them. 

§  1078,  ^•.  The  same  distinction  (§  1078,  i)  exists  between  the  love  of 
the  sexes  in  the  human  race  and  what  is  observed  of  the  sexual  rela- 
tions in  the  brute  creation,  and  is  not  less  opposed  than  our  other  facts 
to  the  assumed  identity  of  Reason  and  Instinct.  Like  all  else  in  relation 
to  the  latter,  the  impulse  is  totally  restricted  to  the  perpetuation  of  or- 


The  Soul. — APPENDIX. — Instinct.  901 

ganic  life.  In  the  human  species  the  same  impulse  is  as  a  spark  in  a 
blaze  of  fire.  The  principle  of  love  takes  in  its  scope  the  loftiest  senti- 
ments of  Mind,  and  anticipates  all  the  intellectual  endearments  of  domes- 
tic society,  and  yields  a  grateful  tribute  to  its  munificent  Author.  If 
there  be  a  low  analogy,  it  is  of  the  lowest  grade,  and  is  nearly  lost  in  the 
sublimity  of  its  intellectual  accompaniments.  Nor  can  there  be  a  paral- 
lel suggested  between  Reason  and  Instinct  more  degrading  to  man,  or 
more  unjust  to  his  Maker,  or  more  characteristic  of  a  perverted  mind, 
than  that  which  is  so  often  drawn  in  respect  to  human  and  brute  affec- 
tions. Yet  he  who  makes  it  has  a  better  opinion  of  himself,  and  only 
thinks  so  of  the  rest  of  his  race. 

§  1078,  I.  And  this  leads  me  to  speak  of  the  very  remarkable  distinc- 
tion between  the  Soul  and  Instinctive  Principle  known  as  Conscience.  I 
employ  the  term  in  its  popular  acceptation,  as  meaning  the  ability  and 
the  impulse  of  man  to  decide  on  the  lawfulness  or  unlawfulness  of  his 
own  actions  and  affections,  and  to  instantly  approve  or  condemn  them 
according  to  their  nature.  Nothing  like  this  has  ever  been  observed  in 
animals.  It  is  purely  intellectual,  and  has  a  clear  reference  to  the  moral, 
Religious,  and  social  condition  of  the  human  race.  It  may  be  said,  how- 
ever, to  be  apparent  in  some  animals,  as  when  the  dog,  for  example,  mani- 
fests a  sense  of  wrong  when  he  surprises  the  game  in  a  manner  opposed 
to  his  instruction,  or  does  other  analogous  acts.  But  this  manifestation 
happens  only  under  the  influence  of  those  physical  causes  which  led  him 
to  act  more  habitually  in  a  different  manner.  The  sense  of  wrong  does 
not  originate  from  the  act,  or  on  account  of  the  act,  but  is  excited  by 
the  presence  of  his  master,  whom  he  associates  with  the  suffering  which 
he  endured  when  his  Instinct  was  undergoing  discipline,  and  thus  re- 
solves itself  into  a  dread  of  punishment.  It  is  therefore  exactly  analo- 
gous to  all  the  other  functions  of  Instinct  which  I  have  indicated,  and 
forms  the  limit  of  associations  of  which  animals  are  capable. — Note  P. 

§  1078,  m.  And  what  shall  be  said  of  that  other  principle,  scarcely 
less  universal  and  impulsive  than  conscience — a  love  of  Fame  and  a  de- 
sire to  live  in  the  memory  of  posterity  ?  The  question  becomes  ridicu- 
lous in  its  application  to  animals,  and  is  hardly  less  so,  in  an  abstract 
sense,  as  it  relates  to  man.  But,  as  an  incentive  to  laudable  action,  it  is 
a  noble  offspring  of  Reason,  and  as  significant  of  the  Soul's  immortality 
it  rises  into  sublimity. 

§  1078,  n.  And  what  of  Religion  ?  What  of  the  universal  desire  of 
immortality  ?  What  of  a  sense  of  dependence  upon  a  Superior  Being  ? 
It  may  be  safely  affirmed  that  animals  have  no  other  knowledge  of  their 
own  existence  than  what  ax'ises  from  present  sensations ;  and  should  a 
chimpanzee  be  seen  bowing  even  to  an  idol,  it  would  be  a  greater  phe- 
nomenon than  the  expostulation  of  Balaam's  ass. 

§  1078,  0.  Even  memorjj,  as  it  belongs  to  animals,  is  nothing  but  an 
association  awakened  by  some  present  impression  upon  the  senses.  It  is 
indispensable,  however,  to  many  of  their  wants  and  habits,  and  hence  is 
so  strongly  pronounced  in  many  species  that  they  will  recognize  objects 
after  a  separation  for  long  intervals  of  time,  particularly  where  strong 
impressions  had  been  made,  as  between  the  dog  and  his  master,  and  wild 
beasts  and  their  former  keepers.  In  man,  on  the  contrary,  memory  is 
often  relative  alone  to  acquirements  which  the  mind  has  made  through 
its  own  processes  of  reflection,  and  they  may  be  as  vast  and  profound  as 
the  elaborate  inductions  which  led  to  the  discovery  of  the  universal  law 


902  INSTITUTES    OF    MEDICINE. 

of  gravitation,  and  thence  to  the  calculation  of  the  existence  of  the  planet 
Neptune.  Nor  does  memory,  in  man,  require  any  extraneous  aid,  like  the 
apparently  corresponding  function  in  animals.  It  is  a  rational  function 
in  one,  independent  of  sense  ;  an  instinctive  one  in  the  other,  and  depend- 
ent upon  sense.  In  one,  it  always  involves  an  exercise  of  Reason,  and 
often  a  vast  complexity  of  ideas  ;  in  the  other,  it  is  simply  relative  to  the 
single  impression  which  had  been  transmitted  to  the  brain  by  some  ex- 
ternal cause,  and  which  can  be  recalled  only  by  renewed  applications  of 
the  same  or  analogous  causes.*  By  extending  the  analysis  in  this  man- 
ner, it  will  be  seen  that  it  is  all  Soul  in  man,  and  all  Instinct  in  animals. 

§  1078,  p.  But  the  most  curious  problem  in  the  history  of  Instinct  is 
its  natural  mutations  in  certain  animals,  and  which  carry  with  them  an 
abundant  proof  of  the  radical  distinctions  between  that  Principle  and  the 
Soul,  and  that  the  former  is  designed  for  the  mere  purposes  of  organic 
life.  I  shall  therefore  give  to  the  subject  a  greater  consideration  than 
would  be  otherwise  expedient. 

This  characteristic  is  seen,  especially,  in  animals  that  are  subject  to 
metamorphosis,  though  in  many  of  the  instances  the  changes  of  organiza- 
tion and  the  modifications  of  Instinct  are  far  gi-eater  than  in  others.  The 
strongest  examples  occur  in  insects,  a  large  proportion  of  which  have  four 
stages  of  existence :  the  egg,  the  larva,  the  puj^a,  and  the  imago,  with 
corresponding  instinctive  habits  in  the  last  three.  Where  the  metamor- 
phoses are  most  remarkable,  as  in  the  foregoing  examples,  some  of  the 
organs  undergo  mutations  that  require  a  change  in  the  stimuli  of  life 
which  could  not  be  realized  without  corresponding  adaptations  of  In- 
stinct. This  is  also  more  conspicuously  illustrated  by  the  difference  in 
the  Avants  and  habits  of  those  animals  which  at  one  period  breathe  in 
the  v/ater  with  gills,  or  analogous  organs,  and  subsequently  in  the  air 
with  lungs. 

Now  these  metamorphoses  are  as  much  the  exact  result  of  determinate 
laws,  ingrafted  upon  an  original  constitution  of  life,  as  the  development 
of  the  human  ovum,  or  the  seed  of  a  plant ;  nor  are  they  in  any  respect 
more  fluctuating  or  less  circumscribed  (§  72, 1051) ;  and  so  a  correspond- 
ing law  obtains  in  respect  to  Instinct,  through  Avhich  the  promptings  of 
Instinct  shall  harmonize  with  those  modifications  of  organic  life  that  dis- 
tinguish the  several  stages  of  metamorphosis.  In  all  the  cases,  from  the 
plant  to  the  insect,  and  fl'om  the  insect  to  man,  the  metamorphoses  or 
other  developments,  and  modifications  of  life,  take  place  in  one  uniform 
way,  according  to  the  species  of  animal  or  plant.  A  potential  whole, 
embracing  all  the  special  conditions  necessary  to  the  progressive  changes 
from  the  ovum,  through  the  larva  and  pupa  to  the  fly,  and  in  all  analo- 
gous instances,  is  as  perfect  in  the  most  mutable  tribes  as  in  the  ova  of 
the  highest  order  of  animals,  or  in  the  seeds  of  plants ;  and,  since  there 
can  be  no  departure  from  a  precise  and  uniform  succession  of  develop- 
ments in  any  of  the  species,  I'espectively,  we  also  learn  that  there  is  no 
transmutation  of  species,  nor  even  an  introduction  of  varieties  (§  1051, 
jmmordial  cell). — Note  Pp  p.  1142. 

In  respect  to  the  various  physical  agents  required  by  animals  subject 
to  metamorphosis,  according  to  their  several  stages,  the  principle  is  alike 
ingrafted  upon  the  ovum,  and  equally  so  in  the  case  of  man,  by  which 
his  development  is  started  by  one  kind  of  vital  stimulus,  and  is  farther 
conducted  through  foetal  life  by  another  kind,  while  a  variety  obtain  af- 
ter independent  life  begins.     It  is  a  metamorphosis  in  all  (§  63-81). 

*  NoTK  Hh  p.  1138. 


The  Soul. — APPENDIX. — Instinct.  903 

This  brings  us  to  the  particular  application  of  our  subject,  the  simple 
subserviency  of  Instinct  to  the  exigencies  of  organic  life.  Here  it  is,  in 
the  well-marked  metamorphic  animals,  that  it  is  distinctly  seen  that  all 
its  modifications  keep  \)a,ce,  pari  jyassii,  with,  the  changes  of  organization, 
and  that  the  law  is  exactly  coincident  with  that  which  respects  the 
changes  of  structure,  and  is  designed  alone  to  fulfil  the  necessities  of  the 
latter.  They  equally  spring  from  a  common  principle  of  mutation  im- 
planted in  the  germ. 

§  1078,  q.  There  remains  to  be  considered  the  comparative  independ- 
ence of  the  Soul  in  the  exercise  of  its  highest  functions ;  when,  also,  cer- 
tain anatomical  facts  between  man  and  animals  will  be  reviewed  for  the 
purpose  of  contrasting  them  in  yet  other  relations  to  the  Soul  and  Instinct. 

Although  there  be  a  co-operation  of  the  brain  with  the  Soul  in  all 
acts  of  intellection,  it  does  not  follow  from  what  has  been  said  that  the 
Rational  may  not  act  in  greater  independence  of  the  organ  than  the  In- 
stinctive faculty.  Just  otherwise,  indeed ;  for  my  argument  to  this  ef- 
fect is  founded,  in  part,  upon  the  distinctions  which  I  have  indicated  be- 
tween the  Soul  and  Instinct,  and  upon  what  I  am  about  to  say  of  the 
general  coincidence  between  the  brain  of  man  and  of  the  higiicst  or- 
ders of  animals,  though  an  opposite  conclusion  has  been  deduced  from 
this  relation.  But  the  inference  as  to  the  equal  dependence  of  the  oper- 
ations of  the  Soul  and  Instinct  upon  a  concurrent  action  of  the  brain  or 
its  equivalent  has  also  depended  upon  a  neglect  of  the  distinction  in  their 
attributes,  or  an  assumption  that  there  is  no  difference.  The  analogy 
in  such  a  case  would  be  sound  and  conclusive  so  far  as  it  respects  man 
and  the  approximate  animals.  But  our  premises  are  indisputable,  that 
all  the  higher  acts  of  intellection,  everything  which  falls  within  the 
province  of  Reason,  have  no  existence  in  animals.  It  is  the  only  thing, 
indeed,  which  essentially  distinguishes  man  from  the  brute,  and  would 
be  in  itself  conclusive  against  the  somewhat  prevailing  doctrine  that  man 
was  once  a  member  of  the  quadrumanous  race.  We  have  also  seen  that 
Instinct  is  more  comprehensive  in  many  insects  where  a  ganglion  takes 
the  place  of  a  brain,  and  far  more  allied  in  its  operations  to  the  plans 
of  Reason,  than  in  the  highest  order  of  animals,  and  is  often  as  mature 
in  the  new-born  as  in  the  adult  being ;  and  since,  also,  the  organization 
of  the  brain  of  the  higher  animals  is  greatly  like  that  of  man,  but  with- 
out any  of  his  intellectual  functions,  we  must  logically  conclude  that 
what  is  so  absolutely  peculiar  to  the  Soul,  and,  as  generally  granted, 
allied  to  God  Himself,  acts  in  greater  independence  of  the  brain  than 
does  simple  Instinct.  But,  so  inscrutable  are  its  connections,  as  well 
as  those  of  Instinct,  with  the  organ  in  which  it  resides,  that  I  shall  not 
trespass  beyond  the  limits  which  are  prescribed  by  observation.  Our 
facts  terminate  abruptly  at  this  point,  and  mystery  begins.  But  we  may 
pursue  the  facts,  and  reason  upon  them  as  upon  the  most  tangible  evi- 
dence. We  will  therefore  interrogate  other  proof  in  support  of  my  con- 
clusions.— Notes  Pp  p.  1142,  Qq  p.  1145. 

We  have  seen  that  every  variety  of  cerebral  structure,  from  its  approx- 
imation to  man's  in  the  higher  animals  to  its  disappearance  in  a  scarcely 
appreciable  ganglion  in  the  lower  tribes,  is  attended  throughout  with  un- 
deviating  and  perfect  manifestations  of  Instinct,  though  according  to  the 
nature  of  the  animal,  while  they  are  only  dimly  seen  in  the  human  spe- 
cies. This,  in  respect  to  Instinct,  is  conformable  with  all  analogy  as  it 
regards  other  organs  where  the  results  depend  upon  anatomical  structure 


904  INSTITUTES    OF    MEDICINE. 

acting  through  the  principle  of  Organic  Life.  There  is  every  variety, 
for  example,  in  the  organization  of  the  liver,  from  its  greatest  elabora- 
tion in  man  and  the  higher  animals  until  we  meet  with  it  in  the  lower 
orders  as  a  bundle  of  tubes  or  a  simple  sac.  Yet  in  all  it  generates  a 
product  which  is  nearly  the  same,  and  which  performs  the  same  office 
throughout.     And  so  of  the  kidneys,  salivary  glands,  stomach,  &c. 

So  far  the  analogy  is  complete  between  Instinct  and  its  organ  and  the 
Principle  of  Life  and  all  parts  of  the  body  which  that  Principle  animates. 
But  Instinct,  as  we  have  seen  (§  1076,  a-c),  must  not,  therefore,  be  con- 
founded with  organic  products.  The  analogy,  indeed,  goes  Avith  our 
other  facts  in  showing  that  it  is  the  cause  of  certain  results  through  the 
instrumentality  of  the  brain,  or  its  equivalent,  and  the  nervous  system, 
as  the  Principle  of  Life  is  the  cause  of  other  results  in  and  through  that 
same  system  of  organs  and  every  other  variety  of  structure. . 

Coming  to  the  brain  of  man,  the  foregoing  analogy  totally  fails  as  it 
respects  the  manifestations  of  Reason  and  Instinct.  There  is  an  endless 
variety  of  the  former,  but  scarcely  a  real  exhibition  of  the  latter.  We 
see  all  in  the  structure  of  the  fully  developed  animal  brain  that  can  be 
detected  in  the  human,  or  with  only  the  modifications  that  are  incident 
to  approximate  species,  but  a  perfect  blank  as  it  respects  the  Rational 
Faculties.  The  analogy,  however,  is  complete  in  man's  so  far  as  the 
brain  subserves  all  that  Instinct  can  discharge  among  the  animal  tribes, 
and  all  that  is  relative  to  the  latter  in  the  contributions  which  the  nerv- 
ous system  makes  to  organic  life.  The  only  difference  here  is  the  substi- 
tution of  the  Intellectual  for  the  Instinctive  functions;  and  whatever  re- 
lates to  the  manifestations  of  Instinct,  and  all  the  influence  of  the  passions 
upon  the  organs  of  organic  life,  are  demonstrative  of  the  co-operation 
of  the  brain  with  the  Soul.  But  the  moment  we  leave  this  ground,  and 
approach  the  abstract  operations  of  the  higher  faculties  of  the  Soul,  there 
is  very  little  direct  indication  that  the  brain  has  any  functional  con- 
nection with  the  processes,  however  much  its  integrity  may  be  nec- 
essary; and  the  only  foundation  for  the  conclusion  that  such  con- 
nection exists  are  the  results  of  sensation  and  the  analogy  supplied 
by  Reason  in  its  exercise  of  the  voluntary  and  other  Instinctive 
functions  of  animals  (§  1078  «,  &c.). 

Again :  we  have  seen  that  in  the  infancy  of  man  the  Mind  is  inoper- 
ative, Avhile  the  Instinctive  Principle  of  animals  is  nearly  as  active  and 
comprehensive  in  their  earliest  as  in  their  latest  stage  of  existence.  We 
have  also  seen  that  Instinct  is  susceptible  of  artificial  impressions,  resem- 
bling education,  in  the  infancy  of  animals,  and  only  then.  This  distinc- 
tion can  proceed  only  from  a  radical  difference  between  the  Soul  and 
Instinct ;  and  the  attendant  final  causes  of  that  difference  consist  in  the 
special  design  of  the  Soul  for  Rational  functions  when  tlie  body  is  suffi- 
ciently mature  for  any  practical  purposes,  and  of  Instinct  for  the  simple 
uses  of  the  body.  The  necessity  of  Instinct,  it  may  be  farther  said,  is 
superseded  in  man  not  only  by  the  endowments  of  Reason  when  it  comes 
into  individual  operation,  but  by  its  delegated  offices  before  its  develop- 
ment takes  place,  while  no  such  protective  care,  as  a  general  fact,  can 
be  extended  by  the  Instinctive  Principle  to  the  new-born  animal.  Hence, 
therefore,  as  there  are  no  superfluities  in  Nature,  Instinct  is  in  full  op- 
eration at  the  birth  of  animals,  when  there  is  no  display  of  it  in  the  hu- 
man race,  nor  is  the  Soul  only  slowly  developed  in  its  Rational  faculties. 
And  thus  do  the  physiological  facts,  the  manifestations  of  Reason  and 
of  Instinct,  and  the  final  causes  concur  together. 


The  Soul. — APPENDIX. — Instinct.  905 

And  now  comes  up  the  remarkable  anatomical  fact,  which  goes  also 
to  the  same  conclusions  (although  supposed  to  be  in  opposition  to  them), 
that  Instinctive  acts  are  irrespective  of  the  progressive  stages  of  cere- 
bral development,  while  those  of  the  Human  Mind  await  that  develop- 
ment. This  corresponds,  in  respect  to  animals,  exactly  with  what  we 
know  of  the  general  maturity  of  the  functions  of  all  other  parts  at  all 
stages  of  life,  and  with  what  we  have  seen  of  the  objects  of  Instinct 
and  Reason,  since  the  former  must  be  in  early  operation  for  the  exigen- 
cies of  Organic  Life,  while  the  Soul,  in  the  complexity  of  its  functions, 
and  according  to  its  objects,  is  only  ready  to  act  when  the  brain  shall 
have  acquired  sufficient  maturity  for  those  endless  physical  impressions 
which  come  through  the  medium  of  the  senses,  and  from  which  the  Soul 
gathers  its  earliest  treasures  of  knowledge. 

Such,  then,  is  the  relative  aspect  in  which  must  be  regarded  the  cor- 
respondence between'  the  progressive  development  and  maturity  of  the 
brain  and  the  operations  of  Mind  in  early  life ;  the  development  or  ma- 
turity of  the  brain  having  as  well  a  reference  to  the  multifarious  physi- 
cal contributions  from  the  Senses,  as  to  their  appropriation  by  the 
Soul ;  while,  also,  the  admirable  Design  obtains  of  rendering  the  brain 
complete  in  all  its  relations  to  the  organs  of  Organic  Life  from  the  mo- 
ment of  birth,  and,  on  the  other  hand,  its  endowment  for  the  uses  of  the 
Soul  exactly  progi'essive  with  those  physical  developments  of  other  parts 
that  are  indispensable  to  the  objects  of  Reason  at  the  different  stages  of 
advancing  life.  The  Design  is  inexpressibly  sublime  in  its  numei'ous, 
yet  distinct  involutions  as  they  relate  to  organic  and  animal  life  and  the 
uses  of  Reason.  The  Soul,  therefore,  may  be,  abstractly  considered,  in 
as  perfect  a  state  in  infancy  as  at  any  stage  of  life. 

Thus  it  appears,  that,  besides  the  physical  development  of  the  brain 
which  is  requisite  for  the  impression  of  natural  objects,  that  maturity 
of  the  organ  is,  also,  as  a  part  of  the  design,  a  necessary  medium  through 
which  the  Soul  may  appropriate  the  impressions.  Having  made  these 
advances,  the  Soul  comes  to  act  in  more  or  less  independence  of  sensa- 
tion, and  to  multiply  knowledge  by  its  own  efforts.  Nevertheless,  it  is 
peculiarly  useful  to  my  purposes  that  aberrations  are  seen  of  occasional 
displays  of  Reason  in  early  childhood  which  are  surpassed  at  adult  age 
only  by  genius  of  the  highest  order.  In  some  of  these  rare  instances 
there  had  been  only  the  most  slender  antecedent  relative  knowledge  ac- 
quired through  the  medium  of  the  senses,  but  the  Soul  itself  originated 
its  own  vast  conceptions,  carried  them  into  a  variety  of  practical  appli- 
cations without  the  instrumentality  of  foreign  aid,  and  to  an  extent 
where  erudition,  with  all  the  appliances  of  sense  and  the  facilities  of 
instruction,  falls  far  short  of  equal  achievements — as  witnessed  in  the 
institution  of  mathematical  principles  and  processes.  And  here  we 
strengthen  our  position  by  the  converse  rule,  since  in  none  of  the  cases 
has  there  been  a  ratio  in  the  advances  of  Mind  corresponding  with  the 
advancing  maturity  of  the  brain,  while  in  some  the  early  intellectual 
ability  has  settled  down  at  adult  age  to  a  common  mediocrity.  In  the 
latter  case  it  cannot  be  doubted  that  the  progress  of  the  brain  has  em- 
barrassed the  Rational  Faculties.  Again,  there  is  every  gradation  in 
Reason  from  the  Hottentot  to  the  highest  order  of  genius.  There  are  no 
two  individuals  alike  either  in  its  compass  or  in  the  manner  of  its  exer- 
cise. How  different  is  all  this  with  Instinct,  which  directs  every  indi- 
vidual of  every  species  of  animal  in  one  uniform  way,  and  no  one  of 


906  INSTITUTES    OF    MEDICINE. 

them  enjoys,  througliout  all  generations,  any  different  or  greater  endow- 
ment than  all  the  rest. 

And  thus  do  the  contrasts  between  the  Soul  and  Instinctive  Principle 
correspond  with  the  anatomical  contrasts,  both  as  they  relate  to  the  brain 
of  man  and  of  animals,  and  to  the  human  brain  and  other  organs  in  the 
state  of  infancy,  and  with  the  coincidences  in  function,  instinctive  and 
organic,  between  the  brain  of  animals  or  its  equivalent  and  other  organs 
at  all  stages  of  life.  And  here,  too,  should  be  brought  into  review  what 
has  been  said  of  the  injuries  which  are  inflicted  upon  the  Mind  and  its 
associate  organ,  and  through  those  influences  upon  the  whole  organism, 
by  overtasking  the  Mind  in  early  life,  while  no  such  injuries  are  sus- 
tained, but  the  contrary  realized,  by  a  severe  exercise  of  Instinct  in  the 
infancy  of  animals  (§  563-5G8). — Note  Pp  p.  1142. 

§  1078,  r.  It  may  be  now  well  to  inquire  into  what  is  meant  by  ideas, 
and  whether  there  be  generally  any  definite  conception  of  their  nature, 
and,  by  ascertaining  the  facts,  endeavour  to  show  by  this  method  that 
the  earliest  acquirements  through  the  instrumentality  of  the  senses 
demonstrate  the  self-acting  and  originating  endowment  of  Mind,  and  that 
it  is  distinguished,  at  its  very  daAvning,  from  the  Instinctive  Principle, 
by  the  characteristic  of  forming  ideas  of  the  nature  of  objects.  This  in- 
quiiy,  like  the  rest,  belongs  alone  to  the  Physiologist.  How,  then,  does 
sensation  give  rise  to  what  are  recognized  as  ideas  by  Reason  ?  The 
impressions  transmitted  to  the  brain  through  the  organs  of  sense,  or  such 
as  may  arise  from  internal  causes,  do  not,  certainly,  constitute  the  ideas, 
as  is  apt  to  be  supposed ;  and,  according  to  my  demonstration,  the  im- 
pressions made  upon  the  brain  cannot,  through  any  physical  or  chemical 
influences  upon  the  organ,  elicit  the  ideas  from  the  organ  itself.  The 
impressions  must,  therefore,  of  necessity,  call  into  action  a  Principle  or 
Agent  by  which  the  ideas  are  alone  formed ;  from  which  it  appears  that 
the  process,  by  which  the  Mind  seizes  and  appropriates  impressions  trans- 
mitted through  the  organs  of  sense,  is  similar  to  that  by  Avhich  it  multi- 
plies and  originates  ideas.  It  is  true,  animals  have  the  capacity  of  form- 
ing ideas  so  far  as  they  depend  upon  the  promptings  of  sensation,  and 
upon  impulsive  associations  with  the  past  that  may  be  awakened  by  re- 
newed sensations  of  a  more  simple  nature.  But  they  stop  there.  They 
are  merely  ideas  of  sensation ;  while,  on  the  other  hand,  the  results  of 
sensation  in  man  terminate  in  intellectual  images  which  have  no  analo- 
gies in  the  brute  creation,  and  these  are  the  essential  final  cause  of  the 
human  Soul.  It  is  the  Soul,  therefore,  which,  mainly,  does  the  work  in 
acts  of  intellection,  while,  in  respect  to  the  simple  ideas  of  sensation,  ex- 
ternal objects,  or  internal  causes  like  that  of  hunger,  supply  the  materi- 
als. This  is  enough  for  my  purposes ;  and  it  will  be  as  vain  to  inquire 
into  the  modus  operandi  of  the  Mind  in  its  abstract  operations,  or  in  its 
perception  of  external  objects,  or  how  impressions  are  made  upon  the 
nerves  of  sense,  or  what  their  nature,  or  how  they  are  transmitted  by  the 
nerves  to  the  brain,  or  how  they  call  the  Mind  or  Instinct  into  action,  as 
to  interrogate  the  modus  opei^andi  of  Creative  Energy. 

§  1078,  s.  In  drawing  to  the  close  of  our  subject,  we  are  naturally  led 
to  inquire  whether  there  be  more  than  one  species  of  the  human  race — a 
question  which  is  unusually  agitated  at  the  present  day. 

Taking  the  extremes  of  the  race  in  physical  and  intellectual  develop- 
ment, it  appears  to  have  been  definitively  shown  that  there  are  no  ana- 
tomical characteristics  which  distinguish  them  as  different  species,  but, 


The  Soul. — APPENDIX. — Imtinct.  907 

on  the  contrary,  mark  them  as  one.  All  the  differences  are  susceptible 
of  ready  explanation  through  the  influences  of  climate,  habits,  &c.,  un- 
less, perhaps,  the  black  color  of  the  African  (§  604-611).  The  Malpi- 
ghian  7-ete  is  abandoned  as  fallacious,  and  the  color  of  all  the  races  is 
now  known  to  depend  upon  carbonaceous  matter  deposited  upon  the 
surface  of  the  true  skin,  differing  only  in  degrees  of  intensity.  The 
greater  tint  of  the  Negro  has  been  referred,  in  a  very  ingenious  Essay  by 
Professor  MuUer  of  Brussels,  to  the  hot  and  arid  climate  which  the  dark- 
est of  that  race  inhabit.  But,  with  all  his  experience  in  those  regions, 
he  is  mistaken  in  his  important  point  that  the  newborn  Negro  is  white ; 
and  his  doctrine  of  the  influences  of  deficient  oxygen  and  dryness  of  the 
air  in  occasioning  the  deposition  and  fixedness  of  the  cutaneous  carbon 
is  inapplicable  to  the  North  American  Indian,  whose  skin  is  as  dark  in 
his  extreme  Northern  as  Southern  limits ;  nor  has  a  Northern  climate 
exerted  a  bleaching  effect,  in  many  generations,  upon  the  Negro  in 
America.  Muller's  theory,  therefore,  of  excess  of  carbon  in  the  blood 
from  an  inadequate  supply  of  oxygen  by  the  rarefied  air  of  the  tropics,  is 
invalidated  by  the  exceptions  before  us.  Nevertheless,  peculiarities  of 
climate  have,  doubtless,  given  rise  to  all  the  shades  of  color,  unless  that 
of  the  Negro  form  an  exception  (§  610).  A  simultaneous  lusus  naturce  of 
a  male  and  female  black,  as  in  the  case  of  the  ivhite  Negro,  may  have  given 
origin  to  the  race.     (Vide  Med.  and  Physiolog.  Comm.,  vol.  ii.,  p.  640.) 

§  1079,  a.  Such  are  the  conclusions  (§  1069-1078)  to  which  the  evi- 
dence of  anatomical  and  physiological  facts  have  successively  led ;  nor 
have  I  any  doubt  that  others  will  see  in  the  demonstrations  that  man  is 
an  animal  only  in  his  physical  being ;  that  in  Mind  he  is  far  less  allied 
to  the  things  of  the  earth  than  he  is  to  their  Author ;  and  will  realize  a 
corroboration  of  their  own  conceptions,  that  the  Soul  and  Instinctive 
Principle  are  so  far  differently  constituted  as  implied  by  the  ultimate  ex- 
istence of  one  in  an  abstract  condition,  while  the  other  shares  the  destiny 
of  organic  life.  They  will  see,  I  say,  a  new  ground  of  belief  in  the  im- 
mortality of  the  Soul,  and  in  the  perishable  nature  of  Instinct.  And  if 
this  be  so,  they  will  see  in  my  premises  and  conclusions  a  contradistinc- 
tion between  God  and  Nature,  and  what  is  equivalent  to  a  demonstra- 
tion of  the  existence  of  a  Creative  Spirit,  in  which  alone  the  Thinking 
part  of  man  can  have  had  its  origin.  And,  coming  to  other  details  in 
relation  to  man,  they  will  realize  in  the  Mosaic  declaration  that  "  the 
Lord  God  formed  man  of  the  dust  of  the  ground,  and  breathed  into  his 
nostrils  the  bi-eath  of  life,  and  man  became  a  livmg  Soul,"  an  Inspiration 
from  Him  Who  "  created  man  in  His  Own  Image,"  and  repose  with 
equal  confidence  in  the  assurance  that,  although  "  the  dust  sliall  return 
to  the  earth  as  it  was,  the  Spirit  shall  return  unto  the  God  Who  gave  it." 
They  will  abide  in  the  emphatic  distinctions  between  the  dust,  the 
breath,  and  the  Soul,  and  regard  the  Spirit  as  a  special  gift,  a  new  Cre- 
ation, and  the  body  as  referring  to  materials  already  in  being,  and  which 
were  designed  in  their  organic  state,  and  kindled  into  life,  to  connect  the 
Spiritual  part  with  the  material  world  ;  and  they  will  also  see  in  the  lim- 
itation of  the  statement  as  to  the  Soul  of  man  what  is  the  ultimate  des- 
tiny of  Instinct, 

Hence  it  follows,  if  Revelation  be  received  as  to  the  immortalitij  of  the 
Soul  and  the  death  of  Instinct,  it  must  be  received,  also,  as  revealing  a 
fundamental  distinction  between  them,  and  should  operate  as  a  perfect 
barrier  with  all  those  veho  uphold  the  Scriptures  against  the  common 


908  INSTITUTES    OF    MEDICINE. 

prejudice  of  identifying  Instinct  and  Reason,  as  confounding  the  revealed 
distinction,  and  therefore  promoting  infidelity  in  its  aim  at  materialism 
and  annihilation. — Notes  Pp  p.  1142,  qQ  p.  1145. 

§  1079,  b.  The  foregoing  subject  has  been  pursued  by  the  Author  in 
a  long  Article  upon  "  Theoretical  Geology,"  in  the  '■'■  Protestant  Episcopal 
Quarterly  Review,''  New  York,  April,  1856,  in  which  he  has  endeavoured 
to  defend,  upon  scientific,  philological,  and  geological  grounds,  the  literal 
interpretation  of  the  Mosaic  Narratives  of  Creation  and  of  the  Noachian 
Flood ;  and,  should  he  think  that  the  spirit  of  the  times  will  justify  the 
publication  of  the  larger  work  to  which  he  referred  in  the  original  edi- 
tion of  the  Essay  on  the  Soul  and  Instinct,  and  which  is  now  completed, 
he  will  submit  it  to  the  press.  His  main  difficulty  is  the  general  concur- 
rence of  the  Religious  press  in  the  revolutionary  views  of  Theoretical 
Geology,  though,  in  saying  this,  nothing  more  is  intended  than  a  simple 
representation  of  the  facts.  It  is  doubtful,  therefore,  whether  a  hearing 
can  be  obtained — certainly  not  a  publisher  at  his  own  risk.  The  Author 
makes  this  statement  in  consideration  of  his  former  announcement  that 
such  a  work  was  on  hand. — See  Supplement,  p.  923-928,  §  1085. 

The  "  Review  of  Theoretical  Geology,"  to  which  reference  is  now 
made  (extending  to  120  pages),  is  an  epitome  of  the  larger  work,  and  is 
believed  by  the  Author,  and  by  better  judges,  to  be  incontrovertible. 
This  is  said,  however,  simply  for  the  purpose  of  inviting  a  criticism  which 
may  either  discourage  the  Author  in  a  farther  attempt,  or  prove  to  him 
an  incentive  to  go  on  with  his  solitary  work.  He  acknowledges,  how- 
ever, some  encouragement  in  a  critical  review  of  Hugh  Miller's  posthu- 
mous work  on  the  "  Testimony  of  the  Bocks,"  which  occupies  five  pages  of 
the  Westminster  Review  for  July,  1857,  and  which  is  remarkable  for  its 
contrast  with  an  otherwise  apparently  universal  shout  of  applause.* 

§  1080.  Again :  such  is  the  nature  of  our  premises,  that,  if  the  Soul 
of  man  be  immaterial,  so  is  the  Instinct  of  animals.  There  are,  more- 
over, no  violent  transitions  in  nature.  The  material  existences,  especial- 
ly the  organic,  pass  gradually,  as  it  were,  into  each  other.  And  so,  it 
cannot  be  doubted,  it  is  Avith  the  immaterial,  from  brute  to  man,  from 
man  to  angels,  from  angels  to  God. 

"Of  sj'stems  possible,  if  tis  confessed 
That  Wisdom  Infinite  must  form  the  best, 
Where  all  must  fall  or  not  coherent  be, 
And  all  that  rises,  rise  in  due  degree ; 
Then,  in  the  scale  oi reasoning  life,  'tis  plain, 
There  must  be  somewhere  such  a  rank  as  man ; 
And  all  the  question  (wrangle  e'er  so  long) 
Is  onlj'  this  :  if  God  has  placed  him  wrong?" 

But  we  have  also  seen  from  our  premises  that,  as  soon  as  Instinct 
shall  have  fulfilled  its  objects,  it  perishes  with  the  life  of  the  animal ; 
since,  especially,  all  its  present  uses  are  limited  to  the  wants  of  the  body. 
Nor  will  its  extinction  aifect  the  analogy  of  which  we  predicate  its  im- 
materiality, nor  contradict  in  the  least  the  immortality  of  the  Soul.  We 
deduce  the  latter,  apart  from  Revelation,  not  from  the  Soul's  immaterial- 
ity, but  from  some  of  the  facts  which  contradistinguish  it  from  Instinct, 
that  all  its  higher  faculties  have  no  relation  to  the  uses  of  the  body,  and 
from  the  analogy  which  subsists  between  them  and  the  Attributes  of  the 
Creator.  We  infer,  also,  the  immateriality  of  the  Soul,  in  part,  from  the 
pame  analogy ;  though  it  is  essential  to  this  analogy  that  it  be  conceded 
that  the  Omniscient,  Omnipresent,  and  Omnipotent  Being  is  as  dififerent 

*  A  protest  against  the  geological  and  astronomical  perversions  of  Holy  Writ  has  just 
been  signed  (1865)  bj-  two  hundred  eminent  scientific  men  of  Great  Britain. 


TJie  Soul. — ^APPENDIX. — Instinct.  909 

from  the  inert  matter  of  which  He  is  the  Author  as  their  manifestations 
are  different  from  each  other.  And  again,  if  these  premises  be  admitted, 
it  follows  that  immateriality,  or  something  totally  distinct  from  matter,  is 
indispensable  to  the  unlimited  duration  of  the  Almighty,  and  therefore 
that  it  must  be  rendered  equally  so  to  the  Soul.  But  the  acknowledg- 
ment of  a  Creator  carries  with  it  a  full  admission  of  His  immateriality, 
otherwise  matter  would  be  self-existent,  and  God  and  the  Universe  would 
be  on  common  gi'ound.  The  latter  is  replete  with  design,  and  that  is 
the  most  tliat  could  be  affirmed  of  the  former.  Neither  should  depend 
for  its  existence  upon  the  other ;  nor,  as  we  have  seen,  can  matter  cre- 
ate matter  (§14  c).     Ilaterialism,  therefore,  i?>  pantheism — atheism. 

It  need  not  be  repeated  that  the  iymnateriality  of  Instinct  is  inferred 
from  its  feeble  analogies  to  the  Soul,  though  not  in  the  least  to  any  man- 
ifestations of  those  attributes  which  ally  the  Soul  to  its  Maker.* 

§  1081.  It  will  have  been  seen  that  materialism,  in  its  proper  accepta- 
tion, and  the  question  as  to  the  materiality  of  the  Soul,  are  distinct  from 
each  other,  since  the  former  denies  the  existence  of  the  Soul  as  a  sub- 
stantive agent,  while  the  latter  admits  it.  My  object  has  been  to  sub- 
stantiate the  existence,  more  than  the  ivimateriality  of  the  Soul.  But  the 
proof  of  the  latter  has  constantly  attended  all  that  I  have  shown  of  the 
self-acting  nature  both  of  the  Soul  and  Instinctive  Principle,  which  con- 
tradistinguishes them  from  every  known  attribute  of  matter.  The  near- 
est approximation,  in  the  light  of  analogy,  to  what  may  be  material,  is 
to  be  seen  in  the  Principle  of  Organic  Life ;  and  here  the  resemblance 
consists  in  action  alone.  But  the  Principle  of  Life  requires  the  opera- 
tion of  numerous  physical  causes  to  bring  and  maintain  it  in  sensible 
action.  It  is  impossible,  therefore,  to  adduce  a  single  phenomenon  of 
the  Soul  or  of  Instinct  that  bears  a  resemblance  to  the  manifestations  of 
matter. 

§  1082.  Our  inquiry  may  be  variously  pursued,  especially  upon  the 
great  basis  of  analogy.  It  is  one  of  no  little  moment  at  the  present  day, 
and  materialism  must  abide  its  own  facts  and  method  of  reasoning ;  a 
ground,  however,  which  nothing  can  shake  when  presented  according  to 
its  ordination  in  nature.  In  the  present  case,  the  admitted  facts  are 
co-extensive  with  all  animal  existences,  and  they  are  bound  together  in 
the  different  races  by  close  resemblances.  Indeed,  in  each  of  the  series 
the  facts  differ  only  by  shades.  The  evidence  here  is  of  the  strongest 
possible  nature,  not  only  on  account  of  the  universality  of  the  facts,  but 
because  they  are  founded  in  the  unchanging  character  of  organic  beings. 

Resting,  therefore,  in  the  conclusions  which  I  have  now  expressed, 
and  anxious  for  their  greater  prevalence  against  a  progressive  and  al- 
ready widespread  materialism,  I  have  been  led  into  this  discussion  in 
the  hope  that  it  may  remove  some  of  the  obscurities  of  the  subject,  and 
also  advance  the  great  truths  in  Physiology  and  Medicine.  The  province 
of  the  Physiologist  extends  beyond  the  mere  physical  relations  of  matter 
and  Mind.  Of  those  relations  he  is  the  only  expounder.  But  it  de- 
volves upon  him,  also,  to  seek  in  the  depths  of  Physiology  for  the  con- 
stitution of  Mind  as  distinguished  from  matter ;  and  thus,  also,  contrib- 
ute towards  a  right  faith  in  a  future  state  of  being.     Wherever,  indeed, 

*  We  have  seen,  §  168,  that  Professor  Miiller,  in  discussing  the  nature  of  the  Vital 
Principle,  concedes  that  even  this  maj'  be  an  immaterial  substance,  and  that  "there  is 
nothing  in  the  facts  of  natural  science  which  argues  against  its  possibility,  and  its  inde- 
pendence of  matter,  though  its  powers  be  manifested  in  organic  bodies — ii>  matter." 


910  INSTITUTES    OF    MEDICINE. 

he  turns  his  inquiries  into  organic  nature,  he  sees  in  the  mechanism  of 
every  part — individually  and  collectively  as  a  harmonious  whole — in 
every  function  and  product,  separately  and  relatively — in  the  properties 
by  which  they  are  carried  on,  and  in  the  laws  by  which  they  are  gov- 
erned, the  most  perfect  evidences  of  consummate  Design.  It  is  the 
duty  of  the  Physiologist  to  turn  all  this  immense  weight  of  proof  against 
those  ci'ude  doctrines  of  materialism,  mental  and  medical,  which  have 
had  their  origin  either  in  the  closet  of  the  speculatist  or  in  the  laboratory 
of  the  Organic  Chemist.  And  thus,  also,  shall  he  secure  from  Mankind 
that  homage  for  Medicine  which  is  due  to  "  the  Divine  Art,"  and  again 
restore  the  Hippocratic  axiom  that  "  a  philosophical  physician  is  like  a 
god"  (§  235). 

§  1083.  Before  concluding  our  subject  I  shall  avail  myself  of  the 
proof  which  it  supplies  against  the  doctrine  oi  spontaneity  of  living  beings, 
now  extensively  prevalent  in  the  scientific  world,  and  against  which  I 
have  alleged  many  objections  in  the  Medical  and  Physiolorjical  Commen- 
taries (vol.  ii.,  p.  123-140),  and  again  in  the  original  Essay  on  the 
'■'■Soul  and  Instinct,^'  and  in  that  upon  "Theoretical  Geology''^  (§  1079,  S), 
and  in  these  Institutes  (§  14  c,  170,  350f  a-m). 

As  it  respects  the  Soul  and  Instinctive  Principle,  Ave  have  now  seen 
that  they  ai'e  substantive  existences,  and  all  organic  beings  are  made  up  of 
the  common  elements  of  matter.  But  there  is  no  element  known  in  the 
inorganic  kingdom  which  affords  any  of  the  manifestations  which  char- 
acterize the  Soul  and  Instinct,  or  any  of  the  results  of  the  organic  mech- 
anism. The  latter,  therefore,  was  endowed  with  new  properties  when 
the  elements  were  brought  into  organic  union.  To  say  that  such  prop- 
erties were  "  slumbering  in  the  elements,"  is  a  frivolous  assumption 
(§  14  c,  175  d,  250J  b,  c,  f-h),  and  necessarily  involves  the  conclusion 
(which  has  been  probably  intended)  that  the  Soul,  also,  is  equally  in- 
herent in  the  elements,  which  is  the  worst  kind  of  materialism.  But  the 
manifestations  of  the  Soul  and  Instinct  are,  as  we  have  seen,  not  only 
totally  different  from  those  of  every  organic  process,  but  cannot  be  gen- 
erated by  the  material  part.  These  principles,  therefore,  were  as  much 
created  as  the  elements  of  matter,  and,  as  they  exist  in  union  with  the 
organized  structure  of  man  and  animals,  it  is  inferable  that  the  structure 
was  created  simultaneously,  and  by  a  common  act,  with  the  spiritual 
part.  Or,  if  the  material  elements  were  first  combined,  it  would  equally 
follow  that  it  was  a  direct  Creative  Act,  since  the  Soul  and  Instinctive 
Principle  must  have  been  created  for  the  distinct  purpose  of  being  asso- 
ciated with  the  material  body.  The  rule,  of  course,  applies,  through  the 
analogies  of  structure,  to  the  vegetable  kingdom,  and  which  it  is  equally 
consistent  to  suppose  was  created  in  the  form  of  plants  as  of  seeds,  or 
as  that  man  and  mammiferous  animals  were  created  in  a  state  of  ma- 
turity, according  to  my  demonstratioif  in  the  Essay  on  the  "  Soul  and 
Instinct"  (p.  158-173).— Note  Pp  p.  1142. 

I  have  also  said  in  relation  to  the  common  opinion  that  intestinal 
worms  are  of  spontaneous  origin,  that,  if  this  be  admitted,  it  must  be  also 
conceded  by  all  that  is  sound  in  analogy,  that  the  door  is  equally  open 
for  any  other  animal,  and  for  man  himself  The  hypothesis  is  without 
a  plausible  fact,  while  the  ova  of  these  parasites,  and  of  such  as  are 
found  in  the  organization  of  the  body,  even  in  the  foetus,  may  require, 
in  the  natural  external  condition  of  the  animals,  a  magnifying  power  of 
some  hundreds  of  times  to  render  them  visible.     They  may,  therefore, 


The  Soul. — APPENDIX. — Instinct.  911 

be  absorbed  into  the  circulation,  where  their  new  mode  of  existence,  as 
Avell  as  in  the  intestinal  canal,  may  so  modify  the  condition  of  the  ani- 
mals that  they  shall  lose  all  resemblance  to  their  characteristics  in  the 
external  world.  The  animal  and  vegetable  tribes  abound  with  equally 
remarkable  aberrations,  that  arise  from  climate,  domestication,  and  cul- 
tivation alone.  But  more  than  this.  From  whence  comes  the  elaborate 
organization  of  these  so-called  parasites  and  their  wonderful  systems  of 
Design?  How  and  from  whence  do  they  obtain,  at  their  start  into  be- 
ing, the  seventeen  or  eighteen  elements  of  which  they  are  composed,  and 
.  which  are  indispensable,  in  every  species  of  animal  and  plant,  to  the  be- 
ginning of  existence  ?  And  should  not  this  objection  have  been  urged 
against  the  pretended  creation  of  the  Acarus  Crossii  out  of  a  simple  so- 
lution of  silex  in  water  (§  350f ,  h)  ?  Is  there  any  thing  in  Chemistry 
that  will  expound  the  intimate  union  of  such  a  number  of  elements  into 
compounds  of  the  most  exact  nature,  or  these  compounds,  by  any  thing 
known  in  physics,  into  systems  of  Design,  and  this  for  every  species  of 
animal  and  plant,  if  you  had  all  the  elements  to  begin  with  1  Or,  take 
oxygen,  hydrogen,  nitrogen,  and  carbon  alone,  the  Chemist  completely 
fails  to  fabricate  the  most  simple  organic  compound  (§  350,  No.  39,  par- 
allel columns).  But  by  no  possible  contingency  can  the  seventeen  or 
eighteen  elements  have  been  assembled  for  a  single  individual  plant  or 
animal ;  and  when  all  the  species  are  regarded  collectively,  the  supposi- 
tion becomes  palpably  absurd.  Nothing  but  Creative  Power  could  have 
gathered  them  together  in  a  single  instance.  This  disposes,  also,  of  the 
^'parturient  faculty  of  the  earth"  as  it  is  called  in  the  ''progressive  devel- 
opment" system  of  theoretical  Geology.  Nor  can  the  pretence  be  set  up 
that  the  so-called  intestinal  parasites  grow  out  of  a  previously  organized 
part,  for  they  are  perfectly  independent  beings,  and  have  no  attachments 
to  the  intestine.  Or,  if  attachments  exist  in  other  cases,  they  are  precisely 
upon  common  ground  with  parasite  plants  as  it  respects  their  original 
independence.  The  doctrine  which  ascribes  Mvguet  "to  the  production  of 
a  parasite  plant  within  the  epithelial  cell"  is  open  to  the  same  objections 
as  apply  to  the  spontaneity  of  animals,  and  is  contradicted  by  all  the 
physiological,  pathological,  and  therapeutical  facts.  It  is  alone  worthy 
of  the  most  imaginative  of  the  microscopical  school,  setting  aside  its  per- 
nicious tendencies  in  Religion*  {Continued  in  ^  1085.) 

I  can  not  but  think,  after  all,  that  whoever  regards  the  animalcule, 
that  can  be  discerned  only  through  a  high  magnifying  power,  in  all  its 
wonderful  complexity  of  organization,  seemingly  existing  in  nothing,  in 
all  its  close  analogies  in  composition  and  structure  to  man  himself,  and 
often  with  a  large  development  of  the  Instinctive  Principle,  and  pon- 
ders upon  the  same  analogies  as  they  are  only  less  complex  in  worms, 
and  only  still  less  in  parasitic  plants,  and  considers  the  stupendous  De- 
signs which  each  part,  and  all  together  in  unison,  fulfil  for  the  growth  and 
well-being  of  each  individual,  and  how  there  is  no  deviation  in  structure 
and  functions  among  all  the  individuals  of  the  species  respectively,  must 
concede  the  descent  of  the  whole  fi-om  progenitors  that  had  been  brought 
into  being  by  an  Intelligence  higher  than  that  which  is  enabled  to  ex- 
plore the  labyrinth  and  trace  out  the  Designs  (§  1051),  and  that  thus 
informed,  he  must  bow  with  reverential  awe  under  the  inspiration  of 
such  contemplations.     (See  Index  L,  Article  Design.) 

*  The  Author  is  gratified  to  observe  that  the  spirit  of  his  arguments  uponspoNTAXK- 
OTJS  GicNKKATioN,  as  expressed  here  and  elsewhere,  is  adopted  in  Amer.  Jour,  of  Science 
and  Art,  May,  1859,  and  b}-  the  same  writer  as  referred  to  in  note  at  p.  1^6,  §  360. 
Comptes  Renclus,  1859,  contains  conclusive  experiments  in  favor  of  cukative  rowKR. 
^1860.— Notes  Ppp.  1142,  Qq  p.  1145. 


912  INSTITUTES    OF    MEDICINE. 


THE  EIGHTS  OF  AUTHORS. 

§  1084.  Upon  all  questions  of  priority  that  concern  the  advancement 
of  Science  and  Art,  there  is,  doubtless,  a  general  understanding  that  the 
principle  should  not  only  be  sacredly  observed,  but  that,  w^henever  vio- 
lated, there  should  be  a  common  effort  to  repair  the  injury.  This  is  alike 
due  to  the  individual,  to  the  principle,  and  to  the  common  good.  Nor  is 
it  less  the  privilege  of  the  individual,  who  may  have  good  reason  to  think 
that  the  principle  has  not  been  extended  to  himself,  to  vindicate  his 
rights,  and  to  appeal  to  that  sympathy  which  forms  the  bond  of  union 
among  honourable  men.  It  is  a  common  cause,  and  not  seldom  demands 
protection. 

The  Author  of  these  Institutes  (and  it  will  soon  appear  that  he  acted 
wisely)  has  sometimes  thought  it  expedient  to  assert  his  claim  of  origin- 
ality, in  advance,  to  many  doctrines  promulgated  in  the  work ;  as,  for 
example,  all  that  is  most  essential  in  the  application  of  the  Nervous 
Power,  or  Reflex  action  of  the  nervous  system  to  Pathology  and  Thera- 
peutics, and  to  much  of  what  is  most  important  in  the  natural  state  of 
the  functions.  This  may  be  readily  seen  by  consulting  p.  106,  §  222  b, 
p.  107-116,  §  224-234,  p.  295-318,  ^75^-493  tZ,  p.  321-341,  ^  495- 
514,  p.  343-353,  §  516-524,  p.  465-467,  §  714-719,  p.  506,  §  803-804, 
p.  515-516,  §  819  h,  p.  661-663,  §  894-896,  p.  666-676,  §  902  5-904, 
p.  679-680,  §  905  a,  p.  690-691,  §  906  g,  p.  693-695,  §  917-923,  p. 
698,  §  931-935,  p.  703-711,  §  940-952,  p.745,^990ia,5,&c.,  where  all 
the  subjects  relate  to  the  reflex  action  of  the  nervous  system,  and  present 
the  nervous  power  as  an  important  vital  agent  in  the  various  processes 
of  organic  and  animal  life,  in  the  production  of  disease,  in  the  operation 
of  remedies,  in  all  the  results  of  bloodletting,  in  the  changes  which  take 
place  in  the  secreted  and  excreted  products — having  also  originally  set 
forth  the  agency  of  the  nervous  power  in  voluntary  motion  (Indexes, 
Article  Will),  and  as  this  power  is  the  efficient  cause  of  the  modifica- 
tions of  organic  results  under  the  influence  of  mental  emotions  (Index 
H.,  Article  Mental  Emotions,  and  references  at  p.  867,  §  1067).  Indeed, 
as  the  reader  will  have  seen,  the  foregoing  doctrines  relative  to  the  reflex 
action  of  the  nervous  power,  operating  as  a  vital  stimulus,  or  vital  dejwess- 
ant,  or  vital  alterative,  as  it  may  be  modified  in  its  nature  by  one  cause 
or  another  (§  226-232,  481,  500,  891^^,894  &,990i«,^»),  pervade  this 
work.  The  same  doctrines  are  at  the  foundation  of  the  Author's  '■^Med- 
ical and  Physiological  Commentaries,"  published  in  1840,  while  the  present 
work  was  published  in  1847.  In  the  mean  time  he  has  also  laboured  to 
inculcate  them  throughout  his  course  of  Medical  Lectures  in  the  Uni- 
versity of  New  York — first  on  the  Institutes  of  Medicine  and  Materia 
Medica  from  the  year  1841  to  1850,  and  subsequently,  to  the  present 
time  (1857),  on  General  Therapeutics  and  Materia  Medica. 

It  may  be  worth  saying,  also,  that  the  Author  preserves  the  term 
"  sympathy,"  though  always  meaning  by  it,  as  he  strictly  defines,  reflex 
action  of  the  nervous  system,  and  this  whether  he  employs  the  term  "  re- 
mote sympathy"  or  "contiguous  sympathy."  The  elements  of  sympa- 
thy, as  set  forth  in  the  work,  are  the  nervous  power  and  sensibility.     All 


Bights  q/^— APPENDiX.^ — Azdhors.  913 

this  will  be  readily  seen  by  a  reference  to  Indexes.  Also,  among  other 
general  remarks  of  a  similar  import,  the  Author  has  the  following  : 

"  Notwithstanding  all  the  laws  of  sympathy  that  are  necessary  to  the 
full  interpretation  of  the  remote  effects  of  morbific  and  remedial  agents 
are  as  well  established  as  any  laws  in  physics,  iheT/  have  not  been  apjjUed 
to  these  important  objects ;  but,  on  the  contrary,  those  philosophers  who 
have  contributed  most  to  their  critical  exposition,  overlook  their  patholog- 
ical and  therapeutical  bearings,  and  cling  to  the  doctrines  of  humoralism  and 
of  the  operation  of  remedies  by  absorption;  nor  have  they  applied,  in  the 
least,  the  nervous  power  in  a  philosophical  manner  to  an  explanation  of  the 
natural  phenomena  of  sympathy"  (p.  Ill,  §  234  a,  169  e  435  c,  906  g). 

When  the  foregoing  works  were  first  published,  it  was  in  the  midst  of 
a  universal  prevalence  of  the  chemical  and  physical  doctrines  of  life 
and  disease,  and  the  Author  stood  alone  in  the  field  of  Vital  Physiology, 
and  in  the  application  of  the  reflex  action  of  the  nervous  system  in  re- 
solving the  great  problems  in  Physiology,  Pathology,  and  Therapeutics. 
A  few,  however,  had  the  quick  sagacity  to  see  its  importance  as  presented 
by  the  Author ;  and  since  the  decline  of  Organic  Chemistry  began,  others 
have  entered  upon  the  inquiry,  and  the  most  zealous  have  promulgated 
as  original  with  themselves  many  of  the  doctrines  which  belong  to  the 
Author  of  these  Institutes,  especially  such  as  are  relative  to  the  nervous 
system.  But  the  Author  has  relied  upon  his  professional  brethren  for 
ultimate  justice:  '■'■JJltimum  et  unicum  remedium."  '■'■Jus  aliquando  dor- 
mitur,  moritur  nunquamy 

But  the  Author  has  lately  seen  so  great  an  indisposition,  in  certain 
quarters,  to  allow  him  any  credit  for  his  labours,  that  he  has  concluded 
to  make  this  expostulation,  which  refers,  particularly,  to  the  following 
dispute  about  the  authorship  of  matters  in  which  neither  of  the  gentle- 
men has  any  interest,  but  the  writer  alone  of  these  Institutes.  This  rival 
claim  appears  in  an  Article  published  by  J.  Adams  Allen,  A.M.,  M.D., 
in  the  ^'■Medical  Independent'^  for  September,  1857,  p.  381,  Detroit,  Mich- 
igan.    Thus : 

"  It  appears  from  a  late  number  of  the  London  Lancet  that  M.  Hall 
(Marshall  Hall)  recognizes  to  a  certain  extent  the  priority  of  Dr.  Camp- 
bell.    His  words  are  these : 

"  'I  arrive  at  this  conclusion:  the  idea  and  the  designation  of  an  ex- 
ciio-secretory  action  belongs  to  Dr.  Campbell,  and  his  details  are  limited  to 
pathology  and  observation.  The  elaborate  experimental  demonstration 
of  reflex  excito-secretory  action  is  the  result  of  the  experimental  labors 
of  M.  Claude  Bernard.  My  own  claim  is  of  a  very  different  character, 
and  I  renounce  every  other.  It  consists  in  the  vast  generalization  of  ex- 
cito-motory  action  throughout  the  system.  I  trust  Dr.  Campbell  will 
be  satisfied  with  my  adjudication.  There  is  the  excito-secretory  func- 
tion as  applied  to  pathology,  an  ample  field  of  inquiry  for  his  life's  ca- 
reer, and  it  is  indisputably — ms  own.  He  first  detected  it,  gave  it  its 
designation,  and  saw  its  vast  importance.'  " 

Dr.  Allen  then  continues : 

"  M.  Hall  thus  far  freely  and  fully  admits  the  priority  of  Dr.  Camp- 
bell, and  the  latter  gentleman  bases  his  claim  upon  the  date,  May,  1850. 
I  shall  undertake  to  show  that  this  same  doctrine  was  first  publicly 
announced  and  illustrated  in  my  Lectures  at  the  Indiana  Medical  Col- 
lege in  November,  1848,  and  thenceforth  continuously  during  the  con- 
tinuance of  my  public  teaching  before  the  several  classes  of  that  College, 

M  M  M 


914  INSTITUTES    OF    MEDICINE. 

and  also  the  Medical  Classes  of  the  University  of  Michigan  until  my  con- 
nection with  that  Institution  'expired  by  limitation'  in  1854.  My  own 
manuscript  containing  this  doctrine  was  written  in  May  or  June,  1848" 
— that  is  to  say,  mo7-e  than  one  yea?-  after  the  jyublicatioti  of  these  Institutes. 

"  What  I  do  claim  is  the  great  generalization  that  the  excito-injiuence  is 
followed  by  a  reflex  change  in  which  the  effect  is  not  a  motion,  hut  a  modi- 
fication OF  VASCULAR  AND  NUTRIENT  ACTION.  That  this  effect  takes 
place  BY  MEANS  of  the  double  nervous  arc.  a  vast  number  of  thera- 
})eutic  phenomena  are  thus  explained."  I  preserve  in  the  quotations 
Dr.  A.'s  capitals  and  italics. 

Now  the  whole  of  the  foregoing  doctrine  is  impressed  upon  the 
Med.  and  Physiolog.  Commentaries,  and  upon  more  than  half  of  the 
pages  of  these  Institutes,  and  has  been  always  taught  extensively  in 
the  Author's  Lectures  since  1841.  In  respect  to  the  present  work, 
see,  particularly,  pages  106  to  111,  283  to  362,  and  the  chapters  upon 
Remedial  Action,  Therapeutics,  Counter-Irritation,  Cathartics,  Se- 
cretion, and  Excretion,  Index  II. 

Dr.  Allen  claims,  also,  the  application  of  the  principle  to  Therapeu- 
tics, and  remarks  that  "  in  my  course  upon  '  General  Therapeutics'  the 
subject  of  '  Counter-Irritation'  came  under  review,"  and  concludes  that 
"  the  impression  must  be  transmitted  to  the  nervous  centres,  and  thence  re- 
flected to  the  affected  organ.  In  other  words,  the  influence  is  primarily  ex- 
erted upon  the  cerehro-sjnnal  system,  and  secondarily  upon  the  internal  afl'ected 
organ.  This  is  the  gist  of  the  whole  matter,  and  the  point  consists  in 
the  recognition  of  reflex  cerebro-spinal  action,  which,  in  the  instances  ad- 
duced, give  rise  to  a  molecular  or  integral  change  in  the  inflamed  tissue, 
and  not  a  muscular  contraction.  The  oral  elaboration  of  this  principle 
was  suggested  by  an  idea  [?]  which  does  not  even  now  appear  to  have 
occurred  to  either  M.  Hall  or  Dr.  Campbell,  viz, :  The  motor  effect  is 
merely  secondary,  and  not  a  neassary  part  of  the  action  of  the  nervous  arc." 

Here,  also,  the  whole  of  the  foregoing  doctrine  appears  throughout 
these  Institutes,  but  not  to  the  neglect  of  the  sympathetic  nerve-  In  the 
long  chapter  upon  '*  Counter- LTitation''''  it  will  be  seen  that  the  Author 
has  employed  nearly  the  language  of  Dr.  Allen,  as  also  in  that  upon 
"  liemedial  Actio7i,'"  with  a  great  elaboration  and  extensive  application  of 
the  doctrine  throughout  the  work ;  which  had  been  also  antecedently 
taught  in  his  Lectures  for  seven  consecutive  years  before  Dr.  Allen  pro- 
mulgated the  same  views.     (Indexes,  Reflex  Action,  Nervous  Power). 

To  show  still  farther  this  partiality  for  the  Author's  Writings,  or  his 
Lectures  (then  familiar  to  his  large  classes  of  students),  he  Avill  quote 
from  Dr.  Allen  the  following  conclusions,  which  he  also  places  in  capitals: 

"The  effect  is  motory,  if  contractile  fibre  be  present. 

"  The  effect  is  secretory,  if  secretory  organs  be  supplied. 

"  The  effect  is  sensation,  if  sensitive  neurine  be  reached. 

"The  effect  is  perception,  or  intellection,  if  the  organ  there- 
of be  in  connection  with  the  reflex  nerve," 

"  The  effect  produced,  then,  depends  tipon  the  structure  and  condition 
of  the  organ  reached^'' 

"  This  influence  is  not  confined  to  the  mere  increase  of  action,  as  the  term 
ExciTOR  might  perhaps  suggest.  The  reverse  may  take  place — the  ex- 
citor  may  rather  become  the  dep)ressor.  It  would  be  as  correct  to  say 
the  depressor-motory,  the  depressor-secretory,  as  to  say  the  excitor-jc/em." 

Now  the  Author  of  these  Institutes  not  only  dwells  emphatically  upon 
the  depressing  and  sedative  influence  of  reflex  nervous  action,  according  to 


Rights  of — APPENDIX. — Authors.  915 

the  nature  of  the  remote  causes  and  special  conditions  of  disease  (§  224- 
233f,  234  d,  455  d-J\  481,  488^,  500  c,  ec,  503,  514  b-h,  516  d,  no.  13, 
526  d,  847  g,  863  d,  891^  1-,  894-895,  902  b-m,  904  a,  945,  947,  951  c, 
966,  973-976,  990  J  a,  ^),  and  upon  its  operation  according  to  the  natural 
structure  and  special  vital  constitution  of  organs,  and  their  varying  con- 
ditions (p.  59,  §  129  g-i,  p.  61-69,  §  132-150,  p.  73,  §  163,  p.  109,  §  229, 
p.  Ill,  §  233|,  p.  285,  §  455  d-f,  p.  313,  §  487  h,  p.  353-362,  §  525-529, 
p.  374-383,  §  576-584,  p.  415-417,  §  649,  p.  418,  §  651 Z*,  p.  421-423, 
§  657-658,  p.  523,  §  827  c,  p.  542,  §  854  bb,  p.  613,  §  892^  b,  p.  644-650, 
§  893  c-2,  p.  665-672,  §  902-903  b,  p.  746,  §  990^  b,  and  the  numerous  ref- 
erences in  those  sections) ;  but  the  Author  represents,  also,  the  reflex 
action  as  variously  alterative  in  organic  life,  and  this  imputed  attribute 
pervades  the  Author's  writings.  He  enforces,  everywhere,  the  doctrine 
that  the  reflex  action  of  the  nervous  power  is  the  modifying  cause 
through  which  all  the  changes  are  effected  by  morbific  and  remedial 
agents  in  parts  that  are  not  immediately  connected  with  the  direct  seat 
of  their  action ;  and,  farther,  that  the  principle  is  precisely  the  same 
when  the  nervous  power  is  brought  into  operation  by  direct  influences 
upon  the  nervous  centres  (as  in  the  case  of  their  diseases,  or  when  the 
Passions  operate,  or  as  the  Will  determines  voluntary  motion),  as  it  is 
when  it  is  brought  into  operation  in  that  indirect  manner  known  as  re- 
flex action.    Hence  he  has  called  the  former  direct  nervous  action. 

Indeed,  every  one  of  the  foregoing  doctrines,  in  all  their  particulari- 
ties, as  quoted  from  the  American  Claimant,  are  taught,  at  great  extent, 
in  the  volume  before  us,  as  may  be  readily  seen  by  consulting  the  refer- 
ences made  in  this  protest,  and,  more  extensively,  Indexes,  Articles 
Stkucture,  Nervous  Power,  Sensation,  Sensibility,  Sympathy,  Or- 
ganic Functions,  Remedial  Action,  Mind,  Mental  Emotions,  Will. 
— "*S'«  quceris  monwnentum,  circumspice.^^  It  may  appear  superfluous, 
however,  to  have  made  these  specific  references  in  an  article  connected 
with  the  work  itself;  but  it  is  done  to  encourage  those  readers  who 
might  not  otherwise  be  inclined  to  ascertain  the  facts. 

But  the  writer  is  more  interested  with  the  European  Umpire,  of 
whom  he  has  felt  that  he  has  much  more  reason  to  complain. 

"  Omne  animi  vitium  tanto  conspectus  in  se 
Crimen  habet,  quanto  major,  qui  peccat,  habetur." — Juvenal. 

That  the  Author's  physiological  and  medical  writings  were  generally 
known  in  Europe  many  years  before  the  pei'iod  at  which  "  Dr.  Camp- 
bell bases  his  claim"  (1850),  is  evident  from  the  distinguished  honors  to 
which  they  had  led  in  that  Country  before  that  period — that  from  the 
Medical  Society  of  Prussia  as  early  as  1842 — that  from  the  Medical  So- 
ciety of  Leipsic  in  1843 ;  and  the  "  Medical  and  Physiological  Com- 
mentaries" (of  1840)  were  published  simultaneously  in  London  and  New 
York ;  and  as  to  the  United  States,  the  Commentaries  were  early  distrib- 
uted throughout  the  land,  and  his  Institutes  of  Medicine  more  than  a  year, 
also,  before  Dr.  A.'s  Lectures  were  delivered ;  and  the  Author's  Lectures 
at  the  University,  which  form  the  groundwork  of  his  Institutes,  had  been 
listened  to  annually  by  Medical  Students  from  all  quarters  of  the  Union 
since  the  year  1841.  In  1848  the  Author  applied  the  doctrine  of  reflex 
nervous  action  to  a  physiological  demonstration  of  the  substantive  exist- 
ence of  the  Soul  and  Instinctive  Principle,  which  was  then  published 
in  pamphlet  form,  and  in  1849  the  work  was  extended  and  assumed 


916  INSTITUTES    OF   MEDICINE. 

the  shape  of  a  book,  and  is  now  incorporated,  in  its  essential  parts,  in 
these  Institutes.   Aho,  fully,  in  Ant]io}:^s  Materia  Medica,  1848,  p.  176-180. 

Nor  is  that  all ;  for  the  whole  of  this  doctrine  of  reflex  nervous  action, 
and  of  the  operation  of  the  nervous  power  as  an  alterative,  an  excitant  of 
the  secretions  and  of  vascular  action  (both  direct  and  reflex),  a  depressant 
and  sedative  (according  to  the  nature  of  exciting  causes),  and  the  great 
immediate  cause  of  diseases  and  their  cure — variously  modifying  organic  ac- 
tions— was  set  forth  extensively  and  circumstantially  in  an  '■'■Essay  on  the 
Modus  Operandi  of  Kemedies"  in  1842,  of  which  the  Author  distrib- 
uted, at  that  time,  a  large  number  of  copies  in  London,  and  addressed 
four  thousand  copies  to  Physicians  throughout  the  United  States.  The 
Author  not  only  sent  a  copy  of  the  work  to  Dr.  Hall,  but  dedicated  it 
to  him  (along  with  Prof  J.  Miiller  and  Dr.  A.  P.  W.  Philip)  in  connec- 
tion with  an  '■^  Essay  on  the  Philosophy  of  Vitality  f  and  he  may  add  that 
he  controverted,  in  the  former  Essay,  doctrines  of  Dr.  Hall  (in  '^Memoir 
on  Diseases  and  Derangements  of  the  Nervous  System,  1841"),  which  were 
in  direct  opposition  to  those  which  are  now  in  question  (also,  p.  296- 
297,  §  476  J,  b).  These  Essays  were  subsequently  bound  up  in  the  Third 
volume  of  the  "  Medical  and  Physiological  Commentaries,"  where  the  for- 
mer may  be  readily  consulted.  But  Dr.  Philip  had  fully  deduced  from 
his  experiments  the  sedative  as  well  as  exciting  influence  of  the  nervous 
system  upon  vascular  action  before  Di*.  Hall's  experiments  were  made 
(§  492) — See  Index  II. — Hall,  M. — for  many  other  unpardonable  criticisms. 

As  to  M.  Bernard,  his  experiments  bearing  upon  the  connection  of  the 
nerves  Avith  the  function  of  secretion,  however  much  they  may  have 
been  varied  and  multiplied,  were  anticipated  long  before  by  those  of 
A.  P.  W.  Philip,  which  are  quoted  extensively  in  these  Institutes  (p.  290- 
321),  and  towards  which  Dr.  Hall  had  no  friendly  disposition  (p.  306- 
308,  and  where  the  writer  has  controverted  his  views).  The  merit  of 
originality  which  belongs  to  the  present  writer,  in  relation  to  these  ex- 
periments, consists  in  their  extensive  application  in  illustrating  the  func- 
tions of  the  nervous  power  as  a  vital  agent,  profoundly  interested  not 
only  as  an  "  excito-secretory"  power,  and  as  a  modifying  cause  of  all 
secreted  products,  nutrition,  &c.,  when  diverted  from  their  natural  stand- 
ard, but  in  deducing  from  them  a  universal  agency  of  the  reflex  action 
of  the  nervous  system,  through  "  the  double  nervous  arc,"  in  the  produc- 
tion and  cure  of  disease,  and  by  which  be  laboured  to  explode  the  chem- 
ical and  physical  doctrines  as  early  as  1840.  But,  that  the  writer  may 
not  be  misapprehended,  he  will  say  that  he  endeavours  to  establish  the 
fact  that  secretion  in  animals,  as  in  plants,  is  conducted  by  powers  im- 
planted in  every  part,  bvit  that  it  is  constantly  influenced  physiologic- 
ally, pathologically,  and  therapeutically,  by  reflex  action  of  the  nervous 
system,  as  also  by  direct  action  (§  227,  481). 

The  writer  is  very  sensible  that  unaccountable  coincidences  often  pre- 
sent themselves  in  the  development  of  new  thoughts,  and  in  the  discov- 
ery of  hidden  things,  especially  where  enduring  reputation  may  be  won. 
"C/i?  mel,  ibi  apes.'''' — '■'■JJno  tiene  la  fama,y  otro  carda  la  lanaP  But  the 
reader,  with  these  Institutes  before  him,  will  quickly  find  that  much  that  is 
claimed  by  Dr.  Hall,  and  all  that  he  has  granted  to  Dr.  Campbell,  in  the 
foregoing  quotation,  and,  therefore,  all  that  Dr.  Allen  appropriates  to 
himself,*  abounds  in  this  volume,  and,  in  fact,  constitutes  the  life  and 

*  "Unus  utrique 

Error ;  sed  variis  illudit  partibus." — Hohace. 


Rights  (/—APPENDIX. — Authors.  917 

soul  ("  <^w?y  KoX  "^vxrf)  of  the  work,  as  it  does,  also,  of  the  ^^ Commenta- 
ries,^^ and  of  the  Essay  on  the  ^^ Modus  02}erandi  of  Bemedies  ;"  nor  can  the 
reader  fail  of  the  conclusion  that,  were  Dr.  Hall's  "adjudication,"  and  Dr. 
Allen's  after-thought,  founded  in  any  justice,  and  were  not  the  claimants 
themselves  the  obnoxious  parties,  the  pi'esent  writer  would  have  been  long 
ago  convicted  by  them  and  by  others  of  arrogant  assurance  and  the  gross- 
est plagiarisms.  Nevertheless,  the  Author  is  most  happy  to  find  that  his 
solitary  position  is  becoming  relieved,  and  that  a  practical  dii-ection  has 
been  given  to  his  labours  by  others  which  cannot  fail  of  carrying  forward 
the  great  doctrines  at  which  he  has  toiled,  and  against  manifold  obstacles, 
during  his  professional  life. — Note  X  p.  112Y. 
New  York,  September,  1857. 

Postscript. — From  what  has  been  seen  in  the  last  preceding  Article 
(which  was  at  first  intended  for  publication  without  this  Postscript),  it 
will  not  appear  remarkable  that  the  Author  regards  it  as  a  duty  to  him- 
self and  to  the  cause  of  that  Philosophy  in  Physiology  and  other 
branches  of  Medicine  which  he  has  labored  to  introduce,  that  he  should 
set  forth  the  principal  details  of  what  he  considers  himself  the  unques- 
tionable Author.  Prompted,  therefore,  by  these  and  other  obvious  rea- 
sons, he  proceeds  to  assert  his  claim  of  originality  to — 

1.  All  that  is  relative,  in  principle,  to  Reflex  Action  of  the  Nervous  Sys- 
tem in  Pathology  and  Therapeutics,  including  the  application  of  antece- 
dent experiments  to  determine  the  "  Laws  of  Sympathy"  and  of  the 
"Vital  Functions,"  as  they  respect  the  natural  conditions,  to  all  the 
great  problems  in  those  branches  of  Medicine,  so  far  as  the  Nervous  In- 
fluence is  involved  as  a  modifying  cause ;  and  a  systematic  generalization 
of  the  whole  subject.  The  Laws  of  Reflex  Action  of  the  Nervous  Sys- 
tem, in  their  Physiological  aspect,  were  understood,  to  a  large  extent,  as 
eai'ly  as  the  time  of  Prochaska  (§  463  b,  476  h),  and  justice  demands  of 
us  that  analogous  contributions  by  Hippocrates  shall  be  acknowledged 
(§  463  a),  while,  also,  it  will  be  seen  through  the  foregoing  references  that 
this  most  important  subject,  in  philosophical  and  practical  medicine,  had 
engaged  the  diligent  attention  of  other  eminent  observers  prior  to  the 
grand  discovery  by  Sir  Charles  Bell  of  the  anatomical  media  (§  464,  &c.), 
by  the  aid  of  which,  and  the  labors  of  many  others,  the  great  Prussian 
Physiologist  reduced  the  laws  of  reflex  action  of  the  nervous  system  to  a 
masterly  generalization.  The  Author  of  these  Institutes  had  also  given 
his  critical  attention  to  the  researches  of  Marshall  Hall,  and  has  express- 
ed his  opinion  of  their  merits  in  many  places,  and  summarily  in  §  463  h. 

2.  The  doctrine  of  Modification  of  the  Nervous  Power  by  the  Causes 
which  bring  it  into  action,  and  according  to  the  nature  of  each  Cause, 
whether  mental  or  physical,  I'emedial  or  morbific,  external  and  internal, 
and  through  which  its  Alterative  influences  are  exerted  in  conformity 
with  its  various  modifications,  respectively — regarding,  therefore,  the 
Nervous  Power  as  a  Vital  Alterative  Agent  and  susceptible  of  an  endless 
variety  of  changes  in  hind  from  the  influence  of  exciting  causes ;  being 
thus  rendered,  in  its  extremes  of  change,  either  a  vital  stimulant  or  seda- 
tive, exerting  alterative  effects,  with  corresponding  results  in  both  the  sol- 
ids and  fluids. — The  application  of  this  philosophy  equally  to  the  cure 
and  production  of  diseases  in  all  their  gradations.     (Index  I.  and  II.) 

3.  The  doctrine  and  demonstration  of  the  operation  oi Remedial  Agents 
and  Morbific  Causes  by  Refiex  Action  of  the  Nervous  System,  as,  also. 


918  INSTITUTES    OF    MEDICINE. 

through  the  foregoing  modification  of  the  Nervous  Power  (No.  2),  and  all 
that  is  relative  to  the  same  action  in  Pathology  and  Therapeutics. 

4.  A  distinct  exposition  of  the  modus  operandi  of  Counter-irritants 
through  Reflex  Action  of  the  Nervous  System,  and  their  associate  local  i7i- 
fluences ;  exemplifying,  also,  by  these  agents,  the  modus  operandi  of  all 
other  agents  applied  to  the  skin  when  they  produce  constitutional,  or  anyt 
internal  efiects,  whether  remedial  or  morbific — as  in  the  case  of  cold,  mer-> 
cury,  t&c.  (Index  II.,  Counter-irritants ;   Causes,  Morbific  ;  and  Remedies). 

5.  A  distinct  exposition  of  the  modus  operandi  of  the  Seton  through 
Reflex  Nervous  Action  and  local  organic  influences,  as  exemplifying  all  the 
essential  philosophy  that  is  ever  concerned  in  the  operation  of  all  reme- 
dial and  morbific  agents,  as  set  forth  in  the  Author's  Essay  on  the  Modus 
Operandi  of  Kemedies  (1842),  and  in  these  Institutes  (p.  G79-681,  §  905  a) 
— being,  however,  only  parallel  with  the  author's  demonstration  of  the 
operation  of  Blisters  and  other  Counter-irritants  through  the  same  causa- 
tions. 

6.  The  operation  of  Aticesthetics  through  Reflex  Nervous  Action,  as  con- 
tained in  this  work. 

7.  Distinction  between  the  agencies  of  Reflex  Nervous  Action  in  the  mo- 
dus operandi  of  the  Author's  group  of  Alteratives  and  among  other  denomi- 
nations of  Remedies  (Index  I.  and  II.) — an  important  consideration,  by 
which  the  gradual  operation  of  Remedies  through  Reflex  Nervous  Action 
is  rendered  clearly  intelligible,  as  in  the  progressive  influences  of  small 
and  frequently  repeated  doses  of  tartarized  antimony,  mercury,  &c.  (p. 
344-345,  §  516  d,  No.  6,  889  m,  902  i-m,  904  hh).  And  so,  also,  of 
the  progressive  operation  of  Morbific  Causes,  either  physical  or  mental — 
as  in  hydrophobia,  sympathetic  diseases,  &c.  (p.  421-422,  §  657  a,  b,  p. 
465-466,  §  715,  p.  661-663,  §  894-896).  The  example  of  the  Seton 
illustrates  the  principle  (No.  5). 

8.  All  embraced  in  this  work,  and  in  the  Medical  and  Physiological 
Commentaries  (vol.  i.,  p.  124-384)  upon  the  Influences  and  Modus  Ope- 
randi of  Loss  OF  Blood  (whether  in  General  Bloodletting  or  Leeching), 
which  are  interpreted  by  the  Author  upon  purely  Physiological  Laws, 
and  mainly  through  Reflex  Action  of  the  Nervous  System. 

9.  The  Law  of  Adaptation,  operating  through  Reflex  Nervous  Action 
(Index  I.). 

10.  The  philosophy  of  the  natural  operation  of  the  Will  and  Mental 
Emotions  through  the  direct  development  and  action  of  the  Nen'ous  Power, 
and  its  efiects  as  an  Alterative  agent  when  the  latter  operates  in  the  cure 
or  production  of  disease,  as  embraced  in  this  work. 

11.  Demonstration  of  the  direct  development  and  propagation  of  the 
Nervous  Poiver  as  an  Alterative  agent,  or  a  simple  Stimulant  or  Depressant, 
in  diseases  of  the  nervous  centres,  «&c.,  and  as  concerned  in  Loss  of  Blood 
along  with  Reflex  Action,  &c. 

12.  What  is  relative,  in  this  work,  to  peculiarities  of  Stimcture  in  its 
Vital  constitution  in  different  parts  (p.  50-73,  «&;c.),  and  their  important 
bearings  upon  Physiological,  Pathological,  and  Therapeutical  doctrines, 
as  it  relates  both  to  the  direct  action  of  remedial  and  morbific  causes, 
and  their  operation  through  Reflex  Action  of  the  Nervous  System. 

13.  The  proof  and  reasoning  embraced  in  these  Institutes,  and  in  the 
Medical  and  Physiological  Commentaries,  and  other  Avorks,  in  behalf  of 
Vital  Solidism,  as  applied  to  Physiology,  Pathology,  and  Therapeutics, 
and  in  opposition  to  the  Chemical  hypotheses. 


Bights  of— AVV'EE'DII..— Authors.  919 

14.  Special  deduction  of  Vital  Principle,  and  peculiar  Laws  of  Organic 
Beings,  from  their  Composition,  as  embraced  in  this  work  (p.  23-49). 

15.  Special  deductions  from  Nitrogen  Gas,  as  contradistinguishing  the 
Organic  from  the  Inorganic  Kingdom,  as  contained  in  the  Essay  on 
the  Philosophy  of  Vitality  (1842),  and  briefly  in  this  work  (p.  34-36, 
§  62  a-lc). 

16.  Special  deduction  of  the  principles  of  Vital  Solidisni,  Physiological 
and  Pathological,  from  the  development  of  the  incubated  Egg  and  the 
physiology  of  Generation,  as  contained  in  the  Essay  on  the  Philosophy 
of  Vitality,  and  in  these  Institutes  (p.  36-49,  §  63-81). 

17.  Analysis  and  elaboration  of  the  Properties  of  Life,  as  contained  in 
this  work  (p.  73-125). 

18.  The  proof  adduced  in  this  work,  and  in  the  Medical  and  Physio- 
logical Commentaries  (vol.  i.,  p.  1-119),  of  the  existence  and  office  of  the 
Vital  Powers  or  Vital  Properties,  with  a  disproof  in  the  latter  work  of  the 
supposed  ideii^ty  of  the  Nervous  Power  and  Galvanism,  with  the  variety 
of  proof  herein  contained  of  the  wonderful  attributes  of  the  Nervous 
Power,  as  one  of  the  properties  of  the  Vital  Principle  of  Animals. 

19.  Exposition  of  Law  of  Vital  Habit  (p.  363-370,  §  535-537). 

20.  All  embraced  in  these  Institutes  and  the  Medical  and  Physio- 
logical Commentaries  in  disproof  of  the  Chemical  and  Physical  hypoth- 
eses as  applied  to  Physiology,  Pathology,  and  Therapeutics. 

21.  All  herein  and  in  the  Medical  and  Physiological  Commentaries 
(vol.  i.,  p.  385-712)  in  refutation  of  the  Humoral  Pathology. 

22.  Demonstration  of  the  dependence  of  Digestion  upon  Vital  Laws, 
and  to  the  exclusion  of  the  Chemical,  as  contained  in  this  work  and  in 
the  Medical  and  Physiological  Commentaries  (vol.  ii.,  p.  79-122). 

23.  Demonstration  embraced  in  these  Institutes,  and  in  the  Medical 
and  Physiological  Commentaries  (vol.  ii.,  p.  1-78),  of  the  dependence  of 
Vegetable  and  Animal  Heat  upon  Vital  Laws,  and  against  the  Chemical 
hypotheses. (p.  236,  §  435  b). 

24.  Experiments  relative  to  the  Circulation  in  the  Brain,  showing  that 
the  organ  is  depleted  in  Bloodletting  (p.  824-828). 

25.  Demonstration  of  the  dependence  oi  Absoiption  and  Circulation  in 
Plants  and  Animals  upon  Vital  Laws  (p.  817-824,  §  1053-1055,  and 
passim). 

26.  Much  of  what  herein  relates  to  the  Powers  which  circulate  the 
Blood,  and  in  the  Medical  and  Physiological  Commentaries  (vol.  ii.,  p. 
398-426). 

27.  The  distinction  between  Inflammation  and  Fever,  and  what  is  most 
essential  in  proving  an  active  condition  of  the  immediate  instruments  of 
Inflammation,  and  the  dependence  of  its  different  stages,  and  of  all  its 
phases  and  products  upon  Vital  Laws,  as  embraced  in  these  Institutes, 
and  in  the  Medical  and  Physiological  Commentaries  (vol.  ii.,  p.  141-214). 

28.  All  herein  relative  to  the  philosophy  of  Venous  Congestion  and 
Varix,  and  in  Medical  and  Physiological  Commentaries  (showing  that 
venous  inflammation  is  the  pathological  condition),  and  the  proof  of  the  de- 
pendence of  Tubercle  and  Scrofula  upon  Inflammation,  and  Cold  as  a 
cause  of  Congestion,  &c.,  in  the  several  Appendixes  to  Venous  Conges- 
tion in  Commentaries  (vol.  ii.,  p.  215-640). 

29.  Much  of  the  Physiological  bearing  of  organic  changes  incident 
to  different  periods  of  Life  upon  practical  medicine  (p.  373-383,  §  570- 
584). 


920  INSTITUTES    OF    MEDICINE. 

30.  The  uses  and  abuses  of  Morbid  Anatomy  as  contained  in  this  work 
and  in  Medical  and  Physiological  Commentaries  (vol.  ii.,  p.  641-677). 

31.  A  generalization  of  the  mutability  of  the  Properties  of  Life,  as 
lying  at  the  foundation  of  disease  and  of  its  cure,  and  of  many  natural 
changes  of  organization  at  the  different  stages  of  life,  of  gestation,  lacta- 
tion, &c.  Also,  the  doctrine  of  a  substitution  of  pathological  conditions  by 
llemedial  Agents,  thi'ough  reflex  nervous  action,  more  favourable  to  the 
law  of  recuperation  than  such  as  had  been  impressed  by  the  truly  mor- 
bific causes,  and  their  progressive  nature  ;  and  the  physiological  distinction 
which  the  Author  has  drawn  between  remedial  and  morbific  agents. — 
See  Index  I.,  Vital  Properties. — Index  II.,  Kemedies  ;  Causes,  Mor- 
bific ;  Therapeutics. 

32.  The  demonstration  of  the  operation  oi  Astringents  upon  Vital  Prin- 
ciples, and  through  reflex  action  of  the  nervous  system  (p.  370-378). 

33.  The  demonstration  of  the  operation  of  Tonics  upon  Vital  Princi- 
ples, and  through  reflex  action  of  the  nervous  system  (p.  57%-583,  §  SOOJ, 
p.  676-679,  §  904  c,  d). 

34.  Attempted  refutation  of  Theoretical  Geology,  and  of  Spontaneity  of 
Being,  to  which  there  are  references  at  p.  908,  §  1079  b,  p.  910-911, 
§  1083. 

35.  A  critical  exposure  of  the  fallacies  of  the  Medical  Docti'ines  em- 
braced in  the  Writings  of  P.  Cii.  A.  Louis,  in  Medical  and  Physiolog- 
ical Commentaries  (vol.  ii.,  p.  679-815,  2xx^  passim). 

36.  A  critical  exposure  of  the  fallacies  contained  in  the  Writings  of 
Liebig,  so  far  as  he  has  applied  Organic  Chemistry  to  Physiology,  Pa- 
thology, and  Therapeutics  (p.  147-178,  p.  234-279,  ixa^  passim). 

37.  K  Therapeutical  Arrangement  of  the  Materia  Medica  upon  Physio- 
logical principles,  and  in  the  order  of  the  relative  therapeutical  value  of 
the  diflferent  substances,  and  as  applied  to  particular  forms  of  disease. 

38.  All  that  is  relative  to  the  Substantive  Existence  and  Physiology 
of  the  Soul  and  Instinctive  Principle,  as  embraced  in  this  work,  and 
in  the  former  Essay  upon  those  subjects  (See  Index  II,  JSTote  at  p.  873). 

39.  Opinion  that  the  Will  exercises  a  controlling  influence  upon  the 
Intestine  in  Defecation,  and  as  evincing  a  remarkable  instance  of  Creative 
Design,  p.  325,  §  500,  e. 

NoTE.^The  foregoing  specifications  appeared  in  the  Fourth  Edition 
of  this  work,  and  as  the  Author  has  seen  no  objections  alleged  that  in- 
validate any  of  the  claims,  but  rather  a  general,  or  at  least  tacit,  admis- 
sion of  them,  and  as  they  have  been  spontaneously  republished  in  several 
medical  periodicals,  he  leaves  them  in  this  Ninth  Edition  without  modi- 
fication, but  will  add  that,  in  regard  to  the  term  '■'■  excito-secretoi^j  func- 
tion^'' although  an  unimportant  matter,  and  referring  simply  to  the  phys- 
iological condition,  he  suggested  the  term  itself  in  sections  514  h,  512, 
902  g,  and  in  many  other  places  ;  nor  will  he  neglect  saying  in  this  con- 
nexion that  he  attempted  to  show  the  influence  of  the  sympathetic  nerve 
upon  the  action  of  the  blood-vessels,  and  the  operation  of  Counter-irri- 
tants and  of  Leeching  through  reflex  nervous  action  as  early  as  the  year 
1834,  in  an  article  in  the  London  Medico-Chirurgical  Review.  See  p. 
827,  §  1056.  The  author  has  now  taught  the  docti'ines  of  these 
Institutes  in  the  Medical  Department  of  the  University  of  tlie  City 
of  ISTew  York  fpr  twenty-six  years. 
New  York,  18C7. 


SUPPLEMENT. 


[The  first  parajTi'aph  of  the  section  with  which  this  Supplement  begins  appeared 
in  the  Fourtli  Edition.     All  that  follows  belongs  to  the  Fifth.] 

COKKELATIO^r   OF   FORCES. 

§  1085.  An  important  omission  was  made  in  that  part  of  our  Ap- 
pendix  which  relates  to  the  progress  of  "  physiological  and  patholog- 
ical chemistry"  (p,  779)  in  not  havmg  converted  to  our  purposes  the 
doctrine  of  the  "  correlation  of  forces,"  to  which  organic  chemistry, 
in  its  discomfiture,  is  now  appealing.*  This  fiction  is  equivalent  to  an 
abandonment  of  the  whole  ground  to  the  vital  sohdist.  It  is  a  full 
acknowledgment  that  the  powers  of  nature,  as  they  operate  in  the  in- 
organic world,  are  entirely  inappHcable  to  living  beings,  and  that  the 
assumption  has  become  necessary  that  they  are  transmuted  into  some- 
thing very  difierent,  but  Avanting  in  every  other  shadow  of  proof  than 
such  as  rests  upon  mere  analogies  observed  in  the  inorganic  world, 
and  without  any  analogies  between  organic  and  inorganic  beings. 
The  supposed  transmutation  is  therefore  claimed  by  the  vital  solidist 
as  his  vital  principle.  But,  curiously  enough,  the  chemico-vitalist,  in 
accepting  this  assumption,  contends,  also,  for  a  vital  principle.  Fi- 
nally, if  the  vital  force  be  a  "transformation  of  heat,"  electricity,  &c., 
why  is  heat,  electricity,  &c.,  so  conspicuously  manifested  as  such  in 
living  beings?  Why  not  altogether  converted  into  the  supposed 
"correlated  force?"  How  will  be  reconciled  with  the  supposed 
"  metamorphosis  of  heat  into  vital  force"  the  prodigious  elaboration 
of  absolute  heat  by  that  organic  structure  which  is  said  to  be  the 
medium  through  which  "heat  is  transformed  into  vital  force?" 
Strange  function  this,  which  is  simultaneously  engaged  in  "  trans- 
forming heat  into  vital  force"  and  generating  heat  under  its  usual 
conditions !  We  suppose  that  it  will  scarcely  be  contended  that  this 
sensible  caloric  is  also  vital  force,  notwithstanding  its  complete  sub- 
mission to  the  vitahzing  power  of  the  whole  organic  being ;  or,  if  this 
consistency  be  maintained,  the  manifestations,  by  this  product  of  or- 
ganization, of  all  the  usual  effects  of  caloric,  both  upon  dead  and  living 
matter,  equally  consign  the  speculation  to  the  same  fate  as  is  attend- 
ing the  physical  forces  in  their  less  mystified  application  to  the  sci- 
ence of  life  (^  234^,  h,  350,  nos.  16, 17, 19,  20,  21,  37,  3761, 447^  448), 
On  different  occasions,  and  sometimes  in  the  course  of  this  work 
(p.  180-190,  §  350f  e-m,  p.  910-911,  §1083),!  have  shown  that  it  is 
the  tendency  of  this  generalization  of  organic  and  inorganic  na- 
ture to  lead  to  other  violations  of  fundamental  laws,  of  which  one  of 
the  most  glaring  is  the  doctrine  of  the  spontaneity  of  living  beings, 
and,  therefore,  a  fully  implied  denial  of  a  Creative  Power — by  which 
I  mean  a  Power  totally  distinct  from  nature.  The  latter,  it  is  true, 
is  often  obtruding  itself  under  the  name  of  the  former ;  and  this,  I 
apprehend,  is  what  is  intended  to  be  implied  by  the  common  geolog- 
*  Much  of  the  present  work;  is  against  the  doctrine  of  "Correlation  of  Forces." 
The  subject  is  critically  examined  in  the  new  edition  of  mv  work  on  the  Soul  and  In- 
STiNCTiVK,  Principlic",  about  to  be  published,  1870. — See  IsTotk  Ddd  p.  1149. 


922  INSTITUTES    OF    MEDICINE. 

ical  expressions,  "the  developmental  system,"  and  "the  progressive  de- 
velopment" of  living  beings,  according  to  their  rank  in  the  scale  of  or- 
ganization. Sometimes,  indeed,  this  appears  to  be  distinctly  avowed, 
and  of  which  I  shall  present  an  example  from  a  late  geological  work  of 
good  repute  to  show  the  method  in  which  the  doctrine  oi  chance  is  tricked 
out  with  the  devices  of  "positive  science,"  but  in  opposition  to  its 
plainest  facts  and  principles.     Thus,  it  is  said  that, 

"  We  are  not  told  that  the  parturitive  powers  of  the  earth,  when 
they  first  began  to  be  exercised,  were  very  different  from  what  they 
are  now.  They  may  have  been  more  rapid  or  more  slow,  but  if  it 
Avas  a  real  physical  energy,  governed  by  law,  and  not  merely  an  arbi- 
trary sign  of  a  contra-natural  power,  it  must,  at  least,  have  had  a 
harmony  in  its  workings — such  a  harmony  as  would  have  required 
that  the  widely  varying  among  its  diversified  effects  should  bear  some 
ratio  to  the  greater  strength  or  longer  duration  in  the  cause.  It 
would  not  have  brought  out  the  full-formed,  fuU-groMTi,  and  ripened 
cedar  of  Lebanon  in  the  same  time  it  required  for  giving  hirth  to  the 
mushroom,  JSTo  intimation  is  giveii  that  the  first  groAvth,  after  the 
instantaneous  starting  powei*,  or  the  utterance  of  the  creative  Word, 
was  not  as  natural  as  any  that  followed.  We  are  rather  led  to  be- 
lieve that  this  first  growth  gave  the  laAV  to  all  subsequent  production. 
If  the  first  plants  or  trees  did  not  come  from  a  previous  organized 
seed,  the  first  seeds,  at  all  events,  grew  out  of  the  plant,  and,  as  far 
as  the  language  gives  tis  any  idea,  in  a  similar  manner,  and  by  a 
similar  law,  and  in  a  corresponding  time,  or  succession  of  times,  to 
that  which  regulated  any  subsequent  seeding,  or  ripening,  or  fructifi- 
cation of  the  parent  organism."  And,  again,  "  There  was  a  j^^'evious 
nature  in  the  eai-th,  whether  it  had  been  in  operation  for  twenty-four 
hours  or  twenty-four  thousand  years.  We  may  compare  this  to  a 
stream  flowing  on  and  having  its  regular  current  of  law,  or  regulated 
succession  of  cause  and  effect.  Into  this  stream  we  may  say  there 
was  dropped  a  new  pov'er — supernatural,  yet  not  contra-natural,  or 
unnatural — varying  the  old  flow,  and  raising  it  to  a  higher  law  and 
a  higher  energy,  yet  still  in  harmony  with  it.  New  causations,  or 
new  modifications  of  causation  arise,  and,  after  the  successions  and 
steps  required,  be  they  longer  or  shorter,  a  world  of  vegetation  is 
the  result  of  this  chain  of  causation  in  the  one  period,  and,  through 
an  analogous,  if  not  similar  process,  an  animal  creation  arose  in  anoth- 
er."— (The  italics  are  mine.) — Professor  Taylee  Lewis'  Six  Days 
of  Creation,  p.  206,  216.     1855. — See,  also,  Dabwin,  p.  814,  note.* 

Such  is  the  philosophy  of  the  "  typical"  or  "  progressive  develop- 
mental system,"  or  spontaneity  of  living  beings.  It  is  defective,  how- 
ever, in  assuming  that  the  same  "  parturitive  powers  of  the  earth" 
which  "gave  birth"  to  the  first  plants  and  animals  continue  to  ope- 
rate now — and  it  is  not  true  to  the  Sacred  Record  in  affirming  that 
— "  no  intimation  is  given  that  the  first  growth  after  the  instantane- 
ous starting  power,  or  the  utterance  of  the  creative  Word,  was  not 
as  natural  as  any  that  followed,"  and  then  explaining  away  what  is 
affirmed  of  the  first  appeai'ance  of  the  vegetable  world,  where  it  is 
most  distinctly  stated,  and  in  remarkable  consistency  with  the  creation 
of  man  and  animals  in  a  state  of  maturity,  that  "  the  Lord  God  made 
the  earth  and  the  heavens,  and  every  plant  of  the  field  before  it  was 
in  the  earth,  and  every  herb  of  the  field  before  it  grew  y  for  the  Lord 
*  See  Koi  ts  P  p,  page  1142,  Q  Q,  page  1145,  awA  foot-note  at  p.  908. 


Correlation — supplement — of  Forces.  923 

God  had  not  caused  it  to  rain  upon  the  earth,  and  there  was  not  a 
man  to  till  the  ground ;"  thus,  also,  assigning  the  reasons.  The  au- 
thor must,  therefore,  abide  by  his  own  authority.  I  may  finally  add 
that  an  examination  of  this  subject  occurs  in  my  Essay  on  Theoret- 
ical Geology ^1  to  which  reference  is  made  at  p.  908,  §  1079,  b. 

Organic  nature  is  one  of  the  greatest  embarrassments  with  which 
modern  theoretical  geology  has  been  obliged  to  contend  ever  since 
Dr.  Buckland  discovered  that  the  trilobite  is  endowed  with  eyes,  and 
it  has,  accordingly,  undergone  many  mutations  as  geologists  have  be- 
come somewhat  informed  of  the  laws  of  living  beings.  Nevertheless, 
such  is  the  hidden  nature  of  physiology,  and  not  to  be  acquired  by 
any  extent  of  anatomical  knowledge  without  a  long  and  laborious 
study  of  the  phenomena  of  living  beings,  and  in  their  morbid  as 
well  as  natural  aspects,  the  propensity  remains  to  group  the  'organic 
world  under  the  category  of  the  inorganic.  Examples  of  this  nature 
are  common  enough,  but,  to  carry  out  still  farther  one  of  the  objects 
of  the  present  section,  I  shall  qiiote  a  paragraph  from  a  work  by  the 
distinguished  Alexander  Von  Humboldt,  who,  according  to  President 
Edward  Everett,  "  owes  his  position  in  the  intellectual  Avorld  to  his 
grasp  of  the  whole  domain  of  science  and  the  majestic  range  of  his 
generalizations."  In  his  generalization  of  the  forces  and  phenomena 
of  nature,  he  undertakes,  upon  this  scheme  of  philosophy  as  applica- 
ble to  inorganic  beings,  to  bring  the  organic  world  within  the  domain 
of  that  philosophy,  a  distinct  enunciation  of  which  occurs  in  his  "  As- 
pects of  Nature." 

"  Reflection  and  continued  study  in  the  domains  of  physiology  and 
chemistry,"  says  this  learned  man, "  have  shaken  my  earlier  belief  in 
a  peculiar  so-called  vital  force.  In  1797,  at  the  close  of  my  work  en- 
titled '  Versuche,'  etc.,  I  already  declai-ed  that  I  by  no  means  regard- 
ed the  existence  of  such  peculiar  vital  forces  as  demonstrated.  Since 
that  time  I  have  no  longer  called  peculiar  forces  what  may  possibly 
only  be  the  operation  of  the  concurrent  action  of  the  several  long- 
known  substances  and  their  material  forces."  "  I  have  said,  in  '  Cos- 
mos,' '  The  myths  of  imponderable  matter  and  of  vital  forces  peculiar 
to  each  organism  have  complicated  and  perplexed  the  view  of  na- 
ture.' "  "  Fai'ther  on  in  the  same  volume  I  have  said,  '  In  a  physical 
descrii)tion  of  the  Universe,  it  should  still  be  noticed  that  the  same 
substances  which  compose  the  organic  forms  of  plants  and  animals 
are  also  found  in  the  inorganic  crust  of  the  Globe ;  and  that  the  same 
forces  or  powers  which  govern  inorganic  matter  are  seen  to  prevail 
in  organic  beings  likewise,  combining  and  decomposing  the  various 
substances,  regulating  the  forms  and  properties  of  organic  tissues, 
but  acting  in  these  cases  under  complicated  conditions.,  yet  xmexpect- 
ed  [unexplained  ?],  to  which  the  very  vague  terms  of  vital  phenom- 
ena., operation  of  vital  forces.,  have  been  assigned,  and  which  have 
been  systematically  grouped  according  to  analogies  more  or  less  hap- 
pily imagined." — p.  408-410. — Also,  Instittites,  p.  272,  §>  447  g. 

Such  is  the  opinion  of  an  imusually  vigorous  mind,  and  remarkably 
enriched  by  an  observation  of  nature ;  and  if  it  can  be  of  any  advan- 
tage to  the  cause  which  he  advocates,  it  is  welcome  to  it.  It  is  the 
high  authority  in  science  which  this  philosopher  has  so  justly  ac- 
quired, and  the  factitious  importance  which  his  opinion  of  organic  life 
derives  from  its  incorporation  in  "the  majestic  range  of  his  general- 


924  INSTITUTES    OF    MEDICINE. 

izations"  that  have  led,  in  part,  to  its  introduction  here.  But  it 
should  be  considered  that  Von  Humboldt  was  an  unprofessional  man, 
without  any  recognition  as  a  physiologist  in  the  department  of  organic 
nature,  and  that  he  was  therefore  rather  less  qualified  to  determine 
the  merits  of  the  question  than  many  others  who  had  made  it  the 
great  topic  of  professional  life,  and  least  of  all,  was  he  entitled  to  em- 
ploy his  authority  in  speaking  contemptuously  of  the  doctrine  which 
imderlies  the  labours  of  Haller,  John  Hunter,  Bichat,  his  own  friend 
John  Mviller,  and,  I  may  add,  of  every  man  of  note  in  medicine  since 
the  days  of  Hippocrates.  It  should,  moreover,  be  considered  that  this 
degradation  of  man  and  other  living  beings  formed  an  indispensable 
element  in  our  Author's  plan  of  the  generalization  of  nature.  With- 
out it,  Cosinos  could  not  have  been  written.  "  The  view  of  nature" 
would  have  been  otherwise  too  much  "  perplexed." 

Besides  the  disposition  which  I  have  always  endeavoured  to  mani- 
fest of  afibrding  the  j^hysical  school  of  organic  nature  the  opportunity 
of  explaining  their  philosoi:)hy  in  their  own  unreserved  way,  I  have 
also  in  view,  in  the  present  case,  my  oft-reiterated  proof  that  it  is  the 
tendency  of  this  generalization  of  the  forces  of  nature  to  conduct  its 
projectors  and  advocates  to  still  greater  violations  of  physiological 
laws,  since  those  laAvs  positively,  enjoin  an  ascription  of  the  "first 
origin"  of  every  existing  species  of  animal  and  plant  to  a  Supreme, 
Intelligent,  Creative  Power.  But,  since  this  is  ignored  by  the  doc- 
ti'ine  which  I  am  about  to  cite,  there  is  necessarily  an  attendant  im- 
plication that  man  and  other  organic  beings  were  "  brought  forth,"  in 
the  language  of  theoretical  geology,  "  by  the  parturitive  powers  of 
the  earth ;"  or,  as  explained  physiologically,  the  properties  impressed 
upon  matter  include  a  certain  number  of  a  vital,  "  slumbermg,"  na- 
ture (§  135  d,  250f  ci-f)j  through  which  the  requisite  17  or  18  ele- 
ments were  assembled  together,  for  every  species  of  animal  and  plant, 
which  then  united  them  into  an  almost  endless  variety  of  precise  ter- 
nary, quaternary,  &c.,  compounds,  then  arranged  them  into  a  miiltitude 
of  complex  designs,  developed  reason  and  instinct,  and  ended  by  en- 
abling man,  and  all  mammiferous  animals,  and  all  unfledged  birds,  to 
provide  sustenance  for  themselves  in  their  state  of  infancy  (§  32-57, 
350|  c-351, 1082, 1083.  Also,  Index  I.,  Articles,  Compositioti,  Struc- 
ture, Life,  Vitalism  and  Solidism,  Design,  God  and  Nature,  the  orig- 
inal Essay  on  the  So^d  and  Instinct,  p.  158-172,  being  an  Appendix 
on  the  foregoing  subject,  and  the  Essay  on  Theoretical  Geology, 
§  1079  i).*  Plere  is  the  intended  paragraph  from  Cosmos,  which  lets 
us  farther  into  the  philosophy  of  "  positive  science  :" 

"  Geographical  investigations  regarding  the  ancient  seat,  the  so- 
called  *  cradle  of  the  human  race,'  are  not  devoid  of  a  mythical  char- 
acter." Our  Author  then  quotes  approvingly  from  his  brother  Will- 
iam as  follows:  "'We  do  not  know,  either  from  history  or  from 
authentic  tradition,  any  period  of  time  in  which  the  human  race  has 
not  been  divided  into  social  groups.  Whether  the  gregarious  con- 
dition was  original,  or  of  subsequent  occurrence,  tve  have  no  historic 
evidence  to  show.  The  separate  mythical  relations  found  to  exist  in- 
dependently of  one  another  in  different  parts  of  the  earth  appear  to 
refute  the  first  hypothesis,  and  concur  in  ascribing  the  generation  of 
the  whole  human  race  to  the  union  of  one  pair.  The  general  prev- 
alence  of  this  myth  has  caused  it  to  be  regarded   as  a  traditionary 

*  I  have  shown  that  man,  mammiferous  animals,  and  birds,  must  have  been  created, 
ex  necessitate  rei,  in  a  state  of  maturity  both  of  mind  and  body. — See  Note  Pp  p.  1142, 


Correlation — supplement — of  Forces.  925 

record  transmitted  from  the  primitive  mau  to  his  descendants.  But 
this  very  circumstance  seems  rather  to  prove  that  it  has  no  historical 
foundation,  but  has  simjDly  arisen  from  an  identity  in  the  mode  of 
intellectual  conception,  which  has  everywhere  led  man  to  adopt  the 
same  conclusion  regarding  identical  phenomena ;  in  the  same  manner 
as  many  myths  have  doubtlessly  arisen,  not  from  any  historical  con- 
nection existing  between  them,  but  rather  from  an  identity  in  human 
thought  and  imagination.  Another  e\'idence  in  favour  of  the  purely 
mythical  nature  of  this  belief  is  aiforded  by  the  fact  that  the  first 
origin  of  mankind — a  phenomejtion  which  is  wholly  beyond  the  sphere 
of  experience — is  explained  in  perfect  conformity  with  existing  views, 
being  considered  on  the  principle  of  the  colonization  of  some  desert 
islatid  or  remote  mountainous  valley  at  ap>eriod  xohen  manhind  had 
already  existed  for  thousands  of  years.  It  is  in  vain  that  we  direct 
our  thoughts  to  the  solution  of  the  great  pyrohlem  of  the  first  origin., 
since  man  is  too  intimately  associated  with  his  own  race  and  with  the 
relations  of  time  to  conceive  of  the  existence  of  an  individual  inde- 
pendently of  a  preceding  generation  and  age.  A  solution  of  those 
diflacult  questions,  which  cannot  be  determined  by  inductive  reason- 
ing or  by  experience — whether  the  belief  in  this  presumed  traditional 
condition  be  actually  based  on  historical  evidence,  or  whether  mankind 
inhabited  the  earth  in  gregarious  associations  from  the  origin  of  the 
race — cannot,  therefore,  be  determmed  from  any  philological  data, 
and  yet  its  elucidation  ought  not  to  be  sought  from  other  sources.'  " 
—  Cosmos.,  vol.  i.,  p.  355,  Harper's  edition. — My  italics  (p.  158,  no.  5i). 
We  may  not  be  surprised,  therefore,  that  our  Aiithor's  generaliza- 
tion of  nature  embraces  Laplace's  doctrine  of  the  evolution  of  the 
solar  system,  and  as  inculcated  in  the  "Vestiges  of  Creation"  (p.  186, 
§  350|  A-^),  and  now  adopted,  indeed^y  many  astronomers.  The 
subject  is  invested  with  a  certain  degree  of  physiological  interest  on 
account  of  the  constitution  of  the  primary  rocks,  and  the  analogical 
reasoning  which  may  be  thence  carried  to  the  spontaneity  of  living 
beings  from  the  assumed  evolution  of  these  rocks  from  a  gaseous, 
chaotic  state,  exclusively  through  the  properties  impressed  upon  mat- 
ter. This  I  have  endeavoured  to  expound  in  my  Essay  on  Theoret- 
ical Geology,  and  I  recur  to  the  subject  now  for  the  purpose  of  show- 
ing the  ha^-mony  with  which  Cosmos  has  carried  out  the  generaliza- 
tion of  nature,  and  of  giving  to  its  system  all  the  advantages  that  can 
inure  from  such  consistency,  or,  on  the  other  hand,  of  enabling  it  to 
accept,  as  graciously,  the  penalties  of  any  defects,  and  thus  subserve, 
in  either  case,  some  of  the  greatest  truths  and  principles  in  nature  and 
Religion.  The  following  extract  embraces  the  doctrine :  when  speak- 
ing of  the  origin  of  aerolites,  he  says, 

"  I  would  ask  why.  the  elementary  substances  that  compose  one 
group  of  cosmical  bodies,  or  one  planetary  system,  may  not,  in  a  great 
measure,  be  identical  ?  Why  should  we  not  adopt  this  view,  smce 
we  may  conjecture  "that  these  planetary  bodies,  like  cdl  the  larger  or 
smaller  agglomerated  masses  revolving  round  the  sun,  have  been 
thrown  off  from  the  once  far  more  expanded  solar  atmosphere,  and 
been  formed  from  vaporous  rings  describing  their  orbits  round  the 
central  body."— Cosmos,  vol.  i.,  p.  132.— Note  Pp  p.  1142. 

It  is  not  now  my  purpose  to  discuss  the  merits  of  the  3Iosaic  His- 
tory of  Creation,  as  this  is  not  the  place,  and,  moreover,  I  have  done 


926  INSTITUTES    OF    MEDICINE. 

that  in  the  Essay  on  Theoretical  Geology.  But  it  is  appropriate  to 
remark  that  if  the  want  of"  experience''  disqualifies  us  for  judging  of 
the  "  first  origin  of  mankind,"  as  intimated  in  one  of  the  foregoing 
quotations,  and  if  Ave  do  not  choose  to  accept  the  accomit  of  Revela- 
tion as  "  historical,"  it  is  highly  incumbent  upon  physiological  science 
to  declare  that  the  laws  of  nature  utterly  contradict  the  doctrine  that 
organic  beuigs  were  evolved  by  those  laws,  and  that  they  therefore 
])roclaim  their  dependence  upon  an  Intelligent,  Creative  Power.  In 
the  former  case  we  have  an  ample  amount  of"  experience,"  and  if  the 
latter  be  admitted,  all  nature  ceases  at  once  to  be  mysterious  (§  4^ 
5),  and  mystery  associates  itself  with  God  alone.  This  doctrine  of 
"  experience,"  it  must  be  allowed,  has  been  carried  to  the  same  sub- 
ject by  distinguished  physiologists  (§  350f  Z),  but  it  is  as  applicable 
to  all  the  miracles  and  prophecies  of  the  Old  Testament,  and  to  all 
the  most  essential  means  upon  which  the  authenticity  of  Christianity 
depends,  as  to  the  origin  of  mankind ;  and  it  Avould  be  quite  as  fatal 
in  science,  and  even  in  the  ordinary  pursuits  of  man,  as  it  is  to  Relig- 
ion. It  is  even  possible  that  Humboldt  would  not  have  won  laurels 
in  America  had  it  not  been  for  the  inductive  philosophy  of  Columbus. 
Our  Author  appropriates  in  Cosmos  the  histoi'ical  facts  of  the  Old 
Testament  so  fiir  as  they  relate  to  simply  human  affairs,  because  it 
alone  informs  us  of  that  era  of  mankind,  and  this  information  was  im- 
portant to  Cosmos ;  and  herein  lies  the  distinction  between  that  ex- 
perience which  is  so  readily  accepted  on  the  mere  testimony  of  man, 
and  that  in  which  man's  agency  is  associated  with  Divine  interposi- 
tion, till  it  finally  culminates  in  the  distinction  between  experience 
fmdi  faith  in  their  abstract  relations.*  A  trust,  therefore,  in  the  mere- 
ly historical  facts  of  the  Bible  (for  our  Author  has  been  defended 
uj)onthis  principle),  is  no  propf  whatever  of  a  belief  in  Revelation,  or 
in  its  Author — no  more  so  than  the  Jew's  trust  in  the  biography  of 
our  Lord,  as  it  respects  His  humanity,  is  a  proof  that  he  is  a  Christian. 
It  is  not  unusual,  indeed,  for  the  mere  Pantheist  to  emjiloy  the  term 
creator  as  a  sort  of  compromise  with  the  Theist,  and  even  to  make 
professions  of  Christianity.  But  this  has  signally  failed  after  the  day 
of  novelty,  and  personal  influence,  and  mutual  admiration  has  ceased, 
and  the  authors  and  actors  have  passed  into  history.  Injustice  is 
sometimes  done,  as  was  remarkably  the  case  with  the  Meligio-Medici, 
for,  although  it  abounds  throughout  with  evidences  of  the  highest 
order  of  faith,  yet  its  author  incurred  the  charge  of  infidelity ;  and 
more  than  fifty  years  after  his  death,  Avhen  time  had  extinguished 
animosities,  Samuel  Johnson  thought  it  necessary  to  contribute  the 
Aveight  of  his  mind  and  character  to  the  just  cause  of  rescuing  the 
Author's  memory  from  this  imputation,  notwithstanding  Browne  had 
made  an  able  defence  of  himself.  But  it  shows  the  strong  course  of 
reason  in  its  deliberations  upon  doctrines  and  professions. 

Fmally,  besides  the  great  question  of  the  identity  of  the  forces  and 
laws  of  organic  and  morganic  beings,  the  remaining  object  of  the 
present  discussion  has  been  equally  in  behalf  of  scientific  interests,  es- 
pecially physiological ;  for  nothing  can  be  more  opposed  to  the  "  ex- 
perience" upon  which  are  founded  the  facts  and  principles  in  physi- 
ology than  the  assumed  or  implied  origin  of  living  beings  in  the 
forces  which  rule  the  inorganic  world ;  and  coming  to  the  intricate, 
but  methodical  constitution  of  the  primary  rocks,  the  evidence  of  a 

*  He  saj's  in  a  letter  to  Varnhagen — "  Possibly  my  '  Book  of  Nature'  is  not  sufficient- 
ly Christian  for  her  Majesty,"  Victoria.—ZeWers,  &c. 


Correlation — supplement — of  Forces.  927 

direct  interposition  of  Creative  Power  in  their  formation  is  as  palpa- 
ble  as  in  living  beings,  as  manifested  in  the  assembling  of  the  numer- 
ous elements  which  compose  the  crystalline  constituents,  and  in  the 
methodical  disposition  of  the  three  crystals  in  the  bosom  of  each  other 
which  make  up  all  the  granite  of  the  globe ;  or,  if  sometimes  the  three 
be  united  with  a  fourtli,  or  that  fourth  replace  one  of  the  three  in 
other  granitic  rocks,  the  same  methodical  arrangement  obtains ;  all 
of  which,  with  other  characteristics,  concur  in  yielding  the  same  kmd 
of  testimony  of  supernatural  dependence  as  the  composition  and 
structure  of  livmg  objects,  however  probable  it  be  in  the  former  case 
that  there  was  a  subordinate  instrumentality  of  the  forces  and  laws 
impressed  upon  matter ;  while,  also,  the  nebular  hypothesis,  and  ev- 
ery other  shape  of  the  Plutonic  doctrine,  is  absolutely  contradicted  by 
the  water  w^iich  enters  into  the  composition  of  the  primary  rocks,  by 
the  uniform  absence  of  all  traces  of  fusion  among  the  crystals,  and 
especially,  also,  by  the  vast  differences  in  temperature  at  which  those 
crystals,  and  that  water,  and  the  numerous  metallic  substances,  im- 
dergo  condensation,  besides  an  array  of  other  facts  whose  introduc- 
tion here  Avould  be  inappropriate,  but  which  I  have  considered  exten- 
sively in  the  Essay  on  Theoretical  Geology.  Here,  therefore,  is  some- 
thing for  the  senses,  something  from  "  experience,"  something  demon- 
,  strable  through  the  estabhshed  facts  and  laws  in  chemistry  and  phys- 
ics. Still,  however,  it  is  certainly  to  be  expected  that  all  who  neglect 
the  facts  which  declare  the  "first  origin"  of  man  and  other  living  be- 
ings in  an  Intelligent,  Creative  Power,  and  refer  their  origin  to  the 
powers  of  nature,  will  unhesitatingly  ignore  the  corresponding  facts 
in  their  relation  to  the  earth,  and  assemble  the  whole  under  a  com- 
mon generalization.  A  critical  attention,  also,  to  the  writings  of 
those  who  sustain  the  nebular  hypothesis  will  result  in  the  conviction 
that  they  are  equally  pledged  to  the  doctrhie  of  the  evolution  of  or- 
ganic nature  through  the  powers  alone  which  appertain  to  matter. 

Science,  for  its  own  sake,  especially  physiological  science,  should 
be  consistent  with  itself.  Nor  may  we  exclude  from  the  interests  of 
the  latter  the  cosmogony  of  the  nebular  hyjDothesis,  for,  as  I  have 
shown,  such  is  the  elementary  composition  of  the  primary  rocks 
(seven  elements  for  feldspar,  ten  for  mica,  and  which,  according  to 
the  nebular  hypothesis,  must  have  existed,  along  wuth  all  other  terres- 
trial things,  in  a  perfectly  blended  condition),  and  such  the  imiform- 
ity  and  arrangement  of  the  crystalline  substances,  and  such,  there- 
fore, the  ground  for  analogical  reasoning,  that  were  it  conceded  that 
the  main  bulk  of  the  earth  was  brought  into  its  organized  condition 
by  its  own  properties  alone,  it  would  be  a  vain  attempt  to  refute  the 
doctrine  of  the  spontaneity  of  living  beings  by  any  demonstrations 
founded  on  their  elementary  composition  and  constituent  parts.  To 
assume,  as  does  the  nebular  hypothesis,  and  that  of  the  spontaneity 
of  living  bemgs,  that  the  elements  of  matter  were  endowed  with  the 
independent  power  of  generating  their  organized  conditions,  is  so 
contrary  to  all  experience  (for  the  artificial  production  of  crystals,  or 
as  witnessed  in  natural  progress,  bears  no  proper  analogy  to  the  com- 
plexity of  the  primary  rocks),  that  it  supposes  a  condition  of  things 
which  is  equivalent  to  Creative  Energy.  It  is  an  illusion,  therefore, 
to  imagine  that  science  divests  itself  of  causes  that  elude  its  ambitious 
grasp  by  assuming  that  "  blind  material  forces"  will  explain  the  origin 


928  INSTITUTES    OP    MEDICINE. 

of  both  living  beings  and  the  primary  crystalline  rocks,  since,  in  either 
case,  it  demands  a  condition  of  forces  and  laws  which  experience  as- 
sures us,  and  science  admits,  does  not  exist  at  present ;  or,  if  it  be 
content  with  a  simple  expression  of  ignorance  of  the  organizing 
causes,  from  "  want  of  experience,"  it  is  equally  an  admission  that 
terrestrial  beings  originated  in  causes  which  have  no  existence  now, 
and  therefore  not  belonging  to  the  constitution  of  nature.  The  plea 
of  a  "  want  of  experience"  simply  means  that  the  causes  which  gave 
origin  to  organic  nature  and  the  primary  rocks  ceased  their  operation 
before  the  observations  of  men  began.  They  have  therefore  no  lon- 
ger an  existence;  otherAvise,  they  would  continue  to  operate,  and 
new  animals  and  plants,  if  not  granitic  rocks,  &c.,  would  be  present- 
ing themselves.  Science,  therefore,  in  separating  from  Supernatural 
Power  convicts  itself  of  inconsistency ;  and  the  essential  difference 
between  the  supposed  "  parturitive  power,"  and  the  co-operation  of 
Divine  Power  with  the  properties  impressed  upon  matter,  in  ex- 
pounding the  problem  before  us,  whether  it  respect  the  organization 
of  the  earth  or  of  living  beings,  consists  in  the  neglect,  in  the  former 
case,  of  all  the  evidences  of  Design,  and  in  a  disposition  to  lean  upon 
the  atheism  of  pantheism.  But  this  in  no  respect  compasses  the  ab- 
stract object  of  the  disciples  of  nature,  for  there  still  remains  the 
crushing  fact  that  it  is  contrary  to  all  "  experience,"  to  all  that  is 
known  of  nature,  to  sujjpose  that  living  beings,  or  the  primitive 
earth,  emerged  from  the  elements  of  matter  without  at  the  same  time 
supi^osing  that  some  supernatural  agency  was  concerned  in  the  works. 
In  the  one  case,  therefore,  science  stultifies  itself,  while,  in  yielding 
to  the  agency  of  an  Intelligent  Creative  Power,  it  simply  obeys  the 
exigencies  of  the  facts  and  the  dictates  of  that  reason  which  j^roftsses 
to  be  a  rude  imitator  of  some  of  the  Designs  which  challenge  its  faith 
in  a  higher  order  of  Reason  (^  350f /-z,  I,  1079  h,  1083).* 

The  Glycogenic  Function  of  the  Liver. 

§  1086.  Among  the  subjects  discussed  in  the  Aj^pendix  to  this 
work  is  the  important  one  of  the  supposed  glycogenic  function  of  the 
liver.  Had  this  anomalous  complication  of  functions,  with  all  its 
other  attendant  joeculiarities,  been  attributed  to  the  liver  only,  it 
would  have  been  more  diflicult  to  have  arrived  at  the  real  facts  in 
the  case.  But  the  discoverer  has  recently  not  a  little  invalidated  the 
plausible  experiments  which  had  conducted  him  to  his  conclusions  by 
assigning  this  same  function  to  the  placenta  "  during  the  early  period 
of  foetal  life."  This  appears  to  have  been  a  kind  of  corollary  from 
the  imputed  function  of  the  fully-develoijed  liver  and  its  immaturity 
during  the  early  period  of  foetal  life,  but  resting  upon  experimental 
observation.  That  such  a  coincidence  should  exist  between  two  or- 
gans so  differently  constituted,  and  whose  principal  offices  are  so  dis- 
similar in  the  economy  of  life,  may  well  raise  our  admiration ;  and 
this  the  more  so,  as  the  glycogenic  function  of  the  placenta  is  said  to 
disappear,  along  with  its  special  anatomical  provision,  as  soon  as  the 
foetal  liver  has  advanced  to  a  maturer  development.  Nature,  there- 
fore, to  be  consistent  in  this  remarkable  scheme,  should  have  allotted, 
also,  to  "the  transitory  glandular  or  epithelial  element  of  the  pla- 
centa," as  to  the  mature  liver,  the  vicarious  function  of  secreting 
bile;  and  hence,  should  the  glycogenic  function  be  established,  and 
*  See  NoTKs  Pp  p.  1142,  Qq  p.  1145. 


Cause  of — supplement — Blood's  fluidity.  929 

the  exact  disappearance  of  the  glandular  element  Avhen  it  is  no  longer 
necessary  to  the  exigencies  of  fcetal  life,  we  may  expect  to  hear  from 
the  eminent  physiologist  that  he  has  demonstrated  the  co-existence 
of  the  tAVO  hepatic  functions  in  the  placenta.  But  the  original  sup- 
position relative  to  the  liver  was  apparently  encumbered  with  diffi- 
culties, as  was  shown  in  sections  1031-1033,  and  the  "vicarious"  na- 
ture of  the  supposed  temporary  office  of  the  placenta  Avoiild  seem  to 
belong  to  the  category  of  the  "  vicarious  spermatozoa,"  as  represent- 
ed in  section  83  b,  or  to  what  is  perhaps  more  analogous  in  §  493  c. 

The  Cause  of  the  Blood'' s  Fluidity. 

§  1087.  It  Avas  a  very  ingenious,  and  so  far  as  appearances  went, 
a  plausible  demonstration  of  Dr.  Richardson's,  in  his  prize  essay,  that 
the  blood  owes  its  fluidity  to  the  presence  of  ammonia.  This  is  a 
question,  however,  not  to  be  determined  by  chemical  exiDcriments,  or 
by  any  other  outside  of  the  living  body.  If  experiments  with  j)ep- 
sin,  or  the  "  digestive  mixture,"  could  not  stand  the  test  of  organic 
philosophy,  nor  even  of  experimental  philosophy  (p.  781,  §  1029), 
it  was  scarcely  probable  that  those  would  long  endure  by  which 
the  new  doctrine  of  the  blood's  fluidity  was  very  plausibly  com- 
mended to  the  attention  of  the  physiological  world ;  and  the  only 
ajsparent  objection  about  it  was,  that  it  did  not  insist  that  the  heart 
and  blood-vessels  are  stimulated  into  action  by  the  solvent  princij^le 
of  the  blood.  It  may  have  been  foreseen  that  such  a  theory  would 
imply  great  fluctuations  beyond  the  standard  frequency  of  the  pulse, 
according  to  the  variable  proportions  of  ammonia.  But  it  is  at 
least  certain  that,  whenever  such  experiments  have  been  attempt- 
ed upon  this  organic,  living,  complex  fluid,  whatever  their  nature, 
they  have  been  shown  to  be  fallacious,  and  such  has  been  the  early 
fate  of  this  new  hypothesis  in  the  hands  of  Briick  and  Zimmermann, 
the  former  particularly  sustaining  the  Hunterian  theory  that  the 
fluidity  is  owing  to  a  vivifying  influence  exerted  upon  the  blood  by 
the  sanguiferous  organs,  while  the  latter  very  justly  supposes  that 
the  coagulation  of  abstracted  blood  is  due  to  chemical  transforma- 
tions. These  transformations  are  prevented,  while  the  blood  is  cir- 
culating, by  the  influences  of  the  blood-vessels  which  maintain  its 
vitality.  When  those  influences  are  withdrawn,  the  oxygen  and 
other  elements  of  the  fluid  pass  very  quickly  under  the  operation  of 
chemical  affinities,  as  set  forth  in  section  54  a.  I  may  finally  add 
that,  when  the  various  characteristics  of  the  blood,  such  of  them  as 
are  represented  in  many  parts  of  this  work,  as  in  sections  688  ee, 
846,  847,  952,  953,  are  duly  considered,  it  must  be  admitted  that  such 
phenomena  evince  the  dependence  of  the  blood's  fluidity  upon  a  cause 
appertaining  to  the  constitution  of  the  blood  itself,  while  other  ob- 
vious considerations  place  it  beyond  doubt  that  so  important  a  con- 
■dition  of  the  pahulu^n  vitm  is  not  committed  to  the  physical  action 
of  any  one  of  its  constantly-fluctuating  constituents ;  for  if  ammo- 
nia be  truly  one  of  them,  it  must  be  as  liable  to  variations,  at  least 
in  proportions,  as  the  serum,  globules,  etc.,  and  the  fluidity  of  the 
blood,  therefore,  exposed  to  the  same  instability.  Richardson's  clever 
observations  have  been  accepted  by  other  physiologists ;  but  they 
are  a  part  of  the  "  experimental  philosophy"  of  the  day,  whose  facti- 
tious analogies  have  been  so  extensively  and  powerfully  arrayed 


930  INSTITUTES    OF    MEDICINE. 

against  the  great  laws  of  organic  beings,  and  tlie  subject  is  intro- 
duced here  as  tributary  to  the  objects  of  these  Institutes. — See  Hu- 
moral Pathology,  Index  II. 

THE    MODUS    OPERANDI    OF    REMEDIES. 

§  1088  a.  As  principles  and  sound  analogy,  the  great  ends  of  sci- 
ence and  the  basis  of  the  healing  art,  are  of  very  secondary  mo- 
ment Avith  the  speculative  as  "svell  as  the  practical  masses  of  man- 
kind, a  demand  is  apt  to  be  made  for  specific  demonstrations  of 
every  problem  that  may  arise  in  the  vast  range  of  observation.  It  is 
not  enough,  for  example,  that  it  be  shown  of  a  thousand  things  that 
they  exert  their  morbific  or  remedial  eftects  through  natural  physio- 
logical laws,  and  that  when  their  influences  extend  to  parts  remote 
from  the  seat  of  their  application  it  is  through  the  medium  of  the 
nervous  system.  Each  particular  fact  must  be  settled  experimentally 
as  if  it  had  no  law  govei'iiing  its  condition.  This  propensity  must  be 
gratified,  and  it  Avill  doubtless  end,  also,  in  satisfying  all  that  organic 
nature  is  perfectly  consistent,  throughout  its  mutations,  in  all  its  laws 
and  principles. 

The  foregoing  considerations  lead  me  into  a  farther  proof  that  cer- 
tain substances,  particularly  arsenic  and  strychnine,  Avhich  are  sup- 
posed to  exert  their  eftects  by  absorption,  have  been  again  shown  to 
be  incapable  of  detection  within  the  organism  when  administered  in 
poisonous  doses.  Two  cases  of  this  nature,  where  large  quantities  of 
strychnine  (two  scruples  in  one  of  them),  and  six  experiments  upon 
animals  by  poisoning  with  the  same  substance,  are  related  by  Dr. 
Alfred  S.Taylor  in  Guy's  Hospital  Reports  (1856,  vol.  ii),  in  which 
none  of  the  poison  could  be  detected  in  the  blood  or  tissues.  Another 
case  is  related  in  the  same  Reports  (1857,  vol.  iii),  in  which  Prof. 
Christison,  and  Dr.  Maclagan  of  Edinburgh,  and  Prof  Geoghegan  of 
Dublin,  to  Avhom  parts  of  the  body  were  sent,  and  Dr.  Taylor,  failed 
of  detecting  the  })oison.  Here  occurs,  also,  the  case  of  Rev.  Dr.  Alex- 
ander, who  died  from  poisoning  by  arsenic,  but  in  whom  none  of  the 
metal  could  be  found. 

Absorption  by  the  Skin. 

§  1088  b.  Experiments,  also,  showing  that  the  skin  in  its  natural 
condition  absorbs  nothing,  even  in  a  state  of  solution,  continue  to  be 
multiplied  ;  and  yet  we  are  constantly  told  in  the  books  that  remedies 
applied  to  this  organ  produce  their  eftects  by  absorption  into  the  cir- 
culation. Let  us  have,  therefore,  some  of  the  late,  reiterated  experi- 
ments in  reference  to  this  question.  Thus,  it  is  stated  m  the  report 
on  Physiology  in  the  London  Medico- Chinirgical  Meview  for  Jan., 
1857,  that, 

"  The  inferences  regarding  the  absorption  of  saline  or  organic  sub- 
stances dissolved  in  water  (in  Duriau's  experiments  vdXh  the  Avarni- 
bath)  are  based  on  the  examination  of  the  urine  before  and  after  the 
use  of  the  bath.  Iodine  and  ferrocyanide  of  potassium,  carbonate  of 
potash,  sulphate  of  quinia,  and  other  salts,  were  employed.  The  re- 
action of  the  urine  after  the  bath  Avas  always  alkaline,  even  Avhen 
nitric  ac/fHiad  been  added  to  the  bath.  Potash  and  soda  Avere  the 
only  bases  found  in  the  urine — no  trace  of  iodine,  cyanogen,  ttc. 

"Poulet  draAvs  the  folloA\Thg  inferences  from  his  experiments:  1. 


Modus  operandi — supplement — of  Remedies.  931 

That  the  urine  becomes  alkaline  after  acid,  as  Avell  as  after  alkaline 
baths.  2.  After  friction  of  the  skin  with  a  solution  of  tartrate  of  an- 
timony or  extract  of  belladonna,  &c.,  none  of  these  substances  Avere 
found  in  the  urine.  3.  The  skin  absorbs,  therefore,  neither  water  (?) 
nor  substances  dissolved  in  it,  as  long  as  the  epidermis  is  entire. 

"  Kletzinsky's  experiments  likewise  confirm  the  non-absorption  of 
salts  through  the  healthy  epidermis." — See  Index  11.^  Articles  Hu- 
iiORAL  Pathology,  Skix,  Cold,  Counter-IrPvItants,  Setox,  Plas- 
ters, Remedies.     Also,  Experiments,  §  481-484,  494  h-e, 

§  1088  c.  It  is  worthy  of  remark,  however,  that  experiments  of  the 
foregoing  negative  character  have  little  influence  upon  doctrines  of 
so  much  simplicity,  and  of  such  comprehensive  and  ready  application 
in  pathology  and  therapeutics  as  humoralism  and  the  operation  of 
remedies  by  absorption.  It  therefore  continues,  as  ever,  to  be  a  pre- 
vailing belief  that,  among  other  things,  the  numerous  preparations  of 
mercury  are  absorbed  both  by  the  skin  and  the  intestinal  canal,  and, 
entering  the  circulation,  not  only  thus  accomplish  their  effects,  but  be- 
come deposited  in  the  tissues  (§  851).  Thus  lodged  in  the  system, 
they  are  supposed  to  inflict  the  manifold  evils  that  are  due  to  vicious 
habits,  or  other  foreign  causes.  But  the  most  curious  circumstance 
attending  this  hypothesis,  and  which  must  not  be  omitted  in  this  rec- 
ord of  "  experimental  philosophy,"  a  practice  has  obtained  extensive- 
ly of  immersing  these  subjects  in  iodine  baths,  for  the  purjiose  of  dis- 
lodging the  supposed  offender.  But  the  facts  being  against  the  phi- 
losophy, at  least  as  it  respects  the  skin,  and  as  iodine  baths  have  been 
said  to  effect  the  liberation  of  mercury  from  the  system  at  long  inter- 
vals after  the  administration  of  the  latter  remedy,  we  may  safely  con- 
clude that  what  has  been  asserted  by  Professor  Lorinser,  and  others, 
of  a  similar  effect  by  the  internal  use  of  iodine,  is  equally  a  mistake, 
especially  when  connected  with  the  various  facts  which  I  have  alleged 
against  the  supposed  absorption  of  mercury. 

Nevertheless,  it  may  be  said  that  negative  facts  cannot  contradict 
the  affirmative.  But,  in  the  first  place,  are  the  affirmative  reliable 
(§  5^-6)  ?  Are  not  the  senses  apt  to  be  deceived  by  preconceived 
hypotheses  ?  Why,  if  many  remedies  of  a  very  irritating  nature  op- 
erate by  absorption,  do  they  not  manifest  their  action  upon  the  heart 
as  readily  as  upon  organs  that  are  incomparably  less  irritable  (§  829)  ? 
Is  not  this  consideration  alone  an  insuperable  objection  to  the  hypoth- 
esis of  absorption  ?  If  it  be  answered  that  reflex  actions  of  the  nerv- 
ous system  excited  by  remedial  agents  should,  in  conformity  with  the 
principles  which  I  have  advanced,  be  equally  liable  to  aflfect  the  heart, 
it  would  only  evince  an  ignorance  of  the  most  obvious  laws  of  the 
nervous  system,  and  which,  in  this  aspect  of  their  remarkable  charac- 
teristics, I  have  endeavoured  to  illustrate  in  former  sections  (§  233| ; 
500y,  it,  m,  &c.).  The  wonderful  endowment  of  the  nervous  system  by 
which  it  receives  and  reflects  impressions  upon  particular  parts  and 
avoids  all  other  parts,  according  to  the  nature  of  the  exciting  cause 
and  other  special  circumstances,  readily  explains,  and  can  alone  ex- 
plain, the  phenomenon  in  question,  especially  considering  its  remark- 
able frequency.  And  here  I  may  add  to  what  I  have  said  of  the  op- 
eration of  ansesthetics  through  reflex  action  of  the  nervous  system, 
that  the  law  of  elective  influence  (§  233|,  500  J,  X;,  &c.)  explains  com- 
pletely the  limitation  of  their  effects  to  the  organs  of  animal  life,  while 


932  INSTITUTES    OF    MEDICINE. 

the  doctrine  of  absorj^tion  is  contradicted  by  that  limitation  (§  827  5, 
1066),  as  is  the  doctrine  in  its  broadest  sense  by  local  diseases. 

Finally,  the  foregoing  negative  observations  (§  1088  a,  h)  are  as 
good,  at  least,  as  the  affirmative ;  and  since,  therefore,  it  is  thus  shown 
that  many  remedies  that  have  been  supposed  to  always  operate  by 
absorption  do  sometimes  produce  their  effects  upon  various  parts 
without  being  taken  into  the  circulation,  and  therefore  by  no  other 
conceivable  method  than  that  which  I  have  indicated,  the  consistency 
of  the  laws  of  nature  is  such  as  to  assure  us  that  the  same  remedies 
always  exert  their  eflects  upon  parts  remote  from  their  seat  of  appli- 
cation through  alterative  influences  of  reflex  action  of  the  nervous 
system,  and  that,  if  they  be  sometimes  absorbed,  the  present  and  fore- 
going considerations,  as  well  as  a  multitude  of  others  which  occur  in 
this  work,  equally  assure  us  that  they  are  admitted  in  such  small 
quantities  as  to  produce  no  efi'ect  whatever,  not  even  upon  the  very 
irritable  heart.  (See  Index  II.,  Ai-ticles  Remedies,  Reflex  Actio:n^, 
Nervous  Power,  &c.) — Note  Aaa  p.  1146. 

Transfusion  of  Remedies  into  the  Circidation. 
§  1088.  d.  The  foregoing  sections  upon  absorption  will  remind  some 
of  our  readers  of  an  experiment  performed  a  few  years  ago  by  Prof. 
Buckheim,  of  uijecting  a  solution  of  about  half  an  ounce  of  sulphate 
of  soda  in  two  ounces  of  water  into  the  jugular  vein  of  two  dogs 
Avithout  any  efiect  upon  the  intestine,  while  both  animals  were  purged 
freely  by  the  same  dose  when  administered  by  the  mouth.  The  dem- 
onstration is,  of  course,  conclusive  against  the  prevailing  doctrine  of 
operation  of  cathartics  by  absorption,  and  jjroves  that  they  exert 
their  direct  efifects  upon  the  mucous  coat  of  the  intestine,  and  by  re- 
flex action  of  the  nervous  system  upon  the  muscular  coat,  and  ujDon 
all  other  parts  that  may  feel  their  influence.  In  the  present  case 
there  is  not  only  the  assurance  arising  from  the  foilure  of  the  injected 
substance  to  excite  the  slightest  action  in  the  intestinal  canal,  but  the 
interpretation  supplied  by  the  exciting  efiect  of  the  nervous  influence 
Avhen  reflected  upon  the  intestinal  muscular  tissue  through  the  direct 
irritation  of  the  mucous  when  the  cathartic  was  swallowed ;  since,  no 
action  being  manifested  in  the  case  of  the  injection,  all  the  results 
from  swalloAving  the  agent  must,  of  necessity,  be  referred  to  the  same 
causation  that  increased  the  peristaltic  movements  (§  889  a).  But 
these  are  facts  which  lie  in  the  depths  of  philosophical  medicine.  To 
be  duly  appreciated  there  must  have  been  a  laborious  study  of  the 
profound  laws  in  physiology,  especially  such  as  are  relative  to  the 
nervous  system  in  its  coimection  with  organic  functions.  In  any 
event,  the  experiments  cannot  fail  of  estabhshing  the  conviction  that 
remedies  do  not  operate  by  absorption,  and  sustain  my  conclusions 
as  to  the  fallacious  nature  of  this  kind  of  "  experimental  philosophy" 
(§  830-837).  Also,  Index  II.,  Articles,  Cathartics;  Oil,  Castor; 
Humoral  Pathology.) 

AbsorjJtion  tliroucjli  the  Epithelial  Cells  of  the  Intestinal  Tube,  and 
Lacteal  Circidation. 

§  1089.  The  folloAving  observations,  so  far  as  they  go,  corroborate 
the  doctrines  in  this  work  (§  275-294,  &c.),  and  in  the  Medical  and 
Physiological  Commentai-ies,  upon  the  subject  of  endosmose  and  ex- 


Absorption  by — supplement — Epithelial  Cells.  933 

osmose,  and  more  particularly  the  manner  in  which  substances  are 
taken  up  by  the  absorbents. 

"  Von  Wittich,"  says  the  London  Medico-Chirurgical  Review  for 
July,  1857,  "contributes  an  observation  of  great  importance  regard- 
ing the  question  at  issue  (the  passage  of  solid  molecules  through  the 
epithelial  cells  of  the  intestinal  tube).  A  rabbit  killed  (by  bleeding) 
six  hours  after  it  had  been  bitten  in  the  back  by  a  dog,  and  thus  de- 
prived of  the  use  of  his  posterior  limbs,  exhibited  the  chyliferous 
vessels  originating  from  the  lower  half  of  the  ileum  filled  with  an  en- 
tirely red  fiuid.  This  redness  was  shown  to  be  caused  merely  by  the 
admixture  of  the  red  blood-globules  in  a  large  proportion,  not  by  that 
of  coloring  matter.  The  corresponding  part  of  the  intestinal  tube 
contained  mucus  mixed  with  blood,  after  the  removal  of  which  the 
mucous  membrane  manifested  the  ajipearance  of  fine  red  dots,  which, 
by  means  of  a  lens,  were  recognized  as  villi  filled  with  blood.  Yon 
Wittich  does  not  hesitate  to  explain  this  state  of  things  by  adopting 
the  view,  that  the  blood-globules  pass  as  such  through  the  epithelial 
cells  and  the  parenchyma  of  the  villi  into  the  chyliferous  vessels ;  but 
is  of  a  similar  opinion  regarding  the  entrance  of  fat  and  other  mi- 
nutely divided  solid  substances  into  the  absorbent  vessels."  He 
found  the  same  true,  also,  of  the  chyliferous  vessels  of  the  caecum. 

The  foregoing  observations  had  been  recently  made  by  others,  one 
of  whom  I  shall  quote  upon  the  particular  question,  for  the  sake  of 
other  facts,  as  related  in  the  Med.  Chir.  Bev.  for  January,  1854. 

"  Briicke  states,  as  the  result  of  his  observations  and  experiments 
(on  man,  swme,  and  other  mammalia),  that  the  cylindrical  epithelial 
cells  of  the  mucous  membrane  of  the  intestmes,  through  which  the 
chyle  i^asses  on  its  way  to  the  lacteal  vessels,  do  not,  as  is  generally 
supposed,  consist  of  a  closed  cavity  surrounded  by  a  complete  mem- 
brane, but  that  this  cavity  is  isolated  from  the  intestinal  tube  merely 
by  a  thin  layer  of  a  mucilaginous  substance.  Briicke  asserts  also  that 
they  possess  a  small  opening  on  their  opposite  side,  through  which 
the  molecules  of  fat  pass  into  the  interior  of  the  villi"  (§  295).  And 
he  goes  so  far  as  to  say  that  one  of  "  the  mechanical  means  for  the 
movement  of  the  chyle  is  the  muscular  contractions  of  the  intestinal 
tube  by  which  the  chyle  is  pressed  into  the  villi."  Why  not,  then, 
other  tinngs  "  pressed  in  ;"  and  is  not  the  analogy  supplied  by  plants 
of  some  application  here?  (§  289-291,  p.  166,  §350,  nos.  26^,  2V,  the 
parallel  columjis,  826  a.)  It  is  an  important  and  sound  conclusion, 
however,  and  in  which  Von  Wittich  and  Moleschott  agree  A^dth 
Briicke,  in  opposition  to  the  prevailing  doctrine  (§  1054-1055),  that, 
"When  the  villi  are  filled,  their  muscular  fibres  contract,  and  the 
fluid  they  contain  is  jiressed  into  the  channels  l}^ng  between  the  mu- 
cous and  submucous  membranes,"  and  that, "  from  the  lacteals  with- 
in the  Avails  of  the  intestmes  the  chyle  is  propelled  by  means  of  the 
muscular  contractions  of  the  tubes  into  the  vessels  of  the  mesentery, 
from  Avhence  it  is  pumped  up  by  means  of  the  respiratory  actions 
into  the  thoracic  duct;"  or  rather,  as  I  have  endeavoured  to  show, 
"  pumped  up"  by  the  derivative  or  suction  power  of  the  right  cavi- 
ties of  the  heart.  {Indexes.,  Cieculatioi^  of  the  Blood,  Lacteals, 
Veins.) 

In  all  the  discussions  upon  the  foregoing  subject  Ave  hear  nothing 
of  the  intestinal  A^eins  being  concerned  in  the  function  of  absorption, 


934  INSTITUTES    OF    MEDICINE. 

although  this  is  as  mucli  a  matter  of  general  belief  as  in  Magendie's 
day  (269,  829). 

Doubtless,  the  essential  fact  relative  to  the  intestinal  villi  was  well 
ascertained  by  Mr.  Cruikshank,  in  the  presence  of  Mr,  Hunter,  whose 
statement  I  quoted  in  the  Med.  and  Physiolog.  Comni.  (1840),  that 
they  had  seen  the  villi  distended  with  chyle,  and  had  no  difficulty  in 
f-eeiug  the  open  orifices.  I  shall  also  repeat  here,  for  pathological  as 
well  as  physiological  purposes,  a  quotation  which  I  made,  in  the  arti- 
cle upon  Endosmose  and  Exosmose  (vol.  i.),  from  R.  Jackson  on 
Febrile  Diseases.  Thus :  "  R.  Jackson,  in  speakmg  of  the  enlarged 
blood-vessels  of  the  villous  coat  of  the  intestmes  (in  yellow  fever), 
remarks  that  'in  some  instances  the  mouths  of  the  canals  Avere  visi- 
ble at  different  x>oints  in  the  interior  surface,  yielding  a  dark-coloured 
liuid  by  pressure.'  Again :  '  The  mouths  of  ducts — not  blood-vessels 
— were  discovered  on  the  interior  of  the  colon,  containing  a  dark-col- 
oured fluid,'  '  Proceedmg  farther  with  the  investigation,  similar  ca- 
nals discharging  a  tar-like  fluid  into  the  interior  of  the  stomach,  more 
especially  near  the  i;pper  orifice,  were  in  like  manner  discovered  in 
almost  all  cases  where  black  vomiting  had  been  a  consj^icuous  symp- 
tom of  the  disease.  The  appearances  were  noted,  and  they  were  oft- 
en verified  by  inspection,'  As  to  the  open  termination  of  the  villi, 
we  are  not  insensible  of  our  solitary  position,  since  it  is  stated  m  the 
British  and  Foreign  Med.  Revieio  that  '  almost  every  modern  phys- 
iologist has  now  abandoned  the  idea  that  the  absorbents  commence 
by  open  mouths  on  the  villous  coat  of  the  intestines,'  This  opinion 
we  are  certainly  bound  to  respect  so  far  as  it  is  supported  hj  any 
facts,  or  is  not  contradicted  by  others," — Medical  and  Physiological 
Commentaries.,  nt  supra. — Also,  Institutes  §  275. 

The  Forces  which  Circidate  the  Blood. 

§  1090,  The  foUowiug  quotation  is  made  from  the  British  and 
Foreign  Med.  Chirurg.  Review  of  January,  1859,  simply  for  the  rea- 
son that  it  sustams  several  of  the  principal  conclusions  set  forth  in 
this  Avork,  and  originally  in  the  Medical  and  Physiological  Com- 
mentaries upon  the  important  subject  of  the  forces  by  which  the 
blood  is  circulated.     See  Index  U.,  article  Circidation  of  the  Blood. 

"  Nelson  considers  the  diastole  of  the  heart  as  the  effect  of  an  act- 
ive movement.  He  assumes  that  the  heart  muscles,  imlike  voluntary 
muscles,  are  possessed  of  a  double  power — that  of  expansion  as  Avell 
as  of  contraction.  The  distention  of  the  ventricles,  the  Author  says, 
'is  an  active  and  inherent  force,'  The  mechanical  forces  actmg  on 
the  movement  of  the  blood  in  the  veins  are:  1,  That  furnished  by 
the  heart  and  arteries ;  2,  That  by  the  pleural  vacuum  of  the  thorax ; 
and,  3,  The  expansive  power  of  the  auricle,"  These,  however,  are 
only  a  part  of  the  forces  concerned,  nor  do  I  suppose  that  the  expan- 
sion of  the  thorax  is  much  of  an  element,  as  I  endeavoured  to  show 
m  the  3Iedical  and  Physiological  Commentaries. 

As  to  Oesterreicher's  old  experiment  of  placing  a  heavy  weiglit  upon 
the  heart  of  a  frog  and  deducing  from  it  the  important  conclusion  that 
the  dilatation  of  the  organ  is  not  an  active  movement,  and  which  con- 
tinues to  be  quoted  as  an  unquestioned  authority,  I  show  in  the  Com- 
mentaries that  the  experiment  proves  exactly  the  contrary. — Med.  and 
Physiolofi.  Comm.,  vol.  ii.,  p.  399-402.     Also,  Notk  Bb  p.  1131. 

New  York,  185'J. 


INDEX  I. 


A. 

A.BS3RBENTS, 

consist  of  the  lacteals  and  lymphatics  ; 
one  for  formative,  the  other  for  de- 
structive purposes,  p.  129,  ^  273. 
See,  also,  Veins,  Tissues,  and  Ab- 
sorption. 
Absorption, 

description  of  the  function,  &c.,  p. 
128-134,  ^  268-295. 

comparative  view  of  its  physical  philos- 
ophy with  that  of  digestion,  animal 
heat,  bloodletting,  humoralism,  in- 
flammation, &c.,  p.  99,  ()  192 ;  p.  132, 
133,  i)  289-292;  p.  197,  ^  362;  p. 
238,  ^  438  b-d ;  §  556,  <J  699  c ;  p. 
482,  ^  744 ;  p.  484,  ij  748  ;  §  837, 
>!»  823  ;  §  841,  ()  863  e ;  §  873,  f)  906 
a  ;  §90466,  (}  909,  910,  1088-1089. 

of  unnatural  agents,  depends  upon 
morbid  changes  in  irritability,  p.  99, 
^  192;  p.  129-134,  (>  277-295;  p. 
519-521,  ()  826-827  ;  p.  677,  ()  904  c. 

operates  universally  through  the  lym- 
phatics, and  without  the  aid  of  any 
specific  stimulus,  p.  46,  (J  74  a,  but 
requires  a  specific  stimulus  in  the 
lacteals.  See  Nutrition. 
Aconite,  Atropia,  Strychni.v,  Hydro- 
cyanic Acid,  Carbonic  Acid  Gas, 
Nitrous  Oxide  Gas,  Sulphuric 
Ether,  Tobacco,  &c. 

their  effects  upon  organic  life,  and 
mode  of  operation,  p.  66,  67,  ^  143, 
148-151  ;  p.  318-321,  ()  493  (i-494 ; 
p.  415-418,  (}  648  c-652  c;  p.  420, 
^  654  a ;  p.  522-525,  ()  827  6-828  c  ; 
p.  672-674,  4  904  6. 
Adaptation,  Law  of, 

propounded  by  the  author  in  a  series 
of  propositions,  p.  45,  i}73  a;  p.  46, 
^  74  a  ;  p.  58,  59,  (J  129  ;  p.  61-63, 
<}  136-137 ;  p.  65,  66,  ()  143  ;  p.  67, 
68,  ^  149-152  ;  p.  69,  ()  156  b,  and 
references  there  ;  p.  89,  <J  188  a ;  p. 
90,  ^  188^  a-c;  p.  93-95,  ^  188^  d 
p.  98,  ()  191  a,  b;  p.  99,  M92  ;  p 
101,  102,  ()  201-203  ;  p.  107,  ^  226 
p.  110,  111,  i5>  233-233| ;  p.  330,  331 
()  500  nn,o;  p.  350-361,^524^529  ;  p 
430-433,  §  675 ;  p.  531,  <J  837  cc-839 
p.  535-539,  ^  847-849  ;  p.  542,  <J  843 
c,  d ;  p.  545,  ()  859  6 ;  p.  553,  ^  870 
aa;  p.  555,  ()  872  a;  p.  561,  562,  ^ 
888  a-d  ;  p.  565,  566,  (}  889  p-k  ;  p. 
570, 1^889  n;  p.  580,  581,  (^  890^  e;  p. 
582-585,  (i  890^-591  e;  p.  586-588, 


Adaptation,  Law  of — continued. 

(j  891  g-l;  p.  592,  593,  ()  891 J  k;  p 
597,  ij  892  c;  p.  601,  ^  892  g ;  p. 
605,  (j  892  m-p ;  p.  607,  i)  892  r ;  p. 
613,  §  892^  6,  c  ;  p.  624,  ^  892§  d; 
p.  629,  ^  892|  s ;  p.  632,  ^  892^  c ; 
p.  633-642,  ^  892|  a-i ;  p.  644-650, 
\  893  c-i;  p.  658-660,  \  893  p-r ;  p. 
662-664,  §  895-899  ;  p.  669,  ^  902 
h,  i  ;  p.  670,  i)  902  m ;  p.  679-683, 
<^  905  ;  p.  684-688,  ^  905^  6,  c ;  p. 
692-694,  <J  914-923  6;  p.  698-709, 
^  929-951. 

Adhesion.     See  Inflammation. 

Adult  Age, 

its  physiological  and  moral  character 
istics,  p.  380-381,  ^  579. 

Affinity,  Vital.     See  Vital  Affinity. 

Age, 

its  physiological  and  moral  character- 
istics, p.  373-383, ^  574-584. 

Alimentary  Canal, 

experiments  to  determine   the  Principle 
uponwhich  its  Action  depends,  p.  315 

Allotropism, 

applied  to  illustrate  the  philosophy  of 
life,  p.  99,  ^91  d. 

Alston,  Dr.  (1733) — shows  that  opium  is 
not  absorbed,  but  acts  through  nerv- 
ous system,  p.  308,  ^  484,  a,  b. 

Alvine  Discharges, 

in  their  relation  to  disease,  p.  452-455, 
^  694,  6941 . 

Alkaloids  of  Cinchona, 
their  therapeutical  uses,  p.  593-607. 

Alteratives, 

all  things  such,  moral  and  physical, 
which  are  capable  of  changing  the 
existing  condition  of  the  vital  states, 
p.  542,  ()  854  c ;  p.  662-665,  ^  895- 
901. 
in  large  doses  or  degrees  their  reme- 
dial or  morbific  effects  may  be  speedy 
and  profound ;  in  small  and  frequent- 
ly-repeated doses  or  degrees,  the 
same  effects  may  be  only  gradually 
established,  in  conformity  with  the 
fundamental  plan  of  organic  nature, 
p.  89,  90, ^  188-188^  6;  p.  107-110. 
()  226-232  ;  p.  122,  (j  240  ;  p.  210,  (j 
387  ;  p.  214-217,  ()  393-399  ;  p.  222- 
227,  ()  409  c-411  ;  p.  230-232,  ()  421- 
424;  p.  250,  251,  ()  441  c;  p.  260- 
265,  (j  445-447  6 ;  p.  272,  273,  ^  447 
h;  p.  280,  ^  449  d;  p.  283-287,  (j  452- 
458  ;  p.  290,  <J  462,  463  ;  p.  295,  (J 
476  a ;  p.  323-332,  ^  498  /-500  ;  p 


936 


INDEX. 


Alteratives — continued. 

335-341,  ()  512-514;  P.  S^-^:,  345, 

(J  516  d,  No.  6  ;  p.  364^369,  ()  546- 
564  ;  p.  423,  «J  659,  660  ;  p.  426,  (J 
666  ;  p.  428,  i)  672  ;  p.  541,  (^  854  a, 
h ;  p.  542,  (}  854  c-c  ;  p.  544,  ^  857  ; 
p.  545,  ^  859  b ;  p.  547,  (}  863  d  ;  p. 
547-550,  ()  863  b-c ;  p.  552,  ^  867  ; 
p.  554,  ()  871  ;  p.  556, '557,  ^  873  ;  p. 
562,  6  888  e ;  p.  567-569,  ^  889  l- 
vim ;  'p.  577,  ^  890  o ;  p.  579  ;  p. 
598-600,  {)  892  d  ;  p.  662-665,  ^  895- 
901  ;  p.  666-670,  ^  902  c-m  ;  p.  679- 
681,  §  905  ;  p.  703-711,  ^  940-952  ; 
p.  724,  ^  961  a;  p.  726,  ^  961  c-e  ; 
p.  732,  733,  ()  973-974. 
Anaemia — a  dogma  in  humoralism,  ^  487 

k,  569  d,  836,  843,  961,  1007  6. 
Analogies, 

between  Animals  and  Plants.  See 
Plants. 

between  semen  and  all  other  vital 
agents,  p.  44-49,  ()  72-80  ;  p.  84,  ^ 
175  b;  p.  331,  ()  500  o. 

between  the  nervous  power  and  all 
other  vital  agents,  p.  107-1 U,^  226- 
2331 ;  p.  662,  663,  ^  896.  See,  also. 
Nervous  Power. 

between  Vital  Principle  and  Mind  and 
Instinct,  p.  84,  ^  175  b;  p.  88,  ^  183, 
184;  p.  89,  ^  186;  p.  98,  ^  191  c; 
p.  112-125,  ^  234-246  ;  p.  370,  ^  567, 
568. 

between  Vital  Properties,  p.  97-99,  ^ 
190-191  ;  p.  100,  ^  197-200  ;  p.  102, 
<}  203  ;  p.  104,  ^  215  ;  p.  105,  ()  220  ; 
p.  107-110,  §  225-232;  p.  112,  (J 
234  i.. 

remote,  but  illustrative,  between  the 
Vital  Principle  and  the  "  Imponder- 
ables," p.  92-95,  ^  188^  d;  p.  112- 
122,  (}  234-238. 

between  all  Physical  and  Moral  Causes, 
in  their  relation  to  Life,  p.  44-49,  ^ 
72-80  ;  p.  62-68,  ^  136-152  ;  p.  84, 
^  157  i,  c  ;  p.  92-95,  ^  188  J-  d  ;  p.  96, 
<J  189  c  ;  p.  97,  ^  190  ;  p.  104,  (}  215  ; 
p.  107-111, ^  225-2331 ;  p.  113-122, 
^  234-240  ;  p.  250,  251,  ^  441  c  ;  p. 
296,  ()  476  c ;  p.  323-332,  {)  500  ;  p. 
356-358,  {)526d;  p.  363-370,  (/  535- 
568;  p.  405-412,  ^  638;  p.  543,  ^ 
857 ;  p.  577,  ^  890  o ;  p.  579,  580,  ^ 
890^  d;  p.  597,  ^  892  c;  p.  631,  (} 
8921  ;  p.  645-647,  ^  893  c,  d ;  p. 
662-665, 1^895-901  ;  p.  669,  i)  902  h; 
p.  670,  ^  902  m ;  p.  679-683,  ^  905  ; 
692-694,  ^  914-923  b;  p.  698-709, 
iji  929-951.  See,  also.  Remedial  Ac- 
tion and  Vital  Agents. 
Analogies,  False, 

productive  of  error,  p.  10,  ^  5^  a;  p. 
43,  1^  67;  p.  84,  ii  175  c;  p.  90-95, 
<)  188  d ;  p.  132,  133,  <;>  289-292  ;  p. 
157-173,  I)  350;  p.   182,  (}  350J  g; 


Analogies,  False — continued. 

p.  238-245,  §  438  i-440  e;  p.  518, 
519,  ()  823,  824. 
Analogy, 

the  great  basis  of  science,  p.  12,  <)  5^ 
/;  p.  183,  ^  350  gg. 
Analysis,  Chemical, 

its  limits,  p.  14,  ^  6 ;  p.  15,  <J  14  J ;  p. 
16,  (J  15;  p.  18,  (J  18  d;  p.  24,  <^  42 ; 
p.  25,  <J  44 ;  p.  27-29,  (}  53,  54 ;  p. 
221,  222,  <)  409  b  ;  p.  228,  <J  417  a. 
Anastomosis, 

its  uses,  p.53,  «J  94 ;  p.  54, 55,  ^  109-1 17. 
Anatomy, 

uses  of,  p.  3,  (J  2  ;  p.  50-73,  ^  83-163. 

the  basis  of  medicine,  p.  3,  ij  2  c ;  p. 
50-73,  ^  83-163. 

teaches  nothing,  per  se,  in  physiology, 
pathology,  or  therapeutics,  p.  3,  ^  2 
c;  p.  50,  ^  83  c;  p.  59,  60,  6  131. 
Anatomy,  Morbid, 

its  uses,  &:c.,  p.  456-463. 
Animalcula, 

their  uses,  p.  15,  <J  14  b. 
Animals,  Food  of, 

of  an  organic  nature,  p.  16,  i^  17;  p. 
17-20,  <)  18. 

can  not  be  indicated  by  chemical  analy- 
sis, p.  17-20,  M8;  P-  219-222,  § 
409;  p.  235,  ^  433.  See,  also, 
Plants. 
Animal  Functions,  p.  280-362,  §  450- 
534. 

consist  of  Sensation,  Sympathy,  Volun- 
tary Motion,  and  the  mental  and  in- 
stinctive,  p.  125,  ^  250. 
Animal.  Heat, 

organic,  and  chemical,  philosophy  of, 
p.  234-279,  ()  433-448. 

chemical  basis  of,  p.  238,  (j  438  h-d , 
p.  276,  277,  M*'''^/ 

organic  basis  of,  p.  271,  ^  447/;  p. 
273,  ()  447  h;  p.  662,  663,  ()  896. 
See,  also.  Combustion, 
Animal  Kingdom, 

dependent  on  the  inorganic,  p.  15,  ^  9  : 
p.  16,  {)Uc;  p.  23,  (j  35,  37 ;  p.  24 
()  41,  42  ;  p.  25,  ^3  ;  p.  135-138,  (, 
300-303i. 

dependent  on  the  vegetable  kingdom, 
p.  15,  ^  10,  13,  14;  p.  16,  (^11;  p. 
135-139, ^  300-303i. 

its  pecuhar  properties^  p.  88,  ^  184  ;  p. 
106,  ^  223.     See,  also,  Sensibility. 
and  Nervous  Power,  and  Sensa- 
tion and  Sympathy,  and  Plants. 
Animal  Life, 

founded  upon  organic  life,  p.  53,  ij  98- 

103;  p.  54,  (j  108,    110,  111  ;  p.  55, 

ij  114-117;  p.  143-146,  ()  322-326. 

See,  also.  Life,  and  Organic  Life. 

Animal  Magnetism, 

who  its  advocates  are,  p.  77,  ij  167  /; 
p.  187,  {)  350|  kk ;  p.  534,  ^  844  ;  and 
British  and  Foreign  Medioai,  Rk 


INDEX. 


937 


Animal  Magnetism — continued. 

VIEW,  Oct.,  1846,  p.  475-487.     Also, 
ibid.,  p.  428-458,  or  Medicine  Relaps- 
ing into  the  Dark  Ages. 
its  deceptive  nature,  p.  77,  ^167  /, 

7iote. 
how  it  may  sometimes  operate,  p.  534, 

^  844. 
hearing,  seeing,  tasting,  one  or  all, 
show  that  perception  is  awake,  and 
that  the  skin,  nerves,  &c.,  equally 
feel  when  cut,  pricked,  &c.,  or  when 
teeth  are  extracted ;  while  connected 
speech  evinces  the  fuU  operation  of 
the  will,  judgment,  reflection,  per- 
ception, memory,  the  understand- 
ing. That  is  a  test,  as  are,  also, 
the  established  laws  in  Physiology, 
p.  77,  note.  Consult,  likewise,  the 
physiological  law  as  pronounced  in 
the  harmonious  and  progressive  de- 
velopment of  all  the  senses  in  in- 
fancy, and  Somnambulism,  and  Rea- 
son. 
firmness  of  purpose  and  mental  ex- 
citement will  enable  most  people, 
especially  in  health,  to  endure  suf- 
fering without  complaint.  The  for- 
mer operates  through  the  will  alone, 
and  does  not  diminish  or  prevent 
suffering ;  the  latter  by  subduing 
common  sensibility,  and  thus  remov- 
ing and  even  preventing  pain,  as 
seen  in  subsidence  of  toothache  at 
the  approach  of  the  dentist,  and  in 
the  subsequent  little  suffering  inci- 
dent, to  the  operation  of  extraction, 
p.  77,  note  ;  p.  124,  ^  243  ;  p.  534,  § 
844;  p.  588,  589,  ^  891  m.  See, 
also,  Sensibility,  Sensation,  and 
the  Nervous  Power. 

Animals  and  Plants, 
their  fundamental  distinction,  p.  15,  (} 
11  ;  p.   17-20,  M8;  p.   135-139,  § 
303-303i.     See,  also.  Plants. 
their  Composition,  p.  15,  ^  12.     See 
Composition. 

Antimony,  Taetakized.  See  Thera- 
peutics, Remedial  Action,  Vital 
Habit,  Sudorifics,  Emetics,  and 
E.xpectorants. 

Antispasmodics,  p.  590-593. 

Appropriation,  or  Nutrition  and  Se- 
cretion, 
laws  of,  p.  217-227. 

Argumentative  Discussion, 
some  common  ground  necessary  to,  p. 
401,  ^  632  b.     See,  also.   Organic 
Chemistry,  its  Recommendations. 

Arsenic,  p.  607-612.  See,  also,  Inflam- 
mation. 

Ar'/eries, 
experiments  to  determine   the  Principle 
vpcn  which  the  Action  of  the  Heart  and 


Arteries — continued 

Arteries  depends,  p.   295-301.     See 
Heart  and  Arteries. 
experiments  relative  to  the  Arteries  in 
their  connection  with  the  Nervous  Sys- 
tem, p.  305-310.— Also,  §  399,  485. 

Arterial  Tissue.  See  Tissues,  anrt 
Structure. 

Assimilation,  p.  134^207. 

asafcetida.     sco  antispasmodics,  auo 
'E.xpectorants. 

Astringents,  p.  570-578. 

Atheism, 

author's  refutation  of,  p.  16,  ^  14  c. 
See,  also.  Design. 

Atmosphere, 

primary    source    of   nourishment    to 

plants,  p.  135-139,  ^  303-303|. 
proves  their  creation  before  animals, 
p.  136-138,  ()  303-303^  b,  c.  See, 
also,  Nitrogen,  Animal  Kingdo.m, 
Animals  and  Plants,  and  Composi- 
tion. 

Atropia — how  it  affects  the  iris  by  reflex 
nervous  action,  and  analogous  things, 
p.  673,  <J  904  6;  p.  838,  ^  1057^. 

Attraction,  Capillary, 

as  applied  to  organic  beings.     See  Ab- 
sorption, and  Capillary  Action. 

Authors, 

their  opinions,  not  themselves,  the  sub- 
jects of  criticism,  p.  6,  (J  4  6 ;  p.  154, 
155,  §  349  d  ;  p.  515,  ^  819  b  ;  p.  540, 
{)  851  c. 
indicated  as  sources  of  authority,  ibid. 
their  fallacious  statements  may  form 
their  best  refutation,  and  yield  the 
greatest  light  to  truth,  p.  17-19,  (}  18 ; 
p.  38-40,  ^  Gif-h;  p.  84-86.  6175  c  , 
p.  96,  9  189  b  ;  p.  132,  133,  ^  289  ; 
p.  135-139,  ^  303-3031  ;  p.  157-191, 
^  350,  351  ;  p.  199-202,  ^  364^376  ; 
p.  220-222,  ^  409  b;  p.  234^279, 
passim ;  p.  433,  434,  <;.  676  i  ;  p.  514, 
515,  ()  819,  §  1028-1030,  1034,  1051. 


Balsams,  Expectorant, 

when  useful.     See  E.xpectorants. 
Belladonna.     See  Narcotics,  and  Aco- 
nite. 
Bile, 

its  mode  of  production,  p.  181,  §  350J  e. 
Blisters.    See  Counter-irritants,  and 

Remedial  Action. 
Blood, 
Author's   theory   of  the  powers   by 

which  it  is  circulated,  p.  208-217. 
chemical  views  of,  p.  18,  §  18. 
organic   elaborations  from,  each  one 
specific,  p.  18,  ^  18  d ;  p.  24^4,  ^ 
40-62  ;  p.  192, ^  354 ;  p. 216,  ^  398  ; 


'J38 


INDEX. 


Blood — continued. 

p.  222,  ^  409  c ;  p.  225,  ()  409  h,  i ; 
p.  227,  ^411. 

homogeneous,  p.  24,  ^  42,  note ;  p.  25, 
^43. 

composed  of  seventeen  elements,  p. 
24,  (J  42  ;  p.  25,  H3  ;  p.  225,  ^  409. 

rapidity  of  its  chemical  changes,  p.  29, 
i)  54  a. 

rapidity  of  its  organic  changes,  p.  233, 
(J  427 ;  p.  535,  ^  846  ;  p.  537,  ^  847 
c;  p.  710,  711,  {}  952. 

decarbonization  of,  a  vital  function,  p. 
229,  230,  I)  419,  420 ;  p.  274-278,  () 
447^. 

not  medicated  by  unaided  Nature,  p. 
531,  §  839. 

chemical  theory  of  its  Circulation,  p.  157, 
158,  159,  (j  350,  Nos.  3,  7,  8,  9  ;  p. 
208,  209,  (J  383  a,  b ;  p.  329,  ^  500  n. 

globules  of,  the  ^'carriers  of  oxygen,"  p. 
255,  (J  441  /;  p.  256,  ^  441^  d;  p. 
275-278,  ^  447i  b,  f.  White,  ^  447i  b. 

shown  by  Kriemer  that  the  nerves  ex- 
ert a  remarkable  influence  upon  the 
blood,  and  applied  by  me  to  import- 
ant principles  in  Pathology  and  Ther- 
apeutics, p.  216,  ()  399  ;  p.  310,  ^  485  ; 
p.  445,  (J  688  ee;  p.  535,  k  846  ;  p. 
709-711,  <J  952 ;  p.  730,  ^  969  c. 
Bloodletting, 

according  to  tissues  affected,  p.  72,  73, 
i)  162. 

A"jthor's  theory  of  its  modus  operandi, 
how  far  original,  p.  691,  ()  906  g. 
Bloodletting,  General,  p.  698-702. 

GENERAL  AND  PRACTICAL  OBSERVA- 
TIONS UPON,  p.  711-777. 

general  Extent  of,  p.  711-724. 

in  Congestive  Forms  of  Disease,  p.  724- 
732. 

in  the  Recognized  Forms  of  Inflamma- 
tion, p.  732-736. 

in  Simple  Continued  and  Simple  Inter- 
mittent Fever,  p.  736-741. 

m  the  Cold  Stage  of  Fever,  p.  739-741. 

in  Apoplexy,  p.  741-747. 

general  Experience,  and  Opinions  re- 
specting, <kc.,  p.  747-766. 

171  the  Diseases  of  Infancy,  p.  766-768. 

in  the  Diseases  of  Old  Age,  p.  768-770. 

misapplied.  Excessive,  &c.,  p.  772-776. 

general  Conclusions  as  to  Loss  of  Blood, 
p.  776-777. 
Bloou-Root.     See  Expectorants,  and 

Therapeutics. 
Blood-vessels, 

their  essential  office,  p.  43,  ^  68-71  ; 
p.  54,  (J  109  b;  p.  208-217,  i)  382- 
399  ;  p.  219,  ()  407,  408  ;  p.  223-227, 
()  409  e-411  ;  p.  289,  ^61^  a. 

their  supposed  chemical  relations,  p. 
43,  (J  67;  p.  178-181,  i)  350J ;  p. 
226,  (J  409  ;". 

the  white,  admit  the  red  globules  through 


Blood-vessels — continued. 

morbid  changes  of  irritability,  p.  99, 
(J  192  ;  p.  216,  ^  399  ;  p.  310,  ^  485. 

experiments  by  Buneva,  Procter,  and 

Kriemer,  showing  the  influence  of 

the  nerves  upon  the,  and  variously 

applied  by  me,  ^  399,  485,  846,  952. 

Brain, 

or  its  equivalent,  the  Ganglionic  Sys- 
tem, in  the  lower  animals  (see  Nerv- 
ous Power,  and  Cerebro-Spinal 
System), 

co-operates  with  the  Mind,  or  with  the 
Instinctive  Principle,  p.  123,  ^  241  c. 

and  spinal  cord,  not  necessary  to  foetal 
life,  as  seen  in  the  anencephalus ; 
bet  the  sympathetic  nerve  is  indis- 
pensable as  supplying  the  stimulus 
to  muscular  tissue  in  organic  life,  per- 
fecting organic  compounds,  &c.  See 
art.  Sympathetic  Nerve. 
Brown,  John  —  his  doctrines,  ^   487  h, 

890if,  1068  a. 


C. 


Calomel.  See  Cathartics,  Therapeu- 
tics, Vital  Habit,  Remedial  Ac- 
tion, and  Alteratives. 

Caloric.     See  Calorification. 

an    unexplained   phenomenon    of,    p. 
276-278,  ^  447^  /. 

Calorification, 
its  philosophy  investigated,  p.  234-279, 
(J  433-448.     See  Heat  of  Animals 
AND  Plants,  and  Combustion. 

Camphor.     See  Antispasmodics. 

Cantharides.    See  Counter-irritants. 

Capillaries  and  Extreme  Vessels, 
the  former  reservoirs  to  the  latter,  p. 

216,  ^  398  ;  p.  483,  ()  746  a. 
the  latter,  the  main  instruments  of  life 
and  disease,  p.  42,  ^  G7 ;  p.  54,  (J 
109  ;  p.  215-217,  ^  394-399  ;  p.  218, 
(J  404;  p.  219,  ^  407  b;  p.  226,  i) 
410  ;  p.  227,  HH  ;  p.  286,  ()  456  a; 
p.289,  H61;  p. 322,  ^498  c;  p.479,  ^ 
741  b;  p.  483,  ()  746  a ;  p.  486,  ()  750  a. 
See,  also.  Heart  and  Arteries. 

Capillary  Action, 
physical  views  of,  subversive  of  all 
principles  in  Physiology  and  Medi- 
cine, p.  215,  ^  394;  p.  216,  ^  398  ; 
p.  219,  ()  407  b  ;  p.  226,  227,  ^  410, 
411 ;  p.  483,  <J  746  a ;  p.  485,  ^  750  a. 
that  its  nature  is  strictly  vital  is  shown 
by  direct  experiment,  p.  127,  i^  263  ; 
p.  134,  i)  293  ;  p.  216,  217,  t)  399  ;  p. 
289,  i)  461^  a;  p.  295-310,  ^  476- 
485  ; — is  shown  by  the  composition 
of  the  blood  and  sap,  p  23,  (J  34,  35 ; 
— is  shown  by  the  variety  and  exact- 
ness of  secreted  products,  and  oth- 
er phenomena,  p.  23,  ^37 ;  p.  24,  25, 
<J  41-46:   p.  40,  41,  ^65;    p.  44,  (j 


INDEX. 


939 


Capillary  A  ction — continued. 

72;  p.  222-227,  ^09-411  ;  p.  479,  ^ 
741  h  ;  p.  663,  (j  896 ;— and  is  shown 
by  the  light  of  analogy  as  reflected 
from  all  sensible  motions  in  organic 
and  animal  life.  See  Capillaries, 
Plants,  Analogies,  Nervous  Pow- 
er, Sympathy,  and  Absorption. 

experiments  by  Buneva,  Procter,  and 
Kriemer,  showing  the  exciting  in- 
fluence of  the  sympathetic  nerve  upon 
the  large  and  small  arteries,  ()  399 ; 
and  its  effect  on  the  blood,  <^  485. 
Capillary  Attraction.     See  Capillary 

Action,  &c. 
Carbon, 

its  elimination  from  the  blood,  a  vital 
function,  p.  236,  237,  ^  437.  See, 
also.  Mucous  Tissue. 

theory  of  its  combustion  in  the  animal 
organism,  as  it  respects  the  genera- 
tion of  heat,  p.  235,  (j  434,  435 ;  p. 
238-248,  ()  438-440 ;  p.  275-298,  ij 
447  C-447I-. 

theory  of  its  combustion  in  producing 
the  circulation  of  the  blood,  p.  157, 
158,  159,  (J  350,  Nos.  3,  7,  8,  9  ;  p. 
208,  209,  ij  383  ;  p.  329,  ()  500  n. 

theory  of  its  combustion  in  producing 
inflammation,  p.  160,  i)  350,  No.  10  ; 
p.  176,  177,  <J350S  a,  350 J  e;  p.  252, 
1^441,  c. 
Carbonic  Acid, 

a  food  of  plants,  p.  136-139,  (^  303  a- 
303§. 

agency  of  light  in  its  decomposition, 
p.  93,  <^  188^  i;  p.  163-167,  ()  350, 
Nos.  64-77. 

Its  connection  with  respiration,  p.  229, 
6  418,  419  ;  p.  274-278,  l^  447^ 

its  supposed  connection  with  animal 
heat.     See  Calorification. 

does  not  excite  heart's  action,  as  sup- 
posed by  some,  ()  477  b,  Exp.  1 . 
Catalysis, 

applied  to  organic  processes,  p.  43,  <J 
67  ;  p.  178-181,  ()  350|  a-350i  e ;  p. 
226,  ^  409  ;. 

conflict  between,  and  the  moving  mole- 
cule, or  the  rival  doctrines  of  the 
Laboratory,  p.  226,  (j  409  ;.     See, 
also.  Protein. 
Catechu.     See  Astringents. 
Cathartics,  p.  563-570. 

physiology  of  their  operation  and  in- 
fluences, p.  339,  ()  514/;  p.  547-550, 
()  863  i;  p.  563-570,  ^  889.  See, 
also.  Remedial  Action. 

most  appropriate  time  for  their  admin- 
istration, p.  554,  ()  871  ;  p.  570,  (^ 
889  n ;  but  the  same  rule  does  not 
apply  equally  to  emetics,  p.  549,  550, 
<J  863  d. 
Causes, 

their  knowledge  important,  p.  4,  ^  3, 


Causes  — continued 

4;  p.- 80,  ()  169  d;  p.  120,  ^  235, 
236  ;  p.  434,  435,  i}  679,  680. 
to  be  sought  through  their  phenomena, 
p.  10,  11,  ^  5|  ;  p.  80,  ()  169  ;  p.  112 
-121,  ^  234  c-237  ;  p.  182,  ^  350i  g , 
p.  434,  ^  679  ;  p.  456,  457,  ^  699. 
undervalued  by  the  ignorant  alone,  p 

5,  M  *■ 
Causes,  Proximate  or  Pathological,  p. 

427-434. 
Causes,  Remote,  of  Disease,  p.  414-427 
Causes,  Final, 
have  led  to  important  discoveries  in 
medicine  and  astronomy.     See  De- 
sign.    Not  acceptable  to  all,  ibid. 
Cells, 

characteristic  of  organic  structure,  p. 
42,  ^  Q7  ■   p.  51,  <J  84;  p.  60,  ()  131. 
supposed  nucleus  of,  in  ovum,  p.  42,  ^ 
67;  p.  44,  <J  72;  p.  812,  ()  1051. 
Cerebro-Spinal  System, 

its  Laws  of  Action,  p.  292-295. 
general  Facts  and  Laws  relative  to,  and 

to  the  Ganglionic,  p.  335-341. 
pervades  all  parts,  p.  54,  i)  111-113. 
important  to  complex  organization,  p. 

54,  (j  111-113;  p.  58,  ij  129. 
designed  especially  for  Animal  life,  p. 

55,  i)   112.     See  Nsrvous   Power, 
and  Sympathy. 

Chemical  Physiologists, 

school  of,  p.  6,  ()^a,c ;  p.  174-191, 
1^350^51. 
Chemical  Compounds, 

their  simplicity,  p.  23,  ^38;  p.  25,  ^ 
46  ;  p.  26,  ^  49,  50. 
Chemical  and  Physical  Views  of  Life, 

their  moral  and  religious  tendencies. 
See  Life,  God    and   Nature,    and 
Vital  Properties  in  the  Elements 
OF  Matter. 
Chemistry, 

its  proper  vocation,  p.  14,  (Ji  6  ;  p.  27, 
<J  53 ;  p.  26,  ()A8;  p.  207,  ^  376|  b. 

its  home  the  Laboratory,  p.  14,  ij  6  ;  p. 
203,  (^  376i  ;  p.  227,  (J  447^/. 

contradistinguished  from  Medical  Phi- 
losophy, p.  8,  ^  5 ;  p.  14,  ^  6  ;  p.  19, 
()  \8  e;  p.  21-.36,  ^  20-62 ;  p.  149- 
207,  ()  337-3761 ;  p.  234-279,  <J  433- 
448. 

usurps  medical  philosophy,  p.  8,  (J  5 , 
p.  13,  ^  5i  a;  p.  202,  203,  ()  376}. 

a  problem  for  its  solution,  p.  281,  ^  450 
e  ;  p.  330,  §  500  nn. 

why  it  fluctuates,  p.  14,  ^  6. 

its  limits,  p.  8,  iji  5 ;  p.  14,  ij  6 ;  p.  15, 
^Ub;  p.  16,  s^  15;  p.  18,  <J  18 ;  p. 
24,  M2  ;  p.  25,  (J  44 ;  p.  27-29,  ^ 
53,  54;  p.  161,  ()  350,  No.  59;  p. 
202,  203,  ^  376^  ;  p.  238,  ^  438  d. 

THE  Author's  opinion  of  its  value,  p. 
133,  <J  292  ;  p.  207,  ^  376|  b. 

as  applied  to  Medicine  illustrates  forci- 


940 


INDEX. 


Chemistry — continued. 

bly  the  universal  maxim,  nc  sutor 
ultra  crepidam,  p.  174-178,  <J  350 J- 
350|. 
Chemistry,  Medical, 

now  and  sixty  years  ago,  p.  8,  §  5. 

errors  of,  why  successful,  p.  10,  11,  ^ 
5^  c;  p.  349  d ;  -p.  202,  ^  376 i- ;  p, 
234,  235,  <J  433. 

admits,  to  the  full  extent,  the  princi- 
ples of  solidism  and  vitalism,  p.  6,  ^ 
4i  b,  d;  p.  19,  ^8  c;  p.  22,  ^  29  ; 
p.  26,  M9  ;  P-  30-33,  §  59,  60 ;  p. 
37,  ^  64  a;  p.  157-173,  ^  350,  Nos. 
47-96  ;  p.  189,  <5  350|  n.  See,  also. 
Organic  Chemistry,  and  Life  in  its 
connection  with  physical  views. 
Chemistry,     Organic.       See     Organic 

Chemistry. 
Childhood, 

its  physiological  and  moral  character- 
istics, p.  375-376,  ^  577. 
Cholera  Infantum, 

treatment  of,  ^  890  I,  1058  d. 
Cholera,  Malignant, 

treatment  of,  ()  630  e,  1058  d. 
(Circulation  of  the  Blood, 

author's  theory  of,  p.  207-217,  J)  377- 
399;  p.  934,  (J  1090. 

chemical  theory  of,  p.  157-163,  ^  350, 
Nos.  3,  4,  5,  7,  8,  9,  10,  19  ;  p.  175, 
(J  350^  ;  p.  208,  209,  ^  383  a,  I ;  p. 
274,  6  447,^  a ;  p.  329,  ^  500  n. 

vicchanical  theory  of,  p.  208,  ^  383  a ; 
p.  210,  ^  387;  p.  212,  ^  391. 

animalcular  theory  of,  p.  208,  ^  383  a.- 
See,  also    Capillaries,  and  Capil- 
lary Action. 
Circulation,  Capillary, 

chemical  thconj  of,  p.  157,  158,  ()  350, 
Nos.  3,  7,  8,  9  ;  p.  208,  209,  ()  383  ;  p. 
274,  (J  U7i  a,  No.  3  ;  p.  329,  <J  500  n. 

physical  views  of,  p.  99,  §  192  ;  p.  132, 
133,  ()  289-292. 

physiological  experiments  relative  to. 
See  Heart,  Arteries,  and  Plants. 
Circulation,  Portal, 

author's  theory  of,  p.  207,  <J  379  ;  p. 
211,  ()  390  a;  p.  214,  ij  392  c. 
Circulation,  Venous, 

author's  theory  of,  p.  209-212,  ^  384- 
392  a ;  p.  214,  ^  392  d ;  p.  934,  «^  1090. 

and  its  bearing  upon  the  pathology  of 
venous  congestion.    See  Venous  Con- 
gestion,   p.   500-513,   and  Venous 
Tissue,  and  Veins. 
Climate, 

its  physiological  influences,  p.  394-396, 
^  615-621. 
Colleges,  Medical.  See  Medical  Edu- 
cation, and  note  there,  Graduates, 
Medical,  and  Defense  of  the  Med- 
ical Profession  of  the  United 
States. 


Colocynth.     See   Cathartics,  Theba- 

peutics,  and  Remedial  Action. 
Combustion, 

in  Organic  Chemistry,  the  cause  oi 
Animal  Heat,  p.  162,  ^  350,  No.  17^  -, 
p.  178,  (J  3501  /;  p.  238,  ^  438  b-d ;  p. 
239-247,  I)  440,  Nos.  1,  2,  3,  4,  5,  6, 
7,  8,  9,  10,  11,  12,  13,  14,  15,  16,  17, 
19;  p.  276-278,  ()  U7k  f. 

the  cause  of  the  Vital  Force  or  Vitali- 
ty, p.  154,  ^  349  c  ;  p.  157-170,  ^ 
350,  Nos.  3,  4,  6,  8,  15,  18,  18^,  19, 
31,  32,  36,  37,  38,  39,  40  ;  p.  177, 
178,  (}  350§  /;  p.  254,  ^  441  e ;  p. 
274,  ^  447^  a. 

the  cause  of  all  Organic  Motions  and 
Results,  p.  158-170,  (J  350,  Nos.  5, 
6,  7,  8,  9,  10,  15,  19,  31,  32,  36,  37, 
38,  39  ;  p.  175,  (}  350^  h-m ;  p.  177. 
178,  l)  350§  d-f;  p.  208,  l^  283;  p. 
254,  (}  440,  No.  10  ;  p.  254,  (^  441  c. 

the  cause  of  Voluntary  Motion,  p.  155, 
()  349  e ;  p.  329,  §  500  n. 

the  cause  of  the  Circulation  of  the 
Blood,  p.  157-163,  (j  350,  Nos.  3,  4, 
5,  7,  8,  9,  10,  19  ;  p.  175,  ^  350  h-l ; 
p.  208,  209,  (}  383  a,  b  ;  p.  274,  ^ 
447J  a ;  p.  329,  (;  500  n. 

the  cause  of  Fever  and  Inflammation,  p. 
160,  (J 350,  No.  10;  p.  175,  ^350^ h-l; 
p.l77,  178,  ^3501  e,/;  p.252,§Ulc. 

the  cause  of  Thought  and  Passions, 
p.  155,  (J  349  c. 

the  cause  of  Sleep,  p.  329,  ^  500  n. 

the  cause  of  Respiration,  p.  162,  163,  § 
()  350,  Nos.  18,  18^^,  19,  &c.  ;  p.  248, 
252,  §  441  b,  c. 

the  cause  of  Mortification,  p.  175,  § 
350i  m. 

and  the  cause  of  Death,  p.  173,  ^  350, 
No.  46  ;  p.  243,  ^  440  cc,  No.  12. 
Composition  of  Organic  Beings,  p.  23- 
49,  ()  32-82. 

contrasted  with  that  of  mineral  com- 
pounds, p.  20-27,  ^  19-51. 

its  requisites,  p.  15,  ^  14. 

elementary  and  proximate,  p.  23,  ^  33. 

of  animals,  nearly  the  same  in  all,  p 
20,  <J  18  c ;  p.  25,  ()  45. 

affected  by  disease,  p.  25,  §  ii;  p.  87, 
{}  182  a. 

mostly  the  same  in  animals  and  plants, 
p.  23,  ^  34-36. 

consists  of  about  seventeen  elements, 
p.  23,  (}  34-36. 

consists  mostly  of  four  elements  vari- 
ously combined,  p.  23,  ij  37  ;  p.  24, 
HI  ;  P-  27,  (J  52-;  p.  222-225,  \  409, 
Compounds,  Mineral, 

few  only,  p.  25,  (}  46. 

cause  of  their  differences,  p.  27  ^  52, 
53  A. 

formed  by  the  union  of  two  elements, 
or  by  the  union  of  binary  compounds 
with  another  element,  p.  23,  ()  38.  39 


INDEX. 


941 


Compounds,  Mineral — continued. 
their  structure,  p.  20,  ()  19. 
their  increase,  p.  21,  ()  20. 
how  distinguished  from  organic  beings, 
p.  15,  ^  7-14  ;  p.  20-22,  ^  19-30. 
Compounds,  Organic, 
their  variety  contrasted  with  mineral, 

p.  24,  25,  {)  41,  46. 
different  in  every  part,  p.  25,  ^  44  ;  p. 

27,  ^  53  5  ;  p.  222-225,  (j  409. 
always  the  same  in  health  in  any  giv- 
en part,  p.  25,  <J  44  ;  p.  27,  ^  53  i  ; 
p.  222-225,  ()  409  ;  p.  227,  HH. 
always  modified  in  one  exact  way  in 
any  given  state  of  disease,  p.  222, 
223,  ij  409  ;  p.  537,  (j  847  d ;  p.  538, 
^  847/,  g.     See,  also,  Organic  Com- 
pounds. 
CoNiUM — has  no  alterative  virtue,  p.  587, 

^891i;  p.  681-683,  (^  905  6. 
Congestion,  Venous,  p.  500-513,  ^  786- 
818. 
authofs  theory  and  investigation  of, 
p.  500-513,  (j  786-818.     See,  also, 
Venous  Tissue. 
Constipation,  Habitual, 
how  best  overcome,  p.  567-569,  ()  889  h 

-889  mm. 
or  other  attendant  of  indigestion  often 
gives  rise  to  chorea,  epilepsy,  &c., 
the  philosophy  explained,  p.  323-332, 
{)  500  ;  p.  356-358,  ()  526  d. 
Constitution,  p.  383-385  ;  p.  271-273. 
Contagion, 
limited  by  physiological  laws,  p.  418- 
420,  (}  652  c-653. 
Contractility.     See  Mobility. 
CoPAivA.    See  Genito-Ueinary  Agents. 
Copper,   Sulphate    of.      See   Emetics, 
Astringents,    Therapeutics,    and 
Remedial  Action. 
Counter-Irritants,  p.  642-660,  ^  893  ; 
p.  679-681,  (J  905. 
supply  an  illustration  of  remedial  ac- 
tion, p.  642-651,  (}  893  n-i ;  p.  679- 
681,  ij  905. 
Creator, 
an  argument  by  the  author  in  proof  of, 
p.  16,  (J  14  c ;  p.  81,  ()  170  a.     See, 
also,  Design. — ^  1085  ;  Note  Pp. 
contradistinguished  from  Nature,  p.  16, 
9  14  c  ,•  p.  25,  H3  ;  P-  46,  (j  7i  a ; 
p.  81.  ()  170  a ;  p.  83,  ^  172  ;  p.  86, 
(}  175  d ;  p.  124,  (J  241  ;  p.  183-189, 
1^350  ?-i-m;  p.  227,  i^  411. 
faiih  in  a,  necessary  to  philosophical 
views  of  life,  p.  317,  (^  493  a.     See 
Design,  and  Life,  moral  and  relig- 
ious tendencies  of  the   Chemical  and 
Physical  Views  of .  Also,  p.  921-928. 
Ckoup — blood-letting  in,  p.  375,  (^  576  e  ; 

p.  728,  ()  964  J;  p.  846,  ^  1058  jo. 
CuBEBs.     See  Genito-Urinary  Agents. 
Cupping, 

its  characteristic   effects   and  uses,  p. 
702-703. 


D. 


Death,  p.  401-404. 
an  extinction  of  the  Vital  Principle, 
p.  30,  ^  58  ;    p.  31,  (J  59  ;    p.  83,  9 
174  ;  p.  96,  ^  189  c. 

"Debility," 
often  fatally  mistaken  for  the  failure 
of  the  will  to  act  upon  the  volunta- 
ry muscles,  p.  296,  ()  476  c ;  p.  313, 
<;>  487  gg,  h  ;  p.  370-372,  9  569  ;  p. 
724-728,  ^  961-964;  ()  887;  §785. 

Decarbonization  of  Blood, 

a  vital  function,  p.  229,  230,  ()  419, 420 , 
p.  274-278,  (J  4474. 

Decomposition,  Vital, 

balances  nutrition,  p.'  34,  ^62b  ;  p.  53, 
^  104  ;  p.  129,  ^  273  ;  p.  217,  ^  401. 
governed  by  peculiar  and  established 
laws,  p.  34,  ^  62  b.  See,  also,  Ap 
PROPRiATioN,  and  Inflammation. 
shows  a  radical  difference  between  01 
ganic  and  inorganic  beings,  and  the 
laws  of  each,  p.  34,  ^  62  b ;  p.  217. 
^  401.  See,  also,  Putrefaction,  and 
Absorption. 

"  Defense  of  the  Medical  Profession 
op  the  United  States,"  p.  460^63, 
()  709,  and  note.  See,  also,  Medical 
Education,  and  note  there. 

Design, 

physiological  proof  of,  p.  6,  iji  4i  i  ;  p 
15,  fU  b ;  p.  24,  <J  40  ;  p.  25,  ^  43, 
46  ;  p.  30,  ij  57  ;  p.  34-36,  ^62;  p. 
37,  ()  64  ;  p.  44,  <;.  72  ;  p.  46,  .J  74  , 
p.  51,  ^83c;  p.  53,  ij  95  ;  p.  55,  ^ 
117  ;  p.  56,  57,  ^  121-125  ;  p.  58,  () 
129  d ;  p.  59,  ^  130 ;  p.  61,  i)  133  c ; 
p.  62,  ()  136  ;  p.  63,  ^  137  ;  p.  65,  <J 
143  c  ;  p.  67-69,  ^  149-156  ;  p.  81, 
(J  169/;  p.  85,  ij  175  c;  p.  87,  ^  180; 
p.  88,  {)  185  ;  p.  93,  ()  188^  ;  p.  97, 
6  190  ;  p.  98,  (}  191  ;  p.  99,  ^  192  ; 
p.  100,  {)  199  ;  p.  102,  /)  201  c  ;  p. 
108,  (J  228  a;  p.  110,  111,  ^  232-233| ; 
p.  122,  ij  239,  240  ;  p.  125,  ^  246  ;  p. 
130,  ^  180 ;  p.  129,  ^  273 ;  p.  135, 136 
^  298,  303  a  ;  p.  137,  138,  ^  303^  b,  c 
p.  141,  9  307;  p.  143-146,  ^  322-326  , 
p.  148,  149,  {)  336  ;  p.  191,  192,  ^  353, 
354  ;  p.  209,  ^  385  ;  p.  210,  ^  387  ; 
p.  212,  §  391  ;  p.  216,  ()  398  ;  p.  224, 
^  409/;  p.  227,  Mil  ;  p.  230-232, 
^  422-425  ;  p.  234,  ()  433  ;  p.  249,  () 
441  c  ;  p.  251,  <^  441  c  ;  p.  253,  ^ 
441  d  ;  p.  280,  ^  449  d  ;  p.  281,  ^ 
450  e  ;  p.  284,  ^  455  a ;  p.  287,  §  458  ; 
p.  290,  M64;  p.  312,  ^  487^;  p. 
323-332,  §  500  ;  p.  335,  <J  512  a ;  p. 
376,  ()  578  b  ;  p.  379,  ^  578  d  ;  p. 
391,  §  603  ;  p.  402,  ^  633  ;  p.  405- 
412,  ()  638  ;  p.  435,  ^  680  ;  p.  472- 
474,  (}  732-733/;  p.  519,  (}  826  a; 
p.  536-539,  ^  847.  In  all  the  fore- 
going physiological  evidences  of  De- 


942 


INDEX. 


Design — continued. 

sign,  the  proof  will  be  greatly  multi- 
plied by  associating  the  processes 
with  the  anatomical  structure,  in 
the  several  instances  respectively. 
But  the  laws,  processes,  and  results 
are  by  far  the  most  important. 
Development  of  Organs,  p.  37-^7,  §  64 
-74  ;  p.  68,  69,  ^  153-159  ;  p.  373- 
380,  ^  574-578. 
Diet, 
importance  of  a  careful  regulation  of, 
in  disease,  p  61,  63,  67,  I)  133,  137,  d, 
e,  151 ;  p.  543,  ^  856  ;  p.  600,  iJ892  e. 
See,  also.  Vis  Medicateix  Natur.<e. 
Digestion,  Physiology  of,  p.  147-207, 
^  332-376i     Also,  p.  15,  16,  ()  10, 
13,  14,  16,  17,  18  a;  p.  134-147,  (} 
296-331. 
chemical  theory  of,  p.  167-170,  ^  350, 
Nos.  29-34 ;  p.  197-199,  ^  362-364i. 
carries  forward,  not  backward,  organ- 
ic compounds,  p.  15,  ^  13,  14 ;  p.  16, 
^  16-18  ;  p.  24,  M2  ;  p.  30,  \  59  ; 
p.  33,  (J  60  ;  p.  135,  {)  301  ;   p.   143, 
^  322  ;  p.  196,  ()  360,  361  ;  p.  201, 
(J  374,  375. 
Distribution,  p.  207-217,  ()  377-399. 
Diphtheria — mistaken  for  a  local  or  hu- 
moral malady,  p.  450,  ^  689  I,  note. 
Disease, 
its  philosophy  sought  in  the  ovum,  p. 

47-49,  ()  75-80. 
hereditary,  philosophy  of,  p.  47-49,  () 

75-80  ;  p.  424,  ()  661. 
coincident  in  animal  and  organic  life, 

p.  55,  (^  117;  p.  98,  ()  191  a. 
influenced  by  relation  of  organs,  p.  59, 

()  129  g. 
influenced  by  vital  constitution  of  tis- 
sues, p.  61,  ^  134  ;  p  64,  ^  138,  141, 
142  ;  p.  67,  (j  149-151  ;  p.  69,  ^  158- 
162.      See,    also.    Venous    Tissue, 
and   Sympathies    of    Tissues    and 
Organs. 
npt  to  continue  in  an  invade»ii  tissue, 
p.  64,  ^  141  h.     See,  also.  Inflam- 
mation. 
disturbs  the  entire  organ,   p.   64,   i) 

141  b. 
specific,  extends  from  one  to  other  tis- 
sues, p.  64,  ^  141  b. 
invades  different  parts  of  a  tissue,  p. 

65,  ^  142,  143. 
ils  cure  due  to  the  mutability  of  the 
vital  properties,  p.  3,  i^  2  i;  p.  61,  <J 
133  e;  p.  87,  ^  177-179;  p.  119,  (J 
234  i;  p.  122,  ()  239;  p.  478,  ^  740 
b.  See,  also.  Therapeutics. 
philosophy  of  its  cure,  p.  67,  68,  ^  150 

-152  ;   p.  662-665,  ()  895-901. 
philosophy  of  its  cure,  in  Organic  Chem- 
istry, p.  176-178,  ()  350 1  a. 
force  of,  according  to  tissues  aflected, 
p.  72.  <J  163. 


Disease — continued. 

illustrates  physiological  states,  p.  73, 
(J  163  ;  p.  265,  ^  447  i ;  p.  476,  §  735 
b.  See,  also.  Age,  Venous  Tissue, 
and  Venous  Congestion. 

depends  upon  the  mutability  of  the  Vi- 
tal properties,  p.  3,  ^  2  i;  p.  11,  ^) 
5i  e  ;  p.  47-49,  (>  74-80  ;  p.  61,  (J  133 
c;  p.  87,  ^  177-182  ;  p.  98,  ^  191  ; 
p.  121,  ^  237,  238  ;  p.  352,  ()  524:  d  , 
p.  514,  ^  819  a,  No.  5.  See,  also, 
Pathology. 

consists,  essentially,  in  changes  of  the 
organic  properties,  p.  3,  §  2  b ;  p. 
98,  ^  191  b.     See,  also,  Pathology 

analysis  of,  in  plants  and  animals,  p. 
98,  ^  191  a. 

establishes  special  susceptibilities,  p. 
3,^2  b;  p.  63,  (J  137d;  p.  65,  ij  143  ; 
p.  67,  ^  149-152;  p.  98,  <)  191  b. 
See,  also.  Pathology,  and  Thera- 
peutics. 

its  effects  conform  to  the  causes,  p. 
105,  (J  220  c.  See,  also,  Remote 
Causes  of. 

never  occasions  putrescency,  p.  105,  ^ 
221.  See,  also,  Humoralism,  and 
Digestion. 

epidemic,  according  to  the  nature  of 
species,  both  of  animals  and  plants, 
p.  98,  ()  191  a. 

affects  the  vital  relations  of  all  agents 
p.  3,  (J  2  b.  See,  also,  establishes 
special  susceptibilities,  as  above. 

mode  of  investigating,  p.  73,  <J  163  ;  p. 
437-442,  ()  685,  686  ;  p.  561,  ^  888  a. 

illustrative  example  of,  in  therapeu- 
tics, p.  430^33,  4  675-676  a. 

predisposition  to,  Author's    philosophy 

of,  p.  87,  <J  181  ;  p.  368,  §  559  ;  p, 

421,  422,  ^  657  a,  b ;  p.  426,  ^  666  ; 

p.  429,  430,  (j  674  d. 

Disease,  Remote  Causes  of,  p.  414r-427, 

^  644-666. 
Disease,   Proximate    or   Pathological 

Cause  of,  p.  427-434,  (j  667-676. 
Discoveries, 

recognition  of  their  priority  useful  as 
well  as  just,  p.  93,  ^  188^  d  ;  p.  290, 
(/  462-164 ;  p.  295,  <)  476  a,  b ;  p. 
308-310,  ^  484,  485  ;  p.  319-321,  6 
494  ;  p.  341,  ^  51U  b  ;  p.  559,  560, 
()  883  b ;  p.  595,  ^  892  a ;  p.  614,  () 
892^  d ;  p.  620-622,  ^  892§  a,  b. 
Dismemberment, 

law  of,  p.  54,  \  108,  109  ;  p.  56,  ^  122, 
123. 
Diuretics, 

their  uses,  and  illustrations  of  reme- 
dial action,  p.  630-633,  ^  892|. 
Doctrines,  Rival, 

should  be  compared  and  contrasted,  p. 
6-8,  ()  ii,  5;  p.  19,  (;>  18  e ;  p    167 
173,  ()  350  ;  p.  189,  190,  ()  3503  n; 
p.   191.  ^  351  ;  p.  219,  ^  407  a;  p 


INDEX. 


943 


Doctrines,  Rival — continued. 

238,  (J  438  ;  p.  246,  <^  440/;  p.  277, 
278,  ^  447^/;  p.  514,  <J  819  a,  Nos. 
1-7. 

Doses  of  Medicine,  &c., 
the  importance  of  accuracy  in,  p.  543- 
545,  ''i  857-860  ;  p.  568,  569,  ^  888 
m,  mm;  p    590,  ^  891  ;   p.  598-604, 
^  892  d-l. 

Ducts,  Living, 
have  no  analogy  in  office  with  inert 

tubes,  p.  99,  ^  192. 
their  functions  identified  with  the 
capillary  attraction  of  glass  tubes, 
sponges,  and  lamp-wicks,  p.  99,  ij 
192  ;  p.  132,  133,  ^  289-292.  See, 
also.  Capillary  Attraction,  Capil- 
lary Circulation,  Absorption,  and 
Appropriation. 


E. 


Education,  Medical, 

in  Europe  and  the  United  States,  its 
disproportion.     See   Medical  Edu- 
cation. 
Effects, 

causes  of,  important  to  know,  p.  4,  § 
3-4  ;  p.  80,  ^  169  d. 

the  foundation  of  philosophy,  p.  10,  ^ 
5J  ;  p.  112-122,  ()  234-240. 

evince  their  causes,  p.  80,  ^  169  ;  p. 
112-121,  <J  234-237.  See,  also,  De- 
sign. 

the  sources  of  knowledge,  p.  2,  3,  ij  2  ; 
p.  50,  51,  (J  83  c. 

the  iKiguage  of  disease  and  of  all  ex- 
istences and  causes,  p.  112-121,  ^ 
234-237.  See,  also,  Remote  Causes 
OF  Disease. 
Elaterium,  p.  655,  656,  ^  893  n,  and 
Cathartics,  and  Remedial  Action. 
Elements  of  Organic  Beings,  p.  23, 
§  34r-37  ;  p.  33-36,  .J  61,  62. 

how  combined,  p.  23,  (J  38,  39.     See, 
also.  Nitrogen,  and  Vital  Proper- 
ties in  the  Elements  of  Matter. 
Elements     of     Dead     Organic     Com- 
pounds, 

how  maintained  in  union,  p.  30,  31,  ^ 
59.     See,  also.  Nitrogen. 
Klements  of  Mineral  Compounds, 

how  united,  p.  23,  ^  38  ;   p.  26,  ^  48, 
49. 
Electricity.     See  Galvanism. 
Emetics, 

physiology  of  their  operation,  and  their 
effects,  p.  325,  326,  <J  500  e,  ee ;  p. 
336,  337,  ^  514  b,  c ;  p.  547-550,  ^ 
863  d;  p.  667-669,  ^  902  e-g.  See, 
also,  SuDORiFics,  and  Nervous 
Power. 

contrary  to  the  general  fact,  p.  63,  ^ 

137  d,  the  stomach  may  be  rendered 


Emetics — continued. 

by  certain  forms  of  disease  more  or 
less  insusceptible  to  their  action, 
as  sometimes  seen  in  croup,  where, 
too,  there  is  a  special  modification  of 
inflammatory  action  in  the  mucous 
tissue  of  the  larynx ;  and  particular- 
ly by  narcotics,  p.  61,  ^  134  ;  p.  64, 
<)  140  ;  p.  374,  ^  576  d ;  p.  554,  <) 
871,  &c. 
when  given  in  small  and  repeated 
doses  in  whooping-cough,  so  that  an 
emetic  effect  is  determined  by  the 
cough,  the  paroxysm  is  broken  ac- 
cording to  the  physiological  influ- 
ence of  the  nervous  power  as  stated 
at  p.  337,  ^  514  c.  Also,  p.  323-332, 
§  500  ;  p.  548,  549,  ()  863  d ;  p.  670, 
^  902  m. 
the  examples  reach  far  into  the  philos- 
ophy of  the  operation  of  the  nervous 
power.  See  Remedial  Action,  and 
Antispasmodics. 
when  employed  in  fever,  often  most 
useful  to  administer  calomel,  with 
or  without  jalap,  two  or  three  hours 
before,  p.  554,  <J  871,  &c. 

Emotions.     See  Mental  Emotions. 

Emollient  Poultices.     See  Poultices. 

Emmenagogues,  p.  628-629.  See,  also, 
Genito-Urinary  Agents,  Ergot, 
and  Amenorrhcea. 

Endosmose  and  Exosmose,  p.  176,  ^ 
350^  n ;  p.  219,  §  407  b,  408  ;  p.  320, 
^  494  dd;  p.  521-525,  <J  827.  See, 
also.  Gases. 

Epsom  Salts.  See  Cathartics,  Thera- 
peutics, and  Remedial  Action. 

Ergot, 
discovery  of  its  uses,  its  importance  to 
mankind,  &c.,  p.  620-628,  ^  8925. 

Errhines, 

their  operation,  p.  340,  341,  ^  5lil,  m. 

Error, 

should  be  contrasted  with  truth,  p.  2, 
^Ib;  p.  6-8,  (jih  5;  p.  19,  H8  e  ; 
p.  157-173,  ^  350  ;  p.  189,  190,  ^ 
350|  n ;  p.  191,  ^  351  ;  p.  219,  (>  407 
a ;  p.  238,  ^  438  ;  p.  246,  (J  440  f; 
p.  277,  278,  ()  447^  /;  p.  433,  434,  (, 
676  b  ;  p.  463,  ()  709  ;  p.  482,  ^  744  , 
p.  514,  (}  819  a,  Nos.  1-7. 
will  be  freely  examined,  p.  2,  ^  1  b. 
its  exposure  necessary  to  truth,  p.  2,  ^ 

lb;  p.  6,  (J  4  J;  p.  515,  (5.819  b. 
involves  argumentative  discussion,  p. 

l,^lb;p.5,i)ib. 
surrenders  reluctantly,  p.  2,  ^  lb;  p. 

5,  H  ^ ;  P-  268,  ^  447  d. 
why  preferred  to  truth,  p.  202,  ^  376J , 

p.  313,  ()  487  h. 
itself,  not  the  Author,  the  subject  of 
criticism,  p.  6,  (J  4  J ;  p.  154,  ^  349  d 
its    Sources,   AiUhorities,    and  Extent 
should  be  known,  p.  154,  ^  349  d 


944 


INDEX. 


Error — continued. 

p.  185-189,  ^  350|  M-m;  p.  515,  ^ 

819  b. 
engages  the  highest  order  of  mind,  p. 

6,  M  *;  P-   154,  (}  349  d;  p.    184, 

185,  ^  3501  yt,  U- ;  p.  204,  t)  376i  a  ; 

p.  476,  (J  733  k;  p.  719,  ^  960  a. 
often  springs  from  a  misappUcation  of 

facts,  p.  10,  11,  (J  51 ;  p.  518,  ()  823. 
often  arises  from-some  absent  fact,  p. 

10,  (J  5i  c. 
springs  from  a  mutilation  of  facts,  p. 

10,  ^  5i  c;  p.  518,  ^  823.  See,  also. 
Organic  Chemistry,  Organic  Heat, 
and  Physiology  of  Digestion. 

leads  to  a  disregard  of  consistency,  p. 

11,  ^  5i  c;  p.  519,  ^  824  a.  See, 
also,  Organic  Chemistry,  its  Rec- 
ommendations. 

hasty  generalization,  a  source  of,  p. 

10,  <J  5i  c. 
relies  upon  the  senses,  p.  11,  ^  5^  c; 

p.  111-121,  ^  234-237  ;  p.  518,  §  823. 
ambition,  a  prolific  cause  of,  p.  11,  ^ 

5^  d  ;  p.  202,  ^  376k 
delights  in  false  analogies,  p.  10,  ^  5i 

a;  p.  U,^5l  c;  p.  13,^5^;  p.  157- 

173,  ^  350,  Nos.  l-i6  ;  p.  234-260, 

(J  433-443  ;  p.  274-278,  ^  447^  ;  p. 

518,  519,  ^  823,  824. 
its  most  ingenious  devices,  p.  2,  ij  1  J  ; 

p.  184,  (}  3501  k. 
one  the  parent  of  another,  p.  762,  ^ 

1006  a. 
coincidences  in  it^  nature,  p.  762,  763, 

^  1006  a. 
liow  best  defeated,  p.  176,  ^  350|  a; 

p.  191,  (J  351  ;  p.  515,  ^819  b. 
its  refutation  should  contemplate  ex- 
tensive and  permanent  influences, 

p.  174,  ^  350i 
how  far  tolerant,  p.  13,  ij  b\  a;  p.  156, 

()  350  a-c ;  p.  185,  ^  3503  kk ;  204,  ^ 

376i  a;  p.  515,  s^  819  b. 
who  are  its  projectors,  p.  516,  (}  820  5. 
its  perseverance  under  defeat,  p.  153, 

<J  349  a ;  p.  516,  §  820  c. 
an  important  cause  of  its  prevalence, 

p.  184,  ^  350i  k;  p.  515,  §  819  b. 
its  exact  distinction  from  truth,  p.  166, 

^  350,  No.  28,  and  parallel  columns, 

p.  157-173.     See  Facts. 
Excretion, 

a  function  of  organic  life  ;  its  nature, 

&c.,  p.  227-234. 
analogous  to  secretion,  but  differs  in 

its  final  cause,  and  does  not  give 

rise  to  true  organic  compounds,  ibid. 
Excretions  and  Secretions, 

as  supplying  symptoms,  p.  450-455. 
ExosMosE.        See  Endosmose. 
Expectorants,  p.  633-644,  ^  892|. 
many  of  them  being  stimulant  to  the 

extreme  vessels,  as  well  as  to  the 

g^eneral  organs  of  circulation,  are 


Expectorants — continued. 

morbific  in  active  fcnns  of  inflam- 
mation, ibid.,  and  Nervous  Power. 

few,  only,  useful  as  curative  agents. 

some  of  them,  as  sulphate  of  zinc,  ex- 
cite but  little  perspiration,  ibid. 

a  mistaken  view  of  the  pathology  of 
phthisis  pulmonalis,  and  an  incon- 
siderate use  of  the  stimulating  ex- 
pectorants, important  causes  of  the 
great  fatality  of  that  disease,  ibid., 
and  its  hypothetical  nature  leads  to 
important  errors  in  practice,  ibid. 
Experimental  Observation  in  Medi- 
cine, 

nature  of,  p.  11,  ^  5i  e,  f ;  p.  148,  ^ 
334;  p.  518,  "J  823. 

imposes  restraints  upon  art,  p.  11,  12, 
^  5^  e,  f.     See,  also,  Therapeutics. 
Experiments  to  determine  the  Laws 
OF   THE  Vital  Functions,  p.   295- 
331,  ij  476-494. 
"  Experimental  Philosophy."  See  Med- 
icine, vitiated  by. 
Extreme  Vessels, 

the  main  instruments  of  organic  life. 
See  Capillaries  and  Extreme  Ves- 
sels. 
Eye, 

of  subterranean  fish,  developed  by  light, 
p.  46,  (j  74. 

its  rudimentary  state,  p.  46,  ^  74. 

Author's  explanation  of  its  develop- 
ment, p.  46,  <5i  74  ;  p.  671,  ()  903. 

action  of  light  upon,  analogous  to  that 
of  all  other  vital  agents,  p.  46,  ^  74  ; 
p.  90-95,  §  188i  d.     See,  also,  Anal 

OGIES.  ||, 

Author's  explanation  of  actioWof  hght 
in  animal  and  organic  life,  p.  90-95, 
^  188,V  d. 

F. 

Facts, 
importance  of,  p.  10,  iJ5|;  p.  515,  iJiSlQfi. 
in  medicine,  the  phenomena  of  organic 

nature,  p.  10,  <J  5|  J ;  p.  202,  ^  376J  ; 

p.  519,  ()  824  a. 
who  may  apply  them  best,  p.  10,  ^  5i 

a ;  p.  115,  116,  i)  234  e,  f;  p.  119,  I 

235  ;  p.  202,  ^  376^ ;  p.  207,  ^  376J 

b  ;  p.  247,  §  440  h. 
how  employed  by  the  vitalist,  p.  10,  ^ 

5i  a,  b;  p.  14,  ij  6  ;  p.  75,  ()  165  b; 

p.  279,  ^  448  /;  p.  330,  §  500  nn ;  p. 

515,  1^819  b. 
how  far  neglected  by  the  Chemical 

Physiologist,  p.  10,  ^  5i  a ;  p.  14,  ^  6  ; 

p.  202,  203,  ()  376^  ;  p.  519,  ^  824  a. 

See,  also,  Organic  Chemistry,  its 

Recommendations,  and  Humoralism. 
false  conclusions  from,  prolific  of  error, 

p.  10,  ij  5| ;  p.  202,  203,  ^  376^.     See, 

also.   Error,   Organic   Chemistry 

and  Humoralism. 


INDEX. 


945 


Facts — continued. 

often  just  otherwise,  p.  10,  ^  5^  a;  p. 
19,  ^  18  e,  A.  C.  ;  p.  157-173,  ^  350, 
Nos.  1-46  ;  p.  189,  190,  <J  350|  n ;  p. 
191,  ()  351 ;  p.  238,  <^  438  ;  p.  246,  ^ 
440/;  p.  277,  278,  ^  447^/;  p.  433, 
434,  ^  676  b ;  p.  460,  ^  709  note ;  p. 
482,  ij  744 ;  p.  514,  <^  819  a,  Nos.  1-3  ; 
p.  518,  ()  823. 

relative  to  organic  beings,  can  not  be 
found  in  the  laboratory,  p.  10,  ^  5|  J  ; 
p.  14,  ^  6  ;  p.  202,  <J  376^ ;  p.  519, 
<J  824  a. 

each  one  too  apt  to  be  regarded  ab- 
stractedly, p.  10,  (}  5i  b. 

should  be  compared,  p.  10,  ^  5i  b.  See, 
also,  often  just  otherwise,  as  above. 

the  importance  of  one  among  many,  p. 
10,  ()  5i  b. 

when  plausible,  can  not  contradict  es- 
tablished ones,  p.  10,  ^  51  b.  See, 
also,  often  just  othenvise,  as  above. 

mutilated  to  suit  hypotheses,  p.  10,  (^ 
bi  c;  p.  519,  ^  824  a.  See,  also, 
often  just  otherwise,  as  above,  and  Or- 
ganic Chemistry,  its  Recommend- 
ations. 

greatly  neglected,  p.  112,  ^  234  b. 

between  the  physiologist  and  physical 
philosopher  of  life,  p.  115,  ^  234  e; 
p.  519,  4  824  a. 

how  to  employ  them  to  the  best  ad- 
vantage, p.  515,  ^  819  b.  See,  also. 
Authors. 

••become  old,"  p.  420,  ^  654  a. 
Fermentation, 

its  cause  and  peculiarities,  p.  28-31,  ^ 
54^59  ;  p.  34-36,  ()  62. 

inapplicable  to  physiological  processes, 
p.  167,  ^  350,  Nos.  29,  78. 

important  in  the  Chemical  and  Humor- 
al Pathology,  p.  172,  <J  350,  Nos.  44, 
45.     See,  also,  IIumoralism. 
Fever,  p.  489^99. 

description  of,  p.  489-497. 

remote  Causes  of,  p.  497-498. 

pathological  Cause  of,  p.  498-499.    See, 
also.     Inflammation,     distinguished 
from  Fever. 
Fish,  eyeless, 

action  of  light  upon,  p.  46,  ()  74  a.     See, 
also,  Light. 
Fcetus, 

the  simplicity  of  its  life,  p.  53,  ^  103. 

Author's  philosophy  of  its  develop- 
ment, p.  36-49,  ()  63-80. 

its  animal  and  mental  faculties  pass- 
ive.    See  Mind  and  Instinct. 

early  development  of  its  nerves,  like 
that  of  the  liver,  kidneys,  organs  of 
animal  life,  &c.,  consistent  with 
their  dormant  state,  p.  234,  §  455  a, 
b;  p  286,  ^  456  ;  p  289,  (J  46H  a; 
p.  342-353,  i;.  516-524. 

physiological    distinction  between    the 

0 


Fcetus — conlinued 

ova  of  mammiferous  and  oviparous 
animals,  p.  56,  ()  122. 
Food, 

of  Animals,  known  only  by  experience, 
p.  17-20,  (J  18;  p.  200,  201,^366,367. 

can  not  be  shown  by  chemistry,  p.  17 
20,  (J  18 

like  physiology,  pathology,  and  thera- 
peutics, consigned  to  the  laboratory. 
p.  234,  235,  ()  433. 

of  Plants,  chemistry  may  indicate 
with  great  advantage,  p.  20,  (J  18  e. 

importance  of  a  right  qiiality  of,  in  dis- 
eases, p.  250-252,  (j  441  c;  p.  543,  () 
856  ;  p.  600,  ij  892  e ;  p.  615,  ^  892^  c. 
Fomentations.     See  Poultices. 
Forces  of  Nature, 

prove  a  Creator,  p.  16,  ^  14  c  ;  p.  SI, 
^  170.     See,  also.  Design,  and  Na- 
ture    contradistinguished     from 
Creative  Power, 
fourcroy, 

sixty  years  ago,  p.  8,  ij  5 ;  p.  203,  ^ 
376i 
Functions  of  Life,  p.  125-372. 

effects  only,  p.  86,  ^76;  p.  120,  ^  235 

the  great  erds  of  life,  ibid. 

mistaken  as  the  cause  of  life,  ibid.  See, 
also,  Life,  Vital  Principle,  Vital 
Properties,  Nervous  Power,  Sym- 
pathy, and  Laws  of  Sympathy. 
Functions,  Organic,  or  Common,  p.  126- 
280. 

peculiar,  or  Animal,  p.  280-362. 

of  Relation,  p.  280-362. 

relation  to  the  Mental  Principlu 
and  Instinct,  p.  362. 

modifications  of,  arising  from  Age, 
Temperament,  Constitution,  Sex, 
Climate,  Habits,  &C  ,  p.  373-397 


G. 


Galvanism  and  Electricity. 

their  modifications  applied  to  illustrate 
the  philosophy  of  life  and  disease,  p. 
114,  (J234<Z;  p.  93-94,  ^  188 K 

their  extended  application  to  the  phi- 
losophy of  life,  p.  93,  94,  <J  188  d;  p. 
112-121,  ()  234-237;  p.  323-332,  ^ 
500  ;  i)  409  hh,  493  cc,  893  a,  893^. 
Gamboge.  See  Cathartics,  and  Thera- 
peutics. 
Ganglionic  or  Sympathetic  System, 

general  ^acts  and  Laws  relative  to,  and 
to  the  Cerebro- Spinal,  p.  335-341. 

its  Laws  of  Action,  and  Propagation  of 
Impressions  in  it,  p.  341,  342. 

its  Laws  of  Action  in  Involuntary  Mo- 
tions, p.  342-349. 

laws  of  its  Sensitive  Functions,  p.  350. 

laws  of  its  Organic  Functions,  p.  350- 
353.    See,  also,  Sympathetic  Nerve. 


946 


INDE^ 


Gases,  and  Ethereal  Vapor, 

effects  of  their  respiration  disprove  the 
doctrines   of  Humoralism,   p.   522, 
523,  ^  827  b,  c;  (}  106Ga.— Note  M. 
iheir  behavior  in  chemical  physiology, 
p.  175,  176,  {)  350^  n-p.     See,  also, 
Endosmose  and  Exosmose. 
absorption  of  Carbonic   Acid   shown 
physiologically  to  be    improbable ; 
and  that  its  instant  operation  as  a 
destructive  agent  upon  man  and  an- 
imals is  a  farther  proof,  p.  522,  523, 
i)  827 ;  p.  672,  (j  904  b. 
Gastric  Juice, 
can  be  generated  by  nothing  in  Nature 
but  the  mucous  tissue  of  the  stomach, 
p.  62,  ^  135  a ;  p.  141,  ^  307 ;  p.  191, 
192,  ()  353  ;  p.  201,  i)  374,  375.     See, 
also.  Digestion,  Physiology  of,  and 
Mucous  Tissue. 
its  manufacture,  p.  197-199,  ()  362-364^. 
Generation,  p.  279-280,  l^  449. 
its  physiology,  p.  36-i9,  <;»  63-81. 
illustrates  the  organic  properties,  p.  44, 

<J  72  ;  p.  97,  \  190  b. 
proves  a  coincidence   in  the  life  of 
plants  and  animals,   p.  56,  ^  121- 
123  ;  p.  280,  ()  449  d. 
Generation,  Organs  of,  p.  55,  (ji  118-121. 
their  influences  in  organic  and  animal 
life,  p.  56,  ()  120  ;  p.  376-380,  (J  578. 
their  importance  in  organic  Design,  p. 
56,  ^  121-123  ;  p.  280,  ()  449  d. 
Genkration,  Spontaneous, 

how  it  happens,  p.  178-184,  ij  3503  a- 

ZbQlg;  p  186, 189,^350iM-350Jm. 

disproved,  p.  16,  ()  14  c. 

inconsistent  with  Creative  Pov/er,  p. 

81,  82,  <^  170.— Note  Pp  p.  1142, 

Genito-Urinary  Agents,  p.  683-689,  (j 

905^. 
Germ.     See  Ovum,  and  Seed. 
Germinal  Disk, 

the  potential  whole,  p.  41,  ij  65. 
Girtanner  —  he   arrays  an   experiment 
against  6000  others,  p.  319,  (J  494  b. 
God  and  Nature, 

confounded,  p.  40,  ^  64  h ;  p.  46,  ^  74 
a ;  p.  76,  ^  167  b  ;  p.  86,  I)  175  d ;  p. 
178-189,  ()  350i  a-3503  m. 
confounded  in  the  same  way  as  the 
vital  force  and  chemical  forces,  or 
as  mind  and  matter,  where  there  is 
less  motive  for  concealment,  p.  154. 
()  349  c  ;  p.  182,  183,  (^  350J  gff  ;  p. 
189,  190,  ()  350i  n.  See,  also,  Vital 
Properties  in  the  Elements  of 
Matter,  and  Problems. 
contradistinguished,  p.  16,  i^  14  c;  p 
25,  ij  43  ;  p.  46,  i^  74  a ;  p.  81,  ()  170 
a;  p.  83,  <J  172;  p.  124,  (j  241;  p. 
227,  ^411. 
the  Latter  the  Interpreter  of  the  For- 
mer, p.  186,  ^  350J  kk ;  p.  227,  ()4:\[; 
p.  317,  §  493  a      See,  also,  Design. 


Graduates,  Medical, 
their  disproportion  in  Europe  and  the 
United  States,  connected  with  a 
greater  disproportic  n  of  Medical 
Colleges,  and  other  facts  adduced 
by  the  Author,  evince  the  great 
superiority  of  the  American  over  the 
European  Medical  Profession.  See 
Medical  Education,  and  Defense 
OF  THE  Medical  Profession  of  the 
United  States. 

Gratitude, 

due  from  physicians  to  their  enlighten- 
ed predecessors.  See  Discoveries. 
Also,  Medical  and  Pk  /siological 
Commentaries,  vol.  ii.,  p.  676,  677, 
^  801-815. 

Granulations, 

their  office,  p.  473,  §  733  c. 

Growth, 

its  philosophy  souo-ht  in  the  germ,  p 

37-47,  ^  64-74. 
its  subsequent  progress,  p.  68,  69,  () 
153-159  ;    p.    373-383,    (>   574-584. 
See,  also,  Appropriation. 

GUAIACUM,    CoLCHICUM,    CiNCHONA,    CoE- 

WEB,  Alcohol,  &c., 
illustrate  disease,  specific  action,  &c., 
p.  417,  <}  650;  p.  424,  {)  662  a;  p 
430,  (}  675,  676  a ;  p.  488,  ()  756  a ; 
p.  553,  ^  870  aa ;  p.  562,  {)  888  c  ;  p 
587,  ^  892  c ;  p.  676-679,  (}  904  c 
See,  also.  Remedial  Action,  As- 
tringents, Alteratives,  and  Ai>- 
aptation.  Law  of. 


H. 


Habit,  Vital, 

its  physiological  and  moral  laws  ana 
phenomena,  p.  363-370,  ^  535-568. 
Habits,  or  Usages, 

their  physiological  influences,  p.  396- 
397,  ^  622-624. 
Heart, 

experiments  to  determine  the  Principle 
upon  which  its  Action  and  that  of  the 
Vessels  of  Circulation  depend,  p.  295- 
301.     See,  also.  Distribution. 

dilates  actively,  ij  262,  263,  392  d,  498 
e,  516  d,  no.  7,  637,  1090. 
Heart  and  Arteries, 

sympathize  more  than  other  parts  with 
local  inflammations,  especially  acute, 
p.  354,  355,  (j  526  a.  See,  also,  In- 
flammation. 

their  sympathies  not  often  inflamma 
tory  nor  profound,  ibid. 

the  extreme  vessels  more  apt  than  the 
heart  and  arteries  to  sympathize  with 
chronic  inflammations,  and  with 
other  forms  of  disease,  and  thus  to 
result,  sympathetically,  in  various 
morbid  conditions,  ibid. 


94- 


Heart  and  Arteries — continued. 

the  foregoing  are  important  distinc- 
tions, practically  and  philosophical- 
ly, ibid.  See,  also,  Blood-vessels 
and  Capillaries. 
Heat,  of  Animals  and  Plants,  p.  234- 
279,  i)  433-448. 

external,  resisted  in  the  same  way 
as  chemical  agents,  p.  30-33,  ^  59, 
GO  ;  p.  258,  ^  442  d. 

internal,  how  generated,  p.  262-273, 
^  445  /-447  h.     See,  also.  Combus- 
tion, and  Organic  Heat. 
Hemorrhage,  Spontaneocs, 

its  philosophy,  advantages,  &c  ,  p.  572- 
575;    p.   770-772.      See,   also,   Su- 

DORIFICS. 

Hellebore.     See  Cathartics,  Thera- 
peutics, and  Emmenagogues. 

HOMCEOPATHY, 

what  doses  of  any  cathartic,  or  emetic, 
will  prove  purgative,  or  produce 
vomiting,  or  may  be  necessary  to 
affect  diseases  remote  from  the  in- 
testinal canal  1  The  answer  will  be 
a  general  test  of  the  applicability  of 
the  mathematical  principle  to  the 
graduation  of  remedial  doses.  A 
common  philosophy,  in  that  respect, 
pervades  the  Materia  Medica,  p.  67, 
^  149-151  ;  p.  541,  542,  ^  854  bb  ;  p. 
543-544,  /)  857 ;  p.  545,  ^  859  ;  p. 
553,  ^  870  aa ;  p.  558,  ^  878  ;  p.  602- 
605,  ^  892  i-m. 

Hospital  Reports  and  Precepts, 
compared  with  private  practice,  <^  621 
a ;  ()  654  a  ;  p.  482,  §  744  ;  p.  457,  f) 
699  c  ;  p.  460-463,  ()  709  ;  p.  573,  (^ 
890  d ;  p.  603,  604,  ()  892  k ;  p.  721, 
<J  9G0  c;  <J  1016;  also.  Essay  on  the 
Writings  of  M.  Louis,  in  Medical  and 
Physiological  Commentaries,  vol.  ii , 
p.  631-633,  679-815. 

HUMORALISM,  p.  514-540. 

contradistinguished  from  Solidism  and 
Vitalism,  p.  147,  ^  330  ;  p.  516-518,  ^ 
821-822 ;  p.  540,  ^  851 ;  p.  550,  863  e. 

has  no  physiological  principle,  p.  147, 
<J  330  ;  p.  558,  <J  878. 

author's  physiological  objection  to,  p. 
534-540,  <)  845-851. 
HvMDRAL  Pathology.    See  Humoralism. 

Ui'BRIDS, 

illustrate  the  philosophy  of  life,  p.  44, 
<5  72. 
Hydrocvanic  Acid, 
its  mode  of  operating,  rapidity  of  its 
effects,  &c.,  p.  318-321,   9  493  d- 
494  ;  p.  523-525,  §  827  d-928  c;  p. 
673,  (i  904  b. 
Hyoscyamus — illustrates  enduring  reflex 

nervous  action,  p.  674. 
Hypotheses, 

the  ground  of,  p.  10,  I)  5i  b;  p.  202,  () 
376^  ;  p.  518,  519,  ^  823,  824. 


Idiosyncrasy,  p.  383-385. 
Ignorance, 

opposes  itself  to  knowledge,  p.  112,  ^ 
234  6. 
Imagination, 

power  of  as  a  remedial  agent,  p.  534,  () 
844;  p.  541,  542,  ^  854  bb ;  p.  558. 
i)  878. 
Imponderables, 

any  number,  p.  84,  1^  175  bb. 

agents,  not  the  causes,  in  organic  be- 
ings, p.  46,  ^  74  ;  p.  90-95,  s^  188^- , 
p.  113,  <J  243  c. 

their  analogies  with  the  principle  of 
life,  p.  113-121,  ^  234  c-237.. 

applied  to  illustrate  the  philosophy  of 
life,  p.  93,  94,  ^  188^  d  ;  p  112-121, 
^  234-237 ;  p.  323-332,  ^  500. 
Indigestion, 

often  the  slov/  result  of  a  long  series 
of  causes,  p.  423,  I)  659. 

its  train  of  maladies  illustrate  the  laws 
of  sympathy.  See  Laws  of,  &c.,  and 
Nervous  Temperament. 

renders  the  mind  irritable,  and  weak 
minds  despondent. 
Individuality, 

of  diseases  and  their  phenomena,  p.  4. 
^2e;  p.  417,  ^650. 
Infancy, 

its  physiological  characteristics,  p.  373 
375,  ^  576. 
Infidelity, 

its  exposure,  a  duty  of  the  Physiolo- 
gist, p.  6,  (J  4  b.     See,  also.  Design, 
and   Nature  contradistinguished 
FROM  its  Author. 
Inflammation,  p.  464-489. — See  Ind.  Jl. 

description  of,  p.  460-480. 

remote  Causes  of,  p.  480-481. 

pathological  Cause  of,  p.  482-489. 

active  and  Passive,  p.  486—489. 

its  philosophy,  p.  99,  ^  192. 

its  vital  nature  shown  by  a  fundament- 
al law  in  pathology,  p.  413,  ^  639  a  ; 
and  by  the  analogy  between  the  ad- 
hesive process  of,  and  the  diseases 
and  reparation,  ingrafting,  &c.,  of 
plants,  and  which  is  also  illustrative 
of  the  nature  of  each,  of  their  de- 
pendence upon  modes  of  action  as 
nearly  allied  as  are  the  modificatiorid 
of  their  common  properties  and  func- 
tions of  life,  and  of  the  near  identity 
of  their  properties  and  functions,  ]>. 
88,  {)  185  ;  p.  474-476,  ^  733  f-k ;  p. 
485,  486,  i)  749-751.  See,  also, 
Plants. 

excited  by  dividing  nerves,  p.  289,  <5 
401. 

its  sympathetic  or  constitutional  ef- 
fects ;  see  above,  and  Fever.  I  add. 
that  the  dependence  of  the  "  fever'' 


948 


INDEX. 


Inflammation  -  -continued. 

upon  the  local  disease,  and  other 
distinctions  between  true  fever  and 
inflammation,  are  well  shown  by  the 
apparently  opposite  constitutional  ef- 
fects of  poisonous  doses  of  arsenic  ; 
as  they  may  happen  to  produce  in- 
flammation in  the  gastro-mucous 
membrane  of  one  subject  and  not 
of  another.  The  difference  proves, 
also,  that  the  poison  does  not  operate 
at  large  by  absorption,  but  accord- 
ing to  its  special  effects  upon  the 
stomach.  See  the  principle,  p.  665- 
670,  ()  902  ;  p.  679-681,  ^  905.  Also, 
HuMORALisM. — Note  L  p.  1120. 
distinguished  from  Fever.  I  add  to 
the  distinctions  which  I  have  set 
forth  in  sections  141  b,  148,  675, 
712-722,  757,  759,  764  a,  764  e,  770, 
&c.,  that  when  inflammation  is  at- 
tended by  a  chill,  this  phenomenon 
generally  happens  only  when  the 
disease  is  on  the  decline ;  that  is 
to  say,  when  suppuration  is  taking 
place.  In  fever,  on  the  contrary, 
it  denotes  the  stage  of  the  most  in- 
tense morbid  action. 
chemical  theory  of,  and  of  Fever,  p.  1 60, 
()  350,  No.  10  ;  p.  175,  /)  350^  h-l ; 
p.  176,  177,  ()  350§  a,  350§  e. 
Inorganic  Kingdom.  See  Kingdoms  of 
Nature,  Organic  Beings,  Organic 
Life,  &c. 
Instinct, 
common  to  man  and  animals,  p.  123, 

()  241  a. 
in   animals,  destitute  of  the  rational 
faculty,  p.  123,  ()  241  a.     See,  also. 
Mind,  and  Reason. 
appertains  to  the  soul  in  man,  p.  123, 

^  241  a. 
the  compound  attributes  of  reason  and 
instinct  in  man,  and  the  simple  state 
of  instinct  in   animals,  meet  ■^vith 
mutually  illustrative  analogies  in  the 
relative  conditions  of  the  principle 
of  life  in  animals  and  plants,  p.  123, 
^  241  a;  p.  88,  <J  184,  185  ;  p.  369,  () 
563  ;  while  other  and  greater  phys- 
ical coincidences  between  man  and 
animals,  and  the  fundamental  dis- 
tinctions between  them,  destroy  the 
argument,  based  upon  analogies,  as 
to  the  identity  of  the  soul  and  the 
instinctive  principle,  ibid. 
endowed  with  understanding  in  ani- 
mals, p.  123,  ()  241  b. 
its  affinity  to  the  soul  in  certain  attri- 
butes, p.  123,  ^  241  c. 
contrasted  with  reason,  p.  123,  124,  ^ 

241  c. 
its  manifestations  far  greater  in  ani- 
mals than  in  man,  p.  123,  ^  241  c. 
progressive   in  man,  but  little  so  in 


Instinct — continued. 

animals,  p.  123, 124,  ()  241  c ;  p  369 

(J  563. 
scarcely  susceptible  of  cultivation  ia 

man,  but  remarkably  so  in  many  ani- 
mals, ibid. 
proof  from,  along  with  reason,  of  one 

species  of  mankind,  p.  123,  (j  241  c, 

note. 
developed  before  reason,  p.  123,  <J  241  o, 
its  inferiority  in  man  compared  with 

animals,  compensated  by  reason,  p. 

123,  ^241. 
its  inferiority  in  man  designed  to  in 

crease     his     moral     responsibility 

through  the  exercise  of  reason, 
sufficient  in  man  for  the  preservatiou 

ofhfe. 
Institutes  of  Medicine, 
their  objects,  p.  2,  ^  2. 
their  consistency,  a  test  of  their  truth, 

p.  1,(J  1;  p.  3,  <J  2  c;  p.  81,  (^  169/; 

p.  331,  (}  500  o;  p.  405-il2,  i;  638. 
their  foundation,  p.  1,  ij  1  ;  p.  22,  ()  31. 
conducted  analytically,  p.  1,  i^  1. 
a  connected  chain  throughout,  p.  1,  ^ 

1  ;  p.  405-412,  (j  638. 

should  be  studied  progressively,  p.  1,  ij  1  • 
now  first  attempted  in  their  proper  ob- 
jects and  natural  relations,  p.  1,  <J  1 
will  be  contradicted  by  collisions  of 
principles  or  facts,  p.  1,  ^  1  ;  p.  3,  <J 

2  c;  p.  259,  (J  442  e.      See,  also, 
Theorif.s,  Rival. 

pervaded  by  the  spirit  of  the  Medical 
AND  Physiological  Commentaries, 

p.  2,  H  «• 
should   form  one  great  symmetrical 
whole,  p.  3,  iji  2  c ;  p.  405-413,  ^  638, 
639  a;  p.  541,  (j  852. 
when  founded  upon  any  other  than  a 
simple  principle,  the  superstnicture 
must  be  incongruous,  chaotic,  p.  2- 
4,  «J  2,  3  ;  p.  173-178,  <J  350i-350i. 
See,  also.  Organic  Chemistry  and 
Physiology,  contracted. 
fundamentally  distinct  from  all  other 
inquiries,  p.  5,  (J  4  Zi ;  p.  8,  9,  iji  5  ;  p. 
14,  ij  6;  p.  19,  i)  \Q  e;  p.   157-182, 
I)  350-3501  g ;  p.  189,  190,  ^  350i  n  , 
p.  191,  (J  351  ;  p.  246,  ()  440  /;  p. 
277,278,  (}U7^f 
Intestinal  Canal, 
potential  whole  of  digestive  system,  p 
41,  (i  65. 
Iodine,   p.    612-620.     Also,  Therapeu- 
tics, and  Remedial  Action. 
Iris, 

physiology  of  its  contraction,  and  ap- 
plication of  in  medicine,  p.  328,  4 
500  ;;  p.  340,  (}  5U  k. 
affected  by  the  "Will,  p.  349,  <^  519. 
Irritability, 

an  important  property  of  the  Vital  Prin- 
ciple, p.  88,  <^  183  ;  p.  89,  ^  188  a. 


INDEX. 


949 


rritability — continued. 

eommon  to  plants  and  animals,  p.  88, 
^  184  a,  185. 

receives  the  impressions  from  all 
agents  in  the  essential  processes  of 
organic  life,  p.  89,  ^  188  a;  p.  95, 

96,  {)  189. 

variously  adapted  by  special  natural 
modifications  to  vital  agents,  p.  43- 
47,  ^  70-74  ;  p.  62,  63,  .J  136,  137  ; 
p.  88,  ^  185  ;  p.  89-99,  (j  188-192  ; 
p.  662-664,  ^  896-900. 

its  natural  modifications  in  different 
parts,  &c.,  important  in  medicine, 
p.  63,  ^  137  ;  p.  64,  ^  141,  142  ;  p. 
66,  ^  143  ;  p.  67,  ^49,  150  ;  p.  68- 
73,  (j  152-163  ;  p.  89-99,  ^  188-192  ; 
p.  210,  <J  387  ;  p.  503,  504,  ^  794-798. 

naturally  modified  in  each  species  of 
animal  and  plant,  germ,  part,  &c.,  p. 

97,  98,  (/  190,  191. 

its  morbid  changes,  p.  63,  <J  137  d;  p. 
65-68,  ^  143-152  ;  p.  98,  (J  191  b. 

according  to  its  natural  modification 
in  a  general,  or  local,  sense,  will  be 
the  operation  of  natural,  morbific, 
and  remedial  agents,  p.  61,  ^  133  i, 
134  ;  p.  62,  63,  ^  135-137  ;  p.  64,  ^ 
138  ;  p.  66-68,  ^  148-152  a ;  p.  73, 
(J  163  ;  p.  97,  98,  ^  190,  191  ;  p.  99, 
ij  192.  See,  also,  analogies  in  Sens- 
ibility, p.  100-103,  ^  199-204. 

its  morbid  changes  alter  the  relations 
and  actions  of  all  natural,  morbific, 
and  remedial  agents,  p.  63,  ^  137  d ; 
p.  65,  {)  143  a-143  c ;  p.  66,  ^  144- 
147  ;  p.  67,  68,  <J  149-152  ;  p.  73,  ^ 
163  ;  p.  98,  ^  191  b  ;  p  541,  542,  <J 
854  bb. 

its  morbid  changes  generally  increase 
the  susceptibility  of  organs  to  the 
action  of  natural  or  remedial  agents, 
ibid,  and  p.  661-664,  (J  894  i-900  ;— 
though  sometimes  lessen  the  sus- 
ceptibility, especially  to  agents  of  cer- 
tain virtues,  p.  365-368,  ()  551-560. 

maybe  increased  through  exalted  sens- 
ibility, p.  104,  (J  110;  p.  586-589,  ^ 
891  g-m. 

its  morbid  changes  allow  the  absorp- 
tion of  morbific  agents,  p.  99,  ^  192  ; 
and  admit  the  red  globules  into  white- 
blooded  vessels,  ibid ;  and  allow  un- 
digested food  to  pass  the  pylorus, 
tbid. 

a  guard  to  the  organism,  p.  99,  §  192. 

belongs  to  all  parts,  p.  89,  §  188  a. 

described,  p.  89-100,  ^  188-193. 

necessary  to  motion,  p.  89,  ^  188  a ; 
p.  107,  ^  226;  p.  110,  <)  233. 

and  Sensibility  receive  the  impressions 
of  all  natural,  morbific,  and  remedi- 
al agents,  p.  89-103,  i)  188-204  ;  p. 
104,  ()  210;  p.  107,  ^  226  ;  p.  110, 
^  233  ;  p.  323-332,  ^  500. 


Irritability — continued. 

distinct  from  Sensioility,  p.  99,  ^  193  ; 
p.  104,  ()  110. 

its  natural  modifications  like  those  of 
Sensibility,  p.  98,  (j  191  ;  p.  100,  ^ 
200  ;  p.  102,  (j  203  ;  p.  108,  ^  227 

its  artificial  changes  analogous  to  those 
of  the  nervous  power,  p.  107,  ()  225  ; 
p.  110,  ^  232. 

its  general  relations  to  external  ob- 
jects, p.  398-400,  <J  626-630. 
Ipecacuanha.      See  Therapeutics,  Re- 
medial Action,  Vital  Habit,  Emet- 
ics, Expectorants,  and  Sudorifics. 
Iron.     See  Tonics. 

important  in  the  chemical  philosophy 
of  organic  processes  and  results,  p. 
274-278,  §  447^ 

indigestible,  and  its  sii])posed  union 
with  the  blood -globules  in  its  in- 
organic states  a  chemical  fallacy, 
Notes  N,  R,  p.  1121, 1123;  but  ex- 
tensively used  upon  that  hypothesis ; 
§  659  d,  836,  843,  1007  b. 


K. 


Kriemek — shows  that  the  nervous  influ- 
ence atl'ects  the  condition  of  the  blood, 
p.  310,  ^  485;  p.  710,  ij  952. 
Knowledge, 

its  limits  and  objects,  p.  120,  ()  235  , 

p.  185,  ()  350|  k. 
its  accumulative  nature,  p.  206,  ^  3761 : 
p.  719-720,  ()  960  a. 


L. 


Lacteals.    See  Absorption,  Nutrition, 

Tissues,  and  Structure. 
Laws  of  Nature, 

have  no  "exceptions,"  p.  120,  121,  () 
237  ;  p.  131,  ^  285  ;  p.  345,  ^  516  d, 
No.  6  ;  p.  383,  ()  584  ;  p.  397,  ()  623. 
See  Nature,  Organic  Beings,  Light, 
Vital  Properties,  &c. 
Le  Gallois, 

his  experiments  upon  the  nervous  sys- 
tem, p.  296-300,  <J  476i-479. 
Life, 

a  cause,  p.  30,  <^  57-59 ;  p.  83-88,  <^ 
175-185  ;  p.  96,  ()  189  c  ,•  p.  120,  ^ 
236  ;  p.  401,  <J  631  ;  p.  435,  ^  680  ; 
p.  474,  475,  ^  733 /-i. 

essentially  the  same  in  plants  and  ani- 
mals ;  see  Plants. 

its  philosophy  learned  from  a  wide  ob- 
servation of  Nature,  p.  4,  (J  2  c ;  p 
U,^6;  p.  207,  ()  376i  b. 

"discovered  in  dead  matter,"  p.  179, 
1^  3501  c.  See,  also.  Vital  Proper- 
ties IN  THE  Elements  of  Matter. 

its  phenomena  seen  distinctly  or  con- 
fusedly, p.  4,  ij  2  e;   p.   157-173,  § 


950 


INDEX. 


Life — continued. 

350  ;  p.  189,  190,  ^  350|  n;  p.  276- 
278,  <J  447^/;  p.  777,  Pom/ret. 

a  knowledge  of,  requires  habits  of  an- 
alytical observation,  p.  4,  ^  2  c  ;  p. 
14,  ^  6  ;  p.  313,  ()  487  h.  See,  also. 
Observation. 

Its  study  compared  with  that  of  botany, 
p.  4,  ^  2  c. 

simple  in  fundamental  laws,  complex 
in  its  phenomena,  p.  4,  ^  2  e  ;  p.  662 
-664,  l)  895-899.  See,  also,  Adapt- 
ation, and  Design. 

general  Remarks  upon,  p.  111-122,  ^ 
234-240. 

considered  a  metaphysical  subtilty,  p. 
112,  ^  234;  p.  482,  ^  744. 

moral  and  religious  tendencies  of  the 
Chemical  and  Physical  views  of,  p. 
6,  HM;  P-8,  ^5;  p.  11,  ^5lc;  p. 
13,  ^5ka;  p.  16,  ^Uc;  p.  46,  (}  74  ; 
p.  84-86,  ^  175  c,  175  d;  p.  95,  96, 
()  189  b  ;  p.  135,  136,  (}  303  a  ;  p.  137, 
138,  ^  3031  b,  c;  p.  141,  ^  307;  p. 
155,  (j  349  e  ;  p.  178,  ^  350J  a;  p. 
181-189,  <j350i/-3503  m;  p.  234,  () 
433  ;  p.  458,  459,  §  701,  704.  See 
Organic  Life,  and  Plants. 
LiFio,  Animal, 

connects  us  sensibly  with  external  ob- 
jects, p.  53,  <J  10b  ;  p.  399,  ^  628. 

requires  repose,  p.  53,  <J  102. 

not  pronounced  in  the  foetus,  p.  53,  ^ 
103.  See,  also,  Nerves,  Sensibil- 
iTV,  Nervous  Power,  Sympathy, 
and  Organic  Life. 

"  animal  life  "  is  employed  in  its  popu- 
lar sense,  at  p.  135,  (J  301  ;  p.  137, 
^  303i  a;  p.  140,  §  304. 
Life,  Organic  and  Animal, 

their  distinctions  and  relations,  p.  53- 
56,  ^  96-120. 

diseases  of,  coincident,  p.  55,  ij  117. 
Their  relations  to  external  objects, 
p.  398-400,  ^  626-630.     See,  also. 
Plants. 
Life,  Organic, 

common  to  plants  and  animals,  p.  53, 
()  101  ;  p.  280,  (^  449  rf ;— modified  in 
each,  p.  54,  I)  107  ;  p.  88,  ()  185. 

has  no  repose,  p.  53,  ^  102. 

necessary  to  animal  life,  p.  54,  <J  108, 
117.  See,  also.  Plants,  Organic 
Life,  Organic  Properties,  and  Vi- 
tal Principle. 

its  condition  in  the  foetus.     See  Blood- 
vessels. 
Light, 

discoveries  in,  p.  90-92,  ^  188^  d. 

applied  to  illustrate  the  philosophy  of 
life,  p.  46,  (J  74  ;  p.  90-95,  ()  188^  d ; 
p.  112-117,  ^  234C-234/;  p.  328- 
331,  <J  500  m-500  o  ;  p.  554,  I)  872  a  ; 
p.  556,  ^  872  a  ;  p.  567,  ^  889  k ;  p. 
671,  ^  903, 


Light — continued. 

a  vital  agent,  p.  46,  ^  74 ;  p.  90-95,  ^ 
I88id;  p.  134,  <J  293;  p.  137,  i<i  303  c; 
p.  164,  ^  350,  No.  65  ;  p.  28'.,  ()  450. 

analogous  to  all  other  vital  agents,  p. 
46, 1^  74  ;  p.  90-95,  ^  188^  d  ;  p.  281- 
283,  ^  450  d-A5l  f;  p.  328-331,  ^ 
500?n-500o;  p.  671,  ^  903.  See, 
also,  Analogies. 

important  in  vital  phOosophy,  p.  92- 
95,  088M  ;  P-  137,  (}  303  e. 

its  component  parts  established,  p.  92, 
§  188^  d. 

its  visible,  chemical,Tithonic,  and  phos- 
phorogenic  rays,  p.  90,  92,  ^  188^  d. 

its  luminiferous  rays  act  as  a  whole  in 
ordinary  vision,  but  not  so  those  or 
the  other  rays  upon  inorganic  com- 
pounds, p.  92-95,  ^  188^  d ;  p.  567, 
^  889  k. 

sought  by  the  leaves  of  plants  in  dark 
places,  upon  a  principle  of  Design 
corresponding  with  the  attraction  of 
roots  to  appropriate  means  of  nour- 
ishment, ibid,  and  p.  166,  167,  ^  350, 
Nos.  26^,  27,  77. 

indispensable  in  vegetable  life,  p.  92- 
95,  ^  l8Sh  d;  p.  137,  ^  303  e. 

chemical  and  vital  theories  of  its  ac- 
tion, ibid. 

if  the  union  of  carbon  into  organic 
compounds  by  the  leaf  of  plants  be 
due  to  organic  influences,  then  are 
the  same  influences  the  cause  of 
the  immediately  antecedent  decom- 
position of  the  carbonic  acid  gas  ; 
and  if,  also,  the  roots  of  plants  de- 
compound the  carbonic  acid  which 
they  extract  from  the  soil,  and  so 
allowed  by  chemists,  it  follows,  far- 
ther, that  light  is  not  the  decompos- 
ing agent  for  the  same  phenomenon 
in  the  leaf,  p.  136,  137,  ^  303  b-e ; 
p.  163-166,  ^  350,  Nos.  64,  65,  66, 
67,  68,  69,  70,  71,  72,  73,  74,  75,  76, 
77,  26^,  27,  28.  See,  also,  Mucous 
Tissue,  in  its  relation  to  carbon. 

author^s  theory  of  white  light,  p.  94,  (^ 
im^d;  p.  566,  567,  ^  889  yt. 

its  velocity,  undulations,  and  mode  of 
excitement,  illustrative  of  the  nerv- 
ous pow-er,  p.  114,  ()  234  e. 

rate  of  its  velocity,  and  of  its  undula- 
tions, p.  114,  ^  234  c. 

its  modus  operandi  in  physics  un- 
known, p.  115,  (J  234  c,/. 

its  laws  known,  p.  115,  ^  234  c. 

its  undulations  aid  not  our  knowledge 
of  its  laws,  p.  115,  (j  234  c. 

develops  the  rudimentary  eye,  by  its 
action  upon  irritability,  p.  46,  ii  74  a. 

comparison  of  its  action  upon  irrita- 
bility in  producing  organic  results, 
and  upon  sensibility  in  the  proces.s 
of  vision,  embarrassing!  to  chemis 


INDEX. 


951 


Light — continued. 

trv,  p. 46,  ^74:  a;  p.  92-95,  §  188^ d ; 

p.' 281-283,  ^  450  e-451/,-  p.  330,  ^ 

500  vn. 
Liver, 
developed  Irom  the  intestinal  Canal, 

p.  41,  1^  65.     See  Assimilation. 
Loss  OF  Blood,  Influences  and  Modus 

Operandi     of,    p.     090-777.      See 

Bloo?31,etting. 
Lobelia, 
preferable  to  tobacco  in  strangulated 

hernia,  p.  717,  <J  960  a.     See,  also, 

Expectorants,  and  Therapeutics. 
Lungs, 
mucous  tissue  of,  alone  eliminates  an 

effete  matter  from  venous  blood,  p. 

62,  ()  135  a;  p.  229,  <)  418,  419  ;  p. 

274-278,  ^  U7i. 
experiments  to  Determine  the  Relation  of 

their  Functions  to  the  Nervous  System, 

p.  315. 
Lymph.     See  Inflammation,  and  Blood- 
letting, General. 
Lymphatics.     See  Absorption,  Tissues, 

Structure,  and  Inflammation. 


M. 


Magnetism, 

an  imponderable  substance.  Why  not 
the  vital  principle,  p.  113,  (>  234  c; 
p.  115,  ()  134  c. 

its  existence  and  laws  known  by  its 
effects,  p.  113,  <J  234  c. 

applied  to  illustrate  the  philosophy  of 
life,  p.  113,  §  234  c.  See,  also.  Gal- 
vanism, Gravitation,  Light,  and 
Imponderables. 
Magnetism,  Animal.  See  Animal  Mag- 
netism. 
Mankind, 

but  one  species  of,  proved  by  the  same- 
ness of  reason  and  instinct  in  all,  p. 
123,  ^  241  c,  note.— 'Note  Fr p.  IU2. 

RACES  of,  p.  391-393. 
Materia  Medica, 

objects  of,  p.  3,  <J  2. 

the  organic,  composed  of  three  or  four 
eleipents,  p.  25,  ■Ji  47 ;  p.  27,  ^  52. 

each  article  of,  has  virtues  peculiar  to 
itself,  p.  27,  i)  52  ;  p.-417,  ij  650  ;  p. 
545,  ^  860. 

its  members  often  embrace  two  or 
more  virtues,  p.  555,  <J  872  a ;  p. 
571,  ^  890  b  ;  p.  597,  ^  892  c  ;  p.  599, 
i)  892  d. 

redundant,  yet  the  bad  may  have  its 
uses,  p.  556,  ^  872. 

remedial  effects  of,  can  be  known  only 
from  observation  in  diseased  states 
of  man,  p.  122,  (}  240  ;  p.  541,  542, 
<J  854  ;  p.  545,  ^  859. 

Pereira's,  the  best,  p.  676,  ^  904  c. 

author's  Arrangeiient  of.  p.  542,  ^ 


Materia  Medica—  conimucd. 

854  c;  p.  564,  ■!>  889  c;  p.  583,  (J  891 
a:  p.  611,  ^  892i  h;  p.  634-646,  ^ 
892|  6-893  d ;  p.  683-689,  ()  905^. 

nature  of  its  relations  to  Therapeutics, 
p.  541,  ^  852  a;  p.  662-665,  ^  895- 
901. 
Materialism, 

disproved,  p.  16,  ^  14  c;  p.  84-86,  y 
175c-175d.  See,  also,  Vital  Prop- 
erties IN  the  Elements  of  Matter, 
Generation  Spontaneous,  Design, 
and  Nature  Contradistinguished 
from  its  Author. 
Materialism,  Medical,  p.  86,  ^  175  d, 

p.  95,  ^  189  b. 
Matter, 

author's  proof  from,  of  a  Creator,  p 
IG,  §  14  c.  See,  also.  Design,  Na- 
ture Contradistinguished  from 
its  Author,  God  and  Nature  Con- 
founded, and  Vital  Properties  in 
the  Elements  of  Matter. 

its  nature  unknown,  p.  80,  ^  169  a;  p 
117,  ()  234:  g. 

its  properties  immutable  in  kind  but 
through  some  change  in  the  ar- 
rangement of  its  compound  or  sim- 
ple molecules,  p.  99,  ()  191  d;  p. 
114,  <J  234  d;  p.  120,  {)  237. 

its  final  cause,  p.  23-25,  (}  34-43,  46 
Mechanical  Relations, 

in  organic  beings,  p.  59,  ^129  k. 
Medical  Education   and   Practice   ir 
Europe  and  the  United  States,* 

comparative  view  of,  p.  13,  i)  5^  a  ;  p 
28,  ()  53  c;  p.  43,  ^  64 ;  p.  50,  ^  83 
k;  p.  60,  (f  131  ;  p.  86,  ()  175  d ;  p. 
133,  <)  291  ;  p.  136,  ^  303  a;  p.  139, 
^  303?  ;  p.  148,  9  334 ;  p.  149,  ^ 
338  ;  p.  154,  155,  ()  149  c-e ;  p.  174- 
182,  ()  350^-3501  /;  p.  185-187,  ^ 
350J  kk;  p.  197-19^,  ()  362-364;  p. 
202,  ^  376L;  p.  219,  ^  408;  p.  220, 
221,^09  6;  p.  226,  H09;;  P- 233, 
§  427  ;  p.  334,  335,  <;»  433  ;  p.  338,  ^ 
438  b-d ;  p.  239-247,  ()  440,  Nos.  1- 
19;  p.  274-278,  ^  447^;  p.  433,  (, 
676  b ;  p.  457,  ^  699  c  ;  p.  458,  ^ 
701  ;  p.  460-463,  ^  709,  and  note ;  p. 
482,  ^  744 ;  p.  484,  485,  ()  748,  749  : 
p.  488,  (}  756  a;  p.  515,  ij  819  b  ;  p. 
518,  519,  (j  823-825  ;  p.  540,  ()  851 
a;  p.  573,  (J  890  d ;  p.  584,  1^  891  c. 
p.  603,  ^  892  k ;  p.  654,  ^  893  n ;  p 
690,  ^  906  a-d;  p.  715-722,  <J  960 
a-d;  p.  760,  ^  1005  /; ;  p.  762,  763; 
•J  1006  a.     See,  also,  British  and 

*  "About  thiwj  Medical  Schools  in  the  United 
States,  in  which  there  is  probably  an  annual  av- 
erage of  4500  students,  1300  of  whom  are  yearly 
graduated.  (Population,  2C,000,000.)  In  France 
with  a  population  of  35,000,OC)0,  there  are  but 
three  Medical  Schools,  which  graduate  only  about 
700  annually!"  —  Boston  Medical  and  Surgicai 
Journal  Dec  2,  1846,  y.  365. 


952 


INDEX. 


Medical  Education — continued. 

Foreign  Medical  Review,  in  advo- 
.icy  of  Animal  Magnetism,  and  the 
■'Water  Cure,"  Oct.,  1846,  p.  428- 
458 ;  p.  475-485 ;  and  Author's  In- 
troductory Lecture  on  the  Im- 
provement OF  Medical  Education 
IN  THE  United  States,  and  Medi- 
cal AND  Physiological  Commenta- 
ries, vol.  i.,  p.  257-273,  283,  300, 
305,  309,  327,  384-440,  511-515 
notes,  626-632,  682-690,  699-712; 
vol.  ii., p.  224-229, 324-327  note, 354- 
377,  700-815.— Inst.,  Note  W  1127. 
Medical  Profession  of  the  United 
States,  Defense  of,  p.  460-463,  () 
709,  and  note  there. 
Mpdical  Science,  "The  Progress  of," 
p.  13,  {}  5^  a,  b.  See,  also,  Medi- 
cine, Medical  Education,  Organic 
Chemistry,  and  Humoralism. 
Medicine, 

philosophy  of,  p.  1,  ij  1. 

the  necessity  of  consistency  in  its 
principles  and  details,  p.  1,  i5>  1- 

the  vi^ork  of  observation,  p.  3,  ij  2  c ;  p. 
11,  ij  b\  e,f. 

its  elevated  nature,  p.  122,  ()  240  ;  p. 
186,  (j  3501  kk ;  p.  412,  §  638.  See, 
also.  Design.— Also,  p.  361,  §  530. 

its  ground-work  simple,  p.  4:,  ^  2  d,  e  ; 
p.  40-49,  ^  65-80  ;  p.  87,  ^  177-182  ; 

'    p.  88,  <)  185. 

its  detads  complex,  p.  109,  ^  232 ;  p. 
120-122,  ()  237-240 ;  p.  405-412,  ^ 
638. 

its  difficulties,  p.  11,12,  <J5ie,-  p.  121, 
<J  237 ;  p.  383,  ^  584 ;  p.  397,  ^  623  ; 
p.  545,  ^  859  b,  and  references  there  ; 
p.  662-664,  ^  895-899.  See,  also, 
Physicians  and  Surgeons. 

its  branches,  a  cemented  chain,  p.  3, 
<J2(Z;p.  131,,^285;  p.  405-412,  ^ii  638. 

the  relations  of  its  branches,  ibid. 

theories  of,  p.  5,  <S>  4. 

chemical,  physiological,  and  chemico- 
physiological  schools  of,  p.  6,  7,  ^ 
4J  a-e. 

vitiated  by  Experiments  under  the  dis- 
guise of  "  Experimental  Philosophy," 
p.  11-14,  I)  5i  c-6;  p.  17-19,  ()  18 
b-e ;  p.  26,  -J  48  ;  P-  28,  ^  53  c  ;  p. 
50,  ^8-d  a,  b ;  p.  60,  <J  131  ;  p.  132, 
133,  ^  289-292;  p.  148,  ()  334;  p. 
164-170,  ()  350,  Nos.  23^,  28,  29,  31, 
39,44.45:  p.  175,  176,  ij  350i  w,  o;  p. 
177-182.  ()  350i/,  3502  a-g ;  p.  197- 
203,  ^  362-376^  ;  p.  371,  <J  569  b  ;  p. 
434,  ^  676  b ;  p  457,  §  699  c ;  p.  482, 
■)  744  ;  p.  484,  485,  (}  748,  749  ;  p. 
489,  490,  ^  757  a ;  p.  509,  <J  810  ;  p. 
515-519,  ()  819-825  ;  p.  528,  ()  830 
a-831  ;  p.  541,  542,  ^  854  bb ;  p. 
573,  ^  890  d ;  p.  603,  604,  ^  892  k ; 
p.  711,  I)  952  b;  p.  715-722,  <}  960 


Medicine — continued. 

a-d;  p.  760,  ^  1005  k;  p.  762,  763, 
(}  1006  a;  p.  765,  <)  1006  g. 

its  relationship  to  chemical  and  me. 
chanical  philosophy,  p.  8,  ^  5  ;  p.  11, 
5i  c ;  p.  202,  203,  t)  376^  ;  p.  434,  ^ 
676  b. 

contradistinguished  from  chemical  and 
mechanical  philosophy,  p.  7,  ^  4^  d; 
p.  8,  9,  ^  5;  p.  8,  ^5;  p.  10,  ()5i  a; 
p.  11,  ()  5i  c,  e;  p.  14,  ^  6;  p.  19,  ^ 
18  e;  p.  21-36,  ^  20-62;  p.  40-42, 
{)  65,   66;  p.  99-111,  (J  188i-233J 
p.  135-139,  <)  303-3035  ;  p.  149-203 
(J  337-376i  ;  p.  234^279,  ^  433-448 
p.  323-332,  ^  500  ;  p.  362,  ^  530  ;  p 
376-380,  <^  578  ;  p.  383,  ^  584  a;  p 
391.  392,  ^  602  d-606  ;  p.  393,  ()  612 
p.  397,  (j  623  ;  p.  398,  ()  626  ;  p,  401 
^  631  ;  p.  405-412,  ^  638 ;   p.  662, 
663,  ^  895,  896. 

its  relative  condition  in  Europe  and  the 
United  States.  See  Medical  Edu- 
cation. 

its  difficulties,  intellectual  nature,  and 
usefulness   to  mankind,   compared 
with  Surgery.     See  Physicians  and 
Surgeons. 
Medicine,  "  Specialities"  in, 

objections  to,  p.  721,  722,  ^  960  c,  d. 
Medicine  and  Surgery, 

their  comparative  usefulness  and  dif- 
ficulties, p.  614,  ^892^.     See,  also, 
Physicians  and  Surgeons. 
Medicines.     See  Remedies. 
Membranes.     See  Tissues. 
Menstruation, 

an  excretory  function,  p.  62,  ^  135  a; 
p.  233,  234,  ^  428-432. 

not  important  in  organic  life,  p.  234,  ^ 
428. 

designed  for  impregnation,  p.  234,  ^ 
428. 

its  suspension,  per  se,  of  little  import- 
ance to  health,  p.  234,  ^  432. 

the  influences  of  its  suspension  depend 
upon  the  cause.  See  Emmena- 
gogues,  Ergot,  and  Uterine 
Agents. 

its   institution,   and   effects   of.     See 
Youth,  p.  376-380. 
Mental  Emotions,  and  Passions. 

how  they  operate,  p.  89,  <J  188  a ;  p. 
95,  (}  188i  d;  p.  107,  ()  227;  p.  108, 
()  228  b;  p.  109,  «^  230,  232  ;  p.  Ill 
ij  2331  ;  p.  326-330,  ^  500  /-500  n 
p.  670,  <)  902  /. 

elect  certain  motor  nerves,  like  the  will 
and  physical  agents,  p.  Ill,  ^  233| ; 
p.  113,  <J  243  c  ;  p.  326-330,  ^  500/- 
500  71. 

designed  for  moral  and  physical  good, 
p.  113,  ()  234:  c. 

morbific  and  curative,  and  analogous  in 
their  influences  with  physical  causes 


INDEX. 


953 


Mental  Emotions,  &,c. — continued. 

anc'  with  tlte  will,  p.  92-95,  ^  188i 
d;  p.  Ill,  ^  23:i;  p.  113,  l^  234  c; 
p.  296,  I)  476  c ;  p.  326-330,  ()  500 
/-500  n ;  p.  534,  M44 ;  p.  670,  ^ 
902  /. 

chemical  theory  of,  p.  155,  ^  349  e.     See 
Mind,  and  Instinct. 
Mesmerism.     See  Animal  Magnetism. 
Metaphysicians, 

regard  the  operations  of  the  rr.ind  ab- 
stractedly from  the  brain,  p.  123,  ^ 
241  c. 
Metastasis, 

its  fallacy,  p.  653-656,  ^  893  n. 
Microscope, 

useless  and  deceptive  in  important  or- 
ganic inquiries,  p.  50,  ^  83 ;  p.  60,  (} 
131  ;  p.  U3,^  320;  p.  219,  H07  6; 
p.  342,  ^  515;   ()  234/,  251,  409  e. 
Mind,  and  its  Properties,  p.  122-125. 

not  a  product  of  secretion,  the  only  in- 
dependent motive  power,  and  capable 
of  being  acted  upon,  p.  84,  85,  ^  175  c. 

confounded  with  the  chemical  forces, 
p.  182,  183,  ^  350|  gg.  See,  also, 
God  and  Nature,  Vital  Properties 
in  the  Elements  of  Matter,  and 
Problems. 

its  analogies  with  the  vital  principle,  p. 
84,  ^  175  b ;  p.  88,  ()  183,  184  ;  p.  89, 
^  186;  p.  98,  {)  191c;  p.  112-125,  (} 
234  c-246. 

its  relation  to  the  brain,  p.  85,  ^  175  c  ; 
p.  98,  ^  191  c;  p.  123-125,  ()  241- 
246  ;  p.  281,  ^  451  ;  p.  332,  (}  500  ;;. 
See,  also.  Mental  Emotions  and 
Passions,  and  Instinct. 

its  morbid  states,  p.  98,  ()  191  c. 

its  individuality,  p.  84,  ^  175 ;  p.  122- 
125,  ()  241-246. 

its  "Plenipotentiaries"  the  Nervous 
Power,  p.  77-79,  ^  167  f. 

its  advancement  in  successive  genera- 
tions, p.  206,  (J  376 {  a;  p.  719,  720, 
^  960  a. 

compared  with  instinct     See  Instinct. 

chemical  theory  of,  p.  155,  ()  349  e. 
See  Problems. 
Mineral  Compounds.     See  Compounds, 

Mineral. 
Minerals, 

their  most  natural  state,  elementary, 
p.  23,  ^  39. 

their  final   cause,  the  existence  and 
welfare  of  organic  beings,  p.  16,  <J 
16  ;  p.  23,  ^  34-36  ;  p.  86,  87,  ^  176  ; 
p.  135-138,  <^  300-303^. 
Mineral  Kingdom, 

independent  of  the  animal,  and  vegeta- 
ble, p.  15,  ^  9-14 ;  p.  137,  138,  ^  303:1 . 

its  final  cause.     See  Minerals. 
Mobility, 

a  property  of  life  o  )mmon  to  animals 
and  plants,  p.  88  ^  183.  184  a. 


Mobility — continued. 

a  preferable  term  to  contractility,  p.  103, 
§  205  b. 

the  cause  of  motion  in  organic  beings, 
p.  103,  ^  205-215  ;  p.  107,  ^  226  ;  p. 
110,  111,  ^  233,  233| ;  p.  284,  ^  455 
a ;  p.  286,  ^  456,  457  ;  p.  289,  ^  461i 
a ;  p.  322-332,  ()  498-500.  See,  also, 
Absorption,  Blood-vessels,  and 
Powers  which  circulate  the 
Blood. 

distinct  from  irritability,  p.  103,  ()  206 ; 
p.  110,  <J  233.  See,  also.  Irrita- 
bility. 

demonstrable  in  plants,  p.  103,  ^  207 , 
p.  134,  ^  293;  p.  286,  ^  456  a;  p. 
322,  ^  498  c. 

occasions  sensible  and  insensible  mo- 
tions, p.  104,  ^  213. 

excited  ihrongh.  irritability,  p.  103,  104, 
(}  208,  215;  p.  107,  ^  226  ;  p.  110,  «J 
233. 

dormant  in  the  seed  and  ovum,  p.  30, 
^  57  ;  p.  56,  {)  123  ;  p.  104,  ()  212. 

modified  in  animal  and  organic  life,  p. 
61,  ^  133  b ;  p.  62-  68,  «J  135-155  ;  p. 
110,  1 1 1,  ^  233,  2331 ;  p.  295,  <J  475  ; 
p.  296,  §  476  c;  p.  314,  ()  488;  p. 
323-332,  ^  500.  See  Motion. 
Molecular  Motion  versus  Catalysis,  p. 

226,  ^  409  ;. 
Morbid  Anatomy, 

its  practical  and  philosophical  uses,  p. 
456-463,  ()  695-709. 
Morbific  Causes, 

philosophy  of  their  action,  p.  47-49,  y 
75-80;  p.  55,  §  117;  p.  59,  <J  129  h, 
p.  61,  ^  133  c;  p.  63,  §  137;  p.  65, 
5  142,  143  ;  p.  67,  68.  ()  149-152  ;  p. 
69,  ^  156  ;  p.  87,  (>  177-182  ;  p.  89,  ^ 
188;  p.  107-110,  ^226-232;  p.  Ill, 
^  2331  ;  p.  414,  ()  644,  645  ;  p.  417, 
()  650;  p.  421,  422,  (}  657;  p.  423, 
^  659  ;  p.  424,  ij  661  ;  p.  425,  ()  664 ; 
p.  426,  ^  666  ;  p.  662-665,  ^  895-901. 

their  difference  from  remedial  agents, 
p.  542,  <J  854.  See,  also.  Remedial 
Action,  Vital  Habit,  and  Thera- 
peutics. 
Morphia.  See  Narcotics,  and  Thera- 
peutics. 
Mortification, 

vital  theory  of,  p.  477,  ^  736  a-e. 

mechanical  theory  of,  p.  477,  ^  736  6, 
e ;  p.  484,  485,  <J  748,  749. 

chemical  theory  of,  p.  175,  i)  350^  m. 
Motion, 

indispensable  to  all  organic  beings,  ex 
cepting  in  the  state  of  the  c-erm,  p 
126-128.     See,  also.  Germ.' 
destructive  of  mineral  compounds,  p. 

21,  <J  24-26. 
sensible  and  insensible,  p.  103,  <J  207. 
how    produced   through    sympathetic 
sensibility,  p.   101,  ^  201,  202  ;  p. 


954 


INDEX. 


Motion — continued. 

104,  (j  209,  210 ;  p.  282,  ^  451  ;  p. 
323-330,  ^  500.  See,  also,  Laws  of 
Sympathy. 

insensible  the  most  important,  p.  104, 
(j  214  ;  p.  227,  ij  410,  411  ;  p.  663,  (j 
896.     See,  also.  Capillaries. 

voluntary,  how  produced,  p.  88,  <J  188  ; 
p.  104,  ^  215  ;  p.  110,  ^  233  ;  p.  Ill, 
^  2333  ;  P-  127,  I)  259  ;  p.  128,  (^ 
266  ;  p.  134,  ^  293-295  ;  p.  323-332, 
1^500. 

spasmodic,  readily  induced  in  the  vol- 
untary muscles,  and  why,  p.  284,  ^ 
455  ;  p.  296,  ^  476  c ;  p.  324-328,  ^ 
500  d-l;  p.  357,  358,  ^  526  d;  p. 
404,  ^  637.  • 

how  produced  in  organic  life,  p.  88,  ^ 
188  ;  p.  110,  ^  233  ;  p.  Ill,  \  233^. 

independent  of  the  nervous  system,  p. 
104,  <J  215  ;  p.  110,  (J  233  ;  p.  127,  ^ 
259 ;  p.  284-289,  ^  454-461^ ;  p. 
663,  9  896.     See,  also.  Experiments 

TO  DETERMINE  THE  LaWS  OF  THE  Vl- 

TAL  Functions,  p.  295-321,  and 
Laws  of  Sympathy,  p.  335-362. 

how  produced  through  irritability,  with 
or  without  the  agency  of  the  nerv- 
ous power,  p.  89,  90,  ^  188,  188i  ; 
p.  95,  ()  189  ;  p.  98,  ^  191  ;  p.  103, 
<;>  208  ;  p.  107-111,  ()  226-2333  !  P- 
323-332,  <J  500  ;  p.  356-358,  (j  526 
d ;  p.  663,  ^  896. 

toluntary  and  involuntary,  their  differ- 
ence lies,  mostly,  in  the  nature  of 
the  stimuli,  and  partly  in  modifica- 
tions of  mobility,  p.  102,  ()  201  ;  p. 
104,  ^  215;  p.  107,  ()  227;  p.  110, 
111,  ^  233,  2332  ;  p.  296,  ^  476  c  ,•  p. 
323-332,  ij  500  ;  p.  357,  358,  l^  526  d  ; 
p.  663,  ^  896.  See,  also.  Mobility, 
and  Will. 

the  great  intrinsic  characteristic  of  the 
organic  kingdom,  inertia  that  of  the 
inorganic,  p.  21,  ^  24  ;  p.  30,  ^  59  ; 
p.  86,  87,  (}  176. 

interests  us  most,  ibid. 

dicmical  Theory  of,  oxydation  of  the 
blood  and  tissues,  p.  158-162,  ^  350, 
Nos.  3,  4,  5,  6,  7,  8,  9, 10,  11,  12,  15, 
16,  17;  p.  208,  ^  283;  p.  274,  ^ 
447^  a. 
Motor  Nerves.  See  Nerves. 
Mucous  Tissue, 

proof  from,  by  the  Author,  that  the 
elimination  of  carbon  from  the  blood 
IS  a  vital  process.  Combine  the  di- 
rect facts  and  the  analogies  at  p.  62, 
^  135  a ;  p.  201,  <J  374,  375  ;  p.  229, 
i)  419  a-419  c.  See,  also.  Carbon, 
and  Light,  in  its  relation  to  carbonic 
acid. 

modified  in  its  organic  properties  in 
different  parts  of  the  body,  and  as 
traversing  different  parts,  shown  by 


Mucous  Tissue — continued. 

its  natural  products,  and  by  the  ef- 
fects of  natural,  morbific,  and  reme- 
dial agents,  p.  62,  63,  <J  135-137  ;  p. 
67,  68,  i)  149-152.  See,  also.  Re- 
medial Action,  and  Therapeutics. 
Mucus, 

the  laws  which  govern  its  formation. 
See  Secretion,  p.  217-227. 

its  morbid  states,  p.  452.     See,  also, 
Inflammation. 
Muscles  of  Voluntary  Motion, 

experiments  to  determine  the  Principle  or 
which  their  Motion  depends,  and  the 
Relation  they  bear  to  the  Nervous  Sys- 
tem, p.  310,  <5  486. 

comparative  effects  of  Stimuli  upon,  aniX 
upon  the  Heart,  when  applied  to  the 
Brain  and  Spinal  Cord,  p.  311-315, 
^  487-489.  See,  also,  Motion,  and 
Will. 


N. 


Narcotics,  p.  583-590,  ()  891  ;  p.  715 
721,  (J  960  a,  b. 

an  unimportant  class  of  agents  compai 
ed  with  many  curative  means,  ibid 

their  preference  as  means  of  relieving, 
or  preventing  pain,  to  agents  which 
strike  at  disease  and  grapple  with 
Death,  evinces  a  want  of  proper 
medical  philosophy,  and  of  a  proper 
reference  to  the  best  interests  of 
mankind,  ibid.     See,  also.  Pain. 

affect  the  nervous  power  so  as  to  ren- 
der it  more  or  less  insusceptible  to 
the  action  of  other  agents,  p.  567,  (/ 
889  k;  p.  672,  ij  904  a,  ij  891i  k. 
See,  also,  Nervous  Power. 
Nature, 

its  foundation  simple,  its  phenomena 
complex,  p.  4,  (J  2  c ;  p.  662-664,  (j 
895-899.  See,  also.  Adaptation 
and  Design. 

contradistinguished  from  Creative  Pow- 
er, p.  16,  H4  c ;  p.  25,  'J  43  ;  p.  46, 
<J  74  a;  p.  81,  ^  170  a,-  p.  83,  ^  172; 
p.  86,  l^llbd  ;  p.  124,  ()  241  ;  p.  227, 
Mil;  P-  317,  9  493  a;  p.  376,  (} 
578  b;  p.  393,  (^612. 

confounded  with  Creative  Power,  p.  40, 
^  64  A  ;  p.  46,  (J  74  a  ;  p.  76,  i)  \Q1  h ; 
p.  86,  ()  175  d  ;  p.  178-189,  i)  350|  a- 
350J  m 

the  Interpreter  of  its  Author,  p.  186,  ^ 
350i  kk;  p.  227,  ^  411.  See,  also, 
Design. 

man  her  interpreter,  p.  5,  ^  4  a. 

the  Conservator  of  Organic  Beings  ; 
see  Vis  Medicatrix  Naturae,  and 
Vital  Principle. 

the  great  fountain  of  rational  enjoy- 
ment, and  the  only  foundation  of 
philosophy  ;  ut  supra. 


INDEX. 


955 


Nature,  Kingdoms  op,  p.  15,  ^  7,  &c. 

the  organic,  and  inorganic,  have,  re- 
spectively, their  peculiar  properties 
and  laws,  p.  4,  (J  3 ;  p.  14,  ij  6 ;  p. 
20-27,  (J  19-51  ;  p.  34-36,  ^  62. 

phenomena  of  the  organic  more  various 
than  of  the  inorganic,  p.  4,  (J  3 ;  p. 
14,  ^  6;  p.  117,  ^  234:  g;  p.  331,  ^ 
500  0. 

our  knowledge  of  each  depends  upon 
the  nature  or  variety  of  the  phenom- 
ena, p.  4,  (J  3 ;  p.  80,  (}  169  ;  p.  111- 
121,  \  234-237. 

not  mutually  dependent,  p.  15,  ^  9-14 ; 
p.  16,  (J  16,  17;  p.  23,  ^  35,  37;  p. 
24,  ()  41,  42;  p.  25,  ^3  ;  P-  135- 
139,  ^  300-303|. 

creation  of  the  vegetable  and  animal 
reversed,  p.  135-138,  ()  303,  303|. 

■motion  the  great  sensible  attribute  of 
the  constitution  of  the  organic,  vis 
incrticB  that  of  the  inorganic,  p.  21, 
(J  24 ;  p.  30,  9  59  ;  p.  86,  87,  (^  176. 

simple  in  their  foundation,  p.  4,  <^  2  e  ; 
p.  331,  <J  500  o;  p.  662-664,  ()  895- 
899. 
Nerves, 

of  what  importance  in  foetal  life,  p.  43, 
(Ji  69  ;  p.  286,  ()  456  ;  p.  289,  <J  46U  a. 

their  early  development  in  the  foetus, 
like  that  of  the  liver,  kidneys,  and 
organs  of  sense,  &c.,  consistent  with 
their  dormant  state  in  the  great  plan 
of  Organic  Design,  as  respects  cere- 
brospinal, p.  42,  ^  67-70  ;  p.  284,  <;> 
455  a,  b  ;  p.  286,  (^  456  ;  p.  289,  ^ 
46U  a;  p.  342-353,  (J  516-524. 

sympathetic,  necessary  to  the  organic 
and  sphincter  muscles  in  the  life  of 
the  foetus,  ^  46 li,  488J,  514  /  g. 
Also,  Sympathetic  Nerve. 

not  the  source  of  motions  or  of  any  or- 
ganic result,  p.  43,  ij  69  ;  p.  46,  (j  74  ; 
p.  89,  ij  188  c;  p.  110,  ()  233  ;  p.  389, 
(^  461  ;  p.  296,  297,  (^  476^  b  ;  p.  317, 
318,  ^  493;  p.  324,  ^  500  c,  d ;  p. 
475,  ^  733  h  ;  p.  483,  ()  746  c.  See, 
also.  Capillary  Action,  Mobility. 

an  important  distinction  between  their 
trunks  and  expanded  extremities,  p. 
280,  ()  450  b;  p.  521,  I)  826  d;  p. 
585,  ()  891  e. 

their  functions  neglected,  or  perverted, 
or  ill  considered,  p.  112,  ij  234  b  ;  p. 
155,  §  349  e;  p.  162,  163,  l^  350, 
Nos.  18,  19,  20  ;  p.  177,  ij  350f  c;  p. 
193,  <J  356  a;  p.  283,  (J  452  b;  p. 
296,  ^  476^  b;  p.  317,  318,  t)  493. 

contribute  to  the  perfection  of  animal 
compounds,  ()  69,  22H,  224, 232,  233, 
399, 405, 446  a,  455,  456  a,  461, 461^ 
a,  485,  488i,  493  c-d,  512  rt-513,  516, 
Nos.  8,  9,  746  c,  846,  902  a-m,  952 
b-h. 
Nekves,  the  Different  Orders  of,  p. 


Nerves — continued. 

290-292.  See,  also,  Cerebro-Spinai 
AND  Ganglionic  Systems,  and  Syjt 
pathetic  Nerve. 
Nerves,  Motor, 

their  functions  and  laws  of  action,  p. 
102,  ()  202  ;  p.  106,  i}  224  ;  p.  110,  (^ 
233  ;  p.  Ill,  ()  2333  ;  p.  293,  ()  471  ; 
p.  326,  ^  500  g;  p.  330,  ()  500  nn  ; 
p.  335-353,  ^  512-524  ;  p.  521,  (j  826 
d;  p.  746,  i)  990t  b. 
Nerves,  Sensitive, 

their  functions  and  laws  of  action,  p. 
101-103,(^201-204;  p.  281,H50e; 
p.  292,  ()  472;  p.  326,  (J  500  g;  p. 
330,  (}  500  nn;  p.  335-353,  (}  512- 
524;  p.  521,  (j  826  d. 

of  true  sensation,  mostly  cerebro-spi- 
nal,  p.  101,  102,  ()  201 ;  p.  284,  i)  455  a. 

of  sympathetic  sensation,  mostly  the 
ganglionic  and  pneumogastric,  p.  101, 
102,  (J  201  ;  p.  109,  ij  230  ;  p.  284,  ^ 
455  J;  p.  746,  1^990^6. 
Nervous  Power, 

a  property  of  the  vital  principle,  and 
peculiar  to  animals,  p.  88,  (j  183, 184 ; 
p.  110,  ^  232. 

affords  a  demonstrative  proof  of  the 
existence  of  a  vital  principle,  and  of 
its  own  existence  as  a  property  of 
that  principle,  and  that  it  operates 
beyond  the  surface  of  organs,  p.  42, 
(^  67 ;  p.  746,  ^  990^  b. 

enters  largely,  or  its  organs,  into  the 
physical  doctrines  of  life,  p.  162, 163, 
(j  350,  Nos.  18,  18^,  19;  p.  Ill,  112, 
^  234  a;  p.  317,  318,  ^  493  ;  p.  475, 
^  733  h. 

commonly  regarded  as  the  electric  or 
galvanic  fluid,  p.  88,  (^  184  b. 

its  action  upon  irritability,  another 
property,  not  more  remarkable  than 
the  control  which  the  will  exercises 
over  other  properties  of  the  mind  and 
the  passions,  p.  88,  ij  184  b. 

generated  especially  by  the  brain  and 
spinal  cord,  but  also  by  the  ganglia 
of  the  sympathetic,  p.  321,  ()  497  ;  p. 
323,  ^  499;  p.  334,  i)  507;  p.  342- 
346,  ()  515,  516;  p.  349,  ()  520;  p. 
353,  {)  524  d,  Nos.  4-7. 

the  philosophy  of  its  operation,  and  its 
application  to  pathology  and  thera- 
peutics, how  far  expounded  by  the 
Author,  p.  106,1^222;  p.  Ill,  ^  234a; 
p.  162,  163,  I)  350,  Nos.  18,  19;  p. 
297,  ()  476i  b ;  p.  317,  318,  (J  493  ;  p. 
320,  ^  494  dd ;  p.  342,  <J  514^  J ;  p. 
515,  4  819  b;  p.  746,  (,  990^  b ;  and 
throughout  the  philosophy  of  Reme- 
dial AND  Morbific  Action,  and  of 
the  Operation  of  Loss  of  Blood. 

its  nature,  useless  to  be  known,  p.  60, 
ilUl,  Milton :  p.  88,  ^  184  J  ;  p.  1 17 
9  234  5. 


956 


INDEX. 


Nervous  Power — continued. 

as  with  Light  and  Magnetism,  not  in 

transitu,  p   115,  ^  234  e. 
like  hght  and  electricity,  brought  into 
operation  by  exciting  causes,  p.  115, 
^  234  e. 
acts  upon  irritability,  p.  88,  I)  184  h;  p. 
89,  {)  188;  p.  107,  I)  226;  p.  110,  (J 
233 ;  p.  323-332,  ^  500.     See,  also, 
Remedial  Action. 
how  developed,  p.  89,  <J  188  ;  p.  107,  ^ 
225-227;    p.   114,  ()  234  e;  p.  323- 
332,  (j  500.     Also,  Remedial  Action. 
excited  directly  and  indirectly,  p.  107, 
ij  227;    p.   323-332,  ^  500.      Also, 
Experiments     to    determine    the 
Laws  of  the  Vital  Functions,  and 
Remedial  Action. 
developed  by  agents   applied  to  the 
brain,  spinal  cord,  and  nerves,  by  the 
will  and  passions,  by  internal  phys- 
ical causes,  by  external  agents  act- 
ing upon  all  parts,  and  by  disease 
of  all  parts,  p.  107-111,  i)  227-233J  ; 
p.  333,  i)  503  ;  p.  334,  ()  507  ;  p.  349, 
(^  520  ;  p.  356-358,  ()  526  d ;  p.  706, 
707,  ()  947,  and  ut  supra. 
superadded  to  the  animal  kingdom,  and 
why,  p.  54,  55,  ()  107-117  ;  p.  106,  ^ 
223 ;  p.  1 10,  ^  232  ;  p.  284,  285,  ^  454, 
455;   p  475,  <J  733  h. 
operates  in  animal  and  organic  life,  p. 
106,  ij  223  ;  p    110,  ()  233  ;  p.  Ill,  ^ 
233J ;  p.  323-332,  ^  500  ;  p.  483,  ^ 
746  c. 
most  important  in  the  organic  life  of 
animals,  yet  its  greatest  final  cause 
is  relative  to  animal  life,  p   55,  <) 
113  ;  p.  106,  ^  223  ;  p.  127,  <^  259  ;  p. 
262,  ^  446  a  ;  p.  284,  285,  ()  454,  455. 
in  constant    operation    upon  various 
parts,  p.  106,  (;>  223  ;  p.  Ill,  ^  233| ; 
p.  113,  (J  234  c  ;  p.  115,  ^  234  e  ;  p. 
335-341,  ^  512-514. 
maintains   harmonious  action  among 
the  viscera  of  organic  life,  p.  55,  ^ 
113  ;  p.  106,  ^  223  ;  p.  108,  (J  228  a; 
p.  110,  <)  232;  p.  284,  M55. 
when  most  obvious  in  its  effect,  in  ani- 
mal and  organic  life,  p.  324,  ^  500  c, 
d ;  p.  332,  ?  501  ;  p.  662,  663,  i)  896. 
its   important  natural   action  mostly 
limited  to  compound  organs,  and  to 
certain  muscles  in  animal  life,  af- 
fecting also  the  functions  of  the  cap- 
illary vessels  in  their  various  offices 
of  circulation,    secretion,    &c.,    and 
capable  of  exerting  the  most  power- 
ful influences  upon  them.     See  ref- 
ereyice.i  above,  and  Nerves  and  Cap- 
illaries. 
but  little  operative  in  fcetal  life,  p.  43, 
<J  69.     See,  also.  Nerves,  and  Cap- 
illaries. 
0J^erates  through  motor  nerves,  p.  106, 


Nervous  Power — continued. 

()  224;  p.  290-292,  ()  462-471 ;  p.  330.. 
(j  500  nn. 

indispensable  to  voluntary  motion  in 
all  animals,  p.  104,  (J  215  ;  p.  110,  i^ 
233  ;  p.  127,  ^  259,  260. 

necessary  to  the  action  of  muscles  both 
in  animal  and  organic  life,  p.  325-327, 
^  500  e-i;  p.  338,  339,  ^  514/,  g. 
Also,  Nerves,  Sympathetic  Nerve. 

may  respond  through  the  same  motor 
nerves  to  impressions  transmitted 
through  various  sensitive  nerves,  p. 
327,  ^  500  i. 

indispensable  to  reflected  motion,  p. 
102,  <J  201  ;  p.  107-111,  ij  227-233| ; 
p.  323-332,  ^  500  ;  p.  404,  ^  637. 

does  not  involve  sensation,  p.  106,  <Si  223. 

implanted  in  the  brain,  spinal  cord, 
ganglia,  and  nerves,  or  in  the  gan- 
glionic system  of  inferior  animals,  p. 
106,  i)  224;  p.  115,  ^  234  e  ;  p.  334, 
()  507,  and  as  aboi-e. 

acted  upon  and  altered  in  kind,  &c., 
p.  107,  (j  225,  226.  See,  also.  Reme- 
dial Action. 

a  vital  agent,  p.  107,  ()  226,  227;  p 
323-332,  i)  500 ;  p.  359,  $  526  d ;  p. 
483,  (}  746. 

its  operation  and  results  analogous  to 
other  vital  agents,  p.  107,  108,  ()  227, 
228  ;  p.  114-118,  ^  334  d-k  ;  p.  331, 
^  500  0 ;  p.  483,  ^  746  c  ;  p.  706-708, 
ij  947,  949.     See,  also.  Analogies. 

excited  through  sympathetic  sensibili- 
ty, p.  108,  ^  227  ;  p.  116,  <)  234/; 
p.  281-283,  ^  450  e,  451. 

partakes  of  the  virtues  of  the  exciting 
causes,  under  the  influence  of  its 
own  nature,  p.  108-110,  ^  227-232  ; 
p.  333,  ()  503  ;  p.  647,  ^  893  e. 

its  modus  operandi,  p.  107-111,  <^227- 
2333  ;  p.  115,  I)  234  e ;  p.  125,  6  245 
p.  296,  ()  476  c ;  p.  323-332,  ^  500 
p.  334,  (J  509,  510  ;  p.  357,  ^  526  d 
p.   663,  ^  896;    p.  703-711,  ^940- 
952.      See,  also,  Remedial  Action, 
and  Remote  Causes  of  Disease. 

exquisitely  susceptible,  p.  11,  ()  5i  e ; 
p.  108,  110,  (}  228,  232  ;  p.  323-332, 
^  500,  501  ;  p.  357,  ^  526  d;  p.  706, 
707,  ()  947. 
operates  according  to  the  nature  of 
the  existing  and  modifying  causes, 
p.  107,  109,  111,  {)  227,  230,  233|  ; 
p.  296,  (}  476  c;  p.  301,  302,  ^  480, 
481  ;  p.  305,  I)  482  ;  p.  309-314,  ij 
484-489  ;  p.  323-332,  \  500  ;  p  334, 
()  509  ;  p.  405-412,  (J  638  ;  p.  662, 663, 
()  896  ;  p.  706,  707,  ()  947.  See,  also, 
Remedial  Action. 
an  important  law  of,  in  relation  to  or- 
ganic life,  and  as  distinguished  from 
the  corresponding  law  in  animal  life, 
p.  312,  ^  487  f 


957 


Norvous  Power — continued. 

its  effects  in  proportion  to  the  sudden- 
ness, as  well  as  violence  of  its  ac- 
tion, p.  11,  (J  5i  e ;  p.  298,  ^  476^  h ; 
p.  300,  ^  479  ;  p.  304,  ^  A81  g  ;  p. 
319,  320,  I)  494;  p.  334,  335,  ^  509- 
511  ;  p.  523,  524,  ^  827  d;  p.  525,  ^ 
828  b ;  p.  662,  663,  <)  896  ;  p.  703- 
7il,  (J  940-952;  p.  726,  ^  961. 

powerfully  operative  in  inducing  and 
removing  syncope,  p.  304,  305,  iJ481 
ff,  h,  Exp.  18  ;  p.  663,  {)  896  ;  p.  703- 
709,  ()  940-95]  ;  p.  726,  <5  961. 

its  influences,  natural,  morbific,  or  re- 
medial, p.  106,  ()  222,  223  ;  p.  107- 
110,  ij  226-232  ;  p.  28't-287,  ^  454- 
458  ;  p.  331 ,  (^  500  0  ;  p.  483,  ^  746  c ; 
p.  662-665,  1^  896-901.  See,  also. 
Remedial  Action. 

Its  relative  effect  when  developed  by 
disease  of  the  nervous  system,  and 
when  by  other  causes  acting  upon 
other  parts,  p.  334,  ^  508,  509  ;  p. 
356-358,  ()  526  d ;  p.  592,  ^  892^. 
See,  also.  Remote  Causes  of  Dis- 
ease, and  Remedial  Action. 

its  modifications  illustrated  by  the 
modifications  of  electricity,  polar- 
ized light,  &c.,  p.  79,  <j  168  ;  and 
ut  supra. 

its  rapidity  of  action  illustrated  by  the 
motions  of  light,  &c.,  p.  114,  <)  234  e ; 
p.  330,  ^  500  nn. 

adapted-  to  the  various  exigencies  of 
life,  p.  108,  ()  228  ;  p.  127,  ^  259  ; 
and  as  above. 

influenced  by  slight  variations  in  the 
intensity,  or  nature,  of  the  operating 
causes,  and  by  the  precise  part  upon 
which  they  operate,  p.  108-110,  () 
228-232  ;  p.  323-332,  (}  500  ;  p.  671, 
072,  ^  904  a.  Also,  Remedial  Ac- 
tion. 

how  affected  by  disease,  p.  109,  ^  229 ; 
p.  662-664,  ()  895  900  ;  and  as  above. 

the  cause  of  consRcutive  diseases,  p: 
109,  ()  229  ;  p.  285,  ^  455  ;  p.  339, 
(}  514:  h.  See,  also,  Pathological 
Cause,  Remote  Causes,  Remedial 
Action,  &c. 

its  connection  with  the  Law  of  Adapt- 
ation, p.  539,  t)  848. 

operates  on  the  organic  constitution 
of  the  brain  and  nervous  system,  as 
upon  other  parts,  p.  109,  ^  230 ;  p. 
334,  ^  509. 

operates,  however,  but  little  as  a  mor- 
bific cause  upon  the  nervous  tissue, 
p.  334,  i)  508  ;  p.  356-358,  ^  526  d. 

mutable  in  its  nature  like  the  organic 
properties,  p.  108-110,  ()  227-232. 
See  Vital  Properties,  their  mutabil- 
ity, and  Remedial  Action. 

its  mutability,  like  that  of  the  organic 
properties,  a  main  foundation  of  dis- 


Nervous  Power — continued. 

ease  and  its  cure,  p.  333,  §  503 
See,  also,  partakes  of  the  virtues,  &c., 
as  above,  and  Vital  Properties,  &c. 

does  not  generate  motion,  p.  110,  {\ 
233  ;  p.  127,  (}  259-261  ;  p.  296,  ^ 
476^  b;  p.  331,  ^  500  o ;  p.  663,  () 
896.  See,  also.  Experiments  to 
determine  the  Laws  of  the  Vital 
Functions. 

maintains  the  balance  of  functions,  p. 
110,  (J  232;  p.  230,  231,  ^  4t22  ;  p. 
284,  285,  §  455  ;  p.  663,  ^  896. 

in  connection  with  the  will,  a  remote 
cause  of  voluntary  motion,  p.  110,  ^ 
233;  p.  Ill,  ij  2331;  p.  113,  <J  234  c; 
p.  284,  ^  455  a ;  p.  288,  ^  459  d,  e ; 
p.  296,  ^  476  c ;  p.  313,  ^  487  gg,  h ; 
p.  314,  ^  488,  488^ ;  p.  324-332,  <J 
500  c ;  p.  357,  358,  ^  526  d ;  p.  370, 
^  569  a. 

its  prolonged  operation,  natural,  mor- 
bific, and  remedial,  p.  110,  111,  ^ 
232,  233^ ;  p.  285-287,  ^  455-458  ; 
p.  333,  ^  506  ;  p.  339,  <)  514  g ;  p. 
344,  345,  ^  516  d.  No.  6  ;  p.  707,  ^ 
949.  See,  also.  Remedial  Action, 
and  Alteratives. 

elects  special  motor  nerves,  in  animal 
and  organic  life,  without  apparent 
reference  to  anatomical  arrange- 
ment, p.  Ill,  ^  2331  ;  p.  113,  f)  231 
c ;  p.  327,  328,  ^  500  k. 

its  law  of  election  adapted  to  the  will, 
remedial  agents,  &c.,  p.  Ill,  ij  233? ; 
p.  287,  {)  458  ;  p.  328,  ^  500  /,  m. 

rendered  insusceptible  of  development 
by  the  will  in  paralysis,  but  suscep- 
tible to  other  causes,  p.  296,  §  476 
c ;  p.  326-332,  ^  500/-/.  See,  also. 
Narcotics. 

rendered  permanently  stimulant  to  the 
organs  of  circulation  by  local  inflam- 
mation, which  thus  influences  the  ef- 
fects of  loss  of  blood,  p.  354,  355,  ^ 
526  a ;  p.  732-736,  ()  971-980. 

depressant  or  excitant  in  phlebitis  and 
venous  congestion,  p.  503,  504,  <J 
794-798  ;  p.  507-510,  ()  806-816  ;  p. 
724-732,  ^  961-970  ;  p.  735,  736,  <J 
978. 

peculiarly  modified  in  delirium  a  potu, 
mania,  hydrophobia,  &c.,  p.  734,  i) 
975  c,  976  a,  b. 

especially  oxcrtant  in  cerebral  inflam- 
mation and  cerebral  congestion,  and 
according,  also,  to  the  nature  of  oth- 
er tissues,  and  the  kind  of  inflam- 
mation, p.  61,  ()  134  ;  p.  64,  ^  140  , 
p.  67,  i)  150,  151  ;  p.  70-73,  tables . 
p.  733-736,  ^  974-980 

variously  modified  in  spasmodic  and 
apoplectic  affections,  p.  356-358,  4 
526  d;  p.  590-593,  i)  891^  ;  p.  741 
747,  ^  99')-990^. 


958 


INDEX. 


rvervous  Tower— conliymed. 

how  productive  of  motion  after  appar- 
ent death,  and  in  decapitated  ani- 
mals, p.  338,  ^  5Ud;  p.  357,  358, 
^  526  d ;  p.  404,  <^  637. 

developed  by  narcotics  with  such  in- 
tensity, permanency,  and  organic  in- 
fluences, as  to  be  more  or  less  in- 
susceptible to  other  agents.  See 
Narcotics. 

is  morbific  or  curative,  according  to 
its  modifications,  p.  107-111,  s^  226- 
233|  ;  p.  336,  <)  5U  b ;  p.  672,  ^ 
904a.     See,  also,  Remedial  Action. 

its  development  by  Narcotics  counter- 
acted by  pain,  &c.,  p.  587-590,  §  891. 

its  preternatural  influences  reach  the 
intimate  organization  of  parts,  read- 
ily, slightly,  and  profoundly,  p.  109, 
•J  230,  231  ;  p.  230,  ^  422  ;  p.  286,  ^ 
455  ;  p.  334,  ()  508,  509  ;  p.  335-341, 
<)  512-514  ;  p.  354,  355,  ^  526  a;  p. 
662,  663,  ^  896  ;  p.  724-726,  ^  961  a 
-e  ;  p.  732-736,  ()  971-980. 

always  operative  upon  muscles  of 
mixed  motion,  and  the  exciting 
cause,  p.  325,  ^  500  e ;  p.  339,  | 
514/,  f. 
little  operative  upon  the  voluntary 
muscles,  excepting  when  the  will 
operates,  p.  110,  ^  233. 
•  illustrated  by  the  "  imponderables,"  p. 
79,  (}  168  ;  p.  113-121,  ()  234  c-237 ; 
p.  330,  ^  500  n. 

spurious  hypotheses  of,  p.  Ill,  112,  § 
234  ;  p.  317,  318,  ^  493. 

illustrative  of  stupendous  Design,  p. 
106-111,  ^223-233i;  p.  125,  ^  246  ; 
p.  284,  ^  454 ;  p.  287,  §  458  ;  p.  323 
-332,  ^  499,  500  ;  p.  662,  663,  «J  896. 

its  agency  in  the  production  of  animal 
heat,  p.  262-264,  ()  446  ;  p.  663,  <j  896. 

its  instrumentality  in  animal  heat  anal- 
ogous to  its  connection  with  all  oth- 
er products  of  living  beings,  p.  54, 
5.5,  ^  109  i,  113  ;  p.  262,  263,  (j  446  ; 
p.  483,  ()  746  c ;  p.  662,  663,  ^  896. 

a  knowledge,  abstractedly,  of  its  oper- 
ation in  health,  of  little  practical  im- 
portance, but  of  the  greatest  moment 
in  disease  ;  ut  supra. 

hitherto  not  applied,  in  any  intelhgible 
sense,  to  the  explanation  of  the  laws 
of  sympathy,  however  those  laws 
may  be  known,  or  to  any  natural  re- 
sults, while  it  is  totally  obscured  in 
the  philosophy  of  disease  by  the 
chemical  and  physical  doctrines,  p. 
106,  ^  222  b ;  p,  264,  ^  447  c  ;  p.  283, 
<J  451/,-  p.  317,  318,  ^  493  ;  p.  320, 
^  494  dd ;  p.  329,  ^  500  nn ;  p.  342,  ^ 
514^  b ;  p.  362,  <}  530  ;  p.  484,  485, 
^  748,  749  ;  p  515-518, ^ 819  i-824  ; 
p.  661,  i!i894a;  p.  691,  ^906^,909. 
See,  also.  Organic  Chemistry,  (Jap- 


Nervous  Power — continued. 

iLLARY  Action,  and  Remedial  Ac- 
tion.    Rights  of  Authors,  p.  912. 

shown,  by  experiment,  that  syncope 
does  not  depend  upon  its  failure  to 
affect  the  heart,  &c.,  p.  305,  ^  481  A  , 
p.  706,  707,  ^  947,  948. 

exerts  a  certain  influence,  as  a  vital 
stimulus,  upon  the  functions  ana 
products  of  animals,  p.  262-268,  ^ 
446-447  d ;  483,  484,  ^  746  c. 

presents  a  problem  for  Chemistry,  p. 
281,  H50e;  p.  330,  (J  500  nn. 

its  functions,  the  Poetry  of  Nature  ; 
ut  supra. 
Nervous  Systems,  General  Uses  of,  p 

284-290. 
Nervous  Tissues.      See  Tissues,   and 
Structure. 

not  much  subject  to  disease,  p.  356- 
358,  (j  526  d. 
Nitrogen, 

a  remarkable  element  of  organic  be 
ings,  p.  34-36. 

a  main  cause  of  putrefaction  and  fer- 
mentation, p.  34,  ^  62. 

abounds  in  animals,  p.  34,  ()  62  a,  /. 

occurs  in  most  parts  of  plants,  p.  35,  ^ 
62/,  note. 

a  principle  of  dissolution,  p.  34,  ^  62. 

shown  by  the  Author  to  prove  a  vital 
principle,  p.  34-36,  ^  62. 

wanting,  naturally,  in  inorganic  com- 
pounds, p.  34,  {)  62  d,  g. 

feebly  compatible  with  chemical  com- 
pounds, p.  34,  35,  (^  62  d-h. 

not  united  with  oxygen  in  the  atmo- 
sphere, p.  34,  ()  62  e. 

most  indifferent  of  all  the  elements,  p. 

34,  (J  62  d. 

maintains  its  connections  in  living  or- 
ganic compounds  equally  with  the 
other  elements,  p.  35,  ^  62/ 

occasions  transformations  in  dead  or- 
ganic and  certain  inorganic  com- 
pounds by  the  contact  of  water,  p. 

35,  ()  62  g. 

in  compounds  of  sudden  transforma- 
tion, heat,  or  mechanical  violence, 
is  the  predisposing,  and  water  a  re- 
tarding, cause. 

occasions  the  ready  explosion  of  ful- 
minating compounds,  p.  35,  i;  62  e. 

another  illustration  in  gun-cotton,  &c. 

one  of  its  obvious  final  causes  in  or- 
ganic beings  is  their  ultimate  disso- 
lution ;  and  this  explains  the  philos- 
ophy of  Tiedemann's  statement,  p. 
28,  29,  ^  54  a ;  p.  36,  ^  62  k. 

Author'' s  proof  from,  of  the  creation  of 
plants  before  animals,  and  against 
the  speculatists,  p.  136-138,  ij  303, 
303i 

NiTROGENIZED  VEGETABLE  FoOD, 

its  uses  in  Chemistry,  p.  17-19,  (j  18 ; 


INDEX. 


959 


Nilrogenized  Vegetable  Food — continued. 
p.  219-222,  ()  409  a,  b.     See,  also, 
Protein. 
Numerical  Method  and  Organic  Chem- 
istry, 

their  parallel,  p.  762,  763,  (j  1006  a. 

alike  necessary  "  Instruments"  in  Med- 
icine, p.  161,  (J  350,  No.  14,  and  as 
above. 
Nutrition, 

laws  of,  p  40-45,  ^  65-73  ;  p.  217-227, 
()  400-411. 

requires  the  blood,  or  sap,  as  a  univer- 
sal stimulus,  while  in  each  part  it  is 
commonly  promoted  by  specific  stim- 
uli, p.  46,  \  74  a;  p.  62,  63,  ()  136, 
137. 

theory  of,  in  organic  chemistry,  p.  180, 
181,  <^  3501  e. 

contradicts  the  chemical  theory  of,  p. 
219-227,  H07-411. 

its  vast  philosophy,  226-227,  ^  410, 41 1 . 
Nutrition  and  Waste, 

ends  of  organic  life,  p.  21,  ij  20,  27  ; 
p   34,  ij  62  A;  p.  53,  ^  104;  p.  129, 
ij  273.     See,  also.  Absorbents. 
Nux  Vomica.     See  Aconite,  &c. 

O. 
Oblivion, 

Error  its  victim.  Truth  its  vanquisher, 
p.  203-207,  (j  376.^,  376J  a;  p.  462, 
note ;  p.  690,  (j  906/;  p.  755,  (J  1004  b. 
Observation, 

the  importance  oi  minute  and  accurate, 
in  all  physiological  and  medical  in- 
quiries, p.  1,  2,  1^  1  ;  p.  3,  4,  ij  2  d,  e ; 
p.  10-12,  (j  bi;  p.  14,  ^  6  ;  p.  16,  <^ 
14  c;  p.  34-49,  ()  62-81  ;  p.  61-73, 
()  133-163  ;  p.  86,  ()  175  d ;  p.  92-96, 
()  188^  d-l89  c  ;  p.  99,  ()  192  ;  p.  101, 
102,  ^  201,  202  ;  p.  106-122,  ^  222- 
240  ;  p.  127,  128,  ^  261-266  ;  p.  132, 
133,  ^  289-291  ;  p.  139,  ()  303?  ;  p. 
143-146,  ^  322-326  ;  p.  152,  153,  ^ 
^  345-349  a ;  p.  154,  155,  ()  349  c-e ; 
p.  157-182,  ^  350-350J  ff;  p.  189, 
190,  ^  350J  n ;  p.  197,  ()  363  ;  p.  200, 
201,  ^  366-375  ;  p.  208-217,  ^  383- 
399;  p.  220-227,  (}  409-411;  and 
so  on. 
Oil,  Castor, 

the  introduction  of,  and  of  aloes  and 
rhubarb,  among  the  group  of  Alter- 
atives in  the  Author's  Arrangement 
of  the  Materia  Medica,  indicative  of 
their  special  influence  in  small  and 
repeated  doses,  p.  557,  (}  873  b ;  p. 
p.  567-569,  ^  889  l-mm;  p.  571,  572, 
(J  890  b ;  p.  636-642,  (^  8924  d-i ;  p. 
687,  <J  905^  c.  See,  also.  Altera- 
tives. 

author's  opinion  that  it  exerts  a  pecu- 
liar alterative  action  upon  the  liver, 
ill  morbid  states  of  that  organ,  ibid. 


Old  Age, 

its  physiological  and  moral  character- 
istics, p.  282,  283,  ^  581.     See,  also. 
Death. 
Opinions, 

not  their  Authors,  the  subjects  of  criti- 
cism.    See  Authors. 

their  want  of  independence,  and  arbi- 
trary nature,  characteristic  of  the 
age,  p.  155,  <)  349  d;  p.  174,  §  350i ; 
p.  176,  ^  350.^  q  ;  p.  202,  ^  376^  ;  p. 
203-207,  (}  3761  a ;  p.  235,  ^  433  ;  p. 
719,  ()  960  a;  p.  762,  763,  ^  1006  a. 

more  independence  of,  in  the  United 
States  than  in  Europe,  and  why,  p. 
460,  (J  709,  and  note.  Also,  Medical 
AND  Physiological  Commentaries, 
vol.  i ,  p.  327;  vol.  ii,,  p.  663-672. 

when  false,  can  not  endure,  p.  174,  (j 
.3501 ;  p.  202-207,  §  376^,  3761  a. 
Opium, 

possesses  a  factitious  reputation  as  a 
curative  agent,  p.  584,  ij  891  c;  p. 
718,  719,  ^  960  a. 

experiments  showing  it  is  not  absorbed, 
p.  302-310,  319,  333,  930. 

its  uses  mostly  limited  to  subduing 
pain  in  the  absence  of  acute  inflam- 
mation, moderating  irritability,  pro- 
curing sleep,  and  restraining  diar- 
rhoea, p.  583-590,  <i  891. 

never  to  be  employed  for  the  relief  of 
pain  when  it  may  aggravate  disease, 
p.  587,  588,  <J  891  k-m. 

curative,  only  by  allaying  irritability, 
and  by  thus  preventing  the  deleteri- 
ous action  of  exciting  causes,  or  the 
unfavorable  action  of  cathartics,  and 
other  irritating  remedies,  and  thus 
promoting  their  favorable  action, 
or  by  calming  restlessness,  and  pro- 
curing sleep,  and  thus  giving  a  fa- 
vorable determination  to  the  whole 
intervention  of  art,  or  to  otherwise 
unaided  Nature,  p.  554,  (J  871,  872 
a;  p.  561,  ^  888  b;  p.  585-590,  ^ 
891  f-s ;  but  for  these  purposes  is 
often  inferior  to  cicuta,  or  hyoscy- 
amus,  especially  where  their  fre- 
quent repetitions  are  useful,  as  in 
chronic  irritability  of  the  stomach, 
irritable  tumors  and  ulcers,  cases  of 
phthisis  attended  by  constipation, 
&c.,  and  where  cicuta,  upon  the 
ground  of  its  sedative  effect,  has  ac- 
quired, in  some  of  the  cases,  the 
reputation  of  possessing  positive 
virtues  of  an  alterative  nature,  ibid. 

removes  diarrhoea  by  quieting  intesti- 
nal irritability,  while  hyoscyamus 
will  not  exert  that  effect  upon  the 
intestinal  mucous  tissue  in  the  same 
morbid  state,  p.  61-63,  ^  134-137  ;  p. 
65,  ^  143  a,  c;  p.  67,  ()  149-151  ;  p 
73,  ^  163 ;  p.  417,  ^  650  ;  p.  427,  ^ 


960 


INDEX. 


Opium-  —continued. 

668-670  :  p.  428,  ^  674  a ;  p.  430- 

433,  4  675,  676  a ;  p.  543,  i}  856  ;  p. 

553-557,  (^  870-874  ;  p.  561,  (}  888  h ; 

p.  566,  567,  ^  889  k ;  p.  570,  ^  889  n; 

p.  571,  572,  ^  890  b;  p.  575,  576,  (} 

890  A-,  I;   p.   577,  578,  ^   890  o;  p. 

583-590,  ij  891  as;  p.  592,  593,  ^ 

89H  i;  P-  718,  ^  960  a. 
OEfJANic  Analysis, 
difficult  in  its  elementary  aspect,  p.  16, 

(J  15  ;  p.  18,  <J  18  d. 
proximate,  hypothetical,  p.  14,  <5  6  ;  p. 

27-29,  ^  53  ;  p.  221,  222,  (f  409  b  ;  p. 

228,  (}  417  a.     See,  also,  Pkotein. 
its  artificial  transformations,  p.  28,  ^ 

53;  p.  228,  ^  4\7  a. 
elementary,  the  legitimate  objects  of,  in 

respect  to  science,  p.  202, 203,  ()  376^. 
OuGAMc  Beings, 
their  general  structure,  p.  20,  ij  19  ;  p. 

50-61,  ^  83-133. 
their  composition,  p.  15,  ij  12 ;  p.  23- 

49,  ^  38-80. 
how  distinguished  from  minerals,  p. 

15-22,  ^  7-30  ;  p.  23-49,  (J  38-80  ;  p. 

112-125,  i)  234-246;  p.   157-173,  () 

350. 
their  peculiar  properties,  p.  73-125,  ij 

164-246. 
their  peculiar  functions,  p.  125-372,  <J 

247-569. 
their  relations  to  external  objects,  p. 

398^00,  ()  626-630. 
generate  motion,  p.  21, '()  24;  p.  31,  ^ 

59  ;  p.  89,  (j  188  a ;  p.  345,  346,  (J  516 

d,  No.  7. 
their  waste  and  renewal,  p.  21,  ^  27 ; 

p.  53,  ()  104 ;  p.  129,  ^  273  ;  p.  217, 

<)  401  b. 
their  seventeen  elements,  p.  23,  ^  34, 

35  ;  p.  225,  {)  409. 
their  four  principal  elements,  p.  23,  <J 

37;  p.  33,  ()  61,  62. 
how  their  elements  combine,  p.  23,  ^ 

38,  39  ;  p.  26,  <J  48,  49  ;  p.  30-32,  (} 

58,  59. 
the  vital  power  combines  their  ele- 
ments, p.  30,  ^  58,  59  ;  p.  36^7,  ^ 

63-74. 
remarkable  contrast  in  the  number  of 

their  compounds  and  those  of  the 

globe,  p.  24, 25,  <J  41, 46 ;  p.  227,  -J  41 1. 
their  vis  vita,  succeeded  by  vis  inertia, 

p.  30,  31,  ()  59. 
nitrogen  gas,  a  remarkable  element  of, 

p.  34-36,  <J  62. 
a  knowledge  and  just  appreciation  of 

their  properties,  functions,  and  laws, 

indispensable  in  medicine,  p.  4,  5,  ij 

3,4;  p.  14,  ()  6. 
why  their  general  laws  are  determined, 

p.  14,  {)  6. 
Organic  Chemistry, 
the  extent  of  its  power,  p.  8,  ^  5 ;  p. 


Organic  Chemistry — continued. 

14,  ^  6;  p.  15,  ^   lib;  p.  16,  (J  ly 
p.  18,  ^  18;  p.  24,  ^2;  p.  25,  §44, 
p.  27-29,  §  53,  54 ;  p.  29,  §  54  6 ;  p, 
161,  ^  350,  No.  59. 

contradistinguished  from  Physiology 
and  Medical  Philosophy,  p.  7,  (^  4J 
rf;  p.  8,  (J  5;  p.  10,  <J  5^  a;  p.  11,  ^ 
51  c;  p.  14,  (J  6;  p.  19,  §  18  c ;  p. 
21-36,  <J  20-62  ;  p.  40-42,  ()  65,  66  ; 
p.  92-111,  ^  188^  d-233l;  p.  135- 
139,  §  303-3035;  p.  149-203,  ()  337- 
376^;  p.  234-279,  I)  433-448;  p. 
323-332,  ^  500;  p.  362,  §  530;  p. 
376-380,  §  578  ;  p.  383,  §  584  a ;  p. 
391,  392,  I)  602  d-606  ;  p.  393,  i)  612; 
p.  397,  (J  623  ;  p.  398,  ^  626  ;  p.  401, 
§  631,  and  so  on. 

school  of,  p.  6,  §  4.^  b. 

decHning,  p.  6,  7,  Hj  ^ ;  P  203,  ()  376i. 

inapplicable  to  medicine,  p.  8,  9,  ()  5; 
p.  13,  ^5ib;  p.  434,  i)  676  b. 

its  foundation,  p.  10,  ()  5i  a,  c ;  p.  13,  ^ 
5i  a;  p.  154,  ^  349  c;  p.  155,  <J  349 
e;  p.  156,  ^  350,  mottoes;  p.  182,  § 
3501  g;  p.  197,  (}  362;  p.  202,  § 
376^  ;  p.  221,  <)  409  b ;  p.  235,  <)  433 
p.  238,  §  438  ;  p.  239-248,  §  440^141 
b;  p.  274-278,  §  447^  ;  p.  456,  (J  698 
p.  519,  (J  824  a. 

its  promises  of  usefulness,  p.  8,  9,  §  5 
p.  12,  §  5^  a. 

extent  of  its  objects,  p.  197,  §  362. 

points  out  the  means  of  sustenance,  p. 
17-20,  (}  18  b-c  ;  p.  156,  §  350,  motto 
d ;  p.  235,  (J  433. 

may  indicate  the  food  for  plants,  p.  20, 
•J  18  e. 

applied  to  physiology,  p.  7,  §  4i  J ;  p. 
13,  -liSi;  p.  14,  §  6;  p.  19,  §  18  e; 
p.  29,  ^  54 ;  p.  38-40,  §  64  e-k ;  p. 
152-203,  §  345-376^;  p.  226,  (J  409 
j;  p.  234-248,  ()  433-441;  p.  274- 
278,  {)  447^. 

its  summary  exhibition  by  Mulder,  p. 
180-183,  ^  350J  e-gg;  p.  189,  190. 
()  350J  n. 

its  own  statement  of  its  ability  and  ob- 
jects, p.  18,  ^I8c;  p.  161,  (}  350,  No. 
59  ;  and  how  far  observed,  p.  157- 
178,  §  350-350?  ;  p.  197,  ()  362  ;  p. 
202,  §  376i 

its  moral  and  religious  tendencies. 
See  Life. 

the  judgment  of  posterity  upon,  p.  9,  ^ 
5  ;  p.  203,  «J  3761 ;  P-  434,  §  676  b  ; 
p.  762,  §  1006  a. 

how  far  substituted  for  medical  philos- 
ophy, p.  8,  §  5  ;  p.  13,  ^  5^  b ;  p. 
174-178,  ^  3501-3503  ;  p.  197,  ()  362  ; 
p.  202,  203,  (}  376i  ;  p.  234,  235,  ^ 
433  ;  p.  456,  §  698  ;  p.  515,  ^  819  b. 

how  far  tolerant,  p.  13,  ^  5^  a ;  p.  156, 
<J  350,  mottoes,  a,  b,  c,  d,  e ;  p.  185,  ^ 
350|U-;  p.  515,  §  819 />. 


961 


Organic  (chemistry — coiUinucd. 

causes  of  its  success,  p.  11,  ^  5|  c;  p. 
17,  i)  18  c;  p.  133,  (J  292;  p.  154, 
155,  (j  349  c,  d;  p.  202,  ()  376^  ;*p. 
234,  235,  ^  433;  p.  515,  ^  819  b. 
See,  also.  Analogies,  False. 

its  recommendations,  p.  6,  7,  ij  ^\h,  d ; 
p.  8,  9,  ^  5;  p.  11,  ij  5i  c;  p.  13,  ij 
b\  b;  p.  14,  ^  6;  p.  17,  (J  18c;  p. 
19,  tjlQe;  p.  26,  ()  48,  49  ;  p.  28,  () 
53  c ;  p.  30-33,  ij  59  ;  p.  36,  ^  62  i  ; 
p.  38-40,  ()  64  e-h ;  p.  43,  ij  67 ;  p. 
85,  ^  175  c;  p.  132-134,  (J  289-293  ; 
p.  136-139,  ^  303-303^ ;  p.  152-192, 
9  345-352  ;  p.  197,  <J  363  ;  p.  199,  ^ 
364^  ;  p.  202,  203,  (,  376,  376^ ;  p. 
220-222,  ^  409  ;  p.  2^6,  ^  409  ;  ;  p. 
234-260,  ^  433-445;  p.  274-279,  (} 
447^^48  ;  p.  434,  ^  676  b  ;  p.  456,  ^ 
698,  p.  515,  6  819  i;  p.  519,  ^  824 
a;  p.  763,  ^  1006  a, 

the  Author^ s  Motives  for  investigating 
its  merits,  p  7,  ^  4^  i,  (Z  ,•  p.  8,  (^  5  ; 
p.  13,  ^  5^  a;  p.  148,  <J  335 ;  p.  154, 
155,  ij  349  ;  p.  156,  ^  350,  mottoes,  a, 
b,  c,  d,  e;  p.  173-178,  ()  350J-350i  ; 
p.  191,  (j  351  ;  p.  197,  ()  362  ;  p  202, 
()  376J  ;  p.  234,  I)  433  ;  p.  239,  ()  438 
d;  p.  241,  ^  440  J;  p.  254,  ()  441  e ; 
p.  265,  ij  447  ^1 ,-  p.  277,  <J  447^/;  p. 
345,  ()  516  <Z,  No.  6  ;  p.  362,  ^  530  ; 
p  456,  (j  698  ;  p.  515,  ij  819  b  ;  p.  540, 
<J  851  c  ;  p.  543,  ^  854  i6. 

its  advantages  to  medicine,  p.  171-173, 
{)  350,  Nos.  41-46;  p.  174-178,  (/ 
350^-350s. 

Its  confirmation  or  overthrow,  p.  148, 
^  335  ;   p.  542,  ()  854  bb. 

problems  for  its  solution,  p.  16,  ^  14  c  ; 
p.  85,  I  175  c;  p.  94,  ()  188^  d;  p. 
155,  ^  349  e;p.  281-283,  ^  450  d- 
4:51  f;  p.  330,  (foOOnn;  p.  377,  379. 
Organic  Chemistry  and  the  Numerical 
Method, 

important  "  Instruments"  in  medicine, 
p.  161,  ^  350,  No.  14;  p.  762,  763,  § 
1006  a. 

their  parallel,  p.  762,  763,  <)  1006  a. 
Organic  Chemistry  and  Physiology, 

contrasted,  p.  19,  <;>  18  e;  p.  157-173, 
<J  350  ;  p.  189,  190,  6  350?  n  ;  p.  191, 
«  351  ;  p.  246,  <J  440  /;  p.  277,  278, 
sS  447i/;  p.  514,  515,  ^  819. 

one  destructive,  the  other  formative 
and  conservative,  p.  8,  9  5  ;  p.  13,  ij 
5^  b ;  p.  18,  (}  18  c;  p  24,  (J  42  ;  p. 
33,  'Ji  60  ;  p.  34-36,  ^62;  p.  37-40, 
^64;  p  135,  ^  301. 
Organic  Compounds, 

their  four  principal  elements,  p.  23,  ^ 
37  ;  p  27,  ^  53  i  ;  p.  33,  ^  61,  62  ;  p. 
44,  §  72. 

always  consist  of  three  or  more  ele- 
ments intimately  combined,  p.  16,  (j 
17;  p.  227,  Hll. 

Pp 


Organic  Compounds — continued. 
formed    of    ccmbustible    substances, 

proper,  of  supporters  of  combustion, 

and  nitrogen  gas,  p.  33,  ij  61. 
fonned  out  of  a  homogeneous  fluid  of 

seventeen  elements,  p.  24,  <J  42. 
formed  originally  by  plants,  p.   15,  ^ 

10,  13  ;  p.  135-138,  ^  298-303^. 
when  decompounded,  how  restored,  p 

15,  §  13,  14. 

mode  in  which  their  elements  com- 
bine, p.  23,  §  37-39  ;  p.  24,  ^42;  p. 

26,  (J  48  ;  p.  27,  ^  51,  52,  53  b ;  p, 
44,  §  72. 

contradistinguished  from  mineral  com- 
pounds, p.  20-27,  §  19-51  ;  p.  221- 
227,  ^  409  J-411. 

progressively  advanced,  p.  24,  ^  42. 

hold  different  ranks,  p.  24,  ^  42. 

different  in  every  part,  p.  25,  ij  44 ;  p. 

27,  <)  53  b;  p.  222-225,  (}  409. 
variety  of,  p.  24,  ij  41  ;  p.  44,  ij  72 ;  p. 

221-227,  (J  409  i^ll. 

not  formed  in  the  blood  or  sap,  p.  24, 
M2  ;  p.  28,  ^  53  i,  c ;  p.  44,  ^  72  ; 
p.  217,  (J  401  b,  402  ;  p.  218,  ^  404  ; 
p.  219-227,  ^  407-411.  See,  also 
Protein. 

confounded  by  chemistry,  p.  29,  ^  54  b. 

uniform  in  health,  p.  21,  ^  22  ;  p.  24,  () 
42 ;  p.  25,  ^  44 ;  p.  26,  ()  iS  ;  p.  27, 
^  53  b;  p.  44,  ^  72  ;  p.  223-227,  ^ 
409/-411. 

exactly  variable  in  disease,  p.  21,  ^  22  , 
p.  25,  §U;  p.  87,  ^  182  a ;  p.  105,  ^ 
220,  221  ;  p.  435,  ()  680  ;  p.  452,  ^ 
693  ;■  p.  473,  <J  733  c ;  p.  474,  ^  733 
/;  p.  478,  479,  (}  739-741  ;  p.  517, 
518,  ij  822  :  p.  536-538,  ^  847  c-f 

fundamental  cause  of  their  differences, 
p.  27,  (^  52,  53  b. 

their  chemical  analysis  uncertain,  p. 

16,  H5  ;  p.  18,  ^18  d;  p.  26,  ^  48  ; 
p.  27-29,  ^  53,  54. 

their  complexity,  p.  24,  ij  41,  42  ;  p. 

25,  M3  ;  p.  26,  M9 ;  P-  32,  ^  60  • 

p.  44,  ^  72. 
their  putrefaction  and  fermentation,  p. 

28,  §  5i;  p.  30-32,  ^  59  ;  p.  34-36, 
^62;  p.  96,  §  189  c. 

their  elements  united  hy  vis  vita,  p. 
30-32,  ^  58,  59  ;  p.  33,  ^  60  ;  p.  36, 
(f62i;  p.  37-44,  (}  64-72. 

when  dead,  vis  inertice  succeeds  to  vis 
vita,  p.  30,  31,  ^  59. 

their  artificial  transformations,  unnat- 
ural, p.  28,  29,  ^  53  5-54  b ;  p.  228, 
§  417. 

chemical  influences  upon,  suppose 
chemical  decompositions  and  re- 
combinations, p.  28.  ^  53  b  ;  p.  228, 

their  nature  disturbed  by  any  chemical 
influence,  p.  28,  <J  53  J;  p.  29,  30,  ^ 
56,57;  p.  228,  ^17  a. 
P 


962 


INDEX. 


Organic  Compounds — continued. 
.when  dead,  their  condition  affected  by 
pre-existing  \ital  intiuences,  p.  28, 

their  chemical  decomposition  rapid,  p. 
29,  30,  f)  54  a,  56 ;  p.  34-36,  ()  62. 

their  dissolution  greatly  owing  to  nitro- 
gen gas,  p.  34-36,  <J  62. 

their  dissolution  promoted  by  the  com- 
plexity of  their  elements,  p.  36,  (j  62 
A,  and  by  water  or  its  elements,  p. 
35,  (}  62  g. 
Organic  Force,  Chemical  Theory  of, 

oxydation  of  the  blood  and  tissues,  p. 
157,  158,  159,  (}  350,  Nos.  3,  4,  5,  7, 
8,  9  ;  p.  274,  (}  447^  a,  No.  2. 

the  cause  and  the  effect,  p.  7,  ^  4i  d; 
p.  84-86,  ()  lib  c,  d;  p.  90,  ^  188^ 
d;  p.  154,  155,  ^  349  c,  e;  p.  254,  I 
441  e ;  p.  274,  ^  44 7^  a.  See  Vital 
Principle,  and  Vital  Properties. 
Organic  Functions, 

their  general  consideration,  p.  126-280, 
i)  251-449. 

common  to  plants  and  animals,  p.  125, 
<)  249. 

their  designations,  motion,  absorption, 
assimilation,  distribution,  o.ppropria- 
tion,  excretion,  calorification,  genera- 
tion, p.  125,  ij  249. 

the  most  essential  carried  on  by  the 
extreme  vessels,  p.  36^1,  ^  63-72. 
See,  also.  Capillaries,  Capillary 
Action,  and  Circulation,  Capil- 
lary. 
Organic  Heat, 

vital  and  Chemical  Theories  of,  p.  234— 
279,  ^  433-448. 

its  interpretation  abandoned  to  chem- 
istry, p.  234,  1^  433  ;  but  is  only  one 
among  many  corruptions  in  Physiol- 
ogy, p.  235,  {)  433. 

Crawford's  theory  of,  p.  235,  ^  434, 
435  a. 

Bichat's  theory  of,  p.  236,  ^  437  a;  p. 

262,  ()  445  g ;  p.  266,  <)  U7  d ;    p. 

270,  ^  447  d. 

Hunter's  theory  of,  p.  237,  <J  437  b. 
Philip's  theory  of,  p.  237,  <J  437  c ;  p. 

263,  ()  446  b. 

Moore's  theory  of,  p.  337,  ^  437  d. 
Mailer's  theory  of,  p.  237,  ()  437  e. 
Tiedemann's  theory  of,  p.  237,  ^  437/. 
Carpenter's  theory  of,  p.  237,  ^  437  g. 
Edward's  theory  of,  p.  237,  ^  438  a ;  p. 
248,  ()  Ul  b;  p.  255,  ^  44U  a ;  p. 

271,  272,  ^447^. 

Elliotson's  theory  of,  p.  273,  ^  447  h. 

Billing's  theory  of,  p.  238,  <^  438  b. 

Roget's  theory  of,  p.  238,  (J  438  c. 

Distinction  between  Liebig's  and  the 
last  two,  p.  238,  ^  438  d. 

Liebig's  theory  of,  as  of  all  organic  pro- 
cesses and  results,  combustion,  or 
the  union  of  oxygen  with  carbon  and 


Organic  Heat  —continued. 

hydrogen,  p.  239-248,  ^  440-441  h, 
p.  252,  ^  Ul  c;  p.  254,  2.55,  <;>  441  c, 
f;  p.  260,  ^445  b;  p.  264,  ^46  c. 
p.  274-278,  {)  447^. 
conflict  in  the  chemical  statements  of, 
p.  239,  240,  ^  440  a,  b;  p.  252,  ^ 
441  c;  p.  246,  ^  440/;  p.  254,  255, 
(j  441  e,f;  p.  260,  I)  445  b;  p.  264,  ^ 

446  c ;  p.  271,  ^  447  /,  g ;  p.  273,  \ 

447  h ;  p.  274-278,  ^  447^ 

theory  of,  regarding  the  conversion  of 
fluids  into  solids,  p.  273,  ^  447  h,  and 
ut  supra. 

contingent  aid  required  by  the  theo- 
ry of  combustion,  p.  239-244,  ^  440, 
Nos.  3,  7,  8,  9,  11,  lU,  12,  13,  14; 
p.  245,  (J  440  e ;  p.  247",  ()  440,  No. 
19  ;  p.  248,  i)  441  a-c ;  p.  252,  <J  441 
c  ;  p.  254,  (J  441  e  ;  p.  257,  ()  442  ;  p. 
264,  ()  446  c  ;  p.  274-278,  ()  447^ 

not  regulated  by  the  quantity  or  qual- 
ity of  food,  p.  239,  240,  ()  440  a ;  p. 
242-244,  ^  440  c,  cc ;  p.  248-253,  (} 
441  b-d. 

chemical  hypothesis  of,  founded  mostly 
upon  facts  and  assumptions  relative 
to  man,  and  man  in  health,  p.  239,  ^ 
440  a,  No.  3;  p  243, 244,  (;i440 cc, No. 
12  ;  p.  248,  (^  441  i  ;  p.  275,  ^  477^  b. 

in  its  relation  to  the  law  regulating 
the  interchanges  of  caloric  among 
inanimate  objects,  p  244-246,  <J  440  e. 

chemical  parallels  of,  with  inorganic 
processes,  and  artificial  mecna 
nisms,  p.  177,  178,  ^  3501  ;  p.  238 
(}  438  b,  c. 

its  supposed  connection  with  exercise 
p.  240,  ^  440  a.  No.  8  ;  p.  243,  244 
^  440  cc.  No.  12. 

its  supposed  connection  with  alcoho 
and  cold  water,  p.  240,  ^  440  a,  b. 

why  reduced  and  exalted  by  cold,  p 

245,  246,  ()  440  e. 

its  greater  evolution  from  animal  than 
vegetable  food,  and  from  alcoho' 
than  water,  and  in  their  connection 
with  different  climates,  explaine«t 
against  organic  chemistry,  p.  240,  § 
440  b ;  p.  245,  <J  440  c ;  p.  250-252, 
(^  441  c ;  p.  257,  (j  442  h ;  p.  335,  336, 
ij  512,  513  ;  p.  394-396,  ^  617-b21. 

chemical  philosophy  of,  in  relation  to 
meat,  fat,  tallow,  wine,  and  oile,  and 
objections,  p  67,  68,  ^  151,  152  ;  p. 
240-243,  (j  440  a-c ;  p.  '^47,  (}  440  *. 

supposed  dependence  of  upon  clothing, 
p.  239,  <;»  440  a,  No.  3  ;  p.  241,  ^  440 
bb.  No.  9  ;  p.  242,  ^  440  c  ;   p.  245, 

246,  6  440  e;  p.  249,  250,  (/  441  c; 
p.  256,  I)  441 J  c;  p.  257-259,  ^  442. 

its  uniformity  in  all  warm-blooded  non- 
hybernating  vertebrata,  under  all  cir- 
cumstances of  heat,  cold,  food,  cloth- 
ing, &c.,  p.  242,  ^  440  c ;  p.  245.  246. 


INDEX. 


963 


Organic  Heat — continued. 

(,  440  e ;  p.  249,  250,  (J  441  c  ;  p.  258, 

259,  <5  442  d,  e. 

more  uniform  ir  warm-blooded  verte- 
brata  than  an"  other  product,  p.  245, 
()  440  e;  p.  253,  9  441  d. 

variable  in  cold-blooded  animals  and 
insects,  according  to  the  external 
temperature,  their  vital  constitution, 
and  diseases,  p.  252,  ^  441  c ;  p.  255, 
^  441^  a;  p.  259,  260,  ^  443,  444. 

generated  by  cold-blooded  animals  and 
insects,  p.  246,  ^  440  e. 

less  uniform  in  cold-blooded  animals 
than  any  other  product ;  see  as  above. 

generated  by  the  egg,  p.  30,  ij  57  ;  p. 
97,   ^    190  J;    p.   256,    ()  44U  d;  p. 

260,  ^  445  b. 

generated  by  plants,  p.  256,  ^  44H  a; 
p.  260-262,  ^  445. 

a  product  of  secretion,  p.  263,  ^  446  ; 
p.  273,  ^  447  A. 

influenced  by  age  and  constitution,  p. 
68,  69,  (J  153-156  ;  p.  248,  (J  441  b  ,■ 
p  255,  ^  44U  a;  p.  257,  258,  ^  442 
a,  b ;  p.  259,  260,  ^  443-445  J ;  p. 
262,  §  445  /;  p.  271-273,  <J  447  g",  A  ; 
p.  275,  ^  447i  b;  p.  384,  §  585  c,  d, 
586  ;  p.  391,  <.  603. 

its  vital  nature  shown  by  hereditary 
constitution,  p.  257,  258,  ^  442  b. 

parallel  in  its  production,  between 
the  warm-blooded  non-hybernating 
mammalia  (young  and  old),  warm- 
blooded hybernating  mammalia,  cold- 
blooded animals,  eggs,  and  plants, 
and  the  coincident  philosophy  of,  p. 
245,  246,  ()  440  e;  p.  248,  ^  441  b  ; 
p.  253,  ()  441  d ;  p.  255-263,  ^  441  / 
446  a ;  p.  272,  ^  447  h  ;  p.  63,  <)  137 
e;  p.  68,  ^  152. 

amount  generated  by  warm-blooded 
animals  depends  upon  the  nature  of 
the  species,  and  not  at  all  upon  any 
given  amount  of  food,  clothing,  de 
gree  of  external  temperature,  &c. 
p.  242-245,  ^  440  c-e  ;  p.  249,  250 
■51  441  c;  p.  257-259,  ^  442-443. 

Influenced  by  sympathy,  p.  270,  ^  447  d 

influenced  by  the  nervous  power,  p 
262-264,  ^  446. 

greatly  affected  by  disease,  injuries 
paralysis,  &c.,  p.  259,  ()  443  b;  p 
264-270,  ^  447  a-d ;  p.  272,  §  447^, 

exalted  in  disorganized  states  of  the 
lungs,  p.  268,  269,  <)  447  d. 

influenced  by  climate,  through  the  law 
of  vital  habit,  p.  256,  ^  441^  a-c ;  p. 
258,  (i  U2b,  c ;  p.  363,  ^  535-540  ; 
p.  394-396,  \  615-621. 

influenced  by  habits  of  exposure  to  cold, 
by  clothing,  &c.,  through  the  law  of 
vital  habit,  p  257,  258,  ()  442  a-d. 

its  vital  nature  shown  in  plants  by  the 
adaptation  of  tropical  to  cold  cli- 


Organic  Heat— continued 

mates,  by  the  rapidity  with  which 
the  tropical  may  be  made  to  endure 
a  frosty  atmosphere,  by  the  ever- 
greens of  northern  latitudes,  c&c, 
ibid,  and  Vital  Habit. 

its  relation  to  vital  habit  explains  the 
dissemination  of  animals  from  the 
region  of  the  Ark,  p.  258,  ^  442  b,  c ; 
p.  363,  (^  537-540  ;  p  364,  ()  544,  548 ; 
p.  369,  (J  562  ;  p.  391,  ^  603  ;  Which 
is  farther  illustrated  by  transferring 
plants  from  southern  to  northern 
climates,  ut  supra. 

its  far  more  rapid  reduction,  or  exalta- 
tion, in  disease,  by  a  small  loss  of 
blood,  than  by  all  other  causes  con- 
joined, a  proof  of  its  independence 
of  combustion,  p.  269,  <J  447  d.  See, 
also.  Loss  OF  Blood,  and  hyberna- 
ting animals,  as  below. 

its  remarkable  vicissitudes  in  hyber- 
nating animals,  and  derivative  proof 
of  its  vital  production,  p.  253,  ()  441 
d  ;  p.  255,  256,  ^  441^  a,  b ;  p.  264, 
^  446  d. 

supposed  dependence  of,  upon  the  red 
globules  of  blood,  and  objections,  p. 
255,  ^  441  /;  p.  260,  261,  A  445  b-e ; 
p.  274-278,  ()  447f 

generated  according  to  the  nature  of 
the  part,  p.  61,  62,  (J  133  b,  134-136 ; 
p.  67,  ()  150,  151  ;  p.  97,  98,  ()  190, 
191  ;  p.  260,  <)  445  a,  b ;  p.  268,  270, 
^U7  d. 

why  it  sometimes  rises  just  antece- 
dently to  death,  p.  269,  ()  447  d. 

why  it  rises  after  death,  p.  266,  267,  ^ 
447  i. 

has  one  provision  for  the  lungs,  and 
another  for  "  the  rest  of  the  body,"  p 
276,  277,  4447^/. 
Organic  Kingdom.     See  the  topics  rela- 
tive thereto. 
Organic  Life, 

its  laws  sought  in  the  ovum,  p.  36-49, 
^  63-81. 

changes  in,  as  constituted  by  tempera- 
ment, domestication  of  animals,  cul- 
tivation of  plants,  and  disease,  have 
their  type  in  the  ovum,  p.  44-49,  ^ 
72-80. 

resists  chemical  agencies,  p.  29-33,  () 
55-60  ;  p.  34,  ij  62  c. 

its  organs,  p.  54,  <S>  105,  107,  111  ;  p. 
57,  ^  125. 

its  most  essential  organs,  p.  40,  §  65  ; 
p.  42,  <J  67 ;  p.  54,  ^  109,  110  ;  p.  55, 
^115;  p.  56,  9  122;  and  are  blended 
in  all  parts,  p.  54,  ()  109  b,  110;  p. 
55,  ^  113-117.  See,  also.  Capilla- 
ries, and  Circulation,  Capillary. 

its  great  immediate  office  nutrition  and 
vital  decomposition,  p.  53,  ^  104  ;  p 
129,  ^  273. 


964 


INDEX. 


Organic  Life — continued. 

Its  great  final  cause  in  respect  to  the 
species,  the  development  of  the  gen- 
erative organs,  and  the  production 
of  germs,  p.  56,  ^  121. 

its  several  functions,  p.  54,  i^  105.  See, 
also.  Organic  Functions. 

begins  in  plants,  p.  15,  ()  10,  14;  p. 
16,  (j  16,  17  ;  p.  135,  (J  298-301,  303  ; 
p.  137,  (j  303^  ;  p.  201,  ^  374,  375. 

never  generates  an  inorganic  sub- 
stance for  organic  purposes,  nor  car- 
ries backward,  in  the  animal  organ- 
ization, an  organic  compound,  p.  15, 
ij  13,  14;  p.  24,  M2  ;  P-  30,  (^  59; 
p.  33,  ^  60  ;  p.  135,  ()  301  ;  p.  196,  <J 
360  ;  p.  201,  (j  374,  375. 

its  simplicity  in  plants  in  respect  to 
organization,  p.  54,  ()  107;  p.  58,  (^ 
129/;  p.  135,  ^  202  ;  p.  136,  (J  303. 

in  plants  the  whole  being,  p.  55,  ij  114  ; 
p.  88,  ^  184,  185. 

complexity  of  its  organs  in  animals,  p. 
54-56,  ij  111-120;  p.  57,  (^  125;  p. 
13.5,  ()  302  a;  p.  140-143,  I)  304- 
319. 

its  comprehensive  system  of  connect- 
ed Designs,  p.  143-146,  ()  322-326. 
See,  also,  Design. 

how  distinguished  from  animal  life,  p. 
53,  ^  98-104  ;  p.  54,  ^  106,  108,  110, 
111;  p.  55,  ^  112-117.  See,  also. 
Life,  Animal. 

mdispensable  to  animal  life,  p.  54,  <J 
108,  110;  p.  55,  <J  115. 

subordinate  to  animal  life,  in  its  com- 
prehensive Design,  p.  15,  I)  10-14; 
p.  55,  I)  113.  114  ;  p.  135,  <J  298,  300. 

gives  rise  to  the  same  diseases  in  the 
organs  of  animal  as  of  organic  life, 
p.  55,  ij  117. 

the  whole  life  of  the  foetus,  p.  53,  ^  103. 
See,  also,  Nerves. 

has  no  repose  but  in  the  germ,  p.  30, 
(J  57;  p.  53,  ^  102;  p.  97,  i)  190  b. 

harmonious  in  its  laws  and  phenome- 
na, p.  1,  ij  1  ;  p.  3,  ij  2,  b,  d  ;  p.  14, 
ij  6  ;  p.  41,  ij  65  ;  p.  44,  (J  72  ;  p.  47- 
49,  ^  75-80  ;  p.  55,  §  117 ;  p.  58,  59, 
^  129;  p.  61,  ^  133  c;  p.  62,  63,  ^ 
135-137;  p.  65,  ^  143  c;  p.  67-69, 
(^  149-156  ;  p.  81,  ^  169/;  p.  85,  ^ 
175  c;  p.  87,  ^  177-182  ;  p.  88,  89, 
i)  185-188  ;  p.  90,  (}  188^  a-d ;  p.  93- 
95,  ^  I88id;  p.  96-99,  «J  189  c-192  ; 
p.  101,  102,  ()  201-203  ;  p.  103,  ^ 
205  a,  207,  208  ;  p.  104,  ^  215  ;  p. 
105,  ^  220  a;  p.  106-111,  ^  223- 
233i;  p.  120-122,  §  237-240;  p. 
124,  125,  ()  243-246  ;  p.  128,  ^  266  ; 
p.  129,  130,  ^  273,  277-279;  p.  131- 
133,  §  285-291  ;  p.  135,  ^  300,  301  ; 
p.  137,  (}  303  e,  303|  a ;  p.  140-147, 
^  304-330  ;  p.  148,  149,  ^  336  ;  p. 
191,  192,  ^  351-353  ;  p.  209,  ^  384, 


Organic  Life — continued. 

385;  p.  212,  <J  392;  p.  216,  ()  39i) , 
p.  217,  ^  401  b;  p.  222-234,  <^  409  c- 
433  ;  p.  271,  ^  447/;  p.  272,  273,  ^ 
447  h;  p.  279,  <J  449  ;  p  282,  ()  451  ; 
p.  283,  §  452  a,  c ;  p.  284-287,  ^  454 
-458  ;  p.  290,  ^  464,  465  ;  p.  323- 
332,  cj  500  ;  p.  405-412,  <J  638  ;  ana 
so  on. 

contrasted  with  the  condition  of  dead 
matter,  p.  23-73,  ()  34-163 ;  p.  434, 
435,  ()  680.  See,  also.  Properties 
OF  Life,  Functions,  Age,  Sex,  and 
Death. 

its  results  always  uniform  under  any 
given  combination  of  circumstances, 
p.  120,  121,  (J  237;  p.  227,  t)  411  ;  p. 
405-412,  <J  638  ;  p.  442,  ^  686  d;  p. 
489,  (^  756  ^<;  p.  619,  ^  892 J-  r.  See, 
also.  Harmonious  in  its  Laics,  as 
above;  and  Design,  Therapeutics, 
&c. 

contradistinguished  from  chemical  and 
mechanical  philosophy.  See  Or- 
ganic Chemistry. 

involves  in  animals  the  two  properties 
which  are  specifically  designed  for 
animal  life.  See  Vital  Principle, 
Vital  Properties,  Nervous  Pow- 
er, and  Sensibility.  See,  also, 
Life. 
Organic  Processes, 

type  of,  in  the  germ,  p.  36-49,  ^  63-81 

proof  of  their  universal  vital  nature 
derived  from  the  function  of  gener- 
ation, p.  280,  ^  449  d. 
Organic  Properties, 

common  to  plants  and  animals,  p.  88, 
^  183,  184  a. 

modified  in  each  department,  p.  88,  ij 
185.     See   Vital   Properties,  and 
Vital  Principle. 
Organism, 

the  universal  body,  p.  52,  <J  89. 

radiated,  p.  53,  i^  93. 

symmetrical  as  a  whole,  p.  53,  ^  95. 

composed  of  two  systems  ;  one  rela- 
tive to  the  individual,  the  other  to 
the  species,  p.  53,  ^  96,  97. 

the  animal  founded  on  the  organic,  p. 
53,  {}  98-103  ;  p.  54,  (j  108,  110,  111  ; 
p.  55,  i)  114-117  ;  p.  143-146,  ^  322- 
326. 
Organization, 

beginning  of  in  plants,  p.  15,  ^  10,  14  a. 
.  rudiments  of,  p.  41,  ^  65 ;  p.  46,  ()  74. 

its  simplicity  in  plants,  p.  54,  ^107; 
p.  135,  (J  302. 

and  vital  properties,  mutually  depend- 
ent, p.  16,  <)\^c;  p.  81,  {)  170. 

its  most  essential  part,  p!  54,  iji  109  i. 
Organized   Structure.      See    Struct^ 

ure. 
Organs,  Development  of.     See  Devel- 
opment. 


INDEX. 


965 


Organs  of  Animal  Life, 

their  designation,  &c  ,  p.  54,  ^  106  ;  p. 

58,  {)  127. 
their  subserviency  to  organic  life,  p. 

54,  55,  9  111-117;  p.  106,  ^  223  ;  p. 

108,  {}  228  ;  p.  Ill,  ^  2335  ;  P-  144- 

146,  ^  323-326  ;  p.  282-289,  ^  451 

C-46H;  p.  325,  ^  500  e;  p.  332,  ^ 

501  c;  p.  338,  339,  ^  5Uf,g. 
act  necessary  to  organic  life,  p.  54,  ^ 

108.     See,  also.  Organic  Life,  and 

Nerves. 
Organs  of  Organic  Life, 
arrangement   of,    according   to   their 

functions,  p.  57,  ^  125. 
compound,  p.  52,  53,  (i  89,  92. 
their  sympathetic  relations,  p.  58,  ^ 

129  c-f. 
their  relations  liable  to  derangements, 

p.  59,  <)  129  g-i;  p.  361,  362,  i)  529. 

See,  also.  Laws  of  Sympathy,  and 

Nervous  Power. 
their  mechanical   relations,   p.   59,   ^ 

129  k. 
indispensable  to  animal  life,  p.  54,  () 

108. 
indispensable  to  each  other,  p.  54,  ^ 

109. 
general  nature   of  the   relations   be- 
tween the  organs  of  organic  and  of 

animal  hfe,  p.  55,  <J  111-117. 
Ovum, 

its  state  of  life,  p.  30,  <J  57 ;  p.  36-42, 

<^  63-66;  p.  97,  iJ190i;  p.  104,9  212. 
its  principle  of  development,  p.  37-40, 

^  64-65. 
vital  Theory  of  its  development,  p.  41, 

^  65. 
chemical  Theory  of  its  development,  p. 

190,  191,  ^  350i  n. 
special    circumstances    attending    its 

condition  and  development,  p.  56,  ^ 

122  ;  p.  97,  4  190  b;  p.  104,  <)  212. 
its  vital  modifications,  p.  44,  <J  72  ;  p. 

56,  ^  122,   123;  p    97,  §  190  b;  p. 

104,  ()  212. 
how  impressed  in  fecundation,  p.  44, 

45,  <J  72-73  ;  p.  97,  ^  190  b ;  p.  104, 

^  212. 
its  development  a  type  of  all  organic 

processes,  p.  45,  ^  73  b ;  p.   68,  § 

153-156  a. 
its  development  supplies  a  type  of  all 

diseases,  p.  45,  ij  72  ;  p.  47-49,  ^ 

75-80. 
transmits  disease,  p.  47,  48,  <J  76-78. 
potentially  the  future  being,  p.  40,  ()  65. 
illustrates  the  general  character  of  the 

properties   of  life,  p    41,  §  72 ;  p. 

47-49,  {)  75-80 ;  p.  256,  (fUlid. 
illustrates  the  philosophy  of  hybrid  an- 
imals and  hybrid  plants,  p.  44,  45,  9 

72. 
its  common  nucleus  of  a  cell,  p.  42,  <5 

67;  p.  50,  s*"  83  b;  p.  60,  ^  131. 


0  V  u  m — continu  ed. 

its  peculiarities  in  different  tribes,  p. 
56,  ^  122  ;  p.  97,  ^  190  b. 

oviparous  and  viviparous,  distinctions 
between,  p.  45,  ^  73  a;  p.  97,  ^ 
190  b. 

organic  life  alone  in  operation  during 
its  development,  p.  53,  ^  103. 

development  of  its  nervous  system, 
organs  of  sense,  and  voluntary  mus- 
cles, like  that  of  the  liver,  stomach, 
&c.,  designed  for  independent  life, 
and  the  work  of  development  de- 
volves, therefore,  upon  the  extreme 
vessels,  p.  42,  ij  67  ;  p.  54,  6  109  ;  p. 
284,  ^  455  a,  b ;  p.  286,  <J  456  ;  p. 
289,  ^  46Ua  ;  p.  342-353,  ^  516-524. 

its  power  of  resisting  external  in- 
fluences, p.  30,  ^  57 ;  p.  56,  ^  123 ; 
p.  256,  iJ441H- 

evinces  great  Design,  p.  56,  ^  123 ;  p. 

97,  ^  190  b.     See  Nerves,  their  early 

development,  &c. 

Oxvdation    of    the   Blood   and   Body. 

See  Combustion,  andORGANicHEAT. 

Oxygen, 

its  relative  connection  with  animals 
and  plants,  p.  137-139,  ^  303^-3035. 

its  connection  with  respiration,  p.  229, 
^  419  ;  p.  266,  (}  U7  d ;  p.  268,  ()  447 
d;  p.  270,  ^^1  447  e  ,•  p  274-278,  ()  Ul^. 

a  test  of  the  assumed  dependence  upon, 
of  motion  and  animal  heat,  p.  255,  1^ 
441/. 

its  connection,  in  organic  chemistry, 
with  the  various  processes  and  re- 
sults of  life.  See  Combustion,  and 
Physiology,  in  relation  to  the  red 
globules  of  blood. 

Christison's  observations  upon  in  dis- 
ease, p.  270,  ()  447  e. 

its  relative  connection  with  the  genera- 
tion of  heat  and  other  products  of 
organic  beings,  p.  273,  ^  447  h 


P. 

Pain, 
rarely  a  cause  of  disease,  p.  588,  ^  891 

does  not  affect  organic  actions  in 
health,  p.  79,  (}  167,  note ;  p.  588,  9 
891  m. 

should  not  be  prevented,  nor  assuaged, 
by  means  which  may  endanger  life, 
p.  584,  ()  891  c,  d;  p.  587,  «J  891  k ; 
p.  593,  ^  8911  k.  See,  also,  Nar- 
cotics. 
Paralysis, 

prevents  the  operation  of  the  will  by 
embarrassing  its  action  upon  the 
nervous  power.  See  Will,  Nerv- 
ous Power,  Narcotics,  Motion,  and 
Analogies. 
Past  and  Present,  p.  203-207,  ^  376|  a 


966 


INDEX. 


Pathology, 

its  general  survey,  p.  413-540,  ^  639- 
851;  comprehending  J?cffio<e  Causes, 
p.  414-427,  ()  644-666  ;  Proximate  or 
Pathological  Cause,  p.  427^34,  <j 
667-676;  Symptoms,  p.  434^55,  <^ 
677-694^  ;  Morbid  Anatomy,  p.  456- 
463,  <J  695-709 ;  Inflammation,  p.  464- 
489,  ^  710-756  ;  Fever,  p.  489-499, 
<5  757-785 ;  Venous  Congestion,  p. 
500-513, 1)  786-818  ;  Humoralism,  p. 
514-540,  ()  819-851. 
objects  and  nature  of,  p.  3,  ^  2  ;  p.  413, 

414,  ^  639-642,  p.  398,  ^  626. 
to  the  physician  the  great  final  object  of 
physiology,  p  3,<)2b;  p.  413,  <J  639 a. 
reflects  light  upon  physiology,  p.  73,  <J 

163;  p.  107-111,  I)  225-233J. 
the  Chemical  System  of,  p.  171-173,  ^ 
350,  Nos.  41,  42,  43,  44,  45,  46 ;  p. 
174-176,  ()  350^  a-g;  p.  251,  252,  ^ 
441c;  p.  515, '5i819  6;  p.  517,  ij  821  c. 
Pancreas, 
developed  from  intestinal  canal,  p.  41, 
()  65.     See,  also,  Assimilation. 
Passions.     See  Mental  Emotions. 
chemical  theory  of,  p.  155,  <5>  349  e. 
See,  also.  Combustion. 
Perception, 
necessary  to  true  sensation,  p.  89,  () 
186  ;  p.  100,  ^  196  ;  p.  124,  ^  242  ; 
p.  282,  ^  451  c. 
not  concerned  in  the  function  of  sym- 
>ithy,  p.  54,  55,  «J  111-117;  p.  101, 
102,  ^  201-203  ;  p.  125,  ()  245,  246  ; 
p.  282,  ()  451  ;  p.  283,  ^  452. 
Phenomena, 

the  foundation  of  philosophy.     See  Ef- 
fects. 
Philanthropy, 
indispensable  in  medical  pliilosophy,  as 
in  the  practice  of  medicine,  p.  122, 
()  240,  &.C. 
Philip,  Wilson, 

his  Experiments  to  determine  the  Laws 
of  the  Vital  Functions,  p.  110,  ^  233. 
neglected,  p.  112,  (/  234  h. 
.statement  of  his,  and  analogous  experi- 
ments by  others,  and  the  author's  in- 
ductions from  them,  p.  290-321,  § 
462-494. 
Philosophy, 

portents  of  coming  changes  in,  p.  7,  I) 
Ai  b ;  p.  8,  9.  <S)  5  ;  p.  U,  ^  6  ;  p.  174, 
^  350i  ;  p.  203-207,  ^  376i  ;  p.  460- 
463,  ^  709,  note.  See,  also.  Physi- 
ology AND  Organic  Chemistry,  con- 
trasted. 
neglected,  p  112,  (;>  234  b;  p.  154,  <J 
349  d ;  p.  202,  ()  376J  ;  p.  219,  ^  408  ; 
p.  234,  235,  ()  433  ;  p.  434,  ^  676  b ; 
p.  457,  ^  699  c ;  p.  482,  (J  744 ;  p. 
484,  {)  748  ;  p.  515,  ^  819  b;  p.  715- 
721,  (}  960  a. 
lis  limits,  p.  185,  ^  850J  k;  p.  206,  (> 


Philosophy — continued. 

376i  a  ;  p.  317,  ()  493  a;  p.  719,  720, 
<J  960  a.     See,  also,  Science. 
trite  and  false,  illustrated  in  the  charac 
ters  of  Pythagoras  and  Anaxagoras, 
p  482,  ^  744. 
false,  illustrated  by  prevailing  fabrics 
in   medicine,   p.    174-178,    ()  350^- 
350? ;   p.  484,  485,    ^   748,  749  ;   p 
515-519,  ()  819  i-825. 
Phlebitis.      See    Venous    Congestion. 

and  Venous  Tissue. 
Phthisis  Pulmonalis, 

ar  inflammatory  disease,  in  all  its 
phases,  and  demanding  loss  of  blood, 
and  a  strictly  antiphlogistic  treat- 
ment in  its  early  stages,  and  ab- 
stinence from  meat  in  the  more  ad- 
vanced, p.  457,  (}  699  c  ;  p.  458,  ^ 
700  b  ;  p.  459,  ^  705  ;  §  756  a;  ()  732 
d;  p.  546-551,  ()  862-864;  p.  573,  () 
890  e;  p  638-641,  <;i  8924  g-i ;  p, 
765,  766,  ^  1007-1008.  See,  also, 
Medical  and  Physiological  Commen- 
taries, vol.  ii.,  p.  608-634 ;  p.  74:3-746. 
Physiologists, 
their  duty  to  their  ov\ti  science,  p.  2,  <) 
lb;  p.  8,  (J  5  ;  p.  122,  ^  240  ;  p.  202, 
^  376^ ;  p.  207,  ^  3761  b ;  p.  277,  ^ 
447^  /;  p.  429.  §  674  a ;  p.  762,  ^ 
1006  a. 
their  proper  vocation,  p.  2-4,  <J  2 ;  p. 
10-14,  ()  5i-6;  p.  202.  ^  376^;  p 
207,  (}  376|  b  ;  p.  239,  ^  438  d ;  p 
279,  ()  448  ;  p.  330,  ()  500  n;  p.  429 
§  674  a. 
the  proper  ground  for  their  inductions 
p.  10,  11,  s^  5i  ;  p.  115,  ()  234  e;  p 
429,  ^  674  a  ;  p.  434,  435,  (j  679,  680 
See,  also.  Facts. 
Physiological  States, 

inferred  from  morbid  states,  p.  61,  <j 
134;  p  64,  ^  140;  p.  73,  ^  163  ;  p 
107-111,  ()  225-2335;  p.  265,  ^  447 
a-c;  p.  272,  §  U7  g ;  p.  501-512,  () 
791-817. 
inferred  from  the  natural  products,  p. 

62,  ^  135. 
inferred  from  natural  stimuli,  p.  62,  6 
136;  p.  97.  (}  190;  p.  98,  <)  191  a 
p    100,  ^  199,  201, 
inferred  from  the  action  of  morbific 
agents,  p.  63,  ^  137;  p.  64,  ()  142; 
p.  66,  (^  143;  p    67,  ()  149,  150;  p 
68-73.  ()  153-162;  p.  98.  ()  191. 
govern  the  morbid  states,  p.  67,  ij  149 

150;  p.  107-111,  (J  225-2333. 
do  not  teach  the  morbid  states,  only  aa 
they  are  illustrated  by  the  morbid, 
p.  3,  ^  2  c,  and  as  above.  See,  also, 
Remeuies,  their  Capabilities  and 
Effects. 
not  taught  by  Anatomy,  p  3.  (J  2  c ;  p. 
50,  (i  83  c;  p.  59,  ^  131.  See,  also, 
Morbid  Anatomy. 


INDEX. 


967 


Physiology, 

its  general  survey,  p.  15-412,  ^  7-638. 

objects  of,  p.  3,  1^  2. 

regards  Nature  according  to  her  ordi- 
nations, p.  3,  1^  2  J;  p.  11,  iji  5  I  e; 
p.  12,  (J  Hf,  ^ha;  p.  330,  <J  500  n. 

schools  of,  p.  6,  <S>  4^. 

considered  under  seven  divisions,  p. 
22,  <;>  31. 

not  learned  from  anatomy,  p.  3,  ij  2  c  ; 
p.  50,  <J  83  c;  p.  59,  (}  131. 

its  relations  to  pathology  and  therapeu- 
tics, p.  1,  n  ;  p.  2,  3,  ^  2;  p.  55,  ij 
115-117;  p.  58,  {)  129;  p.  61-70,  (J 
133-160;  p.  98,  ij  191  ;  p.  102,  l^ 
202  ;  p   107-122,  I)  225-240  ;  p.  131, 

132,  (j  284-288  ;  p.  331,  <J  500  c  ;  p. 
398,  ij  626  ;  p.  405-413,  '^  638,  639  ; 
p.  541,  9  852. 

vitiated  by  experiments,  p.  11-13,  <J 
5i  e,/,  5^  a  ;  p.  14,  ^  6  ;  p.  17,  {)  18 
e ;  p.  26,  ^8  ;  P-  28,  <)  53  c  ;  p.  132, 

133,  ()  289-291  ;  p.  148,  (>  334,  335  ; 
p.  173,  <J  350i;  p.  179-182,  ()  350| 
c-g ;  p.  196-198,  (}  360-364  ;  p.  200, 
()  366  ;  p.  202,  ()  376^  ;  p.  485,  (;  749  ; 
p.  518,  9  823. 

how  far  surrendered  to  Chemistry,  p. 
8,  9,  ij  5  ;  p.  13,  ()  5k  a;  p.  148,  () 
335  ;  p.  155,  ()  349  d;  p.  176,  ^  350J 
q  ;  p.  202,  <^  376^  ;  p.  235,  1}  433. 
the  qualifications  of  chemists  for  its 
investigation,  p.  7,^  H  d ;  p.  8,  9,  ^ 
5;  p.  II,  ()  5i  c,  d;  p.  157-173,  () 
350,  Nos.  3-46  ;  p.  174-182,  <J  350|- 
350^  g ;  p.  202,  203,  (}  376^  ;  p.  239, 
(j  438  d. 
its  essential  philosophy,  as  well  as  of 
disease,  supposed  to  reside  in  the 
red  globules  of  blood,  p.  157-160,  ^ 
350,  Nos.  1-10:  p.  161-163,  (}  350, 
Nos.  15-19  ;  p.  174-178,  ^350^-350?  ; 
p.  208,  ()  383  a ;  p.  251,  252,  ^  441  c ; 
p.  254,  255,  ^  441  e,  f;  p.  26§,  ^ 
445  b  ;  p.  274-278,  ^  447^. 
demonstrative  proof  of  the  error  of  the 
grand  doctrine  in  organic  chemistry, 
that  motion  and  organic  results  de- 
pend upon  oxygen  gas,  p.  255,  ^  441 
/;  p.  318-321,  H94.  See,  also,  Com- 
bustion. 

Physiology  and  Organic  Chemistry 
Contrasted,  p.  19,  <J  18  e;  p.  157- 
173,  ()  350  ;  p.  189,  190,  !^  350J  n ; 
p.  191.  I)  351  ;  p.  246,  (J  440/;  p. 
277,  278,  (j  447.}  /;  p  514,  i,  819  o, 
Nos.  1-7.  See,  also,  Organic  Chem- 
istry, contradistinguished  from,  c^c. 

Physiology,  Summary  Conclusion  of, 
OR  its  Unity  of  Design,  p.  405- 
412,  (}  638. 

Plants, 
indispensable  to  animals,  p.  15,  ^  13, 
14;  p.    17-20,  ()   18;  p.   135-139,  (j 
293—303. 


Plants — continued. 
subsist  on  mineral  substances,  p.  I.'-, 

i)  11,  14;  p.  10,  ^16;  p.  20,  (J  18  e, 

p.  135-139,  ^  298-303A. 
their  food  originally  from  the  atmos- 
phere,  p.    16,   ij   16;  p.   135-138,  ^ 

303-303^. 
have  greater  organizing  power  than 

animals,  p.  15,  <J  11  ;  p.  24,  <J  42 ;  p. 

105,  i)  217  ;  p,  135,  ()  298,  300. 
their  simplicity  of  life,  p  55,  ^  114;  p. 

58,  <J  129  /;  p.  88,  l^  185  ;  p.   135,  () 

302  ;  p.  140,  \  304. 

their  organic  properties,  p.  88,  ^  183, 
184;  p.  93,  ()  188^  d ;  p.  105,  () 
217. 

their  life  essentially  the  same  as  that 
of  animals,  p.  14,  ^  6  ;  \>.\5,()  8-10, 
12-14;  p.  21,  22,  i)  19-30;  p.  23, 
24,  ()  34-42  ;  p.  26,  i,  47-49  ;  p.  27, 
^  52,  53  ;  p.  29,  (J  54  a ;  p.  30-36,  I) 
56-62  ;  p.  44,  (J  72  ;  p.  45,  (^  13  b ;  p. 
48,  >!>  77;  p  49,  MO  ;  P-  51,  52,  ^ 
84,  85  ;  p.  54,  (}  107-109  ;  p.  55,  «J 
112-115;  p.  56,  «J  121-123;  p.  58,  ^ 
129  /;  p.  68,  69,  ()  153-157  ;  p.  82, 
^  170  a,  171 ;  p.  83,  ^  172-174  ;  p. 
86,  ^  176;  p.  88,  ii  184  a,  185;  p. 
89,  6  188  a ;  p.  90,  ^  188^  b,  c  ;  p. 
93-95,  ^  188^  d;  p.  98,  ()  191  a;  p. 
103,  ^  207  ;  p.  104,  ^  214  ;  p.  105,  I) 
217  ;  p.  127,  ()  261-264  ;  p.  129,  130, 
()  277,  278  ;  p.  132-134,  ^  289-295  ; 
p.  140,  ^  304;  p.  163-167,  ()  350, 
Nos.  64-77,  and  Nos.  262S  27,  51  :  p. 
207,  208,  ^81;  p.  224,  225,  1}  409 
g-i;  p.  226,  227,  (/  4l0,  411  ;  p.  260 
-262,  ^  445  a-f;  p.  273,  ^  447  h ;  p 
280,  ()  U9  d;  p.  283,  (}  452  a ;  p 
284,  ()  454,  455  ;  p.  286,  ()  456  a ;  p. 
289,  ^  46U  a;  p.  345,  346,  <)  516  d 
No.  7;  p.  391,  392,  <J  603-606;  p 
395,  ()  618  b;  p.  435,  <J  680  ;  p.  442 
<5  686  d ;  p.  474,  475,  ()  733  f-i ;  p. 
019,  (j  892  r;  p.  746,  (,  990}  b. 

their  creation  before  animals.  Author's 
proof  of,  p.  135,  136,  I)  303  a;  p. 
137,  138,  (1  303i  b,  c. 

essentially  independent  of  animals,  p 
15,  (J  11-14;  p.  16,  ()  16,  17;  p.  135 
136,  ^  303  a;  p.  137,  138,  I)  303^  b,  c 

the  beginning  of  organic  compounds, 
p.  15,  ij  10,  13,  14;  p.  135-139,  d 
298-3035. 

their  manifestations  of  vital  motion,  p. 
103,  ^  207;  p.  134,  ^  293,  294;  p 
163-167,  (}  350,  Nos.  63-77. 

illustrate  coiitinuous  sympathy,  p.  58,  ^ 
129/,-  p.  322,  ()  498  c ;  p.  351,  (J 
524  a.  No.  2. 

the  action  of  light  upon,  p.  46,  «^  74  a  ; 
p.  90-95,  i)   188}  d;  p.   136,   137,  ^ 

303  d,  e;  p.  163-165,  ()  350,  Nos 
64-70. 

their  diseases,  p.  93,  ^  188}  d;  p  98, 


968 


INDEX. 


Plants — continued. 

^  191  a;  p.  322,  ^  498  c;  p.  474,  475, 
^  733  f-i. 
analogy  traced  between  the  process 
of  regeneration  in  inferior  animals, 
of  the  stag's  horn,  &c.,  and  of  rep- 
aration, ingrafting,  &c.,  of  plants, 
and  the  union  of  wounds  by  the  ad- 
hesive process,  and  the  dependence 
of  the  latter  upon  inflammation 
through  the  coincidence  in  the  sim- 
ultaneous effusion  of  lymph  around 
the  wall  of  an  abscess,  the  forma- 
tion of  pus,  the  institution  of  the  ul- 
cerative process  in  the  direction  of 
the  surface,  and  the  ultimate  cica- 
trization, and  thence  a  close  analogy 
between  the  vital  constitution  of 
plants  and  animals,  and  their  morbid 
states,  through  an  example  parallel 
to  an  abscess,  which  is  presented  by 
the  stem  of  trees,  when  circum- 
scribed disease  is  set  up  beneath 
the  surface,  p.  88,  ^  185 ;  p.  470,  <J 
729  a  ;  p.  471-476,  <J  732-733  ;  p. 
479,  (i  741  b. 

Plants  and  Animals, 
their  fundamental  distinction,  p.  15,  ^ 

11-14  b;  p.  17-20,  ()  18. 
their  composition,  p.  15,  i^  12  ;  p.  17- 
20,  iji  18 ;  p.  23-28,  ^  34-53.     See, 
also.  Plants,  and  Organic  Life. 

Pneumogastric  Nerve, 
appertains  to  organic  life.     See  Nerv- 
ous Power. 

Pollen, 
analogous  to  semen.     See  Semen,  and 
Ovum. 

Poultices,  Warm, 
their  uses,  and  mode  of  operating,  p. 
681-683. 

Portal  Circulation.    See  Circulation, 
Portal. 

Potash,  Tartrate  of.    See  Cathartics, 
and  Therapeutics. 

Potash,  Super-tartrate   of.     See  Ca- 
thartics, and  Remedial  Action. 

Predictions — in  medical  philosophy,  <^  5^ 
a,  131,  500/,  854  6^,896,971,  1006^. 

Practice  of  Medicine, 
how  taught  in  Hospitals.     See  Hos- 
pital Reports  and  Precepts. 

Predisposition  to  Disease, 

author's  theory  of,  p.  47-49,  ^  75-81  ; 
p.  87,  (^  181  ;  p.  368,  ()  559  ;  p.  420- 
427,  ^  654-666  ;  p.  429,  430,  ()  674  d  ; 
p.  669,  670,  i)  902  i. 

Pp.inciples, 
importance  of,  p.  4,  <J  3,  4;  p.  331,  ^ 

500  0  ;  p.  489,  ^  756  b. 
consistency,  a  test  of,  p.  1,  ij*  1 ;  p.  3, 
)  2  c;  p.  331,  (}  500  o;  p.  489,  ^ 
756  b.  See,  also,  Vitalism  and 
Solidism,  and  Physiology  and  Or- 
ganic Chemistry,  Contrasted. 


Principles — continued 

in  medicine,  from  their  diversity  and 
discrepancy,  form  no  test  of  the 
rights  of  membership  of  the  medical 
profession,  p.  77,  note  ;  p.  515,  ^  819 
b ;  p.  529,  ^  835  ;  p.  540,  ^  851  ;  p. 
558,  ^  878. 

an  introductory  exposition  of,  p.  1-15, 
^1-6. 
Problems, 

one  for  Organic  Chemistry,  p.  281-283, 
()  450  rf-451  /;  p.  330,  ^  500  n. 

another  for  Mental  Materialism,  p.  84, 
85,  ij  175  c ;  p.  155,  ^  349  e ;  p.  281, 
^  450  e  ;  p.  329,  <}  500  n. 

another  (or  Atheism,  p.  16,  (}  14  c. 
Profession,  Medical,  in  Europe    and 
the  United  States, 

their  relative   merits.     See  Medical 
Education. 
Properties  of  Life.     See  Vital  Prop 

erties. 
Protein, 

an  important  "  instrument"  in  Organic 
Chemistry,  p.  17-20,  ()  18  ;  p.  28,  ^ 
53  c  ;  p.  219-222,  i)  409  a,  b  ;  p.  7G3, 
^  1106  a.  See,  also,  Mulder's  Re- 
ply to  Liebig,  concerning  Truth 
AND  Protein.  London,  1846. 
Proximate  or  Pathological  Cause  of 
Disease, 

general  consideration  of,  p.  427-434. 

founded  upon  physiological  laws,  which 
exclude  all  chemical  and  humoral 
doctrines  from  pathology  and  thera- 
peutics, ^  2,  6,  63,  74,  80,  117,  129 
h,  133  c,  137,  143,  149-156,  163,  169 
/,  177-182,  224-231, 233i, 285-295, 
335,  3501,  360,  384-387,  393,  422- 
424,  427,  447  b,  500,  514,  524  d,  527, 
529  b,  549,  561,  573-630,  638,  638^, 
639  a,  671,  674,  680,  686  b,  705,  733 
e,  f,  741,  745,  747-751,  768,  772  e. 

*  785,  787,  792,  795,  801  e,  808,  822, 
839,  847,  852-856,  858,  862,  863  d-h, 
884,  889  a-f,n,  895-902,  905,  912. 
Proximate  Principles  of  Organic  Com- 
pounds, 

their  reputed  nature,  p.  29,  ^  54  b. 

are  chemical  transformations,  p.  18, 
19,  M8 ;  p.  28,  29,  ^  53  6-54  a. 

their  true  nature,  p.  24,  25,  ^  42^14 ; 
p.  27,  15.  53  ;  p.  40-42,  ^  65-66. 
Pulse, 

in   its    relation   to    disease,   p.   443- 
448. 
Pus, 

depends  upon  inflammation.     See  In- 
flammation, and  Design. 
Putrefaction, 

its  causes  and  pecuharities,  p.  28- -31, 
()  54-59  ;  p.  34-36,  (J  62.  See,  also. 
Nitrogen. 

its  principal  cause  evinces  that  it  is 
not  concerned  in  digestion  nor  in 


INDEX. 


969 


Putrefaction — continued. 

any  process   of  organic    life,   ibid 
See,  also,  Digestion. 

more  philosophically  the  cause  of  the 
explosion  of  gunpowder  than  of  di- 
gestion or  of  the  waste  of  living 
hodies,  p.  35,  ^  62  c.  See,  also, 
Digestion,  Chemical  Theory  of,  and 
Physiology  of,  and  Decomposition, 
Vital. 

incompatible  with  life,  p.  10,  (j  n  \  p. 
105,  ()  221  ;  p.  533,  534,  ^  843. 
Sx.iHL  and  Junker  define  "  life  as  a 
state  opposite  to  putridity." 

rapid  in  dead  animal  compounds,  p. 
34,  4  62  c ;  p.  96,  ()  189  c. 

takes  place  under  organic  conditions, 
p.  28,  (j  54  a. 

promoted  mostly  by  nitrogen  gas,  p. 
34-36,  (j  62. 

important  in  the  philosophy  of  Organic 
Chemistry  and  Humoralism,  p.  167- 
170,  <;>  350,  Nos.  29-39  ;  p.  172,  () 
350,  Nos.  44,  45  ;  p.  179,  (^  3501  c; 
p.  181,  (j  350i  e ;  p.  199,  200,  ^  365  ; 
p.  514,  ^  819  a,  Nos  1,  2,  3 ;  p.  517,. 
^  821  c ;  p.  529,  ()  835. 
Pylorus, 

admits  the  passage  of  solid  food,  &c., 
through  morbid  changes  of  irritabil- 
ity, p.  99,  ^  192. 


Q. 

QUINIA, 

its   therapeutical  uses,  with   various 
relative  considerations,  p.  593-607. 


R. 


Races  of  Mankind, 

evince  the  influences  of  climate,  &c., 
without  any  remarkable  physiologi- 
cal, but  greater  moral,  distinctions, 
p.  391-393. 
Reason, 

its  great  characteristics,  judgment  and 
reflection,  p.  123,  ()  241  b;  p.  124,  ^ 
241c. 

the  peculiar  attribute  of  the  soul,  p. 
123,  <J  241  a ;  p.  124,  ^  241  c. 

contrasted  with  instinct,  p.  123,  124,  () 
241  b,  c. 

its  alliance  to  instinct,  p.  123,  124,  ^ 
241  c. 

as  associated  with  instinct,  a  connect- 
ing moral  medium  between  man  and 
animals,  p.  123,  ()  241  c. 

the  connecting  link  between  man  and 
his  Maker,  p.  124,  ^  241  c.  See, 
also,  Truth. 

author's  proof  from,  in  connection  with 
'nstinct   of  the  identity  o    mankind 


Reason — continued. 

in  respect  to  species,  p.  123,  ^  241 

c,  note.     See,  also,  Instinct. 
Reflex  Action, 

its  general  philosophy  known  in  former 
times  ;  its  mechanism  and  physio- 
logical laws  lately  determined,  p 
290,  <J  462-465  ;  p.  320,  (j  494  di ; 
p.  362,  ^  530.  See,  also,  Nervous 
Power,  Sensibility,  Sympathetic, 
and  Sympathy. 
Relations,  Sympathetic, 

of  a  general  nature,  p.  58,  <^  129  ;  p. 
63,  ^  137  ;  p.  64-66,  ()  140-143.  See, 
also.  Sympathy,  Ganglionic  System, 
and  Nervous  Power. 

mechanical,  p.  59,  ij  129  k. 
Remedial  Action,  or  Modus  Operandi 
OF  Remedies, 

considered  critically,  p.  661-689.    See, 
also.  Remedies,  considered  generally, 
&c. 
Remedies, 

the  cause  of  their  differences,  p.  27,  (j 
52  ;  p.  68,  (}  155.  See,  also.  Anal- 
ogies. 

their  specific  relations  to  organs,  p.  63, 
{)  137;  p.  66,  ^  143.  See,  also, 
Adaptation,  Law  of. 

their  action  accords  with  the  existing 
condition  of  the  vital  states,  p.  3,  ^ 
2  b;  p.  59,  ()  129  g-i;  p.  66-69,  «J 
144-156  ;  p.  73,  (J  163  ;  p.  98,  <J  191 
b  ;  p.  122,  ()  240  ;  p.  437-442,  (j  685- 
686.  See,  also,  Pathology,  and 
Therapeutics. 

analogous  in  action  to  morbific  causes, 
p.  542,  I)  854;  p.  662-665,  ()  895^ 
901  See,  also,  Remedial  Action, 
and  Analogies. 

their  cApabilities,  effects,  and  doses,  to  be 
known  only  by  their  trial  under  vari- 
ous conditions  of  human  maladies, 
and  to  be  obtained  only  by  a  careful 
reference  to  their  virtues  and  to  the 
existing  pathological  conditions,  p.  3. 
<J  2  c  ;  p.  63,  (J  137  d  ;  p.  65,  ^  143  c ; 
p.  67,  (}  150,  151 ;  p.  122,  (^  240  ;  p. 
148,  ^  334  ;  p.  417,  <^  650  ;  p.  428,  f, 
671-674  a;  p.  430-433,  ^  675,  676 
a ;  p.  434,  ()  680  ;  p.  437-442,  ^  685, 
686  ;  p.  459,  ^  705  ;  p.  464,  <)  712, 
713;  p.486,  <;»750  6,-  p.  488,  (J756i; 
p.  528,  {}  831  ;  p.  541,  542,  ^  854  ;  p. 
543,  1^  857 ;  p  545,  ^  859  ;  p.  547,  ^ 
863  d ;  p.  565,  i)  889  /,  g ;  p.  567- 
569,  i)  899  l-mm ;  p   572-574,  9  890 

d,  e ;  p.  575,  576,  (j  890  h-l ;  p.  ^7. 
578,  4  890  o-q;  p.  580,  581,  \  890J 
e-g;  p.  584,  ^  891  d;  p.  586-589,  I 
891  h-p;  p.  590-593, 1^89 U;  p  597- 
600,  ^  892  c,  d;  p.  608-610,  ^  892i 
c,d;  p.  613,  <J  892^i;  p  615,  ^892^ 

e,  f;  p.  619,  ()  892i  r  ;  p.  623,  ()  892§ 
c ;  p.  625,  «J  892?  /;  p.  628,  629,  ^ 


9ro 


INDEX. 


Remedies — continued. 

mn  g-s ;  P-  630,  ^  892|  ;  p.  633- 
635,  <)  892|  a-c;  p.  637-G39,  ^  892f 
e-g;  p.  645,  ^  893  c;  p.  649,  650,  ij 
893  A,  i;  p.  652,  653,  iji  893  m,  ti;  p. 
057,  658,  ()  893  p ;  p.  662,  663,  <J  895- 
897;  p.  664,  ^  900;   p.  679-683,  ^ 
905  ;  p.  684-688,  ()  905.V  ^f,  c  ;  p.  692, 
693,  ^  915-921  ;  p.  698-700,  ()  929- 
935  ;  p.  702,  703,  ()  939-942  ;  p.  707, 
^  948,  949;  p.  711-715,  ^  953-960; 
p.  724,  <)  961  a;  p.  726,  ()  961  c,  d; 
p.  732-734,  ()  971-975,  and  so  on. 
the   philosophy   of  their   action   con- 
sidered generally,  and  under  various 
aspects,  p.  3,  ^  2  i ;  p.  27,  ij  52  ;  p. 
44,  i)  72  ;  p.  45,  ^  73  ;  p.  55,  H17  ; 
p.  59,  {)  129  h;  p.  61,  ()  133  c;  p.  63, 
\  137 ;  p.  65,  §  143 ;  p.  67,  ^  149- 
152  ;  p.  73,  ()  163  ;  p.  87,  <J  177-182  ; 
p.  89,  ()  188  a;  p.  98,  <;.  191  a,  b;  p. 
99,  ()  192;  p.  101-104,  ^  201-204; 
p.  100-111,  ^  223-2335  ;  p.  321-335, 
\  495-511;    p.  405-412,    (}  638;   p. 
540,  ^  851 ;  p.  662-665,  ^  895-901. 
See,   also.   Remedial  Action,    con- 
sidered critically. 
do  not  operate  by  absorption,  p.  301- 
314,  ^  481-488^;  p.  318-321,  ^  494. 
See,    also,   Humoralism,  Remedial 
Action,   Analogies,    and    Adapta- 
tion, Law  of. 
fchown  not  to  act  upon  any  chemical  or 
physical  principle  by  the  variety  of 
agents  which  will  remove  a  common 
form  of  disease,  as  the  intermittent 
fever,  or  as  iodine,  mercury,  quinia, 
&c.,  will  alike  induce  absorption  of 
lymph  in  indurated  enlargements  of 
the  hver,  &c.,  p.  133,  <J  291.;  p.  603, 
604,  ^  892  k,  kk;  p.  615,  616,  ^  892i 
/;  p.  677-679,  ()  904  d.     See,  also, 
Absorption. 
are  constantly  influenced  by  the  order 
of  their  app'ication,  ut  supra.     See, 
also,  Therapeutics,    and   Adapta- 
tion, Law  of 
action  of,  oftei    depends  upon  the  ef- 
fects of  antecedent  and  subsequent 
remedies,  ibid,  &c. 
can  not  be  isolated  from  a  consecutive 
series,  and  each  one  studied  in  its  ef- 
fects by  itself.     See  general  Thera- 
peutics, Bloodletting,  and  Reme- 
dial Action. 
Respiration, 
physiology  of,  and  its  comprehensive 
exemplification  of  remote  sympathy, 
p.  325-328,  ^  500  e-m. 
in  organic  chemistry,  the  cause  of  all 
motions,  processes,   and  results,  the 
cause  of  itself,   and  the   cause  of 
death,  p.  173,  k  350,  No.  46.     See, 

also,    Co.MBUSTION. 


Respiration — continued. 
the  death  of  organic  chemistry,  p.  24y, 
<^  440  cc,  No.  12. 

Revelation, 
its  fundamental  statements  coincide 
with  the  constitution  and  phenome- 
na of  nature,  and  their  admission  is 
indispensable  to  the  progress  of 
truth,  and  of  science,  p.  16,  <J  14  c  ; 
p.  23,  l)  34-36  ;  p.  34,  \  62  c ;  p.  46, 
^  74;  p.  49,  Ml  ;  P-  86,  (}  175  rf; 
p.  135-138,  ^  303-303J ;  p.  174-192, 
()  350^353  ;  p.  317,  ^  493  a;  p.  401, 
i)  632  b.     See,  also,  Design- 

Revulsion, 

objections  to  the  doctrine  of,  p.  653- 
656,  ^  893  n. 

RocHELLE  Salts.    See  Cathartics,  The- 
rapeutics, &c. 

Rdsii,  Benjamin, 

On  Bloodletting  in  various  forms  of 
disease,  and  at  all  ages,  §  994,  999, 
1010  6,1017  c.     Note  F  F,  p.  1135. 


Saline    Cathartics.     See   the   several 
Denominations. 

Sap, 
composed  of  the  same  seventeen  ele 
ments  as  blood,  p.  23,  (J  34-37  ;  p. 
24,  ^  41,  42. 
its  motion  shown  to  be  a  vital  process 
by  direct  observation,  and  by  the 
variety  of  unique  eliminations  from 
the  sap,  p.  24,  ^  41,  42  ;  p.  134,  () 
293;  p.  224-227,  s*!  409  g--411.     See, 
also,     Assimilation,     Absorption. 
Capillaries,  and  Plants. 

Science, 
must  keep  itself  within  the  fundament- 
al  restraints    of  Revelation  ;    see 
Revelation. 

Sarsaparilla.     See    Alteratives,    Io- 
dine, and  Remedial  Action. 

Scammonv.     See  Cathartics,  and  The- 
rapeutics. 

Schools  of  Medicine, 

three  :  Physiological  or  Vital,  Chemi- 
cal, and  Chemico-physiological,  p 
6,  7,  ^  4^  a-e. 
the  Physiological  contradistinguish  or- 
ganic and  inorganic  Nature,  p.  6,  ^ 
4i  a  ;  the  Chemical  confound  organ- 
ic and  inorganic  Nature,  p.  6,  ^  4^  J  ; 
the  Chemico-physiological  compro- 
mise philosophy,  p.  7,  ^4^  c  ;  p.  197. 
()  361. 

Secretion, 
the  function  upon  which  nutrition  and 
growth  immediately  depend  ;  better 
designated  as  Appropriation,  p.  217 
-227,  HOO-411. 


INDEX. 


971 


Secretion — continued. 

chemical  philosophy  of,  p.  168-170,  <J 
350,  Nos.  31,  32,  37,  38,  39  ;  p.  180- 
182,  <)  350J  e,f.  See,also, Combustion. 
Seckktions  and  Excretions, 

lernis  applied  to  the  products  of  the 
functions,  and  used,  at  present,  in 
their  morbid  acceptation,  and  as 
supplying  symptoms,  p.  450-455,  i) 
690-694i. 
Skdatives, 

their  uses  and  mode  of  action,  p.  583- 
593,  (}  891-89U  ;  p.  681-683,  ^  905  b. 
See,  also.  Narcotics,  Hydrocyanic 
Acid,  and  Analogies. 
Seisd, 

its  state  of  life,  p.  30,  ij  57  ;  p.  97,  ^ 
190  6. 

evinces  great  Design,  p.  56,  ^  123  ;  p. 
97,  ^  190  b.     See,  also,  Ovum. 
Semen, 

a  vital  stimulus,  p.  44-46,  ^  72-73  ;  p. 
47-49,  ^  75-80  ;  p.  97,  ^  190  i. 

acts  upon  the  ovum,  p.  44,  ij  72  ;  p. 
97.  ^  190  b. 

transmits  disease,  p.  47-49,  ()  75-80. 

its  analogies  with  other  vital  agents, 
p.  45,  (}  73,  74  ;  p.  97,  ^  190  b. 

imparts  constitutional  peculiarities,  p. 
44,  (J  72. 

vicarious,  p.  50,  <J  83  b.   See,  also.  Ovum. 
Seneka, 

its  merits  in  croup,  p.  638,  ^  892 1  /. 
Senna, 

objections  to  its   common  use  ;   see 
Cathartics,  and  Therapeutics. 
Sensation, 

its  philosophy,  p.  89,  ^  186,  188  b ;  p. 
100-103,  (J  194-204  ;  p.  280-283,  i) 
450-451. 

of  three  kinds,  common,  specific,  and 
sympathetic,  p.  280-283,  ()  450-451. 

common,  the  cause  of  pain,  and  uni- 
versal, p.  100,  <)  198  ;  p.  281,  ()  450  d. 

specific,  the  function  of  the  senses,  and 
the  fountain  of  knowledge,  p.  100, 
^  199  ;  p.  281,  ()  450  e. 

sympathetic,  concurs  with  the  nervous 
power  in  producing  the  function  of 
remote  sympathy,  p.  101-103,  ()  201 
-204  ;  p.  107,  108,  ^  227  ;  p.  282- 
284,  ^  451-453  ;  p.  290,  291,  ^  462- 
467  ;  p.  323-332,  (/  500. 

sympathetic  develops  the  nervous  pow- 
er, p.  101,  {)  201  ;  p.  107,  ^  227. 

common  and  specific  terminate  in  the 
brain,  and  end  in  exciting  percep- 
tion, p.  100,  I)  196,  199^  ;  p.  101,  ij 
201  ;  p.  280-282,  (j  450  c-451  b. 

common  and  specific  require  the  exer- 
cise of  perception,  p.  124,  ()  241  d  ; 
p.  281,  ()  450  e. 

tympalhetic  may  terminate  in  any  part 
of  the  nervous  system,  does  not  af- 
fect perception,  but  ends  in  exciting 


Sensation — continued. 

the  nervous  power,  p.  101-103,  §  201 
-204  ;  p.  107,  108,  ()  227  ;  p.  124,  (, 
242  ;  p.  281-287,  (J  451-459  a;  p 
321,  ^  497  ;  p.  323-332,  ^  500  ;  p. 
342,  343,  ()  515,  516  d,  Nos.  3,  4 :  p. 
349, 1)  520-522  ;  p.  353,  ^  524  d,  Nos. 
4,  5,  6. 

common  and  specific  may  result  in  the 
development  of  the  nervous  power 
by  exciting  the  mental  emotions 
along  with  perception,  when  the 
emotion  develops  the  nervous  pow- 
er, or  sympathetic  may  be  in  simul- 
taneous operation  through  nerves 
of  organic  life,  p.  101,  ^  201  a;  p. 
103,  ^  209  ;  p.  341,  ^  514  m.  See, 
also.  Pain,  and  Mental  Emotions. 

sympathetic  is  appropriated  exclusively 
to  organic  life  in  animals,  since  the 
nervous  power  operates  upon  irrita- 
bility in  developing  motion,  and  mo- 
bility in  its  functions  in  animal  life 
is  only  a  modification  of  the  same 
property  in  organic  life,  p.  89,  ^  188 
a;  p.  103,  ^  208;  p.  110,  ^  2.33;  p. 
126,  127,  ^  258-260  ;  p.  323-332,  (> 
500  ;  p.  349,  <J  519  ;  p.  671,  ^  903. 
See,  also,  Nervous  Power. 

common  and  specific  depend  mostly 
upon  cerebro-spinal  nerves,  p.  101, 
102,  4  201. 

sympathetic  depends  mostly  upon  the 
sensitive  fibres  of  the  ganglionic 
and  pneumogastric  nerves,  p.  102,  <! 
201  c. 

sympathetic  is  necessary  to  reflected 
motion,  but  never  operates  when 
motion  is  generated  by  causes  act- 
ing directly  upon  the  nervous  cen- 
tres, p.  101,  ()  201  ;  p.  107,  108,  ^ 
227;  p.  671,  (}  903,  and  ut  cit. 

what  is  its  chemical  rationale  in  con- 
nection with  Perception  and  Sympa- 
thy, p.  85,  (J  175  c  ;  p.  155,  ^  349  e ; 
p.  281,  ^  450  ;  p.  329,  330,  ()  500  ?! 
Sensibility, 

peculiar  to  animals,  p.  100,  (/  194. 

"  organic"  is  irritability,  p.  99,  <)  193  ; 
p.  101,  ^  201  a;  p.  671,  ^  903. 

the  great  inlet  of  knowledge,  p.  100,  (/ 
195;   p.  281,  ()  450  e. 

receives  and  transmits  impressions,  p. 
46,  ()74:a;  p  89,  <J  188  i ;  p.  93-96, 
«J  188i  rf-189  c;  p.  100,  ^  195;  p. 
101-103,  ^  201-204;  p.  281-283,  ^ 
45«  e-451  ;  p.  671,  (J  903. 

its  organs,  the  nerves,  p.  100,  (j  196- 
p.  280,  ^  450  b. 

is  of  three  kinds,  p.  100,  ^  196  ;  p.  280, 
()  450  a. 

common,  belongs  to  all  parts ;  the 
source  of  pain  ;  generally  dormant 
in  organic  life,  but  roused  by  dis- 
ease, p.  100,  ^  198. 


972 


INDEX. 


Sensibility — continued. 

specific,  peculiar  to  the  senses  ;  exqui- 
sitely susceptible,  but  rendered  ob- 
tuse by  disease,  p.  100,  t)  199  ;  p. 
281,  §  450  e. 

common  and  specific,  relative  to  the 
brain,  or  its  equivalent,  alone  as  their 
center ;  the  sources  of  true  sensa- 
tion ;  require  the  exercise  of  per- 
ception, p.  89,  ()  188  b;  p.  100,  ^ 
199^  ;  p.  280,  (J  450. 

sympathetic,  an  element  of  remote 
sympathy,  p.  46,  ^  74  a. ;  p.  89,  ^ 
188  a;  p.  101-103,  <;>  201-204;  p. 
104,  <;i  209  ;  p  282-284,  ^  451  c-453  ; 
p.  671,  ^  903  ;  is  relative  to  the 
brain,  spinal  cord,  and  ganglionic 
system,  as  its  centers,  p.  101,  102,' 
^  201 ;  p.  287,  ^  459.  See,  also. 
Sensation,  sympathetic  may  termin- 
ate, &c.  ;  effects  of,  reflected  from 
nervous  centers,  p.  89,  <J  188  a ;  p. 
101,  ^  201  ;  p.  108,  <)  227  ;  p.  223- 
232,  ^  500  ;  necessary  to  reflected 
motion,  ibid;  resides  especially  in 
the  sympathetic  and  pneumogastric 
nerves,  p.  102,  ij  201  c;  p.  104,  (^ 
209  ;  does  not  involve  true  sensa- 
tion or  perception,  p.  101,  ^  201  b; 
p.  103,  ()  204. 

possesses  modifications  analogous  to 
those  of  irritability,  p.  100,  <J  200; 
p.  102,  ^  203  ;  p.  108,  ^  227. 

common,  low  in  the  nervous  centers,  p. 
107,  (}  224. 

less  in  trunks  than  nervous  ramifica- 
tions, p.  107,  (J  224 ;  p  347,  §  516  d, 
No.  11  ;  p.  521,  ^  826  d. 

its  general  relations  to  external  ob- 
jects, p.  53,  9   100  ;  p.  398-400,  (} 
626-630. 
Serous  Tissue.     See  Tissues. 
Serum.     See  Inflammation. 
Seton, 

philosophy  of  its  operation  applied  to 
the  modus  operandi  of  all  morbific 
and  remedial  agents,  p.  679-681. 
Sex,  p.  393-394. 
Sexual  Organs, 

their  relations  to   organic  life,   &c., 
p.   55,   56,    ^    118-121.     See,   also. 
Youth. 
Sleep, 

how  explained  in  materialism,  p.  85, 
H75c;  p.  329,  330,  (J  500  ?i. 

awaking  from  disproves  materialism, 
p.  85,  (}  175  c. 
Soda,  Sulphate  of.     See  Cathartics, 

and  Therapeutics. 
Soda,  Muriate  of.     See  Astringents, 

and  Remedial  Action. 
Solar  Spectrum, 

physiologically  and  chemically  ap- 
plied, p  92-95,  ^  188i  d;  p.  115,  § 
234  c 


Solar  Spectrum — contvmied. 
its  invisible  rays,  p.  91,  ^  188^  rf;  p. 
115,  §  234  e.     See,  also,  Analogies. 

SoLIDIsM, 

the  basis  of  medicine,  p.  1,  ^  1.     See, 
also.  Vitalism  and  Solidism. 
Soul, 
created  after  structure,  p.  81,  ^  170  a. 
a  stimulus  of  the  brain,  p.  85,  ij  175  c. 
that  judgment,  reflection,  and  percep- 
tion, require,  for  their  exercise,  the 
co-operation  of  the  brain,  is  analogic- 
ally inferable  from  the  manifest  con- 
currence of  the  nervous  system  with 
the  will  in  voluntary  motion,  p.  281, 
^  451  a.     See,  also,  Mind,  and  Nerv- 
ous Power. 
Somnambulism, 
subjects  of,  between  the  sleeping  and 
waking  state  ;    speech  incoherent ; 
rational   faculty  dormant ;    instinct 
mostly,  but  feebly,  operative.     See 
Animal   Magnetism,    Reason,    and 
Instinct. 
"Specialities"  in  Medicine, 

not  founded  in  philosophy,  p.  G87,  () 
905i  b;  p.  721,  722,  §  960  c,  d. 
Specific  Action, 
illustrated  by  remedial   and  morbific 
agents,  p.  417,  (J  650 ;  p  424,  ^  602 
a ;  p.  430,  (j  675,  676  a ;  p.  487-489, 
(j  754-756  ;  p.  542,  (}  854  c ;  p.  553, 
\  870  aa ;  p.  562,  ij  888  e ;  p.  597, 
()  892  c;  p.  662-665,  ()  895-901  ;  p. 
676-679,  <^  904  c,  d.     See,  also,  Al- 
teratives, and  Analogies. 
Spermatozoa, 

the  supposed  germ,  p.  42,  §  67. 
Sphincter  Muscles, 
held   in  contraction   by  the   nervous 
power,  p.    Ill,   ()   233.V;    p.  339,    ^ 
514  5^. 
illustrate  the  law  of  prolonged  influ- 
ence, ibul,  and  p.  344,  345.  ^  516  (^, 
No, 6  ;  p.  426,  ^  666 ;  p.  670,  <^  902  k. 
physiology  of  their  contraction  applied 
pathologically    and   therapeutically, 
ibid,  and  Remedial  Action. 
Spinal  Cord, 
its  general  physiological  laws,  p.  292- 
295,  (j  473-475 
Sponge,  Burned,  Vegetable  .^thiops, 
and  Cod's  Liver  Oil,  p.  619,  ^  892^. 
Spontaneous  Generation.    See  Geneb- 

ATiON,  Spontaneous. 
Squill.      See    Expectorants,    Thera- 
peutics,   Emetics,   Diuretics,    and 
Re.medial  Action. 
Stethoscope, 

its  advantages,  p.  640,  <^  892i  A. 
Stimulants, 

their  uses,  &c.,  p.  579-583. 
Stimuli,  Vital,  p.  21,  <;»  21  ;  p.  62,  ^  136, 
137;  p.  90,  6  188i 
everv  part  has  its  own,  p.  62,  ^  136 


INDEX. 


973 


Stimuli,  Vital — continued. 
of  one  part  offensive  to  other  parts,  p. 

63,  ()  137. 
certain  natural  ones  acted  upon  and 

appropriated  to  various  uses,  p.  90, 

<;i  188^  c;  p.  107-111,  ()  226-233i 
their  adaptation  to  parts,  p.  62,  ^  136  ; 

p.   63,   §   137  c.      See,   also,  Vital 

Agents,  and  Analogies. 
Stomach, 
alone  generates  a  digestive  fluid,  p.  62, 

(j  135  a;  p.  191,  192,  <J  353;  p.  229, 

SS  419. 
induction  from,  of  the  vital  nature  of 

decarbonization  of  the  blood,  p.  229, 

230,  ()  419,  420.     See,  also.  Carbon, 

and  Mucous  Tissue. 
its  peculiar   product   artificially  pre- 
pared, p.  197-202,  §  362-376^ 
Its  variety  of  structure  and  compre- 
hensive relations  in  the  function  of 

assimilation,  p.  140-147,  (}  305-330. 
formative  not  destructive,  p.  15,  ^  13, 

14;  p.  16,  ()  16-18;  p.  24,  ()  A2  ;  p. 

30,  (ji  59  ;  p.  33,  ^  60  ;  p.  135,  ^  301 ; 

p.  143,  {)  322  ;  p.  196,  ^  360,  361  ;  p. 

200,  ()  374,  375. 
chemical  theory  of  its  function  of  dis:es- 

tion,  g.  167-170,  §  350,  Nos.  29-34; 

p.  197-199,  ()  362-364^. 
its  usual  unaltered  state  after  death, 

adverse  to  the  chemical  theory  of 

digestion,  ut  supra. 
Story, 
his  opinion  of  the  times,  p.  203-207,  § 

376J  a. 
Stramonium.     See  Aconite,  &c. 
Strength  and  Weakness,  or  Debility, 
in  what  they  consist,  p.  370-372,  ^  569 ; 

p.  312,  313,  ^  ^87  g,h. 
Structure, 
its  physical  and  vital  characteristics, 

p.  50-73,  ^  83-1.63. 
important  to  be  known  in  its  sensible 

and  functional  character,  p.  51,  (J  83  c. 
its  minuteness,  unimportant  to  know, 

p.  59,  60,  ^  131. 
composed  of  Tissues,  p.  52,  §  85-88. 

See,  also,  Tissues. 
its  vital  characteristics,  p.  52-73.     See, 

also,  Tissues. 
m  plants  and  animals,  how  different,  p. 

54,  55,   ^   107-117;    p.   134-140,  ^ 

293-304.     See,  also.  Plants. 
of  organic  beings,  heterogeneous,  p. 

20,  i}  29. 
its  ultimate  intricacy,  p.  59,  <J  130. 
created  before  life,  p.  81,  ^  170. 
Strychnia, 
effects  on  the  nervous  system,  see  Ac- 
onite, &c. 
SunoRiFics, 
tbe  term  objectionable,  p.  250,  251,  <J 

441    c;   p.  335-341,   ^  512-514;    p. 

547,  ()  863  d  ;  p.  550,  ^  863  e  ;  p.  630, 


Sudorifics — co7itinued. 

<;»  8925  h  ;  p.  661-664,  ^  894-900  ;  p. 
666-669,  i)  902  b,  i ;  p.  678,  §  904  d, 
&c.  ;  p.  704,  ^  943  a,  b,  944  a. 

many  agents,  like  hot  water,  &c.,  may 
induce  far  greater  diaphoresis  than 
the  antimonials  and  ipecacuanha ;  the 
former  excite  the  circulation,  the 
latter,  like  loss  of  blood,  depress  it, 
and  perspiration  is  in  proportion  ; 
the  former  of  no  useful  effect  or  in- 
jurious, the  latter  profoundly  cura- 
tive, ibid.  See,  also.  Remedial  Ac- 
tion, and  Alteratives. 

the  author's  philosophy  of  nervous  in- 
fluence places  the  phenomena  of  pete- 
chial effusions  of  blood  under  the 
skin  during  the  operation  of  emetics 
upon  physiological  grounds,  as  it 
does,  in  the  same  way,  the  supposed 
miracle,  implied  by  the  expression, 
"  a7id  his  sweat  was,  as  it  were,  great 
drops  of  blood  falling  down  to  the 
ground.^'  In  this  case  the  erno 
tions  were  peculiar  and  violent,  and 
operated  in  their  compound  aspect, 
according  to  the  explanations  which 
occur  at  p.  631,  ^  892.f  b,  and  ut 
supra.  See,  also,  Nervous  Power, 
Mental  Emotions,  Analogie.?,  Cap- 
illaries, Emetics,  and  Sweat. 
Also,  other  facts  and  illustrations 
relative  to  the  secretion  of  blood  by 
the  skin,  piamater,  &c.,  in  Medical 
and  Physiological  Commentaries,  vol. 
i.,  p.  371-384  {pathology  of  spontanC' 
ous  hemorrhage) ;  p.  683-690,  {en- 
dosmose  and  exosmose) ;  vol.  ii.,  p. 
546-566,  (philosophy  of  spontaneous 
hemorrhage.) 
Suppuration, 

a  result  of  inflammation,  instituted  for 
great  final  causes,  p.  471-474,  ^  730 
-733  ;  p.  546-551,  ^  862,  863. 

variable  according  to  the  exact  condi- 
tion of  pathological  states,  p.  478- 
480,  (J  740,  741  ;  p.  484,  ()  748  ;  p. 
536-539,  ^  847  c-848. 

occurs,  in  a  special  product,  upon  mu- 
cous  surfaces   without   ulceration, 
and  farther  illustrative  of  final  caus- 
es, p.  472,  ^  733  a. 
Sweat, 

an  excreted  product,  p.  230,  ^  420-422. 

considered  in  its  relation  to  disease,  p. 
451,  452 ;  and  to  physiological  in- 
fluences, see  Sudorifics,  and  Ex- 
cretion. 

coincidence  between,  and  mucus  and 
carbon,  as  products  of  organization, 
p.  230,  ^  420.     See,  also,  Mucous 
Tissue. 
Sympathetic  Influences, 

laws  of,  p.  55,  <)  113,  115,  117;  p.  58, 
(}  120,  124  ;  p.  57,  ^  125  ;  p.  5S,  59. 


974 


INDEX. 


Sympathetic  Influences — continued. 

n29  ;  p.  63-66,  ^  137-143 ;  p.  67, 
68,  ^  149-152;  p.  106-111,  ^  222- 
233J  ;  p.  321-341,  ^ 495-514 ;  p.  405 
-412,  ^  638  ;  p.  661-689,  ^  894-905^ ; 
p.  692,  693,  ()  914-921  ;  p.  698,  699, 
(J  929-935  ;  p.  702-711,  ()  939-952  ; 
p.  746,  (}  990^  a.  See,  also,  Sympa- 
thy. 

depend,  in  part,  upon  the   nature  of 
tissues,  p.  64,  <J  140-142  ;  p.  67,  () 
150-152  ;  p.  73,  ^  163.     See,  also. 
Tissues. 
Sympathetic  Nerve, 

pervades  all  parts,  p.  54,  55,  ^  111, 
113;  p.  58,  <J  129;  p.  284-289,  ^ 
454-46 U. 

its  ganglia  to  be  regarded  as  analogous 
to  brain,  especially  in  inferior  ani- 
mals, and  as  contributing  to  gener- 
ate the  nervous  power  in  the  higher 
orders,  p.  55,  H13  ;  p.  321,  iji  497  ; 
p.  346,  ^  516  d,  Nos.  8,  9  ;  p.  349, 
350,  ()  520-523  ;  p.  353,  ^  524  d. 

its  prolongation  through  the  chain  of 
ganglia  consists  truly  of  communi- 
cating branches ;  thus  making  the 
ganglia  so  many  intimately  connect- 
ed centers  of  sympathy  ;   ibid,  &c. 

its  ganglia,  plexuses,  &c.,  the  media 
of  contiguous  sympathy,  and  more 
or  less  of  remote,  in  the  higher  ani- 
mals, <)  473  c,  497,  516  d,  Nos.  3,  4, 
5,  <J  520,  893 ;— the  only  centres  of 
sympathy  in  the  inferior  animals,  ut 
cit.  ;  ganglia  shown  to  be  centres  of 
sympathy  by  their  resemblance  to 
brain  ; — shovYn  by  the  ramifications, 
and  the  interchanges  of  their  nerves  ; 
— shown  by  the  absence  of  brain  and 
spinal  cord  in  all  but  the  higher  an- 
imals ;  ut  cit.,  and  passim. 

this  nerve  subserves  the  functions  of 
organic  life,  maintaining  through  re- 
flex actions  their  harmonious  rela- 
tions, supplying  an  exciting  and  mod- 
ifying influence,  and  thus  also  pro- 
moting the  secretions  and  exalting 
the  vital  states  of  organic  compounds, 
and  supplies  the  stimulus  to  muscu- 
lar fibre  in  organic  life,  ()  113-117, 
22 H,  224-226,  2334,  259,  261,  264, 
409  k,  455-46U,  473  c,  475^,  478  6, 
4881,  489,  490,  493  cc,  497,  500  g,  m, 
514/,  516,  Nos.  3,4,  5,  520,  523-524, 
647^,  746  c,  893  a-e,  893^  902  e-h, 
904  Ob,  905  a,  939/,  942  6,  1059. 
Sympathetic  Relations, 

such  as  are  natural,  ^  129,  137.,  &c. 

morbid,  p.  59,  ^  129  i;  p.  64-66,  ^  140 
-143,  147.     Adaptation,  Law  of. 
Sy.mpathies,  Morbid, 

of  the  Inditidual  Tissues  ;  see  Tissues. 

of  the  Compound  Organs ;  See  Organs, 

COMPQUND. 


Sympathy, 

its  general  consideration,  p.  283-3C:i, 
M52-530;  p.  412,  ^  638^. 

of  three  kinds,  continuous,  conlig^ious, 
and  remote,  p.  321-335,  ()  495-511. 

contiguous  and  remote  depend  upon  the 
nervous  power,  operating  in  its  con- 
nection with  sympathetic  sensibility, 
ibid.  See,  also.  Nervous  Power, 
and  Sensibility,  sympathetic. 

continuous,  common  to  plants  and  ani- 
mals, p.  322,  323,  ()  498  ;  p.  351,  ^ 
524  a,  No.  2. 

its  main  centers,  in  the  higher  ani- 
mals, the  brain  and  spinal  cord,  p. 
323,  ()  499.  See,  also,  Sympathetic 
Nerve,  and  Nervous  Power. 

its  physiological  laws  well  settled,  p. 
Ill,  \  234  a. 

not  applied  pathologically  or  therapeu- 
tically, p.  Ill,  (J  234  a.  See,  also, 
Humoralism,  and  Organic  Chemis- 
try. 

its  natural  conditions  neglected  or  rid- 
iculed, p.  1 1 1,  <;>  234  J ;  p.  283,  (j  452  b. 

how  far  expounded  by  the  Author ;  see 
Nervous  Power,  the  Philosophy  of 
its  Operation,  &c. 

admitted  Laws  of,  and  their  applica- 
tion, by  the  Author,  to  pathology  and 
therapeutics,  p.  280-361,  <J  450-530. 

physiological  Laws  of,  luminously  ex- 
pounded by  the  great  Prussian  Phys- 
iologist, p.  341,  i)  514^  b  ;  p.  362,  ^ 
530. 
Symptoms, 

the  index  of  disease,  p.  434-445. 

certain  special  ones,  p.  442-44.'5. 

mode  of  investigating,   p.  430-433,  ^ 
675,  676  a ;  p.  437-4 12,  ^  685,  686  ; 
p.  561,  <J  888  a. 
Syncope, 

produced,  not  as  supposed,  by  deficien- 
cy of  blood  at  the  center  of  the  cir- 
culation, or  by  privation  of  nervous 
influence,  but  by  a  strong  determina- 
tion of  the  nervous  power  upon  all 
the  organs  of  circulation  ;  reproduced 
by  the  antecedent  enfeebled  action 
of  those  organs,  p.  304,  305,  (j  481 
g,  h;  p.  703-709,  ()  940-951. 

removed  by  the  action  of  the  nervous 
power,  or  by  irritating  the  heart  me- 
chanically, p.  89,  {)  188  a;  p.  107, 
108,  <J  226,  227 ;  p.  705,  §  945. 

T. 
Tables, 

of  Organs  according  to  their  relative 

functions,  p.  07,  ^  125. 
of  Tissues  in  their  order  of  liability  to 

inflammation,  p.  70,  71. 
of  Tissues  as  to  force  of  disease,  p.  72. 
of  Tissues  inflamed,  as  to  treatment,  p 
72,  73. 


INDEX. 


975 


Tables — contimied. 
of  the  fluid  products  of  secretion,  p. 
218,  ^  406. 

Temperament, 
physiological,  pathological,  and  thera- 
peutical considerations  relative  to, 
p.  383-391,  <J  585-603.  Five,  the 
sanguine,  melancholic,  choleric,  phleg- 
matic, and  nervous,  ibid. 
philosophy  of,  shown  by  impregnation, 
p.  48,  <J  76  ;  p.  49,  ^  80. 

Theories,  Rival, 

should  be  compared  and  contrasted,  p. 
6-8,  ^  4^,  5  ;  p.  19,  (^  18  e ;  p.  131- 
133,  ()  281-295  ;  p.  157-173,  ^  350  ; 
p.  189,  190,  (}  350i  n;  p.  191,  (>  351  ; 
p.  208-217,  9  382-399;  p.  219-227, 
()  408-411  ;  p  238,  ()  438  ;  p.  246,  ^ 
440/;  p.  277,  278,  ^  447i/;  p.  433, 
434,  ^  676  b ;  p.  456,  457,  (/  699  ;  p. 
463,  i)  709  ;  p.  482,  -J  744 ;  p.  484,  ^ 
748;  p.  499,  ^  785;  p.  500-504,  ^ 
786-797  ;  p.  514,  ^  819  a,  Nos.  1-7  ; 
p.  662,  ()  896,  &c.  ;  p.  690,  ^  906/; 
p.  691,  §  908-910. 

Theory, 

natural  to  the  mind,  p.  5,  ij  4  a  ;  p.  10, 

inculcated  by  the  Creator,  p.  5,  ^  4  a. 
founded  in  Nature,  p.  5,  ij  4  a. 
implies  the  greatest  reference  to  facts, 

p.  5,  ^  4  b. 
should  be  studiously  considered,  p.  5, 

Mi;  P-  10.  ^  5;  c. 
undervalued  by  the  ignorant  alone,  p. 

5,    ()4:b. 

true,  OT  false,  always  guides  the  igno- 
rant practitioner,  p.  5,  i^  4  b. 
how  to  make  one,  p.  10,  i^  5^  b,  c. 

THER.iPEUTICS, 

considered  in  its  various  aspects,  p. 

541-777,  ^  852-1027. 
the  chemical  system  of,  p.   176-178,  ^ 

350i. 
Thought, 
chemical  theory  of,  p.  155,  ()  349  e  ; 

and  corresponds  with  the  chemical 

theory  of  delirium  and  mania,  p.  243, 

^  440  c. 
Time, 

the  arbiter  of  right,  p.  622,  ^  892§  b. 
Tissues, 
of  the  animal  body,  p.  52,  ^  86. 
their  individuality  important,  p.  52,  () 

88  ;  p.   61,  ()  133;  p.  70,  ^  162;  p. 

416,  <)  649  b-d.     See,  also,  Venous 

Tissue. 
their  distinctions  physical  and  vital,  p. 

52,  ^  89  ;  p.  61-73,  <)  133-163. 
their  union,  p.  52,  <J  89-92. 
a  knowledge  of  important  in  medicine, 

p.  50,  ij  83;  p.  61,  ^  132-134;  p.  67, 

(J  149-152  ;  p.  69-73,  ^  160-163;  p. 

353-362,  ()  525-530  ;  p.  468,  ()  722  c. 
their  respective  modifications  of  life, 


Tissues — cmitinued. 

p.  61-64,  ()  133-138  ;  p.  64,  ^  142, 
p.  416,  417,  ()  649  b-d. 

their  special  products,  p.  62,  ij  135  ;  p. 
141,  ()  307. 

their  special  stimuli,  p.  45,  <J  73  ;  p.  62, 
^  136  ;  p.  92-95,  ()  188^  d. 

their  relative  liability  to  disease,  p.  70- 
72,  ij  162. 

their  relative  force  of  disease,  p.  72,  4 
162. 

inflamed,  their  relative   demands   for 
bloodletting,  p.  72,  ij  162. 
Tissues,  Sympathies  of, 

of  the  individual,  p.  353-301. 

of  similar,  p.  353-358. 

of  dissimilar,  p.  359,  360. 

of  individual  in   their  relation  to  each 
other  in  Compound  Organs,  and  with 
Entire  Organs,  p.  360,  361. 
Tobacco, 

on  the  one  hand,  and  Lobelia  on  the 
other,  "tried  somewhat  extensively 
as  substitutes  for  bloodletting  in  in- 
flammatory affections,"  p.  715-718, 
(j  960  a,  g ;  p.  515,  ^  819  b ;  p.  527, 
(J  829  ;  p.  529,  ^  835  ;  p.  540,  ^  851. 

exemplifies  the  laws  of  vital  habit,  p. 
364,  (}  542-548  J  ;  p.  718,  <)  960  a,  note. 

its  use  unwarrantable  in  strangulated 
hernia,  p.  716-718,  ^  960  a. 

its  limited  use  as  a  luxury  admissible 
in  health  only,  p.  718,  ^  960  a,  note 
Tongue, 

as  supplying  symptoms,  p.  448-450. 
Tonics, 

general   consideration  of  their  uses, 
mode  of  operating,  &c.,  p.  579-583. 
Truth, 

how  best  ascertained  and  established, 
p.2,^2b;  p.  23S,  ()  438  d ;  p.  463, 
^  709  ;  p.  515,  ^  819  b.  See,  also, 
Error,  and  Facts. 

its  compass  and  nature,  p.  11,  ^  5^  c. 

its  fundamental  distinction  from  error, 
p.  166,  ()  350,  No.  28  ;  p.  157-173, 
189,  190. 

can  be  sustained  by  itself  alone,  ibid. 

man's  ultimate  love  of,  his  greatest  aj)- 
proximation  to  his  Maker,  p.  124,  <) 
241  c. 
Tubes, 

organic  and  inorganic,  have  no  resem- 
blances in  structure  or  function,  p 
99,  ^  192 ;  p.  318,  ^  493  d. 

U. 

Ulceration. 

its  pathological  character,  &c.,  p.  470, 
471,  <J  729  a,b;  p.  472^75,  ()  733 ; 
p.  477,  ()  736  c,  737  ;  p.  478,  4  740  a 
Understanding, 

a  property  of  the  mind  and  of  the  in- 
stinctive principle,  p.  123,  ^  241  h. 
See  Mind. 


976 


INDEX. 


Unity  of  Design.     See  Design. 
Urea, 
its  importance  in  organic  chemistry,  p. 

228,  ^  417. 
Ukinaey  Agents, 
their   general   uses,   influences,   &c., 

considered,  p.  683-689.     See,  also. 

Diuretics. 
Urinary  Organs, 
product  of,  inorganic  matter,  p.  228,  ^ 

417  a. 
contribute,  by  depurating  the  blood,  to 

the  process  of  assimilation,  p.  330, 

1^421. 
remarkable  sympathy  between,  and  the 

skin,  p.  330-332,  ^  422-424.     See, 

also.  Nervous  Power. 
product  of,  very  variable  in  health  and 

disease,  p.  232,  233,  ij  425-427. 
but  little  subject  to  disease,  p.  450,  451, 

<^  691. 
adaptations  to,  of  urinary  agents,  p. 

683-689,  ^  905i 
Urine, 
its  relations  to  disease,  p.  450,  ^  691. 
its  spontaneous  transformations  occur 

as  readily  as  those  of  blood,  p.  228, 

^  417,  &c. 
morbid  states  of,  sufliciently  recognized 

by  inspection,  p.  233,  ^  427  ;  p.  451, 

<J691. 
Uterine  Agents, 

considered  in  their  various  therapeuti- 
cal aspects,  p.  683-689.     See,  also, 

Emmenagogues,  and  Ergot. 
Uva-Ursi.  See Genito-Urinary Agents. 


Vegetable  Kingdom, 
essentially  independent  of  the  animal, 
p.  16,  ^  16,  17;  p.  135-138,  ^  300- 
303^.  See,  also,  Plants,  and  Or- 
ganic Life. 
its  importance  to  animals,  p.  15,  ^  11- 
14  ;  p.  16,  §  16 ;  p.  135-138,  ^  300- 
303i 

Veins, 
their  ordained  function  in  respect  to 
the  circulation,  their  peculiar  vital 
constitution,  their  one  and  peculiar 
vital  stimulus,  their  extreme  liability 
to  irritation  and  inflammation,  as 
well  as  direct  observation,  prove 
that  they  take  no  part  in  the  function 
of  absorption,  p.  62,  §  136  ;  p.  63,  § 
137  6,  c  ;  p.  128-134,  ^  269-295  ;  p. 
210,  <^  387;  p.  527, 1^829.  See,  also. 
Absorption  Venous  Tissue,  Circu- 
lation Venous,  and  Venous  Con- 
gestion. 
function  of  their  valves  explained,  p. 
212,  ^  391. 

Venous  Congestion, 
inquiry  into  its  pathology,  philosophy. 


Venous  Congestion — continued. 

influences,  treatment,  &c.,  p.  500- 
513,  ^  786-818  ;  p.  724-732,  ()  961- 
970;  p.  756-759,  ^  1005. 

constituted,  essentially,  by  inflamma- 
tion of  the  venous  tissue,  p.  503,  ^ 
794,  795. 

coincident  in  its  pathology  with  that 
of  phlebitis  and  varix,  p.  503,  504,  ^ 
796,  797. 

its  influences  upon  the  system  difTereni 
from  those  of  inflammation  of  other 
tissues,  p.  507,  508,  ^  806  ;  p.  724- 
726,  (j  961  a-t. 

modifies  the  phenomena  of  idiopathic 
fever  and  of  other  inflammatory  af- 
fections, and  increases  their  danger, 
p.  508,  509,  ^  809-811  ;  p.  511,  () 
815,  816;  p.  725,  ^  961  b. 

insidious,  p.  508,  509,  (j  806-810 ;  p. 
724,  ()  961  a;  p.  756-759,  ()  1005  a-h. 

its  prostration  of  the  functions  of  ani- 
mal life  mistaken  for  "  debility"  of 
organic  life,  p.  726,  ()  961  b.  See, 
also.  Will. 

illustrates  the  sway  of  theory  in  the 
treatment  of  disease,  p.  500,  i)  789  ; 
p.  501,  ()  790  b;  p.  729,  ^  967;  p.  4, 
5,  <J  4  a,  b.     See  Venous  Tissue. 
Venous  Tissue, 

author's  exposition  of  the  peculiarities 
of  its  vital  constitution,  and  of  their 
bearing  upon  venous  circulation,  and 
upon  the  pathology  and  treatment  of 
phlebitis,  venous  congestion,  and 
varix,  and,  also,  of  the  influences  of 
its  pathological  conditions  upon  the 
system  at  large,  and  upon  coexisting 
membranous  inflammations,  and 
upon  idiopathic  fever,  p.  62,  ^  136  ; 
p.  63,  {)  137  e ;  p.  64,  ^  140,  141  a , 
p.  67,  ^  149-151  ;  p.  73,  ^  163  ;  p. 
209-212,  ^  387-390  ;  p.  214,  ^  392  d, 
393  ;  p.  352,  ^  524  d ;  p.  353,  ^  525 
a;  p.  354,  355,  ()  526  b;  p.  416,  ^ 
649  b,  c ;  p.  424,  425,  §  662  b,  c ;  p. 
440,  441,  ^  686  b ;  p.  444,  445,  ()  688 
c,  e ;  p.  447,  448,  ^  688  i,  k ;  p.  450, 
I)  689  b ;  p.  453-455,  ^  694,  694i  ;  p. 
468,  (J  722  c  ;  p.  500-513,  (}  786-818  ; 
p.  724-732,  ^  961-970  ;  p.  735,  (}  978  ; 
p.  756-762,  ()  1005. 
Vis  Medicatrix  Nature, 

what  it  is,  and  what  its  advantages,  p. 
87,  ^  177  ;  p.  122,  <J  239,  240  ;  ]>. 
457,  ^  699  c ;  p.  470-475,  ()  729-733 
/;  p.  476,  I)  735  a;  p.  489,  <J  757  a, 
p.  492,  493,  ()  764  b,  c  ;  p.  497,  ^  775  ; 
p.  498,  499,  ^  784,  785 ;  p.  531,  ()  839  , 
p.  536,  §  847  a;  p.  541,  ^  853  ;  p. 
542.  ()  854  e  ;  p.  543-551,  ^  855-864  ; 
p.  558,  ^ 878  ;  p.  662-664,  ^ 895-899 , 
p.  683,  ^  905  b;  p.  435,  ^  680. 

not  recognized  in  the  chemical  and 
humoral   pathology,   p.    169-173,  (J 


INDEX. 


97? 


Vis  Medicatrix  Naturae — coidinucd. 

350,  Nos.  36-46  ;  p.  176-178, 1)  350i  ; 
p.  540,  ^  851  a ;  p.  550,  ^  863  e ;  p. 
661,  mottoes. 

does  not  institute,  nor  carry  on,  the 
recuperative  process  in  the  blood,  p. 
535,  536,  ^  847  a-c ;  p.  546,  ()  863  a. 
Vis  Inertia, 

takes  the  place  of  Vis  Vitce,  p.  30,  31, 
■J  59  ;  p.  105,  <5  216. 
Vision, 

vital  and  Chemical  Theories  of,  p.  93- 
95,  {}  188^  d. 
Vital  Affinity, 

a  property  of  the  Vital  Principle,  and 
common  to  plants  and  animals,  p. 
88,  §  183,  184  a. 

unites  the  elements  of  organic  com- 
pounds by  associate  action  with  the 
other  organic  properties,  p.  42,  43,  § 
67,  68  ;  p.  89,  ^  187,  188  ;  p.  104,  {) 
212  ;  p.  105,  ^  217,  218  ;  p.  135,  ^  299. 

modified  in  plants  and  animals,  p.  88, 
^  185;  p.  105,  ^  217. 

susceptible  of  morbid  changes,  p.  47, 
48,  ^  75,  76,  78  ;  p.  105,  <;>  220  ;  p. 
146.  147,  (J  327-331  ;  p.  535,  536,  ^ 
846,  847. 

its  morbid  changes  illustrated  by,  and 
analogous  to,  its  progressive  natu- 
ral modifications  from  the  ovum  to 
old  age,  and  such  as  result  from  the 
slow  influences  of  climate,  cultiva- 
tion, &c  ,  p.  42,  43,  ^  67,  68-70  :  p. 
48,  <;»  77  ;  p.  68,  69.  ()  153-159  ;  p. 
363,  (}  538  ;  p.  364.  ^  548  ;  p.  369,  ^ 
562  ;  p.  376-380,  ^  578. 

how  opposed  to  chemical  affmity,  p.  30 
-33,  >J  59,  60. 
Vital  Agents, 

whatever  acts  upon  life,  p.  21,  ij  21  ; 
p.  45,  ^  73  ;  p.  46,  ij  74  ;  p.  62,  63, 
^  136,  137  ;  p.  90-95,  i)  1881 ;  &c. 

act  upon  irritability  in  generating  all 
sensible  and  insensible  motions,  and 
upon  sensibility  in  the  function  of 
sensation  and  in  the  transmission 
of  all  influences  from  remote  parts 
to  the  nervous  centers,  whether 
relative  to  animal  or  to  organic  life, 
p.  21,  ^  21  ;  p.  45,  ^  73  ;  p.  46,  t)  74 ; 
p.  86,  \  lib  d;  p.  89,  ^  188  ;  p  95- 
102.  ^  189-203  ;  p.  107-111,  ^  226- 
233J;  p.  112,  ()  234  c;  p.  114,  ij  234 
e  ;  p.  119,  ^  234  i  ;  p.  280-283,  ^  450 
-451  ;  p.  284-287,  ^  454-458  ;  p.  289, 
^  461  ;  p.  296,  <J  476  c  ;  p.  313,  ^  487 
h;  p.  323-341,  (}  500-514;  p.  398- 
400,  ^  626-630  ;  p.  405-412,  (}  638  ; 
p.  661-664,  <;»  894-901  ;  p.  692,  693, 
)  915,  920  ;  p.  698,  ^  929-934  ;  p. 
707,  ^  949  ;  p.  726,  ^  961  ;  p.  732, 
t^  973  ;  p.  746,  ^  990^  a.     See,  also, 

A.'fALOGIES. 

Fliilosophy  of  their  operation,  p.  47-49, 

a  Q 


Vital  Agents — continued. 

i)  73-80;  p.  89,  ()  188;  p.  90-99,  9 
188Jr-l93  ;  p.  106-11 1,  ^  223-2333  ; 
p.  296,  ^  476  c;  p.  313,  ^  478  h  ;  p 
321-335,  {j  495-511;  p.  661-664,  <} 
894-901  ;  p.  692,  693,  ^  915,  920. 
See,  also,  ilEiiEDiAL  Action. 

internal  and  external,  p.  21,  ^  21  ;  p. 
45,  (J  73  ;  p.  62,  -^  136  ;  p.  90,  <J  188i  ; 
p.  106,  107,  ^  223.  226  ;  p.  llO,  111, 
•J  233,  2331  ;  p.  296,  ^  476  c  ;  p.  313, 
§  487  A  ;  p.  398-400,  ^  626-630  ;  p. 
405-412,  §  638. 

how  necessary  to  life,  p.  21,  ij  21  ;  p. 
30,  <5  57  ;  p.  45,  ^  73  ;  p.  46,  >J  74  a  ; 
p.  62,  ^  136  ;  p.  63,  ^  137  d,  e;  p. 
65,  ^  143  c  ;  p.  67,  (}  150,  151  ;  p.  90, 
^  188i  ;  p.  106,  107,  ^  223,  226  ;  p. 
110,  ^  233  ;  p.  285,  ^  455  c;  p.  398 
-400,  ()  626-630. 

act  and  acted  upon,  p.  21,  <J  25  ;  p.  24, 
M2;  p.  90,  (}  188  c;  p.  108-110,  (j 
227-232  ;  p.  134-144,  d  296  322;  p. 
227,  Hll- 

do  not  act  upon  the  structure,  p.  95-97, 
t)  189;  p.  107-111,  ^  226-2.331;  p. 
1 12,  ^  234  c  ;  p.  282,  ^  451  b  ;  p.  330, 
{)  .500  n;  p.  746,  (J  990 1  a 

their  action  conforms  to  the  f:i)id  of  ir- 
ritability and  sensibility,  p.  43-47,  <J 
70-74;  p  62-69,  (}  136-156;  p.  97- 
103,  {}  190-204;  p.  109,  ^  229;  p. 
110,  ()  233;  p.  399,  ^  628,  630;  p. 
662-664,  .;.  895-900. 

include  the  morbific,  p.  90,  ^  188 J  b, 
and  as  above.     See,  also,  Analogies. 

their  most  comprehensive  relations  to 
organic  states,  p.  21,  ij  21  ;  p.  67,  68, 
<;»  149-152;  p.  120-122,  ^  237-240: 
p.  398-400,  ^  626-630  ;  p  405-412, 
^  638 ;  p   662-665,  ^  895-901. 

their  relations  to  life  affected  by  dis- 
ease, p.  3,  (^  2  J  ;  p.  47-49,  ^  75-79  ; 
p.  59,  (/  129  g-i;  p.  61,  ^  133  c;  p. 
63-68,  ^  137C-1.52  ;  p.  73,  H63;  p 
98,  ^  191;  p.  108,  109,  <J  227-230, 
p.  120-122,  ^  237-240.  See,  also. 
Remedial  Action,  Therapkutics, 
general,  and  Adaptation,  Law  of. 

analogies  between  the  physical  and 
moral,  p.  1 1 1 ,  (J  2335  ;  p.  296,  s^  476  c , 
p.  313,  ()  487  h  ;  323-332,  i)  500  ;  p. 
662-665,(^895-901..  See,  also,  Anal- 
ogies. 

each  one  has  special  virtues  and  ex- 
erts special  influences,  p.  2\,  ()  21 
25  ;  p.  30,  i)bl;  p.  45-49,  ^  73-80  ; 
p.  62-64,  (J  135-140  ;  p.  65-68,  (^  143 
-152  ;  p.  73,  <J  163 ;  p.  87,  (j  lid  ;  p 
90,  ^  188^  a-c  ;  p.  92-95,  /)  188i  d ;  p 
98,  ^  191  ;  p.  100,  (J  198,  199  :"p.  101 
-103,  ^  201-204;  p.  104,  ^  215  ;  p 
107-111,  ^  226-2331  ;  p.  119,  1}  235 
p.  417,  I)  6.50;  p.  662-665,  ^  895-901 
See,  also.  Remote  Causes  of  Dis- 
Q 


978 


INDEX. 


Vital  Agents — continued. 

EASE,     Therapeutics,     and    Vital 

Habit. 
Vital  Force,  Chemical  Theory  of.    See 

Organic  Force,  Chemical  Theory 

OF. 

Vital  Functions, 

experiments   to  Determine   their  Laws, 
and  their  application  by  the  Author  to 
physiology,  pathology,  and  therapeu- 
tics, p.  290-321,  6  462-494. 
Vital  Habit, 

its  laws  and  phenomena,  physiological 
and  moral,  p.  363-370,  §  535-568. 
Vital  Principle, 

has  various  properties,  p.  83,  <J  175  ;  p. 
88,  §  183,  184.  See,  also,  Vital 
Properties. 

has  remarkahle  analogies  with  the  soul, 
and  with  the  principle  of  instinct,  p. 
84,  ^  175  b;  p.  281,  282,  (J  451. 

illustrated  by  light,  &c.,  p.  79,  (J  168  ; 
p.  84,  f)  175  b;  p.  114,  115,  ^  234,  e, 
f;  p.  330,  <J  500  nn. 

a  whole,  p.  41,  42,  ^  65-67  ;  p.  56,  ^ 
122;  p.  82,  ()  171  ;  p.  97,  ^  190  b; 
p.  435,  (J  680. 

lecognized  at  all  ages,  p.  73,  ^  164. 

recognized  by  all  who  deny  its  exist- 
ence, p  6,  7,  ij  4.V  b,  d ;  p.  19,  ^  18  e ; 
p.  30-33,  (}  59,  60  ;  p.  38-40,  ^  64  c- 
h;  p.  95,  96,  (}  189  b;  p.  157-173,  () 
350;  p.  189,  190,  ^  350 J  n;  626  b. 

history  of  its  vicissitudes  with  medical 
philosophers,  p.  73-79,  ^  164-168. 

opinions  respecting,  p.  24,  4  42  ;  p.  37 
-41,  (J  64,  65;  p.  74-79,  (}  165-167; 
p.  132,  133,  ()  289,  290;  p.  149-155, 
<;»  337-349;  p.  157-173,  ^  350;  p. 
189,  190,  ^  3501  n;  p.  514,  (}  819  a. 

its  existence  and  laws  variously  attest- 
ed, and  by  adequate  phenomena,  p. 
36-49,  ^  63-80  ;  p.  75,  ^  165  b;  p. 
80,  ()  169  ;  p.  84,  i)  175  bb  ;  p.  111- 
122,  <J  234-240  ;  p.  182,  <J  350|  g;  p. 
330,  <;.  500  nn  ;  p.  398,  ^  626  b. 

shown  by  elementary  composition,  p. 
15,  <)  10-14  ;  p.  16,  {}  16,  17  ;  p.  20- 
49,  ()  19-80;  p.  79,  (}  167^. 

proved  by  nitrogen  gas,  p.  34-36,  <)  62. 

proved  by  its  phenomena,  p.  75,  ^  165 
b ;  p.  79,  (J  168  ;  p.  80,  ()  169  ;  p.  84, 
^  175  bb. 

proved  by  the  function  of  appropriation, 
p   24,  25,  (}  41-43  ;  p.  227,  ^411. 

proved  by  the  nervous  power,  p.  106- 
111.^  223-2335  ;  p.  323-332,  ^  500  , 
p   746,  ^  990^  b. 

proved  by  -universal  consent  ;  see 
above,  recognized  by  all  who  deny  its 
existence. 

its  nature  unknown,  as  of  all  things 
else,  p.  79,  ^  168;  p.  117,  ^  234:  g ; 
p.  152,  (,  345  ;  p.  428,  429,  ^  674  a; 
p.  499,  ^  785. 


Vital  Pimciple — continued. 

inseparable  from  living  organic  matte^, 
p.  81,  i)  170;  p.  96,  ^  189  c. 

created  after  structure,  p.  81,  ^  170. 

and  organic  matter  mutually  depend- 
ent, p.  81,  ()  170;  p   96,  ^  189  c. 

indivisible,  p  82,  <J  171. 

summary  definition  of  its  characteris- 
tics, p.  82,  (}  172. 

fundamental  cause  of  all  phenomena 
of  organic  beings,  p.  24,  ij  42  ;  p.  30 
-49,  ^  57-81  ;  p.  73,  ^  164;  p.  96,  (f 
189  c;  p.  115,  6  234  e;  p.  157-173, 
(,  350,  Nos.  47-97  ;  p.  435,  (;  680  ;  p. 
662-664,  ()  895-900,  and  so  on. 

combines  the  elements  of  matter  in 
plants,  p.  15,  ^  11,  13  ;  p.  30,  ^  58  ; 
p.  83,  I)  173;  p.  135-139,  ^  298-3035. 
See,  also.  Plants. 

modifies  and  appropriates  organic  com- 
pounds in  animals,  p.  15,  ^  11,  14  a; 
p  83,  <J  173  ;  p.  143,  144,  ^  322  ;  p. 
196,  ()  360,  361. 

re-arranges  the  elements  of  organic 
compounds,  p.  24,  25,  (;  40-45  ;  p. 
30,  <;i  58  ;  p.  40-49,  ^  65-80  ,  p.  150, 
^  339  a,  b;p.  1 52,  1.'  3,  ^  345-349  a ; 
p   227,  ^  411. 

essentially  the  same  in  plants  and  ani- 
mals, p  88,  ^  185.  See,  also.  Plants, 
and  Organic  Life. 

on  a  par  with  magnetism  and  light,  p. 
75,  ()  165  b  ;  p.  79,  (}  168  ;  p.  80,  f) 
169  b;  p.  81,  9  170  a;  p.  84,  ()  175 
bb;  p.  99,  ^  191  d;  p.  112-120,  (} 
234  c-237  ;  p.  330,  (^  500  nn ;  p.  746, 
i)  990^  b 

how  far  creative,  p.  25,  ^  43 ;  p.  37  • 
40,  «;>  64  c-h ;  p.  81,  ^  170  ;  p.  82,  83, 
(^  172  ;  p.  149,  i)  33G  ;  p.  169,  ()  350, 
No.  84;  p.  227,  i)  411.  See,  also. 
Nature,  contradistinguished  from 
Creative  Power. 

resists  chemical  agencies,  p.  30-33,  ^ 
57-60  ;  p.  194,  ^  358 ;  p.  196,  ^  360 
See,  also.  Digestion. 

the  source  of  growth,  p.  30,  ij  57  ;  p 
36-44,  ^  63-72;  p.  227,  MH  ;  P 
435,  ^  680.     See,  also.  Plants. 

develops  the  germ,  p.  36-49,  '^  63-81 
p.  97,  ()  190  b. 

strongly  pronounced  in  the  ovum,  p. 
42,  §  67 ;  p.  44,  ^  71  ;  p.  97,  ^  190  b 

laws  of,  deduced  from  the  ovum,  p.  30 
^  57,  58  ;  p.  36-49,  ^  63-81  ;  p.  97, 
^  190  ft. 

presides  over  organic  processes  and 
results,  p.  30,  <5  58  ;  p.  31-32,  ^  59  ; 
p  37-49,  ^  64-80  ;  p.  148-154,  §  335 
-349  e;  p.  196,  197,  9  360,  361  ;  p. 
227,  >;>  411  ;  P-  273,  <;.  447  A;  p.  405- 
412,  <J  638  ;  p.  435,  ^  680  ;  p.  474, 
475,  ^  733  f-i ;  p.  662-664,  f)  895- 
900. 

makes  no  demands  on  chemistry,  p 


INDEX. 


979 


Vital  Principle — continued. 

15,  (j  13,  14  ;  p.  16,  ^  16-18  ;  p.  24, 
M2  ;  p.  30-33,  (j  59,  60  ;  p.  42,  (j  66, 
67 ;  p.  44,  ^  71  ;  p.  84,  ()  175  bb ;  p. 
135,  (J  301  ;  p.   143,  ^  322  ;  p.   194, 

195,  ^  358,  359  ;  p.  196,  197,  ^  360, 
361  ;  p.  201,  <J  374,  375;  p.  203,  ^ 
376^;  p.  227,  MH  ;  P-  276-279,  ^ 
447i  /;  p.  376-380,  ()  578  ;  p.  405- 
412,  ^  638  ;  p.  160-162,  ^  350,  Nos. 
58-61. 

generates  Motion,  and  variously,  p. 
21,  ()  24  ;  p.  31,  ^  59  ;  p.  37-49,  ()  64 
-80;  p.  86,  87,  ^  176,  177;  p.  103, 
^  205,  208,  209  ;  p.  107-111,  ^  226- 
233j  ;  p.  323-332,  ^  500  ;  p.  746,  ^ 
990^  a. 

mutable  in  its  nature ;  see  Vital 
Properties. 

its  mutability  the  fundamental  cause 
of  disease  and  its  cure  ;  see  Vital 
Properties. 

Its  mutability  designed  for  useful  pur- 
poses ;  see  Vital  Properties. 

formative  not  destructive,  p.  16,  ^  16- 
18  ;  p.  83,  ^  172  ;  p.  135,  (J  301  ;  p. 

196,  ^  360;  p.  227,  ^11. 

its  nature  altered  in  man  since  his 
Creation,  which  proves  the  Mosaic 
statement,  p.  401,  <J  632. 

subject  to  extinction,  p.  11,  ij  5|  e ;  p. 
30,  31,  <J  68,  59  ;  p.  83,  ^  174  ;  p.  87, 
<J  176  ;  p.  96,  <J  189  b,  c  ;  p.  189,  190, 
^350  n;  p.  401,  ^  631. 

by  its  formative  action  its  own  de- 
stroyer, p.  382,  383,  <J  581-584  ;  p. 
401,  402,  ^  633. 

a  bond  of  union  between  mind  and 
matter,  p.  116,  117,  <^  234/. 

considered  identical  with  the  chemic- 
al forces,  p.  154,  ^  349  c ;  p.  180- 
182,  <J  3501  e-gg ;  p.  189,  190,  ^  3501 
71.  See,  also.  Vital  Properties  in 
THE  Elements  of  Matter,  and 
Problems. 
Vital  Properties, 

elements  or  properties  of  the  Vital 
Principle,  just  as  judgment,  reflec- 
tion, understanding,  the  will,  &c., 
are  properties  of  tl|p  soul,  p.  88,  ^ 
183. 

four  are  common  to  plants  and  ani- 
mals, and  are  called  organic,  or  com- 
mon, viz.,  irritability,  mobility,  vital 
affinity,  and  vivification,  p.  88,  <^  184; 
and  two  superadded  to  the  life  of 
animals  along  with  the  nervous  sys- 
tem, and  are  called  peculiar,  viz., 
sensibility  and  the  nervous  ■power,  p. 
88,  ()  183-185.  See,  also,  the  sever- 
al Properties. 

the  common  or  organic  co-operate  more 
or  less  together  in  organic  process- 
es, p.  42,  43,  (}  67,  68  ;  p.  89,  ()  187, 
188 ;  p.  103,  <J  208,  209  ;  p.  104.  (} 


Vital  Properties — continued. 

212;    p.   105,  ()  217,  218;   p.  135,  ^ 
299. 

perform  the  functions  which  are  as- 
cribed, in  a  collective  sense,  to  the 
Vital  Principle,  and  individually  as 
analyzed  under  each  property;  see 
the  several  denominations. 

the  organic,  essentially  the  same  in 
plants  and  animals,  but  specifically 
modified  or  varied  in  each,  as  known 
by  coincidences  in  their  composition, 
structure,  susceptibility  to  the  action 
of  internal  and  external  agents, 
growth  and  nutrition,  and  all  their 
essential  functions,  and  products, 
diseases,  reparation,  generation. 
&c.,  p.  15,  ^  9-14;  p.  20-22,  (}  20- 
30  ;  p.  23-25,  ^  34-45  ;  p.  27,  (j  51- 
53  ;  p.  28-45,  ^  54-73  ;  p.  54-56,  < 
105-124  ;  p.  68,  ()  155  ;  p.  88.  ij  185  ; 
p.  89,  ()  188  ;  p.  90,  I)  \8S\  a-d ;  p. 
93-95,  4  188i  d;  p.  97,  98,  §  190, 
191  ;  p.  99,  ^  192  ;  p.  103-105,  ^  205 
-221;  p.  118,  ^234^;  p.  120,121,^ 
236-238  ;  p.  125,  ^  249  ;  p.  127,  128, 
^  260-266  ;  p.  134,  ^  293-295  ;  p.  135 
-138,  ^  298-303^  ;  p.  140,  (J  304  ;  p. 
163-167,  ^  350,  Nos.  64-77,  26i,  27  ■ 
p.  203,  ^  376i  ;  p.  224-229,  <)  A09  g- 
419  a ;  p.  260-263,  §  445-446  ;  p.  271 
-278,  ^  447/-447i/,-  p.  279,  280,  (J 
449  ;  p.  284,  285,  ^  454-455  e ;  p. 
286,  <)  456  a :  p.  322,  323,  H98  ;  p 
398-400,  ^  626-630  ;  p.  473-476,  () 
733  e-k. 

possess  natural  modifications  in  differ- 
ent organs  and  tissues,  and  in  the 
conditions  of  the  ovum,  p.  30,  ()  57 ; 
p.  43,  ij  70  ;  p.  44,  <J  72  ;  p.  46,  <J  74  ; 
p.  61-63,  <}  133-137;  p.  64,  (J  138, 
p.  67-73,  <;>  149-162  ;  p.  82,  ^  172  ; 
p.  88,  ^  185  ;  p.  97,  98,  I)  190,  191  a ; 
p.  100,  {)  197-200 ;  p.  102,  ^  203  ;  p. 
105,  (J  217;  p.  114,  <)  234  d.  See, 
'also.  Tissues,  Venous  Tissue,  and 
Analogies. 

their  definite  character  and  permanen- 
cy, p.  87,  ^  178-182  ;  p.  120-122,  () 
237-239;  p.  181,  182,  ^  3501  /,  g ; 
p.  662-665,  ^  895-901.  See,  also, 
Vis  Medicatrix  Nature. 

mutable  in  their  nature,  p.  3,  ()  2  b ;  p. 
11,  ^  5i  e  ;  p.  47-49,  (}  74-80  ;  p.  61, 
<5  133  c,  134;  p.  68,  69,  <J  153-156  ; 
p.  87,  ^  176-182  ;  p.  98,  99,  §  191  b- 
192;  p.  105,  ()  220,  p.  107-110,  () 
225-232;  p.  121,  122,  ij  237-240  ;  p. 
352,  ^  524  d ;  p.  376-380,  ()  578  ;  p. 
405-412,  <;.  638;  p.  417,  ^  650;  p 
428,  ^  672  ;  p.  435,  <J  680  ;  p.  478, 
479,  ^  740,  741  ;  p.  662-664,  ^  896- 
900. 

their  mutability  has  corresponding 
changes  in  the  properties  of  the 


980 


INDEX. 


V^ital  Properties — continued. 

mind  and  instinct,  p.  98,  (j  191  c ;  p. 
123,  124,  ^  241  c  ;  p.  369,  370,  ()  564- 
568  ;  p.  374,  (}  576  b ;  p.  376,  ()  577 
b;  p.  377,  i)  578  c;  p.  380,  381,  § 
579  ;  p.  382,  ()  581. 
Iheir  natural  modifications  in  different 
parts  shown  by  natural  stimuli,  p. 
46,  ^  7i  a;  p.  62,  ()  136;  p.  97,  <) 
190  i-191  a;  p.  100,  I)  199,  201  ;  — 
bv  natural  products,  p.  24,  ^  42  ;  p. 
50,  ^  83  ;  p.  62,  ^35;  p  97,  ij  190  ; 
p  227,  {)  411  ;  p.  229,  H19  ;  P-  233, 
234,  ()  428-432  ;  p.  378,  ^  578  c  ;— 
by  action  of  foreign  agents,  p.  61,  <5 
134 ;  p.  63,  ^  137  ;  p.  67,  ()  149-151  ; 
p.  73,  ^  163 ;  see,  also.  Remote 
Causes  of  Disease,  Tissues,  Ven- 
ous Tissue,  Therapeutics,  &c.  ; — 
by  organization,  p.  64,  ^  141  ;  p.  88, 
()  185;  p.  100,  101,  ()  194-201;  p. 
106,  ()  223  ;  p.  223-227,  ^  409-411  ; 
— by  morbific  causes,  p.  64,  ^  142  ; 
p.  66,  ^  143;  p.  67,  ()  149,  150;  p. 
68-73,  §  153-162  ;  p.  98,  ^  191  ;  see, 
also.  Remote  Causes  of  Disease, 
&c. ; — by  the  development  of  organs, 
p.  46,  ^  74;  p.  68,  69,  ^  153-159  ;  p. 
87,  ^  178;  p.  97,  ^  190  b;  p.  375,  ^ 
577;  p.  376-380,  ()  578  ;— by  the 
ovum,  p.  42^5,  ^  67-73  ;  p.  97,  <J 

190  b ; — by  comparison  of  plants  and 
animals,  p.  15,  (}  10-14;  p.  16,  ^  16, 
17;  p.  20,  (J  18  e;  p.  54,  55,  ^  107- 
117  ;  p.  56,  <;»  121-123  ;  p.  88,  ^  185  ; 
p.  97,  ()  190  b,  c  ;  p.  135-140,  ^  298- 
305;  p.  223-227,  H09C-411;  p.  474, 
475,  ^  733  f-i ;— by  the  variety  of 
effects,  p.  67,  (}  149-151  ;  p.  120- 
122,  <^  226-240  ;  p.  222-227,  ^  409  c- 
411  ;  p.  474,  475,  ^  733  f-i. 

their  natural  modifications  in  different 
species  of  beings,  and  in  different 
parts,  have  important  final  causes, 
p.  15,  ^  9-14  ;  p.  30,  ^57;  p.  42-46, 
()  66-74  ;  p.  61,  ^  133  b  ;  p.  62,  (J  135, 
136  ;  p.  65,  {)  143  c  ;  p.  67-69,  ()  150- 
156;  p.  87,  ^  180;  p.  88,  ^  185;  p. 
93,   95,  ()  188^  ;  p   97,  98.  <)  190  b- 

191  a;  p.  99,  ^  192;  p.  100-102,  ^ 
199-203  ;  p.  104,  ()  212,  214  :  p.  105, 
(j  217  ;  p.  352  ()  524  d;  p.  375,  376, 
()  577  b;  p.  376-381,  ^  578-579. 

their  mutability  designed  for  useful 
purposes,  p.  3,  <J  2  Z>;  p.  61,  ()  133  c; 
p.  63,  «Si  137  c ;  p.  68,  69,  ^  153-156 ; 
p.  87,  ^  180  ;  p.  120,  §  237  ;  p  352, 
^  524  d;  p.  376,  «^  578  b;  p.  378,  (J 
578  c ;  p.  435,  ()  680  ;  p.  662,  ()  895. 

their  mutability  the  fundamental  cause 
of  disease,  p.  3,  ^  2  i;  p.  11,  5^  e  ; 
p.  47-49,  ()  74-80  ;  p.6\,()  133  c  ;  p. 
87,  ^  177-182  ;  p  98,  I)  191 ;  p.  121, 
()  237,  238  ;  p.  352,  ^  52id;  p.  662- 
604,  ^  895-900. 


V^ital  Properties    -continued. 

their  mutability  the  ground-work  o 
cure,  p.  61,  (}  133  e;  p.  89,  ^  177- 
179;  p.  119,  ^  234  i;  p.  122,  ^  239; 
p.  428,  ^  672 ;  p.  544,  545,  ^  858  ;  p. 
546-551,  ()  862-864 ;  p.  662-664,  ^ 
895-900. 

their  mutability  the  great  cause  of  dif- 
ficulties in  medicine,  p.  120,  121,  4 
237  ;  p.  662,  ^  895  ;  p.  664,  (}  899. 

subject  to  extinction  ;  see  Vital 
Principle,  subject  to,  &c. 

a  knowledge  of  their  modifications, 
natural  and  morbid,  contrasted  with 
a  knowledge  of  the  undulations  of 
light,  &c.,  p.  115,  116,  (;>  234/.  See, 
also,  Adaptation,  Law  of. 
"Vital  Properties  in  the  Elements 
OF  Matter," 

disproved,  p.  16,  <J  14  c. 

how  they  are  supposed  to  create  man, 
and  other  organic  beings,  p.  86,  ^ 
175  d;  p.  160,  161,  170,  ^  350,  Nos. 
12,  13,  39  ;  p.  178-184,  I)  350i  a-g ; 
p.  186-192,  ^  350|  kk-354:. 

supposed  to  animate  hydrogen,  nitrogen, 
oxygen,  and  carbon,  and  that  these 
are  the  special  elements,  which,  with 
the  aid  of  heat,  moisture,  &c.,  create 
organic  beings,  p.  181,  182,  ^350%  f. 
Vital  Properties  and  Functions, 

modifications  of ,  arisiiig  from  Age,  Tern- 
perament.  Constitution,  Sex,  Climate, 
Habit,  &c.,  p.  373-397. 
Vital  Stimuli,  Sedatives,  and  Altera- 
tives. See  Vital  Agents,  Altera- 
tives, and  Analogies. 
Vitalism  and  Solidism, 

the  foundation  of  medicine,  p.  1,  iji  1. 

deduced  from  the  seed  and  ovum,  p. 
30,  (^57;  p.  36-49,  ^  63-81  ;  ;).  56, 
()  121-123  ;  p.  97,  ^  190  b ;  p.  279, 
280,  ()  449. 

their  doctrines  virtually  conceded  by 
their  opponents,  p.  19,  <S»  18  e  ;  p.  22, 
(^  29  ;  p.  30-33,  ^  57-60  ;  p.  38-40, 
^  64  e-h ;  p.  95,  96,  ^  189  b  ;  p.  152- 
154,  (J  345-349  c  ;  p.  157-173,  ^  350  ; 
p.  189,  190,  {)  350i|  n ;  p.  191,  9  351  ; 
p.  478,  4790(5i  740  ;  p.  514,  ^  819  a, 
Nos.  4-7. 

always  consistent,  p.  1,  ^  1 ;  p.  40-49, 
^  65-81  ;  p.  81,  ()  169/;  p.  94,  95,  ^ 
188^  d ;  p.  147,  ^  330,  333  ;  p.  235, 
§  435  a;  p.  331,  i)  500  0;  p.  405- 
412,  ^  638  ;  p.  413,  ^  639  a ;  p.  541. 
()  852  ;  p.  662-665,  ^  895-901.  See, 
also.  Analogies,  and  Nervous 
Power. 

admits  of  no  unnecessary  multiplica- 
tion of  causes,  p.  81,  ^  169/;  p.  154, 
(^  349  b;  p.  194-197,  ^  358-361  ;  p. 
234,  ()  433;  p.  264,  265,  ^  446  c, 
447  a,  b;  p.  271,  i)  447/;  p.  276- 
278,  §  447^/;  p.  331.  (>  500  0;  p 


INDEX. 


9S1 


Vitalism  and  Solidism — continued. 

405-412,  ij  638  ;  p.  550,  ()  863  e ;  p. 
662,  ()  895  See,  also.  Organic 
Chemistry  and  Physiology  Con- 
trasted. 
contradistinguished  from  Humoralism, 
p.  147,  ^  330;  p.  516-518,  (J  821, 
822  ;  p.  535-540,  ()  846-851  ;  p.  550, 
()  863  e ;  p.  662-664,  ^  895-900. 

"Vitality  seen  in  Dead  Matter,"  p. 
179,  ^  350i  c.  See,  also,  Vital 
Properties  in  the  Elements  of 
Matter. 

ViVIFICATION, 

a  property  of  the  Vital  Principle,  and 

common  to  animals  and  plants,  p. 

88,  <J  183,  184  a;  p.  105,  218-221. 
with  vital  affinity,  bestows  life,  p.  105, 

ij  218. 
belongs  to  the  assimilating  organs,  and 

to  their  subsidiary  fluids,  p.  105,  § 

219. 
liable  to  morbid  changes,  p.  105,  <J  220. 
Voluntary  Motion, 
physiology   of     See    Motion,    Will, 

Nervous  Power,  and   Muscles   of 

Voluntary  Motion. 
Vomiting, 
physiology  of,  p.  666-669,  <^  902  b-g. 

W. 

White  Vitriol,  or  Sulphate  of  Zinc, 
its  uses,  &c.     See  Zinc  Sulphate, 
and  Re.medial  Action. 
Will,  The, 

its  relation  to  motion,  p  89,  <J  186, 
188  a;  p.  95,  ^  188^  d;  p.  97,  i) 
190  a  ;  p.  104,  (}  215  ;  p.  107,  ^  227  ; 
p.  110,  111,  ^  233,  233^;  p.  113,  ^ 
234  ;  p.  124,  125,  <J  243-246  ;  p  210, 
<J  486;  p.  282,  ^  451  c;  p.  284,  ^ 
454;  p  288,  ()  459  d,  e;  p.  296,  (^ 
476  c ;  p.  313,  ()  487  gg,  h  ;  p.  314, 
()  488^ ;  p.  324-328,  f  500  d-l ;  p. 
357,  ^  526  d. 

nresides  in  animal  hfe,  p.  124,  ^  243 ; 
p.  296,  ()  476  c  ,•  p.  313,  ^  487  gg,h; 
p.  314,  ^  4881 ;  p.  327,  328,  ^  500  k ; 
p.  357,  ^  526  c. 

scarcely  reaches  to  organic  life,  p.  124, 
ij  243  ;  p.  282,  ^  451  c;  p.  284,  285, 
(j,  544-545  c  ;  p.  296,  <J  476  c;  p.  313, 
^  487  gg,  h  ;  p.  314,  <J  488^  ;  p.  324- 
328,  {)  500  d-l. 

has  no  operation  after  removal  of  the 
brain,  p.  288,  ^  459  d,  e ;  p.  324,  § 
500  d;  p.  357,  ()  526  d;  and  has 
analogies  to  this  in  being  wholly  in- 
operative in  paralysis,  and  more  or 
less  so  in  narcotization,  and  in  its 
failure  to  act  as  usual  upon  the  mus- 
cles of  locomotion,  or  in  protruding 
the  tongue,  in  febrile  diseases,  and 
which  is  so  often  mistaken  for  "  de- 


Will,  The — continued. 

bilily,"  p.  296,  ()  476  c;  p.  313,  t, 
487  gg,  k ;  p.  370-372,  ^  569  ;  p. 
481,  <;i  743  ;  p.  483,  (J  746  c ;  p.  498, 
^  780;  p.  724,  ^  961  a;  p.  751,  i) 
999  b. 
the  analogies  in  its  effects  with  those 
of  external  and  internal  physical 
agents  prove  the  distinct  nature  of 
mind,  as  do,  also,  perception  and 
the  passions,  and  are  fatal  to  men- 
tal materialism,  p.  85,  «S>  175  c;  p. 
93-95,  <J  188^  d;  p.  97,  ()  190  a;  p. 
104,  (J  215  ;  p.  107-1 1 1,  <J  226-233^  ; 
p.  113,  ()  234  c  ;  p.  124,  125,  ^  243- 
246  ;  p.  282,  ^51  c  ;  p.  284,  ^  454  • 
p.  288,  ()  459  d,  e ;  p.  296,  (J  476  c  * 
p.  313,  ^  487  gg,  h  ;  p.  314,  ^  488^  ; 
p.  323-332,  <J  500.  See,  below.  Its 
elective  power,  <^c. 
a  distinct  element  of  the  mind  and  in- 
stinctive principle,  p.  97,  ^  190  a;  p 
296,  ()  476  c;  p.  326,   ()  500  n;  p. 

357,  ^  526  d  ;  p.  369,  ()  563.  and  ibid. 
a  stimulus  to  the  brain,  like  the  nerv- 
ous power  to  that  and  to  other  parts, 
p.  124,  §  244;  p.  282,  ()  451  c;  p. 
288,  (J  459  d,  e ;  p.  296,  ^  476  c  ;  p. 
326,  327,  328,  ()  500  h,  k.  See,  also, 
Nervous  Power. 

being  shown  to  prove  the  distinct  na- 
ture of  mind,  and  its  possession  of 
special  attributes  or  properties,  I 
thus  prove,  also,  by  the  analogies 
between  the  mental  properties  and 
the  properties  of  life,  the  distinct 
nature  of  a  Vital  Principle  with  its 
several  properties  as  its  elements ; 
as  above  and  below,  and  p.  83,  84,  ^ 
175,  Vital  Properties,  and  In- 
stinct. 

its  modus  operandi,  p.  125,  ()  245  ;  p. 
296,  ^  476  c ;  p.  324-328,  ^  500  d-l ; 
p.  357,  <J  526  d. 

controls  other  properties  of  the  mind, 
and  the  passions,  p.  88,  ()  184  b ;  p. 
124,  4  243. 

its  elective  power  in  animal  life  analo- 
gous to  that  of  the  passions  and 
physical  agents  in  organic  life,  p. 
110,  111,  iji  233,2331;  p.  113,1^234; 
p.  125,  ^  245,  246  ;  p.  327,  328,  9 
500  k. 

its  philosophy  in  developing  voluntary 
motion  the  same  as  when  motion  is 
developed  by  the  nervous  power  in 
organic  life,  whether  physical  agents 
or  the  passions  be  the  remote  causes 
in  the  latter  case,  p.  Ill,  ^  233?  ;  p. 
114,  ()  234  e ;  p.  125,  ^  245,  246  ;  p. 
281,  282,  (J  451  a  ;  p.  296,  ^  476  c  ;  p 
324-328,  ^  500  d-l. 
Worms, 

how  they  produce  C(mvulsioris,  p.  35(>- 

358,  ^  526  d. 


982 


INDEX. 


Wounds, 

their  union  by  the  first  intention  depends 
upon  inflammatory  action,  p.  471, 
472,  ^  732  d-f. 

union  of,  has  close  analogies  in  the  re- 
generative and  reparative  processes 
of  animals  and  plants,  and  the  dif- 
ferences of  the  latter  reconciled 
with  the  inflammatory  nature  of  the 
former,  p.  474,  475,  ^  733  /-A.  See, 
also,  Plants. 

do  not  heal  uniformly  where  several 
tissues  are  involved,  as  in  the  stumps 
of  amputated  limbs,  on  account  of 
their  difference  of  organization  and 
vital  constitution,  p.  61,  ^  132-134 ; 
p.  64,  ()  138-141  ;  p.  67,  ^  149  ;  p. 
69,  ^  158  ;  p.  70,  ^  162,  table  1  ;  p. 
73,  ^  163. 


VOUTH, 

its  relations  to  childhood,  p.  376,  ^  578 
a,  b. 

its  prominent  characteristic,  the  full 
development  of  the  organs  of  gener- 
ation, p.  377,  (J  578  b. 

distinguished  by  many  physiological 
changes,  and  corresponding  suscep- 
tibilities to  morbific  and  remedial 
agents,  p.  27,  ^  52  ;  p.  68-70,  ij  153- 
160 ;  p.  412,  <)  686  d;  p.  377-380,  § 
578  c,  d. 

the  period  of  the  institution  of  the 
menses,  and  of  the  secretion  of  se- 
men ;  the  latter  shows  by  analogy, 
as  to  object  and  time,  that  the  former 
is  a  secreted  product,  while  its  ob- 
ject and  time  of  institution  show 
that  it  has  no  general  relation  to  or- 
ganic life,  and  that,  contrary  to  the 
prevailing  belief,  its  suspension,  per 
se,  is  of  little  moment  in  morbid  con- 
ditions, p.  233,  234,  ()  428-432  ;  p. 
377-380,  l^  578  c,  d. 

distinguished  by  changes  in  the  moral 
emotions    which    correspond    with 


Youth — continued. 

the   vital  developments,  p.  380,   ^ 
578  d. 

the  coincident  changes  in  the  moral 
and  physiological  constitution,  at 
this  and  other  periods  of  life,  illus- 
trate, each  by  itself  and  by  analogy, 
the  mutability  of  the  vital  and  intel- 
lectual properties,  p.  68,  69,  ()  153- 
159  ;  p.  374,  ^  576  b-d ;  p.  375,  376, 
^  577  b-d;  p.  380,  ^  578  d  ;  p.  381, 
^  579  b.  See,  also.  Vital  Proper- 
ties, their  mutability,  &c..  Ovum,  and 
Plants. 

the  period  of  life  when  the  development 
of  special  functions  displays  the  con- 
stitution of  the  nervous  power,  the 
natural  oflice  of  this  power  in  the 
organic  and  animal  economy,  its  in- 
direct and  unceasing  development 
and  reflection  upon  every  part  of  the 
being  by  the  organic  progress  of  the 
generative  organs,  in  the  fulfillment 
of  its  natural  oflices  and  as  a  morbif- 
ic and  curative  agent,  its  direct  ex- 
citement by  mental  emotions  and 
passions,  and  how  the  principle  ot 
life  is  a  bond  of  union  between  the 
corporeal  and  the  intellectual  part ; 
ibid,  and  Nervous  Power,  Moral 
Emotions,  Analogies,  and  p.  384- 
292,  ^  454-470 ;  P.  361,  362,  <5 
530. 

offers  problems  to  chemical  physiciA)gy, 
p.  377,  379,  I)  578  c,  d.  See,  also. 
Problems. 


Zinc,  Sulphate  of, 
its  uses  and  special  influences  as  an 
emetic  and  astringent,  p.  547-549,  () 
863  d;  p.  553,  ()  870  a;  p.  571,  (j 
890  b ;  p.  577,  578,  ()  890  o ;  p.  582, 
<;»  890^  h;  p.  63,  ^  137  d;  p.  65,  ^ 
143  c;  p.  67,  ^  150,  151;  p.  365- 
368,  ^  549-558  ;  p.  566-568,  ^  889 
k,  I;  p.  582,  ^  890i  g. 


INDEX   11. 


A. 

Acclimation, 

philosophy  of,  p.  364-366,  <J  544-556 ; 
p.  425,  ^  664,  44U  h  1047- 

the  same  philosophy  concerned  in  the 
exemption  from  repeated  attacks  of 
intermittent  and  yellow  fevers,  &:c., 
as  respects  small-pox,  measles,  scar- 
latina, &c.  Nevertheless,  the  sub- 
jects of  the  former  must  continue  to 
reside  in  the  malarious  climates,  or 
the  original  susceptibility  will  return, 
p.  364-366,  ()  544-556 ;  p.  425,  ^  664. 
665.  Self-limited  Diseases,  Index 
II. 

It  is  more  owing  to  abstemious  habits 
than  to  any  peculiarity  of  Constitu- 
tion that  the  Negro  escapes  yellow 
fever,  &c.,  more  than  the  white  pop- 
ulation, who  may  be  equally  accli- 
mated. The  indulgences  of  the  lat- 
ter render  them  more  susceptible  of 
the  morbific  action  of  the  essential 
predisposing  cause,  and  act  as  excit- 
ing causes  when  the  system  is  pre- 
disposed to  the  disease.  The  reverse 
of  this  happens  with  the  malignant 
cholera,  since  in  that  affection,  vege- 
table food,  excepting  the  simplest  kind 
(and  fruits  also),  is  the  principal  ex- 
citing cause.  Mulattoes  are  said  by 
some  to  be  more  liable  to  yellow  fever 
than  the  Negro,  and,  where  that  is 
observed,  it  is  because  their  habits 
are  more  luxurious  ;  not  because,  as 
has  been  assumed,  they  are  impreg- 
nated with  the  blood  of  the  white  man. 
It  is  a  full,  not  an  empty  stomach,  that 
aids  in  breeding  pestilence,  p.  251. 
Absorption, see /nc/.i.  Hum.  Pathol.,//. 
Adaptation,  Law  of.  See  Lidex  I. 
Age,  Adult, 

begins  at  the  age  of  twenty  to  twenty- 
five  years,  and  reaches  to  about  sixty 
years,  p.  380,  (/  579  a — from  the  end 
of  Youth  to  the  end  of  Manhood  there 
are  but  few  changes  of  organization 
or  in  the  vital  endowments,  but  the 
Passions  are  now  in  greatest  opera- 
tion, and  supply  a  fruitful  evidence  of 
the  existence  of  a  self-acting  Princi- 
ple, distinct  from  the  bodily  structure, 
and  of  its  influences  in  laying  deeply 
the  foundations  of  disease.  Never- 
theless, some  new  predispositions  to 
disease  spring  from  the  organic  con- 
stitution peculiar  to  this  age,  espe- 


Age,  Adult — continued. 

cially  in  the  female,  p.  381,  <J  579  b; 
p.  865-868,  ()  1067.  Also,  Mental 
Emotions,  and  Remedial  Action, 
subdivision  Mental  Emotions,  Index 

n. 

Age,  Old, 

divided  into  three  stages,  extending  from 
sixty  to  eighty-five  years  and  upward, 
p.  382,  ()  580 — changes  in  organiza- 
tion are  now  taking  place  through 
which  the  Organic  Properties  are  in- 
flicting death  upon  themselves,  though 
morbific  causes  operate  with  a  dimin- 
ished intensity,  corresponding  with 
the  waning  activity  of  Organic  Life  ; 
the  Passions  are  comparatively  power- 
less, and  the  Mind  is  gradually  going 
with  the  Organic  Functions.  Rem- 
edies are,  therefore,  less  energetic, 
nature  less  recuperative,  and,  for  like 
reasons,  art  must  be  prompt  and  effi- 
cient in  proportion  to  the  exigencies 
of  declining  nature,  p.  382-383,  ij  581 
Zi-584 ;  p.  401-402,  ij.  633 ;  p.  768-770, 
^  1014-1017. 

Age,  Stages  of, 

the  periods  which  mark  the  times  when 
the  greatest  physiological  changes 
take  place,  with  corresponding  fluc- 
tuations in  disease  and  in  mental 
characteristics — all  depending  upon 
natural  modifications  or  mutations  of 
the  Vital  Properties  and  Functions,  p. 
373,1^574,575.  Also, Vital  Proper- 
ties, Index  I. ;  Infancy,  Childhood, 
Youth  ;  Age,  Adult  ;  Age,  Old,  //. 

Alcohol — not  absorbed,  p.  172,  no.  94. 

Aloes, 
its  physiological  and  therapeutical  in- 
fluences, p.  366,  ij  556  6 ;  p.  547,  ^  863 
d ;  p.  566,  <J  8i9  i ;  p.  568,  ^  889  m,  p. 
856-857,  (j  1063. 

Alteratives,  Modus  Operandi  of — con- 
tinued from  Index  1. 
made  a  distinct  group  by  the  Author, 
and  why,  p.  835-837,  (J  1057^ — their 
basis  of  arrangement,  ibid. 
Nevertheless,  all  remedies,  and  all  mor- 
bific causes,  act  as  Alteratives,  and 
bring  about  the  changes  in  the  solids 
and  fluids  (when  not  exclusively  rela- 
tive to  the  direct  seat  of  action),  either 
through  operation  of  reflex  or  direct 
nervous  influence,  when  the  nervous 
power  is  modified  according  to  the 
special  virtues  of  every  agent,  whether 
physical  or  mental,  and  thus  establish- 


984 


INDEX    II. 


AlterativeSjModus  Operandi  of — continued. 
es  changes  in  conformity  with  the  vir- 
tues of  each,  p.  107-112,  <^  227-234; 
p.  303,  ()  481  d;  p.  323-336,  ^  499-512 ; 
p.  G6 1-663,  (^  894-896  ;  p.  665-670,  () 
902  a-7n  ;  p.  679-681,  §  905  a.  Also, 
Sympathy,  Sensibility,  Sensation, 
Sympathetic  Influences,  Nervous 
Power,  Index  I.;  Remedies;  Causes, 
Morbific  ;  Nervous  Power,  Reflex 
Action  of  Nervous  System,  Mental 
Emotions,  Remedial  Action,  sicb- 
division  Mental  Emotions,  Secre- 
tion and  Excretion,  Counter-Irri- 
tation, Blood-letting,  Index  II. 
u  difference  in  the  operation  of  reflex 
action  of  the  nervous  system,  as 
brought  about  by  the  Author's  group 
of  Alteratives  and  remedies  of  other 
denominations,  when  the  latter  arc 
employed  for  only  a  present  or  an 
interrupted  eflcct ,  and  the  same  is 
true  of  Morbific  Causes,  as  their  ef- 
fects may  be  suddenly  or  gradually 
produced,  p.  05,  i^i  123  b,  c  ;  p.  66-67, 
^  148  ;  p.  HI,  1^  233.V,  233 J  ;  p.  285- 
288,  ^  455  d~f,]).  333,  <>  503-506  ; 
p.  339-340,  ()  514  g-k ;  p.  344-345, 
()  516  d,  No,  6;  p.  365,  ^  551  ;  p. 
366,  «5  556;  p.  416^17,  ^  649  c ;  p. 
420-424,  <^  654-661  ;  p.  426,  >^  626  ; 
p.  497,  ^  777  ;  p  532,  ^  841  ;  p.  547, 
(J  863  d;  p.  55l,()  887;  p.  568-569, 
^  889  m,  mm,  p  646-649,  ^  893  c-h  ; 
p.  661-663,  \  894-898  ,  p.  668-670, 
(j  892  g-m;  p.  679-681,  \  905  a;  p 
849-851,  ^  1059;  p.  891,  ()  1077. 

Amenorrhcea.  See  Menstruation,  In- 
dex I. 
generally  consequent  upon  morbid  states 
of  the  digestive  organs,  and  resulting 
from  the  alterative  action  of  reflex 
nervous  influence,  as,  also,  when  oc- 
casioned by  exposure  of  the  feet  to 
cold.  In  the  former  case,  is  not  the 
principal  evil  nor  often  of  much  im- 
portance. Cure  the  primary  affec- 
tions, and  the  uterine  symptoms  will 
commonly  subsidy  without  the  true 
emmenagogues,  or,  at  least,  these 
agents  will  then  act  far  more  effi- 
ciently, and  with  greater  safety.  In 
the  latter  case,  a  pediluvium  will  often 
re-establish  the  function,  which  shows 
how  readily  the  nervous  influence 
will  produce  and  remove  disease,  and 
how  it  is  modified  by  exciting  causes, 
and  goes  with  a  multitude  of  corre- 
sponding facts  in  demonstrating  the 
operation  of  morbific  and  remedial 
agents  through  the  alterative  action 
of  reflex  nervous  influence,  p  233- 
234,  i)  428-432  ;  p.  629,  ^  892f  r ; 
p  684-687, 'Ji  895i  A.  Also,  Nervous 
Power,  Index  I.  and  II. ;   Reflex 


Amenorrhoea — continued. 

Action  of  Nervous  System,  Index 
II. 
Amylene, 

peculiar  effects  of,  on  inhalation,  p.  863- 
864,  <J  1066  b. 

illustrates  different  kinds  of  Sensibility, 
ibid.     Also,  Sensibility,  Sensation, 
Index  I. 
Anaesthetics.     See  Gases,  Index  I. 

philosophy  of  their  operation  through 
alterative  action  of  reflex  nervous  in- 
fluence, p.  862-864,  ()  1066.  Also,  p. 
522-524,  ^  827  b-e  ;  p.  674-675,  () 
904  b;  p.  931,  ()  1088  c— Kote  M. 
Anatomy,  Morbid, 

all  deviations  of  which  it  is  cognizant 
are  owing  to  antecedent  changes  of  a 
vital  nature,  and  which  constitute  the 
essence  of  disease,  p.  456,  ^  695, 696. 

its  importance  greatly  overrated,  and 
the  consequences,  p.  456-457,  "Ji  697- 
699;  p.  460-463,  (^  709,;  p.  604,  ^ 
892  k.  Also,  Examination  of  the 
Principal  Writings  of  P.  Ch.  A. 
Louis,  M.D.,  in  Medical  and  Physi- 
ological Commentaries,  vol.  ii.,  p.  679- 
815. 

cannot  help  us  to  a  knowledge  of  pa- 
thological conditions  during  life,  but 
through  certain  results  ascertained  at 
former  times,  p.  458-459,  (^  702-703  ; 
p.  510,  ^13  a. 

comes  in  at  the  close  of  life,  p.  457-458, 
ij  700-702  ;   p.  459,  (}  704. 

must  rely  upon  symptoms,  remote  causes, 
and  effects  of  remedies,  for  a  knowl- 
edge of  disease  under  treatment,  p. 
489,  ^  705  a. 

abortive  in  idiopathic  lever,  p.  489-490, 
(}  Ibl  a. 

its  legitimate  objects,  p.  458-459,  ^703, 
705  ;  p.  460,  ij  707.     Also,  Compar- 
ative Merits  of  the  Hippocratic 
AND  Anatomical  Schools,  in  Medi- 
cal and  Physiological  Commentaries, 
vol.  ii.,  p.  641-677. 
Animal  Heat..    See  Organic  Heat,  In- 
dex I.  and  //. 
Animals, 

fundamentally  distinguished  from 
Plants,  p.  815,  ^  1052  a.  Also,  An- 
imals AND  Plants,  Index  I. 

hybrid,  why  incapable  of  procreating,  p. 
816,  (j  1052  b. 
Animals  and  Plants  —  continued  from 
Index  I. 

Animals  subsist  upon  organic  com- 
pounds, Plants  upon  the  elements  of 
matter  —  a  distinction  confirmed  by 
microscopic  observation  of  the  most 
inferior,  p.  815-816,  ()  1052  a.  Also, 
Plants,  Index  I. 
Antimony,  Tartarized, 

its  prodigious  power  in  developing  and 


INDEX    II, 


98^ 


Antimony,  Tartarized — continued. 

modifying  the  nervous  influence,  and 
as  an  alterative  agent  through  reflex 
action  of  the  nervous  system,  p.  532- 
533,  <J  841  ;  p.  557,  <J  873  ;  p.  668, 
§  903  g  ;  p.  675-676,  ()  904  bb  ;  p.  833, 
<i  1057  h.  Also,  (^  524  a,  No.  1,  964 
d.     Also,  Alteratives,  Index  II. 

its  action  illustrated  through  lawr  of  Vi- 
tal Habit,  p.  365,  366,  ^  549-556  a. 

its  administration  determined  by  its  ef- 
fects upon  the  stomach — against  ab- 
sorption, p.  530-533,  ^  837  6-841  ; 
p.  557,  (J  873  ;  p.  675-676,  l^  904  66. 

eflects  of,  compared  with  analogous 
ones  of  other  agents,  p.  547,  ^  863  d; 
p.  557,  <J  873  ;  p.  637,  <J  892A  e ;  p, 
728,  <;»  964  d;  p.  849-851,^  1059. 

its  lavif  of  operation  in  small  alterative 
doses,  p.  344-345,  ^  516  c?,  No.  6  ;  p. 
AZ\,^  675  ;  p.  675,  i)  904  bb\  p.  851, 
(j  1059.     Alteratives,  Index  II. 

its  results  as  an  expectorant,  p.  639,  <^ 
892A  ej. 

its  fatal  eflfects  in  small  doses,  p.  728, 
<J  964  d;  p.  846-847,  ^  1058  p. 

like  arsenic,  iodine,  &c.,inhealthno  ef- 
fects in  its  smallest  therapeutical 
doses,  and  thus,  like  those,  by  its  con- 
trasted eflects  in  disease,  denotes  the 
increased  susceptibility  of  organs  in 
their  morbid  states, illustrates  the  doc- 
trines of  Vital  Solidism,  and  disproves 
the  Chemical  hypothesis  of  therapeu- 
tical action,  p.  59,  ^  129  h,  i;  p.  63, 
(}  137  d;  p.  6.5-66,  (}  143  c-145  ;  p. 
67-68,1^149-152;  p.  170-173,  <!i  350, 
Nos.  40,  41,  42,  43,  44,  45,  parallel 
columns;  p.  176-178,  <J  350^  a-f; 
p.  541-542,  <J  854  66;  p.  607,  §  892i 
6;  p.  612,  1^  892^  a. 
Antispasmodics, 

the  group  introduced  to  illustrate  the 
philosophy  of  the  modus  operandi  of 
morbific  and  remedial  agents  through 
reflex  action  of  the  nervous  system, 
p.  590,  ^  89U  a  ;  p.  592-.593,  ^  89U 
k.  Also,  Remedies,  and  Remedial 
Action,  Index  II 

afford  relief  by  modifying  the  reflex 
nervous  influence,  rendering  it  seda- 
tive instead  of  irritating,  or  changing 
more  essentially  its  nature,  according 
to  the  nature  of  its  exciting  cause, 
and  thus  rendering  it  more  profound- 
ly alterative,  p.  592-593,  >J891i  k. 

Case  of  epilepsy  stated,  to  show  how  in 
this  aflection  the  nervous  influence  is 
sometimes  developed  in  a  direct  man- 
ner by  disease  of  the  nervous  centres, 
and  at  other  times  how  the  point  of 
departure  is  from  some  distant  part, 
when  reflex  action  of  the  nervous  sys- 
tem is  brought  into  operation,  and 
how,  in  either  case,  convulsions  en- 


Antispasmodics — continued. 

sue  as  the  result  of  the  development 
and  operation  of  the  nervous  power — 
leading  to  a  parallel  between  the  fore- 
going results  and  the  reflex  action  of 
the  nervous  system  as  instituted  by 
Antispasmodics,  and  showing,  also, 
how  the  nervous  influence  is  of  an 
exciting  nature  in  the  former  case, 
and  how  it  is  rendered  depressing  in 
the  latter,  and  upon  which  the  relief 
depends — and  the  same  rule  obtains 
with  Opium  and  other  Narcotics  when 
they  relieve  Spasms,  p.  592-593,  ^ 
891  A:.  Also,  Nervous  Power,  Sen- 
sibility, Sympathy,  Sympathetic  In- 
fluences, Index  I. ;  Reflex  Action 
of  Nervous  System,  Remedial  Ac- 
tion, Remedies  ;  Causes,  Morbific  ; 
Whooping-cough,  Index  II. 

Although  Narcotics  relieve  spasm  in 
iha  foregoing  manner,  they  also,  un- 
like the  simple  Antispasmodics,  so 
modify  the  reflex  nervous  influence 
as  to  render  it  morbific — thus  present- 
ing a  compound  aspect  of  its  modi- 
fied condition,  through  which  as  a 
sedative  it  may  relieve  spasm,  but  si- 
multaneously exert  a  perniciously  al- 
terative effect  upon  other  parts  ;  or 
this  latter  may  be  such  as  to  counter- 
act the  sedative  influence,  when  no 
relief  of  spasm  will  ensue,  p.  593,  ^ 
891^  k.  Also,  the  foregoing  Refcr- 
eiices. 

greatly  misapplied  in  the  treatment  of 
convulsions  from  teething,  wounds, 
worms,  &c.,  and  in  hysteria,  chorea, 
epilepsy,  congestive  asthma,  &c.  — 
particularly  from  neglecting  their  re- 
mote causes  and  complications,  and 
addressing  them  to  the  symptom  rath- 
er than  the  pathological  conditions, 
p.  590-592,  ()  89  H  b-h;  p.  593,  ^ 
891  k. 

feebly  endowed  with  curative  virtues, 
p.  592,  IJ89U  1. 
Apoplexy, 

bloodletting  in,  and  the  principles  by 
which  it  should  be  regulated,  p  741- 
746,  <^  990;  p.  848,  iJ1055  u. 

sanguineous,  depends  upon  capillary 
hemorrhage  arising  from  congestion, 
p.  740,  <;i  990  6,  c,  m.  Also,  Medical 
and  Physiological  Convmentaries,  vol. 
i.,  p.  371-384,  Article  Pathology  of 
Cerebral  Hemorrhage  ;  and  vol.  ii.,  p. 
546-550,  Article  Spontaneous  Hemor- 
rhage. 

its  treatment  often  embarrassing  and 
empirical,  p.  741-745,  ()  990  b-q. 

determines  a  pernicious  nervous  influ- 
ence upon  the  great  organs  of  life, 
p.  742,  i)  990  d-i;  p.  745-746,  (J 
990  i. 


986 


INDEX    II. 


Arsenic,  (Arsenious  Acid  &c.) 

destitute  of  a  tonic  virtue,  p.  607,  <J  892^ 
a  ;  p.  608-609,  ()  892i  c. 

inferior  to  cinchona  as  a  febrifuge,  but 
next  in  value,  and  has  done  less  mis- 
chief, ibid,  and  p.  610-611,  <5>  892^ 

its'inodus  operandi,  Note  L  p.  1120. 

in  therapeutical  doses  produces  no  ap- 
parent effect  upon  the  healthy  body, 
showing,  like  Iodine,  Tartarized  An- 
timony, &:c.,  in  their  small  doses,  how 
the  relations  of  the  system  to  the  ac- 
tion of  remedies  is  changed  by  dis- 
ease, and  hence  the  fallacy  of  reason- 
ing from  the  effects  of  remedies  upon 
the  healthy  system  to  its  morbid 
states,  p.  607-608,  ^  892i  a,  b.  Also, 
p.  63,  (^  137  d ;  p.  65,  i)  143  c  ;  p.  67, 
^  149-151  ;  p.  68,  ()  152  b;  p.  122, 
()  240  ;  p.  465-466,  (}  715 ;  p.  482, 
^  744  ;  p. 541-542,  ^ 854  bb ;  p.  545, 
^  859  b;  p.  612,  <J  892^  a;  p.  623, 
^  892t  c— Note  L  p.  1120. 

its  accidental  superiority  to  Cinchona  in 
Autumnal  intermittent  fever,  while 
not  so  in  the  Vernal,  and  why,  p. 
608-609,  ()  892i  c;  p.  597-598,  <) 
892  c. 

when  preferable  to  Cinchona,  p.  609, 
<)  892i  d-g. 

equally  useful  in  intermitting  inflamma- 
tion, intermitting  headaches,  periodic 
tic  douloureux,  p.  611,  ^  892  /,  g; 
and  in  chronic  cutaneous  diseases,  p. 
611-612,  i)  892i  h,  I. 

its    morbific    effects    in    therapeutical 
doses,  in  morbid  states  of  the  body, 
p.  608,  (J  892i  b. 
Asthma, 

treatment  of,  p  337,  <^  514;  p.  591,  ^ 
89H/,-  p.  848,  ()  1058  2v. 

employed  to  illustrate  the  substantive 
existence  and  self-acting  nature  of 
the  Soul,  p.  886-887,  ^  1077. 
Astringents,  Modus  Operandi  of, 

supposed  to  act  upon  physical  princi- 
ples, p.  570,  <)  890  a. 

when  employed  internally,  they  operate 
upon  vital  principles,  either  locally,  or 
through  reflex  action  of  the  nervous 
system,  corresponding  in  this  respect 
with  other  remedies  —  and  illustra- 
tions, p.  570-578,  ^  890.  Also, 
Remedies,  Remedial  Action,  Re- 
flex Action  of  Nervous  System  ; 
Causes,  Morbific,  Index  II. ;  Nerv- 
ous PovfER,  Index  I.  and  II. 

but  more  than  other  remedies  are  cura- 
tive in  some  diseases  by  direct  action 
upon  the  surfaces,  being  then  a  sim- 
ply local  remedy,  <J  890  b. 

applied  to  outward  surfaces,  some  op- 
erate mechanically,  (J  890  c. 

much  abused  in  hemorrhages,  dysen- 
tery,  &c.,    p.   572-575,  ()   890  d-k. 


Astringents,  &c. — continued. 

Also,  p.  507,  ()  805  ;  p.  509,  (j  812  ; 
p.  550,  <}  863/;  p.  770-772,  ^  1018- 
1019. 

their  abuse  arises  from  the  physical 
doctrines  of  their  operation  and  of 
hemorrhage  and  of  secreted  products, 
p.  573-574,  (J  890  d-ee,  o.  Also, 
He.morrhage, Spontaneous;  Secre- 
tion and  Excretion,  Index  II. 

the  symptom  the  thing  considered,  p. 
572, 1)  890  d  ;  p.  590-591,  ij  89U  b-f. 
variety  of  means  having  no  astringent 
virtue — ipecacuanha,  tartarized  anti- 
mony, bloodletting,  cold  —  will  often 
arrest  hemorrhages  and  other  mor- 
bid products  more  efficiently  and  use- 
fully, and  prove  the  philosophy  of  the 
operation  of  astringents  upon  parts 
distant  from  the  seat  of  their  appli- 
cation through  alterative  action  of  the 
reflex  nervous  influence,  ibid. 

no  two  exactly  alike  in  effects,  and  re- 
quire discrimination,  p.  578,  ^  890  p. 

of  very  limited  uses,  <J  890  q;  but  in- 
flict great  injuries  in  various  mala- 
dies, p.  572-576,  (J  890  d-n. 
Authors,  Rights  of, 

the  Author  recurs  to  this  subject  (p.  912) 
for  the  purpose  of  saying  that  when- 
ever he  is  under  obligations  to  others, 
he  has  expressed  it  in  the  Text  of  the 
Institutes,  as,  for  example,  in  rela- 
tion to  the  laws  of  the  nervous  sys- 
tem, at  p.  283,  i)  452  b  ;  p.  290-321, 
^  463-494;  p.  336-353,  (j  514-524; 
p.  362,  ()  530  ;  but,  in  the  Medical  and 
Physiological  Commentaries,  where 
the  Author  is  constantly  interested 
with  the  labors  and  opinions  of  a  mul- 
titude of  writers,  he  has  endeavored 
to  do  them  full  justice,  not  only  in 
the  Text,  but  by  marginal  references, 
cf  which  there  are  nearly  five  thou- 
sand in  the  first  two  volumes. — Note 
Xp.  1127. 


B. 


Becquerel  and  Rodier, 

their  work  on  "  Pathological  Chemistry 

in  its  Application  to  the  Practice  of 

Medicine,'"  and  its  advantages,  p.  800, 

()  1035. 
their  opinions  of  animal  sugar,  ursmia, 

urea,   diabetes,   &c.,  p.  785-787,   ^ 

1031  b. 
belong  to  the  School  of  Vitalists,  p.  800, 

i)  1035. 
Bernard,  Cl., 

experiments  on  nervous  system,  p.  792, 

()  1032  d;  p.  804,  ^  1039. 
produces  diabetes  mellitus  by  pricking 

the  medulla  oblongata,  p.792,§  1032  d. 
alleges  the  production  of  sugar  by  the 


INDEX    II. 


987 


Bernard,  CI. — continued. 

liver,  &c.,  and  Author's  opinion,  p. 
783,  <J  1031  a  ;  p.  785-786,  ()  1031  b; 
p.  790,  ()  1032  b ;  p.  793,  ^  1032  d. 
Bile — continued  from  Index  I., 

none  of  its  constituents  detected  in  the 

blood,  p.  783,  ()  1031  b. 
its  morbid  appearances  regarded  in  the 
light  of  symptoms,  p.  452-455,  ^  694. 
not  rendered  "green"  by  calomel  and 
acids  in  the  living  body,  p.  454,  ^  694. 
its  production  considered  in  connection 
with   different  cathartics,  and  as  il- 
lustrating  their   alterative   influence 
through  reflex  action  of  the  nervous 
system,  and  the  modification  of  the 
nervous  power  according  to  the  nature 
of  the  cathartic,  and  how  the  nervous 
power  is  the  immediate  remote  cause 
of  the  variable  phenomena  relative  to 
the  secreted  product,  p.  366,  ()  556  b; 
p.  554-556,  <J  872  ;  p.  563-564,  ^  889 
a  ;  p.  566,  ^  889  i ;  p.  568-569,  ^  889 
771,  mm ;  p.  668-669,  ^  902,  g ;  p.  834, 
<J  1057  /;  p.  854,  (}  1061  ;  p.  856-857, 
^  1063  b ;  p.  859,  ()  1064.     Also.  Se- 
cretion and  Excretion,  Index  II. 
Blisters.     See  Counter-Irritants,  In- 
dex II. 
Blood — continued  from  Index  I. 

analysis  of,  allowed  by  Chemistry  to  be 
incapable  of  yielding  any  reliable  re- 
sults, p.  780-782,  <;>  1029-1030. 
nothing  to  be  learned  from  its  analysis 

as  to  disease,  ibid. 
circulation  of,  ascribed  to  oxygen  gas,  p. 
208,^383;  p.  818-819,  i^  1054— con- 
tradicted by  circulation  of  in  Plants, 
p.  820-823,  i)  1054-1055. 
nothing  can  make  healthy  blood  but  the 
healthy  action  of  the  solids,  p.  192,  () 
354  ;  p.  535-539,  (j  847-848. 
occupies  from  one  to  two  minutes  in 
going  the  round  of  the  circulation, 
p.  672,  (J  904  J;  p.  863,  ()  1066  b. 
Bloodletting, General — continued  from 
Index  I.  See  Loss  of  Blood,  Index  II. 
varied  from  effects  of  Leeching,  p.  698- 

702,  (J  929-938. 
considered  under  five  stages,  p.  698-702: 
1  st,  earliest  impression  is  exerted  upon 
all  the  bloodvessels,  p.  698,  (^  930; 
p.  711,  ^  953. 
2d,  the  vessels  undergo  a  vital  con- 
traction, p.  698,  (}  931  ;    p.  711,  ^ 
953. 
3d,  contraction  of  larger  series  con- 
curs with  the  smaller  in  developing 
reflex  nervous  influence,  which  in- 
creases in  an  increasing  ratio  the 
contraction  of  the  latter,  p.  698,  ^ 
932  ;  p.  703,  ()  940. 
4th,  the  heart  becomes  affected  by  the 
same  reflex  action  of  the  nervous 
system   which  is   excited   by   the 


Bloodletting,  General — continued. 

vital  influences  attending  the  con- 
traction   of   the   general  vascular 
system,  while,  also,  the  nervous  in- 
fluence becomes  early  and  rapidly 
developed  in  a  direct  manner  by  the 
contraction  of  the  cerebral  vessels — 
thus  establishing  the  compound  in- 
fluence oi  direct  and  reflex  nervous 
action,  p.  698,  ()  933 ;  p.  703,  ^  940- 
942  a  ;  p.  707,  <J  948-949  ;  p.  709, 
^  951  c,d.     Also,  Nervous  Power, 
Index  I.  and  II. ;  Reflex  Action 
OF  the  Nervous  System  ;  Reme- 
dial Action,  subdivision  Mental 
Emotions. 
5th,  the  influence  upon  the  heart  (4th) 
reacts  through  the  nervous  centres 
upon  the  capillary  vessels,  and,  by 
thus  increasing  the  changes  in  the 
vascular  system,  especially  in  that 
of  the  brain,  increases  in  a  still  more 
rapid  ratio  the  foregoing  compound 
influence   of  the   nervous   power, 
when  syncope  hastens  on  as  a  con- 
sequence, p.  693,  <J  920 ;  p  698-699, 
^  934-935  ;  p.  701,  ^  937  6-938  b; 
p.  703-707,  (J  940-949 ;    p.  709,  ^ 
951  c,  d;  p.  824-828,  (J  1056. 
failure  of  heart's  action  not  in  the  least 
owing  to  "  deficiency  of  blood  in  the 
organ"  or   "diminution    of  cerebral 
action,"  but  wholly  the  result  of  reflex 
and  direct  action  of  the  nervous  sys- 
tem, p.  699,  ^  935  a ;   p   703-712,  ^ 
942-952,  and  ul  supra — with  a  quali- 
fication after  syncope  ensues,  p.  705- 
706,  ()  945. 
in  producing  syncope,  how  connected 
with  gastro-intestinal  irritation,  and 
with  the  depressing  emotions,  p.  668- 
669,  ^  902  g,  h ;  p.  703-704,  ^  943- 
944  a — all  depending  upon  reflex  or 
upon  direct  nervous  influence.     See 
Nervous  Power,  and  Remedial  Ac- 
tion, subdivision  Mental  Emotions, 
and  Mental  Emotions,  Index  II. 
illustrated  by  remedies  for  syncope,  and 
by  examples,  p.  705,  ^  945 ;   p.  706, 
«J  946  ;    p.  712,  ()  955  b;  p.  726-731, 
<^  961  c-970  ;  p.  733-736,  <J  974-980. 
reflex  nervous  influence,  as  also  direct, 
begins  at  the  earliest  contraction  of 
the  small  bloodvessels,  especially  of 
the    nervous    centres,  p.  703-704,  4 
940-944. 
blood  excluded  from  the  vessels  by  their 
vital,  not  a  physical  contraction,  p. 
692,  ^  912  ;  p.  699,  ^  935  c;  p.  707, 
^  949;  p.  711,  ^  953.     Also,  Inflam- 
mation, Index  II. 
hypotheses  of  its  operation  mostly  me- 
chanical, p.  691,  ^  909,  910. 
effects   of,  disprove  the  doctrine  of  a 
passive  condition  of  the  bloodvessels 


988 


INDEX    II. 


Bloodletting,  General — continued. 

in  inflammation  and  venous  conges- 
tion, p.  485-486,  ij  750  ;  p.  488,  i)  766 
b;  p.  505,  (}  801  ;  p.  700,  <^  935  d;  p. 
724-730,  ()  961-970  ;  p.  740,  ij  988  a. 

objections  to,  contrasted  with  other 
means  as  substitutes,  p.  372,  i)  569  e  ; 
p.  396,  ()  621  a;  p.  544,  ^  857  ;  p.  558, 
5  878  ;  p.  579,  ()  890i  a ;  p.  584,  () 
891  e  ;  p.  602-604,  (;  892  i~l ;  p.  638, 
^  8924/;  p.  715-722,  i)  959-960  ;  p. 
751-752,  ^  999  c;  p.  754,  ()  1002/; 
p.  756-757,  ^  1005  b-g ;  p.  759-760, 
\  1005/  k;  p.  760,  <)  1005  A- ;  p.  763- 
766,  <J  1006  c-1008  ;  p.  857-861,  ^ 
1063-1065  J;  <J892(/-^-;  p.  872,  P.S. 

philosophy  of  its  operation  subordinate 
to  other  considerations,  p.  691,  ^  907. 

illustrates  the  modus  operandi  of  other 
remedies,  p.  691,  ()  908. 

eflfects  of,  upon  the  blood,  p.  710,  ()  952. 

its  effects  depend  upon  a  great  variety 
of  circumstances,  which  should  en- 
gage the  attention  of  the  Physician, 
p.  430-433,  (i  675  ;  p.  444-445,  ()  688 
e,  ec;  p.  700-701,  ^  935  e-938 ;  p. 
704,  1^  943-944;  p.  709-711,  (J  951  c 
-952;  p.  713-714,  ()  956-958  b;  p. 
724-731,  ()  961-970;  p.  741-745,  § 
990  ;  p.  756-759,  <)  1005  a-h  ;  p.  765- 
766,  ^  1007  b-d. 

of  its  proper  extent,  p.  711-715,  ()  953- 
959. 

general  rules  to  be  observed,  p.  711- 
714,  <J  954-958 ;  p.  748-753,  ^  992- 
1001  ;  p.  756, ^  1004  rf;  p.  766-777, 
<)  1027. 

rules  not  to  be  observed,  p.  713,  (>  955  d ; 
p.  715,  ^  959  ;  p.  720,  ^  960  a ;  p.  728, 
^  965  a;  p.  774-778,  « 1024-1026. 

in  embarrassing  cases,  p.  375,  ^  576  e ; 
p.  641-642,  (J  892-1  i ;  p.  712-713,  () 
955  b-e;  p.  714,  i^"'957 ;  p.  726-728, 
^961c-964c;  p.  729,  ^  967  ;  p.  734- 
735,  <^  976  6-977 ;  p.  741-745,  ^  990 
as ;  p.  765-766,  <)  1007  b-1008  ;  p. 
871-872,  i)  1068  d. 

svncope  not  a  test  of  the  proper  extent 
'  of,  p.  715,  (}  959  ;  p.  726-730,  <^  961- 
969 — but  will  sometimes  remove  se- 
vere inflammation  through  the  power- 
ful alterative  efl;ect  of  reflex  nervous 
influence,  p.  704,  ^  943  b ;  p.  709,  ^ 
951  b-d. 

proposed  substitutes  for,  such  as  tobacco, 
aconite,  belladonna,  veratrum  viride, 
dry  cupping,  &c.,  p.  711,  ()  954  b; 
p.  715-721,  «J  960  ;  p.  860,  ^  1065  a. 

causes  of  objections  to,  p.  722,  <5i  960/; 
p.  729,  (}  967;  p.  752,  ^  1000,  1001. 

general  bloodletting  the  proper  method 
in  all  active  ijiflammations  of  internal 
organs,  p.  713,  ij  956  ;  p.  729,  i)  965  b, 
966  ;  p.  736,  i)  979,  980. 

its  tolerance  promoted  in  inflammations 


Bloodletting,  General — continued. 

by  a  stimulating  nervous  influence 
exerted  upon  the  sanguiferous  system, 
and  more  so  in  inflammation  of  the 
brain  than  of  other  organs,  being  di- 
rect in  the  former  case  and  reflex  in 
the  latter,  p.  508,  (^  806  ;  p.  732-734, 
^  973-975  ;  p.  735,  ()  977 ;  p.  736,  ^ 
979,  980. 

hence  is  it  that  inflammation  of  the  brain 
generally  requires  a  greater  loss  of 
blood  than  other  parts,  p.  508,  ij  806  ; 
p.  696,  ()  925  c  ;  p.  733-736,  ^  974  b- 
979 ;  p.  748-749, ^  992 ;  p.  774-776, 
<)  1024  a-^;  p.  872.  ^  1068  d;  p.  824- 
828,  ()  1056  ;  p.  847,  (J  1058  q. 

borne  to  a  great  extent  in  hydrophobia, 
on  account  of  the  above  nervous  in-* 
fluence,  p.  734,  <?  976  a. 

often  imperfectly  borne  in  mania  and 
delirium  tremens,  p.  734,  ()  976. 

in  pneumonia,  p.  572-575,  ^  890  c-h ; 
p.  602,  ()  892  ? ;  p.  638-639,  (/  892|-  g ; 
p.  638-642,  <)  892A/-? ;  p.  738,  ()  984 
b ;  p.  749,  (j  992  d";  p.  750,  ^  995  ;  p. 
757-760,  ()  1005  h-k;  p.  770,  (J  1017c ; 
p.  846,  ^  1058  0  ;  p.  870,  ^  1068  c. 

in  apoplexy,  embarrassing  on  account 
of  a  prostrating  nervous  influence, 
p.  741-747,  (j  990-990i. 

in  dysentery,  and  an  opposite  practice, 
p.  573, 1)  890  :  p.  575,  ^  890  h  ;  p.  747, 
()  991  b;  p.  842,  (^  1058/— Notk  Gg. 

in  erysipelas,  p.  759-760,  ^  1005  j. 

in  purpura  hemorrhagica,  p.  754,  ^  10C2 
d,  e. — III  Croup,  (^  576  e,  964  d. 

in  venous  congestion  and  congestive  fever, 
p.  724-731,  (j  961-970.— Note  Ff. 

why  its  effects  are  modified  by  venous 
congestion,  and  why  Physicians,  in 
such  cases,  are  deterred  from  its  ap- 
plication, p.  724-726,  ij  961  a-e. 

to  a  small  extent,  often  produces  syn- 
cope in  congestive  fever,  but  may  be 
soon  borne  in  ample  amount,  and 
why,  p.  726-729,  (j  961  c-965,  968; 
p.  735,  ^  978,  979 — previous  stimula- 
tion may  be  necessary ;  p.  727,  <J 
964  a,  b — well  borne  as  soon  as  reac- 
tion takes  place,  p.  730,  (Ji  969 — 
leeches  improper  in  such  cases,  and 
why,  p.  729,  ()  966. 

well  borne  in  venous  congestion  of  the 
brain,  and  for  the  same  reason  as  in 
cerebral  inflammation,  p.  507-508, 
ij  806  ;  p.  730,  ^  969  b;  p.  733-734, 
<^  974  c-975  b. 

its  depressing  effecfs  in  congestive 
fevers,  at  the  first  bleeding,  owing  to 
the  depressing  influence  of  reflex 
nervous  influence  propagated  over  the 
sanguiferous  organs  by  the  affected 
veins,  p.  503-513,  (j  795-818  ;  p.  724- 
726,  <!i  961  a-e;  p.  729-730,  \  967- 
969.     Also,  p.  444-445,  <J  688  d-cc. 


INDEX    II. 


989 


Bloodletting,  General — continued. 

fatal,  in  supposed  but  mistaken  cases  of 

venous  congestion,  p.  730,  "^  970  a,  b. 
in  yellow  fever,  p.  747-748,  (J  991  6-992 

a,  c ;  p.  749-750,  <J  993-994  ;  p.  751, 

<J  999  ;  p.  753-754,  I)  1003  a-c ;  p. 

869,  ()  1068  b. 
in  typhus  fever,  p.  754,  <J  1002  d ;  p.  755, 

()  1004  &. 
in  jail  fever,  p.  754,  ij  1002 /^and  pu- 
trid fevers,  ibid. 
in  intermittent  fever,  p.  63,  <^  137  c,  (Z  ; 

p.  65,  (j  143  6,  c ;    p.  424,  ()  662  6 ; 

p.  430-433,  ij  675  ;  p.  553,  i)  870  aa ; 

p.  570,  ij  889  71 ;  p.  597-598,  ^  892  c  ; 

p.  600,  (J  892  (Z ;  p.  605-606,  ^  892 

■m-;),-    p.   608-610,   ()  892i  c,  d;  p. 

737-739,  (J  983-985  ;  p.  740,  ^  989  ; 

p.  754-755,  ()  1003  ;   p.  756-757,  () 

1005  a-g;  p.  829,  ^  1057  i. 
in  plague,  p.  755,  ^  1002  rf,  e. 

in  reduced  and  emaciated  subjects,  p. 
765-766,  <)  1007  b-d. 

in  simple  continued  fevers,  p.  491-495, 
(J  762  i-768  a;  p.  736,  (J  981. 

in  the  cold  stage  of  fever,  and  how  it 
operates,  p.  739-740,  (}  986-988. 
Also,  p.  430-433, ^  675  ;  p.  548-550, 
()  863  d. 

most  useful,  in  fevers  attended  by  reac- 
tion, just  as  the  subsidence  of  the 
hot  stage  begins,  and  why,  p.  430- 
433,  ^  675  ;  p.  547-549,  <)  863  d ;  p. 
570,  <S»  889  n  ;  p.  739-740,  ^  887-889. 

in  Infancy,  p.  767-768,  ^  1009-1013. 

in  Old  Age,  p.  768-770,  §  1014-1017. 

under  no  controlling  influence  by  cli- 
mate or  season  in  any  country  or  at 
any  epoch,  and  what  Hippocrates  de- 
scribes are  perfect  portraits  of  our 
own  diseases,  p.  761-762,  ^  1005  b- 

1006  a;  p.  868-870,  ()  1068  a,  b. 
large  abstractions  of  blood,  when  ap- 
propriate, lead  to  speedy  convales- 
cence, and  restoration  of  bodily  vigor, 
p.  747-759,  (^  891-1005  ;  p.  765-766, 
\  1007-1008;  p.  870-872,  <J  1068 
c,  d. 

when  appropriate,  the  earlier  the  better, 
and  decisively  at  once,  p.  642,  ij  892-i 
i;  p.  711,  (j  954  b;  p.  712,  «J  954  c"^- 
p.  713,  1^  955  e;  p.  714,  <^  957;  p. 
729,  l)  968 ;  p.  749,  ^  992  d ;  p.  750, 
<5  997;  p.  751,  ^  999;  p.  870-872, 
^  1068  c,  d. 

repeated  and  small  abstractions  of  blood, 
where  free  bloodletting  is  necessary, 
although  large  in  the  aggregate,  are 
often  fruitless,  p.  714,  ^  958  b  ;  p. 
728-729,  ^  965  b  ;  p.  751-752,  ^  999- 
1000. 

when  excessive,  may  maintain  or  pro- 
duce inflammation,  and  why,  p.  697, 
^  927  b ;  p.  708,  (^  950 ;  p.  733,  ^ 
974  b;  p.  773-774,  (^  1023  a,  i— for 


Bloodletting,  General — continued. 

which  Leeches  may  be  a  remedy,  p. 
774,  <J  1024  a. 

"  morbid  irritation  and  excessive  reac- 
tion from  loss  of  blood,"  p.  772-776, 
^  1020-1026  — the  latter  misappre- 
hended, which  is  often  dependent  on 
too  small  a  loss,  or  on  remaining  in- 
flammation, <J  1021-1024 — supposed 
examples  of,  ^  1023  a,  c-g. 

its  advantages  and  safety  denoted  by 
spontaneous  hemorrhages — Nature's 
remedy,  and  a  lesson  to  man,  p.  507, 
^  805  ;  p.  546-551,  ^  862-863  ;  p. 
572-575,  ^  890  d-g ;  p.  641-642,  ^ 
8924  i;  p.  770-772,  (}  1018-1019. 

experience  and  opinions  of  distinguish- 
ed Physicians,  ancient  and  modern, 
as  to  bloodletting  in  inflammatory, 
congestive,  and  febrile  diseases,  p. 
747-776,  f)  991-1026. 

admissions  of  eminent  Physicians  as  to 
their  neglect  of  the  remedy,  p.  756- 
761,  ()  1005  a-k — contrasted  with  the 
abuse  of  other  remedies,  p.  372,  <J 
569  e;  p.  395,  ^  621  a;  p.  572-570, 
()  890  c-n;  p.  579,  ^  890^-  a  ;  p.  581, 
^  890i  /;  p.  584,  i)  891  c;  p.  590- 
591,  §  8911r  a-f;  p.  603-604,  ()  892 
k;  p.  637-639,  ^  892^  c,  f;  p.  715, 
718,  ^  960  ;  p.  763-766,  ^  1006  c- 
1007;  p.  856-861,  (}  1063-1065. 

the  head  and  shoulders  of  the  patient, 
if  possible,  should  be  always  elevated 
during  the  operation,  as  one  of  the 
important  means  of  regulating  the 
extent  of  the  remedy,  and  there  may 
be  risk  without  this  precaution,  p. 
705,  {}  945  ;  p.  758, 1}  1005  h ;  p.  872, 
^  1068  d. 

eifects  of,  diflferent  in  General  Bloodlet- 
ting, Cupping,  and  Leeching,  p.  691, 
•J  911  ;  p.  713,  (^  956  ;  p.  729,  ^  966. 

eflfects  of,  as  manifested  in  Leeching, 
p.  692-698,  ^ 912-928 ;  p.  729,  ^  966. 
Also,  Leeching,  Index  II. 

eflTects  of,  as  manifested  in  Cupping,  p. 
702,  ()  937.    Also,  Copping,  Index  II. 

general  conclusions  as  to  Bloodletting, 
p.  776-777,  ^  1027.  Also,  p.  872,  P.S. 
Blood,  Circulation  of.     See  Circula- 
tion OF  Blood,  Index  II. 
Blue  Mercurial  Pill — continued  from 
Index  I., 

its  uses,  and  analogies  with  Calomel, 
p.  840,  ()  1058  c  ;  p.  848,  ^  1058  s,  v  ; 
p.  850,  ()  1059. 
Brain, 

Author's  experiments  upon,  to  determine 
the  quantity  of  blood  circulating  in  the 
brain,  and  to  show  that,  as  in  other 
parts,  it  may  be  reduced  by  Blood- 
letting, and  the  provision  through 
which  this  reduction  is  effected,  p. 
824-828,  ()  1056. 


990 


INDEX    II. 


Brain,  Inflammation  of, 

treatment  of,  p.  507-508,  ^  806  ;  p.  651, 
^  893  k ;  p.  696,  <)  925  c ;  p.  733-736, 
<>  974  c-979  ;  p.  748,  ^  992  b,  c ;  p. 
774-776,  i)  1024  a-g ;  p.  824-828,  ^ 
1056;  p.  847,  ^  1058  q;  p.  872,  ^ 
1068  d. 

develops  a  powerfully  exciting  nervous 
influence  in  a  direct  manner,  and 
thus  sustains  the  organs  of  circula- 
tion against  the  depressing  influence 
of  loss  of  blood,  but  which  is  common 
to  inflammations  of  other  parts  in  an 
inferior  degree  when  the  influence  is 
through  reflex  nervous  action,  p.  507- 
508,  4  806  ;  p.  732-734,  (}  973-975 ; 
p.  735,  ^  977 ;  p.  736,  i)  979,  980— 
and  to  this  stimulating  nervous  in- 
fluence upon  the  bloodvessels  is  due 
the  incumpressihility  of  the  pulse  in 
inflammations,  p.  445,  ^  688  ec — and 
to  its  modified  condition  the  hardness 
is  owing,  as  also  the  changes  which 
the  blood  undergoes,  ^  485,  500  m, 
688  d-ee — while,  also,  the  influence 
is  so  variously  determined  as  to  occa- 
sion intermission  of  the  heart's  action, 
various  inequalities  in  action  of  the 
radial  arteries,  p.  512,  (j  390  I — and 
illustrates  the  philosophy  of  animal 
heat,  p.  265-266,  ^  447,  447  d.  Also, 
Nervous  Power,  Index  I.  and  II. ; 
Reflex  Action  of  Nervous  System, 
Mental  Emotions,  and  Remedial 
Action,  subdivision  Mental  Emo- 
tions, Index  II. 
Brain,  Venous  Congestion  of, 

treatment  of,  proceeds  upon  the  same 
plan  as  for  inflammation  of  the  brain 
and  congestive  fevers,  p.  374—375,  () 
576  d,  e  ;  p.  504,  ^  798  ;  p.  505,  i)  801 
b,c;  p.  696,  ^  925  b,  c;  p.  724-731, 
^  961-970. 

owing  to  the  natural  constitution  of  the 
venous  tissue,  congestion  and  active 
inflammation  of  the  veins,  contrary 
to  what  happens  in  inflammation  of 
other  tissues,  develops  a  prostrating 
nervous  influence,  by  which  blood- 
letting is  often  imperfectly  borne  at 
its  first  application,  except  cerebral 
congestion,  which  develops  much  of 
the  stimulating  nervous  influence  that 
is  incident  to  inflammation  of  other 
tissues,  p.  61-63,  ()  133  b-\Zl  c ;  p. 
64.  ()  140  ;  p.  67,  ^  149-151 ;  p.  503- 
505,  <J  794-801  ;  p.  507-508,  ^  806  ; 
p.  509-511,  (j  811-815;  p.  724-730, 
061-969;  p.733-734,  §974c-975a. 
Brown-Sequard, 

his  experiments  on  the  nervous  system 
modify  those  by  Sir  C.  Bell  in  relation 
to  spinal  nerves,  p.  802-804,  (j  1037- 
1039. 

observations  upon  the  iris,  p.  806,  (j  1042. 


Calomel, 

considered  as  an  alterative  in  all  its 
doses,  p.  838-850,  (j  1058-1059. 

its  effects,  where  most  strongly  pro- 
nounced, p.  839,  <J  1058  h — and  its 
extensive  sway,  p.  839-840,  (j  1058  J 
— powerfully  alterative,  p.  564,  ^  889 
c;  p.  839,  (j  1058  b. 

must  be  considered  in  connexion  with 
other  remedies,  p.  841,  ^  1058  e. 

its  best  combinations,  p.  838-839,  () 
1058  a. 

its  effects,  according  to  doses,  p.  543— 
544,  {)  857  ;  p.  840,  ()  1058  d ;  p.  850, 
<J  1059  :  p.  576,  <)  890  /. 

does  not  impart  a  green  color  to  intes- 
tinal fluids,  p.  454,  ()  694  b. 

in  malignant  cholera,  p.  841,  ^  1058  d — 
in  cholera  infantum,  p.  841 ,  ^  1058  d — 
in  dysentery,  sporadic  and  epidemic, 
p.  842-848,  <J  \ObSf—m  fevers,  p.  843, 
<5i  1058  g — in  scarlet  fever,  p.  843,  ^ 
1058  h — in  measles  and  small-pox, 
p.  844,  (^  1058  t — in  whooping-cough, 
p.  844,  <^  1058  k — in  jaundice,  p.  844- 
845,  <J  1058  / — in  erysipelas,  p.  845, 
^  1058  m — in  acute  rheumatism,  and 
acute  gout,  p.  846,  ^  1058  7m  —  in 
pneumonia,  p.  846,  <J  1058  a — in  croup, 

p.  846,  ^  1058  p in    inflammation 

of  brain,  Y>.  847,  ^  1058  q — in  inflam- 
mation of  serous  tissues,  p.  847,  () 
1058  r — in  wflammation  of  kidneys, 
p.  847,  ^  1058  i — in  inflammation  of 
eyes,  p.  848,  ()  1058  t  —  in  apoplexy, 
p.  848,  {)  1058  u — in  epilepsy,  p.  848, 
\  1058  V — in  asthma,  p.  848,  ()  1058  w 
— in  chorea,  p.  844,  v  1058  x — in  de- 
lirium tremens,  p.  849,  ^  1058  y — in 
puerperal  fever,  p.  849,  ^  1058  z. 
Cantharides.  See  Countee-Irritants, 
Index  II., 

their  morbific  effects  show  that  remedies 
operate  by  substituting  pathological 
conditions  of  a  transitory  nature  for 
others  more  profoundly  morbid,  p. 
63,  ^  137  rf;  p.  65,  ()  143  a-c ;  p.  67, 
()  149-151 ;  p.  542-543,  (^  854  c-857 ; 
p.  645-646,  ij  893  c,  d;  p.  652,  ^  893  /. 

their  remedial  and  morbific  eff'ects,  ex- 
ternally or  internally  applied,  demon- 
strate the  operation  of  remedies  and 
morbific  causes  upon  parts  beyond 
their  direct  seat  of  action  through 
alterative  effects  of  reflex  nervous 
influence,  p.  646-652,  (}  893  e-m; 
p.  679-681,  (J  905  a.  Also,  Reflex 
Action  of  Nervous  System,  Reme; 
dies;  Causes,  Morbific,  Index  II. 
Also,  p.  850-851,  ()  1059. 

in  producing  inflammation  of  the  bladder 
without  injuring  the  stomach,  and  as 
the  stomach  may  subsequently  become 


INDEX    II. 


991 


Cantharides — continued. 

diseased  through  a  morbific  reflex  ac- 
tion of  the  nervous  system  determined 
by  the  vesical  inflammation — shows 
how  many  morbific  causes,  such  as 
miasmata,  cold,  iStc,  may  exert  all 
their  direst  effects  upon  the  skin  and 
mucous  tissue  without  deranging 
those  organs,  but  that  the  impression 
may  develop  a  morbific  reflex  action 
of  the  nervous  system  that  shall  insti- 
tute disease  in  other  parts,  which  may 
then  call  into  action  a  reflex  influence 
that  will  light  up  disease  in  the  skin, 
or  mucous  tissue,  or  other  parts — 
thus,  also,  showing  how  mercury  ad- 
ministered by  the  stomach,  or  applied 
to  the  skin,  will,  without  affecting 
those  organs  sensibly,  establish  in- 
flammation in  the  mouth  and  salivary 
glands,  and,  by  the  same  inductive 
philosophy,  how  remedial  agents  ap- 
plied to  the  same  organs,  do  also, 
through  the  alterative  action  of  the 
reflex  nervous  influence,  establish 
salutary  pathological  changes  in  dis- 
eased parts  remotely  situated,  and 
without  manifesting  any  action  upon 
the  stomach  or  skin,  p.  59,  I)  129  A ; 
p.  63,  ()  137  d;  p.  65,  ()  143  a-c;  p. 
66-67,  ^  148-151  ;  p.  101-102,  ()  201- 
203  ;  p.  332-334,  (J  502-506  ;  p.  339- 
340,  (}  5Ug,h;  p.  347-348,  <J  516  d, 
No.  13  ;  p  351-352,  t)  524  c ;  p.  367- 
368.  ()  558  a;  p.  416-417,  ^  649  c; 
p.  421-423,  ^  657-658,  660  ;  p.  426, 
^  666  ;  p.  429-430,  ()  674  d ;  p.  465, 
^  714  ;  p.  522-523,  ()  827  b,c;  p.  539, 
^  848  ;  p.  862-864,  ()  1066. 
demonstrate,  like  Arsenic,  Tartarized 
Antimony,  Iodine,  &c.,  the  modus 
operandi  of  remedial  and  morbific 
agents  through  alterative  influence 
of  reflex  nervous  action,  and  the  fal- 
lacy of  the  doctrine  of  absorption,  and 
how  remedies  operate  by  that  medium 
through  increased  susceptibility  of 
parts  morbidly  affected,  and  accord- 
ing to  peculiarities  in  the  natural 
constitution  of  tissues,  and  how  they 
prove  remedial  or  morbific  according 
to  their  just  application,  and  upon  a 
common  principle — by  the  failure  of 
the  vesicating  plaster  to  affect  any 
internal  organ  in  its  healthy  state 
excepting  the  bladder,  while  it  will 
overthrow  inflammations  of  all  other 
internal  parts,  or  will  aggravate  the 
same  disease  if  not  duly  applied,  but 
will  exert  no  such  effects  when  ad- 
ministered internally  excepting  upon 
the  bladder.  See  last  preceding'  refer- 
ences.    Also,  <J  1059,  1088. 

Casein.     See  Milk,  Index  II. 

Castor  Oil.     See  Oil,  Castor,  Index  II. 


Cathartics — continued  from  Index  I., 

their  curative  and  morbific  effects  upon 
disease  spring  from  irritation  of  the 
alimentary  mucous  tissue,  by  which 
the  reflex  action  of  the  nervous  system 
is  brought  into  alterative  effect  upon 
morbid  parts,  and  according  to  the 
nature  and  dose  of  the  cathartic,  and 
involve,  also,  continuous  sympathy, 
p.  101-102,  ()  201-203;  p.  107-110, 
^  227-232  ;  p.  303,  (i4:81  d;  p.  322- 
324,  ^  498-500  c;  p.  339,  ()  514:  f; 
p.  563-567,  §  889  a-k ;  p.  661-663, 
4  894-896;  p.  835-841,  <J  1057^- 
1058;  p.  851-859,  ^  1060-1064. 
Also,  Nervous  Power,  Index  I.  and 
II  ;  Sympathy,  Sensation,  Sensi- 
bility, Index  I. ;  Reflex  Action  of 
Nervous  System,  Remedial  Action, 
Therapeutics,  Index  II,  ()  1088  d. 

no  two  alike  in  eflTects,  p.  964,  §  889  c. 
Also,  p.  27,  (i  52;  p.  63,  (>  137  b-d ; 
p.  64-65,  {)  138-143  c;  p.  67-68,  (J 
149-152  b;  p.  73,  <)  163;  p.  400,  () 
630  rf;  p.  417,  (f  650;  p.  418-420,  () 
652  c-653  d ;  p.  424-425,  <)  662-663  ; 
p.  545,  ^  860  ;  p.  547-550,  <J  863  d ; 
p.  838-843,  I)  1058  a-f,  p.  851-862, 
^  1060-1065. 

each  modifies  the  nervous  influence  in 
a  way  peculiar  to  its  own  virtues,  and 
Calomel  and  Blue  Pill,  rendering  it 
most  usefully  alterative,  are  arranged 
first  in  order  in  the  Author's  Materia 
Medica  and  Therapeutics,  p.  564,  ^ 
889  c;  p.  838-843,  §  1058  a-f.  Also, 
Nervous  Power,  Index  I  and  II. ; 
Alteratives,  Remedial  Action,  In- 
dex II. 

may  produce  their  curative  efl^ects  with- 
out purging,  p  564,  ij  889  b. 

the  evacuations  the  least  important  ot 
the  effects,  yet  often  a  necessary  re^ 
suit  of  that  irritation  of  the  intestinal 
mucous  tissue  which  is  required  to 
establish  a  powerful  development  of 
reflex  nervous  influence,  p.  564-565, 
()  889  b-f. 

the  principal  objects  contemplated,  p. 
566,  (;»  889  h. 

special  relation  of  alimentary  canal  to 
nervous  system  goes  to  corroborate 
the  Author's  doctrine  of  operation  of 
remedial  and  morbific  agents  through 
reflex  action  of  nervous  system,  p. 
565-566,  ij  889  g. 

peristaltic  action  increased  through  in- 
fluence of  reflex  action  of  nervous 
system  upon  the  muscular  coat  of  in- 
testine, which  exemplifies  the  essen- 
tial philosophy  of  their  remedial  and 
morbific  effects  upon  other  parts,  p. 
107-112,  (J  227-234;  p.  284-285,  (} 
455  a-f;  p.  323-341,  ij  499-514  ;  p. 
347-348,  ^  516  d,  No.  13;  p.  361,  () 


992 


INDEX    II. 


Cathartics — continued. 

529  ;  p  563-564,  ()  889  a,  b  ;  p.  565- 
566,  l^  889  /,  g;  p.  592-593,  <^  89U 
k;  p.  661-664,  ()  894-900;  p.  665- 
671,  i)  902  a-l;  p.  679-681,  ^  905  a. 

some  affect  different  parts  of  intestine 
unequally,  according  to  their  special 
virtues  and  to  the  difference  in  struc- 
ture and  vital  constitution  of  differ- 
ent portions  of  the  canal,  p.  566,  i; 
889  i;  p.  856-857,  §  1063  b.  Also, 
p.  59,  i)  129  g-i;  p.  61-73,  ^  133- 
163  ;  p.  98,  ^  191  i— but  is  not  the 
principle  which  should  determine 
their  choice,  p.  566,  §  889  i. 

their  combinations,  proportions  of  each, 
addition  of  other  things,  dose,  time 
of  exhibition,  and  relation  to  other 
remedies,  very  important,  p.  566-570, 
^  889  k-n.  Also,  p.  339-340,  ()  514 
h ;  p.  *3-544,  i)  857 ;  p.  548-549,  ^ 
863  d;  p.  648-651,  ()  893  g-k ;  p. 
657,  ()  893  p;  p.  696,  ^  926  ;  p.  838- 
849,  I)  1058  a-z. 

often  cumulative  in  effect,  important, 
and  illustrated,  p.  667-569,  ^  889 
l-mm. 

mode  and  philosophy  of  overcoming 
habitual  constipation  through  pro- 
gressive and  alterative  influence  of 
reflex  nervous  action,  and  contrast, 
p.  568-569,  <;i  889  771,  mm.  Also,  p.  344 
-345,  (}  516  d,  No.  6  ;  p.  532,  ^  841  ; 
p.  365,  ()  551  ;  p.  646-649,  ^  893  c-h : 
p.  667-669,  ()  902,/,  g;  p.  679-681, 
\  905  a. 

the  most  appropriate  time  for  exhibi- 
tion, and  why,  p.  570,  ^  889  n.  Also, 
p   547-549,  (j  863  d ;  p.  740,  ^  989. 

three  principal  objects  contemplated,  p. 
566,  ^  889  h. 
Cath.^rtics,  Saline, 

their  therapeutic  and  morbific  effects, 
and  relative  value,  p.  853,  ^  1061. 

overrated,  and  as  "  refrigerants"  falla- 
cious, ibid. 

example  of  their  usefulness  in  combina- 
tion with  Rhubarb,  p.  555,  ()  872  a. 
Causes,  Morbific, 

operate  upon  the  same  principle  of  al- 
terative influence  of  reflex  action  of 
nervous  system  as  remedial  agents, 
and  more  or  less  according  to  differ- 
ences in  the  vital  constitution  of  dif- 
ferent parts,  and  their  existing  pre- 
ternatural susceptibilities,  p  3,  ^  2  c  ; 
p.  55,  {}  117;  p.  59,  (J  129  h;  p.  61, 
5  133  c;  p.  62-73,  <;>  135  a-l 63;  p. 
87,  ()  177-182  ;  p.  89,  I)  188  :  p.  101- 
102,  ()  201-203;  p.  107-112,  (^  226- 
234  b;  p.  131-132,  ^  285-288;  p. 
265,  {)  447  b;  p.  285-286,  <J  455  d- 
456  ;  p.  323-341,  t)  499-514;  p.  365- 
366,  ()  551-556  ;  p.  373-390,  <J  574- 
601;   p.  399,  ^  630;    p.   415-418,  () 


Causes,  Morbific — continued. 

649-651  ;  p.  421-423,  l)  657-658  ;  p. 
424,  (;>  661  ;  p.  426,  i)  666  ;  p.  445,  <> 
688  ee;  p.  451,  i)  691,  692  ;  p.  465- 
467,  ()  714-719  ;  p.  475,  ij  733  h  ;  p. 
478-479,  ^  740-741  ;  p.  483-484,  ^ 
746  c  ;  p.  525-527,  ()  827  c-828  e;  p. 
530-533,  837  b-SU  ;  p.  538-539,  ^ 
847  g--848;  p.  541-542,  854  a-d; 
p.  547,  <)  863  d ;  p.  554,  ^  871  ;  p. 
563-564,  ^  889  a ;  p.  565,  ^  889  g ; 
p.  569,  i)  889  mm  ;  p.  571-572,  ^  896 
b ;  p.  574-576,  <^  890  ce-n ;  p.  580, 
^  890tr  e;  p.  592-593,  ()  89H  k ;  p. 
644-651,  {)  893  c-i ;  p.  657-658,  ^ 
893  0,  p  ;  p.  661-663,  ^  894-896  ;  p. 
665-670,  i)  892  a-m  ;  p.  679-681,  ^ 
905  a ;  p.  802-804,  I)  1039  ;  p.  862- 
864,  ()  1066  ;   p.  501-512,  ^  792-817. 

their  operation  at  the  beginning  devel- 
opment of  the  ovum  supplies  a  key  to 
the  essential  philosophy  of  disease, 
as  the  development  of  the  ovum  does, 
also,  to  that  of  physiology,  p.  47-49, 
<J  75-80. 

reflect  light  upon  pathological  condi- 
tions, p.  414,  ()  642  a ;  p.  424,  ()  662 
a-c,  p.  396,  ^621  b. 

two  kinds,  predisposing,  and  exrciting 
or  occasional,  which  are  bofir  exter- 
nal and  internal,  physical  and  mental, 
p.  414-415,  (J  645-648. 

the  predisposing,  general  and  specific, 
p.  415,  ^  648. 

the  predisposing,  most  important  as  lay- 
ing the  foundation  of  disease,  p.  414, 
^  645  b. 

the  exciting,  develop  disease  after  the 
predisposition  is  formed,  p.  414,  ^ 
645  c. 

the  predisposing  often  also  the  exciting 
cause,  such  as  all  animal  and  vege- 
table poisons,  &c.  Many  internal 
causes,  physical  and  mental,  may  be 
either  predisposing  or  exciting,  or 
may  act  as  both.  Also,  numerous 
external  causes  that  are  more  or  less 
intermingled  with  the  atmosphere, 
and  which  are  essentially  predispos- 
ing and  generally  require  the  subse- 
quent operation  of  exciting  causes  for 
the  development  of  disease,  may  be 
both  predisposing  and  exciting,  of 
which  kind  are  concentrated  mias- 
mata, p.  414,  ()  645  c;  p.  418,  ()  652 
c;  p.  420-421,  ^  654-656;  p.  423,  ^ 
659-660. 

like  remedial  agents,  exert  their  first  ef- 
fects locally,  and  thence  upon  other 
parts  through  the  alterative  influence 
of  reflex  action  of  the  nervous  system, 
p.  415-416,  1^  649  a,  b  ;  p.  421-423, 
\  657-658  ;  p.  520,  ()  826  c  ;  p.  592, 
(}  89U  g,  k;  p.  849,  (^  1059  ;  p.  930, 
^  1088  ;   Remedies,  Remedial  Ac- 


INDEX    II. 


993 


Causes,  Morbific — continued. 

TioN,  Index  II. ;  Nervous  Power, 
Index  I.  and  II. ;  Sympathy,  Sensi- 
bility, Vital  Properties,  Index  I. 

all  such  as  are  of  a  miasmatic  nature, 
and  cold  and  analogous  causes,  do  not 
induce  disease  in  parts  which  are  the 
direct  seat  of  their  action,  but  in  oth- 
er parts  by  reflex  action  of  the  nerv- 
ous S3'stem,  or  subsequently  upon 
their  direct  seat  of  action  by  reflex 
influences  propagated  by  the  primary 
derangements,  p.  59,  ^  129  h;  p.  63, 
<i  137  d;  p.  65,  ()  143  a-c ;  p.  66-67, 
^  148-151  ;  p.  332-334,  ^  502-506  ; 
p.  339-340,  ^  514  g,  k ;  p.  347-348, 
<!i  516  fZ,  No.  13  ;  p.  351-352,  ^  524 
c;  p.  367-368,  ()  558  a;  p.  416-417, 
^  649  c ;  p.  421-424,  ()  657-660 ;  p. 
426,  ()  666  ;  p.  429-430,  <^  674  d ;  p. 
465,  «J  714  ;  p.  522-523,  (J  827  i,  c  ;  p. 
539,  ()  848  ;  p.  862-864,  «J  1066. 

their  impression  is  made  either  upon 
sympathetic  sensibility  or  irritability 
through  the  medium  of  their  direct 
seat  of  action,  when,  in  either  case, 
the  morbific  influences  are  propagated 
to  other  parts  by  an  alterative  influ- 
ence of  reflex  action  of  nervous  sys- 
tem, which  is  also  true  of  remedial 
agents,  p.  66-67,  (>  148-151  ;  p.  89- 
90,  {)  188-188^  d,  &c.  ;  p.  101-103, 
()  201-204;  p.  106-109,  <)  222-230; 
p.  280-282,  ^  450-451  ;  p.  284-287, 
^  455-459  ;  p.  323-362,  i)  499-530  ; 
p.  415-417,  ^  649  a-c;  p.  421-423, 
<}  657-658  ;  p.  661-663,  <^  894  6-896  ; 
p.  665-670,  ()  892  a-ni ;  p.  679-681, 
(j  905  a ;  p.  520,  ()  826  c ;  p.  849,  (^ 
1059  ;  p.  930,  t)  1088.  Reflex  Ac- 
tion OF  Nervous  System,  Index  II.  ; 
Nervous  Power,  Index  I.  and  II. 

influenced  by  special  endowments  of 
different  tissues  and  parts  of  tissues, 
by  their  varying  susceptibilities,  by 
age,  constitution,  habits,  and  by  many 
morbific  causes  which  simply  predis- 
pose the  body  to  be  acted  upon  by 
some  other  predisposing  cause  of 
more  profound  operation,  but  the 
former  of  which  without  the  latter 
would  be  inoffensive,  and  yet  not  un- 
frequently  add  to  the  violence  of  the 
disease,  as  witnessed  in  epidemic 
measles,  and  other  epidemics,  p.  59, 
()  129  h,  i;  p.  61-73,  ^  133-163;  p. 
366-367,  ()  556  a-d;  p.  372-397,  (j 
573-625 ;  p.  399,  ^  628, 630 ;  p. 415- 
416,  ()  649  a-c;  p.  418,  (^  851  b;  p. 
423-425,  <J  659-663  ;  p.  428,  i)  671  ; 
p.  503-512,  ()  795-817 ;  p.  524,  (J  827 
e,  689/,  961  a  970  c. 

eflfects  of,  according  to  one  or  more, 
each  one  or  according  to  the  number, 
ccEleris  paribus,  producing  special  in- 

R 


Causes,  Morbific — continued. 

fluences  that  result  in  particular  forms 
of  disease,  and  so  of  remedies,  p.  27, 
i)b2\  p.  400,  ^  630  d;  p.  417-420, 
i}  650-653  ;  p.  423-425,  i)  659-663  ; 
p.  545,  ^  860  ;  p.  547-550,  (^  863  d. 

one,  generally  the  most  important,  and 
commonly  indispensable  to  any  given 
form  of  disease,  as  in  malignant  chol- 
era, plague,  yellow  fever,  all  cases  of 
poisoning,  all  resulting  from  remedial 
agents,  &c.,  p.  418,  ()  652  b  ;  p.  419- 
420,  <J  653  ;  p.  423,  i)  659  ;  p.  545,  <J 
860. 

since,  therefore,  the  same  cause  is  always 
necessary  to  the  production  of  any 
specific  form  of  disease,  and  there  is 
no  resemblance  between  the  miasm 
which  is  allowed  by  all  to  sometimes 
generate  yellow  fever,  plague,  &c., 
and  the  morbid  products  of  living  or^ 
ganization,  it  is  impossible  that  these 
diseases  should  be  contagious  ;  and, 
for  the  same  reason,  small-pox,  mea' 
sles,  and  scarlet  fever  can  never  be 
propagated  but  by  contagion,  however 
the  body  may  be  predisposed  by  other 
causes  to  the  more  ready  and  profound 
action  of  their  virus,  p.  419-420,  (^  653. 
Also,  Self-limited  Diseases,  Index 
II 

operate  according  to  the  structure  and 
vital  constitution  of  parts,  and  as  they 
may  be  diverted  from  their  natural  con- 
dition. See  Structure,  and  Reme- 
dies, references  under  this  clause,  In- 
dex II. 

manifest  their  effects  at  intervals  corre- 
sponding more  or  less  with  their  na- 
ture, p.  420-423,  ^  654-659  ;  p.  426, 
()  666  a ;  p.  631-632,  i)  892i  b,  c. 

the  predisposing,  often  obscure,  p.  423, 
^  659. 

there  may  be  a  long  series  of  predis- 
posing causes,  each  one  progressively 
aflfecting  the  organic  states,  but  with- 
out any  special  marks  of  disease,  when 
some  exciting  cause,  innocent  in  per- 
fect health,  may  give  rise  to  a  sudden 
explosion  of  morbid  symptoms,  p.  65- 
66,  ^  143  b,  c  ;  p.  423,  ()  659  ;  p.  426, 
^  666. 

the  effects  of  morbific  causes,  physical 
and  mental,  like  those  of  a  remedial 
nature,  owing  to  the  mutability  of  the 
properties  of  life,  p.  87,  ()  177-182  ; 
p.  120-122,  (}  237-240  ;  p.  414,  ^  642 
b ;  p.  542,  ()  854  c,  d.  Also,  Vital 
Properties,  Index  I. 

hereditary  predisposition  equivalent  to 
remote  predisposing  causes,  p.  424,  ^ 
661  ;  p.  560-561,  (J  886. 

one  disease  becomes  apredisposingcause 
of  the  same  or  of  other  diseases  in  other 
parts,  or  may  act  simply  as  an  exciting 
R  R 


994 


INDEX    II. 


Causes,  Morbific — continued. 

cause  when  the  latter  are  predisposed 
by  other  causes,  or  may  be  both  to- 
gether, and  more  or  less  according  to 
the  peculiarities  attending  the  vital 
constitution  of  different  parts,  and  by 
its  disturbing  influence  of  that  reflex 
action  of  the  nervous  system  by  which 
all  parts  are  constantly  maintained  in 
harmonious  relation  to  each  other,  and 
in  one  universal  concerted  action ;  and, 
as  diseases  thus  spring  up,  one  after 
another,  through  the  natural  and  for- 
ever operating  law  of  reflex  nervous 
action,  they  react  upon  and  mutually 
aggravate  each  other,  while,  through 
the  same  natural  operation  of  the  nerv- 
ous influence,  a  blow  may  be  simul- 
taneously struck  at  the  whole  by  a 
single  remedy,  as  by  bloodletting  or 
a  cathartic,  p.  59,  ()  129  A,  i;  p.  GI- 
GS, I)  133-152  ;  p.  75,  i)  165  b  ;  p.  89, 
I  188  a;  p.  101-102,  ()  201-203;  p. 
95,  (}  189  ;  p.  107-122,  ()  226-240  ; 
p.  282,  i)  451  e,f;  p.  284-286,  ^  455- 
456;  p.  323-361,  <;>  499-529;  p.415,i<) 
647  ;  p.  422,  <;.  660 ;  p.  424-425,  (}  662  ; 
p. 428,  ^673;  p.450,  H89/;  p.465- 
467,  (,  714-719  ;  p.  483,  (^  746  c;  p. 
497,1^779;  p.  506,  (^  803,804;  p.  508 
-512,  ^ 807-817 ;  p.  561,  ^ 886,  887  ; 
p.  592,  >J  891i  k;  p.  661-663.  <J  894- 
897 ;  p.  665-670,  ()  902  a-m  ;  p.  679- 
681, 1^  905  a  ;  p.  703-709,  ^  940-951. 

stimulants,  irritants,  and  sedatives,  give 
rise  to  analogous  conditions  of  disease, 
though  modified  by  the  nature  of  each 
cause,  p.  480,  f)  743  ;  p.  487-489,  ^ 
756  ;  p.  497-498,  ^  779-780  ;  p.  510 
-512,  ()  813-817;  p  523,  ()  827;  p. 
708,  ()  950  ;  p.  733,  ^  974  b;  p.  773- 
775,  ^  1024  ;  p.  829,  ^  1057  a. 

their  modus  operandi,  and  of  remedial 
agents,  through  reflex  action  of  the 
nervous  system,  illustrated  by  a  Scton, 
p.  679-681,  <;.  905  a. 

may  extinguish  the  susceptibility  to  their 
action,  p.  364-366, 1)  544-556  ;  p.  425, 
^  664.     Also,  Sm.4LI--pox,  Lidex  II. 

may  establish  a  permanent  predisposition 
to  disease,  p.  425-426,  (:)  665.  Also, 
Predisposition,  Index  II. 

the  predisposing,  important  to  be  known, 
p.  424-425,  ^  662 ;  p.  487-488,  ^ 756 ; 
p.  509,  <J  811;  p.  510,  ^813*,-  p.  545, 
5  859  b;  p.  560-561,  <S>  886. 

do  not  operate  upon  all  exposed  in 
times  of  epidemics,  and  why,  p.  394, 
1^615,616;  p.  397,  ^  623-625  ;  p.  415, 
(^  648  b ;  p.  425,  ^  663. 

prcdisposilion,  in  what  it  consists,  p.  426 
-427,  <^  666.     Also,  Predisposition, 
Index  II. 
Cause,  Pathological.     See  Pathologi- 
cal Cause,  Index  II. 


Cell,  Primordial,  (See  Cells,  Index  I.), 

differs  in  organization  in  each  species 
of  animals  and  plants,  as  shown  by 
microscope,  p.  812-814,  (j  1051. 

wanting  in  low  organic  beings,  p.  813- 
814,  ^  1051  b. 

shown  to  be  radically  different  in  ani- 
mals and  plants  by  the  difference  in 
the  means  of  their  subsistence,  p.  15, 
<^  1 1  ;  p.  135-138,  (^  298-303i  ;  p.  815, 
(Ji  1052.  Also,  p.  44,  ^72. 
Cerebro-Spinal  System.     See  Index  I., 

and  Nervous  System,  Index  II. 
Chemical      Physiologists  —  continued 
from  Index  I., 

their  unavoidable  inconsistencies,  con- 
tradictions, admissions,  and  perver- 
sions of  Nature  demonstrate  the  ab- 
sence of  all  relationship  of  Organic 
Chemistry  to  Physiology,  Pathology, 
and  Therapeutics,  ^.2,1)  \b ;  p.  6-14, 
(^  4i-6  ;  p.  19,  (^  \S  e;  p.  24,  ()  42 ; 
p.  30-32,  'J  57-59  ;  p.  33,  ij  60  ;  p. 
38-40,  ()  64  e-h ;  p.  43,  (J  67 ;  p.  86, 
(J  175  d;  p.  95-96,  ^  189  b;  p.  132- 
133,  «J  289-292;  p.  139,  ^  303f ;  p. 
149,  ^  338-339  a;  p.  152-155,  (>  345 
-349  ;  p.  156-173,  ^  350,  the  parallel 
columns  ;  p.  174-191,  ^  350^-350|-; 
p.  196-203,  {)  360-376^  ;  p.  234-236, 
^  433-436;  p.  237-261,  <}  437^- 
445  d ;  p.  274-279,  (}  447^-448  ;  p. 
482,  ^  744  ;  p.  484-489,  <)  747-756 ; 
p.  514-540,  ()  819-851 ;  p.  690-691, 
I  906-910;  p.  779-782,  ^  1028- 
1030;  p.  794-799,  ^  1033  6-1034. 
Also,  Organic  ChemIstry,  Index  I. 
and  II. 
Chemistry,  Medical  —  continued  from 
Index  I, 

continues  to  offer  its  testimony  in  be- 
half of  rational  medicine,  p.  779-782, 
^  1028-1030.  Also,  p.  433-434,  <j 
676  b  ;  p.  762,  «;»  1006  a. 

why  incapable  of  yielding  any  light  to 
the  different  branches  of  Medicine, 
p.  8,  1^5  ;  p.  157,  ()  350,  mottoes,  h, 
i,  k;  p.  191,  ^  351  ;  p.  202-203,  ^ 
3764  ;  p.  207,  ^  376f  b ;  p.  798,  ^ 
1034. 

where  Fourcroy  left  it  seventy  years 
ago,  as  admitted,  p.  9,  (J  5  ;  p.  202,  ^ 
3761  ;  p.  781,  ^  1029. 
Childhood, 

extends  from  the  age  of  two  and  a  half 
to  fifteen  or  seventeen  years  in  males, 
and  fourteen  to  seventeen  in  females, 
p.  375,  (}  577  a — its  physiological  and 
mental  characteristics,  ^  577  b — which 
give  rise  to  new  diseases  or  to  new 
modifications  of  infantile,  with  illus- 
trations, ()  577  c — and  corresponding 
results  from  remedies,  ^  577  d. 
Chloroform,  Action  of.  See  Anaes- 
thetics, Index  II. 


INDEX    II. 


995 


Chorea, 

treatment  of,  p.  590,  ()  891^  h,  d;  p.  848, 
ij  1058  e.     Also,  Antispasmodics, /«- 
dex  II. 
Cinchona  and  its  Alkaloids, 

introduction  into  practice,  p.  593-595,  ^ 
892  a. 

exemplify  what  are  called  specific  vir- 
tues, but  which  are  often  manifested 
only  when  preceded  by  other  reme- 
dies that  may  be  more  curative,  or 
will  be  morbific  without  the  latter ; 
since  the  "  specifics"  possess  tonic  as 
well  as  febrifuge  virtues,  and  the  for- 
mer will  transcend  the  latter  if  the 
.  pathological  conditions  be  not  brought 
into  a  proper  relation  to  the  febrifuge 
virtue  ;  while,  also,  they  are  specific 
only  in  the  same  sense  as  coffee  and 
the  cold  dash  are  specifics  for  poison- 
ing by  opium,  p.  595-596,  ^  892  aa. 
Also,  p.  67,  (}  149-151  ;  p.  422-425, 
<J  662  a-c  ;  p.  430-433,  (^  675  ;  p. 
508-511,  ()  807-816;  p.  547-550,  <J 
863  d ;  p.  553-556,  ^  870  «a-872  a ; 
p.  571-572,  (}  890  b;  p.  581,  «J  890^ 
c;  p.  596-598,  <J  892  b,  c;  p.  605- 
607,  ^  892  m-r  ;  p.  737-738,  «J  984. 

a  great  practical  error  to  suppose  that 
Cinchona  cures  intermittents  by  its 
tonic  virtue,  since  it  will  aggravate 
all  other  fevers,  at  least  in  their  early 
stages,  and  all  inflammations  and  con- 
gestions that  are  not  the  consequence 
of  the  same  causes  that  produce  inter- 
mittents, p.  553,  ^  870  aa ;  p.  605- 
607,  ^  892  m-r ;  p.  608-609,  ()  892^  c. 

exemplify,  with  other  things,  the  im- 
portance of  ascertaining  the  remote 
predisposing  cause  of  disease,  p.  417- 
418,  <J 548-551  a;  p.  424-425,  ()  662  a- 
c.    Also,  Causes,  Morbific,  Index  II. 

their  modus  operandi  not  obscure,  as 
reputed,  but  through  remote  sympa- 
thy or  alterative  influence  of  reflex 
action  of  nervous  system,  p.  596-597, 
(j  892  d;  p.  676-679,  ()  904  c,  rf— il- 
lustrated by  the  modus  operandi, 
through  remote  sympathy,  of  the  cold 
dash  and  coffee  as  antidotes  for  poi- 
soning by  opium,  p.  338,  ^  514  <Z ;  p. 
592-593,  {)  89H  k;  p.  737-738,  ^ 
984  b.  Also,  Sympathy,  Sensibil- 
ity, Sensation,  Nervous  Power, 
Index  I.  Nervous  Power,  Reflex 
Action  of  Nervous  System,  Reme- 
dial Action,  Index  II. 

only  one  of  a  vast  variety  of  means  that 
will  arrest  intermittent  fever,  and  de- 
rived from  the  three  kingdoms  of  Na- 
ture, as  well,  also.  Mental  Emotions 
— thus  showing  their  modus  operandi 
through  alterative  influence  of  reflex 
nervous  action,  or  oi direct  in  the  case 
of  the  Passions,  and  the  consequent 


Cinchona  and  its  Alkaloids — continued. 
substitution  of  more  favorable  patho- 
logical conditions  according  to  the 
nature  of  the  remedy,  p.  597,  <5i  892  c. 
Also,  p  69,  ()  149-151  ;  p.  87,  (j  177- 
182 ;  p.  107-110,  ^  227-232  ;  p. 426, 
<J  666  ;  p.  430-433,  ^  675-676  ;  p.  473 
-474,11  733  e ;  p.  542,  ^  854  c-e ;  p. 
545,  ^  860  ;  p.  547-550,  <;.  863  d ;  p 
061-670,  ^  894-902  ;  p.  704,  ^  943  b 
-944  «  ;  p.  707,  ^  947  ;  ()  892  b,  892^ 
V,  951  c.  Remedial  Action,  subdi- 
vision Mental  Emotions,  Index  II. 

two  methods  of  treatment  by,  the  mod- 
erate and  excessive,  one  regarding 
the  recuperative  law,  the  other  rely- 
ing wholly  upon  the  drug,  and  their 
results  considered,  p.  596-604,  <J  892 
Z>-i-.— Notes  K  p.  1119,  L  p.  1120. 
Circulation  of  the  Blood — continued 
from  Index  I.     See  Veins,  Index  II. 

a  right  estimate  of  the  powers  which 
carry  on  the  circulation  import&nt  in 
philosophical  and  practical  medicine, 
p.  208,  (^  382  ;  p.  214-215,  «J  393-396 
—  prevailing  errors  in  regard  to  it 
prolific  of  evil,  p.  208,  ^  383  ;  p.  215, 
(j  394. 

Author  assigns  seven  elements,  which 
concur  harmoniously  together,  p.  209, 
(J  384  ;  p.  934.  i)  1090. 

Author  shows  an  exquisite  vital  consent 
of  action  of  veins  with  the  arteries 
through  reflex  influence  of  cerebro- 
spinal and  ganglionic  systems,  "not 
less  so  than  the  iris  with  the  retina" 
— excluding  the  mechanical  doctrine, 
p.  210,  «;>  389  ;  p  215,  i)  394,  395  ;  p. 
216,(^399;  p.  286,  ^56  a,  J  ;  p.  340, 
(J  514  k ;  p.  827, §  1 066,  p.  503,  §  794. 

venous  circulation  determined  princi- 
pally by  derivative  power  of  the  right 
cavities  of  the  heart,  and  the  arterial 
through  the  pulmonary  veins  by  the 
left  cavities  ;  but  a  propelling  power 
of  the  arterial  capillaries  is  indispens- 
able, assisted  also  by  the  muscular 
power  ofthe  veins,  p.  210-211,1^388, 
389,390  6;  p.  212-213,  ij  392;  p.  215, 
()  396  ;  p.  503,  ^  794  ;  p.  934,  <J  1090. 

objections  answered,  p.  211,  <J  389,  390 
b;  p.  214,  ()  392  c. 

Author  shows  that  the  suction  power 
of  the  heart  is  indispensable  to  the 
portal  circulation,  and  to  that  of  the 
lymphatics,  lacteals,  thoracic  duct,  and 
umbilical  vein,  p.  211,  (;» 390  a;  p.  214, 
^  392  c,  d — and  shows  that  the  valves 
of  the  veins  are  always  open  unless 
there  be  a  reflux  of  blood,  p.  212,  <;>  391 . 

the  action  of  the  capillary  arteries,  and 
the  influence  of  the  nervous  system 
upon  them,  and  upon  the  veins,  shown 
by  their  natural  phenomena  and  by 
Exp.  by  BuNivA   and  Procter,    p. 


996 


INDEX    II. 


Circulation  of  the  Blood — continued. 

216,  6  394-399  ;  p.  227,  MH  ;  P- 
485,  «^  750  a,  and  p.  827,  ^  1056. 
Also,  Medical  and  Physiological  Com- 
mentaries, Article  Powers  which 
Circulate  the  Blood,  vol.  ii ,  p. 
398-426,  where  the  foregoing  sub- 
jects are  elaborated ;  and  j4§ticle  The- 
ories OF  Inflammation,  p.  141-207. 

Coffee, 

its  modus  operandi  through  alterative 
action  of  reflex  nervous  influence  as 
an  antidote  for  poisoning  by  opium, 
and  illustrated  by  analogous  effects 
of  cold  dash  through  the  same  influ- 
ence, p.  338.  i^bUd;  p.  592-593,  () 
89 U  k;  p.  737-738,  ^984  6. 

Cold,  Shower  Bath,  &c., 

employed  to  illustrate  the  reflex  action 
of  the  nervous  system  in  the  produc- 
tion and  cure  of  diseases,  whatever 
part  may  be  the  seat  of  the  direct  ac- 
tion of  remedial  and  morbific  agents, 
and  to  show  how  readily  and  vari- 
ously the  nervous  influence  is  modi- 
fied in  its  nature,  and  how,  as  render- 
ed thus  alterative  of  organic  actions, 
it  readily  lights  up  diseases,  or  proves 
the  direct  efficient  means  of  cure — 
being  equally  true  of  mental  emotions 
according  to  their  nature  as  of  phys- 
ical causes,  p.  107-112,  <^  227-234  b ; 
p.  230,  ()  422 ,  p.  245,  <J  440  e ;  p. 
253,  1^  441  d;  p.  323-324,  (>  499- 
500  c;  p.  338,  ^  514  d;  p.  339-341, 
^514  g-m ;  p.  359,  ^  527  b ;  p.  360, 
^527d;  p.416-417,  ^649  c;  p.  421 
-422,  ^  657  ;  p.  661-663,  ()  894-896  ; 
p.  670-671,  ^  902  m ;  p.  880,  (^  1074. 
Also,  Skin  ;  Causes,  Morbific,  In- 
dex II;  p.  580,  §  8901  d- 
illustrates,  also,  from  its  want  of  astrin- 
gency,  and  difficulty  of  its  absorption, 
the  modus  operandi  of  Astringents 
through  alterative  influence  of  reflex 
action  of  nervous  system,  p.  533,  ^ 
842  ;  p.  572,  ()  890  b.  Also,  last  pre- 
ceding references,  and  Ipecacuanha, 
Index  II. 

COLOCYNTH, 

its  therapeutical  and  morbific  eflfects,  p 
856,  ()  1063. 
Combustion,  Spontaneous, 

of  the  human  body,  p.  863,  <J  1066  a. 
Constipation,  Habitual, 

most  successfully  treated  by  small  and 
frequently-repeated  doses,  and  not  by 
full  and  rarer  doses,  of  cathartics — 
the  reflex  nervous  influence  being 
mildly  maintained  in  the  former  case, 
while  it  is  abrupt  and  violent  in  the 
latter,  p.  366,  ()  556  b,  and  references 
there ;  p.  567-569,  ^  889  l-mm.  Also, 
Alteratives,  Cathartics,  Exer- 
cise, Index  II. 


Consumption.     See  Phthisis  Pulmona- 

Lis,  Itidex  II. 
Contagion — continued  from  Index  I, 

subject  to  the  law  of  limitation  in  re- 
spect to  causes  of  a  specific  nature — 
showing  that  yellow  fever,  plague, 
small-pox,  measles,  and  scarlet  fever 
can  not  b^  alike  produced,  in  either 
case,  by  vegetable  miasmata  and  by 
the  morbid  products  of  living  organi- 
zation. And  so,  upon  the  same  prin- 
ciple, nothing  will  change,  in  a  sound 
constitution,  an  inflammation  of  the 
common  kind  into  a  specific  form,  un- 
less as  when  a  specific  virus  is  applied 
to  a  wound  or  an  ulcer,  and  also  un- 
less some  specific  predisposition,  like 
the  scrofulous  diathesis,  be  implanted 
in  the  constitution  (which  is  equiv- 
alent to  a  specific  remote  cause) ;  and 
each  one  of  the  specific  causes  will 
produce  a  particular,  and  generally 
well-marked  species  or  variety  of  the 
disease.  And  so  of  yellow  fever,  in- 
termittent fever,  plague,  &c.,  p.  27, 
^  52  ;  p.  418-420,  ()  652-653.  Also, 
Causes,  Morbific,  Index  II. 
Convulsions, 

contrary  to  the  opinion  of  Marshall  Hall, 
that  "  all  convulsive  aflfections  arc 
diseases  of  the  true  spinal  or  excito- 
motory  system ;"  they  are  commonly 
owing  to  simple  irritation  propagated 
from  distant  parts  both  upon  the  brain 
and  spinal  cord,  and  the  consequent 
reflection  of  an  irritating  nervous  in- 
fluence upon  the  voluntary  muscles. 
Hence  a  division  of  the  gum,  or  of  a 
nerve  or  tendon,  or  a  warm  poultice 
to  them,  or  an  enema,  may  at  once 
put  an  end  to  the  trouble,  p.  357-358, 
^  526  d;  p.  590-591,  ^  89H  b;  p. 
592-593,  ()  89U  k. 

questions  of  this  nature  not  to  be  de- 
termined by  experiments  which  do 
not  refer  to  the  nervous  system  as  a 
whole,  p.  287-290,  <J  458-46H;  p. 
292,  ()  473  a ;  p.  296,  <)  476  c ;  p. 
303,  ^  481  e,  f.  Also,  Mental  Emo- 
tions, Index  II. 

nevertheless,  diseases  ot  the  brain  and 
spinal  cord  are  apt  to  give  rise,  both 
by  direct  and  reflex  action,  to  great 
disturbances  in  the  organs  of  organic 
life,  and  the  Passions,  through  the 
intercommunication  of  the  cerebro- 
spinal and  sympathetic  systems,  may 
produce  convulsions,  as  in  hysteria ; 
though  not  so  diseases  of  the  nerv- 
ous centres,  unless  they  result  in  ef- 
fusion or  disorganization,  p.  334,  () 
508. 

how  relieved  by  Antispasmodics  through 
reflex  action  of  the  nervous  system. 
See  Antispasmodics,  Index  II. 


INDEX    II. 


997 


Cotton  Wool, 

a  sedative,  and  curative  of  inflammations 
and  ulcers,  p.  833,  ()  1057  k. 
Counter-Ieritants, 

belong  to  Author's  eighth  order  of  Anti- 
phlogistics,  and  consist  of  Vesicants, 
Rubefacients,  Suppurants,  Escharot- 
tcs,  Potential  Cauterants,  Actual  Cau- 
terants.  Other  groups  belong  to  this 
order  of  Local  Applications,  p.  642- 
644,  ()  893  a,  b. 

vesicants  the  most  important,  but  mostly 
limited  to  the  genus  Cantharis,  p.  644, 
«J  893  c. 

all  may  operate  upon  internal  parts 
through  alterative  influence  of  reflex 
action  of  nervous  system  ;  but  many 
of  them  are  commonly  local  only  in 
their  effects.  Whenever  they  exceed 
the  limit  of  local  action,  it  is  through 
reflex  nervous  influence,  and  this  in- 
fluence, especially  in  the  case  of  vesi- 
cants, instead  of  being  curative,  may 
produce  or  aggravate  disease,  accord- 
ing to  existing  susceptibilities  and  the 
natural  endowment  of  tissues  and  or- 
gans, and  throw  the  whole  body  into 
universal  commotion — by  which  is 
exemplified  the  close  analogy  between 
remedial  and  morbific  agents,  and,  as 
demonstrated  (articles  Cantharidcs, 
Seton, Cold,  &c..  Index  II.),  that  reme- 
dies do  not  operate  by  absorption,  but 
through  alterative  action  of  the  nerv- 
ous influence,  and  according  to  the 
nature  of  the  remedy  or  mental  emo- 
tion and  the  existing  susceptibilities 
of  organs  that  may  arise  from  disease, 
&c  ,  p.  338,  I)  514  d;  p.  359-360,  (} 
527  b ;  p.  592,  i;  89U  9 ;  V  642-659, 
()  893  a-q ;  p.  679-681,  ^905  a;  p. 
850,  ^  1059 ;  ^  1088.  Reflex  Ac- 
tion OF  Nervous  System,  Remedies  ; 
C.iusEs,  Morbific  ;  Mental  Emo- 
tions, Structure,  Index  II. ;  Nerv- 
ous Power,  Index  I.  and  II. 

introductory  review  of  problems  relative 
to  the  operation  of  other  remedies 
through  alterative  action  of  reflex 
nervous  influence  to  facilitate  an 
understanding  of  the  same  modus 
operandi  of  Counter-irritants,  which 
opens  widely  a  view  of  the  Author's 
principles  relative  to  vital  solidism, 
and  direct  and  reflex  action  of  the 
nervous  system  in  the  production  and 
cure  of  disease,  p.  645-646,  ^  893  c,  d. 

their  immediate  effect  strictly  morbific, 
variously  modifying  the  nervous  in- 
fluence, and  imparting  to  it  an  alter- 
ative condition  which  may  be  either 
i  curative  or  morbific  according  to  ex- 
isting susceptibilities,  &c.,  p.  646- 
658,  ^  893  c-p.  Also,  the  foregoing 
references  to  Index. 


Counter-irritants — continued. 

the  artificial  inflammation  produced  by 
the  vesicating  plaster  either  in  the 
skin  or  the  bladder  readily  subsides, 
and  thus,  also,  through  its  develop- 
ment and  modification  of  reflex  nerv- 
ous influence,  it  institutes  such  path- 
ological changes  in  diseased  internal 
organs  as  to  lead  to  their  speedy  cure 
— thus  illustrating  the  morbific  nature 
of  positive  remedial  action  and  its  dis- 
tinction from  the  effects  of  more  pro- 
foundly morbific  causes,  that  remedies 
cure  by  substituting  new  and  transi- 
tory pathological  conditions,  and  the 
great  recuperative  law  of  Nature  ;  and 
which  is  farther  shown  by  the  manner 
in  which  the  plaster  of  Cantharides 
will  arrest  erysipelas,  and  the  oil  of 
turpentine  relieve  scalds,  p.  646-647,  () 
893c-e;  p. 652,  (^893/;  p.  682,  ^905b. 

the  foregoing  quick  subsidence  of  the 
artificial  inflammations  illustrates, 
also,  the  principle  involved  in  the 
spontaneous  subsidence  of  the  self- 
limited  diseases  ;  for,  however  pro- 
foundly their  morbific  causes  may 
operate,  they  carry  with  them  the 
virtues  which  administer  to  the  re- 
cuperative law,  and  are  on  common 
ground  with  remedial  agents  when 
these  give  rise  to  inflammation,  p. 
544-545,  ^  853  ;  p.  850,  ()  1059. 
Also,  Remedies,  Remedial  Action  ; 
Diseases,  Self-limited,  Index  II. 

their  curative  and  morbific  effects  upon 
deep-seated  parts  refute  the  doctrine 
of  the  operation  of  remedies  by  ab- 
sorption, and  confirm  the  Author's 
doctrine  of  the  alterative  influence 
of  reflex  action  of  nervous  system,  p. 
338,  ^  514  d;  p.  347,  ^  516  d,  Nos. 
12,  13;  p.  642-647,  <)  893;  p.  679- 
681,  <J  905  a;  p.  850,  <J  1059  a,  1088. 

the  cutaneous  effusions  to  which  they 
give  rise  not  instrumental,  p.  648,  ^ 
893  /;  also.  Sweat,  Index  II. — nev- 
ertheless, full  vesication,  like  active 
purging,  is  often  indispensable  ;  and 
there  is  a  great  difference  in  the  results 
of  simple  Rubefacients  and  vesication 
by  Canthandes,  ibid.,  and  p.  564,  <J  889 
b;  p.  565,  <J  889/ — which  difference 
is  owing,  in  part,  to  the  difference  in 
the  virtues  of  the  remedies,  and  in 
part  to  the  difference  in  time,  as  seen 
particularly  in  vesication  by  Canthar- 
ides and  scalding  water,  and  in  the 
difference  in  results  in  the  treatment 
byoneortheotherofacute  and  chronic 
inflammations — and  by  the  whole  of 
which  is  illustrated  the  philosophy 
which  concerns  the  vast  difference 
between  a  sudden  and  gradual  devel- 
opment of  reflex  nervous  influence 


998 


INDEX    II. 


Counter-irritants — continued. 

of  a  deleterious  nature,  as  seen,  in 
the  former  case,  in  the  fatal  effects 
of  blows  upon  the  epigastric  region, 
the  shock  of  surgical  operations,  and 
the  violent  passions,  hydrocyanic  acid, 
tartarized  antimony,  a  large  abstrac- 
tion of  blood,  p.  648,  I)  893  g-;  p.  650- 

651,  i)  893  I.  Also,  p.  296,  ^  476  c, 
476^  i;  p.  298-299,  ij  476i  ^-477  a  ; 
p.  300,  I)  479;  p.  304,  (^  481  g;  p. 
319-320,  <)  494  ;  p.  334-336,  ^  509- 
511  ;  p.  523-524,  <)  827  d;  p.  525,  () 
828  b,  c  ;  p.  661-663,  ^  894-896  ;  p 
703-711,  ^  940-952  ;  p.  726,  (^  961. 

opposed  to  the  sudden  and  violent  op- 
eration of  counter-irritants,  &c.,  as 
last  considered,  is  the  gradual  and 
persistent  development  of  reflex  nerv- 
ous influence  as  manifested  by  small 
and  frequently  repeated  vesications, 
and  by  setons  and  issues,  in  treating 
chronic  inflammations — the  decision 
being  in  favor  of  the  first  remedy,  p. 
648-649,  <J  893  g,  h;  p.  679-681,  ^ 
905  a — it  being  the  same,  also,  in  the 
case  of  small  and  repeated  leechings, 
p.  696-697,  ^  926,  927  a.  Also,  Al- 
teratives, Leeching,  Lidex  II. 

the  extent  and  part  of  the  surface  vesi- 
cated, and  the  intensity  of  the  artificial 
inflammation,  and  the  time  of  applica- 
tion, as  it  respects  antecedent  means, 
are,  as  with  other  remedies  in  their 
appropriate  use,  important  considera- 
tions, p.  649-652,  ^  893  i-n. 

comparison  between  the  physiological 
effects  of  scalding  water,  cantharides 
plaster,  rubefacients,  and  moxa,  p. 
650-651,  ^  893  i. 

the  vesicating  piaster  generally  too  small, 
and  may  be  useful  only  from  a  determ- 
ination of  a  powerfully  alterative  in- 
fluence of  reflex  action  of  the  nervous 
system,  obtained  by  vesicating  a  very 
large  surface,  p.  651,  ^  893  k;  p.  847, 
()  1058  q. 

in  acute  inflammations,  and  often  in 
chronic,  bloodletting,  cathartics,  &c., 
important  as  preliminary  remedies, 
and  vesicants  should  be  the  last  in 
the  series,  p.  657-658,  ()  §93  p;  p. 
765-766,  (J  1007  6-1008  ;  p.  847,  ^ 
1058  q. 

how  managed  in  cerebral  inflammation, 
p.  651,  ^  893  k ;  p.  847,  ()  1058  q. 

with  certain  exceptions,  the  nearer  vesi- 
cants are  applied  to  the  region  of  dis- 
ease the  better,  nor  does  it  appear  to 
be  of  any  great  moment  what  tissue 
of  an  organ  may  be  affected,  p.  651- 

652,  ()  893  k-m. 

Utility  of  vesicants  in  hemorrhage  from 
important  organs,  p.  659,  <^  893  r. 
Also,  Hemorrhage,  Index  II. 


Counter-irritants — continued. 

vesication  by  Cantharides  sometimes 
followed  by  a  bad  condition  of  the 
skin,  but  only  so  in  special  and  se- 
vere forms  of  disease,  p.  657,  <^  893 
o;  far  greater  evils  result  from  their 
premature  application,  and  where 
bloodletting,  &c.,  should  be  the  rem- 
edies, p,  657-658,  ^  893  p. 

unfavourable  conditions  for  their  use,  p. 
657-658,  ()  893  o,  p. 

analogy  between  counter-irritation  and 
leeching,  p.  648-649,  (/  893  g,  h ;  p. 
659,  (j  893  q  ;  p.  696-697,  ^  926,  927 
a.     Also,  Leeching,  Index  II. 

many  other  local  remedies  not  belong- 
ing to  the  group  of  Counter-irritants 
operate  more  or  less  upon  the  same 
principle  of  alterative  influence  of  re- 
flex action  of  nervous  system,  such 
as  iodine,  mercurial  plaster,  veratria, 
aconite,  camphor,  &c.,  p.  659,  ^  893 
q.  Also,  Plasters,  Aconite  under 
Sedatives,  Index  II. 

the  doctrines  of  7netastas2S  and  repul- 
sion examined  through  the  analogous 
vital  endowments  of  tissues  of  the 
same  kind,  and  in  connexion  with 
counter-irritation — the  doctrines  hav- 
ing led  to  a  great  abuse  of  remedies 
— the  whole  illustrating  the  capri- 
cious alterative  influences  of  reflex 
action  of  the  nervous  system  when 
directed  by  malpractice,  p.  652-656, 
<)  893  n.  Also,  Structure  ;  Causes, 
Morbific  ;  Remedial  Action,  Lidex 
II. ;  Nervous  Power,  Index  I.  and 
II  Also,  p.  351,  "J  524  J,  c. 
Croton   Oil,  Modus  Operandi   of.     See 

Oil,  Croton,  hidcx  II. 
Croup, 

illustrates  diflerences  in  the  vital  con- 
stitution of  parts,  p.  61-62,  <J  134, 
135. 

its  disappearance  in  early  life  owing  to 
changes  in  the  constitution  of  tissues, 
p.  374,  ^  576  d^;  p.  376,  <J  577  e 
Also,  Structure,  Index  II. 

treatment    of,  by   bloodletting,  &.C.,  p. 
375,  ^  576  e ;  p.  638,  <)  892^.  /;  p. 
696,  ^  925  b  ;  p.  76.6-778,  (  1009- 
1013  ;  p.  846,  §  1058  p,  964  d^ 
Cupping, 

intermediate  in  efi'ects  between  general 
bloodletting  and  leeching,  but  most 
allied  to  the  former,  since  it  does  not 
institute  the  specific  changes  of  the 
latter  in  the  divided  vessels,  p.  702- 
703,  ()  939. 

deficient  in  that  special  reflex  nervous 
influence  which  belongs  to  leeching, 
and  in  that  important  abruptness  and 
decision  of  the  same  influence  which 
forms  the  great  advantage  of  general 
bloodletting,  and  can  therefore  rarely, 


INDEX    II. 


999 


Cupping — continued. 

if  ever,  supersede  the  other  methods, 
p.  702-703, 1)  939  e,f.  Also,  Gener- 
al Bloodletting,  Leeching,  Nerv- 
ous Power,  Index  II. 

diiference  from  leeching  farther  shown 
by  the  blood  flowing  from  larger  ves- 
sels, and  will  not  flow  without  cup- 
ping-glasses, while  patients  have  died 
of  hemorrhage  from  a  single  leech- 
bite,  p.  694,  {)  922 ;  p.  702,  ^  939. 

most  useful  in  early  life,  as  the  quan- 
tity of  blood  abstracted  is  greater  in 
the  ratio  of  size,  p.  696,  <J  925  b ;  p. 
703,  ^  939  / 


D. 


Darwin,  Ch. — On  the  Origin  of  Species 

by  Natural  Selection,  p.  814,  note. 
Death — continued  from  hidex  I., 

physiology  of,  p.  401,  ^  631  ;  p.  402- 
404,  ()  634-637;  Note  C  p.  1113. 

when  natural,  the  result  of  progressive 
changes  incident  to  organic  functions, 
p.  401-402,  ^  633.  Also,  Structure, 
Childhood,  Youth,  Index  II. 

life  maintained  after  apparent  death,  p. 
403,  i;»637;  p.  805,  <^  1041. 

rise  of  heat  after  apparent,  p.  266,  ^ 
U7  d. 

reflex  action  of  nervous  system  often 
occurs  after  apparent  death,  and  oc- 
casions movements  of  the  voluntary 
muscles,  p.  403,  <)  637;  p.  805,  () 
1041. 

alternate  contraction  and  dilatation  of 
iris  from  light  after,  p.  806,  ()  1041  ; 
p.  875-876,  ()  1072  a. 
"Debility" — continued  from  Index  I., 

doctrine  of,  and  its  fatal  tendencies,  p. 
313,  ()  487  h  ;  p.  371-372,  ()  569  b-e 
p.  396,  t)  621  a;  p.  480-481,  ()  743 
p.  486-489,  (i  752-750  ;  p.  499,  <J  785 
p.  511,  ()  815;    p.  715-721,  ()  959- 
960  b;   p.  722,  ()  960  g;   p.  729,  ^ 
967;  p.  730-731,  l)  969  c-970  b;  p. 
735-736,  ^  977-990  ;  p.  749,  «;>  992  c  ; 
p.  751,  ()  999  c  ;  p.  753,  ^  1001  b  ;  p. 
756-757,  (,  1005  b-h  ;  p.  759-760,  () 
1005  ;,  k  ;  p.  764,  ^  1006  /-1007  b  ; 
p.  856-861,  <J   1063-1065;    p.  868- 
869,  ()  1068  a,b;  ^  887;  ^61*. 
Defecation, 

Author's  opinion  that  the  Intestine  is 
under  the  controlling  influence  of  the 
Will,  and  that  in  Defecation  the 
Will  brings  it  into  action  in  concert 
with  the  determination  of  the  nerv- 
ous influence  upon  the  abdominal, 
levator,  perinaeal,  and  sphincter  mus- 
cles —  supplying  a  remarkable  in- 
stance of  Creative  Design  in  the  crit- 
ical nature  of  rendering  a  portion  of 
the  intestine  a  voluntary  part,  and  as- 


Defecation — continued. 

sociating  its  action  with  that  of  the 
other  muscles  that  are  engaged  in 
defecation,  p.  325,  ()  500  e  ;  p.  326,  () 
bOOh.  Also,  p.  HI,  (J  233 J;  p.  113, 
^  234  c ;  p.  330,  ()  500  n  ;  and  Will, 
Intestine,  Index  I.  and  II. 
Delirium  Tremens, 

supplies  an  unusual  example  of  the 
modifying  effects  of  disease,  accord- 
ing to  the  nature  of  its  remote  cause, 
upon  the  operation  of  loss  of  blood, 
as  it  respects  its  influences  upon  the 
nervous  system,  especially  when  con- 
trasted with  its  effects  in  cerebral  in- 
flammation and  congestion,  p.  734,  ^ 
976  b;  p.  849,  ()  1058  y.  Also, 
p.  673,  note;  Brain,  Inflamma- 
tion OF,  Index  II;  p.  425,  i)  662  c. 
Diabetes, 

produced  by  pricking  floor  of  fourth 
cerebral  ventricle,  p.  792,  ^  1032  d. 

the  only  disease  in  which  sugar  is  said 
to  be  found  at  large  in  the  blood,  and 
this  questioned  by  many  Chemists,  p. 
786,  i)  1031  ;  p.  789,  ^  1032  b. 

blood  in,  said  by  Chemists  to  be  per- 
fectly natural,  p.  786-787,  i)  \Q^\  b. 

vegetable  food  in,  said  to  be  conducive 
to  the   disappearance  of  saccharine 
matter  from  the  urine,  p.  784,  <J  1031  b. 
Diarrhcea,  and  Cholera  Infantum, 

their  principles  of  treatment,  p.  567,  (j 
889  k  ;  p.  571-572,  «J  890  b  ;  p.  575- 
576,  ^  890  h-l;  p.  577-578,  ^  890 
o-q;  p.  841,  ()  1058  d. 
Digestion  in  Animals  and  Plants,  or 
Assimilation, 

the  principal  element  of  assimilation  in 
animals,  p.  147,  ()  332. 

assimilation,  common  to  plants  and  an- 
imals, p.  125,  <^  249. 

the  function  by  which  the  properties  of 
life  are  communicated  to  dead  mat- 
ter, p.  134,  i)  296. 

chemical  changes  arrested  in  stomach, 
p.  134,  ij  297  ;  p.  135,  ^  301  ;  p.  150, 
«J  339  h. 

food  of  animals  organic,  of  plants  inor- 
ganic, p.  15,  ^  1 1-14 ;  p.  20,  (jlS  c; 
p.  135,  (j  300  ;  and  Index  I  and  11, 
Plants,  Plants  and  Animals. 

the  animal  dependent  on  the  vegetable 
kingdom,  but  reciprocally  useful  to 
each  other,  p.  15,  <)  9-14;  p.  135- 
136,  ()  303  ;  p.  137,  ()  303i  a-c— 
plants  the  providers  —  animals  the 
consumers,  p.  15,  ^  14 ;  p.  137,  () 
303i  a. 

assimilatin''  organs  very  simple  in 
plants,  pT  135-137,  ^  302-303. 

food  of  plants  mostly  from  atmosphere, 
and  comments  upon,  p.  135-137,  <J 
303. 

office  of  roots  and  leaves,  and  light  and 


loao 


INDEX    II. 


Digestion  in  Animals,  &c. — continued. 
darkness,  p.  136-137,  (^  303  c-e;  p. 
138-139,  <)  303^-303f. 

something  of  nitrogen,  and  oxygen,  p. 
136-137,  ^  303  a-303i  b;  p.  138,  ^ 
303^,  and  of  iron,  Notes  N,  R. 

carbonic  acid  gas,  food  of  plants,  and 
proportion  of  in  atmosphere,  how  it 
got  there,  and  other  comments,  and 
its  relation  to  oxygen,  p.  135-138,  (} 
303  a-303^. 

Liebig's  identification  of  functions  of 
living  with  the  physics  of  dead  plants, 
p.  13J,  ()  303i 
Digestion  (in  Animals) — continued  from 
Index  I., 

digestion,  respiration,  and  calorification, 
the  main  intrenchments  of  Organic 
Chemistry,  p.  147,  ^  333. 

comparative  view  of  reasoning  from  re- 
sults of  experiments  upon  animals  to 
physiological  and  morbid  conditions 
of  man,  and  chemical  experiments 
upon  dead  matter  with  the  same  in- 
tentions, p.  148,  ()  334,  335. 

the  three  schools  have  different  theories 
of,  p.  6-7,  ()  4^  ;   p.  149,  ^  337. 

Liebig's  doctrine  of  Chymification,  and 
method  of  reasoning,  p.  149-150,  ^ 
338-339  a;  p.  154-178,  ()  349-350|-. 
Also,  p.  239-279,  ()  440-448. 

Conclusions  from  Dr.  Beaumont's  ex- 
periments, and  tabular  view  of,  p.  150, 
()  339  b ;  p.  200,  ()  366. 

Spallanzani,  Hunter,  Fordyce,  Tiede- 
mann,  their  vital  doctrines  of,  p.  150- 

152,  <^  340-344. 

Front's  and  Carpenter's  reasoning  upon, 

p.  152-153,  ^  145-148. 
Roget  and  Wagner  doubtful  about  it,  p. 

153,  (J  348. 

Mulder's  application  of  Chemistry,  p. 
179-183,  ^  350J  a-g. 

opinion  of  the  "  Manchester  Literary 
and  Philosophical  Society^''  rendered 
in  favour  of  Author's  views,  p.  156, 
^  350. 

the  parallel  columns,  p.  19,  ^  18  e;  p. 
156-173,  ()  350;  p.  182,  i)  350J  gg  ; 
p.  189-190,  ()  350i  n;  p.  277-278,  ^ 
447^  b. 

organs  of,  in  animals,  complex  and  va- 
rious, with  a  corresponding  variety  in 
functions  and  gastric  juice,  and  food, 
p.  140,1^304-306;  p.  191-192,  (;.  353; 
p.  223-226,  (}  409  e-j. 

how  to  make  up  an  unknown  animal 
from  any  given  part,  as  a  tooth,  or 
bone,  &c.,  p.  144-145,  ()  323-324— 
all  the  parts  referring  to  the  digestive 
organs  and  special  nature  of  the  gas- 
tric juice,  and  the  kind  of  instinct 
also,  p.  145,  <}  325;  p.  193,  <J  356. 

varieties  as  to  stomach,  salivary  glands, 
liver,  and  organs  of  mastication,  p. 


Digestion  (in  Animals) — continued. 

140-141,  ()  306,  309-311  ;  p.  192,  <5 
353. 

prerogatives  of  the  stomach,  and  its  dis- 
tinctions from  all  things  else,  p.  145, 
^  325;  p.  148-149,  ()  336;  p.  193,  () 
356;  p.  191-196,  <;.  353-360. 

Chemistry  inconsistent  with  itself  in 
assuming  that  its  agencies  disturb 
those  organic  compounds  in  chymifi- 
cation which  had  been  elaborated  for 
the  purpose  of  receiving  in  the  stom- 
ach the  first  impress  towards  restor- 
ing their  organic  endowments,  and 
since  also  any  chemical  change  would 
be  a  restoration  of  the  compounds  to- 
wards that  condition  of  which  the 
vegetable  kingdom  takes  charge,  p. 
196,  ^  360,  361.  Also,  p.  15,  ^  13, 
14  ;  p.  16,  ()  16-18  ;  p.  24,  {)A2;  p. 
30,  ^  59  ;  p.  33,  (J  60  ;  p.  135,  (}  301 ; 
p.  143,  <J  322  ;  p.  201,  ()  374,  375. 

physiological  endowment  of  the  pyloric 
orifice,  p.  141-142,  ()  313. 

gastric  juice  the  principal  assimilating 
agent,  and  what  the  Vitalists  and 
Chemists  say  of  it,  p.  140-141,  ^  307  ; 
p.  150-152,  ()  340-344 ;  p.  152-153, 
<)  345-348;  p.  157-173,  ()  350,  Nos. 
6,  7  X  54  ;  8  X  55  ;  1 1,  12  X  58  ;  25- 
27  X  71-76  ;  29  X  78,  79,  parallel  col- 
umns ;  p.  193-199,  ^  356-364^^. 

uses  of  bile,  saliva,  &c.,  p.  142,  ^  314- 
316. 

chemical  substitutes  for  gastric  juice,  p 
197-203,  <;>  363-3761^;  p.  781,1)1029 
p.  784,  ()  1031  b. 

Chemistry  allows  that  "  we  are  wholly 
ignorant  of  the  proximate  metamor- 
phosis of  albuminous  bodies  in  the 
stomach  during  digestion  ;"  and  that, 
"  although  hypotheses  are  not  want- 
ing regarding  the  mode  of  action  of 
Pepsin,  we  know  nothing  of  its  na- 
ture,'' p.  781,  ^  1029. 

lacteals,  thoracic  duct,  progress  of  chyle 
to  the  lungs,  globules  in  chyle,  &c., 
p.  142-143,  ^  317-321. 

progress  of  assimilation  through  its  va- 
rious stages  to  its  consummation  in 
the  capillary  vessels  (the  main  instru- 
ments of  life  and  disease),  and  in  all 
its  magnificent  varieties,  yet  always 
the  same  in  every  individual  of  each 
species  of  animals  and  plants,  yet 
more  or  less  different  in  each,  p.  143 
144,  ()  319,  322  ;  p.  192-193,  <)  354- 
356  ;  p.  221-227,  (>  409  i-411. 

illustrations  of  the  foregoing  varieties 
in  organization,  products,  &c.,  and 
their  uniformity  in  each  species,  and 
in  all  parts  of  each,  drawn  from  indi- 
vidual animals  and  plants,  p.  223- 
226,  ()  409  c-j. 

the  whole  of  the  foregoing  united,  and, 


INDEX    II. 


1001 


Digestion  (in  Animals) — continued. 

along  with  the  laws  of  reflex  action 
of  the  nervous  system,  by  which  all 
are  maintained  in  one  everlasting  har- 
mony of  functions,  constitutes  a  more 
sublime  edifice  of  Design  than  all  else 
in  the  world  of  matter,  p.  146,  ()  326. 
Also,  p.  54-55,  (J  107-117;  p.  106- 
112,  ^  222-234  b;  p.  284-287,  ()  454- 
458. 

physiology  of  assimilation  applied  path- 
ologically— gastric  juice  changed  by 
gastric  disease,  which,  as  well  as  the 
influence  of  the  disease,  affects  the 
condition  of  the  blood,  though  Chem- 
istry cannot  tell  us  how  ;  and  Humor- 
alism  defeated  in  practice,  the  Vital 
Solidist  resolves  the  problem  and  de- 
monstrates the  art  of  making  healthy 
blood,  p  146-147,  ()  328-330  ;  p.  534 
-537,  ^  845-847  c;  p.  540,  ^  851  b; 
p.  780,  <J  1029  ;  Notk  R  p.  1123. 
Disease — continued  from  Index  I., 

conceded  that  Chemistry  reflects  little  or 
no  light  upon  it,  p.  433-434,  (^  876  b ; 
p.  762,  ()  1006  a ;  p.  779-782,  <J  1029, 
1030. 

remains  without  essential  change  at  all 
times  and  in  all  climates,  p.  401,  ^ 
632  b;  p.  761,  (}  1005  /-1005^  a,  b; 
p.  764-765,  ()  1006/,  g-;  p.  868-872, 
()  1068. 

produced  by  morbific  causes  in  parts  that 
are  not  their  direct  seat  of  operation 
through  alterative  influence  of  reflex 
action  of  nervous  system  ;  and  so  of 
cure  by  remedies,  p.  323-341,  ()  500- 
514  m.  Also,  Causes,  Morbific  ; 
Remedies,  Remedial  Action,  In.  II. 

depends  also  upon  the  natural  consti- 
tution of  parts.  See  Causes,  Mor- 
bific, first  subdivision.  Index  II. 

produced  and  cured  by  Mental  Emotions 
through  direct  development  of  nervous 
influence.  See  Mental  Emotions, 
Remedial  Action,  subdivision  Men- 
tal Emotions,  and  Nervous  Power, 
Index  II. 

disease  of  one  part  becomes  the  cause 
of  disease  in  another  part  through 
alterative  influence  of  reflex  nervous 
action  ;  and  disease  of  one  part  super- 
vening as  a  sympathetic  result  in  an- 
other part  may  reflect,  after  the  man- 
ner of  Counter-irritants,  through  re- 
flex action  of  nervous  system,  a  salu- 
brious influence  upon  the  primary 
affection,  p.  340,  ^  514  h;  p.  351- 
352,  <^  524  c;  p.  679-681,  ^  905  a; 
also,  Counter-Irritants,  Index  II. 
— but  which  art  cannot  imitate  by 
internal  remedies,  though  attempted, 
p.  654-656,  ()  893  n;  p.  856-861,  <^ 
1063  6-1065 — or,  as  it  subsides  in 
the  secondary  affection,  it  may  again 


Disease — continued. 

return  to  its  primary  seat — the  whole 
exemplifying  the  reflex  nervous  in- 
fluence as  a  curative  or  morbific  cause, 
and  its  development  and  modification 
according  to  the  varying  states  of  the 
organs,  p.  333,  <^  503  ;  p.  351-352,  <J 
524  a-c  ;  p.  360-361,  (;>  528  ;  p.  421- 
422,  «J  657  a  ;  p.  423,  ^  660  ;  p.  473- 
474,  (}  733  e;  p.  506,  ^  804  ;  p.  679- 
681,  (}  905  a,  89H  A-,  893  n,  902  b. 

analysis  of  a  case  of  fever,  complicated 
with  inflammations  and  venous  con- 
gestions, showing  how  to  investigate 
disease,  and  trace  out  the  consecutive 
derangements  that  are  superinduced 
by  morbific  influences  of  reflex  nerv- 
ous action,  p.  438-442,  ^  686  b-d. 
Also,  Sy.mptoms,  Index  II. 

important  in  leading  to  a  knowledge  of 
physiological  states  and  of  the  proper- 
ties and  laws  of  organic  beings,  p.  265, 
()U7b;  p.413,i^639  6;  p. 798, 1)1034, 
and  references  there. 
Diseases,  Self-limited, 

illustrate  the  recuperative  tendency  of 
Nature,  and  the  uses  of  remedies,  p. 
544-545,  <)  858. 

treatment  of,  mostly  expectant,  but 
when  complicated  with  local  inflam- 
mation the  constitutional  affection  is 
so  brought  under  their  influence, 
through  reflex  action  of  nervous  sys- 
tem, as  to  admit  of  active  treatment, 
p.  59,  (}  127  h,  I ;  p.  61,  <;»  134  ;  p.  63, 
^  137  b,  c;  p.  65,  ^  143  c;  p.  67-68, 
()  149-152  ;  p.  69,  ()  156  b  ;  p.  73,  ^ 
163;  p.  430-433,  ()  675-676  a;  p. 
508-509,  ^  809-811  ;  p.  531,  ()  839; 
p.  538,  ^  847  §-,  h  ;  p.  539,  «;»  848  ;  p. 
544-545,  (J  858  ;  p.  553,  ()  870  aa ; 
p.  597-599,  (J  892  c,  d;  p.  732,  ^  970 
c;  p.  733-736,  ^  973  b-980.  Also, 
Law  of  Adaptation,  hidex  I. 

their  causes  impress  a  curative  disposi- 
tion which  cannot  be  improved  by  re- 
medial agents  ;  thus  showing  also,  as 
in  the  case  of  Counter-irritants,  the 
principle  upon  which  remedies  oper- 
ate, p.  531,  (}  839  ;  p.  544-545,  ^858, 
861.  Also,  Counter-Irritants,Can- 
tharides.  Index  II. 

the  principle  through  which  their  causes 
extinguish  the  susceptibility  of  the 
system  to  their  repeated  operation  is 
the  same  as  involved  in  acclimation, 
with  the  difference  that  the  acclimated 
must  continue  to  live  under  the  influ- 
ence of  the  morbific  causes,  or  the 
susceptibility  to  their  action  will  re- 
turn, p.  364,  (}  543-548;  p.  421.  ^ 
654  b ;  p.  425,  ()  664.  Also,  p.  170- 
173,  Nos.  40-45,  parallel  columns. 
Disgust, 

determines  vomiting  by  first  propagat- 


1002 


INDEX    II. 


Disgust — cojitmued. 

inn-  the  nervous  influence  upon  ♦he 
mucous  coat  of  the  stomach,  upon 
which  it  acts  after  the  manner  of 
emetics,  when  the  process  of  reflex 
nervous  action  is  instituted  as  in  the 
case  of  emetics  ;  and  when  vomiting 
arises  from  tickling  the  throat,  or  a 
fall,  or  sailing,  &c.,  it  is  the  result  of 
a  double  process  of  reflex  action  of 
nervous  system,  but  is  otherwise  like 
that  from  disgust — and  employed  by 
the  Author  to  interpret  tlie  modus 
operandi  of  remedial  and  morbific 
causes,  physical  and  mental,  through 
direct  or  reflex  action  of  the  nervous 
system,  and  to  illustrate  the  substan- 
tive existence  and  self-acting  nature 
of  the  Soul,  p.  324-328,  i)  500  c-dd, 
k;  p.  340,  i)  514  k-m ;  p.  547-550, 
i)  863  d;  p.  889-890,  ^  1077.  Also, 
Joy  and  Anger,  Love,  Grief,  Fear, 
Jealousy,  Hope,  Shame,  Yawning, 
Sneezing,  Sea-Sickness,  Mental 
Emotions,  Reflex  Action  of  Nerv- 
ous System,  Remedial  Action,  sub- 
division Mental  Emotions,  Index 
II.;  Nervous  Power, /«(/.Z  a«(^/Z 

Distribution.     See  Circulation. 

Diuretics, 
proper,  are  feebly  endowed  with  cura- 
tive virtues ;  while  other  and  the  most 
useful  means  for  dropsy,  such  as 
bloodletting,  cathartics,  may  be  far 
more  diuretic  through  their  profound 
influences  upon  disease;  by  which, 
also,  is  illustrated  the  inflammatory 
nature  of  dropsical  affections,  p.  630- 
633,  (}  892i.  Also,  p.  364,  ()  545  ; 
p.  419-420,  (}  653  ;  p.  421,  «^  654  b  ; 
p.  563-564,  (J  889  a,  b ;  p.  665-669, 
i5>  902  a-i;  and  Iodine,  Index  II. 
the  philosophy  of  their  operation  through 
alterative  influence  of  reflex  action  of 
the  nervous  system,  and  how  the 
nervous  influence  is  variously  modi- 
fied and  rendered  variously  alterative, 
as  in  the  case  of  other  remedies,  and 
as  denoted  by  corresponding  effects 
of  fear  and  other  mental  emotions,  p. 
230-233,  ()  422-427 ;  p.  630-632,  ij 
892J  b,  c.  Also,  Joy  and  Anger, 
Love,  Grief,  Mental  Emotions,  Re- 
flex Action  of  Nervous  System, 
Remedial  Action,  subdivision  Men- 
tal Emotions,  Index  II. ;  Nervous 
Power,  Index  I.  and  II. 

Dropsy, 

its  pathology,  inflammation,  p.  630,  (j 

()  892i  b. 
requires  a  variety  of  treatment,  accord- 
ing to  its  stage  and  complications,  p. 
617,  ^  892i  k;  p.  632-633,  ^  892| 
c-e. 
no  essential  difference  in  the  pathology 


Dropsy — continued. 

of  what  is  called  active  and  passive, 
p.  633,  <J  892i  g. 

Dysentery, 

its  antiphlogistic  treatment,  and  objec- 
tions to  Astringents  in,  p.  573,  <J  890 
(/,  e;  p.  575,  *;»  890  h;  p.  747,  ^  991 
b;  p.  842,  ^lOoSy;-  Note  Go  p.  1138. 


E. 


Elaterium, 

employed,  along  with  other  cathartics, 
to  illustrate  the  doctrine  of  revulsion, 
through  its  profound  development  of 
a  morbific  reflex  nervous  influence, 
and  the  misapplication  of  Cathartics 
upon  the  principle  of  counter-irrita- 
tion, p.  655-656,  ()  893  n ;  p.  722,  ^ 
960  g;  p.  856-862,  ^  1003-1065. 
Emetics — continued  from  Index  I, 

their  therapeutical  as  well  as  physiolog- 
ical effects  take  place  through  reflex 
action  of  the  nervous  system,  the  lat- 
ter of  which,  like  the  increased  peri- 
staltic action  arising  from  cathartics,  is 
a  simple  concurring  element  of  other 
alterative  influences  of  the  same  ac- 
tion reflected  upon  other  parts  ren- 
dered susceptible  by  disease,  p.  107- 
1 10,  <;i  227-230  ;  p.  323-324,  (J  500  c ; 
p.  326-328, 1)  500  h-k ;  p.  333,  ij  504  ; 
p.  336-337,  <J  514  a-c ;  p.  532-533, 
^  841  ;  p.  547-550,  ()  863  d  ;  p.  661- 
663,  (j  894-896  ;  p.  666-669,  ()  902  c- 
i ;  p.  675-676,  \  904  bb ;  p.  876-877, 
^  1072  a ;  p.  879-880,  ij  1074  ;  p.  886 
-891,  i^  1077.    Also,  Ipecac,  hid.  IL 

modify  the  reflex  action  of  the  nervous 
system  according  to  the  nature  of  the 
exciting  cause,  whether  physical  or 
mental,  and  upon  which  modification 
the  special  nature  of  the  alterative  in- 
fluences depends,  p.  547-550,  ^  863 
d ;  p.  664,  \  900 ;  p.  667-669,  ^  902 
e-i.  Also,  preceding  references,  and 
Alteratives,  Cathartics,  Disgust, 
Sea-Sickness,  Mental  Emotions, 
Remedial  Action,  subdivision  Men- 
tal Emotions,  Index  II. ;  Nervous 
Power,  Index  I.  and  II. 
Emmenagogues, 

arranged  in  the  Author's  Therapeutical 
System  of  the  Materia  Medica  under 
the  general  denomination  of  Uterins 
Agents,  which  are  distinguished  by  a 
variety  of  virtues  in  relation  to  the 
uterine  system  in  its  morbid  or  pre- 
ternatural states,  p.  628,  <J  892|  q  ;  p. 
684-687,  ()  895i  b. 

inadmissible  in  inflammatory  and  irrita- 
ble states  of  the  uterus,  tbid. 

amenorrhoea  apt  to  be  a  sympathetic 
consequence  of  abdominal  derange- 


INDEX    II. 


100:5 


Emmenagogues — continued. 

merits,  and  maintained  by  them ;  but 
this  morbific  effect  of  reflex  nervous 
influence  is  also  apt  to  be  overlooked, 
and  the  uterine  afliiection  to  be  regard- 
ed as  the  principal  malady,  while  the 
evils  that  may  arise  immediately  from 
the  latter,  though  comparatively  un- 
important, depend  mostly  upon  its 
morbid  disturbance,  and  little  upon 
the  failure  of  the  discharge,  p.  233- 
234,  (}  428-432  ;  p.  628-629,  <5>  892f 
r;  p.  684-687,  ^  895i  b. 
remedies  should  be  addressed  to  the 
primary  derangements,  while,  also, 
emmenagogues  may  or  may  not  be 
expedient,  but  probably  means  of  a 
local  nature  —  so  that  a  variety  of 
treatment  is  necessary  in  the  multi- 
farious conditions  attending  amenor- 
rhoea,  p.  545,  <)  859  b,  and  references 
there;  p.  616-617,  ()  892i /,  k;  p. 
628-629,  ()  892-1  r-t ;  p.  684-687,  ^ 
895^  b.  Also,  Amenorrhcea,  Index 
II. 

Emotions.  See  Mental  Emotions,  Re- 
medial Action,  subdivision  Mental 
Emotions,  Joy  and  Anger,  Grief, 
Hope,  Love,  Disgust,  Fear,  Jeal- 
ousy, Shame,  Index  II 

Endermic  Remedies.  See  Remedies, 
Endermic,  Index  II. 

Endosmosis — continued  from  Index  I, 
admitted  to  be  sustained  only  by  "  scanty 
facts,"  p.  797,  ij  1034.     Also,  Anes- 
thetics, hidex  II 

Epilepsy, 

the  convulsions  of.  dependent  on  reflex 
action  of  nervous  system,  or  upon 
direct  and  reflex,  according  to  the 
nature  of  the  cause  which  develops 
the  nervous  influence,  how  counter- 
acted by  Antispasmodics  through  the 
same  agency  ;  how  the  whole  inter- 
prets the  modus  operandi  of  remedial 
and  morbific  causes,  physical  and 
mental,  through  the  same  alterative 
processes  of  nervous  action,  and  the 
treatment,  p.  591,  ()  89H  e;  p.  592- 
593,  ()  89H  fc;  P-  848,  <J  1058  v.  Also, 
Reflex  Action  of  the  Nervous 
System,  Antispasmodics,  Remedies  ; 
Causes,  Morbific  ;  Remedial  Ac- 
tion, Mental  Emotions,  Bloodlet- 
ting, Lidex  II. ;  Nervous  Power, 
Index  I.  and  II. 

Epispastics.  See  Counter-Irritants, 
Index  II. 

Ergot, 

its  introduction  into  practice  accom- 
panied by  all  the  important  qualifica- 
tions in  its  use,  p.  620-622,  ()  892| 
a,  b ;  p.  625,  <J  892f /,  g — encountered 
opposition,  ibid.,  and  p.  626,  ^  892|  /. 
its  primary  action  upon  the  stomach, 


Ergot — continued. 

and,  through  reflex  nervous  influence, 
upon  the  uterus — illustrative  of  the 
modus  operandi  of  all  remedial  and 
morbific  agents — and  its  reputed  de- 
leterious eflfects  upon  the  nervous 
centres  by  absorption  due  to  other 
causes,  generally  to  reflected  nervous 
influence  excited  by  the  uterus  and 
determined  with  violence  upon  those 
centres,  p  623,  ()  892f  c  ;  p.  626-627, 
^  892-|  /.  Also,  Epilepsy,  Antispas- 
modics, Nervous  Power,  Index  II. 

excites  the  uterus  in  its  impregnated 
state  to  contraction  in  numerous  ani- 
mals, as  well  as  the  human  subject, 
p.  624,  ^  892|-  d— but  only  then,  and 
often  fails  unless  parturition  has  be- 
gun, or  when  the  organ  is  rendered 
susceptible  by  morbid  states,  as  in 
cases  of  hydatids  and  menorrhagia, 
showing,  like  numerous  other  things, 
the  mutability  of  the  properties  of  life, 
and,  like  Arsenic,  Iodine,  Tartarized 
Antimony,  that  the  action  of  remedies 
depends  greatly  upon  a  morbidly  in- 
creased susceptibility  of  the  parts  dis- 
eased, and  that  no  safe  conclusions 
can  be  drawn  from  experiments  with 
remedies  upon  healthy  subjects  as  to 
their  influences  upon  morbid  states, 
ibid.  Also,  Arsenic,  Remedies,  Al- 
teratives, Reflex  Action  of  Nerv- 
ous System,  Index  II. ;  Nervous 
Power,  Index  I.  and  II. 

reasons  for  thinking  it  not  reliable  for 
producing  abortion,  p.  624-625,  § 
892|  d. 

circumstances  under  which  its  use  is 
desirable  or  admissible  in  cases  of 
labor,  p.  620-622,  ()  892|  a,  b;  p. 
625-627,  <^  892 /-n. 

employed,  also,  to  restrain  uterine  hem- 
orrhage, for  expulsion  of  placenta, 
polypi,  hydatids,  and  in  puerperal 
convulsions,  ibid. 

its  want  of  astringency,  and  in  some- 
times arresting  other  hemorrhages 
than  uterine,  illustrates,  like  Cold, 
Ipecacuanha,  and  Counter-irritants, 
the  modus  operandi  of  Astringents 
through  reflex  action  of  the  nervous 
system,  p.  627-628,  ()  892|-  o.  Also, 
Astringents,  Cold,  &c..  Index  II. 

fatal  to  some  small  animals — illustrating 
distinctions  in  vital  constitutions,  p. 
622, '!)  8931;  c.  Also,  p.  61-63,  <J  133- 
137;  p.  88,  (J  185;  p.  98,  ^  191  a. 
Erysipelas — complex  pathology  of,  and 
treatment  of,  <J  630  e,  689  I,  814,  970 
c,  1005  j,  1058  m. 

employed  to  show  that  remedies  operate 
by  substituting  one  pathological  con- 
dition for  another,  p.  642-646,  ()  893 
a-e;  p.  652,  ^  893  I;  p.  872,  P.S. 


1004 


INDEX    II. 


Erysipelas — continued. 

Also,  Counter-Irritants,  Remedies, 
Therapeutics,  Index  II ;  §905  b. 

Exciting  Causes.  See  Causes,  Mor- 
bific, Index  II. 

Excito-Secretory  Action,  as  resulting 
FROM  Reflex  Action  of  the  Nerv- 
ous System.  See  Secretion  and 
Excretion,  Generalization  of  Re- 
flex Action  of  Nervous  System, 
Index  II. 

Excretion.  See  Secretion  and  Excre- 
tion, Index  II. 

Exercise, 

its  modus  operandi  consists  especially 
in  instituting  through  muscular  action 
a  salutary  reflex  nervous  influence 
upon  various  organs,  but  particularly 
upon  the  stomach,  intestines,  and 
liver,  while,  also,  these  organs  are 
rendered  the  source  of  the  same 
nervous  development  and  its  determ- 
ination upon  themselves  by  the  me- 
chanical influences  of  jolting  ;  hence 
the  superior  advantages  of  running 
for  overcoming  habitual  constipation, 
p.  543,  ()  855  ;  p.  580,  ()  890^  d;  p. 
670-671,  <J  902  in.  Also,  Constipa- 
Tio.v,  Habitual  ;  Friction,  Respira- 
tion, Heat,  Cold,  Skin,  Phthisis, 
Food,  Whooping-Cough,  Altera- 
tives, Reflex  Action  of  Nervous 
System,  Index  II. 

Expectorants — continued  from  Index  I, 
the  name  objectionable,  as  diverting  at- 
tention from  the  pathological  states, 
and  thus  leading  to  errors  in  practice, 
p.  633-634,  ()  8924  a;  p.  641,  §  8924 
I ;  p.  739,  <)  984  c. 
Alteratives  adapted  to  Pulmonic  Inflam- 
mation substituted  for,  in  Author's 
Therapeutical  Arrangement  of  the 
Materia  Medica,  and  Bloodletting 
ranked  as  the  first  in  importance, 
and  Tartarized  Antimony  the  second, 
p.  634,  I)  892|  b  ;  p.  641,  ()  892*  i. 
the  substances  distributed  into  four  non- 
stimulating,  fifteen  stimulating,  one 
stimulating  and  narcotic,  one  sedative 
and  narcotic,  and  three  stimulating 
and  antispasmodic,  p.  635,  §  492J  c. 
the  several  expectorants  proper  stated, 
and  reasons  for  their  order  of  arrange- 
ment, serving  also  as  an  example  of 
the  principles  upon  which  the  arrange- 
ment of  other  groups  is  founded,  p. 
635-641,  (f  892  c-i. 
sustain  special  relations  to  the  pulmo- 
nary mucous  tissue  in  its  morbid  states 
— illustrating  the  diflTerence  in  the 
vital  constitution  of  the  same  tissue 
in  different  organs,  and  that  remedies 
operate  through  increased  irritability 
arising  from  disease,  and  according 
to  the  precise  modes  in  which  they 


Expectorants — continued. 

may  develop  and  modify  the  reflex 
action  of  the  nervous  system,  through 
which  their  eflects  are  exerted,  p.  634 
-637,  §  8924  b-d.  Also,  p.  62-64,  () 
136-140  ;  p".  65,  66,  <^  143  ;  p.  67,  ^ 
149-151  ;  p.  73,  i)  163 ;  and  Reme- 
dies, Remedial  Action,  Reflex 
Action  of  Nervous  System,  Se- 
cretion AND  Excretion,  Index  II. ; 
Nervous  Power,  Index  I.  and  II 

all  of  them  capable  of  useful  or  injurious 
effects,  but  two  only  ever  wanted  in 
acute  pulmonic  inflammation,  the  oth- 
ers in  chronic  conditions  alone,  p.  634 
-635,  <J  892|  b,  c. 

why  Squill  is  ranked  before  two  of  the 
non-stimulating,  p.  635-636,  ()  8924  c. 

the  best  eflfects,  especially  of  the  non- 
stimulating,  may  or  may  not  result 
in  expectoration,  which  shows  the 
alterative  principle  upon  which  reme- 
dies operate,  p.  637,  ()  892  d,  e  Also, 
Alteratives,  Index  II. 

the  utility  of  bloodletting  and  tartarized 
antimony  in  acute  pulmonic  inflam- 
mation, p.  641-642,  <J  892-|  i.  Also, 
Pneumonia,  Index  II. 

resolution,  not  expectoration,  is  wanted, 
if  possible,  in  ail  cases  of  active  pul- 
monic inflammation ,  and  as  cough 
depends  upon  a  variety  of  pathological 
conditions,  it  is  a  very  slender  guide 
to  the  treatment,  which  should  be  de- 
termined by  all  the  symptoms  as  sig- 
nificant of  their  exact  cause  or  causes, 
and  it  may  be  then  found  that  some- 
thing else  than  Expectorants  are  the 
appropriate  remedies,  p  636-642,  ^ 
8924  d-i.  Also,  p.  428,  ()  674  a;  p. 
437-442,  §  684-686 ;  p.  456-460,  ^ 
695-708 ;  p.  479-480,  ^  741  a,  b ;  p. 
541-542,  §  854  bb ;  p.  548-550,  ()  863 
d;  p.  551-554,  <!i  867-871  ;  p.  572- 
579,  §  680  d-n ;  p.  587,  ^  891  ^;  p 
663-665,  §  897-901  ;  p.  738-739,  «J 
984  c-985;  p.  759,  ^  1005;;  and 
Whooping-Cough,  Phthisis  Pul- 
monalis,  Index  II. 

secreted  products  are  a  secondary  result, 
symptoms  only,  however  much  they 
may  be  Nature's  means  of  cure,  and 
may  be  produced  by  remedies  of  op- 
posite virtues  through  their  variously 
modifying  effects  upon  the  reflex  ac- 
tion of  the  nervous  system,  and  may 
arise  as  well  from  an  increase  as  a 
diminution  of  disease,  whether  it  occur 
naturally  or  be  the  result  of  remedies, 
p.  634,  \  8924  a ;  p.  637,  ()  8924  d. 
Also,  p.  546-551,  §  862-864,  and 
Secretion  and  Excretion,  Reflex 
Action  of  Nervous  System,  Reme- 
dial Action,  Index  II. ;  Nervous 
Power,  Index  I.  and  II. 


INDEX    II. 


lOOo 


Ether,  Sulphuric.     See  AnjEsthetics, 
Index  II. 


Fear, 

demonstrates  the  direct  development 
and  profound  operation  of  the  nerv- 
ous influence  upon  the  secretions, 
contradicts  all  chemical  and  physical 
hypotheses  of  operation  of  remedial 
and  morbific  agents,  and  goes  to  es- 
tablish the  substantive  existence  and 
self-acting  nature  of  the  Soul ;  what 
but  the  nervous  influence  will  expound 
the  torrent  of  sweat,  the  copious  flow 
of  urine,  the  thumping  heart,  the  pro- 
truded eyeballs,  the  ghastly  and  pallid 
countenance,  while  convulsions  and 
purging  sometimes  enhance  the  aston- 
ishing spectacle  —  all  of  which,  too, 
often  follow  upon  loss  of  blood  and 
the  operation  of  an  emetic,  and  all  the 
phenomena  in  all  the  cases  equally 
due  to  direct  or  reflex  action  of  the 
nervous  system  —  and  also  observe 
that  the  sweat,  the  urine,  the  intesti- 
nal fluids,  as  supplied  by  Fear,  are 
simple  elements  of  the  more  profound 
manifestations  of  the  nervous  system 
in  its  universal  excito-secretory  func- 
tion, while  the  corresponding  results 
from  loss  of  blood  and  emetics  illus- 
trate the  manner  in  which  the  nerv- 
ous system  is  instrumental  in  chang- 
ing the  character  of  the  secreted  pro- 
ducts, according  to  the  manner  in 
which  the  nervous  influence  is  modi- 
fied by  morbific  and  remedial  agents, 
p.  230-232,  ()  422-424  ;  p.  324,  ()  500 
c;  p.  331,  ^  500  o;  p.  332,  ()  501  c; 
p.  334,  {)  508-510;  p.  341,  -^  514  m; 
p.  534,  §  844;  p.  630-631,  ^  892  J  ; 
p.  666-669,  ^  902  b-i ;  p.  703-705,  () 
943-944  b;  p.  708-710,  (}  951-952; 
p.  866,  ()  1067  a;  p.  877,  ()  1072  b; 
p.  880,  <^  1074;  p.  891,^077.  Also, 
Mental  Emotions,  Remedial  Ac- 
tion, subdivision  Mental  Emotions, 
Reflex  Action  of  Nervous  System, 
Secretion  and  Excretion,  Loss  op 
Blood,  Bloodletting,  Generaliza- 
tion of  Reflex  Action  of  Nervous 
System,  Cold,  Skin,  Kidney,  Joy 
AND  Anger,  Grief,  Hope,  Lovk, 
Jealousy,  Shame,  Disgust,  Weep- 
ing, Laughing,  Sea-Sickness,  Index 
II. ;  Nervous  Power,  Index  I.  and  II. 

Fever, 

farther  distinctions  between,  and  inflam- 
mation— the  former  universal,  the  lat- 
ter local — the  increased  heat  and  in- 
creased excitement  in  fever  owing  to 
the  malady  at  large  in  the  system, 
that  of  inflammation  to  a  local  cause 


Fever — continued. 

developing  a  stimulating  reflex  action 
of  the  nervous  system  which  is  greatly 
expended  upon  the  heart  and  arteries, 
after  the  manner  of  anger,  when  that 
passion  develops  the  nervous  influence 
in  a  direct  manner — has  none  of  the 
morbid  products  of  inflammation, 
while  in  the  latter  the  constitutional 
symptoms  yield  as  soon  as  the  local 
malady  gives  way — begin  in  diflferent 
modes  ;  no  chill  in  inflammation,  un- 
less preceding  the  formation  of  an 
abscess,  and  no  such  paroxysms,  as 
to  their  nature  and  definite  intervals, 
as  in  fever,  unless  in  the  analogy 
supplied  by  phthisis  pulmonalis — may 
subside  suddenly,  unlike  inflammation 
— pulse  and  blood  differently  affected, 
p.  64-65,  (i  141-143  c ;  p.  66-67,  i) 
148  ;  p.  429,  ^  674  c ,  p.  367,  ij  557 
a;  p.  444-445,  (^  688  d-ee  ;  p.  465- 
467,  <J  714-718  ;  p.  489-490,  i,  755  ; 
p.  493,  ^  764  c ;  p.  495,  l^  IIQ  ;  p. 
496,  ^  lib  ;  p.  497-498,  (^  779-785  ; 
p.  733-736,  {)  974-980.  Also,  Ln- 
flammation.  Index  I.  and  II. 

many  varieties  of,  and  corresponding 
names,  p.  490,  ()  758. 

is  not  contagious,  p.  419-420,  (^  653; 
p.  537,  I)  847  d,  e;  p.  869,  ^  1068  b, 
note.     Also,  Contagion,  Index  II. 

compounded  of  paroxysms  when  con. 
tinued  beyond  a  day,  p.  493-496,  (} 
765-772. 

ephemera  a  simple  type  of,  and  descrip- 
tion, p.  490-493,  <;>  759-764. 

has  three  stages,  cold,  hot,  and  crisis,  or 
sweating,  &c.,  p.  430-433,  I)  675  ;  p. 
491-493,  ()  763-764  c. 

cold  or  formative  stage,  the  period  of 
most  intense  morbid  action,  p.  491,  ^ 
{}  764  a ;  p.  739-740,  I)  986-989. 

hot  stage  manifests  the  recuperative 
tendency,  and  the  crisis  still  greater, 
p.  430-433,  I)  675  ;  p.  492-493,  ^  764 
b-e ;  p.  548-549,  ()  863  d ;  p.  740,  () 
989. 

secreted  products  advance  the  crisis,  p. 
450-452,  ()  690-693  ;  p.  453-454,  ^ 
694  b,  Nos.  2,  3  ;  p.  471-474,  (>  732- 
733  e;  p.  493,  ()  763  c~c  ;  p.  546-551, 
()  862-864 ;  p.  740,  ij  989. 

access,  symptoms  of,  p.  492,  ^  764  a. 

when  the  paroxysms  take  place,  and  in 
obedience  to  a  law  of  the  constitution, 
p.  494-496,  ^768-771;  p.  570, «;» 889  71. 

difficult  to  understand  the  cause  of  defi- 
nite intermissions,  but  nothing  like  it 
in  inflammations,  p.  495,  ^  770. 

irregularities  in  paroxysms,  p.  494-496, 
^  768-772. 

analogies  between  continued,  remittent, 
and  intermittent,  p.  493-495,  I)  76^ 
768  ;  p.  496,  ^  773,  774. 


1006 


INDEX    II. 


Fever — continued. 

natural  duration  of,  p.  496,  <J  774 ;  p. 
545-546,  ij  861. 

vegetable  miasmata  the  predisposing 
causes,  p.  497,  ^  777 — also,  among 
the  causes  of  inflammation,  ^  779 — 
and  of  venous  congestions,  p.  510- 
512,1^813-817.  Also,  Causes,  Mor- 
bific, and  Predisposition,  Index  II. 

pathological  cause  of,  increased  action, 
but  more  especially  a  change  in  kind 
— not  "debility"  nor  "  vitiated  blood," 
and  illustrated  by  other  things,  p.  65, 
^  114  6,  c,  p.  66,  (}  148  ;  p.  376-380, 
<)  577  c-578  ;  p.  464-467,  ^  712-719  ; 
p.  498,  ^  781-785.  Also,  Patholog- 
ical Cause,  Index  II. ;  Debihty, 
Index  I 

relapses  of,  and  why,  and  not  a  new 
fever,  p.  495,  ()  769  ;  p.  598-604,  () 
892  d-k.  Also,  Predisposition, 
Vital  Habit,  Index  II. 

gives  rise  to  inflammations,  either  as  a 
predisposing  or  exciting  cause,  or 
both  together,  p.  438-442,  ()  686  b,  c ; 
p.  497-498,  ^  779-780. 

special  analysis  of,  and  principles  of 
treatment,  illustrative  of  the  philoso- 
phy of  disease  and  operation  of  reme- 
dies, and  mode  of  investigating  dis- 
ease, p.  430-433,  ^  675-676  ;  p.  438- 
442,  <)  686  b-d.  Also,  p.  65-66,  ()  143 
c;  p.  67-68,  ()  150-152  ;  p.  73,  ()  163 ; 
p.  430-433,  ()  675  ;  p.  553-556,  ()  870 
aa-872  ;  p.  570-574,  ^  890  ;  p. 596- 
604,  (}  892  b-kk;  p.  609-611,  ^  892i 
d-f;  p.  648-652,  <^  893  g-m  ;  p.  713- 
714,  ^  955  e-958  b  ;  p.  724-732,  <J  961 
-970  ;  p.  739-740,  ^ 986-989  ;  p. 843, 
^ 1059  g. 
Fever,  Intermittent, 

description  of,  p.  491-497,  {}  761-775. 

treatment  of,  under  its  various  condi- 
tions, the  best  and  the  worst,  and 
suggestive  principles,  p.  63,  <S>  137  c, 
d ;  p.  65,  ()  143  b,  c ;  p.  430-433,  ^ 
675-676  a;  p.  505,  ()  801  c;  p.  508- 
509,  (J  809-811  ;  p.  512,  ^  817;  p. 
535-539,  (}  847;  p.  548-551,  i)  863 
d-g;  p.  552-553,  ^  868-870  aa;  p. 
570,  ()  889  n ;  p.  597-607,  ^  892  c-r ; 
p.  609-611,  ^  892J  d-h;  p.  724-732, 
§  961-970;  p.  736-739,  ^  981-985; 
p.  740,  <;>  989  ;  p.  754-755,  ^  1003  ; 
p.  757-759,  <J  1005  h. 
Fever,  Jail, 

treatment  of,  by  bloodletting,  p.  754,  () 
1002/ 
Fever,  Puerperal, 

experience  of  eminent  Physicians  as  to 
its  prompt  and  decisive  treatment  by 
bloodletting,  p.  756-757,  i)  1005  b-g. 
Also,  p.  72,  Table  III. 

question  as  to  cathartics  in,  p.  849,  () 
1058  2.     Also,  p.  63,  (}  137  d;  p.  64, 


Fever,  Puerperal — continued. 

(}   140;    p.  67,  I)   150-151;    p.  73.  § 
165. —  Opium,  in.  Note  H  p.  1117. 

Fever,  "Putrid," 

treatment  of,  by  bloodletting,  p.  754,  "J 
1002/. 

Fever,  Scarlet, 

treatment  of,  p.  843,  ()  1058  h. 

Fever,  Typhus, 

pathology  of,  and  treatment  by  blood- 
letting, §  892  ?  ;  §1002  d,  e;  p.  755, 
^  1004  b.    Also,  stimulants  ^  984  a.* 

Fever,  YELLovir,  and  Pestilential, 
bloodletting  in,  p.  747-748,  ^  991  b- 
992  c;  p.  749-750,  I)  993-994;  p. 
751,  ()  999  ;  p.  753-755,  ^  1002-1004; 
p.  869,  ^  1068  Zi;  Note  Ff  p.  1135. 
not  contagious,  p.  27,  ij  52  ;  p.  418-420, 
^  652-653  ;  p.  537,  <)  847  e ;  p.  869, 
^  1068  b.    Also,  Contagion,  hidex  II. 

Fibrin, 

its  formation  as  a  coat  upon  blood  ab- 
stracted in  inflammations,  in  preg- 
nancy, cStc. — denoting,  also,  a  greater 
fluidity  of  the  blood  than  natural,  p. 
445,  ij  688  ee;  p.  710,  ()  952  b,  c. 
Also,  Pulse,  Index  II. 
remarkable  changes  to  which  it  is  liable 
during  venesection,  p.  710,  ^  952  b-f 
— showing  that  no  conclusions  can 
be  drawn  as  to  the  relative  quantity 
of  lymph  in  inflammatory  diseases, 
p.  711,  (J  952  h.  Also,  p.  535-536, 
i)  846-847  c.  Also,  Pulse,  Index  II. 
"  cannot  be   chemically  exhibited  in  a 

pure  state,"  p.  780,  <J  1029. 
Simon's  vital  exposition  of,  p.  800-801, 
<^  1035. 

Fomentations, 

their  modus  operandi  i;i  relieving  pain 
and  diseases.  See  Poultices,  Heat, 
Warm  Bath,  Index  II. 

Food — continued  from  Index  I., 

by  simple  contact  with  the  stomach, 
will,  like  wine,  &;c.,  often  light  up 
warmth  on  a  cold  surface,  and  invigo- 
rate the  muscles  by  the  same  stimu- 
lating influence  of  reflected  action  of 
the  nervous  system,  and,  like  the 
physiology  of  Respiration,  and  the 
interchange  of  action  between  the 
skin  and  kidneys  through  the  same 
medium,  and  like  the  same  causation 
which  expounds  the  various  efl'ects  of 
cold  air  upon  internal  organs,  supplies 
an  elementary  principle  through  which 
the  modus  operandi  of  remedial  and 
morbific  agents  beyond  the  direct  seat 
of  their  operation  may  be  readily  un- 
derstood to  depend  upon  alterative  in- 
fluences of  reflex  action  of  the  nervous 
system,  and  through  modifications  of 
that  action,  according  to  the  nature 
of  the  causes,  whether  physical  or 
mental,  by  which  it  is  excited,  p.  68, 


'  Also,  Bloodletting  in,  Notes  S  p.  1124,  Ii  p.  1139. 


INDEX    II. 


lOO: 


Food — continued. 

(}152a;  p.  245,  ^  440  c  ;  p.  250-251, 
§  441  c  ;  p.  262-263,  t)  446  a  ;  p.  335- 
336,  ^  512  a,  b  ;  p.  339,  ()  514  h ;  p. 
565,  ^  889  ^ ;  p.  579-580,  ()  8904  rf. 
Also,  Exercise,  Friction,  Heat, 
Cold,  Phthisis,  Amenorrhcea, 
Whooping-Cough,  Reflex  Action 
OF  Nervous  System  ;  Causes,  Mor- 
bific ;  Remedies,  Remedial  Action, 
Index  II. ;  Nervous  Power,  Index 
I.  and  II. 

how  its  odor,  &c.,  Influences  the  mind, 
and  contradicts  the  chemical  and 
physical  doctrines  of  modus  operandi 
of  remedial  and  morbific  agents,  and 
establishes  Author's  theory  of  direct 
development  of  nervous  influence  by 
the  Passions,  and  its  profound  in- 
fluence upon  the  Secretions,  p.  866, 
^  1067  a  ;  p.  877-878,  ()  1072  6-1073 
a;  p.  879-882,  (}  1074-1075.  Also, 
Fear,  Joy  and  Anger,  Jealousy, 
Disgust,  Love,  Mental  Emotions, 
Remedial  Action,  subdivision  Men- 
tal Emotions  ;  Brain,  Inflamma- 
tion of;  Secretion  and  Excretion, 
Index  II. ;  Nervous  Power,  Index  I. 
and  II. 

what  is  above  said  of  the  contact  of  food 
with  the  stomach  resolves  the  paradox 
of  the  "vomited  pill  of  opium,"  and  of 
the  "  scarlet  efflorescence,"  as  set  forth 
at  p.  673,  <J  904  b ;  though  we  may 
bring  to  the  aid  of  our  interpretation 
what  is  said  of  Idiosyncrasy  at  p.  384, 
^  585  b.  Also,  Opium,  Supposito- 
ries, Heat  {enemas). 

some  kinds  poisonous  to  some,  but  salu- 
brious to  most  others,  owing  to  the 
development  of  a  morbific  reflex  action 
of  the  nervous  system,  p.  384,  <^  685  b. 
Also,  Opium  {the  pill  and  "  scarlet 
efflorescence"),  Skin  (eruptions).  In- 
dex II. ;  Nervous  Power,  Sympathy, 
Forces,  Correlation  of,  p.  921,  "J  1085. 
Friction, 

operates  through  reflex  nervous  action 
in  relieving  disease,  and  exemplifies 
the  modus  operandi  of  other  agents 
applied  to  the  skin,  p.  670-671,  |  902 
m.  Also,  Skin,  Cold,  Heat,  Exer- 
cise, Food,  Respiration,  Phthisis, 

■    Whooping-Cough,  Kidney,  Index  II. 
Functions  of  Life — continued  from  In- 
dex I, 

common  to  animals  and  plants — 1,  mo- 
tion— 2,  absorption — 3,  assimilation — 
4,  distribution — 5,  appropriation — 6, 
excretion — 7,  calorification — 8,  gener- 
ation, p.  125,  i;>  249. 

peculiar  to  animals — 1,  sensation — 2, 
sympathy — 3,  voluntary  motion — 4, 
other  mental  and  instinctive  functions, 
p.  125,  ^  250. 


Functions  of  Life — continued. 

common  functions — motion,  p.  126- 
128,  ()  253-267— absorption,  p.  128 
-134,  ^  268-295;  p.  817-824,  (J 
1053-1055  —  assimilation  (includ- 
ing physiology  of  digestion),  p  134 
-207,  ()  296-373i— distribution  (in- 
cluding the  powers  which  circulate 
the  blood),  p.  207-217,  ()  377-399  ; 
p.  817-824,  ()  1053-1055— appro- 
priation (nutrition  and  secretion), 
p.  217-227,  <;»  400-411— excretion, 
p  227-234,  (}  4:l2-4r32— calorifica- 
tion, p.  234-279,  ()  433-448  ;  p.  807 
-812,  ()  lOA3-l050—!rencratwn,  p 
279-280,  H19  ;  p.  816-817,  ^  1052 
b,c. 

peculiar  functions — sensation,  p.  280 
-283,  ()  450-451 — sympathy  (reflex 
action  of  the  nervous  system),  p. 
283-362,  H52-530.  Also,  Reflex 
Action  of  Nervous  System,  Sym- 
pathy, Index  II.;  Nervous  Pow- 
er, Index  I.  and  II. 

functions  relative  to  the  mind  and  in- 
stinct, p.  362,  ^  531-534;  p.  876- 
911,  i}  1069-1083. 

G. 

Galvanism — Electricity.    See  I}idex  I. 

Gases  and  Fumes.  See  Humoral  Pa- 
thology, Anesthetics,  Index  II.  ,- 
Gases,  Index  I. 

Gereralization  of  Reflex  Action  of 
the  Nervous  System, 
as  the  medium  through  which  all  reme- 
dial and  morbific  agents  exert  their 
effects  upon  parts  beyond  their  direct 
seat  of  action,  and  as  universally  en- 
gaged in  the  excito-secretory  action, 
not  only  as  a  simple  excitant,  but, 
what  is  far  more  important,  as  the 
modifying  cause  of  all  deviations  from 
their  natural  standard,  with  the  few 
exceptions  that  attend  the  perfectly 
local  action  of  escharotics,  vesicants, 
&c.,  but  which  modify  all  the  secre- 
tions beyond  their  direct  seat  of  opera- 
tion through  reflex  action  of  the  nerv- 
ous system,  including,  also,  the  cor- 
responding effects  of  the  nervous  in- 
fluence as  developed  by  the  Passions. 
See  Medical  and  Physiological  Com- 
mentaries, vol.  i.,  p.  568-574  (1840), 
and  many  other  places  to  the  same 
effect;  Reflex  Action  of  the  Nerv- 
ous System,  Remedial  Action,  Rem- 
edies ;  Causes,  Morbific  ;  Thera- 
peutics, Secretion  and  Excretion, 
Mental  Emotions,  Remedial  Ac- 
tion, subdivision  Mental  Emotions  ; 
Sympathy,  subdivision  Remote  and 
Contiguous,  Index  II.  ;  Nervous 
Power,  Index  I.  and  II. 


1008 


INDEX    II. 


Generalization,  &c. — continued. 

of  which  the  following  are  some  of 
the  illustrations  of  the  foregoing 
imputed  eflects  of  direct  and  reflex 
action  of  the  nervous  system  : 
Cathartics,  Emetics,  Bloodletting, 
Loss  of  Blood,  Leeching,  Antispas- 
modics, Counter-irritants,  Seton, 
Alteratives,  Narcotics,  Sedatives, 
Expectorants,  Diuretics,  Astrin- 
gents, Tonics  and  Stimulants,  Mer- 
curial Remedies,  Anccsthctics,  Ela- 
terium;  Antimony ,Tartarized ;  To- 
bacco ;  Oil,  Croton ;  Hydrocyanic 
Acid,  Plasters ;  Hydrophobia,  Vi- 
rus of ,  Predisposition  to  Diseases; 
Self-limited  Diseases,  Co?ivulsions, 
Phthisis,  Asthma,  Inflammation ; 
Brain,  Inflammation  of;  Amenor- 
rhea, Hysteria,  Whooping-Cough, 
Sea- Sickness,  Humoral  Pathology, 
Sphincter  Muscles,  Heart,  Skin, 
Cold,  Heat,  Warm  Bath,  Food, 
Exercise,  Friction,  Respiration, 
Defecation,  Metastasis ;  Stomach, 
Blows  upon ;  Sweat,  Urine,  Hyber- 
nating  Animals,  Joy  and  Anger, 
Hope,  Fear,  Love,  Jealousy,  Grief, 
Shame,  Disgust,  Laughing,  Weep- 
ing, Yawning,  Roosting,  Sneezing, 
Soul  and  Instinct,  Index  II. ;  Will, 
Index  I.  and  II. 
Generation,  Spontaneous,  or  Sponta- 
NElTY  of  Being — continued  from  In- 
dex I, 
advocated  by  Physiologists,  p.  86,  ^  175 

d;  p.  188-189,  ^  350  Z,  m. 
facts  and  arguments  against,  p.  910-911, 
()  1083.     Also,  Generation,  Index  I. 
a  doubtful  exception  to  the  laws  of  the 
organic  function,  p.  817,  ^  1052  c. 
Genito-Urinary  Agents, 

introduced  to  illustrate  the  principles 
on  which  the  Author's  Therapeutical 
Arrangement  of  the  Materia  Medica  is 
based,  p.  684,  ()  905^  a,  b;  p.  687-889, 
<J  905i  c.  Also,  p.  634-636,  ij  892|  b,  c. 
present  a  large  variety  of  remedial  vir- 
tues, which  are  mostly  relative  to  the 
genito-urinary  organs,  and  thus  illus- 
trate what  is  meant  by  specific  action, 
being  addressed  directly  to  these  or- 
gans, and  not  regarding  their  diseases 
as  sympathetic  of  derangements  of 
other  parts,  however  much  they  may 
be  so,  p.  687-689,  ()  905^  c.  Also. 
p.  62-64,  ()  135-138  ;  p.  65,  1:j  143  «; 
p.  66,  ^  143  d ;  p.  545,  <J  859  J ,  p. 
584-585,  iji  891  rf;  p.  592,  ^  89U  z,- 
p.  623,  l^  892^  c ;  p.  634,  ^  892|  b. 
Geology,  Theoretical, 

the  Author's  work  upon,  p.  908,  (^  1079  b. 

GONORRHCEA, 

its  principles  of  treatment,  p.  576,  ^  890 
m  ;  p.  689,  ()  905^  c. 


Grief, 

demonstrates  Author's  theory  of  the 
operation  of  remedial  and  morbific 
causes  through  the  medium  of  direct 
and  reflex  action  of  the  nervous  sys- 
tem, contradicts  the  chemical  and 
physical  hypotheses,  and  goes  to  con- 
firm Author's  demonstration  of  the 
substantive  existence  and  self-acting 
nature  of  the  Soul,  p.  326-327,  (>  500 
/,  I,  ]  ;  p.  331,  i)  500  o  ;  p.  341,  ^  514 
VI ;  p.  534,  <J  844 ;  p.  630-631,  (}  892i ; 
p.  703-705,  ^  943  a,  944  b ;  p.  709,  ^ 
951  c ;  p.  866,  ^  1067  ;  p.  877,  <^  1072 
b;  p.  880,  ^  1074.  Also,  Mental 
Emotions,  Remedial  Action,  sub- 
division Mental  Emotions,  Secre- 
tion and  Excretion,  Food,  Joy  and 
Anger,  Love,  Fear,  Jealousy,  Hope, 
Shame,  Disgust,  Laughing,  Weep- 
ing, Yawning,  Roosting,  Sneezing, 
Soul  and  Instinct,  Index II. ;  Will, 
Index  I.  and  II. 

Granulation, 

evinces  great  Design,  and  involves  pro- 
found physiological  laws,  p.  472-475, 
(}  733  c-f.  Also,  Inflammation,  In- 
dex II 


H. 

Hall,  Marshall,  and  the  Author. 

his  opinion  of  the  cause  of  voluntary 
motion,  p.  77,  <^  167/.  Also,  Will, 
Mental  Emotions,  Index  II. ;  Nerv- 
ous Power,  Index  I.  and  II. 

experiments  on  nervous  system  adverse- 
ly to  A.  P.  W.  Philips,  p.  306-310,  ^ 
483  i-484 — proving  to  have  been  a 
repetition  of  Alston's,  p.  309,  No.  4. 

advocates  the  chemical  and  humoral 
hypotheses  of  operation  of  remedies 
and  secretion,  but  is  contradicted  by 
his  own  experiments,  p.  308,  ^  483  c ; 
p.  342,  <J  5l4i  b.  See,  also.  Medical 
and  Physiological  Commentaries,  vol. 
iii..  Essay  on  Modus  Operandi  of 
Remedies  (1842),  in  which  occurs  the 
example  of  the  Seton,  as  presented 
at  p.  679-681,  ()  905  a  of  these  Insti- 
tutes ;  and  vol.  i.,  p.  569-574  (1840), 
where  appears  a  distinct  and  anatomi- 
cal exposition  of  the  reflex  action  of 
the  nervous  system  as  applied  by  the 
Author  to  Pathology  and  Therapeu- 
tics, and  where  he  presents  it  in  array 
against  the  humoral  pathology,  and  as 
being  all  that  is  ever  concerned  in  the 
modus  operandi  of  remedies  and  of 
morbific  causes  (and  in  the  example 
of  the  Seton  also)  beyond  their  direct 
seat  of  action — the  Author  being  in 
advance  of  the  one,  and,  unfortunate- 
ly, not  sufficiently  submissive  for  the 
rest,  to  the  chemical  and  humoral  doc- 


INDEX    II. 


1009 


Hall,  Marshall — continued. 

trines  of  the  day.  It  may  be  added, 
also,  that  in  either  of  the  above  refer- 
ences to  the  Commentaries  will  be 
found,  quite  elaborately  set  forth, 
"the  gist  of  the  whole  matter," 
Institutes,  p.  814. 

affirms  that  the  sympathies  in  organic 
life  are  owing  to  the  mutual  influences 
of  organs  among  each  other,  p.  308, 
()  483  c. 

believes  "that  the  "spinal  marrow,  ex- 
clusive of  the  cerebrum,  is  the  source 
of  animal  life" — and  that  "  the  irrila- 
bilily  of  the  muscles  of  organic  life 
depends  probably  on  the  ganglionic 
sijstem,"  p.  296,  ^  476 1^  b.  Also,  p. 
88,  ()  183,  184  a;  p.  89,  <)  188  a;  p 
100-102,  ()  194-202 ;  p.  284-290,  () 
455-46 H.  Also,  objections  to,  in 
Essay  on  Modus  Operandi  of  Reme- 
dies in^Iedical  and  Physiological 
Commentaries,  vol.  iii  (1842). 

supposes  "  all  convulsive  affections  to 
be  diseases  of  the  true  spinal  or  cxci- 
to-motory  system,"  and  Author's  ob- 
jections, p.  357,  ()  526  d ;  p.  467-468, 
•J  719.  Also,  Convulsions,  Hysteria, 
Whooping-cough,  Index  II. 

his  contributions  toward  the  laws  of  re- 
flex action  of  nervous  system,  p.  290, 
(^  463  b. 

supposes  organic  actions  to  depend  upon 
the  nervous  system,  and  not  upon 
properties  inherent  in  all  parts,  p.  217, 
()  399.  Also,  Vital  Properties,  Or- 
ganic Life,  Index  I. 

his  experiments  showing  the  circulation 
of  the  blood  independently  of  the  sym- 
pathetic system,  p.  127,  (j  233. 

his  opinion  upon  bloodletting  as  to  rule 
of  practice,  and  Author's  objections, 
p.  712-713,  ()  955  d;  p.  715,  ^  959  a. 
Also,  extended  objections  to,  in  Med- 
ical and  Physiological  Commentaries, 
vol.  i.,  p.  216-233,  p  239-271  (1840) 

his  opinion  as  to  tolerance  of  loss  of 
blood,  and  Author's  objections,  p.  728 
-729,  ij  965.  Also,  critical  objections 
to,  in  Medical  and  Physiological  Com- 
mentaries, vol.  i.,  p.  239-271  (1840). 

his  opinion  as  to  "excessive  reaction 
from  loss  of  blood,"  and  Author's  ob- 
jections, p.  469,  (J  722  d  ;  p.  772-776, 
<^  1020-1026.  Also,  critical  objections 
to,  in  Medical  and  Physiological  Com- 
mentaries, \o\.\.,]i  239-271. 
Habit,  Vital, 

so  designated  and  investigated  by  the 
Author  through  a  long  chain  of  anal- 
ogies, embracing  the  results  attendant 
upon  natural,  morbific,  and  remedial 
agents,  and  of  the  mind,  p.  363-370. 

relates  to  the  modifications  of  functions, 
and  the  variations  of  their  results  as 

S  s 


Habit,  Vital — continued. 

arising  from  the  repeated  or  continued 
operation  of  causes,  and  lies  at  the 
foundation  of  some  of  the  most  im- 
portant and  comprehensive  laws  in 
Medicine,  p.  363,  ()  535  ;  p.  364-369, 
()  542-563  ;  p.  532-533,  '^  841  ;  p. 
567-569,  ()  889  l-mm;  p.  585,  t)  891 
/,-  p.  648-649,  §  893  g,  h ;  p.  675- 
676,  <J  904  b. 

belongs  to  both  plants  and  animals,  p. 
363,  <)  536-538. 

philosophy  of,  in  organic  and  animal 
life,  p.  363-370,  ^  539-568 

illustrated  by  effects  of  natural,  reme- 
dial, and  morbific  agents,  p.  257-258, 
^  442  b,  c ;  p.  364-369,  ()  542-563  ; 
p.  425,  ^  064  ,  p.  532-533,  ^  841  ;  p. 
567-569,  <)  889  /-?n77i ,  p  585,  I)  891 
/,-  p.  648-649,  (}  893  g,h;  p  675- 
676,  {)  904  b;  p  809,  i)  1047  Also, 
Acclimation,  Index  II. 

manifested  by  the  Mind  and  Instinctive 
Principle,  p  369-370,  ^  564-568  ;  p. 
894-895,  ()  1078  b. 

illustrates  the  instability  of  the  vital 
properties,  p.  363,  ^  541.  Also,  Vital 
Properties,  Index  I. 

generally  results  in  diminished  irrita- 
bility, but  may  be  the  reverse,  and 
either  practically  important,  v/ith  il- 
lustrations, p.  366-367,  ij  556  a-d  ; 
p.  532-533, 1^  841  ;  p.  567-569,  (}  889 
l-mm;  p.  585,  iji  891  /". 

always  relative  to  impressions,  niore  or 
less  durable,  upon  the  vital,  mental, 
or  instinctive  constitution,  p.  363,  (J 
540  ;  p.  894-895,  ^  1078  b. 

liable  to  obtain  under  the  repeated  or 
continued  operation  of  almost  all 
agents  capable  of  affecting  the  vital 
or  mental  properties,  p.  364,  i)  543. 

through  which  miasmata,  tobacco,  crude 
food,  &c.,  cease  to  be  injurious,  p.  364, 
<S)  544.     Also,  Acclimation,  Index  II. 

or  may  obtain  from  one  apphcation  of 
particular  causes,  so  as  to  render  them 
inoperative  afterward,  p.  364,  (ji  545. 

lessens  or  increases  the  susceptihility 
of  organs  to  the  action  of  remedies, 
p.  364,  ^  546  ;  p.  532-533,  ()  841 ,  p. 
542,  <;.  854  c,  d;  p.  66.5,  <J  901. 

demonstrates  the  operation  of  remedies 
and  morbific  causes  by  alterative  in- 
fluence of  reflex  action  of  the  nervous 
system,  p.  364,  (J  547 ;  p.  532-533,  (^ 
841  ;  p.  649,  ^  893  h. 

its  effects  generally  most  prominent  in 
organic  life  when  causes  are  long  in 
operation — a  law  of  great  practical 
bearing,  p.  364,  (J)  548  a,  b 

not  much  applicable  to  food  and  other 
perfectly  natural    stimuli  —  showing 
Design  ;  though  some  kinds  liable  to, 
p.  364-365,  i)  548^^  a,  b. 
s 


1010 


INDEX    II. 


Habit,  Vital — continued. 

follows,  in  respect  to  morbific  and  reme- 
dial agents,  the  law  which  governs  the 
relative  duration  of  disease  when  pro- 
duced by  remedies  and  truly  morbific 
causes,  p.  365,  <^  549-554  ;  p.  366,  ^ 
555;  p  542, 1^854  c-rf,  p.  665,  (^901. 
Also,  Cantharides,  Counter-Irri- 
TANTs,  Index  II 

illustrated  by  the  tolerance  of  frequently- 
repeated  and  increased  doses  of  medi- 
cines, and  its  subsidence  on  their  sus- 
pension for  a  short  time,  p.  364,  <^  543 ; 
p  365,  {}  551, 552  ,  p.  532-533,  i)  841 , 
p  569,  ^  889  mm  ;  p.  649,  ^  893  h. 

its  effects  vary  according  to  the  exact 
nature  of  its  causes,  p  366.  <J  553. 

allied  to  the  principle  which  lies  at  the 
foundation  of  disease  and  its  cure,  p 

366,  ij  555  ,  p  542,  <J  854  c-f 
liable   to   be   influenced   by    accidental 

causes,  and  to  thus  affect  the  treat- 
ment of  disease,  with  examples,  p 

367,  ^  556  rf-557. 

embraces  the  cumulative  effect  of  reme- 
dies, and  predisposition  to  disease, 
with  illustrations,  p.  368,  <^  558  a,  b, 
559  ;  p  568-569,  6  889  m  ,  p  669- 
670,  ^  902  I ;  p.  675-676,  <J  904  b 
A'so,  Predisposition,  Remedies,  In- 
dex II. 

relates  to  the  tenacity  of  many  diseases, 
p  368,  1^  560 — and  to  many  acquired 
natural  habits  of  the  constitution,  () 
561 — and  to  luxuries  and  customs,  (} 
539  a,  543,  548^  b,  562— and  to  the 
periodical  desire  of  food,  and  many 
little  usages,  (}  563 — and  to  the  culture 
of  the  mind,  or  of  any  mental  faculty 
at  the  expense  of  others,  and  to  its 
enjoyments,  and  to  the  senses,  and 
to  the  voluntary  muscles,  <^  543,  564- 
567 — and  to  analogies  between  cer- 
tain special  injuries  in  organic  life 
and  o/  the  mind,  p  370,  <5i  568 ;  p. 
894,  (J  1078  i 
Heart  See  Heart  and  Arteries,  In- 
dex I., 

constantly  influenced,  and  tlie  arteries 
also,  in  all  diseases,  by  reflex  action 
of  the  nervous  system,  and  the  pulse 
is  felt  simply  for  the  purpose  of  ascer- 
taining the  extent  and  nature  of  these 
influences,  and  of  thus  arriving  at  the 
nature  and  extent  of  the  remote  affec- 
tion, while,  also,  the  heart  and  arteries 
do  not  often  fall  under  the  alterative 
influence  of  the  reflex  action  so  far  as 
to  produce  disease — employed  by  the 
Author,  along  with  many  other  anal- 
ogous things,  to  illustrate  the  reflex 
action  of  the  nervous  system  as  the 
immediate  cause  of  diseases  and  their 
cure  through  its  alterative  influences 
upon  the  organic  states,  beyond  the 


Heart — continued. 

direct  seat  of  operation  of  remedial 
and  morbific  causes — the  nervous  in- 
fluence being  rendered  variously  al- 
terative, or  simply  stimulating  or 
sedative,  according  to  the  nature  of 
the  causes  by  which  it  is  brought 
into  any  increased  or  preternatural 
operation,  p.  301-310,  ()  480-485  ;  p. 
355-356,  (}  526  a,  b ;  p  443-448,  <j 
687^-688;  ^  714,  715,  961  a. 
its  highly  irritable  nature  employed  by 
the  Author  to  prove  that  remedies  do 
not  operate  by  absorption,  since  the 
most  powerful,  when  swallowed,  act 
mostly  upon  other  parts,  and  do  not 
often  affect  the  heart,  except  by  re- 
ducing diseases  upon  whose  morbif- 
ic reflex  nervous  influences  the  dis- 
turbances of  the  heart  depend,  <)  500 
m,  687i,  694J,  826  cc,  829,  893  c, 
p,  904  C--905  a,  973-»5,  1024. 

Heat — continued  from  Index  I., 
applied  to  the  surface,  or  intestinal  canal, 
by  stomach  or  rectum,  and,  wliether 
dry  or  moist,  illustrates,  like  Cold, 
the  operation  of  remedies  and  mor- 
bific causes  through  alterative  in- 
fluence of  reflex  action  of  the  nervous 
system,  and  supplies,  in  its  varieties, 
whether  dry  or  moist,  and  the  different 
temperatures,  from  98°  to  120°  Fah., 
a  critical  illustration  of  the  modifica- 
tions which  the  reflex  influence  un- 
dergoes, and  through  the  manner  in 
which  it  impresses  organs  favorably 
or  unfavorably,  according  to  their  ex- 
isting susceptibilities,  and  according 
to  the  degree  or  kind  of  heat ;  illus- 
trates, also,  the  modus  operandi  of 
remedial  and  morbific  agents  through 
the  same  alterative  reflex  nervous  in- 
fluence, and  equally  according  to  the 
nature  and  intensity  of  the  agents, 
and  that,  although  closely  allied,  our 
remedies  may  be  curative  or  morbific 
according  to  their  exact  nature  and 
dose,  p.  246,  ()  440  c;  p  253,  l)Aild; 
p.  351,  i)  524  a ;  p.  589,  (J  891  p  ;  p. 
681-683,  ^  905  a.  Also,  Warm 
Bath,  Cold,  Skin,  Friction,  Food, 
Exercise,  Respiration,  Cathartics, 
Emetics,  Index  II. 
operates  in  raising  the  temperature  of 
the  surface  as  a  stimulus  of  organic 
actions,  and  without  the  agency  of 
the  nervous  system,  but  will  not  so 
influence  the  reflex  action  of  the 
nervous  system  as  to  raise  the  tem- 
perature of  internal  organs,  nor  will 
cold  reduce  it  unless  it  impair  their 
functions — a  remarkable  evidence  of 
Design  when  contrasted  with  theman- 
ner  in  which  Croton  oil,  and  leeching 
the  anus,  will  develop  a  powerful  re- 


INDEX    II. 


1011 


Heat — continued. 

flex  nervous  influence  through  the 
mere  propagation  oi  continuous  sym- 
pathy along  the  mucous  tract  of  the 
intestine,  p.  249-250,  s^  441  c;  p. 
256-259,  ^  44H-442  c;  p.  809-812, 
<J  1046-1050.  Also,  Organic  Heat, 
Index  I.  and  11. ;  Hybernating  Ani- 
mals ;  Oil,  Croton;  Leeching,  Sup- 
positories, SvMPATHY,  subdivision 
continuous,  Index  II. 
simple  warm  water,  as  an  enema,  among 
a  multitude  of  analogies  in  these  In- 
stitutes, by  its  development  of  a  stim- 
ulating reflex  action,  and  its  determ- 
ination of  an  exciting  effect  upon  the 
muscular  coat  of  the  intestine  and  ab-* 
dominal  muscles,  shows  that  if  Croton 
Oil,  or  other  cathartic,  be  added  to  the 
water,  the  alterative  eflects  of  the  lat- 
ter upon  remote  diseases  is  through 
the  same  reflex  influence,  now  modi- 
fied by  the  nature  of  the  added  cathar- 
tic, and  carried  by  the  iVuthor  to  the 
interpretation  of  all  remedial  and  mor- 
bific agents  beyond  their  direct  seat  of 
operation  through  alterative  influences 
of  reflex  action  of  nervous  system, 
ibid.,  and  Suppositories,  Opium  {the 
J3J//,&c.),Reflex  Action  OF  Nervous 
System,  Remedial  Action,  Index  II.; 
Nervous  Power,  Sympathy,  Lidex  I. 
and  II. 

Heat,  Animal.    See  Organic  Heat,  hidex 
I.  and  II. 

Hemorrhage,  Spontaneous, 

philosophy  of,  practically  very  important 
— not  owing  to  ruptured  vessels,  but 
morbid  vascular  action,  p.  507,  ^  805  ; 
p.  509,  <J  812  ;  p.  533,  ()  842  ;  p.  572, 
i)Q^Oa-h;  p.  694,  .J  922  ;  p.  738-739, 
^984c-985;  p. 770-772,'^  1018-1019. 
Also,  Medical  and  Physiological 
Commentaries,  Article  Pathology  of 
Cerebral  Hemorrhage,  vol.  i.,  p.  371- 
384 ;  Article  Spontaneous  Hemor- 
rhage, vol.  ii.,  p.  546-550. 
if  what  the  Author  has  said  of  the  phys- 
iology of  Bloodletting  and  Leeching 
be  founded  in  nature,  it  is  obvious 
that  the  foregoing  comparative  safety 
of  spontaneous  hemorrhage  must  de- 
pend upon  a  comparatively  milder 
development  of  the  nervous  influence 
when  Nature  institutes  the  loss  of 
blood,  p.  694,  ^  922  6— and  the  inter- 
pretation is  farther  confirmed  by  the 
comparatively  slight  prostration  that 
results  from  the  drain  in  malignant 
cholera,  prolonged  diarrhoea,  abscess- 
es, mennorrhagia,  &c.,  with  such  as  is 
brought  about  by  the  continued  use  of 
the  mildest  purgatives, 
nature's  mode  of  cure,  and  often  suc- 
cessfully in  such  quantities  as  cannot 


Hemorrhage,  Spontaneous — continued. 
be  iniitated  by  art,  and  in  such  ad- 
vanced stages  of  disease  that  blood- 
letting is  inadmissible,  p.  471-472,  () 
732  ;  p  507,  ^  805  ;  p.  550.  ^  863/; 
p.  573-575,  {)  890  e-/,  p  770-772, 
^  1019;  NoTEsFFp.  1135,Iip.  1139. 

Nature,  therefore,  concurs  with  expe- 
rience in  protesting  against  the  use 
of  Astringents  to  restrain  this  natural 
means  of  cure,  unless  proceeding  to 
an  alarming  excess,  p.  573-575,  (} 
890  a-h;  p.  771-772,  <J  1019  g,  h. 
Also,  "  Debility,"  Index  I.  and  II. 

nevertheless,  when  practicable,  as  in 
the  early  stages  of  disease,  and  if  the 
hemorrhage  proceed  from  an  import- 
ant organ,  the  pathological  condition 
should  not  be  left  to  Nature,  but  Art 
should  interfere  with  its  direct  Anti- 
phlogistics,  especially  Bloodletting, 
Tartarized  Antimony,  and  Vesicants, 
and  this  particularly  in  pulmonary 
hemorrhage.  See  foregoing  refer- 
ences, and  Expectorants,  Astrin- 
gents, Pneumonia,  Index  II. 

all  preternatural  eff*usions  are  designed 
for  useful  ends,  and  form  some  of  the 
most  remarkable  examples  of  Design. 
If  they  take  place  within  cavities  or 
the  structure  of  organs,  it  is  still  the 
same,  nor  does  Nature  depart  from 
any  great  law  for  the  sake  of  special 
exigencies,  p.  471-476,  ()  732  i-733  ; 
p.  546-547,  ii  862-863  rf;  p.  550-551, 
\  863  e-864. 
Hiccough, 

introduced  to  illustrate  the  coincidences 
which  attend  the  operation  of  the 
nervous  influence,  whether  brought 
into  action  by  the  mind  or  by  physical 
causes — presenting  an  example  of  a 
paroxysm  brought  on  by  a  sense  of 
choking,  which  was  evidently  the  re- 
sult of  reflex  nervous  action  induced 
by  gastric  derangement,  and  which 
had  the  efi*ect  of  exciting  through 
mental  sympathy  the  same  condition 
in  three  others  that  antispasmodics 
failed  of  removing,  but  which  was 
overcome  in  all  the  cases  by  a  mustard 
emetic — thus  illustrating,  as  in  hys- 
teria, the  modus  operandi  of  an  emetic 
in  arresting  the  paroxysms  through 
the  development  of  another  series  of 
reflex  actions  and  the  introduction  of 
movements  in  other  associated  mus- 
cles, though  most  successfully  in  the 
mental  cases  whose  causes  were  more 
transient — and  illustrating  the  differ- 
ence in  the  modes  in  which  antispas- 
modics and  emetics  relieve  spasmodic 
affections  through  the  agency  of  reflex 
action  of  the  nervous  system,  and  the 
differences  among  other  things  to  the 


loi; 


INDEX    II. 


Hiccough — continued. 

same  effect  (as  may  be  seen  in  the 
references  below)  —  and  illustrative 
of  the  delicate  shades  in  variety  in 
which  mental  emotions  modify  the 
nervous  influence,  and  how,  through 
their  medium,  the  mere  disgust  aris- 
ing from  the  thought  of  taking  an 
emetic  will  develop  the  nervous  in- 
fluence so  as  to  stop  a  paroxysm  of 
hysteria  without  vomiting,  and  con- 
trasted with  the  effect  of  an  emetic 
in  overcoming  the  same,  and  vv'ilh 
the  united  effect  of  disgust  in  other 
cases  as  brought  on  by  the  recollection 
of  a  former  occurrence  of  the  same 
nature — while  the  whole,  in  all  its 
wonderful  relations  to  the  mind  in 
its  endless  variety  of  demonstrations 
upon  the  organic  mechanism  through 
its  direct  development  and  diversified 
modifications  of  the  nervous  influence, 
and  the  perfect  correspondence  in  these 
respects  with  the  effects  of  physical 
agents  applied  to  the  nervous  centres, 
or  as  they  may  be  affected  by  disease, 
and  thusdevelopthe  nervous  influence 
in  a  direct  manner,  or  as  other  physical 
causes  give  rise  to  reflex  action,  and, 
in  all  the  cases,  modify  the  nervous 
influence  in  a  manner  analogous  to 
the  various  mental  emotions,  not  only 
reflect  a  flood  of  light  upon  the  modus 
operandi  of  all  morbific  and  remedial 
agents,  but,  through  the  foregoing 
analogies  between  the  mental  and 
physical  causes,  declare  the  substan- 
tive existence  and  self-acting  nature 
oftheSoM/,p.  337-338,  ^  514  c.  Also, 
Hysteria  and  Hiccough,  Convul- 
sions, Whooping-Cough,  Antispas- 
modics, Emetics,  Disgust,  Fear, 
Mental  Emotions,  Soul  and  In- 
stinct, Remedial  Action,  Reflex 
Action,  Index  11.  ;  Nervous  Power, 
Sympathy,  Index  I.  and  II. 

Hope, 

"  cheer  up  the  patient,  and  he  is  sure 
to  do  well,"  or,  as  Hippocrates  has  it, 
"  he  docth  the  best  cures  in  whom 
most  trust" — who  can  mistake  an  an- 
tagonistic substantive  cause — some- 
thing more  than  imaginary — acting  in 
opposition  to  itself,  when  grief,  dis- 
appointment, despondency,  despair, 
lay  deeply  the  foundations  of  disease, 
but  rarely  too  deeply  for  the  mastery 
of  Hope — who  can  mistake  a  common 
substantive,  self-acting  agent,  known 
as  the  Soul,  which  develops  and  jnodi- 
fies,  according  to  the  nature  of  each 
emotion,  another  agent  known  as  the 
nervous  power,  or  nervous  influence 
(no  matter  which),  upon  whose  altera- 
tive efl'ccts,  and  as  it  may  bo  rendered 


Hope — continued. 

morbific  or  curative  by  the  Spiritual 
part,  all  the  astonishing  variety  de- 
pends ;  and  who  so  unjust  to  his  rea- 
son as  not  to  concede  an  exact  analogy 
between  the  modus  operandi  of  these 
and  other  emotions,  and  of  all  physical 
causes,  whether  morbific  or  remedial, 
and  thus  embrace  the  operation  of  the 
whole  under  a  common  philosophy — ■ 
or,  reasoning  from  the  latter  to  the 
former,  equally  concede  the  instru- 
mentality of  the  nervous  influence  in 
the  former  case,  and  its  development 
by  an  agent  of  the  same  substantive 
existence  as  the  physical  causes,  p. 

'  107-111,15.227-2331;  p.  324,  ^  500  c; 
p.  326,  ()  500  g;  p.  327,  ^  500;;  p. 
333,  ^  503  ;  p.  534,  «J  844  ;  p.  661- 
664,  ^  894  5-900 ;  p.  667,  <J  904  c ; 
p  865-868,  ^  1007;  p.  879-882,  ^ 
1074-1075;  p.  886-891,  ()  1077. 
Also,  Mental  Emotions,  Grief,  Joy 
AND  Anger,  Love,  Jealousy,  Weep- 
ing, Shame,  Disgust,  Fear,  Food, 
Hunger,  Thirst,  Respiration,  Ex- 
ercise, Skin,  Cold,  Heat,  Convul- 
sions, Antispasmodics,  Seton  ; 
Causes,  Morbific  ;  Remedies,  Ca- 
thartics, Emetics,  Remedial  Ac- 
tion, Soul  and  Instinct,  Index  II. 

Humboldt — generalizations,  p.  923-926. 

Humoral  Pathology — See  Humoralism, 
Index  I.) 
inconsistent  opinions  of  its  intelligent 
Advocates,  p.  156-173,  parallel  col- 
timns  ;  p.  514-515,  parallel  columns ; 
p.  519,  ij  825  ;  p.  520,  ()  826  c  ;  p.  754, 
I  1002/;  p.  755,^  1004  c. 
Author's  motives  for  the  inquiry,  p.  515, 

illustrates  propensity  for  simple  views 
in  Medicine,  p.  516,  <)  820  c. 

an  old  affair,  p.  516,  ()  820  c. 

the  doctrine  stated,  p.  516-517,  ^  821  b. 

its  eleven  special  points,  which  are  pro- 
posed to  be  investigated  and  examined 
in  order,  p.  518-519,  ^  823-824. 

arguments  in  behalf  of,  drawn  fromyeast, 
putrid  herrings,  spoiled  sausages,  pu- 
trid urine,  putrid  cheese,  putrid  brain, 
and  cold  meat,  p.  172-173,  Nos.  44, 
45,  parallel  columns  ;  p.  517,  ()  821  c  ; 
p.  528,  ()  832-835. 

argument  from  "  hereditary  impurities" 
and  "impoverished  blood,"  p.  52'J,  (J 
836. 

argument  from  remedies  injected  into 
circulation,  p.  529-530,  ^  837  a,  b ; 
p.  677,  '^  904  c ;  p-  932,  (j  1088  d. 

argument  from  Astringents  and  Tonics, 
p.  533,  {)  842. 

general  argument  from  putridity,  p.  533, 
^  843. 

curious  inductions   from   injcclionr.   of 


INDEX    11. 


1013 


Humoral  Pathology — continued. 

morbific  matters  into  the  circulation, 
and  examined,  p.  527-528,  ()  830-831. 
action  of  poisons  inserted  in  wounds, 
aorainst  Humoralism,  with  examples, 
and  other  illustrations,  p.  319-321,  ^ 
494  b-e ;  p.  525-526,  ^  828  a-c,  and 
references  there ;  p.  526,  ()  828  d. 
Also,  Hydrophobia,  Virus  of,  Index 
II. 

deleterious  agents  and  remedies  not  ab- 
sorbed, unless  they  first  inflict  disease 
upon  the  absorbing  vessels,  and  then, 
if  at  all,  but  sparingly,  and  quickly 
carried  off  by  kidneys,  p.  99,  ()  192  ; 
p.  129-134,  *;.  277-295  ;  p.  230,  <J  422 
b;  p.  519-521,  (i  826-827,1088-1089. 

their  absorption  disproved  by  the  refusal 
of  the  absorbents  to  admit  bile,  intes- 
tinal acids,  and  all  other  things  that 
may  undergo  fermentation  in  the  in- 
testine, urine,  &c.,  p.  62-63,  <J  136- 
"  137;  and  ut  supra.  Also,  Absorp- 
tion, Index  I.     Also,  p.  932,  ^  1089. 

false  conclusions  from  the  absorption  of 
nitrate  of  silver,  acetate  of  lead,  &c., 
since  they  become  soon  converted  in- 
to inert  compounds  in  the  alimentary 
canal,  p.  530,  ^  837  c. 

how  do  sulphuric  acid  and  acetate  of 
lead  arrest  the  night-sweats  of  pul- 
monary phthisis^  Ask  the  Chemist 
what  is  their  condition  when  he  mixes 
them  with  blood,  p.  530,  <J  837  c ;  p. 
.  577,  ^  890  0. 

many  poisons  applied  to  wounds  produce 
no  effect  upon  surfaces,  and  inflict 
their  constitutional  effects,  in  the  for- 
mer case,  through  alterative  influence 
of  reflex  action  of  nervous  system, 
unless  violently  forced  into  the  torrent 
of  blood  ;  and  here  the  Author  ad- 
monishes against  confounding  experi- 
ments upon  nerves  with  those  upon 
their  expanded  extremities,  p.  520- 
521,  ij  826  d;  p.  525,  ^  828  a. 

contrast  between  effects  of  poisons  as 
applied  to  different  surfaces  and  as 
inserted  in  wounds,  p.  520-521,  ij 
826  d. 

eminent  Chemists  do  not  agree  in  the 
least  in  regard  to  absorption  of  some 
important  remedies,  and  others  are 
receding,  p.  520,  ()  826  ;  p.  779-782, 
^  1028-1030  ;  p.  783-784,  <J  1031  b; 
p.  787,  ^  1032  a;  p.  794,  ^  1033  a. 

absorption  of  morbific  and  remedial 
agents  disproved  in  those  instances 
where  their  effects  are  enduring  or 
long  delayed,  as  the  hydrophobic  vi- 
rus, miasmata,  mercurials,  by  the  fre- 
quent renewal  of  the  blood,  p.  520,  ^ 
826  b ;  p.  677,  ()  904  c. 

absorption  of  violent  agents  disproved 
by  their  failure  to  act  upon  the  highly 


Humoral  Pathology — continued. 

irritable  heart  when  they  act  with  vio- 
lence upon  other  organs,  p.  527,  ()  829. 

if  admitted  that  the  causes  of  disease 
and  means  of  cure  be  absorbed  (whose 
nature  is  sufficiently  material),  it  be- 
longs to  Vital  Solidism  alone  to  ex- 
plain their  modus  operandi,  ()  284, 
827/,  904  c,  1033  b. 

v;hat  mental  emotions  say  to  it,  p.  534. 
(}  844.  Also,  Mental  Emotions,  the 
several  individual  Passions,  Skin, 
Cold,  Heat,  Food,  Friction,  Exer- 
cise, Phthisis,  Whooping-Cough, 
Seton,  and  other  analogous  things. 
Index  II. 

Andral's  doctrine  of  primary  changes  in 
the  blood  refuted  by  a  fundamental 
law,  p.  535-538,  ()  846-847. 

nothing  can  make  healthy  blood  but 
the  healthy  action  of  the  solids, 
and,  did  the  blood  take  the  initiatory 
step  in  disease,  there  could  be  no  re- 
covery, p.  535-539,  ^  846-847, 

a  great  fundamental  law  in  a  universal 
adaptation  of  blood  and  secreted  pro- 
ducts, however  morbidly  changed,  to 
all  parts  of  the  organism  respectively, 
by  which  they  are  rendered  inoffensive 
to  the  respective  parts,  p.  62-63,  <J  136 
-137  c ;  p.  536-.539,  (}  847  e-850.  Al- 
so, p.  62-63,  ()  136, 137,  Adaptation, 
Law  of.  Index  I.   A\?o,  p.  146  §  328. 

dependence  of  all  morbid  products,  in 
each  instance,  upon  special  physio- 
logical changes,  fatal  to  Humoralism, 
p.  479,  iji  741.  Also,  Secretion  and 
Excretion,  Index  II 

Author  resolves  the  whole  chaos  of  the 
Humoral  Pathology  into  a  system  of 
grand  Designs,  through  the  applica- 
tion of  the  natural  organic  functions, 
and  alterative  influence  of  direct  and 
reflex  action  of  the  nervous  system, 
and  which  he  has  equally  applied  to 
all  the  problems  in  Pathology  and 
Therapeutics,  and  to  all  the  philoso- 
phy involved  in  the  modus  operandi 
of  morbific  and  remedial  agents,  both 
physical  and  mental,  p.  519-521,  ^S 
826  a,  b,  d;  p.  523,  <J  827  b,  c;  p. 
525-527,  ()  828-829  ;  p.  530,  ^  837 
b ;  p.  532-533,  ^  841  ;  p.  534,  (J  844  ; 
p.  538,  539,  ^  847  g,  848.  See  Medi- 
cal and  Physiological  Commcntancs, 
vol.  i.,  p.  569-574  (1840),  where  occurs 
a  distinct  and  anatomical  exposition 
of  the  reflex  action  of  the  nervous  sys- 
tem, which  the  Author  there  arra3's 
against  the  doctrines  in  Humoralism. 
Also,  Institutes,  Pathology,  Reflex 
Action  OF  Nervous  System;  Causes, 
Morbific  ;  Remedies,  Remedial  Ac- 
tion, Therapeutics,  Seton,  Coun- 
ter-Ireitants,  Mental   Emotions. 


1014 


INDEX    II. 


Humoral  Pathology — continued. 

the  individual  Passions,  Exercise, 
Food,  Suppositories,  Bloodletting, 
Leeching,  Skin,  Cold,  Heat,  Fric- 
tion, Convulsions,  Respiration, 
Cathartics,  Emetics,  &;c..  Index  II.; 

contradicted  by  physiological  laws,  () 
284,  285,  639,  674-676,  822,  829, 
835,  839,  847-851,  863  e,  889  a-f,  n. 

supposed  absorption  of  certain  gases 
and  fumes  refuted,  and  shown  to 
operate  through  reflex  action  of  the 
nervous  system,  p.  320,  (}  494  dd ;  p. 
521-525,  ()  827 ;  p.  862-864,  (}  1 066— 
Liebig's  hypotheses  of,  p.  175-176, 
^  350^  n-p.  Also,  Anesthetics, 
Hydrocyanic  Acid,  Index  II. 

miasmata  produce  disease  through  alter- 
ative influence  of  reflex  action  of  the 
nervous  system,  p.  522-524,  ()  827 
b-e.  Also,  Predisposition,  Causes, 
Morbific;  Hydrophobia,  Virus  of  ; 
Seton,  Alteratives,  Anesthetics, 
and  the  preceding  references  to  In.  II. 

morbific  blood  should  produce  no  local, 
but  universal  disease, p.  539,  ij)  847  A. 

a  great  and  prevailing  error  to  confound 
the  altered  states  of  the  blood  with  the 
pathology  ofdisease,  or  with  the  causes 
of  disease,  which  is  owing  as  much  to 
morbid  influences  of  the  solids  as  are 
the  morbid  products  of  the  liver,  or  of 
otherparts — beingon  common  ground 
in  all  the  cases  as  merely  efl^ects  or 
f  ymptoms,  and  all  referable  to  altera- 
tive influence  of  direct  or  reflex  action 
of  the  nervous  system  beyond  the  di- 
rect seat  of  operation  of  any  physical 
agent,  p.  478-480,  ()  740 ;  p.  551,  ^ 
839  ;  p.  535-539,  ij  847.  Also,  Se- 
cretion AND  Excretion,  Index  II. 

reasons  why  the  blood  cannot  be  medi- 
cated, p.  531-533,  ()  838-841  ;  p.  535 
-539,  ()  846-847;  p.  U7,  §  330. 

illustrations  from  Tartarized  Antimony 
and  other  remedies,  p.  530,  ()  837  c ; 
p.  531-532,  <J  840,  841  ;  p.  533,  (;- 842. 

its  special  objects  in  the  treatment  ofdis- 
ease, and  the  difference  in  the  practical 
habits  of  the  Hunioralist  and  the  Vital 
Solidist,  p.  356,  i)  526  c  ;  p.  540,  ^  851 ; 
p.  550,  ^863  e 
Hunger, 

like  the  exciting  cause  of  Respiration, 
a  Seton,  Cold,  &c.,  incapable  of  being 
"absorbed"  —  associated  with  the 
physiology  of  respiration  and  the  in- 
fluences of  food  in  developing  a  reflex 
action  of  the  nervous  system,  to  illus- 
trate the  modus  operandi  of  morbific 
and  remedial  agents  upon  parts  beyond 
their  direct  scat  of  operation  through 
an  alterative  influence  of  the  reflex 
action  corresponding  with  the  nature 
of  the  exciting  causes — the  analogies 


Hunger — continued. 

being,  that  in  respiration  the  point  of 
departure  for  the  reflex  nervous  in- 
fluence is  the  mucous  tissue  of  the 
lungs,  and  that  of  food,  in  the  examples 
presented,  and  of  hunger,  the  mucous 
tissue  of  the  stomach,  while  all  the 
remote  influences  of  either  are  con- 
ducted through  the  nervous  system, 
but  with  the  difference  that  the  reflex 
action  of  the  nervous  system,  in  the 
case  of  respiration  and  food,  is  natural 
and  salutary,  while  in  that  of  hunger, 
when  prolonged,  it  is  morbific — and 
the  analogies  between  the  examples 
of  food  and  hunger  are  farther  con- 
tinued in  their  equal  development  of 
reflex  action  of  the  nervous  system 
and  in  the  co-operation  of  mental 
emotions  that  develop  a  direct  nerv- 
ous influence,  which,  in  one  case, 
falls  upon  the  salivary  glands  with  a 
salutary  effect,  while  it  is  morbific  in 
the  other,  and  by  which  is  also  illus- 
trated the  modifications  which  the 
nervous  influence  undergoes  accord- 
ing to  the  nature  of  the  causes  which 
bring  it  into  operation.  See  Food, 
Thirst,  Reflex  Action  of  Nervous 
System,  Remedial  Action,  Mental 
Emotions,  the  individual  Passions, 
Skin,  Cold,  Heat,  Disgust,  Seton, 
&c.,  Index  II. ;  Nervous  Power, 
Sympathy,  Index  I.  and  II. 

Hybernating  Animals, 

employed  to  illustrate  the  philosophy  of 
animal  heat  as  a  secreted  product,  and 
in  connexion  with  reflex  action  of  the 
nervous  system,  p.  249,  <^  441  c;  p.« 
253,  i)  441  d;  p  255-256,  ()  44U  a; 
p.  257,  ()  442  a ;  p.  262-263,  <)  446  a ; 
p.  264-265,  ()  446  d,  447  a ;  p.  332, 
^500o.  Also,  Organic  Heat, /nrfez 
I.  and  II. 
show  how  intense  cold,  or  merely  prick- 
ing, may  develop  in  animals  of  a  pecu- 
liar constitution  a  reflex  nervous  in- 
fluence that  shall  prove  a  stimulus  to 
organic  functions,  and  speedily  exalt 
the  temperature  of  the  entire  body 
from  39°  to  97°  F.— and  thus  show- 
ing, also,  that  animal  heat  is  on  com- 
mon ground  with  other  secretions,  p. 
249,  {j  441  c ;  p.  253,  (/  441  d ;  p.  262- 
263,  ^  446  a ;  p.  264-265,  i)  446  d, 
447  a.  Also,  Heat,  Cold,  Skin,  Index 
II ;  Vital  Properties,  Index  I. 

Hybrid  Animals — continued  from  Index 
I, 
why  incapable  of  procreating,  p.  86,  ij 
1052  h. 

Hydrocyanic  Acid,Nux  Vomica,  Strych- 
nia, 
exert  their  destructive  effects  through 
reflex  action  of  the  nei^'ous  system,  * 


INDEX    II. 


1015 


Hydrocyanic  Acid,  &c. — continued. 

to  which  they  impart  a  pernicious 
modification  ;  and  compared  with 
other  things,  p.  176,  (j  350^  -p;  p. 
296,  <;.  176  c;  p.  298,  ()  476^  h;  p. 
318-320,  ()  493  rf-494  dd;  p.  323- 
324,  i)  500  c ;  p.  334,  (^t  509  ;  p  368, 
^  558  a,  b;  p.  481,  «^  743;  p.  521,  () 
826  d;  p.  523,  <J  827  c,  <f;  p.  525- 
526,  ^  828  a-c ;  p.  672-675,  i)  904  i  ; 
p.  706,  ()  946  i.  Also,  Remedial 
Action,  Reflex  Action,  Antispas- 
modics, Index  II. ;  Nervous  Power, 
Sympathy,  Index  I.  and  II. 

when  fatal  in  man,  indistinguishable  in 
the  blood  or  organization,  p.  672,  ^ 
904  b. 
Hydrophobia,  Virus  of, 

its  morbific  effects  propagated  from  bit- 
ten part  through  alterative  influence 
of  reflex  action  of  the  nervous  system, 
to  which  it  imparts  a  pernicious  modi- 
fication ;  and  compared  with  other 
things,  p.  66-67,  (}  148  ;  p.  333,  (>  503, 
506;  p.  344,  iji  516  rf.  No.  6  ;  p.  356, 
^526c;  p.  368-369,  1^  558-561  ;  p. 
421-423,  {)  654  J-659  a;  p.  520,  i) 
826  b;  p.  523,  t)  827  b,  c;  p.  525,  ^ 
828  a;  p.  526,  <)  828  d;  p.  661-663, 
(J  894-896  ;  p.  666-670,  I)  902  b-m  ,■ 
p.  679-681,  ^  905  a.  Also,  Medical 
and  Physiological  Commentaries,  vol. 
i.,  p.  494-513;  p.  569-574  (1840), 
where  the  alterative  influence  of  reflex 
action  of  the  nervous  system  is  fully 
applied  to  this  problem.  This  opinion  is 
confirmed  by  observations  made  many 
years  after  the  Author's  exposition. 

the  disease  admits  of  a  great  loss  of  blood 
on  account  of  a  powerfully  stimulating 
nervous  influence  determined  upon 
the  vascular  system,  p.  733-734,  ^ 
974  c-976  a.  Also,  Inflammation  ; 
Brain,  Inflammation  of  ;  Blood- 
letting, Index  II. ;  Nervous  Power, 
Index  I.  and  II. 

the  only  morbid  animal  poison  that  is 
not  a  new  formation,  and  its  morbific 
power  limited  to  the  canine  and  feline 
tribes,  though  all  animals  are  liable  to 
its  profound  influences.  The  disease 
supposed  by  many  to  occur  spontane- 
ously in  man,  p.  421,  <^  654  b.  Also, 
Medical  and  Physiological  Comment- 
aries, vol.  i.,  p.  498-506. 
Hysteria  and  Hiccough, 

depend  upon  reflex  action  of  the  nervous 
system,  which  commonly  has  its  point 
of  departure  in  the  former  affection 
from  the  uterine  system,  and  in  the 
latter  from  the  mucous  tissue  of  the 
stomach,  though  an  emotion  of  the 
mind  may  determine  both,  even  on 
witnessing  this  affection  in  others,  as 
in  yawning,  through  its  direct  devel- 


Hysteria  and  Hiccough — tontinuci^. 

opment  of  the  nervous  influence — 
relieved  by  emetics,  which,  by  intro- 
ducing a  new  development  of  reflex 
action  of  the  nervous  system,  and 
directing  its  influence  upon  other 
muscles,  breaks  up  the  paroxysm — 
showing,  also,  how  readily  simple 
irritations  of  the  nervous  centres  will 
produce  convulsions,  whether  through 
direct  development  of  the  nervous  in- 
fluence by  mental  emotions,  or  by  re- 
flex action  of  the  nervous  system,  as 
in  teething,  intestinal  troubles,  dtc, 
while  diseases  of  the  brain  and  of  the 
spinal  cord  do  not  often  give  rise  to 
them  unless  they  result  in  effusion  or 
disorganization,  p.  Ill,  (^  233|  ;  p. 
326,  ^  500  g-,  p.  337-338,  «J  514  c,  rf; 
p.  358,  ()  526  c.  Continued  under 
Hiccough,  Index  II.  Also,  Convul- 
sions, Antispasmodics,  Whooping- 
CouGH,  Mental  Emotions,  hidex  II. 


I. 

Idiosyncrasy, 

depends,  particularly,  upon  a  special 
modification  of  irritability,  through 
which  certain  medicines,  or  certain 
doses  of  medicine,  some  kinds  of  food, 
and  certain  mental  emotions,  and  other 
things  (all  on  common  ground),  will 
act  with  violence,  or  prove  morbific, 
when  they  would  exert  no  effect  upon 
others — all  depending  upon  their  de- 
velopment of  a  morbific  influence  of 
direct  or  reflex  action  of  the  nervous 
system,  and  going  with  the  rest  of  our 
subjects  to  illustrate  the  philosophy 
of  life,  the  modus  operandi  of  all  mor- 
bific and  remedial  causes,  physical 
and  mental,  through  the  agency  of 
direct  or  reflex  nervous  influences, 
and,  as  it  respects  the  mental  causes, 
to  substantiate  the  substantive  exist- 
ence and  self-acting  nature  of  the 
S.oul,  p.  384,  ^  585  b;  p.  631-632,  ij 
8921  b,  c.  Also,  Opium  (the  ''fill," 
and  "  scarlet  efflorescence''') ;  Causes, 
Morbific  ;  Food,  Mental  Emotions, 
Soul  and  Instinct,  Fear,  Index II,- 

Ignorance  in  Medicine, 

confessions  of,  when  excusable  and 
laudable,  i)  904  c,  905J. 

Imagination — continued  from  Index  I., 
on  common  ground  with  the  mental 
emotions  as  it  respects  its  influence 
in  organic  life,  and  the  prolific  parent 
of  a  great  variety  of  modifications  of 
the  latter — exemplifying  the  appa- 
rently endless  variety  in  contrasts 
and  near  affinities  in  the  modified 
conditions  of  the  nervous  influence 
as  developed  by  one  emotion  or  an" 


1016 


INDEX    II. 


Imagination — continued. 

other,  according  to  its  nature,  inten- 
sity, concurring  causes,  &c.,  p.  631- 
632,  ^  892i  b,  c — and  to  what  is  there 
said,  it  may  be  worth  adding  that  I 
know  an  individual  who  is  purged  by 
the  disgust  at  the  supposed  neces- 
sity of  taking  a  cathartic.  Also, 
Mental  Emotions,  the  individual 
Passions,  Bloodletting,  Remedial 
Action,  Soul  and  Instinctive  Prin- 
ciple, Index  II. ;  Nervous  Power, 
I?idex  I.  and  II. 
Infancy, 

extends  from  birth  to  end  of  first  denti- 
tion, p.  373,  ()  576.  a  —  its  various 
charcLCteristics,  physical  and  mental, 
(}  576  b,  c — diseases  of,  correspond 
with  mutations  in  structure  and  other 
physiological  characteristics,  and  ex- 
amples, p  576  d — and  require  corre- 
sponding modifications  of  treatment, 
with  illustrations,  p  375,  ()  576  e ;  p. 
766-768,  <)  1009-1013.  Also,  Age, 
Index  II 

its  numerous  peculiarities,  in  connex- 
ion with  those  which  are  incident  to 
Youth,  illustrate  the  changes  which 
organs  undergo  in  their  vital  consti- 
tution, and  exemplify  the  Author's 
doctrines  relative  to  Irritability  and 
the  changeable  nature  of  the  Proper- 
ties of  Life,  and  invite  the  ingenuity 
of  the.  Chemical  Interpreter,  p.  374- 
375,  ()  576  c-f;  p.  376-380,  <J  578. 
Also,  Irritability,  Vital  Proper- 
ties,Vital  Principle,  Organic  Life, 
Index  I. ;  Structure,  Index  II. 
Infants,  Cholera  of.     See  Diarrhoea, 

Index  II. 
Inflammation — continued  from  Index  I., 

distinct  from  Idiopathic  Fever,  and  how 
distinguished,  p.  64-65,  (f  143  e;  p. 
63-67,  ^  148  ;  p.  70-73,  the  Tables; 
p.  367,  i)  557  a ;  p.  444-445,  ()  688 
d-ee ;  p.  464,  ()  712  ;  p.  466,  ^  716  ; 
p.  489-490,  ()  757,  759  ;  p.  491-492, 
^  764  a;  p.  493,  (}  764  e;  p.  495,  () 
770  ;  p.  497-499,  «J  779,  780,  784  a, 
785.     Also,  Fever,  Index  II. 

nevertheless,  is  generally  confounded 
with  fever,  p.  464,  ^  713.  Also, 
Fever,  Lidex  II. 

the  distinction  herein  made  between 
Inflammation  and  Fever,  embraced 
in  part  under  both  articles,  and  also 
other  distinguishing  characteristics  in 
Medical  and  Physiological  Comment- 
aries, Articles  Inflammation  and  Ve- 
nous Congestion,  vol.  ii.,  the  Author 
claims  as  peculiar  to  himself,  p.  464, 
()  710  b;  p.  489,  (;  757. 

its  general  characteristics,  p.  469,  (J  725 
-728.     Also,  p.  444-445,  (}  688  d-ec. 

its  four  principal  Btages,  formative,  sup- 


Inflammation — continued. 

purativc,  ulcerative,  restorative,  the 
last  three  being  results  of  the  recu- 
perative disposition,  or  "termina- 
tions," as  they  are  called,  p.  470-475, 
^  729-733— take  place  in  all  parts 
under  common  laws,  p  471,  ^  732  d 
— illustrated  by  a  deep-seated  abscess, 
showing  great  Design,  p.  472-474,  ij 
733  ;  p.  546,  (^  862. 
involves  reparation,  p.  474,  ij  733  / — 
which  is  analogous  to  regeneration, 
p.  474-475,  ^  733 — but  controverted 
by  physical   theorists,  p.  475,  ^  733 

its  termination  in  resolution  during  the 
formative  stage,  which  it  is  the  great 
aim  of  art  to  efiect,  p.  470,  <^  729  a; 
p.  476,  (j  735 ;  p.  638,  639,  640,  i)  8924 
g ;  p.  642,  ^  892|  i. 

the  suppurative  stage  the  next  most  fa- 
vorable termination  of,  p.  471,  ()  730  ; 
p.  472,  I)  733  a,  b. 

secretions  of  lymph,  scrum,  mucus,  &c., 
may  take  the  place  of  suppuration,  but 
are  analogous  in  principle,  p.  471,  () 
732 — all  acting  as  depletory  means, 
thid.,  and  p.  546-548,  (^  862-863  d. 

what  Nature  contemplates  besides,  in 
effusions  of  lymph  and  pus,  p.  472,  (j 
732  c-733  c. 

called  adhesive  stage  when  lymph  takes 
the  place  of  suppuration,  which,  in 
wounds,  constitutes  "  healing  by  first 
intention,"  p  471,  ^  732  c,  d — objec- 
tions answered  to  its  dependence  upon 
inflammation,  p.  475,  <Si  733  g-k. 

adhesive  process  occurs  within  the  struc- 
ture of  all  organs  through  a  general 
law,  and  although  often  a  greater  evil 
than  the  disease  which  it  is  designed, 
in  part,  to  relieve,  Nature  has  still 
provided  means  for  its  removal,  p. 
471,  <;>  723  d. 

ulceratiofi  more  or  less  attendant  on 
suppuration,  and  its  objects  and  laws, 
p.  471,  ^  730  ;  p.  472,  (}  733  b. 

granulatwn,  a  consequence  of  inflam- 
mation, belongs  to  reparation,  is  pro- 
moted by  suppuration,  and  involves 
profound  physiological  laws,  p.  471. 
()  730 ;  p.  472-475,  ^  733  c-f,  and 
references  there. 

irregularities  of  its  stages,  p.  476-480, 
{)  734-741. 

an  irregularity  in  being  diffuse,  as  in 
erysipelas  and  phlebitis,  p.  476,  <J 
735  b. 

in  its  different  stages  being  accelerated 
or  protracted,  which  is  often  true  in 
the  latter  respect  of  the  formative 
and  restorative,  p.  477,  <J  737. 
in  the  products  of  the  second  stage, 
when  pus,  or  lymph,  or  serum  de- 
viate from  their  natural  standard, 


INDEX    II. 


1017 


Inflammation — continued. 

and  from  certain  peculiarities  in  the 
nature  of  particular  tissues,  or  as 
arisinof  from  specific  forms  of  dis- 
ease, p.  471,  ()  730,  732  ;  p.  478,  ^ 
739. 
mortification  the  greatest  irregularity, 
and,  like  resolution,  commonly  hap- 
pens in  the  formative  stage  —  the 
result  of  a  profound  alteration  of 
the  properties  and  actions  of  life, 
and  not  dependent  upon  stagnation 
and  coagulation  of  blood,  as  com- 
monly supposed,  p.  477,  ^  736  b ; 
p.  484,  ()  748 — and  dead  parts  re- 
moved from  the  living  through  the 
vital  process  of  ulceration,  and  not, 
as  generally  alleged,  by  the  vis  a 
tergo,  or  a  mere  solution,  p.  477,  ^ 
736  c. 
all  the  varieties  in  pus,  lymph,  mucus, 
serum,  &c.,  depend  (^catcris  paribus) 
upon  precise  pathological  conditions, 
respectively,  p.  478-479,  <^  740-741. 
Also,  p.  222-227,  ^  409  c-411  ;    p, 
228,  {)  415  ;  p.  436,  ()  682  b;  p.  452, 
^  693  ;  p.  479,  ()  741  a  ;  p.  531,  (}  838 
-840;    p.  536-539,  ^  847  c  — which 
contradicts  all  chemical  and  humoral 
hypotheses,  ibid. — nor  is  pus  owing, 
as  supposed,  to  a  degeneration  of  blood 
or  of  tissues,  p.  479,  ^  741  a. 
its  tendency  to  confine  itself  to  the  tissue 
in  which  it  springs   up,  and  deeply 
founded  in   physiological    laws    that 
relate  to  the  different  tissues,  p.  64, 
^  141  b;   p.  354,  ^  526  a;    p.  480,  'J 
741  c;    p.  652-653,  ()  893  n.     Also, 
Structure,  Index  II. 
its   remote   causes,  p.  414-427,  <)  644- 

666  ;  p.  480-481,  (J  742-743. 
may  be  produced  by  sedatives,  even  loss 
of  blood,  as  well  as  by  stimulants,  di- 
rect irritants,  &c.,  p.  480-481,  <)  743  ; 
p.  512,  <)  817  ;  p.  523,  (j  837  ;  p.  708, 
()  950  ;  p.  733,  ^  974  b ;  p.  773-775, 
(j  1024;  p.  829,  ()  1057  a.  Also, 
Causes,  Morbific,  Index  II. 
its  precise  character,  even  in  the  common 
form,  depends  mostly  upon  the  nature 
of  the  remote  cause,  in  sound  consti- 
tutions, or  when  two  or  more  operate, 
upon  their  united  properties,  or  will 
be  modified  by  hereditary  predispo- 
sitions, idiosyncrasies,  &c.,  and  its 
various  modifications  as  produced  by 
diflTerent  kinds  of  mechanical  injuries, 
and  their  different  modes  of  treatment 
employed  to  illustrate  the  principle 
that  every  morbific  and  remedial  agent 
produces  modifications  of  the  vital 
states  peculiar  to  its  own  virtues,  p. 
417-418,  ()  650-652  c ;  p.  468-469, 
<^  722  h,  c;  p.  641,  ^  8924  i ;  p.  664, 
\  900;  p.  669,  (^  902  h;  p.  671-672, 


Inflammation — continued. 

SS  904  a.  Also,  p.  61-67,  I)  133-151, 
and  Causes,  Morbific  ;  Remedies, 
Index  II. 

its  varieties,  common  and  specific — as 
induced  by  cold  and  wounds,  forming 
an  example  of  the  first,  and  by  all 
natural  and  morbid  animal  poisons, 
and  all  poisons  of  the  Materia  Medica, 
and  hereditary  predispositions,  of  the 
la.st,  p.  419-421,  i)  653  6-655;  p. 
424,  {}  661  ;  p.  468,  <^  721  ;  p.  641,  i) 
892|  I. 

is  either  acute  or  chronic,  but.  whichever 
it  be,  the  general  principles  of  treat- 
ment are  the  same,  though  modified 
in  its  details,  p.  469,  ^  723.  Also, 
Bloodletting,  Counter-Irritants, 
Expectorants,  Index  II. 

nevertheless,  there  are  numerous  grada- 
tions between  acute  and  chronic,  and 
between  common  and  specific,  each 
series,  respectively,  approximating 
each  other  in  some  of  the  modifica- 
tions, and  showing  that  they  all  belong 
to  a  common  family,  p.  468,  I)  722. 

active  and  '^passive,"  shown  to  be  essen- 
tially the  same  condition,  requiring 
the  same  principles  of  treatment, 
though  generally  supposed  to  be  in 
opposition,  p.  486-489,  i)  753-756. 

intermittent,  depends  upon  the  causes 
of  intermittent  fever,  requires  the 
same  general  treatment  as  the  com- 
mon form,  with  probably  the  ultimate 
use  of  Cinchona,  or  Arsenic,  p.  424, 
(J  662  b;  p.  487-488,  <;»  756  a,  b;  p. 
605-606,  <^  892  p ;  p.  609,  ()  892^  c  ; 
p.  611-612,  <^  892i  h,  i ;  p.  615-616, 
(j  892^/;  p.  737-739,  <;>  894-895. 

rheumatic,  like  the  intermittent,  demands 
the  direct  antiphlogistic  remedies,  and 
perhaps  ultimately  other  remedies 
suited  to  their  specific  forms,  such  as 
Colchicum,  and  certain  acrids,  p.  488 
-489,  f)  756  a,  b ;  p.  561,  ij  888  b ;  p. 
737-739,  ()  984-985. 

scrofulous,  another  specific  form  calling 
for  the  same  general  treatment  as  the 
two  preceding,  but  more  particularly 
for  special  remedies  like  Iodine,  Ba- 
rytes,  and,  like  the  rest,  illustrate  the 
philosophy  of  remedial  action,  &c., 
p.  488-489,  (J  756  a,  6 ;  p.  561,  §  888 
b;  p.  615,  ^  892)r  e;  p.  619-620,  <J 
892^  u;  p.  664-6"65.  (}  900-901  ;  p. 
737-739,  ^  984-985.  Also,  Spe- 
cifics, Index  II. 

its  immediate  instruments  the  terminat- 
ing series  of  the  arterial  system,  p. 
226-227, 1)  410, 411;  p.  355.  i)  528  a ; 
p  483,  <^  746  a — and  why  the  serous 
vessels  admit  the  red  globules,  p.  99, 
^  192 — the  nervous  system  locally 
interested  in  the  results,  but  in  other 


1018 


INDEX    II. 


Inflammation — continued. 

respects  acts  only  as  an  exciting  cause 
of  inflammation  by  direct  or  reflex  ac- 
tion, p.  475,  ^  733  h ;  p  483-484,  ^ 
746  c.  Also,  Reflex  Action  of  the 
Nervous  System.  Index  II  ;  Nerv- 
ous Power,  Sympathy,  Index  I.  and 
II. 

its  proximate  or  ■pathological  cause  con- 
sists of  two  fundamental  elements — 
1st,  an  increased  action  of  the  vessels ; 
2d,  and  by  far  the  most  important,  a 
change  in  kind,  ^  747,  750-751,  910, 
953  d,  e.    Also,  ()  384,  399,  410,  485. 

involves  the  whole  philosophy  of  all 
other  diseases,  p.  482,  <^  745. 

the  prevailing  mechanical  doctrine  of, 
which  supposes  a  passive  relaxation 
of  the  vessels,  and  stagnation  of  blood, 
considered,  p.  484-485,  ij  748,  749. 

always  a  local  disease,  while  fever  affects 
the  system  universally,  p.  65,  ()  143 
a,b;  p.66,  H48;  p.  417-418,  ^^  650; 
p.  422,  <;>  657  b ;  p.  464,  ^  712  ;  p.  489- 
491,(^1757-760;  p.  498,  ^  784.  Also, 
other  distinctions  in  first  subdivision. 
Also,  Fever,  Index  II 

nevertheless,  inflammation  is  often  com- 
plicated with  fever  at  the  invasion  of 
the  latter,  and  may  be  its  exciting, 
though  not  its  predisposing  cause, 
and  fever  rarely  exists  long  without 
giving  rise  to  inflammation,  of  which 
it  may  be  either  an  exciting  cause  in 
organs  already  predisposed,  or  may 
be  the  predisposing  as  well  as  excit- 
ing cause,  p.  227,  HI  1  ;  P-  355,  ^  526 
a ;  p.  464,  <^  71 1-713  ;  p.  481,  ^^i  743  ; 
p.  498,  ()  784  ;  p.  506,  ^  803,  804  ;  p. 
508-509,(^809-811;  p.  510,  (J  813. 

the  general  arterial  excitement  and  heat 
of  skin  attendant  on  inflammation  and 
fever,  but  which  is  often  absent  in 
both,  and  always  more  or  less  inter- 
mitting in  the  latter,  have  led  to  their 
supposed  unity,  p.  464,  465,  <5>  713- 
714.  Also,  references  in  first  sub- 
division, and  Fever,  Index  II. 

the  constitutional  excitement  of  local 
inflammation  is  owing  to  remote  sym- 
pathy, while  that  of  fever  arises  from 
the  disease  at  large  throughout  the 
system — the  exciting  influence  of  the 
reflex  action  of  the  nervous  system, 
in  the  former  case,  being  determined 
especially  upon  the  heart  and  arteries, 
while,  also,  the  same  phenomenon  is 
most  strongly  pronounced  in  inflam- 
mation of  the  brain,  when  the  devel- 
opment of  the  nervous  influence  is 
direct,  as  in  the  case  of  the  Passions, 
but  instituting,  as  a  consequence, 
circles  of  reflex  action,  p.  227,  i!>  41 1  > 
p.  355,  (j  526  b ;  p.  46.5-468,  ()  714- 
719  ;    p.  804-805,  ^  1040,  and  refer- 


Inflammation — continued. 

cnccs  there.  Also,  Brain,  Inflam- 
mation OF  ;  Joy  and  Anger,  and  the 
other  individual  Passions,  Fever,  first 
subdivision.  Index  II. 

no  "general"  inflammation,  and  the 
term  "inflammatory  fever"  hypothet- 
ical and  objectionable,  p.  466,  ()  716. 

farther,  the  foregoing  exciting  and  alter- 
ative influence  of  reflex  action  of  the 
nervous  system  upon  the  general 
circulatory  system,  and  its  local  de- 
termination upon  individual  parts,  is 
the  cause  of  consecutive  inflamma- 
tions, while  each  one  as  it  comes  for- 
ward in  the  progressive  series  joins  in 
the  development  of  the  morbific  reflex 
action,  and  thus  also  mutually  aggra- 
vate each  other,  and  multiply  the  ratio 
of  the  consecutive  derangements  — 
and  these  disturbances  of  the  never- 
ceasing,  ever-changing  reflex  action 
will  depend  greatly  upon  the  activity 
of  disease,  and  upon  the  importance 
of  the  organs  and  the  nature  of  the 
tissue  affected,  though  not  always  so, 
p.  227,  Hi  1;  p.  355,  (5)526  o;  p.  465- 

466,  ^  715  ;  p.  467-468,  ()  718,  719  ; 
p.  506-509,  (5)806-811;  p.  511,  (^815; 
p.  679-681,  (J  904  a;  p.  724-727,  ^ 
961  ;  p.  730,  ^  969;  p.  731,  ^  970  c; 
p.  732-734,  {}  973-975  ;  p.  804-805, 
^  1040,  and  references  there.  Also, 
Structure, Reflex  Action;  Causes, 
Morbific,  Index  II. ;  Nervous  Pow- 
er, Sympathy,  Index  I.  and  II. 

such  is  the  correspondence  among  the 
foregoing  influences  and  derange- 
ments, that  a  modification  may  be 
given  to  the  reflected  nervous  in- 
fluence by  a  single  remedy,  as  Blood- 
letting and  Tartarized  Antimony  (and 
in  fever  also,  and  as  complicated  with 
inflammation),  that  will  overthrow  all 
the  extensive  lesions,  p.  65-66,  (J  143  c, 
and  references  there ;  p.  66-67, 1)  148 ; 
p.  465-466,  (J)  715,  and  re/crcwccs  there; 
p.  498,  (J  784  b,  and  references  there ; 
p.  731-732,  ^  970  c. 

produces,  also,  through  the  foregoing 
sympathetic  influences,  other  forms 
of  disease,  which  concur  in  modifying 
the  reflex  nervous  influence,  and  this 
often  depending  upon  the  special  vital 
constitution  of  tissues  and  organs,  p. 

467,  (^  718.     Also,  Structure. 

the  development  and  modification  of  the 
reflex  action  of  the  nervous  system, 
and  its  influence  upon  one  part  or  an- 
other, depends,  more  or  less,  not  only 
upon  the  special  vital  constitution  of 
tissues  and  the  relations  which  they 
bear  to  compound  organs  as  one  or 
another  may  be  the  seat  of  inflamma- 
tion, and  more  or  less  so  as  it  respects 


INDEX    II. 


1019 


Inflammation — continued. 

the  determination  of  the  morbific  in- 
fluence upon  different  parts,  but  its 
influence  when  resulting  from  ve- 
nous inflammation  is  a  strong  exem- 
plification of  the  special  modes  in 
which  the  alterative  influence  of  re- 
flex nervous  action  is  modified  by  the 
nature  of  a  tissue  when  affected  by  a 
common  form  of  disease,  and  serves 
to  illustrate  the  great  fact  that  every 
cause,  both  physical  and  mental,  that 
may  bring  it  into  operation,  imparts 
to  it  a  special  modification  peculiar  to 
its  own  virtues,  p.  444-446,  ^  688  c,f; 
p.  506-509, 'J  806-811;  p.  511,  (j*  815  ; 
p.  724-726,  <J  961  ;  p.  730,  <^  969; 
p.  731,  ()  970  c;  p.  732-734,  (}  973- 
975.  Also,  Structure,  Index  II. ; 
Nervous  Power,  Index  I.  and  II. ; 
Vexous  Congestion,  Venous  Tissue, 
Index  I. 

develops  a  reflex  action  of  the  nervous 
system  which  imparts  to  the  pulse  its 
peculiar  characteristics  of  hardness 
and  incompressibility,  and  the  pecu- 
liar modification  of  the  nervous  in- 
fluence as  instituted  by  inflammation 
is  farther  manifested  in  its  production 
of  those  changes  of  vascular  action 
that  lead  to  the  buffing  and  cupping 
of  abstracted  blood,  while,  on  the 
other  hand,  this  protean  power  may 
be  almost  instantly  made  to  change 
its  shape  and  establish  a  totally  new 
order  of  things  under  the  loss  of  blood 
or  a  mental  emotion,  p.  227,  ij  411  ; 
p.  355,  i)  526  a ;  p.  444-445,  ^  688 
a-f;  p.  708-710,  ^  951-952  b;  p. 
804-805,  ()  1040,  and  references  there. 

develops  an  exciting  nervous  influence 
which  sustains  the  system  under  the 
loss  of  blood,  though  o<^some  tissues, 
and  in  their  connexion  with  compound 
organs,  more  than  others,  while  the 
loss  of  blood  so  modifies  the  alterative 
influence  of  the  reflex  nervous  action 
(and  upon  which  all  the  phenomena 
of  Bloodletting  depend)  as  to  speedily 
change  the  whole  condition,  p.  732- 
736,  ()  973-980.  Also,  p.  70-73,  the 
Tables  ;  p.  227,  <J  411 ;  P-  355,  ()  526 
a ;  p.  444-^46,  ()  688  d ;  p.  506-509, 
^806-811;  p.  511,  ^815;  p.  709- 
710,  ()  952  ;  p.  724-734,  (}  961-976  ; 
p.  735-736,  ^  978-980  ;  p.  804-805, 
^  1040,  and  references  there.  Also, 
Bloodletting,  Loss  of  Blood, 
Reflex  Action,  Antispasmodics  ; 
Brain,  Inflammation  of  ;  Struc- 
ture, Index  II. ;  Nervous  Power, 
Sympathy,  Index  I.  and  II. ;  Venous 
Congestion,  Venous  Tissue,  Index  I. 

when  affecting  the  brain,  the  exciting 
nervous  influence  is  greater  than  of 


Inflammation — continued. 

other  organs,  and  here,  too,  the  nerv- 
ous influence  is  developed  in  a  direct 
manner,  and  the  motor  nerves  are 
alone  concerned ;  but  as  soon  as  felt 
by  other  organs,  they  react  upon  the 
nervous  centres,  and  give  rise  to  cir- 
cles of  reflex  action,  p.  671,  ^  903; 
p.  733-734,  ()  974  c-975.  Also,  Ve- 
nous Congestion  ;  Brain,  Inflam- 
mation of  ;  Mental  Emotions,  the 
individual  Passions,  Index  II. 

when  affecting  any  important  organ  in 
small-pox,  measles,  and  scarlet  fever, 
it  gives  rise  to  such  alterative  in- 
fluences of  the  reflected  nervous  ac- 
tion as  enables  the  system  to  bear 
the  remedies  that  would  be  necessary 
when  the  same  disease  occurs  inde- 
pendently, and  which  might  be  other- 
wise fatal,  p  59,  {)  129  h,  i ;  p.  61,  () 
134  ;  p.  63,  9  137  b-e ;  p.  65,  ()  143  c  ; 
p.  67,  ^  150-151  ,  p.  69,  <J  156  b;  p. 
.  73,  H63  ;  p  227,  MH  ;  P-  355,  ^ 
526  a  ;  p.  538-539,  ^  847  g--849  ;  p. 
542-543,  (J.  854/;  p.  544-545,  «J  858  ; 
p.  804-805,  <)  1040,  and  references 
there. 

all  the  foregoing  influences  of  reflex 
action  of  the  nervous  system  are 
examples  of  that  alterative  action  as 
brought  into  operation  by  all  remedial 
and  morbific  causes,  physical  and 
mental,  whenever  they  act  upon  parts 
beyond  the  seat  of  their  direct  opera- 
tion, though  variously  modified  accord- 
ing to  the  nature  of  the  exciting  cause, 
and  are  the  medium  through  which  all 
the  remote  changes  in  the  solids  and 
the  fluids  (the  blood  included)  are 
brought  about,  p.  483-484,  ^  746  c  ; 
p.  679-681,  ()  905  a.  Also,  Blood- 
letting, Loss  OF  Blood,  Cathar- 
tics, Emetics,  &c.  ;  Causes,  Mor- 
bific ;  Remedies,  Therapeutics,  Re- 
medial Action,  Secretion  and  Ex- 
cretion, Reflex  Action  of  Nervous 
System,  Mental  Emotions,  the  in- 
dividual Passions,  &.C.,  Index  II. 

founded  wholly  upon  the  physiological 
states,  1^  749-751.   Patholog.  Cause. 
Inflammation,  Pathological  or  Proxi- 
mate Cause  of, 

supplies  the  whole  philosophy  of  other 
diseases,  p.  482,  <^  745. 

its  immediate  instruments  the  extreme 
arterial  capillaries,  the  nerves  and  ab- 
sorbents participating,  p.  483,  ^  746. 
Also,  p.  220-227,  H09  J-41 1 ;  p.  355, 
^  526  a. 

irritability  and  mobility  increased,  p. 
484,  (}  747.  Also,  p.  89,  M88  ;  p. 
103-104,  ^  205-215  ;  Organic  Life, 
Vital  Properties,  Vital  Principle, 
Index  I. 


1020 


INDEX    II. 


Inflammation,  &c. — continued. 

constituted  by  an  active  contraction  and 
dilatation  of  arteries  and  veins,  but 
more  especially  by  a  change  in  the 
natural  kind,  and  an  increased  circu- 
lation and  volume  of  blood,  p.  209- 
210,  ^  384-387  ;  p.  214-215,  ()  392- 
39G;  p.  216,  ^  399;  p.  305-310,  ^ 
483-485;  p.  485-48G,  <)  750-751; 
p.  503,  ()  794  ;  p.  792-793,  ()  1022  d; 
p  803-804,  <^  1039,  910,  935  c,  d. 

mechanical  theory  of,  which  supposes 
passive  relaxation  of  vessels,  and 
stagnation  and  coagulation  of  blood, 
but  which  is  contradicted  by  facts,  p. 
484-486,  <;»  748-751.  Also,  Medical 
and  Physiological  Commentaries,  vol. 
ii.,p.  141-214. 

Hunter's  opinion  of,  p.  484,  ^  747. 

Magendie's  opinion  of,  p.  482,  i)  744. 

active  and  '^passive"  shown  to  be  essen- 
tially the  same,  p.  486-489,  (}  752- 
756. 
Inflamm.\tion,  Treatment  of, 

discussed  under  the  several  practical 
subjects,  Bloodletting,  Cathartics, 
Tonics  and  Stimulants,  individual 
Remedies,  &c.,  Index  1.  and  II. 

Table,  indicative  of  the  variety  in  the 
vital  constitution  of  different  tissues 
and  compound  organs,  and  of  parts 
of  a  continuous  tissue,  illustrated  by 
their  relative  liability  to  inflammation, 
and  by  the  efliects  of  some  remedial 
agent,  as  bloodletting,  upon  the  va- 
rious tissues  of  organs,  p.  70-73,  ^ 
160-162 — and  another  of  the  relative 
liability  of  different  tissues  of  the  same 
nature  remote  from  each  other  to  sym- 
pathize together  in  their  diseases,  re- 
spectively, through  reflex  action  of  the 
nervous  system,  p.  353,  (^  525  a — and 
another  showing  the  relative  liability 
of  different  tissues,  respectively,  when 
morbidly  affected,  in  any  one  part,  to 
continuous  sympathy  in  their  several 
parts,  p.  354,  <J  526  a,  and  in  connex- 
ion with  Tables  at  p.  70-73  —  all 
serving  as  an  important  basis  of  an 
extended  philosophy  in  Physiology, 
Pathology,  and  Therapeutics.  Also, 
Structure;  Sympathy,  Continu- 
ous, Index  H.  ;  Nervous  Power, 
Sympathy,  Index  I.  and  II. 
Instinct.  See  Soul  and  Instinctive 
Principle,  Index  II. ;  and  Instinct, 
Index  I. 
Intestine, 

contrary  to  opinions  before  entertained, 
this  organ  is  subjected  very  greatly 
to  the  control  of  the  Will ;  and  that 
it  is  closely  allied  to  the  respiratory 
and  sphincter  muscles  in  being  also 
under  the  influence  of  reflex  action  of 
the  nervous  system,  and  liable  to  a 


Intestine — continued. 

temporary  suspension  of  that  influence 
by  an  act  of  volition ;  and  that  the  whole 
intestine  is  subject  to  this  compound 
influence,  though  perhaps  the  lower 
more  than  the  upper  part,  is  evident 
from  what  is  said  in  the  text,  and  as 
will  be  more  apparent  from  consider- 
ing how  completely  a  strong  desire 
for  defecation  may  be  resisted  till  the 
increased  reflex  nervous  action  is  fully 
overcome  by  counteracting  nervous 
influence  determined  by  the  Will  upon 
the  intestinal  muscular  tissue — being 
a  very  remarkable  instance  of  the  ac- 
tion of  the  Will  in  Organic  Life,  and 
forming,  in  connexion  with  its  asso- 
ciate action  upon  other  muscles  con- 
cerned in  defecation,  an  impressive 
example  of  Design,  p.  325,  ^  500  e ; 
p.  326,  ()  500  h;  p.  867,  <^  1067  a— 
while,  also,  it  appears  that  the  stomach 
is  partially  liable  to  influences  of  the 
Will,  as  seen  in  spontaneous  vomit- 
ing, p.  327,  ^  500  j — and  in  its  control 
over  sea-sickness,  p.  889-890,  §  1077. 
Also,  Mental  Emotions,  Reflex 
Action  of  Nervous  System,  Anti- 
spasmodics, Sea  -  Sickness,  Fear, 
Index  II.  ;  Will,  Nervous  Power, 
Index  I.  and  II.   Also,  p.  349.  ()  519. 

different  portions  of,  according  to  the 
special  vital  constitution  of  each  part, 
when  affected  by  disease,  or  when 
certain  cathartics  operate,  develop  dif- 
ferently, and  occasion  different  reflex 
influences  of  the  nervous  system,  and 
require  modifications  of  treatment  as 
the  same  disease  may  affect  one  part 
or  another,  and  reasons  assigned  for 
the  rapid  development  of  a  curative 
or  morbific  reflex  action  of  the  nerv- 
ous system  when  cathartics  operate, 
p.  467,  ()  718  ;  p.  565,  ()  899  ;  p.  856- 
857,  ^  1063  b.  Also,  p.  62-67,  ^  135- 
151;  p.  70,  Table  II. 
Iodine, 

its  introduction  into  practice,  p.  614,  (} 
892i  d. 

exemplifies,  like  arsenic,  tartarized  anti- 
mony, &c.,  the  fallacy  of  reasoning 
from  the  effects  of  remedies  upon  the 
healthy  system  to  its  morbid  states, 
since  it  produces  its  effects  only  upon 
very  special  conditions  of  the  latter, 
and  thereby,  as  with  the  effects  of  all 
,  other  remedies,  demonstrates  the  mu- 
tability of  the  properties  of  life,  and 
their  greater  susceptibility  when  mor- 
bidly affected,  and  goes  with  the  rest 
in  supplying  interesting  problems  for 
cAcniicaZ  interpretation,  p.  612,  i5i892i. 
Also,  p.  3,  (J  2  b;  p.  120-122,  ^  237- 
240  ;  p.  352,  ^  524  d  ;  p.  435,  ^  680  ; 
Arsenic;    Antimony,  Tartarized; 


INDEX    II. 


1021 


Iodine — continued. 

Remedies,  Therapeutics,  Lidex  II. ; 
Vital  Properties,  Index  I. 
some  of  its  imputed  evil  effects  rarely  if 

ever  witnessed,  p.  612,  ^  892^  a. 
often  as  efficient  when   applied   exter- 
nally as  internally,  while,  in  the  for- 
mer case,  it  must  be  in  the  region  of 
the  affected  organ — thus  showing,  as 
in  the  case  of  counter-irritants,  &c., 
that  its  operation,  when  employed  in- 
ternally, is  not  by  absorption,  but  in 
both  cases  alike  by  alterative  influence 
of  reflex  action  of  the  nervous  system, 
p.  613,  <)  892^  c;   p.  619,  ^  892^  t. 
Also,  Counter-Irritants,  Sedatives 
{Aconite),   Alteratives,   Index  II. ; 
Nervous    Power,  Sympathy,  Index 
I.  a7id  II ;  p.  930-931,  ()  1088  b,  c. 
adapted  only  to  bronchocele,  and  not  to 
other  affections  of  the  thyroid  gland, 
p.  613,  -J  892^  c. 
its  uses  in  scrofula,  &c.,  depend  much 
upon  other  appropriate  treatment,  p. 
615,  ()  892^  e;  p.  619,  <J  892^  s,  ii. 
examples  of  its  curative  effects  in  ob- 
stinate chronic  indurations  of  liver, 
spleen,  uterus,  lymphatic  glands,  &c., 
p. 615-616,^892^/.    Also, Leeching, 
Index  II. 
is  stimulating,  and,  if  inflammation  be 
active,  and  especially  of  any  important 
organ,  it  should  be  reduced  by  general 
bloodletting  before  employing  iodine, 
and  leeching  is  often  useful  in  indo- 
lent conditions,  p.  615,  <J  892^  c;  p. 
619-620,  ()  892^  m— and  a  neglect  of 
which  in  early  phthisis  cuts  off"  the 
chance  of  recovery,  <S»  892^  e. 
its   uses   in   skin    diseases,    secondary 

syphilis,  &c.,  p.  617,  <J  822i  g-i. 
in  amenorrhcea  of  scrofulous  subjects, 
and  how  it  relieves,  p.  685-686,  ()  905^ 
b.    Also,  Amenorrhcea,  Index  II. 
in   chronic   rheumatism   and  gout,  ill- 
conditioned  ulcers,  &c.,  p.  617-618, 
^  892^  l-p. 
useful  in  dropsies  complicated  with  or- 
ganic disease,  by  relieving  the  latter, 
but  not  in  other  cases,  p.  617,  <J  892^^ 
k;  p.  630,  i!>892J  a. 
fucus  vesiculosus,  burnt   sponge,  cod- 
liver  oil,  how  did  they  get  into  prac- 
tice] p.  619,  <J  892^  r. 
Ipecacuanha, 

its  virtues  illustrated  through  its  salutary 
effects  in  its  largest  and  smallest  doses 
upon  various  conditions  of  disease — 
illustrates,  along  with  Cold,  Opium, 
&c.,  the  modus  operandi  of  Tonics 
and  Astringents  through  alterative 
influence  of  reflex  action  of  nervous 
system — and  employed  to  show  the 
importance  of  addressing  remedies 
not   only  to   thp    exact  pathological 


Ipecacuanha — continued. 

conditions,  but  to  those  particularly 
which    may    have     established    and 
maintain  sympathetic  derangements, 
p.  533,  ^  842  ;    p.  554-555,  ()  872  a ; 
p.  557,  ^  873  a ;  p.  572,  ()  890  bb ;  p. 
573,  ^  890  d ;  p.  576-578,  «J  890  l-o ; 
p.  634,  <;»  892|  g;   p.  641,  ^  8924  i; 
p.  851,  ^  1059.     Also,  Alteratives, 
Astringents,  Cold,  Opium,  Ergot, 
Index  II. 
as  an  alterative  in  small  doses,  p.  557,  (J 
873  ;  p.  851,  (}  1059.    Also,  as  above, 
and  Antimony,  Tartarized;  Alter- 
atives, Index  II. 
its  action  in  emetic  doses  quickened  by 
the  union  of  the  sulphate  of  copper  or 
of  zinc,  which  arises  from  the  sudden 
increase  of  gastric  irritability  effected 
by  the  minerals — involving  a  principle 
which  reaches  far  into  the  practical 
details  of  other  remedies,  both  in  their 
combinations  and  consecutive  order 
of  application,  p.  567-568,  (J  889  /. 
Also,  p.  63,  (j  137  d,  e ;   p.  65-66,  ^ 
143  c,  d;  p.  67,  i)  149-151  ;  p.  73,  () 
163  ;   p.  367,  (J  556  c  ;  p.  566-569,  ^ 
889  k—m. 
unlike  Tartarized  Antimony,  is  accumu- 
lative in  its  small  therapeutical  doses, 
and  requires  a  different  mode  of  ad- 
ministration, p.  557,  (J  873  a  ;  p.  567- 
568,  ^  889  I.     Also,  p.  365-368,  ^  549 
-558  ;    p.  532-533,  <)  841,  and  Anti- 
mony, Tartarized  ;    Cold,  Altera- 
tives, Index  II.     Also,  Emetics. 
in  some  constitutions,  and  whether  in- 
haled in  small  quantities  or  taken  by 
the  stomach  in  a  grain  or  less,  pro- 
duces  asthmatic   breathing   through 
exciting  influence  of  reflex  action  of 
nervous    system — the    coincidences 
showing  how  all  remedial  and  morbific 
agents  exert  their  effects  through  the 
same  medium,  and  illustrative  of  the 
modus   operandi  of  Anaesthetics,  ut 
supra,  and  An.^esthetics,  Antispas- 
modics, Reflex  Action  of  Nervous 
System,  Sympathy,  Index  II. ;  Nerv- 
ous Power,  Index  I.  and  II. 
Iris — continued  from  Index  /., 

of  extirpated  eye,  affected  by  light,  p. 

806,  ^  1042. 
the  physiology  of  its  movements  applied 
by  the  Author  to  an  interpretation  of 
the  modus  operandi  of  remedial  and 
morbific  agents  through  alterative  in- 
fluences of  reflex  action  of  the  nervous 
system,  p.  340,  <^  514  k — and  in  illus- 
trating the  substantive  existence  and 
self-acting  nature  of  the  Soul,  p.  875- 
876,  ()  1072  a.  Also,  Atropia.  p.  673 
Irritability — continued  from  Index  /., 
Dr.  Carpenter  arraigned  upon,  p.  95- 
96,  ^  189  b — and  upon  development 


1022 


INDEX    II. 


Irritability — continued. 

of  the  Ovum,  p.  39-40,  <^  64  g — and 
Digestion,  p.  153,  ()  34S  —  and  Ab- 
sorption, p.  133,  ^  291 — and  upon  the 
opinion  that  the  "  tendency  to  decom- 
j)Osition  after  death  bears  a  very  elosc 
relation  with  the  activity  of  the  changes 
which  take  place  in  the  part  during  life,'" 
p.  39,  ^  64  g — and  upon  "  vital  prop- 
erties in  the  elements  of  matter"  in 
connexion  with  "  transcendentalism," 
p.  85-86,  ^  175  d;  p.  182,  ()  350|/, 
note. 


Jalap, 

often  subdues  excited  states  of  the  gen- 
eral circulation  during  its  direct  ac- 
tion, is  the  most  decisively  antiphlo- 
gistic of  all  the  cathartics,  and  the 
safest  of  the  active  purgatives — and 
its  most  useful  combinations,  with 
some  suggestions  as  to  remedial  ac- 
tion, p.  547-550,  ^  863  d ;  p.  686,  ^ 
905^  b;  p.  851-853,  ()  1060. 
Jealousy, 

a  passion  not  without  its  contributions  to 
the  Author's  philosophy  of  the  modus 
operandi  of  remedial  and  morbific 
causes,  physical  and  mental,  through 
alterative  influence  of  either  direct  or 
reflex  action  of  the  nervous  system, 
and  going  with  the  rest  to  illustrate 
the  modifications  of  the  nervous  in- 
fluence according  to  the  nature  of  its 
exciting  cause,  and  aiding  in  Author's 
demonstration  of  the  substantive  ex- 
istence and  self-acting  nature  of  the 
Soul,  p.  95,  <^  188^  d;  p.  107-111,  <^ 
227-233J;  p.  324,  ()  500  c;  p.  326, 
<)  500  g;  p.  327,  ^  500;;  p.  333,  (} 
503;  p.  631,  (J  892 J  6;  p.  661-664, 
(J.  894  b-900;  p.  709,  ^  951  b-d;  p. 
865-866,  {)  1067 ;  p.  879-882,  ^  1074- 
1075;  p.  886-891,  <^  1077;  p.  901,  <J 
1078  I.  Also,  Mental  Emotions  ; 
Brain,  Inflammation  of  ;  Remedial 
Action,  subdivision  Mental  Emo- 
tions, Fear,  Love,  Hope,  Joy  and 
Anger,  Shame,  Disgust,  Laughing, 
Weeping,  Yawning,  Sneezing,  Res- 
piration, Sphincter  Muscles,  Ex- 
ercise, Food,  Friction,  Skin,  Cold, 
Phthisis,  Whooping -Cough,  Anti- 
spasmodics, Opium,  Convulsions, 
Bloodletting,  Reflex  Action  of 
Nervous  System, hidex  II. ;  Nervous 
Power,  Sympathy,  Index  I.  and  II. 

illustrates  the  manner  in  which,  like 
compounded  remedies,  a  compound 
Passion  will  so  modify  the  reflex  ac- 
tion of  the  nervous  system  as  to  afi*ect 
the  secretions  in  a  different  manner 
from  either  of  the  individual  agents. 


Jealousy — continued. 

and  which  furnished  a  theme  for 
Sappho,  p.  631,  ()  892i  b.  Also,  p. 
90-95,  {)  188^  d;  Shame,  Secretion 
AND  Excretion,  Index  II. 

Joy  AND  Anger, 

the  Passions  which  destroy  life  sudden- 
ly by  a  sudden  and  violent  determina- 
tion of  the  nervous  influence  upon  the 
brain,  and,  through  that  organ,  upon 
the  heart,  &c.,  after  the  manner  of 
blows  upon  the  epigastrium — demon- 
strate Author's  theory  of  the  opera- 
tion of  remedial  and  morbific  agents 
through  alterative  influence  of  reflex 
action  of  nervous  system — contradict 
the  physical  hypotheses — and  con- 
tribute in  establishing  demonstration 
of  the  substantive  existence  and  self- 
acting  nature  of  the  Soul,p.  95,  iji  188'^; 
p.  107-111,  ()  227-2331 ;  p.  284-286, 
(}  455-457 ;  p.  298,  <J  476^  h  ;  p.  300- 
302,  ^  478-480  ;  p.  326-329,  ^  500 
f-n;  p.  334-335,  ^  507-511  ;  p.  362, 
^  634  ;  p.  670,  <)  902  I;  p.  704,  «J  944 
a ;  p.  707,  ^  947  ;  p.  709,  <J  951  b-d ; 
p.  865-868,  ()  1067;  p.  879-881,  ^ 
1074;  p.  887,  ()  1077.  Also,  Stom- 
ach, Blows  upon,  and  the  several 
references  to  yl?i«c/es  under  Jealousy, 
Index  II. 
consider,  also,  their  milder  operation — 
how  Joy  lights  up  every  feature,  glad- 
dens the  heart,  and  invigorates  diges- 
tion ;  or  Anger  thumping  at  your  side, 
but  diflferently  from  Fear,  injecting  the 
face,  while  Fear  blanches  it,  protrud- 
ing the  fiery  eyeballs,  though  not  after 
the  manner  of  Fear,  and  imparting 
herculean  strength  to  the  muscles, 
while  Fear  paralyzes,  and  compare 
with  what  is  said  of  the  development 
and  modification  of  the  nervous  in- 
fluence, both  direct  and  reflex,  by 
physical  agents,  under  Article  Gen- 
eralization OF  Reflex  Action  op 
Nervous  System,  Index  II.  Also, 
p.  324,  (j  500  c ;  p.  326,  ^  500  g ;  p. 
865-868,  '  1067  ;  p.  879-882,  (j  1071- 
1075. 


K. 

Kidney, 

effect  upon,  in  producing  saccharine 
urine,  by  pricking  medulla  oblongata, 
p.  792,  I)  1032  d. 

its  diseases,  treatment  of,  p.  450,  451, 
<J  691  ;  p.  847,  ^  1058  s. 

the  reciprocal  sympathies  between  the 
skin  and  kidneys,  in  their  natural 
condition,  through  reflex  action  of 
the  nervous  system,  evince  the  great 
liability  of  the  nervous  influence  to 
disturbances  frop  slight  causes,  and. 


INDEX    II. 


1023 


Kidney — continued. 

like  tiie  physiology  of  respiration, 
supply  a  key  to  the  whole  philosophy 
of  the  operation  of  remedies  and  mor- 
bific causes  upon  all  parts  beyond  the 
seat  of  their  direct  etlects  through 
alterative  influence  of  reflex  nervous 
action  —  while,  also,  the  torrent  of 
urine  which  is  often  generated  by  the 
contact  of  cold  air  with  the  surface, 
and  its  sudden  expulsion  from  the 
bladder  by  the  cold  dash  or  by  the 
warm  bath,  supply  a  simple  element 
of  the  universal  instrumentality  of  the 
reflex  nervous  influence  in  inducing 
disease  and  of  changing  the  condition 
of  morbid  states,  and  of  the  secreted 
products,  according  to  the  manner  in 
which  the  nervous  influence  may  be 
modified  by  remedial  and  morbific 
agents — and  taking  along,  also,  the 
exactly  corresponding  effects  of  Fear, 
Loss  of  Blood,  &c.,  in  suddenly  aug- 
menting the  urine  and  perspiration, 
and  in  inducing  purging  and  convul- 
sion of  muscles,  we  reach  the  certain- 
ty that  these  effects  of  the  latter  are, 
equally  with  the  former,  owing  to  the 
exciting  and  alterative  influences  of 
that  same  protean  power,  and  that  it 
may  be  brought  into  direct  operation 
as  well  by  causes  acting  directly  upon 
the  nervous  centres  as  when  it  involves 
both  orders  of  nerves,  p.  107-111,  ^ 
227-233f  ;  p.  230-233,  ^^  422-427  ; 
p.  284-287, \  455-459  ;  p.  290-291, 
\  462-470  ;  p.  295-321,  ^  476-494  ; 
p.  321,  ^  496,  497;  p.  631-632,  () 
892f  ;  p.  651-653.  (}  894-896;  p. 
665-676,  <J  902-904;  p.  679-681,  i} 
905  a.  Also,  Reflex  Action  of 
Nervous  System,  Mental  Emo- 
tions, Fear,  and  the  other  individ- 
ual Passions,  Weeping,  Skin,  Cold, 
Heat,  Warm  Bath,  Respiration, 
Convulsions,  Spasmodic  Affec- 
tions,Whooping-Cough,  Food,  Loss 
OF  Blood,  Bloodletting,  Secretion 
and  Excretion.  Index  II. ;  Sympa- 
thy, Nervous  Power,  Index  I.  and 
IL 
not  a  "  strainer,"  as  commonly  supposed, 
p.  222-227,  H09C-411  ;  p.  230-233, 
^  422-427  ;  p.  318,  (J  493  d;  p.  631^ 
632,  ^892f  ;  p.  788,  ^  1032  a;  p.  801, 
(j  1036  ;  p.  910-911,  (}  1083,  and  con- 
firmed particularly  through  the  last 
preceding  references, 
its  modified  action,  as  denoted  by  fluc- 
tuations of  the  urine,  generally  owing 
to  diseases  of  other  organs,  especially 
of  the  digestive,  and  induced  by  reflex 
action  of  the  nervous  system,  which 
disturbs  its  functions  without  induc- 
infj  absolute  disease,  when  the  urine 


Kidney — continued. 

should  be  regarded  as  a  symptom  only, 
like  that  of  the  pulse,  or  the  morbid 
aspects  of  the  tongue,  through  which 
some  knowledge  is  obtained  of  the 
nature  and  force  of  disease  in  other 
parts,  p.  232-233,  (j  426,  427.  Al- 
so, Pulse,  Tongue,  Amenorrhcea, 
Urine,  hidex  II.  ;  Menstruation, 
Index  I     Also,  p.  847,  ()  1058  s. 

Kiestine, 

declared,  on  authority,  to  be  a  "pure 
illusion,"  p.  787,  i;  1032  a. 


L. 

Lactation, 

exemplifies  the  natural  instability  of  the 
properties  of  life,  which,  in  being  de- 
signed for  useful  ends,  becomes  the 
occasion  of  diseases  and  of  their  cure, 
p.  3,  (J  2  h ;  p.  61,  ^  133  c ;  p.  68-69, 
(^153-156;  p.  87,  <J  180;  p.  120-122, 
(j  237-240  ;  p.  352,  ^  524  d ;  p.  376- 
380,  §  578;  p.  662,  ()  895.  Also, 
Vital  Properties,  Organic  Life, 
Index  I ;  Youth,  Infancy,  Vomit- 
ing, Pregnancy,  Index  II. 

alterative  influence  of  reflex  action  of  the 
nervous  system,  excited  by  the  uterus, 
the  efficient  cause,  ibid.,  and  p.  Ill,  ij 
233J;  p.  351,1^524*.  Also,  Metas- 
tasis and  Repulsion,  Index  II 

considered  in  connexion  with  the  vital 
and  mechanical  doctrines  of  secretion, 
and  as  a  proof  from  analogy,  along 
with  the  now  admitted  absence  of  the 
constituents  of  the  bile  in  the  blood, 
that  the  kidney  is  not  a  "  strainer," 
and  in  its  relation,  also,  to  the  sup- 
posed production  of  sugar  by  the  liv- 
er, p.  783-793,  ^  1031-1032.  Also, 
the  preceding  references,  and  refer- 
ences under  Kidney  and  "  Strain- 
age,"  Index  II. 

diverted  from  its  natural  state,  and  the 
milk  altered  by  mental  emotions 
through  direct  propagation  of  the 
nervous  influence,  p.  788,  ^  1032  a, 
and  Mental  Emotions  ;  Brain,  In- 
flammation of  ;  Remedial  Action, 
subdivision  Mental  Emotions  ;  the 
individual  Passions,  Secretion  and 
Excretion,  Reflex  Action  ,IndexII. 

proof  derived  from,  that  sugar  does  not 
exist  in  the  blood,  p.  785,  ij  1031  b  ■ 
p.  790,  ()  1032  b. 
Lacteals,  (See  Absorption,  Index  I.) 

circulation  in,  depends  upon  suction  of 
the  heart  and  their  own  action,  p.  211, 
^  390  a;  p.  214,  ()  392  c,  d. 

exclude  the  bile,  and  all  intestinal  prod- 
ucts excepting  chyle,  unless  diseased, 
and  why — and,  for  like  reason,  exclude 
remedial  agents,  and  not  liable  to  in- 


1024 


INDEX    II. 


Lacteal  s — continued. 

flammation  like  the  Lymphatics  and 
Veins — all  evincing  great  Design,  p. 
99,  ^  192;  p.  129-131,  (}  277-284, 
and  references  there  ;  p.  356,  ()  526  c  ; 
p  632,  ^  892i  c.  Also,  Lymphatics, 
Veins,  Index  II.  Also,  p.  933,  ()  1089. 

allusion  to,  in  connexion  with  the  ana- 
tomical relations  of  the  intestinalcanal 
to  the  nervous  system,  and  Author's 
doctrine  of  the  operation  of  Cathartics 
through  alterative  influence  of  reflex 
action  of  the  nervous  system,  p.  565. 
have  terminal  orifices,  p.  933,  ^  1089. 

Liebig's  and  Carpenter's  mechanical 
doctrine  of  the  function  of  absorption, 
p.  132-133,  {)  289-292. 
Lactic  Acid, 

not  found  in  the  blood,  and  physiological 
conclusions,  p.  784,  <St  1031  b. 
Laughing, 

excited  in  a  direct  manner  through  the 
Will  and  Mental  Emotion,  showing 
how  the  latter  sometimes  conspires 
with  the  former  in  determining  the 
nervous  influence  upon  the  voluntary 
muscles,  and  may  be  excited  through 
reflex  action  of  the  nervous  system, 
as  an  ultimate  result,  by  tickling  the 
feet,  and  may  then  prove  fatal — illus- 
trative of  the  modus  operandi  of  reme- 
dial and  morbific  causes,  physical  and 
mental,  through  alterative  influence  of 
direct  and  reflex  nervous  action,  and 
of  the  substantive  existence  and  self- 
acting  nature  of  the  Soul,  p.  323-328, 
^  499-500  m ;  p.  707,  <5  947  ;  p.  709, 
^  951  b-c;  p.  880,  ()  1074  ;  p.  887,  ^ 
1077.  Also,  Mental  Emotions,  Joy 
AND  Anger,  and  other  individual  Pas- 
sions ;  Brain,  Inflammation  of  ; 
Reflex  Action,  Index  II. ;  Sympa- 
thy,Nervous  Power,  Index  I.  aiidll. 
Lead,  Acetate  of, 

arrests  hemorrhage  of  lungs,  uterus, 
&c.,  and  colliquative  sweats,  through 
alterative  influence  of  reflex  action  of 
nervous  system,  since,  if  absorbed,  it 
would  be  rendered  inert  by  conversion 
into  another  salt,  or,  if  otherwise,  the 
quantity  of  a  grain  at  a  dose,  diluted 
by  the  mass  of  blood  and  other  fluids, 
would  not  be  felt,  p.  530,  I)  837  c ;  p. 

577,  <;>  890  0. 

the  modus  operandi  of  Astringents  and 
of  other  remedies  illustrated  in  the 
foregoing  manner,  and  by  other  reme- 
dial influences  of  the  acetate  of  lead, 
and  by  comparison  with  other  Astrin- 
gents and  with  other  things,  p.  577- 

578,  ()  890  0.  Also,  Astringents, 
Index  II. 

Leeching, 

the  philosophy  of  its  effects  divided  into 
seven  stages,  p.  692-698,  <^  914-928. 


Leeching — continued. 

1st,  as  in  general  bloodletting,  the  first 
essential  effect  consists  of  a  con- 
traction of  the  capillary  bloodves- 
sels ;  but  in  leeching  there  is  an 
antecedent  vital  impression  of  a 
very  peculiar  nature  produced  up- 
on the  extreme  vessels  to  which 
the  leeches  are  applied,  ()  915. 

2d,  an  immediate  vital  contraction  of 
these  vessels,  arising  in  part  from 
the  foregoing  specific  impression, 
and  in  part  from  the  direct  abstrac- 
tion of  their  natural  stimulus,  ^  916. 

3d,  then  follows,  by  continuous  sym- 
pathy along  the  vessels  (or  continu- 
ous influence,  as  the  Author  prefers, 
p.  322,  ^  498  a),  and  through  reflex 
action  of  the  nervous  system,  p. 
321,  ()  496,  a  propagation  of  the 
foregoing  changes  to  the  entire 
system  of  extreme  and  capillary 
vessels  throughout  the  body,  and 
why,  <J  917. 

4th,  the  larger  vessels,  sooner  or  later, 
participate  through  the  foregoing 
influences  (3)  in  the  contraction, 
^  918.  Also,  Sympathy,  Continu- 
ous, Index  II. 

5th,  simultaneously,  and  at  an  early 
stage,  the  heart  is  brought  under 
-  the  influence  of  the  reflex  action 
of  the  nervous  system,  which  in- 
creases in  a  rapid  ratio,  p.  693,  ij 
919  ;  p.  698,  ()  933. 

6th,  during  the  progress  of  the  fore- 
going influences  and  changes  they 
become  more  or  less  compounded, 
the  reflex  nervous  influence  which 
is  propagated  from  the  extreme  to 
the  larger  vessels  and  the  heart  in- 
stitutes reflex  influences  upon  the 
extreme  vessels,  while  these,  in 
being  thus  impressed,  institute  an 
increased  amount  of  the  reflex  in- 
fluence upon  the  heart  and  larger 
vessels,  which  increases  still  farther 
the  contraction  of  the  small  vessels, 
and  this  complex  or  double  circle  of 
sympathies  continues  to  advance 
till  the  heart  becomes  overpowered 
in  its  action,  and  syncope  takes 
place,  p.  693,  ()  920,  and  references 
there. 

7th,  the  specific  artificial  impression 
instituted  by  leeches  at  the  place 
of  their  impression  continues  to 
exert  a  powerful  development  of  re- 
flex action  of  the  nervous  system, 
which  is  determined  with  the  fore- 
going effect  (2-6)  upon  the  heart 
and  arteries  long  after  the  blood 
has  ceased  flowing,  and,  for  this 
reason,  the  system  may  be  more 
prostrated  by  much  smaller  quan- 


INDEX    II. 


.     1025 


Leeching — continued. 

tities  of  blood  taken  by  leeching 
than  by  general  bloodletting,  and 
syncope  may   ensue   some  hours 
after  the  blood  has  ceased  flowing, 
p.  693,  ^921  a-c,  and  references 
there. — Note  Dd  p.  1132. 
direct  and  reflex  action  of  fhe  nervous 
system  the  essential  cause  of  all  the 
effects,  ibid.,  and  p.  703-711,  ^  940- 
952 — and  which  is  distinctly  shown 
by  the  effect  of  a  single  leech  in  re- 
lieving ophthalmia,   or  pleurisy,   or 
amenorrhcea,  &c.,  when   applied   to 
the  skin,  since  there  is  no  vascular 
connexion  between  the  skin  and  the 
internal  parts,   and  the  quantity  of 
blood  too  insignificant  to  affect' the 
volume  of  the  circulating  mass.     See 
Bloodletting,  General,  Index  11. 
che  eff'usion  of  blood  is  owing  to  the 
specific  change  instituted  by  leeches 
in  the  vital  condition  of  the  extreme 
vessels,  being  analogous  to  the  pro- 
cess of  secretion,  and  differing  totally 
in  that  respect  from  the  results  of 
cupping,  although  in  the  latter  case 
larger  and  far  more  numerous  vessels 
are  divided,  and  then  require  the  aid 
of  an  exhausting  receiver,  p.  694,  (j 
922  a ;  p.  702,  ()  939  b,  c. 
hence  it  is  evident  that  cupping-glasses 
should  not  be  applied  in  leeching,  and 
for  other  reasons,  p.  702,  ^  939  d. 
a  remarkable  diflference,  also,  betv?een 
the  effects  of  leeching  and  of  spon- 
taneous  hemorrhage,  which  is   also 
analogous  to  a  secretory  process,  and 
may  amount  to  many  pounds  without 
much  impairing  the  strength  or  in- 
ducing syncope — owing  to  a  differ- 
ence in  the  development  of  the  reflex 
action  of  the  nervous  influence  in  the 
two  cases,  p.  694,  ()  922  b.      Also, 
Hemorrhage,    Spontaneous,    Index 
II. 
other  special  influences  may  be  obtained 
through  the  medium  of  special  vital 
relations  which  one  organ  may  bear 
to  another,  while  the  auxiliary  part 
will  not  only  co-operate  in  the  develop- 
ment of  salutary  alterative  influences 
of  reflex  action  of  the  nervous  system, 
but  may  itself  be  thus  relieved  of  dis- 
ease more  efifectually  than  by  any  oth- 
er means — as  seen  in  hepatic  conges- 
tion, when,  if  leeches  be  applied  to  the 
anus,  or  septum  nasi,  the   artificial 
change  which  is  there  established  is 
propagated    continuously    along    the 
mucous  tissue  of  the  intestine  and 
up  the  duct  of  the  liver  into  the  laby- 
rinth  of  the   organ,  while,  also,  the 
liver  is  not  only  thus   relieved  and 
brought   to   institute   salutary  reflex 

Tt 


Leeching — continued. 

action  of  the  nervous  system,  but  the 
continuous  impression  upon  the  intes- 
tinal mucous  tissue  institutes  other 
usefully  alterative  influences  of  reflex 
action,  and  after  the  manner  of  Croton 
oil  applied  to  the  tongue,  or  of  sup- 
positories, p.  694-695,  i)  923  a-d 
Also,  p.  64,  ij  141  b;   p.  322-323,  I) 
498  ;  p.  343,  ^  516  rf,  No.  2  ;  p.  344- 
345,  (J  516  d,  No.  6  ;    p.  349,  ^  520; 
p.  350,  ^  523,  No.  7  ;  p.  351,  i)  524  a, 
No.  2  ;  p.  355-359,  ^  526  b,  c ;  p.  526, 
^  828  d ;   p.  563-564,  ^  889  a ;   Oil, 
Croton;  SapposiTORiEs;  Sympathy, 
Continuous  ;    Alteratives  ;    Anti- 
mony, Tartarized,  Index  II. 
for  uie  foregoing  and  other  reasons,  it 
may  be  most  useful  to  apply  leeches 
to  a  part  remote  from  the  seat  of  dis- 
ease, while  in  a  larger  proportion  of 
cases  the  application  should  be  made 
near  or  directly  to  the  aflected  part, 
p.  694-695,  <J  923-924— and  the  me- 
chanical doctrine  of  revulsion  not  to 
be  thought  of,  p.  695,  ()  924.     Also, 
Metastasis  and  Revulsion,  Coun- 
ter-Irritants,   Reflex  Action  of 
Nervous  System,  Index  II. 
again,  the  best  influences  will  sometimes 
follow  the  application  to  a  distant  part 
between  which  and  the  seat  of  disease 
there  are  apparently  no  particular  nat- 
ural relations,  as  to  the  feet  in  amen- 
orrhcea, and  the  septum  nasi  in  cerebral 
affections,  p.  694-695,  <}  923  ^>-924. 
operates,  in  part,  upon  principle  con- 
cerned  in  Counter- Irritation,  when 
the   reflex  nervous  influence  is  de- 
veloped by  the  irritation  of  the  skin, 
p.  659,  ^  893  g ;   p.  696-697,  ^  926, 
927  a — and  the  philosophy  considered 
of  the  salutary  effects  of  frequent  and 
small  abstractions  of  blood  by  leeches 
in  chronic  inflammation — being,  be- 
sides the  influences  peculiar  to  loss 
of  blood,  and  by  leeching,  analogous 
to  the  philosophy  concerned  in  small 
and  repeated  vesications  in  the  same 
conditions  of  disease,  and  closely  allied 
in  principle  to  the  continued  operation 
of  small  and  repeated  doses  of  altera- 
tive medicines,  p.  648-649,  (;  893  g-,  h. 
Also,  p.  649,  ()  893  h;   Counter-Ir- 
ritation, Alteratives  ;  Antimony, 
Tartarized,  Index  II. 
useful  when  applied  over  indolent  tu- 
mours, and  often  when  not  of  an  in- 
flammatory nature,  both  by  changing 
the  morbid  action,  and  particularly  by 
establishing   a    susceptibility   in   the 
tumours  to  the  local  or  constitutional 
action  of  other  remedies,  as  Iodine, 
Mercury,  Vesicants,  &c. ,  p.  659,  i^  893 
q;  p.  684,  905^  b;  p.  616,  ^  892i/, 


1026 


INDEX    II. 


Leeching — continued. 

often  useful  only  after  general  bloodlet- 
ting, in  chronic  inflammations,  which 
demand  the  sudden  and  special  phys- 
iological influences  of  the  latter  reme- 
dy to  overcome  the  obstinacy  of  morbid 
habit,  p.  298,  <)  476i  h ;  p.  658,  ^  893 
;>;  p.  697,  ^927  a;  p.  711,^953.  Al- 
so, Bloodletting,  General  ;  Habit, 
YiTAh,  Index  II. — but  often  beneficial 
in  certain  mild,  though  chronic  cases, 
without  the  general  remedy,  <S»  927  b. 

should  neverprecede  general  bloodletting 
when  the  latter  may  be  more  useful, 
as  in  all  cases  of  severe  inflammations, 
p.  696,  ()  925  ;  p.  713-714,  ()  956-958  ; 
p.  729,  ^  966  ;  p.  733,  <^  974.*  Also, 
p  642,  ^  892A  i ;  p.  658,  ()  893  p;  p. 
871-872,  ()  1068  d;  Bloodletting, 
General  ;    Inflammation,  Index  II. 

most  sensibly  felt  in  Infancy,  and  may 
then  be  sufficient  when  general  blood- 
letting would  be  indispensable  at  a  la- 
ter age,  as  the  susceptibility  to  reme- 
dial action  is  then  greatest,  and  a  lar- 
ger volume  of  blood  is  abstracted  in 
the  ratio  of  size,  and  quickly.  &c.,  p. 
696,  <)  925.  Also,  p.  67,  ^  150-151  ; 
p.  375,  ^  576  e — but  never  in  the  cere- 
bral inflammations  and  congestions  of 
that  age,  p.  696, 1)  925  c ;  p.  733-734, 
^  974  c-975  b.  Also,  Brain,  Inflam- 
mation of;  Inflammation,  Infancy, 
Index  II. 

injurious  as  an  early  remedy  in  the  grave 
forms  of  visceral  congestions  and  in- 
flammations, p.  729,  ^  965  b,  966. 

the  nature  of  its  influences  considered 
when  excessive,  having  some  pecu- 
liarities which  difier  from  the  inju- 
rious influences  that  arise  from  the 
excessive  use  of  general  bloodletting, 
p.  697-698,  ^  927  b.  Also,  Blood- 
letting, General,  Index  II. 

may  be  a  remedy  for  inflammation  in- 
duced by  excessive  general  bloodlet- 
ting, p.  698,  ^  928  ;  p.  774,  ^  1024  a. 
Also,  Bloodletting,  General,  Index 
II. 

like  general  bloodletting,  more  salutary 
than  spontaneous  hemorrhages  even 
of  large  extent,  when  the  remedies 
may  be  adopted,  on  account  of,  in  the 
former  case,  the  specific  influence  in- 
stituted in  the  extreme  vessels  of  the 
bitten  part,  and  the  consequent  special 
modification  of  the  nervous  influence, 
and,  in  the  latter,  the  suddenness  of 
its  development,  p.  298.  ^  476^  h ;  p. 
693-694,  <)  921-922  ;  p.  702,  <)  939  ; 
p.  770-772,  ()  1018,  1019.  Also, 
Hemorrhage,  Spontaneous ;  Stom- 
ach, Blows  upon  ;  Joy  and  Anger, 
Index  II. 

the    most    unfavorable   cases   for,  and 


Leeching — continued. 

where  general  bloodletting  is  import- 
ant, p.  729,  ij  966. 

unlike  general  bloodletting,  leeching 
may  be  superintended  by  the  unpro- 
fessional, as  the  quantity  of  blood 
abstracted  is  generally  comparatively 
small,  is  slowly  taken  away,  and  the 
results  slowly  manifested,  though  in 
Infancy  these  considerations  do  not 
obtain  as  at  later  years,  p.  696,  ()  925 
b;  p.  714,  ()  958  i. 
Lehmann, 

his  admissions  that  Medicine  has  nothing 
to  hope  from  Chemistry,  p.  779-782, 
()  1029-1030. 

l)is  opinion  of  Vital  Physiologists,  p. 
795-799,  <^  1034. 

avows  that  "  there  is  no  essential  dif- 
ference between  organic  and  inor- 
ganic bodies,"  ibid.  Also,  Mijlder, 
Index  II. 

his  opinion  upon  the  production  of  ani- 
mal sugar,  &c.,  p.  783-795,  l^  1031- 
1033. 

affirms  that  the  component  parts  of  the 
bile  are  not  found  in  the  blood,  in 
which  he  agrees  with  Miilder  and 
Kane,  p.  180,  ()  350f  e;  p.  783,  (} 
1031  b — and  from  which,  and  other 
facts,  the  Author  reasons  to  other 
secretions,  p.  784-793,  ^  1031  b- 
1032. 
Leucorrhcea, 

its  principles  of  treatment,  p.  576,  ^  890 
n;  p.  688,  ij  905^  c. 

best  special  remedies  for,  Cantharides 
internally.  Nitrate  of  Silver  externally, 
p.688,  ^905ic. 
Light — continued  from  Index  I, 

how  it  produces  sneezing  through  a 
compounded  series  of  reflex  actions 
of  the  nervous  system,  and  employed 
by  Author  to  illustrate  the  modus 
operandi  of  remedial  and  morbific 
agents  through  alterative  influences 
of  the  same  medium,  p.  340-341,  ^ 
514  I.  Also,  Iris,  Odors,  Disgust, 
Mental  Emotions.  &c.,  Index  II. 
Liver — continued  from  Index  I., 

does  it  produce  sugar  1  p.  783-794,  ^ 
1031-1033. 

objections  to  hypothesis  of  double  func- 
tion, p.  789,  790,  ^  1032  a. 

supposed  effect  upon,  by  pricking  me- 
dulla oblongata,  p.  792,  ^  1032  d. 

allowed  not  to  be  a  "  strainer,"  p.  783, 
^  1031  b.     Also,  "  Strainage,"  Index 
IL 
Loss  OF  Blood,  (Bloodletting,  Ind.  II.) 

when  appropriate,  promotes  the  salutary 
effects  of  all  other  remedies,  prevents 
their  morbific  effects,  and  should  there- 
fore, when  employed,  precede  all  oth- 
ers, and  often  even  to  the  extent  of  its 


INDEX    II. 


1027 


Loss  of  Blood — continued. 

repetition,  p.  367,  ^  556  c ;  p.  375,  () 
576  c ;  p.  550,  ()  863/;  p.  552,  ^  868  b ; 
p.  572-574,  ()  890  d-f;  p.  641-642, 
§  892| ;  p.  658,  ^  893  jo  ;  p.  713-714, 
^  956-958 ;  p.  729-730,  ^  968-969  ; 
p.  733-734,  ^  974-975  ;  p.  736, 1)  979 ; 
p.  739,  ^  985.  Also,  Bloodletting, 
Leeching,  Index  II. 

its  management  in  Croup, ^  5*76  6,  964  d. 

leeching  may  succeed,  in  Infancy,  in  grave 
inflammations  and  congestions  of  all 
organs  excepting  the  brain,  and  in  the 
latter  case  general  bloodletting  should 
be  practised,  and  why,  p.  696,  ^  925 ; 
p.  733-734, 1^974-975;  p.  767,  ^  1009 
b,  c. 

the  philosophy  of  its  effects  wholly  refer- 
able to  alterative  influences  of  direct 
and  reflex  action  of  the  nervous  sys- 
tem, p.  690-711,  ()  906-952.  Also, 
Bloodletting,  Leeching,  Index  II. 

affects  profoundly  the  secretions  and  the 
blood  itself  through  alterative  influence 
of  reflex  action  of  the  nervous  system 
exerted  upon  the  capillary  vessels,  as 
may  also  a  mental  emotion,  p.  703- 
711,  ^  940-952  —  which  should  be 
connected  with  that  condition  of  the 
same  influence  that  so  alters  the  ac- 
tion of  the  sanguiferous  vessels  in 
inflammations  as  to  impart  the  hard- 
ness and  incompressibility  of  pulse, 
and  buffiness  and  cupping  of  blood 
which  its  loss  removes,  p.  444-445, 
^  688  a~f;  p.  804-805,  (}  1040.  Also, 
Bloodletting,  Mental  Emotions, 
Fear,  and  the  other  individual  Pas- 
sio7is,  Pulse,  Secretion  and  Excre- 
tion, Inflammation,  Remedial  Ac- 
tion, Index  II. ;  Nervous  Power, 
Sympathy,  Index  I.  and  II. 

its  effects  through  the  nervous  system 
illustrated  by  the  Passions  and  other 
things,  p.  666,  I)  902  c ;  p.  667-669, 
§  902  e-i ;  p.  704,  ()  944  a ;  p.  706- 
709,  ()  946  J-951.  Also,  various  cita- 
tions under  last  general  references. 

when  death  is  brought  on  immediately 
by  the  ordinary  operation  of  blood- 
letting, or  as  it  follows  leeching,  or 
the  passions,  it  is  wholly  owing  to 
the  prostrating  influence  of  direct 
and  reflex  action  of  the  nervous  sys- 
tem upon  the  great  organs  of  life,  p. 
693-694,  <J  921-922  ;  p.  703-705,  () 
942  i-944  b;  p.  706-709,  ^  947-951. 
Also,  Joy  and  Anger,  Index  II. 

like  sudden  mental  emotions,  blows  upon 
the  epigastrium,  shocks  from  surgical 
operations,  hydrocyanic  acid,  &;c.,  a 
small  loss  of  blood  may  determine  the 
nervous  influence  with  so  much  vio- 
lence upon  the  brain  itself  as  to  extin- 
guish life  suddenly ;  as  seen  in  blood- 


Loss  of  Blood — continued. 

letting  after  the  brain  has  sustained 
a  shock  of  the  nervous  influence,  and 
through  that  shock  all  other  organs, 
in  cases  of  falls,  p.  709,  <J  951  b-d. 
Also,  Stomach,  Blows  upon  ;  Hy- 
drocyanic Acid,  Index  II. ;  Nervous 
Power,  Index  I.  and  II. 

if  syncope  take  place,  reanimation  is 
established  by  stimulants,  cold  air, 
snapping  drops  of  cold  water  upon 
the  face,  6ic.,  through  their  develop- 
ment of  an  exciting  reflex  action  of 
the  nervous  system,  p.  338,  ()  514  d; 
p.  705,  <)  945.  Also,  Cold,  Skin, 
Heat,  Food,  Index  II. 

Author's  tabular  arrangement  of  the  dif- 
ferent tissues  and  organs,  and  parts 
of  continuous  tissues,  illustrating  the 
difference  in  their  vital  constitution 
by  their  relative  liability  to  inflamma- 
tion, the  relative  danger  of  the  disease. 
and  the  relative  proportion  of  loss  ot 
blood  that  may  be  required,  as  the 
disease  may  affect  one  part  or  another. 
p.  69-73,  1}  160-162.  Also,  Struc- 
ture, Index  II. 

proposal  of  pricking  the  heart  in  per- 
sisting cases  of  syncope  originally 
made  by  the  Author,  in  Medical  and 
Physiological  Commentaries,  vol.  i. 
p.  178,  note  {184:0);  Institutes,  p.  705, 
(J  945. 

its  operation  expounded  by  Author  in 
Medical  and  Physiological  Comment- 
aries, altogether  through  direct  and 
reflex  action  of  the  nervous  system — 
Article  Bloodletting,  p.  121-362, 
vol.  i.  ( J  840).  Also,  ibid.,  p.  568-572, 
where  the  mechanism  and  the  doc- 
trine of  reflex  nervous  action  is  specif- 
ically set  forth  as  the  Author's  engine 
against  the  Humoral  Pathology. 

first  recorded  quantities  of  blood  ab- 
stracted, p.  755,  ()  1004  c. 

why  Hippocrates  has  not  stated  quan- 
tities, p.  756,  {)  1004  d. 
Love, 

like  every  other  passion,  has  its  own 
special  way  of  developing  and  modi- 
fying the  nervous  influence,  and  di- 
recting it  upon  special  parts  with 
well-marked  effects,  while  its  local 
influences  of  a  direct  nature  generate 
a  reflex  action  of  the  nervous  system 
less  productive  of  agreeable  results — 
contradicts  the  chemical  and  humoral 
doctrines  in  physiology  and  disease, 
and  goes  with  the  rest  in  sustaining 
the  Author's  interpretation  of  the  mo- 
dus operandi  of  remedial  and  morbific 
agents,  p.  95,  §  188^ ;  p.  107^108,  ^ 
227-228;  p.  Ill,  (J233f ;  p.  326-328, 
§  500  g-m;  p.  335-336,  (/  412-513  ; 
p.  417,  (J  649  c ;  p.  631,  <J  892f  b;  p 


1028 


INDEX    II. 


Love — continued. 

709,  (^  951  6,  c ;  p.  891,  (^  1077.  Also, 
Mental  Emotions,  Jealousy,  and 
the  other  individual  Passions,  Dis- 
gust, Shame,  Friction,  Yawning, 
Sea- Sickness,  Remedial  Action, 
Seton,  Index  II. 

considered  in  its   distinction   between 
man  and  animals,  p.  900-901,  <J  1078 
i,L 
Lungs, 

the  philosophy  and  treatment  of  their 
various  maladies,  p.  633-642,  <)  8924. 
Also,  Pneumonia,  Bloodletting, 
Counter-Irritants,  Inflammation, 
Index  II. 
Lymph, 

as  a  morbid  product,  depends  upon  in- 
flammation, and  designed  for  useful 
ends,  and  analogous  to  suppuration 
in  principle,  p.  471-475,  ()  732-733. 
Also,  p  546-547,  ()  862-863. 

Becquerel  and  Rodier's,  and  Simon's 
opinion   of  its  dependence  on  vital 
laws,  p.  800-801,  \  1035. 
Lymphatics, (See  Absorption,  Index  I.) 

circulation  in,  dependent  on  same  causes 
as  in  Lacteals,  which  see,  Index  II. 

termination  of,  in  mesenteric  veins,  led 
Magendie  to  the  inference  that  the 
veins  perform  the  office  of  absorption, 
which  is  contradicted,  also,  by  Design 
in  relation  to  the  general  functions  of 
the  absorbent  and  venous  systems,  p. 
128-129,  ()  269-273  ;  p.  527,  ^  829. 
Also,  p.  62,  <J  136  ;  p.  63,  <)  137  b,  c ; 
p.  210,  ^  387;  and  Circulation  of 
Blood,  Lidex  II. ;  Veins,  Lidcx  I. 

absorb  nothing  but  what  is  natural  to 
them,  not  even  pus,  p.  99,  ^  192;  p. 
129-131,  ^  227-284,  and  references 
there ;  p.  632,  ()  892J  c,  1088-1089. 

participate  in  the  ulcerative  process,  p. 
129,  {)  272 ;  p.  472-473,  ^  733  b-d; 
p.  483,  (j  746  b,  &c. 

like  the  veins,  particularly  liable  to  dif- 
fuse inflammation,  and  supplying  in 
cither  case  a  good  illustration  of  con- 
tinuous sympathy,  p.  356,  ()  526  c ; 
p.  526-527,  ()  828  d,  e.  Also,  Veins  ; 
Sympathy,  Continuous,  Index  I.  and 
II. ;  Lacteals,  Index  II. ;  Venous 
Congestion,  Venous  Tissue,  Index  I. 


M. 
Magendie, 

his  mistake  in  supposing  that  the  veins 
perform  the  office  of  absorption,  p. 
128-129,  ()  269-273  ;  p.  527,  <^  829. 
Also,  p.  62,  <J  136  ;  p.  63,  <J  137  b,  c ; 
p.  210,  ()  387,  and  Veins,  Index  I ; 
Circulation  of  Blood,  Index  II. 

his  opinion  of  "Vitality"  and  Inflamma- 
tion, p.  482,  (J  744;  p.  509  ()  810. 


Mankind,  Unity  of — continued  from  In- 
dex I, 
briefly  considered,  p.  906-907,  ()  1078  s. 
Also,  Races  of  Mankind,  Index  I. 
Materialism — continued  from  Index  I, 
the  chemical  and  functional  doctrines  of, 
p.  882-885,  ^  1076  ;  p.  894,  note. 
Materia  Medico — continued  from  Index 

farther  illustrations  of  the  principles 
upon  which  the  Author  has  founded 
his  Therapeutical  Arrangement  of, 
p.  830-831,  ij  1057  c;  p.  835-838,  (j 
1057i;  ji.  851,  ()  1060;  p.  853,  ^ 
1061  ;  i)  1062,  2  b,  854-860,  892^  h. 
Measles, 

like  small-pox,  scarlet  fever, and  mumps, 
a  self-limited  disease,  and  cannot  be 
placed  in  a  better  condition  for  the 
recuperative  law  than  is  done  by  its 
own  cause,  and,  like  the  other  affec- 
tions, illustrates  the  close  analogy 
between  morbific  and  remedial  agents, 
p.  544-545,  ^  858  ;  p.  844,  ()  1058  z— 
and  what,  also,  is  generally  true  of  the 
former  in  regard  to  their  laws,  is  about 
the  same  in  respect  to  measles.  See 
the  Articles.  Also,  Contagion, 
Miasm  ;  Causes,  Morbific  ;  Reme- 
dies, Therapeutics. 
Medical  Science,  Progress  of — contin- 
ued from  Index  /., 

what  is  apt  to  be  so  denominated,  p.  795, 
^  1033  b. 

its  future  prospects  at  the  hands  of 
Chemistry,  p.  8-10,  ij  5 ;  p.  14,  iji  6  ; 
p.  203-204,  {)  367i  ;  p.  779-782,  <J 
1028-1030. 

in  its  present  state,  intolerant  of  those 
who  look  upon  Nature  less  super- 
ficially, p.  12-13,  (jb^a;  p.  795-799, 
^  1034 — which  explains  the  remote 
cause  that  has  compelled  the  Article 
on  the  "  Rights  of  Authors,"  p.  912 
-920. 
Medicine — continued  from  Index  I, 

sudden  revolutions  in,  p.  795,  ()  1035  b. 
Medicines,  Combinations  of.    See  Reme- 
dies, Index  II. 
Memory — loss  of,  Note  Hh  p.  1138. 

different  in  man  and  animals,  p.  901- 
902,  ()  1078  a. 
Menorrhagia, 

commonly  a  sympathetic  result,  like 
amenorrhcea,  of  abdominal  diseases, 
though  more  frequently  than  the  lat- 
ter, and  the  whole  condition  generally 
more  important,  and  greater  advan- 
tages are  bestowed  by  astringents  in 
one  case  than  by  emmenagogues  in 
the  other,  while  either  equally  require 
the  main  treatment  to  be  addressed 
to  any  existing  predisposing  disease. 
See  Amenorrhcea,  Emmenagogues, 
Astringents;    Causes,   Morbific,- 


INDEX    II. 


1029 


Menorrhagia — continued. 

Hemorrhage,  Spontaneous;  Ergot, 
Loss  OF  Blood,  Uterus,  Index  II. 

Menstruation.     See  Index  I. 

Mental  Emotions, 

see  a  subdivision,  Mental  Emotions, 
under  Remedial  Action,  where  the 
references  to  this  subject  are  numer- 
ous, and  present  a  variety  of  physio- 
logical, pathological,  and  therapeutical 
problems,  illustrative  of  the  Author's 
doctrine  of  their  action  through  the 
direct  development  of  the  nervous  in- 
fluence, and  of  developments  of  reflex 
action  of  the  nervous  system  as  con- 
sequences of  the  impressions  made 
upon  parts  remote  from  the  nervous 
centres  by  the  antecedent  direct  de- 
velopment ;  and  also  the  numerous 
references  under  the  several  subdivis- 
ions of  Reflex  Action  of  the  Nerv- 
ous System,  and  of  Nervous  Power 
{Index  II.),  where  the  analogies  with 
the  foregoing  are  clearly  and  variously 
established — each  and  all  of  which, 
certainly  their  united  force,  must  ere 
long  sweep  away  those  chemical  and 
physical  doctrines,  which,  though 
promulgated  by  Genius  of  the  highest 
order  in  the  walks  of  Chemistry,  and 
to  which  mankind  are  under  profound 
obligations,  have,  for  that  very  reason, 
vitiated  all  Medical  Science,  and  ren- 
dered its  practice  an  empirical  art. 
See  Shame,  Grief,  Disgust,  Joy  and 
Anger,  Hope,  Fear,  Jealousy,  Love, 
Weeping,  Micturition,  Laughing, 
Yawning,  Roosting,  Sneezing, 
Mind,  Soul  and  Instinctive  Prin- 
ciple, Chemical  Physiologists,  In- 
dex II. ;  Organic  Chemistry,  Index 
I.  and  II. 
bear  a  strict  analogy  in  effects  with  those 
of  disease,  injuries,  and  physical  irri- 
tations of  the  nervous  centres,  which 
develop  the  nervous  influence  in  a 
direct  manner,  and  are  then  alone 
interested  with  the  system  of  excito- 
motory  nerves  or  fibres  of  compound 
nerves,  and  farther  establish  their 
analogy  with  the  Mental  Emotions 
through  the  reflex  actions  of  the  nerv- 
ous system  that  supervene  as  conse- 
quences of  the  impressions  upon  dis- 
tant parts  by  the  direct  development, 
and  other  resulting  circles  of  complex 
reflex  actions — whose  results  declare 
their  dependence  upon  something,  that 
they  are  precisely  the  same  in  all  the 
cases,  and  that,  therefore,  they  are 
equally  due  to  a  common  cause,  and 
equally  so  when  physical  agents  act- 
ing upon  the  skin  give  rise  to  exactly 
the  same  phenomena,  and  that  since 
neither  the  external  physical  causes 


Mental  Emotions — continued. 

nor  the  brain,  nor  spinal  cord,  are 
transmitted  to  the  affected  parts,  it  is 
quite  logical  to  suppose  that  the 
Mental  Emotions  are  restrained  from 
wandering  away  from  those  nervous 
centres  upon  which  they  institute  their 
primary  action,  and  that,  if  there  be 
any  thing  of  a  substantive  nature  in 
a  blister,  or  in  the  stick  which  inflicts 
a  blow  upon  the  head,  and  upon  which 
all  the  distant  effects  depend,  it  is 
equally  certain  that  a  substance  quite 
as  real,  and  quite  as  distinct  from  the 
nervous  centres,  occasions  the  corre- 
sponding results  of  the  mental  emo- 
tions, and  therefore,  also,  through  the 
same  efficient  medium — all  of  which 
is  elaborately  apparent  in  the  follow- 
ing sections,  p.  101-102,  ^  201-202 
p.  107-108,  ()  227;  p.  109,  ^230;  p 
111, '^233J;  p.  289,  M61  ;  p.  296 
476  c;  p.  302,  <^  481  b;  p.  315-310 
(J  492  ;  p.  321,  (}  496,  497  ;  p.  323- 
330,  I)  500  a-n ;  p.  333,  (,  503-505 
p.  336-337,  (}  514  b ;  p.  338-339,  ^ 
514  d~h;  p.  347-348,  (/  516  d.  No.  13 
p.  416-417,  (J  649  c;  p.  592-593,  ^ 
891iZ:;  p.  631-632,  (^  892f  6  ;  p.  061 
-663,  ^  894  i-896 ;  p.  666-668,  (/  902 
b-g ;  p.  670,  ()  902  / ;  p.  675-676,  <) 
904  b;  p.  679-681,  ^  905  a;  p.  704, 
()  944  a  ;  p.  707,  ^  947-949  ;  p.  709, 
(}  951  b,  c;  p.  865-868,  ^  1076;  p. 
874-881,  ()  1071-1075  ;  p.  876-877, 
()  1072  a ;  p.  886-890,  ()  1077.  Also, 
the  foregoing  Articles. 

as  Mental  Emotions,  therefore,  often 
give  rise  to  alterative  influences  of 
reflex  actions  of  the  nervous  system, 
they  differ  in  those  respects  from  the 
Will,  whose  displays  of  the  nervous 
influence  terminate  in  the  voluntary 
muscles,  and  without  exerting  any 
other  effect  than  that  of  simple  mo- 
tion, and  it  is  alone  interested  in 
excito-motory  nerves  or  fibres  of  that 
denomination.  See  Will,  Index  I. 
and  II. ;  Nerves,  Motor  ;  Nerves, 
Sensitive;  Nervous  Power, /?!rfcx/. 

do  not  operate  upon  the  brain  or  other 
organs  in  the  metaphysical  manner 
as  commonly  supposed  of  all  the  attri- 
butes of  the  mind,  nor  according  to  the 
doctrine  of  Chemistry,  but  in  no  other 
conceivable  way  than  as  appertain- 
ing to  a  substantive  self-acting  agent 
exciting  the  nervous  influence  and 
determining  it  upon  other  organs,  or 
upon  the  nervous  centres  themselve? , 
according  to  the  exact  analogies  sup- 
plied by  all  physical  causes,  and  like 
those,  also,  modifying  the  nervous  in- 
fluence according  to  the  nature  of  the 
individual  emotions — the  effects  of  the 


103U 


INDEX    II. 


Mental  Emotions — continued. 

Will  through  the  same  causation  con- 
curring in  this  demonstration,  p.  107- 
lll.'J  226-233f  ;  p.  266,  i^  447  (Z ;  p. 
289,  M61  ;  p.  296,  <^  476  c;  p.  298, 
ij  476^  h;  p.  300,  ()  479;  p.  301,  (j 
480  ;  p.  302,  (^481  6 ;  p.  304,  (>  481 
g;  p.  306-308,  ()  483  b;  p.  324,  (j 
600  c,  d;  p.  335,  <;i  511  ;  p.  402-403, 
^  634-635  ;  p.  534,  <J  846  ;  p.  706- 
709,  ij  947-951  ;  p.  631,  <J  892i  4; 
p.  661-662,  i)  894  b;  p.  745-746,  ^ 
990i  ;  p.  865-868,  «J  1067  ;  p.  878- 
882,  ij  1074-1075  ;  p.  887,  ()  1077. 

since,  therefore,  according  to  the  fore- 
going references,  the  Meiital  Emotions 
and  the  Will  develop  the  nervous  in- 
fluence by  their  direct  action  upon  the 
brain,  and  without  the  intervention  of 
sensitive  nerves,  and  since,  also,  the 
nervous  influence,  when  thus  devel- 
oped by  the  Passions,  brings  about 
precisely  the  same  morbid  and  cu- 
rative results  as  when  other  things 
operate  through  reflex  action  of  the 
nervous  system,  it  supplies  as  full  a 
demonstration  against  any  chemical 
doctrine  that  may  be  carried  analog- 
ically from  the  supposed  positive  and 
negative  condition  of  atoms  in  the 
galvanic  battery  to  the  double  nervous 
arc ;  foregoing  references,  and  Will, 
Index  I.  and  II. 

not  only  induce  and  remove  disease  like 
all  morbific  and  remedial  agents  of  a 
physical  nature,  but,  like  physical 
causes,  it  is  one  of  their  most  obvious 
characteristics  to  determine  the  nerv- 
ous influence  with  such  a  modifying 
effect  upon  the  instruments  of  organic 
processes  as  to  increase  or  diminish,  or 
to  change  the  natural  condition  of  the 
secretions,  p.  266,  i)  447  d ;  p.  289,  § 
461  ;  p.  296,  (j  476  c ;  p.  302,  (j  4:81  b ; 
p.  631-632,  ^  892i  b.  Also,  Fear, 
Jealousy,  and  the  other  individual 
Passions,  Food,  Cold,  Kidney,  Skin, 
Remedial  Action,  subdivision  Men- 
tal Emotions,  Index  II. 

having  established  the  strict  analogies 
between  the  morbific  and  remedial 
effects  of  the  various  Passions  and 
all  physical  agents,  and  that  they  are 
all  exerted  through  the  medium  of  the 
nervous  system,  and  according  to  the 
particular  nature  and  intensity  of  each 
one,  and  that  they  constantly  operate 
not  only  in  a  direct  manner  through 
the  excito-motory  nerves  alone,  and 
according  to  direct  physical  impres- 
sions upon  the  nervous  centres,  and 
according  to  their  nature,  but  that  the 
Passions,  like  the  physical  impres- 
sions, through  their  effects  upon  or- 
gans distant  from  the  nervous  cen- 


Mental  Emotions — continued. 

tres,  give  rise  to  alterative  influences 
of  reflex  action  of  the  nervous  system 
according  to  the  nature  of  each  one, 
and  since  none  but  the  Materialist 
will  assume  that  they  operate  in  any 
chemical  or  physical  manner,  we  ar- 
rive at  the  incontrovertible  conclusion 
that  all  the  analogous  effects  of  reme- 
dial and  morbific  agents  of  a  physical 
constitution  are  not  only  carried  on 
through  the  same  causation,  but  that 
they  are  equally  destitute  of  all  relation 
to  physics  and  chemistry,  ut  supra, 
and  the  individual  Passions,  Blood- 
letting, Loss  of  Blood  ;  Brain, 
Inflammation  of,  Index  II. 
an  apparently  endless  variety  of  prob- 
lems are  presented  by  the  Passions 
in  their  independent  influences,  and 
which  become  greatly  complicated  by 
their  relations  to  foreign  causes,  by 
the  variety  of  ways  in  which  they  are 
brought  into  operation,  by  the  manner 
in  which  they  modify  the  condition  of 
organs  so  as  to  predispose  them  to  the 
morbific  action  of  foreign  causes,  or, 
again,  defeat  or  promote  the  salutary 
effects  of  remedies,  or  as  they  are 
directly  morbific  or  remedial  them- 
selves, and  according  to  the  nature 
and  intensity  of  each,  or  by  their  pro- 
duction through  mental  sympathy,  as 
in  laughing,  weeping,  and  even  hic- 
cough, or  in  that  analogous  but  inde- 
finable influence  propagated  from  one 
to  another,  as  witnessed  in  yawning, 
micturition,  &c.,  but  all  of  which  are 
perfectly  resolvable  through  the  Au- 
thor's doctrine  of  alterative  and  vari- 
ously modified  influence  of  direct  and 
reflex  action  of  the  nervous  system, 
evince  their  subjection  to  laws  as 
peculiar  as  are  all  the  phenomena  (p. 
112-121,  (j  234  c-237  ;  p.  514,  No.  7, 
parallelcolumns) ;  and  here  the  Author 
will  extend  the  example  which  occurs 
at  p.  866-867,  (j  1067,  in  relation  to 
the  influence  of  Fear  upon  digestion, 
and  suppose  that  one  of  the  individuals 
should  reject  the  food  from  the  stom- 
ach, in  which  case  the  emotion  would 
simply  render  the  nervous  influence 
an  irritant  to  the  mucous  tissue  of  the 
stomach,  while  the  mechanical  irrita- 
tion of  the  food  would  develop,  in  con- 
junction with  the  gastric  irritation  by 
the  passion,  the  reflex  nervous  action 
which  determines  the  act  of  vomiting ; 
and  the  analogy  in  substantive  remote 
causes,  and  the  sameness  of  the  imme- 
diate exciting  cause  of  the  paroxysm 
become  abundantly  manifest  in  the 
fact  that  the  mind  itself  may  subse- 
quently reproduce  the  act  by  calling 


INDEX    II. 


1031 


Mental  Emotions — continued. 

up  a  recollection  of  the  event,  and  as 
described  at  p.  324,  ()  500  c ;  p.  547- 
548,  ^  863  d ;  p.  666,  ()  902  c,  and 
under  the  Article  Disgust.  See, 
also.  Hiccough,  Hysteria,  Imagina- 
tion, Fear,  Joy  and  Anger,  Jeal- 
ousy, Love,  Shame,  Sea-Sickness, 
Weeping,  Laughing,  Sneezing, 
Roosting,  Whooping-Cough,  Phthi- 
sis, Food,  Cold,  Heat,  Skin,  Seton. 

their  influences,  and  the  eflfects  of  the 
Will,  employed  by  the  Author  in  de- 
monstrating the  substantive  existence 
and  self-acting  nature  of  the  Soul  and 
Instinctive  Principle,  p.  876-881,  ^ 
1071-1075.  Also,  Will,  Index  I. 
and  II. 

how  regarded  in  their  relations  to  the 
higher  powers  of  the  mind,  p.  877- 
881,  (i  1072  J-1075. 

from  all  which  it  appears  that  every 
consideration  relative  to  the  Mental 
Emotions  —  their  very  nature,  the 
variety  of  their  effects  in  organic  life, 
physiological,  pathological,  and  thera- 
peutical, the  rapidity  with  which  they 
may  institute  the  changes,  the  manner 
in  which  they  modify  the  operation  of 
physical  agents,  the  anatomical  me- 
dium through  which  they  exert  their 
effects,  denote  the  total  absence  of 
any  connexion  with  the  laws  which 
govern  the  conditions  of  dead  matter, 
while  the  complete  analogies  of  their 
effects  with  those  of  physical  causes, 
and  the  multitudinous  variety  of  means 
which  will  arrest  some  given  condi- 
tions of  disease,  and  often  with  great 
instantaneousness,  and  in  common 
with  mental  emotions,  show  that  the 
physical  causes,  by  this  correspond- 
ence with  mental  emotions,  are  equally 
independent  of  chemical  and  physical 
laws  ;  and  their  united  force  bears  an 
overwhelming  testimony  in  corrobora- 
tion of  what  is  so  abundantly  substan- 
tiated by  the  phenomena  of  the  men- 
tal causes;  nor  is  there  a  principle  or 
a  fact  promulgated  by  Chemistry  of 
practical  application  at  the  bedside  of 
the  sick,  p.  296,  <J  476  c ;  p.  302,  (/ 
481  b;  p.  377-380,  (^  578;  p.  547- 
548,  ^  863  d;  p.  664,  (;  900  ;  p.  666, 
()  902  c ;  p.  667-669,  <J  902  e-g ;  p. 
679-681,  ()  905  a;  p.  707,  ()  947  ;  p. 
709,  (/  951  b;  p.  866-868,  ^  1067; 
p.  889-890,  <^  1077.  Also,  the  indi- 
vidual Passions,  Skin,  Cold,  Seton, 
Counter- Irritants,  Respiration; 
&c..  Index  11    Also,  p.  95,  ^  188^  rf. 

their  development  of  the  nervous  in- 
fluence by  their  action  upon  the  brain, 
and  their  operation  upon  distant  parts 
through  that  influence,  as  also  of  the 


Mental  Emotions — continued. 

Will,  wholly  peculiar  to  the  Author, 
p.  106,  <J  222  b;  p.  296,  ()  476  c,  and 
ut  supra,  and  Reflex  Action  of  the 
Nervous  System,  Remedial  Action, 
subdivision  Mental  Emotions  ;  Au- 
thors, Rights  of.  Index  II. 

Mercurial  Pill,  Blue.    See  Blue  Pill, 
Index  II. 

Mercurial  Remedies, 

whether  applied  to  the  skin  or  taken  in- 
ternally, produce  their  constitutional 
effects  through  alterative  influence  of 
reflex  action  of  the  nervous  system, 
both  in  their  largest  and  smallest 
doses,  and  when  their  operation  is 
slowly  progressive  illustrated  by  nat- 
ural processes,  as  contraction  of  the 
sphincter  muscles,  respiration,  &c., 
and  by  effects  of  cold  applied  to  the 
surface,  seton,  tartarized  antimony, 
&c. — displaying,  also,  the  strict  anal- 
ogy in  effects  between  remedial  and 
morbific  agents,  and  that  the  former 
operate  by  substituting  pathological 
conditions  more  favorable  than  those 
of  the  latter  to  the  recuperative  law, 
since,  when  the  full  constitutional 
effects  of  mercury  induce  inflamma- 
tion of  the  parotids,  and  mouth,  and 
the  "  mercurial  fever,"  the  gravest 
forms  of  various  diseases  disappear 
as  a  consequence,  and,  therefore, 
when  they  subside  under  milder  in- 
fluences, it  is  still  in  consequence  of 
milder  degrees  of  analogous  chan- 
ges, p.  66-67,  ()  148  ;  p.  338-339,  () 
514  d-h ;  p.  344-345,  ()  516  d.  No.  6  ; 
p.  524,  (}  827  e;  p.  526,  ()  828  d;  p. 
541,  ^  853-854  b;  p.  542-543,  ^  854 
c-857  ;  p.  567-569,  <J  889  l-mm ;  p. 
645-647,  (J  893  c-e ;  p.  661-663,  () 
894  i-896 ;  p.  664-672,  ^  900-904 ; 
p.  678,  ^  904  rf ;  p.  679-681,  ^  905  a; 
p.  850,  ^  1059.  Alteratives  ;  An- 
timony, Tartarized;  Cantharides; 
Hydrophobia,Virus  of  ;  Skin,  Cold  ; 
Oil,Croton;  Suppositories,  Leech- 
ing, Index  IL  P.  930-931,  ij  1088  b,  c. 
their  constitutional  effects  promoted  by 
other  cathartics  and  by  loss  of  blood, 
which  raise  the  irritability  of  the  in- 
testinal mucous  tissue  and  of  the 
system  at  large,  through  which  the 
influences  of  the  mercurial  agent  are 
promoted,  p.  367,  ()  556  c.  Also,  p. 
63,  \  137  d,  e;  p.  65-66,  ^  143  c,  d; 
p.  67,  ^  149-151  ;  p.  73,  ()  163,  and 
Ipecacuanha,  Index  II. 

Mercury,  Chloride  of.  See  Calomel, 
Index  II. , 
illustrates  the  modus  operandi  of  Astrin- 
gents by  its  comparative  effects  in 
cholera  infantum  with  those  of  the 
latter  in  diarrhoea,  &c.,  p.  576,  ^  890  I, 


1032 


INDEX    II. 


Metamorphosis, 

philosophy  of,  p.  902,  ^  1078  p. 
Metaphysicians  —  continued  from  Index 
I., 

should  take  for  their  basis,  in  intellectual 
philosophy,  the  physiological  facts 
which  demonstrate  the  substantive 
existence  and  self-acting  nature  of 
the  Soul.  See  Soul  and  Instinctive 
Principle,  Index  II. 

identify  the  Soul  and  Instinctive  Princi- 
ple, p.  895,  (J  1078  b;  p.  889,  (J  1078  h. 
Metastasis,  Revulsion,  and  Repulsion, 

have  been  interpreted  upon  no  intelligi- 
ble principle,  but  which  depend  upon 
alterative  influences  of  reflex  action 
of  the  nervous  system — illustrating 
the  practical  consequences  of  unsound 
doctrines,  p.  351-352,  ()  524  h-d;  p. 
652-656,  ^  893  n;  p.  695,  ^  924. 
Also,  Counter-Irritants,  Elate- 
EiuM,  Lactation,  Mumps,  Uterus. 
Miasm,  Vegetable, 

the  cause  of  the  numerous  varieties  of 
fever,  and  often  of  inflammations  and 
venous  congestions,  and  modify  the 
character  of  each  according  to  the 
particular  modes  of  vegetable  decom- 
position and  recombination  of  the  ele- 
ments as  brought  about  by  varying 
temperatures,  climate,  season  as  to 
moisture  and  dryness,  and  other 
chemical  influences,  p.  417-418,  (} 
650;  p.  424,  <J  662;  p.  480-481,  ^ 
743  ;  p.  490,  i)  758  ;  p.  493-494,  (J 
765-767  ;  p.  496,  I)  773  ;  p.  497-498, 
()  ni-im  ;  p.  510-512,  (j  813-817. 
Also,  Causes,  Morbific  ;  Remedies, 
Remedial  Action,  Index  II 

is  generally  the  predisposing  cause  on- 
ly, but  may  be  also  the  only  exciting 
cause,  p.  420,  ()  654  a;  p.  421-422, 
()  654  c-657  a  ;  p.  497,  ^  779. 

does  not  produce  disease  in  the  surfaces 
upon  which  it  operates,  unless  through 
reacting  influences  of  the  reflex  law 
of  the  nervous  system,  and  through 
which,  also,  as  in  the  case  of  cold,  the 
morbific  influences  are  propagated 
upon  all  other  parts  from  the  surface 
upon  which  the  primary  impression 
is  made,  p.  221-222,  ^  657  a;  p.  426, 
()  666  a.  Also,  Causes,  Morbific  ; 
Hydrophobia, Virus  OF  ;  Skin,  Cold, 
Seton,  Sphincter  Muscles,  Whoop- 
iNG-CouGH, Alteratives;  Antimony, 
Tartarized  ;  Predisposition,  &c., 
Index  II     Also,  ^  89U  ?,  1088  I, 

like  the  virus  of  small-pox,  measles,  &c., 
may  establish  a  permanently  protec- 
tive influence  against  repetitions  of 
the  same  disease — intermittent  and 
yellow  fevers,  for  example — but  with 
the  difierence  that  the  susceptibility  is 
more  likely  to  return  in  the  case  of  the 


Miasm,  Vegetable — continued. 

fevers  unless  the  subjects  continue  to 
reside  under  the  influence  of  their 
predisposing  causes,  p.  364,  ()  544, 
545  ;  p.  365-366,  <)  550-555  ;  p.  368, 
()  559,  560  ;  p.  370,  ()  566  b;  p.  425, 
^  664.  Also,  Small-pox  ;  Diseases, 
Self-limited  ;  Vital  Habit,  Accli- 
mation, Index  II. 

cannot  produce  disease — such  as  yellow 
fever,  plague,  malignant  cholera,  dys- 
entery, &c. — that  may  be  communi- 
cable, nor  can  a  contagious  disease  be 
generated  in  others  by  any  other  cause 
than  the  animal  product  which  arises 
from  each  disease  respectively — a  fun- 
damental law  which  is  without  excep- 
tion, p.  27,  (^  52  ;  p.  419-420,  ^  653  ; 
p.  842-843,  ()  1058/. 

its  morbific  action  promoted  by  various 
causes  which  increase  the  suscepti- 
bility of  the  system,  with  illustrations 
from  Cathartics,  Bloodletting,  &c.,  p. 
524,  (^827e;  <J961a;  ^970c;  and 
Remedies,  Acclimation,  Index  II. 

often  predisposes  the  system  to  the  ma- 
lign action  of  other  morbific  causes, 
renders  the  consequent  diseases  more 
dangerous  and  complicates  their  treat- 
ment, as  the  malignant  cholera,  small- 
pox, measles,  scarlatina,  and  increases 
their  epidemic  character,  ^  630  e ;  § 
652  b;  p.  420,  (}  654  a;  p.  425,  ^ 
663  ;  p.  510-511,  ()  813-816  ;  p.  553, 
(J  870  aa ;  p.  604-606,  ^  892  m-p. 

illustrates  the  philosophy  of  Vital  Habit, 
p.  364,  ()  543-548  ;  p.  365-366,  ^  550 
-554  ;  p.  368,  ^  559,  560  ;  p.  370,  ^ 
566  b. 

may  establish  the  predisposition  quickl}^ 
and  although  the  subject  pass  imme- 
diately from  its  farther  influence,  an 
explosion  of  disease  may  follow  at 
once  as  a  consequence,  or  only  after 
weeks  or  months,  p.  420,  (}  654  a ;  p. 
421,  ^  655  c,  d.  Also,  Hydrophobia, 
Virus  of  ;  Predisposition,  Altera- 
tives, Index  II. 
Micturition, 

its  phenomena  as  arising  from  mental 
sympathy,  and  in  connexion  with 
those  of  Fear,  noises,  &c.,  illustrative 
of  the  remarkable  effects  of  mental 
emotions  in  organic  life  through  the 
nervous  influence,  and  of  its  diversi- 
fied modifications  according  to  the 
precise  nature  of  the  emotion,  p.  534, 
()  844  ;  p.  630-632,  <^  892f  ;  also. 
Jealousy,  Mental  Emotions — and 
when  regarded  in  connexion  with  the 
corresponding  cflTects  of  cold  applied 
to  the  surface,  and  of  cathartics, 
bloodletting,  &c.,  an  identity  of  a 
common  proximate  cause  is  estab- 
lished, only,  in  the  case  of  the  men- 


INDEX    II. 


1033 


Micturition — conlimied. 

tal  emotions  the  nervous  influence  is 
developed  in  a  direct  manner,  and  in 
which  the  excito-motory  nerves  are 
primarily  interested,  while  in  the 
other  cases  the  sensitive  nerves  take 
the  initiatory  step,  and  reflex  action 
is  the  consequence — all  concurring 
together  in  advancing  the  Author's 
doctrine  of  the  modus  operandi  of 
morbific  and  remedial  agents,  physi- 
cal and  mental,  through  alterative  in- 
fluences of  direct  and  reflex  action  of 
the  nervous  system.  See  Remedies  ; 
Causes,  Morbific  ;  Remedial  Ac- 
tion, Mental  Emotions,  &c.,  Index 
II. 
Migration, 

its  want  of  analogies  with  the  acts  of 
reason  employed  to  demonstrate  the 
distinction  between  the  Soul  and  In- 
stinctive Principle,  p.  896,  <;>  1078  d; 
p.  898,  (^  1078  q. 
Milk, 

its  production  originally  dependent  upon 
alterative  influence  of  reflex  action  of 
the  nervous  system,  whose  point  of 
departure  is  the  uterine  system,  p. 
231-232,  ^  424;  p.  351,  (^  524  b. 
Also,  Kidney,  Secretion  and  Ex- 
cretion, Weeping,  Food,  Fear, 
Cold,  Uterus,  Organs  of  Genera- 
tion, Index  II.  ;  Youth,  Nervous 
Power,  Index  I.  and  II. 

rendered  "morbid"  by  mental  emotions, 
through  alterative  influence  of  nervous 
power,  p.  788,  ij  1032  a. 

"  we  analyze  healthy  and  morbid  milk, 
and  yet  we  are  ignorant  of  the  sub- 
stances whose  admixture  we  term 
casci«,"  p.  780,  H029._ 

disquisition  as  to  the  origin  of  its  sac- 
charine   matter,  p.  785,  ^   1031  ;    p. 
788-791,  <J  1032  a,  h. 
Mind — continued  from  Index  I, 

its  influence  upon  the  action  of  remedial 
agents,  p.  865-868,  ^  1067.  Also, 
Mental  Emotions,  the  individual 
Passions,  Index  II. ;  Will,  Index  I. 
and  II. 

its  phenomena  far  more  multifarious 
than  of  inorganic  nature,  and  more, 
therefore,  is  known  of  the  former 
than  of  the  latter,  p.  182,  ()  350i  g. 
Also,  p.  84,  ()  175  bb;  p.  112-121,  ^ 
234  J-237 ;  Soul  and  Instinctive 
Principle.  Mental  Emotions,  the 
individual  Passions,  Index  11. ;  Will, 
Index  I.  and  II. 

subject  to  the  law  of  Vital  Habit,  and 
under  complex  influences,  p.  369-370, 
^  566-568  ;  p.  894-895,  ^  1078  b. 

suffers  permanently  from  premature 
education,  but  not  so  with  Instinct, 
and  throutrh  reflex  nervous  influence 


Mind — continued. 

from  too  much  or  improper  food  in 
early  life,  p.  370,  §  568  ;  p.  894-895, 
•J  1078  b.  Also,  Infancy,  Childhood, 
Youth,  Food,  Uterus,  Vomiting. 

what  constitutes  Ideas,  and  employed 
to  illustrate  the  substantive  existence 
and  self-acting  nature  of  the  Soul,  p. 
906,  (J  1078. 

its  modus  operandi  inscrutable,  ibid. 

contrast  -between,  and  Instinct,  in  the 
infancy  of  man  and  animals,  p.  892- 
895, '!i"l078fl,  ^>,-  p.  904-906, «;.  1078  7. 

contrasted  with  the  Instinctive  Princi- 
ple as  they  respect  the  relative  varie- 
ties in  the  main  central  portion  of  the 
nervous  system,  p.  896,  <J  1078  d;  p. 
897-898,  I)  1078  e;  p.  903-906,  (} 
1078  q. 

various  other  contrasts  and  analogies 
between.  See  Soul  and  Instinctive 
Principle. 

the  brain,  or  its  equivalent,  co-operates 
with,  in  all  intellectual  and  instinctive 
acts,  but  more  so  in  the  latter  case, 
p.  894,  ()  1078  b;  p.  903-906,  (}  1078  q. 

identified  by  metaphysicians  with  In- 
stinct, p.  895,  ^  1078  b;  p.  899,  ^ 
1078  h. 

the  doctrines  of  Materialism  in  relation 
to,  p.  882-886,  {)  1076  ;  p.  894,  note. 
Morbid  Anatomy.     See  Anatomy,  Mor- 
bid, Index  II. 
Morbific    Causes.       See   Causes,  Moe- 

BiFic,  Index  II. 
Mortification — continued  from  Index  I., 

results  from  a  profoundly  morbid  condi- 
tion of  the  formative  stage  of  inflam- 
mation, when  not  owing  to  direct  vio- 
lence as  variously  inflicted,  p.  447,  ^ 
736  a,  b. 

dead  parts  removed  from  living  through 
the  vital  process  of  ulceration,  p.  477, 
<J  736  c. 

imputed,  in  inflammations,  by  the  pre- 
vailing physical  doctrines,  to  stagna- 
tion and  coagulation  of  blood,  p.  484- 
485,  ^  748,  749. 
Motion — continued  from  Index  I., 

after  apparent  death,  in  voluntary  and 
involuntary  muscles,  and  the  philoso- 
phy of,  p.  403-404,  ^  637 ;  p.  805,  ^ 
1041. 

dependent  upon  properties  implanted  in 
all  parts,  p.  806,  (J  1 042.     Also,  Vital 
Properties,  Organic  Life,  Index  I. 
Mucus, 

Table  of  parts  by  which  it  is  produced 
according  to  their  physiological  dif- 
ferences, with  corresponding  varieties 
in  the  product,  p.  218,  (;  406.  Also, 
p.  61,  (}  133  a,  b;  p.  62-63,  ^  135- 
137. 

its  varieties  depend  in  its  morbic^  as  well 
as  natural  states  upon  the  physiologi- 


1034 


INDEX    II. 


Mucus — continued. 

cal  peculiarities  of  different  parts  of 
the  mucous  tissue,  and  their  exact 
modifications  in  disease,  p.  436,  <J  682 
b;  p.  452,  (}  693;  p.  455,  ()  694i. 

denotes  a  greater  intensity  of  inflamma- 
tion, and  greater  danger,  and  calls  for 
more  vigorous  yet  cautious  practice 
when  intermixed  with  blood,  p.  572- 
576,  (j  890  c-n. 

its  redundancy  generally  denotes  inflam- 
mation, and  it  is  then  equivalent  in 
principle  to  suppuration,  with  which 
it  often  alternates,  and  with  lymph, 
in  some  parts  of  the  mucous  tissue, 
p.  452,  «J  693 ;    p.  471,  ^  732  a. 

is  increased,  or  diminished,  or  altered 
from  its  natural  condition  through 
reflex  action  of  the  nervous  system 
in  all  parts  beyond  the  seat  of  the 
direct  operation  of  foreign  causes, 
and  more  or  less  so  upon  their  direct 
seat  of  action  through  reverberated 
nervous  influences ;  and  affected  in 
the  foregoing  manner  by  the  passions 
or  other  causes  acting  directly  upon 
the  nervous  centres  through  direct 
development  of  the  nervous  influence, 
and  through  reflex  action  when  the 
changes  are  induced  by  disorders  of 
other  and  distant  parts,  p.  422-423,  () 
658;  p.  465-467, 1^715-719;  p.  478- 
479,  (j  740-741.  Also,  Bile,  Lacta- 
tion, Weeping,  Food,  Kidney,  Skin; 
Water,  Hot  ;  Antimony,  Tartau- 
IZED  ;  Fear,  Mental  Emotions,  &c.. 
Index  II. 

a  peculiar  modification  of,  diagnostic  of 
pneumonia,  p.  436,  <J  682  b. 

operates  as  a  depletive  means,  but  far 
less  so  than  most  other  products  of 
morbid  processes,  excepting  from  the 
lungs,  being  also  a  result  of  the  recu- 
perative law,  p.  471,  i)  732  b ;  p.  546- 
551,  ^  862-863  ;  p.  633-634,  ^  892| 
a  ;  p.  635-640,  ^  8924  h. 
Mucous  Tissue — continued  from  Index  I, 

the  important  part,  in  one  of  its  arrange- 
ments, upon  which  remedial  agents 
make  their  impressions,  and  from 
which  emanate  those  modified  condi- 
tions of  reflex  action  of  the  nervous 
system  through  whose  variously  diver- 
sified alterative  influences,  according 
to  the  nature  of  the  agent,  &c.,  bring 
about  all  their  changes  in  parts  re- 
motely situated,  and  constantly,  also, 
through  reacting  nervous  influences 
upon  the  tissue  which  is  the  direct 
seat  of  remedial  or  morbific  action, 
and  the  philosophy  of  all  of  which 
may  be  found  in  the  physiology  of 
respiration,  where  the  point  of  depart- 
ure for  the  reflex  action  of  the  nerv- 
ous system  is  the  same  tissue  in  the 


Mucous  Tissue — continued. 

lungs,  and  where  the  exciting  cause 
is  of  such  an  insensible  nature  that 
it  is  diflacult  to  decide  upon  its  real 
character,  and  also  farther  coincident 
with  other  natural  processes,  as  may 
be  seen  through  the  references  under 
the  Articles  subjoined,  p.  66-67,  I) 
148;  p.  359,  ()  527  a,  b;  p.  361,  ^ 
529  b;  p.  415-417,  ()  649  a-650  ;  p. 
421-422,  ()  657-658  ;  p.  530,  ()  837  b 
p.  542,  ()  854  c,  d ;  p.  545,  ()  860 ;  p 
547-550,  <J  863  d-e ;  p.  554,  ()  871 
p.  561,  ^  888  c;  p.  563-566,  <J  889 
a-i;  p.  567-569,  ()  889  l-mm;  p 
571,  <^  890  b;  p.  575-576,  ^  890  ^-w 
p.  628-629,  {)  892^  q-t ;  p.  634-641 
^  8924-  b-i;  p.  687-688,  ^  905^  c 
Also,  Respiration,  Sphincter  Mus 
CLEs,  Youth,  Skin,  Cold,  Heat 
Counter-Irritants,  Seton,  Exer 
cisE,  Ulcers,  Iris,  Phthisis,  Sea- 
Sickness,  Heart,  Kidney,  Stomach 
Emetics,  Vomiting,  Disgust,  Odors 
Cathartics  ;  Hydrophobia,  Virus 
of;  Roosting,  Yawning,  Antispas- 
modics, Reflex  Action,  Remedial 
Action,  &c..  Index  II. ;  Nervous 
Power,  Sympathy,  Index  I.  and  II. 
Table,  referring  to  the  different  modifi- 
cations of  its  organic  conditions  in 
different  parts,  and  indicative  of  their 
relative  liability  to  inflammation,  p. 
70,  Table  H. — another,  showing  its 
relative  liability  to  that  disease  com- 
pared with  other  tissues.  Table  I. — 
another,  showing  the  relative  danger 
when  aflfected  with  high  inflammation 
as  it  forms  a  component  part  of  differ- 
ent organs,  and  as  the  same  disease 
may  affect  other  tissues  in  their  com- 
pound relations,  p.  72,  Table  HI. — 
another,  showing  the  exigencies  for 
bloodletting  in  high  inflammation,  ac- 
cording to  its  last  foregoing  relations, 
and  comparatively  with  other  tissues 
in  their  connexion  with  compound 
organs,  Table  IV. 
the  difference  in  the  vital  constitution 
of  its  different  parts  where  it  occurs 
continuously,  as  from  the  mouth  to 
the  lungs,  and  from  the  mouth  to  the 
anus,  variously  illustrated  by  the  cor- 
responding variety  in  its  products,  by 
the  natural  changes  in  some  of  its 
parts,  by  the  differences  in  effects 
that  arise  from  remedial  and  morbific 
agents,  whether  acting  immediately 
upon  its  surface,  or  through  alterative 
influences  of  reflex  action  of  the  nerv- 
ous system,  or  through  direct  develop- 
ment of  the  nervous  influence  by  the 
Passions,  and  according  to  the  special 
modifications  of  disease  ;  and  the  va- 
riety in  its  vital  constitution  farther 


INDEX    II. 


1035 


Mucous  Tissue — continued. 

shown  as  the  tissue  occurs  in  parts 
remote  from  each  other,  and  as  it 
sympathizes  in  remote  parts  through 
reflex  action,  p.  61-66,  ^  134-143 ; 
p.  67,  ()  149-151  ;  p.  70,  Table  II.  ; 
p.  107-111,  ^  227-2331;  p.  374,  ^ 
576  d ;  p.  415-41 7,  ^  649  a-c ;  p.  436, 
'^  682  b ;  p.  452.  (J  693  ;  p.  522-523, 
<^  827  b-d ;  p.  547-550,  i)  863  d ;  p. 
555,  i)  872  a  ;  p.  566,  (j  889  i ;  p.  571, 
^  890  b;  p.  575-576,  ^  890  ^-n;  p. 
634-641,  ^  892|-  b-i;  p.  661-663,  () 
894  6-896 ;  p.  666-672,  ()  902  a-904 ; 
p.  840-841,  t)  1058  d,  c;  p.  854,  ^ 
1061 ;  p.  856-857,  ^  1063;  p.  862- 
864,  (J  1066. 

Table  showing  its  relative  liability  with 
that  of  other  tissues  to  sympathize 
continuously  in  their  several  parts, 
p.  354,  <J  526  a.  Also,  Sympathy, 
Continuous,  Index  II. 

Table  showing  its  relative  liability  com- 
pared with  other  tissues  to  morbid 
sympathies,  through  reflex  action  of 
the  nervous  system,  in  organs  remote 
from  each  other,  p.  353,  ^  525  a. 

its  own  sympathies  in  parts  remote  from 
each  other,  and  with  other  tissues,  () 
512.  514/,  523,  no.  7,  527  a-529,  689 
I,  889,  892%  b-i,  902  e,  904  bb. 

MiJLDER, 

applies  catalysis  in  expounding  secreted 
■  products,  in  which  he  does  not  agree 
with  LiEBiG,  p.  178-182,  ^  350t  a-f; 
p.  226,  i)  409  ;. 

decides  that  the  component  parts  of  the 
bile  and  of  other  secretions  are  not  to 
be  found  in  the  blood,  and  that  we 
have  "no  knowledge  whether  the  bile 
proceeds  from  the  blood  or  from  the 
secreting  organ,"  p.  180-182,  <J  350f  e. 
Also  Lehmann,  Index  II. 

maintains  that  there  is  no  essential 
difference  between  living  and  dead 
matter,  p.  179-182,  ^  350i  c-f ;  also, 
Lehmann,  Index  II. — and  yet  he  does 
not,  p.  189-190,  i)  350}  n,  parallel 
columns — but  believes  with  Dr.  Car- 
penter and  others  that  Carbon,  Oxy- 
gen, Hydrogen,  and  Nitrogen  are  en- 
dowed with  life,  p.  178,  ij  350|  a;  p. 
181-182,(^3501/. 

upon  the  Soul,  p.  183,  ^  350f  gg. 

MiJLLER, 

the  chief  expositor  of  the  physiological 
laws  of  reflex  action  of  the  nervous 
system,  p.  341-342,  (j  bU^b;  p.  362, 
<J  530. 

nevertheless,  fails  of  applying  them 
pathologically  and  therapeutically,  is 
at  fault,  like  Marshall  Hall,  in  his 
physiological  attributes  of  the  nervous 
influence,  adopts  the  physical  doctrine 
of  Absorption,  and,   like  Dr.  Hall, 


Miiller — continued. 

patronizes   the  Humoral  Pathology, 
p.  283,  l)  452  b ;  p.  320,  ^  494  dd. 

Mumps, 

occasions  inflammation  of  the  testes  and 
mammse  through  alterative  influences 
of  reflex  action  of  the  nervous  system, 
and  exemplifies  the  disposition  of  tis- 
sues of  analogous  organization  and 
function  to  sympathize  with  each 
other,  and  is  an  example  of  the  me- 
tastasis of  Authors,  p.  59,  (J*  129  i; 
p.  351-352,  ()  524  b,  c;  p.  353-354, 
()  525  ;  p.  652-653,  ()  893  n.  Also, 
Metastasis, Inflammation ;  Causes, 
Morbific  ;  Reflex  Action,  &,c..  In- 
dex II. ;  Nervous  Power,  Sympathy, 
Index  I.  and  II. 


N. 


Narcotics — continued  from  Index  I.  See, 
also.  Opium,  Index  I.  and  II. 

limited  in  a  group  to  such  as  relieve  pain 
and  induce  sleep,  p.  583,  (j  891  a,  b. 

greatly  overrated,  p.  584,  i)  891  c ;  p.  715 
-720,  ()  960  a;  Note  H  p.  1117. 

considerations  relative  to  their  injurious 
tendencies,  and  the  neglect  of  more 
important  means,  ibid. 

very  deficient  in  curative  virtues,  and 
illustrations,  p.  584,  i^i  891  d. 

their  modus  operandi  like  that  of  all 
other  remedies  and  of  all  morbific 
causes — that  is  to  say,  when  their 
effects  extend  beyond  their  direct  seat 
of  operation,  it  is  through  alterative 
influences  of  reflex  action  of  the  nerv- 
ous system — supplying  examples,  al- 
so, of  the  remarkable  manner  in  which 
the  nervous  influence  is  variously  mod- 
ified and  rendered  alterative  according 
to  the  nature  of  the  causes  by  which 
it  is  brought  into  action,  p.  107-111, 
{}  227-233} ;  p.  309-310,  (j  484  b,  Nos. 
5,  6;  p  321-341,  ()  496-514  m;  p. 
567,  <J  889  k;  p.  585,  ^  891  e ;  p. 
589-590,  (^  BQl  0,  p;  p.  592-593,  () 
89HA-;  p.  661-663,  (J  894-896;  p. 
665-675,  i)  902-904;  p.  679-681,  <^ 
905  a.     Also,  Antispasmodics,  Index 

n. 

an  example  derived  from  Aconite  applied 
to  the  skin  in  its  sudden  relief  of  neu- 
ralgia of  the  sciatic  nerve,  to  show  its 
operation  through  alterative  influence 
of  reflex  nervous  action,  p.  838,  () 
1057^. 

analogy  between  the  sedative  effect  ex- 
erted upon  the  nervous  influence  by 
Narcotics  when  developed  by  reflex 
action,  and  as  developed  in  a  direct 
manner  by  certain  Emotions  of  the 
Mind,  p.  296,  I)  476  c;  p.  302,  ^  481 


1036 


INDEX    II. 


Narcotics — continued. 

b ;  p  589-590,  ^  891  p ;  p.  592-593, 
(^  89H  A-  ,■  p  670,  ()  902  /.  Also,  Hic- 
cough, Hysteria,  Axtispasjiodics, 
Mental  Emotions,  Opicm,  Food, 
Index  II. ;  Nervous  Power,  Index  I. 
and  II. 

the  variety  in  their  virtues,  respectively, 
of  much  practical  advantage,  p.  585, 
«J89I/. 

their  effects  generally  increase,  at  first, 
by  frequent  repetition,  but  subse- 
quently decrease,  though  may  be  a 
good  deal  maintained  by  substituting 
one  for  another  during  their  continued 
use,  ibid.,  and  <S>  981  s. 

directly  sedative,  as  shown  by  their  less- 
ening morbid  sensibility  and  irritabil- 
ity, and  by  the  manner  in  which  they 
counteract  spasmodic  affections,  p. 
590,  ^  891  q;  p.  592-593,  <»  89H  k; 
p.  828-833,  {)  1057  a-i. 

their  greatest  use,  to  produce  sleep  and 
relieve  restlessness,  though  in  this 
they  may  fail,  or  aggravate  the  trou- 
ble, when  other  means  would  be  effi- 
cient, p.  586,  i)  891  g,  h  ;  p.  715-721, 
§  960  a,  b. 

their  next  great  use,  to  relieve  morbid 
states  of  irritability,  through  which 
opium  arrests  diarrhoea,  &c.,  with 
practical  illustrations,  p.  572,  ()  890  a; 
p.  576,  ^  890  / ;  p.  587,  <}  891  i. 

next  in  order  comes  paiii.  for  which  they 
are  mostly  esteemed,  and  most  abused 
— the  symptoms  commonly  demanding 
very  different  remedies,  such  as  loss  of 
blood,  blisters,  warm  bath  and  foment- 
ations, p.  587-589,  ^  891  k-p ;  p.  715- 
721,  ^  960  a,  b. 

their  effects  often  counteracted  by  a  pe- 
culiar stimulating  nervous  influence 
developed  by  pain,  so  that  quantities 
are  often  admissible  that  would  be 
fatal  in  health,  p.  590,  ^  891  r— and 
again  by  a  very  different  modification, 
as  in  the  delirium  of  drunkenness,  p. 
590,  1^  891  r;  p.  734,  i)  976  b. 

the  less  important  the  part,  the  safer  will 
they  be,  in  a  general  sense,  or  where 
disease  is  not  profound,  p.  587-589, 
()  891  k-p. 

less  morbific  in  chronic  than  acute  dis- 
eases, where,  also,  they  are  most  suc- 
cessful, ibid. 
Nauseants, 

a  subdivision  of  Author's  group  of  Seda- 
tives, p.  830,  ^  1057  rf. 

prolific  in  examples  of  the  operation  of 
remedial  and  morbific  agents  through 
alterative  influence  of  reflex  action  of 
the  nervous  system,  of  which  Croup 
supplies  one  of  the  most  obvious, 
where  no  amount  of  Tartarized  Anti- 
mony or  Ipecacuanha  will  moderate 


Nauseants — continued. 

the  symptoms  till  nausea  takes  place, 
when  immediately  a  melioration  often 
sets  in,  and  advances  rapidly  when 
vomiting  ensues — and,  as  the  latter  is 
admitted  to  depend  upon  reflex  action 
of  the  nervous  system,  it  goes  with  the 
former  fact  in  showing  that  the  dis- 
ease is  equally  overcome  by  the  same 
influence  determined  upon  the  mucous 
tissue  of  the  larynx — while,  also,  the 
mineral  and  vegetable  substance,  in 
alike  subduing  the  disease,  demon- 
strates, like  a  thousand  other  analo- 
gous cases,  the  absurdity  of  the  chem- 
ical and  everj'  other  physical  rationale, 
p.  336-337,  ij  514  b,  c ;  p.  365-366,  ^ 
551-554;  p.  486,  ()  750  b;  p.  532- 
533,  (J  841  ;  p.  666-670,  ()  902  b-m; 
p,  675-676,  <J  904  b.  Also,  Antimony, 
Tartarized  ;  Alteratives,  Disgust, 
Mental  Emotions,  Index  II. 

Negro, 

his  color,  and  that  of  other  races,  con- 
sidered, p.  393,  <J  610 ;  p.  907,  (}  1078  s. 
Also,  Races  of  Mankind,  Index  I. ; 
Medical  and  Physiological  Comment- 
aries, vol.  ii.,  p.  640. 

Nervous  Power — continued  from  Ind.  I. 
its  existence,  attributes,  and  functions, 
(whateverit  maybe,  or  if  a  better  name 
can  be  substituted),  as  well  as  of  the 
Organic  Properties,  more  demonstra- 
ble than  any  thing  relative  to  mere 
physics,  p.  76,  (J  167  a;  p.  79-81,  <J 
167^-169/;  p.  84,  (^  175  b ;  p.  85- 
87,  ()  175  d-177 ;  p.  88,  i)  184  b,  185  ; 
p.  95-96,  6  189  b;  p.  111-121,  (^  234- 
237  ;  p.  326-331,  ^  500  g-o. 
although  its  existence  as  an  agent  is 
variously  demonstrable,  as  above,  it 
is  sufficiently  so  by  considering  that 
all  motions  have  a  positive  exciting 
cause — the  lining  membrane  of  the 
heart  and  bloodvessels  is  stimulated 
by  the  blood,  the  retina  by  light,  the 
mucous  tissue  of  the  alimentary  canal 
by  food  and  bile,  &.c. — therefore  the 
analogies  prove  that  the  muscles  of 
respiration,  the  iris,  the  sphincter 
muscles,  and  all  other  muscles,  must 
have  an  analogous  cause,  and  when 
the  variety  in  the  results  is  consider- 
ed, as  arising  from  mental  as  well  as 
physical  causes,  the  great  fallacy  of 
the  chemical  rationale  becomes  glar- 
ingly apparent — and  so  of  the  Soul 
and  Instinctive  Principle,  p.  62,  <^  136. 
Also,  p.  107-122, 1)  226-240.  and  fore- 
going references,  and  Soul  and  In- 
stinctive Principle,  Index  II. 
nevertheless,  the  Author  expresses  him- 
self as  entirely  opposed  to  all  specula- 
tions as  to  the  nature  of  such  a  power, 
and  it  is  wholly  unimportant  whether 


INDEX    II. 


1037 


Nervous  Power — continued. 

it  be  conceded  that  some  other  un- 
known influence  (ahvays  excepting 
the  chemical  rationale)  is  exerted  at 
the  extremities  of  the  excito-motory 
nerves,  since,  whatever  it  may  be,  it 
will  in  no  respect  affect  the  Author's 
application  of  the  physiological  laws 
of  the  nervous  system  in  resolving 
the  great  problems  in  Pathology  and 
Therapeutics,  p.  117-118,  ()  234  g; 
p.  330,  ^  500  nn;  p.  878-879,  ()  1073  a 
— but,  in  accepting  this  part  of  the 
alternative,  it  must  be  made  to  explain 
in  some  intelligible  manner  the  end- 
less variety  of  effects  that  ensue  upon 
the  operation  of  natural,  morbific,  and 
remedial  agents,  physical  and  mental 
(many  of  which  are  incapable  of  being 
absorbed),  according  to  the  nature  of 
each  one,  and  shown  to  be  of  some 
practical  use  in  medicine,  but  which 
is  perfectly  resolved  by  the  Author's 
doctrine  of  special  modification  of  the 
nervous  power  by  the  several  causes 
respectively.  The  iexmpower  is  sanc- 
tioned by  long  usage  and  by  late  emi- 
nent writers,  as  Liebig,  for  example, 
when  speaking  of  the  functions  of  the 
nervous  system  (p.  158-171,  Nos.  51- 
62,  65,  69,  70,  72-74,  79,  81,  87-91, 
■parallel  columns) ;  but  the  present 
writer  prefers  the  term  nervous  in- 
fluence (as  he  says  oi  continuous  sym- 
pathy, p.  322,  ^  498  a),  which  ex- 
presses his  meaning  exactly,  and  is 
exempt  from  all  hypotheses,  p.  88,  ^ 
184  6,-  p.  107-110,  <J  227-232;  p.  112, 
§  234  b  ;  p.  302,  ()  481  b ;  p.  305,  ^ 
482;  p.  309-314,  H84-489;  p.  323- 
332,  I)  500  ;  p.  333,  <)  503  ;  p.  334,  ^ 
509  ;  p.  405-412,  (^  638  ;  p.  530,  ^ 
837  b;  p.  547-550,  ^  863  d;  p.  661- 
663,  ()  894  J-896  ;  p.  665-670,  §  902 
a-m;  p.  706-709,  <)  947-951. 
operates  upon  the  minute  structure  of 
organs,  whether  vascular,  muscular, 
&c.,  and  both  by  reflex  and  direct 
action,  as  it  may  be  excited  in  one 
case  through  sensitive  nerves,  or  in 
the  other  by  causes  acting  directly 
upon  the  nervous  centres,  and  through 
which  action  upon  their  organic  states 
all  the  secreted  products,  and  all  the 
other  natural  conditions,  are  increased 
or  diminished,  or  turned  from  their 
natural  conditions,  or  again  restored, 
in  all  parts  beyond  the  seat  of  the 
direct  operation  of  all  causes  which 
disturb  its  natural  action — all  organs 
being  rendered  preternaturally  sus- 
ceptible of  the  influences  of  the  nerv- 
ous system  by  their  morbid  state;  and 
where  it  is  not  directly  affirmed  that 
all  the  foregoing  results  are  due  to 


Nervous  Power — continued. 

influences  of  reflex  or  direct  action  of 
the  nervous  system  upon  the  organic 
states,  it  is  so  by  an  obvious  implica- 
tion, for  brevity's  sake,  founded  upon 
the  Author's  universal  application  of 
the  foregoing  principle — and,  farther, 
the  nervous  influence  may  prove  a 
simple  excitant  or  depressant,  or,  what 
is  far  more  important,  and  distinctly 
and  variously  shown  by  unequivocal 
demonstration,  and  which  can  be  ex- 
pounded by  no  other  philosophy,  and 
which  is  fundamental  in  the  Author's, 
it  may,  according  to  the  nature  of  the 
causes,  physical  and  mental,  that  bring 
it  into  preternatural  action,  undergo 
as  great  a  variety  of  modifications  as 
there  are  special  virtues  in  the  several 
causes,  remedial  or  morbific,  rendering 
it  variously  alterative,  and  from  which 
results  through  the  influences  exerted 
by  this  protean  agent  upon  the  instru- 
ments of  action  the  endless  variety  of 
changes  that  occur  in  the  solids  and 
fluids  remote  from  the  direct  seat  of 
operation  in  the  case  of  all  physical 
agents,  and  always  so  in  the  case  of 
the  Passions  or  other  causes  affecting 
the  nervous  centres,  and  even  in  the 
case  of  the  direct  seat  of  action  the 
changes  in  the  direct  seat  are  apt  to 
be  consequent  upon  reflex  actions 
coming  either  through  the  appropriate 
nerves  of  the  part,  or  depend  upon  re- 
flex actions  excited  by  remote  organs, 
p.  61,  l^  133  c;  p.  63,  ()  137  d;  p.  65, 
<J  143  c;  p.  66-67,  ()  148  ;  p.  101-102, 
()  201-203;  p.  106-118,  ()  222-234; 
p.  125,  {)  245  ;  p.  215,  ()  395  ;  p.  226- 
227,  ()  410-411  ;  p.  230-233,  ^  422- 
427;  p.  250,  H4lc,-  p.  262,  H46a; 
p.  264-270,  ()  446  (Z-447  d ;  p.  286,  () 
456  a,  b  ;  p.  301-302,  ()  481  ;  p.  305- 
310,  ()  483-485;  p.  323-336,  ^  499- 
512  ;  p.  337,  338,  §  514  c,  d ;  p.  339- 
340,  ^  514  h;  p.  344-345,  ^  516  d, 
No.  6  ;  p.  347,  ^5l6d,  No.  10  ;  p.  348, 
^  516  d,  No.  13;  p.  351,  ^  524  a; 
p.  356-358,  ^  526  d ;  p.  359,  ^  527 
a,  b;  p.  421-423,  ()  657-658  ;  p.  451- 
452,  (J  692  ;  p.  486,  ^  750  b ;  p.  483- 
484,  (J  746  c ;  p.  506,  ^  803.  804 ;  p. 
546-550,  ^  862-863/;  p.  563-566,  (J 
889 a-^;  p.  585,  ij  891  e;  p.  589-590, 
^891;>,-  p.  592-593,^5  89 H  A- ;  P-612 
-613,  ^  892J  a,  b;  p.  631-632,  ^  892i  ; 
p.  637,  ^  892|  d,  e ;  p.642'648,  ^  893 
a-g;  p.  661-663,  i)  894-896  ;  p.  666- 
672,  ^  902  6-904  a  ;  p.  679-681,  ^  905 
a;  p.  692-69.5,  1^  915-924;  p.  697- 
701,  ^  927-928  ;  p.  703-710,  ^  940- 
952;  p.  831-833, '5l057/-yt;  p.  862- 
864,  (J  1066  ;  p.  865-868,  ^  1067  ;  p. 
875-877,  ^  1072  a;   p.  886-891,  ^ 


1038 


INDEX    II. 


Nervous  Power — continued. 

1077.  Also,  Reflex  Action,  Men- 
tal Emotions,  Remedial  Action. 
exalts  the  condition  of  all  organic  com- 
pounds, solid  and  fluid,  including  the 
blood ;  a  law  profoundly  concerned 
in  pathology  and  therapeutics,  ^  226, 
232,  399,  405,  446  a,  461,  485,  488^, 
512,  733  h,  746  c,  846,  902,  952. 
explanatory  specifications  of  the  mechan- 
ism through  which  the  nervous  power 
operates  in  its  function  of  reflex  action, 
for  the  purpose  of  applying  it  to  the 
interpretation  of  the  modus  operandi 
of  all  remedial  and*  morbific  agents 
upon  parts  beyond  the  seat  of  their 
direct  operation,  and  also  of  its  limita- 
tion in  other  cases  to  the  motor  nerves, 
and  as  the  cause  of  all  the  physiologi- 
cal changes  in  the  solids,  and  of  all 
increased  or  otherwise  modified  secre- 
tions in  parts  not  the  immediate  sub- 
jects of  other  agents  through  its  va- 
rious influences  upon  the  instruments 
of  organic  processes,  and  of  its  modi- 
fications according  to  the  nature  of  its 
exciting  causes,  as  well,  also,  for  prov- 
ing the  substantive  existence  and  self- 
actingnature  of  the  Soul  and  Principle 
of  Instinct,  p.  101-102,  (}  201-202; 
p.  106,  ^  224-227;  p.  112,  «;.  234  i; 
p.  116-117,  ^  234/;  p.  282,  (}  451  d; 
p.  285-287,  ^  455  d-459  a ;  p.  290- 
295,  ^  462-475i  ;  p.  300,  <;>  479  ;  p. 
309-310,  ^  484  b,  Nos.  5  and  6  ;  p. 
321,  ^  496,  497  ;  p.  323-328,  ^  499  a 
-500  m;  p.  331-341,  ()  500  0-514  n  ; 
p.  344-345,  <J  516  (i,  No.  6 ;  p.  348, 
\  516  d,  No.  13  ;  p.  416-417,  <J  649  c; 
p.  421-423,  ()  657-658  ;  p.  465-466, 
()  715  ;  p.  483-484,  ^  746  c ;  p.  592- 
593,  <^  8911  k;  p.  661-663,  ()  894- 
896  ;  p.  665-670,  <^  902  a-n;  p.  679 
-681,  <^  905  a;  p.  703-710,  ij  940- 
952;  p.  873-881,  ^  1069-1075;  p. 
886-891,  ()  1077;  (}  111-113,  224, 
488^,  524  d,  no.  7,  89U  g,  893  a. 
nevertheless,  the  Author  endeavors  to 
show  that  the  functions  of  organs  in 
the  organic  life  of  Animals  are  carried 
on,  like  the  analogous  ones  in  Plants, 
by  properties  inherent  in  all  parts,  and 
that  the  nervous  power  or  nervous 
influence  contributes  nothing  more 
toward  the  functions  of  the  nutritive 
and  other  secretory  vessels  than  that 
of  exerting  a  modifying,  or  exciting, 
or  depressing  influence  upon  them, 
through  which  the  products  are  per- 
fected in  their  character,  or  increased 
or  diminished  ;  but  these  instruments 
of  life  are  constantly  liable  to  preter- 
natural influences  of  the  nervous 
power,  and  of  an  endless  variety,  and 
there  is  no  function  in  the  natural 


Nervous  Power — continued. 

state  of  the  body,  no  condition  of  dis- 
ease, no  action  of  remedies,  in  which 
the  nervous  influence  does  not  par- 
ticipate (p.  54-55,  ij  109  i-117;  p 
284-287,  ()  454  c-459  ;  p.  2^9,  ()  461 ; 
p.  483-484,  {)  746  c),  while  organs  in 
their  compounded  condition  are  more 
manifestly  under  its  perpetual  har- 
monizing influence  through  the  im- 
pressions made  upon  their  minute 
structure  —  it  being,  therefore,  the 
Author's  doctrine  that  the  nervous 
influence  is  merely  an  exciting  or 
modifying  cause  of  the  organic  func- 
tions, and  whenever  he  speaks  of  that 
influence  as  a  cause  of  certain  effects, 
or  objects  to  its  application  as  a  cause 
of  any  of  the  processes  of  life,  he 

»  always  means  in  the  former  case  that 
it  influences  the  processes  of  life,  and 
in  the  latter  that  these  processes  are 
carried  on  by  causes  or  properties 
inherent  in  all  parts,  p.  23,  ^  34-38  ; 
p.  24,  ^  41,  42;  p  54,  ^  109  b;  p.  66- 
67,  ()  148;.p.  75-76,  ^  167a,-  p.  110, 
^  233  ;  p.  222-227,  i}  409  c-411  ;  p. 
284-286,  ()  Ab^^bl ;  p.  289,  (^  460- 
46H;  p.  294,  (J  475;  p.  295-296,  (J 
476  b;  p.  313-315,  (}  488-489;  p. 
317-318,  <J  493 ;  p.  421-423,  ()  657- 
658;  p.  483-484, (;> 746c,-  p. 353, no. 7. 
Vital  Properties,  Organic  Life, 
Index  I. ;  Respiration,  Sphincter 
Muscles,  &c..  Index  II.  ij  990^  a,  b. 
is  the  agent  through  which  the  Will  and 
Mental  Emotions  operate.  See  Will, 
Index  I  and  II. ;  Mental  Emotions, 
and  the  individual  Passions,  Index  II. ; 
Nervous  Power,  Lulex  I 
but  there  is  an  essential  difference  in  the 
influence  of  the  nervous  power  upon 
organs  that  are  less  interested,  or  not 
at  all,  in  the  essential  processes  of 
organic  life,  where,  as  in  voluntary 
motion,  respiration,  contraction  of  the 
sphincter  muscles,  peristaltic  move- 
ments, the  nervous  power  is  the  only 
immediate  stimulus  which  brings  the 
muscles  into  action ;  though  here, 
also,  the  motions  are  accomplished 
by  inherent  powers,  p.  110,  (^  233, 
and  many  of  the  preceding  references. 
Also,  Vital  Properties,  Nervous 
Power,  Index  I  ;  Sphincter  Mus- 
cles, Respiration,  Iris, Cathartics, 
Index  II. 
its  development  direct  when  the  Will  or 
Mental  Emotions  operate,  or  any  dis- 
turbances affect  the  nervous  centres, 
and  indirect  when  the  exciting  in- 
fluences proceed  from  other  parts 
through  sensitive  nerves  or  fibres, 
and  the  transmitted  impression  de- 
velops the  nervous  influence — consti- 


INDEX    II. 


1039 


Nervous  Power — continued. 

tuting  reflex  action  of  the  nervous 
system  or  remote  sympathy  —  both 
orders  of  nerves  or  fibres  of  compound 
nerves  being  always  engaged  in  the 
latter  case,  while  in  the  former,  when 
the  Will  and  Passions  operate,  the 
excito-motory  nerves  or  fibres  are 
alone  concerned,  and  the  influence 
alone  centrifugal,  unless  the  Passions, 
as  is  common,  and  diseases  of  the 
nervous  centres,  &c.,  institute  im- 
pressions upon  distant  parts  that  are 
reverberated  upon  the  nervous  cen- 
tres, when  the  nervous  influence,  al- 
though direct  at  its  incipient  move- 
ment, may  establish  a  complex  circle 
of  reflex  actions,  and  undergo  modifi- 
cations of  its  alterative  influence,  not 
only  according  to  the  nature  of  its 
primary  exciting  cause,  but  according, 
also,  to  that  of  the  particular  natural 
constitution  of  different  parts,  and 
any  present  modified  condition  of 
parts  upon  which  its  influences  may 
fall,  since,  also,  any  preternatural 
condition  of  an  organ,  whether  ren- 
dered temporarily  so  by  disease,  or 
only  temporarily  disturbed  by  the 
nervous  influence  (as  in  sneezing 
from  a  strong  light  impinging  upon 
the  retina,  p.  327,  (J  500  i ;  p.  333,  ^ 
504  ;  p.  340-341,  ()  514  /),  is  equiva- 
lent to  influences  propagated  in  a  like 
manner  by  the  action  of  remedial  and 
morbific  agents,  and  will  modify  the 
nervous  influence  in  a  corresponding 
manner ;  and  upon  this  reflected  in- 
fluence and  its  modifications  depend 
the  diseases  of  organs  that  grow  out 
of  each  other,  and  the  nature  of  the 
affections  as  they  may  spring  up  con- 
secutively, and  in  connexion  with  the 
constitutional  nature  ofdifferent  parts, 
or  as  they  may  conspire  together  in 
aggravating  or  relieving  the  condi- 
tions of  each  other,  p.  59,  ()  129  h,  i; 
p.  61-63,  ()  133-152  ;  p.  73,  <;»  163  ; 
p.  101-102,  ()  201-202;  p.  107-119, 
<J  224-234 ;  p.  232-284,  ^  451-453  ; 
p.  285-286,  (J  455  ;  p.  296,  (}  476  c ; 
p.  321,  ()  496,  497;  p.  323-328,  () 
499-500  /;  p.  331-334,  (/  500  o-510  ; 
p.  347-348,  (}  516  d,  No.  13,  517; 
p.  429-430,  ()  674  d ;  p.  526,  (}  828  d; 
p.  539,  f)  848  ;  p.  592,  I)  89H  f^ ;  P- 
642-648,  <)  893  a-g ;  p.  661-663,  (} 
894-896 ;  p.  665-676,  (J  902  a-904  6; 
p.  679-681,  ^  905  a;  p.  692,  (}  914- 
921 ;  p.  698-699,  ()  930-935  ;  p.  703- 
710,  ^  940-952  ;  p.  745-746,  ij  990^  ; 
p.  831-833,  ^  1057  f-h;  p.  838,  ^ 
10571;  p-  865-868,  ^  1067;  p. 874- 
881,  ^  1071-1075;  p.  886-891,  () 
1077. 


Nervous  Power — continued. 

"  exhaustion  of,"  an  hypothesis  without 
foundation,  p.  805,  ^  1041. 

when  remedies  properly  applied  (as  with 
morbific  causes)  develop  the  alterative 
action  of  the  nervous  influence,  it  is 
not  commonly  by  exciting  disease  in 
parts  which  are  the  direct  seat  of  their 
operation,  but  when  this  result  ensues 
it  is  mostly  through  reflex  action  of 
the  nervous  system  directed  upon  the 
seat  of  their  operation — though  prom- 
inent exceptions  occur  in  the  case  of 
Counter-irritants,  p.  66-67,  <^  148  ;  p. 
336,(}  5U  b-h;  p.  416-417,  ^J  649  c  ; 
p.  421-423,  ()  657-658  ;  p.  483-484, 
I  746  c ;  p.  522-523,  ^  827  b,  c ;  p. 
862-864,  <^  1066.  Also,  Miasm,  Skin, 
Cold,  &c..  Index  II. 

considered  in  its  slowly  progressive 
operation  through  reflex  action  of 
the  nervous  system,  when  brought 
into  effect  by  agents  belonging  to 
Author's  group  of  Alteratives,  and 
analogous  means,  both  physical  and 
mental — the  same  being  also  true  of 
the  slowly  progressive  operation  of 
morbific  causes,  p.  1 1 1,  <J  233^,  233f  ; 
p.  285-286,  ()  455  d-f;  p.  333,  (J.  503- 
506 ;  p.  339,  ()  514  g-;  p.  344-345,  i) 
516  d,  No.  6  ;  p.  365,  (j  551  ;  p.  366, 
()  556  ;  p.  416-417,  ()  649  c;  p.  420- 
424,  (}  654-661  ;  p.  532,  ^  841  ;  p. 
547,  (j  863  d;  p.  551,  ^  877;  p.  568- 
569,  ()  889  m,  mm ;  p.  646-649,  <J  893 
e-/i ;  p.  661-663,  <J  894-896 ;  p.  668- 
670,  ()  902  g-m ;  p.  675-676,  §  904  6  ; 
p.  679-681,  ij  905  rt.  Also,  Sphincter 
Muscles,  Alter.\tives;  Hydropho- 
bia, Virus  of  ;  Small-pox,  MijTsm, 
Predisposition,  Index  II. 

may  operate  profoundly  with  morbific, 
but  little  with  remedial  effect,  long 
after  the  exciting  cause  is  withdrawn, 
p.  66-67,  ()  148.  150  ;  p.  Ill,  i^i  233^, 
2331 ;  p.  285-286,  i)  455  d-f;  p.  333, 
()  503-506  ;  p.  339-340,  ^  514  g,  h; 
p.  344-345,  (J  516  d.  No.  6;  p.  364, 
i)  545  ;  p.  365,  (^  549,  550  ;  p.  368,  ij 
558,  560;  p.  416-417,  ^  649  c ;  p. 
420-424,  (J  654-661  ;  p.  425-427,  ^ 
664-666  ;  p.  532,  ^  841  ;  p.  542,  ^ 
854  c-e ;  p.  668-669,  ^  902  g ;  p.  707 
-708,  ^  949. 

the  incorporation  of  the  cerebro-spinal 
and  ganglionic  systems  in  all  parts 
renders  them  all  the  constant  subjects 
of  direct  and  reflex  nervous  influence ; 
but  in  the  natural  state  of  the  body 
this  influence  is  not  strongly  pro- 
nounced, excepting  in  certain  in- 
stances, as  respiration,  the  contrac- 
tion of  the  sphincter  muscles,  the 
motions  of  the  iris,  of  the  stomach 
and  intestine,  and  of  the  heart ;    but  • 


1040 


INDEX    II. 


Nervous  Power — continued. 

otherwise  mostly  so  when  morbific 
and  remedial  agents  and  the  mental 
emotions  operate,  p.  55,  ()  111-117; 
p.  58-59,  {)  129  a,  i;  p.  61,  <)  133  c; 
p.  62-67,  ()  136-151  ;  p.  87,  ^  177; 
p.  88,  «J  184-185  ;  p.  101-102,  ^  201- 
202;  p.  106-112,  ^222-234;  p.  116- 
117,  ^  234/  g;  p.  253,  (J  441  d;  p. 
262-268,  (J  446  a-447  d ;  p.  284-290, 
(}  454-4611  c;  p.  296,  ()  476  c;  p. 
323-341,  ^  499-514;  p.  344-345,  () 
516  <Z,  No.  6  ;  p.  348,  ^  516  d,  No.  13 ; 
p.  350-353,  (j  524  ;  p.  354-362,  i)  526 
-530;  p.  508-509,  i^i  807-81 1  ;  p.  537 
-539,  <J  847  e-848  ;  p.  563-565,  ^  889 
a-g;  p.  592-593,  ()  891i  k;  p.  642- 
650,  <;>  893  a-i ;  p.  657,  ()  893  p ;  p. 
661-681,  ()  894-905;  p.  692-709,  ^ 
914-951  ;  p.  745-747,  ()  990^  a,  b; 
p.  804,  ()  1040  ;  p.  865-868,  (J  1067  ; 
p.  874,  ()  1071 ;  p.  877-881,  ^  1072  b- 
1075;  p.  886-890,  ()  1077,  89H  g- 

other  strongly  marked  examples  of  reflex 
action  of  the  nervous  system,  and  of 
an  alterative  nature,  occur  in  natural 
mutations  of  the  body  from  Infancy 
to  Youth,  and  others  in  other  natural 
conditions  to  which  the  system  is  in- 
cidentally liable,  as  in  gestation  and 
lactation.  See  Youth,  Lactation, 
Uterus,  Organs  of  Generation, 
Milk,  Index  II. 

the  entire  dependence  of  respiration 
upon  reflex  action  of  the  nervous  in- 
fluence coincides  with  the  dependence 
of  the  act  of  vomiting  upon  the  same 
causation,  and  carried  by  the  Author 
through  a  chain  of  analogies  consist- 
ing of  the  various  modifications  of 
respiration,  of  vomiting  as  produced 
by  emetics  of  various  kinds,  by  loss 
of  blood,  by  tickling  the  fauces,  by 
tobacco  applied  to  the  soles  of  the 
feet,  by  pregnancy,  by  shock  of  falls, 
by  mental  emotions,  &c.,  and  the  di- 
vers influences  and  results  according 
to  the  nature  of  the  cause,  and  other 
coincidences  supplied  by  the  iris, 
sphincter  muscles,  skin,  cold,  sup- 
positories, tetanus,  &c.,  which  de- 
pend upon  other  modifications  of  the 
nervous  influence  through  reflex  ac- 
tion, and  the  analogies  supplied  by  the 
will  in  voluntary  motion — all  carried 
to  the  interpretation  of  all  the  eflTects 
of  active  emetics  and  cathartics,  both 
remedial  and  morbific,  and  by  the 
same  analogies,  their  effects,  when 
they  fall  short  of  vomiting  or  purging, 
or  other  prominent  results  that  arise 
from  larger  doses,  through  alterative 
influences  of  reflex  action  of  the  nerv- 
ous system,  upon  parts  beyond  the 
seat   of  their  direct   operation,  and 


Nervous  Power — continued. 

against  the  chemical  and  physical 
doctrines  of  operation  through  ab- 
sorption— and  all  this  chain  of  analo- 
gies applied  to  the  modus  operandi 
of  all  other  remedial  and  morbific 
causes,  physical  and  mental,  while 
the  same  interpretation  of  all  the 
others  is  sustained  by  other  special 
demonstrations  in  immediate  connex- 
ion with  a  large  number  of  the  several 
things  respectively,  p.  66-67,  ^  148 ; 
p.  110,  ()  232  ;  p.  323-341,  (j  499-514 
m ;  p.  344-345,  (^  526  d,  No.  6  ;  p.  347 
-348,  (}  516  d,  No.  13  ;  p.  421-423,  ^ 
657-658  ;  p.  526,  ^  828  d ;  p.  532- 
533,  <J  841  ;  p.  542-543,  t)  854  c-f; 
p.  547-550,  <^  863  d ;  p.  563-566,  ^ 
889  a-g ;  p.  568-569,  ()  889  m,  mm ; 
p.  592,  <;>  89H  k;  p.  631-632,  ^  892f 
b;  p.  661-663,  <J  894-896;  p.  666 
-672,  <)  902  i-904  b;  p.  679-681, 
<J  905  a;  p.  703-710,  ^  940-952; 
p.  831-833,  ()  W57  f-g;  p.  838,  <j 
1057^.  Also,  Stomach,  Nauseants, 
Skin,  Cold,  Shower  Bath,  Tetanus, 
Disgust,  Syncope,  and  the  several 
Articles  under  Generalization  of 
Reflex  Action  of  the  Nervous 
System,  Index  II. 

examples  of  its  effects  in  subduing  vio- 
lent inflammations,  augmenting  and 
altering  the  natural  secretions,  and 
of  variously  and  suddenly  modifying 
the  condition  of  morbid  fluid  products, 
and  the  condition  of  the  blood,  when 
brought  into  operation  by  Mental 
Emotions,  p.  296,  ()  476  c ;  p.  230- 
232,  ()  422  6-424 ;  p.  335-336,  ^512 
a,  b  ;  p.  630-632,  f)  892i  b  ;  p.  709- 
710,  ()  951  i-952 ;  p.  865-868,  ^  1067 ; 
p.  877-878,  (i  1072  b.  Also.  Milk, 
Sweat,  Urine,  Food,  Weeping, 
Mental  Emotions,  Index  II. ;  Su- 
DORiFics,  Index  I. 

is  the  exciting  cause  of  all  diseases 
which  spring  up  as  consequences  of 
each  other ;  but  the  secondary  aflfcc- 
tions,  one  or  more,  may  be  very  dif- 
ferent from  the  primary,  depending, 
in  part,  upon  the  peculiar  constitution 
of  difl*erent  tissues,  or  parts  of  a  tissue, 
p.  62-68,  ^  135-152  ;  p.  109,  ^  229 ; 
p.  339-340,  <^  514  h ;  p.  465-469,  ^ 
715-722;  p.  483-484,  <J  746  c.  Also, 
Causes,  Morbific  ;  Inflammation, 
Skin,  Tobacco,  Seton,  Index  II. 

expounds  the  philosophy  of  Metastasis 
and  Revulsio7i.  See  Metastasis, 
Index  II. 

may  operate  upon  the  organic  constitu- 
tion of  the  nervous  centres,  and  thence 
upon  the  heart,  stomach,  &c.,  with  a 
suddenly  fatal  effect,  through  reflex 
action  of  the  nervous  system,  as  with 


INDEX    II. 


1041 


Nervous  Power — continued. 

blows  upon  the  epigastrium,  surgical 
operations,  hydrocyanic  acid,  &c.,  or 
directly  through  its  sudden  and  violent 
determination  upon  the  brain,  as  in 
the  case  of  joy  and  anger,  when  it 
may  act  by  suddenly  destroying  the 
life  of  the  brain,  and  also  farther  ex- 
emplified by  the  sudden  determination 
of  syncope,  and  the  consequent  sudden 
interruption  of  pleurisy,  &c.,  through 
direct  and  reflex  action  of  the  nervous 
system,  and  equally  acts  upon  all  other 
parts  of  the  nervous  system,  p.  107- 
111,^  226-2334  ;  p.  296,  <J  476  c  ;  p. 
298,  ()  476^  h ;  p.  300,  <^  479  ;  p.  301, 
(J  480;  p.  302,  <;.481  b;  p.  304,  H81 
g;  p.  306-308,  ()  483  b ;  p.  320,  ()  494 
del ;   p.  324,  ^  500  c,  d ;   p.  334-335, 
^  509-511  ;    p.  402-403,  ^  634-635  ; 
p.  534,  ()  844  ;  p.  704,  <;.  943  a-944  a ; 
p.  707,  ()  947;  p.  709,  ()  951  b-d ;  p. 
831-833,  (}  1057  f-ff;  p.  858,  ()  1057^  : 
p.  862-864,  ()  1066  ;    p.  865-868,  ^ 
1067;    p.  878-881,  >;.  1074-1075;    p. 
887,  <J  1077.     Also,  Jov  and  Anger, 
Mental  Emotions;  Serpents, Virus 
OF  ;    Stomach,  Blows  upon  ;    Pain, 
Oxygen,  Opium,  Sedatives  (Aconite), 
Neuralgia,  Antispasmodics  ,  Brain, 
Inflammation    of  ;     Bloodletting, 
Loss  of  Blood,  Lidcx  II. ;    Will, 
Index  I.  and  //.—Note  Q  p.  1122, 
its  opposite  influences  upon  the  sensi- 
bility of  nerves  through  reflex  action 
of  the  nervous  system  the  cause  and 
cure  of  pain  (when  not  the  direct  result 
of  causes  operating  locally)  and  accord- 
ing to  the  nature  of  the  means  by  which 
it  is  brought  into  operation,  whether 
by  morbific  causes,  or  sedatives,  loss 
of  blood,  &c.,  and  equally   relieved 
through  the  same  influence  by  men- 
tal emotions,  and  according  to  their 
nature,  p.  296,  ^  476  c ;  p.  302,  ()  481 
b ;  p.  323-324,  (}  500  c ;  p.  584-585, 
<J  891  d,  c;    p.  587-590,  ^  891  k-s ; 
p.  592-593,.^  891^  k;   p.  831-832, 
<)  1057/;  p.  838,  ()  1057^:   p.  862- 
864,  ^  1066.     Also,  Pain,  Sedatives 
(Aconite),  Neuralgia,  Antispasmod- 
ics, Bloodletting,  Poultices, /?!rfca; 
// 
hoplied  through  alterative  influence  of 
reflex  action  of  the  nervous  system 
to  the  modus  operandi  of  Cinchona, 
Loss  of  Blood,  and  of  other  things  of 
whose  mode  of  operation  we  are  said 
to  be  ignorant,  and  in  connexion  with 
illustrations  drawn  from  the  modus 
operandi  of  a  Seton,  and  where,  also, 
under  the  several  references,  the  or- 
ganic influences  of  remedial  agents 
through  the  instrumentality  of  nerv- 
ous action  and  the  philosophy  which 

Uu 


Nervous  Power — continued. 

concerns  their  substitution  of  transi. 
tory  pathological  conditions   for  the 
more  profound,  is  summarily  present- 
ed, p.  596-597,  ()  892  6,  c  ,•  p.  676-68 1 , 
^  904  c-905  a.     Also,  p.  67,  (j  149- 
151  ;  p.  73,  l)  163  ;  p.  108-110,  4  227 
-232  ;    p.  542,  ^  845  c-e ;   p.  554,  ^ 
871  ;   p.  592-593,  <J  891Jr  k;  p.  661- 
663,  ^  894-896  ;    p.  664^665,  i)  900- 
901  ;  Bloodletting,  Remedies,  Re- 
medial Action,  Index  II. ;  Nervous 
Power,  Index  I. 
influences  very  profoundly  the  functions 
of  secretion   and  excretion,  whether 
brought  into  preternatural  action  by 
physical  agents,  or  loss  of  blood,  or 
mental  emotions,  and  is  always  the 
cause  of  the  redundances  that  may 
arise  and  the  changes  they  may  un- 
dergo in  parts  beyond  the  seat  of  the 
direct  action  of  physical  causes,  and 
all  other  causes  through  its  modifying 
influences  upon  the  immediate  instru- 
ments, ^  113,  224,  226,  399,  446  a, 
461,  485,  489,  493  cc,  512,  524,  no.  7, 
^  657-658  ;   p.  631-632,  <J  892J ;  p. 
668-669,  (J  902  g,  h ;  ()  893  J  ;  <S>  943 
a,   b;     Secretion    and    Excretion, 
Bile,  Sweat,  Milk,  Weepino,  Fear, 
Jealousy,  Skin,  Kidney, Cold, Heat; 
Water,  Hot  ;    Food,  Tea,  Emetics, 
Bloodletting,  Loss  of  Blood,  Men- 
tal Emotions,  Index II. ;  Sudorifics, 
Index  I. 
exerts  the  same  influence  in  the  produc- 
tion of  animal  heat  as  upon  other  se- 
cretions, p.  262-270,  '^  446-447  ;    p. 
807-808,  <J  1044-1045.     Also,  p.  68, 
()  152  a  ;  p.  245,  ^  440  c  ;  p.  250-251, 
(^  441  c;   p.  335-336,  I)  512  a,  h;   p. 
339,  4  514  h;    p.  365,   ^  889  g;    p. 
579-580,  ()  890^  d ;    Organic  Heat, 
Index   I. ;    Hybernating   Animals, 
Tea,  Index  II. 
employed  by  the  Author  to  expound  the 
dependence  of  the  first  act  of  respira- 
tion through  reflex  action  of  the  nerv- 
ous system,  whose  centripetal  source 
is  the  skin.     See  Reflex  Action  of 
the  Nervous  System  ;    also.  Skin, 
Syncope,  Index  II. 
is  the  immediate  cause  of  syncope  as 
arising   from   loss   of  blood,   and  of 
subsequent  restoration,  and  supplies 
analogies  for  the  Author's  doctrines 
in  relation  to  the  nervous  influence 
as    connected   with    Pathology    and 
Therapeutics.       See   Syncope,  Loss 
OF  Blood,  Mental  Eimotions,  Index 
11 
exerts  its  effects,  in  modifying  the  con- 
dition of  the  solids  and  fluids,  upon 
the  capillary  vessels,  and  in  develop- 
ing muscular  motion  upon  the  indi- 
U 


1042 


INDEX    II. 


Nervous  Power — continued. 

vidual  fibres,  &c.,  p.  54,  <)  109  b;  p. 
220-227,  ^  409  b-All  ;  p.  355,  <)  526 
a;  p.  804-805,  (^  1040.  Also,  Causes, 
Morbific  ;  Remedies,  Remedial  Ac- 
tion, &c..  Index  II.;  Nervous  Pow- 
er,Vital  Properties,  Organic  Life, 
Index  I. 

hardness  and  mcomprcssihility  of  pulse, 
and  buffing  and  cupping  of  blood,  in 
inflammations,  depend  upon  its  modi- 
fying influence  upon  the  sanguiferous 
organs,  while  the  loss  of  blood,  or  a 
mental  emotion,  will  quickly  change 
its  influence  and  render  it  subversive 
of  those  conditions,  p.  444-445,  <J  688 
a-f;  p.  708-710,  §  951-952  b;  mis- 
taken for  Galvanism,  §  409  hh,  k, 
493  cc;  893  a;  500  X-,  7h,  nn,  o;  893^. 
Note  Y,  p.  1130. 

direct  and  reflex,  employed  as  the  prin- 
cipal basis  in  demonstration  of  the 
substantive  existence  and  self-acting 
nature  of  the  Soul  and  Instinctive 
Principle,  p.  873-881,  ij  1069-1075; 
p.  886-891,  t)  ion. 

determines  the  act  of  roosting  and  of 
sleeping  in  the  erect  posture,  and  in 
a  manner  analogous  to  its  action  upon 
the  sphincter  muscles,  p.  890-891,  <5> 
1077.  Also,  Sphincter  Muscles, 
Alteratives,  Suppositories,  Grief, 
Hope,  Index  II. ;  p.  325,  (}  500  dd. 

recent  observations  upon,  confirming 
important  principles  in  these  Insti- 
tutes, p  803-808,  {)  1039-1045. 

is  not  a  movable  substance,  i?j  transitu 
from  part  to  part,  but,  like  the  prin- 
ciple of  Light,  is  every  where  diffused 
through  its  appropriate  medium,  and, 
like  that  principle,  is  brought  into  op- 
eration by  exciting  causes,  and  with 
every  variety  of  effect  according  to 
the  nature  of  the  causes,  nor  is  there 
any  greater  difficulty  in  understand- 
ing its  imputed  modifications  than  the 
polarization  of  light,  or  any  other  at- 
tributes which  the  Author  assigns  it 
than  such  as  appertain  to  Light,  p.  80, 
^  169  b,  d;  p.  84,  ()  175  b,  bb ;  p.  88, 
(^  184  b;  p.  1 14-120,  ^  234  c-235  ;  p. 
330,  i)  500 nn;  p.  334,  (j  507;  p.  670, 
ij  902  k. 
Nervous  System.  See  Nerves;  Nerves, 
Motor  ;  Nerves,  Sensitive,  Index  I. 

anatomical  account  of,  and  of  its  uses, 
and  precautions  to  be  observed  in  ex- 
periments upon — with  a  reference  to 
Author's  application  of  direct  and  re- 
flex action  of,  to  the  modus  operandi 
of  all  morbific  and  remedial  agents 
beyond  the  seat  of  their  direct  opera- 
tion, embracing  in  this  application  the 
natural  interchange  of  actions  among 
all  parts  which  is  carried  on  through 


Nervous  System — continued. 

reflex  actions  of  the  nervous  system, 
and  for  applying  the  same  to  the 
propagation  of  disease  from  one  part 
to  another,  and  for  resolving  the  op- 
eration of  Mental  Emotions  and  the 
Will  through  direct  development  and 
instrumentaHty  of  the  nervous  in- 
fluence, and  as  more  fully  set  forth 
in  other  places,  p.  284-362,  <^  454- 
530;  p.  661-681,  (j  894-905;  p.  692 
711,  {)  915-952. 

perfects  or  ammalizes  the  constitution 
of  all  organic  compounds,  solid  and 
fluid,  including  the  blood  ;  a  law  pro- 
foundly concerned  in  pathology  and 
therapeutics.      iS'ee  this  at  p.  1038. 

is  the  medium  through  which  all  parts 
of  the  organic  system  are  maintained 
by  its  reflex  actions  in  harmonious  re- 
lations, and,  although  in  constant  op- 
eration among  all  parts,  its  manifest- 
ations are  not  strongly  pronounced 
except  in  particular  functions,  as  in 
respiration,  the  motions  of  the  heart 
and  intestines,  the  motions  of  the 
iris,  &c.,  or  as  brought  into  action  by 
special  causes,  as  in  deglutition,  and 
when  its  reflex  action  starts  the  urine 
as  excited  by  cold,  or  the  milk  at  the 
time  of  parturition,  or  by  Mental 
Emotions  when  its  displays  are  very 
various  and  strongly  manifested,  and 
by  the  Will ;  but  is  brought  into  pre- 
ternatural operation  by  all  morbific 
and  remedial  agents,  and  is  the  im- 
mediate exciting  cause  of  diseases 
and  their  cure  in  all  parts  beyond  the 
seat  of  the  direct  action  of  morbific 
and  remedial  agents,  and  of  diseases 
that  ensue  upon  each  otlier ;  and,  if 
our  Chemical  friends  continue  to  ap- 
ply the  laws  of  the  science  which  they 
cultivate  to  the  modus  operandi  of  re- 
medial and  morbific  agents,  they  must 
accept  the  absurdity  of  supposing  that 
all  the  foregoing  natural  results  of  the 
nervous  influenceg  are  equally  chemi- 
cal, and  deny  to  organic  actions  (that 
is,  Nature)  all  participation  in  the 
work  of  cure,  p.  54-55,  <S>  111-117; 
p.  58-59,  ()  129  a,  ? ;  p.  61,  ()  133  c; 
p.  62-67,  ()  136-151;  p.  87,  <)  177; 
p.  88,  ^  184-185 ;  p.  101-102,  (}  201- 
202  ;  p.  106-112,  ^ 222-234  ;  p. 226, 
^  409  k ;  p.  295,  ^75^  P-  253,  (j  441 
d ;  p.  262-268,  ()  446  a-447  d  ;  p.  284 
-290,  9  454-46 U  c  ;  p.  296,  ^  476  c  ; 
p.  301,H81  b;  p.  318-341,(5  493  cc- 
514  ;  p.  344,  (}  516  d.  No.  6  ;  p.  348, 
<^  516  rf.  No.  13  ;  p.  350-353,  «;»  524  ; 
p.  354-362,  ()  526-530  ;  p.  465-469, 
()  715-722;  p.  508-509,  i)  807-811  ; 
p.  537-539,  iji  847  e-848  ;  p.  563-565, 
(}  889  a-g;  p.  592-593,  ^  89H  /t;  p. 


INDEX    II. 


1043 


Nervous  System — continued. 

642-650,  <J  893  a-i;  p.  657,  ^  893  ;?,• 
p.  661-681,  (}  894-905;  p.  692-709, 
/  §  914-951  ;  p.  745-747,  ()  990^  a,  b  ; 
p.  804,  (J  1040  ;  p.  865-868,  i)  1067 ; 
p.  874,  ()  1071  ;  p.  877-881,  ()  1072  b 
-1075;  p.  886-890,  ^  1077,^^8911^. 

all  remote  effects  of  the  Mental  Emo- 
tions, and  of  the  Will,  and  of  physical 
agents  applied  to  the  nervous  centres, 
and  of  all  diseases  of  those  centres, 
and  of  the  nerves,  are  consequences 
of  the  nervous  influence,  developed  at 
first  in  a  direct  manner,  though  all  but 
the  Will  are  generally  followed  by  re- 
flex actions,  p.  107,  i)  227  ;  p.  109,  ^ 
230;  p.  670-671,  ()  902  Z-903;  p. 
733-734,  (}  973-975.  Also,  Mental 
Emotions,  Sympathy  (experiments). 
Index  II. ;  Will,  Index  I.  and  II. 

experiments  upon,  mostly  by  A.  P.  W. 
Philip,  to  determine  the  "  Laws  of 
the  Vital  Functions,"  in  the  relations 
it  bears  to  the  Heart  and  Vessels  of 
Circulation,  p.  295-310,  <J  476-485; 
p.  311-315,  <J  487-489— and  to  the 
Voluntary  Muscles,  p.  310-315,  ^  486 
-489 — and  to  the  Alimentary  Canal, 
p.  315,  ^  490,  491— and  to  the  Lungs, 
p.  315,  ^  491  ;  with  practical  applica- 
tions by  the  Author  to  Pathology  and 
Therapeutics,  and  introduced  for  the 
sole  purpose  of  applying  them  to  the 
interpretation  of  the  effects  of  all  mor- 
bific and  remedial  agents  beyond  the 
seat  of  their  direct  action,  and  of  the 
Passions,  through  alterative  influences 
of  reflex  action  of  the  nervous  system 
in  the  former  case,  and  of  primarily 
direct  and  secondarily  reflex  in  the 
latter,  and  of  the  naturally  concerted 
actions  among  all  parts,  their  disturb- 
ances of  each  other,  &c.,  ibid.,  and 
throughout  a  greater  part  of  the  work. 

the  varieties  of  sympathy  or  reflex  action 
as  conducted  through  the  medium  of 
the  nervous  system,  and  various  phys- 
iological illustrations,  p.  321-335,  () 
495-511 — and  the  physiological  laws 
of  sympathy  or  reflex  action  of  the 
nervous  system  introduced  for  the 
purpose  only  of  applying  them  as 
stated  in  the  preceding  subdivisions, 
p.  335-362,  ^  512-530. 

generalization  of  its  laws  as  applied  by 
the  Author  to  interpret  the  modus 
operandi  of  morbific  and  remedial 
agents,  both  physical  and  mental,  as 
aforesaid,  and  from  which  arise  all 
the  changes  in  the  solids  and  fluids 
as  a  consequence  of  the  alterative  in- 
fluence exerted  by  the  nervous  action 
upon  the  various  series  of  capillary 
vessels,  and  showing  specifically  that 
this  action,  both  direct  and  reflex,  is 


Nervous  System — continued. 

the  fundamental  cause  not  only  of 
increased  secretions  so  far  as  the 
function  does  not  depend  upon  other 
stimuli,  but  of  the  various  modifica- 
tions which  the  secretions  undergo  in 
disease,  according  to  the  nature  of  the 
cause  by  which  the  nervous  influence 
is  excited,  whether  physical  or  mental, 
p.  230-231,  H22-423;  p.  289,^61; 
p.  631-632,  ^  8921 ;  p.  668-669,  ^ 
902  g,  h ;  p.  704,  (}  943  a,  b.  Also, 
Fear,  Jealousy,  Weeping,  Tea, 
Food  ;  Water,  Hot  ;  Secretion 
and  Excretion,  Mental  Emotions, 
Remedial  Action,  Index  II ;  Nerv- 
ous Power,  Sympathy,  Index  I.  and 
II. 

exerts  the  same  influence  in  the  produc- 
tion of  animal  heat  as  upon  other  se- 
cretions, only  in  the  former  case  it  is 
simply  an  excitant,  while  in  the  latter 
it  increases,  diminishes,  and  modifies 
their  condition  in  an  endless  variety 
of  ways,  according  to  the  nature  of 
the  exciting  causes,  p.  262-270,  i) 
446-447  ;  p.  807-808,  i)  1044-1045. 
Also,  p.  68,  (}  152  a ;  p.  245,  ()UOe; 
p.  250-251,  (}  441  c;  p.  289,  ^  461  ; 
p.  335-336,  (j  512  a,b;  p.  339,  ()  514  A; 
p.  365,  <)  889  g ;  p.  483-484,  ()  746  c  ; 
p.  579-580,  (J  8901  d-  Also,  Organic 
Heat,  Index  I ;  Hybernating  Ani- 
mals, Index  II. 

Brown-Sequard's  interesting  and  inge- 
nious discoveries  in  relation  to  spinal 
cord,  p.  802-803,  ()  1037. 

acts  as  a  whole  in  its  natural  state  so 
far  as  the  great  nervous  centres  are 
engaged  in  developing  motion  or 
otherwise  influencing  or  modifying 
actions  and  their  results  in  organic 
and  animal  life,  however  much  cer- 
tain parts  may  hold  a  predominating 
power,  and  the  great  sympathetic 
system  derives  a  concurrent  action 
from  the  cerebro-spinal,  and  there- 
fore experiments  made  upon  isolated 
portions  with  a  view  to  their  inde- 
pendent functions  are  liable  to  falsify 
Nature,  p.  11-12,  (^  51  e-f;  p.  54-55, 
(}  110-117;  p.  287-289,  ()  459-461  ; 
p.  292,  ()  473  a ;  p.  293,  I)  473  c ;  p. 
296-298,  <;>  467^^  a-h ;  p.  303,  (}  481 
e-f;  p.  306-308,  ^  483  b,  c ;  p.  357- 
358,  <J  590-591. 

mistakes  in  regard  to  reflex  action  from 
confounding  results  of  experiments 
on  trunks  of  nerves  with  those  upon 
their  expanded  extremities,  p  338,  ^ 
514  d;  p.  347,  ^  516  d,  No.  10,  p. 
520-521,  <J  826c,  d.  Also,  Medical  and 
Physiological  Commentaries,  vol.  i., 
p.  507,  563-566. 

an  intimate  connexion  established  be- 


1044 


INDEX    II. 


Nervous  System — continued. 

tween  the  organs  of  organic  and  ani- 
mal life  by  the  intercommunication  of 
the  cerebro-spinal  and  ganglionic  sys- 
tems and  the  consequent  interchanges 
of  reflex  nervous  action,  p.  54-55,  () 
110-117;  p.  107,  ^  224;  p.  110,  i; 
232  ;  p.  284-287,  ()  454-459  ;  p.  341 
-353,  ()  514^-524  — and  hence  the 
convulsions  of  the  voluntary  muscles 
which  ensue  upon  intestinal  irritation 
and  upon  spasm  of  the  stomach,  and 
various  other  resulting  consequences 
of  a  reciprocal  nature,  p.  347-348, 
Nos.  11-13,  &c.  ;  p,  642,  ()  893  a. 

subject,  like  all  other  organs,  to  a  determ- 
ination of  direct  and  reflex  nervous 
influence  upon  its  own  organization 
when  developed  by  the  Passions,  or  by 
inflammation,  or  injuries,  or  mechani- 
cal or  other  physical  irritations  of  the 
nervous  centres  ;  but  its  own  afiec- 
tions  in  this  respect  are  of  diflScult 
analysis,  p.  109,  ^  230  ;  p.  356-358, 
9  526  d ;  p.  709,  <;>  951  c ;  p.  831-832, 
()  1057/,  g.  Also,  Neuralgia,  Opium, 
Sedatives,  Antispasmodics  ;  Brain, 
Inflammation  of  ;  Mental  Emo- 
tions, Joy  and  Anger,  and  the  other 
individual  Passio7is,  Anesthetics, 
Oxygen,  Pain;  Serpents,Virusof  ; 
Hydrocyanic  Acid;  Stomach, Blows 
UPON  ;  Nervous  Power,  Index  II. 

the  nervous  influence  may  be  determ- 
ined with  such  sudden  violence  upon 
the  brain  as  to  instantly  extinguish  life, 
though  doubtless,  also,  the  same  in- 
fluence is  propagated  simultaneously 
upon  all  the  organic  viscera,  p.  107- 
111,  (^  226-233J;  p.  298,  ()  476|-  h; 
p.  300,  H79  ;  p.  301,  <^  480  ;  p.  304, 
H81  g- ;  p.  306-308,  ^  483  b;  p.  320, 
^  494  dd ;  p.  324,  ()  500  c,  d ;  p.  334- 
335,  ^  509-511  ;  p.  402-403,  ()  634, 
635  ;  p.  534,  (^  844  ;  p.  709,  ^  951  c  ; 
p.  865-868,  ^  1067;  p.  879-881,  ^ 
1074-1075;  p.  887,  ^  1077.  Also, 
Joy  and  Anger  ;  Stomach,  Blows 
UPON,  Index  II. 

a  great  misapprehension  of  Marshall 
Hall's  in  supposing  "all  convulsive 
affections  to  be  diseases  of  the  true 
spinal  or  excito-motory  system,"  and 
that  "  the  spinal  marrow,  exclusive  of 
the  cerebrum,  is  the  source  of  animal 
life,"  and  that  "  the  trritabibty  of  the 
muscles  of  organic  life  depends,  prob- 
ably, on  the  ganglionic  system,"  and 
his  mistake  in  contradicting  an  im- 
portant experiment  by  A.  P.  Wilson 
Philip,  p  296-297,  (}  476^  b;  p.  306- 
308,  ij  483  b,  c  ;  p  357-358,  ^  526  d ; 
p.  467-468,  ^  719.  Also,  p.  11-12, 
()  54  e,f;  p.  54-55,  ()  110-117;  p. 
287-290,  (J  458-46 H  ;    P-  292,  ()  473 


Nervous  System — continued. 

a ;  p.  296,  ()  476  c,  476J-  b ;  p-  298- 
299,  ^  476  ;t-477  a ;  p.  300,  ^  479 ; 
p.  303,  ()  481  e,f;  p.  357-358,  ^  526 
d;  p.  590-591,  ^891i;  p.  592-593,  § 
891i  k;  and  Convulsions,  Hysteria, 
Mental  Emotions,  Index  II. — nor 
does  the  Author  acquiesce  in  his  doc- 
trine that  "  the  Soul  sends  forth  emis- 
saries and  plenipotentiaries  ichick  con- 
vey its  sovereign  mandates  along  the 
voluntary  nerves  to  muscles  subdued 
to  volition,"  p.  77,  ()  167  f. 

diseases  of  the  brain  and  spinal  cord  are 
apt  to  give  rise  to  great  disturbances 
in  organs  of  organic  life,  but  not  to 
convulsions  unless  efiusion  or  disor- 
ganization happen,  but  which  are  com- 
monly dependent  on  simple  irritations 
of  the  nervous  centres,  p.  334,  ^  508  ; 
p.  357-358,  ^  526  d;  p.  590-591,  <) 
89 H  J;  p.  592-593,  ^891 H-;  P- 733 
-735,  ^  974  c-976. 

its  painful  affections,  when  situated  in- 
ternally, occasioned  and  relieved  by 
alterative  influences  of  reflex  nervous 
action  upon  the  sensibility  of  the 
nerves,  and  through  the  same  in- 
fluence when  dissipated  by  mental 
emotions,  and  according  to  the  nature 
of  the  means  by  which  it  is  brought 
into  operation,  p.  584^585,  ^  891  rf,  e; 
p.  587-590,  ^  891  k-s ;  p.  592-593, 
()  1057|-.  Also,  Sedatives  {Aconite). 
Opium,  Poultices,  Antispasmodics, 
Bloodletting,  Nervous  Power,  /n< 
dex  II. 

is  constantly  charged  with  the  nervous 
power  or  nervous  influence,  or  what- 
ever name  may  be  most  acceptable, 
which  is  not  m  transitu,  a  movable 
substance,  but,  like  the  principle  of 
light,  is  every  where  diffused  through 
its  appropriate  medium,  and,  like  that 
principle,  is  brought  into  operation  by 
exciting  causes,  while,  also,  the  polar- 
ization of  light  supplies  some  analogy 
to  the  Author's  supposed  modifications 
of  the  nervous  influence  according  to 
the  nature  of  the  causes  by  which  it  is 
brought  into  preternatural  operation, 
p.  114-115,  <.234c. 

it  has  been  seen  in  a  preceding  subdivi- 
sion that  it  is  exceedingly  difficult  to 
determine  by  experiments  the  special 
functions  of  any  part  of  the  brain  or 
of  particular  nerves  or  fibres  as  they 
may  influence  the  organic  functions, 
and  doubtless,  in  a  general  sense,  the 
phenomena  as  manifested  in  health 
and  disease  are  entitled  to  a  large 
ground  of  reliance,  p.  115-119,  ij  234 
7-235;  p.  309-310,  (J  484  b.  No.  5; 
p.  413-414,  ij  640  ;  p.  434,  ^  679  ;  p. 
.     442,  (^  686  d;   p.  541-542,  I)  854  b; 


INDEX    II. 


1045 


Nervous  System — continued. 

and  in  respect  to  the  question  before 
us  we  may  appeal  to  what  was  accom- 
plished by  our  predecessors  (deny  it  as 
we  may),  in  inferring  the  existence 
and  many  of  the  laws  of  reflex  action 
of  the  nervous  system  from  natural 
phenomena  alone,  p.  290,  i)  463  a,  b  ; 
p.  295-296,  §  476  b ;  which  brings  us 
to  the  Author's  immediate  object — 
that  of  having  inferred  different  series 
of  excito-motory  nerves  or  fibres  of 
compound  nerves  for  the  fulfilment 
of  several  special  functions,  one,  for 
example,  for  common  sensation,  an- 
other for  specific,  a  third  for  sympa- 
thetic, another  for  voluntary  motion, 
another  for  the  glandular  organs,  &c., 
p.  100-103,  <J  197-204;  p.  280-283, 
^  450-451  ;  p.  330,  ()  500m«;  though 
it  cannot  be  satisfactorily  inferred 
from  the  simple  phenomena  in  health 
or  disease  whether  there  be  any  spe- 
cial excito-motory  nerves  or  series  of 
fibres  destined  for  influences  upon 
the  glandular  or  other  fluid  products, 
p.  230-232,  (J  422  6-424  ;  p.  335- 
336,  ()  512  a,  b;  p.  630-632,  ()  892i 
b ;  and  an  experiment  by  Claude 
Bernard  of  pricking  the  floor  of  the 
fourth  cerebral  ventricle  discredits 
ail  analytical  conclusions  upon  the 
question  of  excito-secretory  nerves, 
but  very  greatly  so  upon  many  others 
of  a  specific  nature,  p.  792-793,  ^ 
1032  rf,  and,  doubtless,  about  the  only 
reliable  amount  of  experimental  in- 
quiry as  to  the  influence  of  the  nerves 
upon  the  secretions  was  supplied  by 
A.  P.  W.  Philip,  as  published  in  the 
London  Philosophical  Transactions 
for  1815  and  1817,  and  of  which  a 
summary  abstract  relative  to  our  sub- 
ject occurs  at  p.  314-315,  ^  489  ;  p. 
317-318,  ^  493  a-d.  Also,  p.  264,  ^ 
446  c ;   p.  289,  ()  460,  461  ;   and  Hy- 

BERNATING  AnIMALS,  IndcX  II. 

its  mechanism  and  laws  of  reflex  action 
upon  which  is  founded  the  Author's 
physiological  demonstration  of  the 
substantive  existence  and  self-acting 
nature  of  the  Soul  and  Instinctive 
Principle,  p.  873-874,  ^  1070-1071— 
and  physiological  examples  of  the  re- 
flex action,  and  of  the  Will  in  its  sim- 
ply direct  action,  and  of  the  Mental 
Emotions  in  their  operation  through 
direct  development  of  the  nervous  in- 
fluence and  the  subsequent  institution 
of  reflex  actions,  and  the  application 
of  the  whole  to  the  foregoing  object, 
and  to  the  explosion  of  the  doctrines 
in  materialism,  p.  874-892,  i)  1072- 
1077  ;  p   904-906,  ^  1078  g-r. 

relative  structure  and  other  physiological 


Nervous  System — continued. 

conditions  of  the  main  central  part  in 
the  infancy  of  man  and  animals,  as 
implied  by  their  intellectual  and  in- 
stinctive habits,  respectively,  p.  892- 
895,  !^  1078  «,  6 ;  p.  904-906,  ()  1078  q. 
a  concurrence  of  action  between  the 
main  central  portion  and  the  Soul 
and  Instinctivie  Principle,  p.  892,  ^ 
1078. 
the  central  part  of,  less  subservient  to 
the  Soul  than  to  the  Instinctive  Prin- 
ciple, p.  894,  ij  1078  b ;  p.  903-906, 
<J  1078  q. 
its  varieties  in  the  principal  central  por- 
tion employed  to  distinguish  the  Soul 
from  the  Instinctive  Principle,  p  896, 
(}  1078  d;  p.  897-898,  t)  1078  e;  p. 
903-906,  ^  1078  q.  Also,  Soul  and 
Instinctive  Pkinciple,  Index  II. 

Neuralgia, 
its  sudden  relief  by  Aconite  when  applied 
along  the  course  of  an  affected  nerve 
demonstrative  of  the  modus  operandi 
of  remedies  through  alterative  in- 
fluence of  reflex  action  of  the  nervous 
system,  and  of  the  modification  of  that 
influence  according  to  the  nature  of 
the  exciting  cause,  and  that  the  nerv- 
ous influence  may  be  determined  with 
alterative  effect  as  well  upon  the  or- 
ganic constitution  of  any  part  of  the 
nervous  system  as  upon  other  organs, 
and,  farther,  shows  that  pain  is  relieved 
by  that  influence,  p.  838,  i)  1057^. 
Also,  Antispasmodics,  Opium,  Seda- 
tives, Index  II. 

Nitric  Acid, 

applied  as  a  pediluvium,  subverts  syph- 
ilis and  hepatic  diseases,  and  increases 
the  secretion  of  bile,  through  alterative 
influence  of  reflex  action  of  the  nerv- 
ous system,  p.  530,  ^  837  c — while 
"  our  astonishment  is  great  that  the 
bile  is  not  more  frequently  affected 
by  the  various  medicinal  agents  put 
into  the  stomach" — but  far  less  so 
than  that  the  highly  irritable  heart 
should  escape,  were  there  any  found- 
ation for  the  doctrine  of  operation  by 
absorption,  p.  527,  (}  829.  Also,  Sul- 
phuric Acid  ;  Lead,  Acetate  of  ; 
Silver,  Nitrate  of  ;  Opium,  Cold, 
Index  II. 

Nitrous  Oxide  Gas, 

employed,  in  connexion  with  oxygen 
and  other  things,  to  show,  in  part, 
upon  chemical  grounds,  that  anaes- 
thetics are  not  absorbed,  but  that  they 
produce  their  constitutional  eflfects 
through  alterative  influences  of  reflex 
action  of  the  nervous  system — the 
philosophy  being  the  same  as  in  res- 
piration when  the  reflex  action  is  ex- 
cited by  an  inappreciable  irritation  of 


1046 


INDEX    II. 


Nitrous  Oxide  Gas — continued. 

the  pulmonary  mucous  tissue,  p.  522- 
523,  ^  827  b-d ;  p.  862-864,  ^  1066. 
Also,  RespiratioiV,  Emetics,  Stom- 
ach, Oxygen,  Index  II. ;  Nervous 
Power,  Index  I.  and  II. 

Nux  Vomica.     See  Hydkocvanic  Acid, 
Index  II. 


O. 

Odors, 

the  physiology  of  vomiting  from,  &c., 
through  reflex  action  of  the  nervous 
system,  employed  by  the  Author  in 
illustrating  the  modus  operandi  of  all 
morbific  and  remedial  agents  through 
alterative  influences  of  direct  and  re- 
flex nervous  action ,  and  for  the  same 
purpose,  also,  and  to  show  how  an 
endless  variety  of  impressions  from 
slight  causes  and  upon  various.parts, 
and  from  various  causes  incapable  of 
absorption  or  chemical  action,  and 
coming  from  mental  as  well  as  phys- 
ical sources,  will  institute,  through 
complex  circles  of  reflex  actions,  a 
common  ultimate  effect,  such  as  vom- 
iting, or  other  results,  and  how,  when 
instituted  by  mental  emotions,  the 
impression  which  is  primarily  made 
upon  a  distant  part  will  institute  reflex 
actions  that  result  in  violent  manifest- 
ations— all  of  which  is  exemplified  in 
t'le  case  of  offensive  odors  in  their 
production  of  vomiting,  whose  pri- 
mary impression  is  made  upon  the 
olfactory  nerve,  and  thus  transmitted 
to  the  brain,  from  whence  the  nerv- 
ous influence  is  propagated  upon  the 
mucous  tissue  of  the  stomach,  which 
It  irritates  after  the  manner  of  an 
e.nctic,  when  this  impression  is  re- 
turned to  the  nervous  centres  and 
chence  reflected  upon  the  abdominal 
muscles  and  muscular  coat  of  the 
stomach,  the  former  of  which  are 
thrown  into  convulsive  action  and 
the  action  of  the  latter  violently  re- 
versed— and  again,  when  a  strong 
light  gives  rise  to  sneezing,  whose 
primary  impression  is  made  upon  the 
retina,  when  the  nervous  influence  is 
reflected  from  the  brain  through  ex- 
cito-motory  fibres  of  the  nasal  branch 
of  the  fifth  pair  of  nerves  upon  the 
Schneiderian  membrane,  which  it  irri- 
tates after  the  manner  of  snuff",  when 
this  impression  is  returned  to  the 
nervous  centres  through  sensitive 
fibres  of  the  same  nasal  branch,  and 
thence  reflected  with  convulsive  effect 
upon  the  abdominal  muscles,  but  in  a 
diflferent  manner  from  the  odor — and 
again,  as  an  offensive  spectacle  gives 


Odors — continued. 

rise  to  vomiting,  the  rationale  being 
the  same  as  that  for  the  odor,  with 
the  difference  that  in  the  case  of  the 
spectacle  the  primary  impression,  as 
in  the  case  of  sneezing,  comes  through 
the  optic  nerve — or  yet  again,  as  when 
the  mind  itself  will  occasion  vomiting 
by  calling  up  the  recollection  of  the 
odor  or  the  spectacle,  when  the  mind 
is  the  only  agent  concerned,  but  the 
remaining  process  the  same  as  in  the 
other  cases — these  analogies,  with 
numerous  others  supplied  by  other 
affections  of  the  mind,  and  along  with 
their  morbific  and  curative  effects, 
being  then  carried  by  the  Author  to 
vomiting  as  produced  by  blows  upon 
the  head  or  epigastric  region,  or  by  ir- 
ritating the  fauces,  or  drinking  warm 
water,  or  by  undigested  food,  or  as 
arising  from  irritations  of  the  uterus 
or  kidney,  &c.,  and  all  considered  in 
connexion  with  the  morbific  and  cura- 
tive effects  upon  internal  organs  of 
cold  applied  to  the  surface  or  as  it 
increases  the  secretion  of  urine,  and 
many  other  analogous  things — and 
the  demonstration  supplied  by  all  the 
analogies,  which,  in  all  the  foregoing 
cases,  inevitably  turns  upon  direct  and 
reflex  action  of  the  nei"vous  system, 
applied  to  the  interpretation,  through 
the  same  rationale,  of  all  the  analogous 
eflfects  which  flow  from  the  operation 
of  all  other  morbific  and  remedial 
agents  of  a  tangible  nature;  and  ulti- 
mately employed  in  demonstrating  the 
substantive  existence  and  self-acting 
nature  of  the  Soul  and  Instinctive 
Principle,  p.  324,  <J  500  c;  p.  327- 
328,  ^  500  i-m;  p.  340-341,  ^  514 
f:-m;  p.  522-524,  (f  827  b-d ;  p.  530, 
(^  837  b;  p.  534.  ^  844;  p.  631-632, 
^  892  J  b ;  p.  666-670,  ()  902  b-vi ;  p. 
703-705,  ()  940-945  ;  p.  707,  ^  947  ; 
p.  709-710,  ()  951-952;  p.  865-868, 
^  1067;  p.  888-890,  ^  1077.  Also, 
Generalization  of  Reflex  Action, 
Index  II. 

their  presence  in  the  secretions  supplies 
no  ground  for  the  doctrine  of  remedial 
action  by  absorption,  p.  520,  (}  826  b ; 
p   523-524,  {)  827  d. 
Oil,  Castor, 

its  special  action  upon  the  liver  as  an 
alterative,  and  its  great  advantages, 
p.  555,  ()  872  ;  p.  568-569,  ()  889  7?!  ; 
p.  834,  {)  1057  /,-  p.  853,  (J  1060. 

as  an  adjuvant  to  Calomel  and  Blue  Pill, 
one  of  the  best,  p.  834,  <i  1057  I;  p. 
839,  {)  1058  a;  p.  845-846,  <^  1058 
777,  n;  p.  847,  (^  1058  q ;  p.  848,  <5 
1058  t;  p.  853,  ()  1060. 

as  a  remedy,  in  small  and  repeated  doses, 


INDEX    II. 


1047 


Oil,  Castor — continued. 

for  habitual  coijstipation,  p.  366,  () 
556  b;  p.  555,  ()  872 ;  p.  568,  ()  889 
m ;  p.  834,  <^  1057  /.  Also,  Altera- 
tives, Index  II. 

best  cathartic  in  scarlet  fever,  p.  843,  <S> 
1058  h. 

should  be  exhibited  in  carefully  regu- 
lated doses  throughout  the  progress 
of  many  diseases,  and  at  the  advanced 
stages  of  all,  and  for  its  gradually  al- 
terative effect,  p.  555,  ^  872 ;  p.  568- 
569,  ^  889  m ;  p.  834,  ()  1057  I. 

possesses  a  soporific  virtue,  p.  834-835, 
^  1057  /. 

time  for  its  administration  compared 
with  other  cathartics,  p.  570,  ^  889 
n ;  p.  835,  ()  1057  /. 

injected  into  the  circulation,  and  why  its 
effects  in  that  case,  or  in  other  similar 
examples,  prove  nothing  in  behalf  of 
the  supposed  operation  of  remedies  by 
absorption,  p.  529-530,  <^  837  a,  b ;  p. 
675-676,  <)  904  b ;  p.  677,  (}  904  c. 
Oil,  Croton, 

its  operation,  as  a  cathartic,  when  sim- 
ply applied  to  the  tongue,  or  intro- 
duced into  the  rectum,  in  the  quantity 
of  a  drop,  illustrates  the  principle  of 
continuous  sympathy  (or,  as  the  Au- 
thor prefers,  continuous  influence,  p. 
322,  I)  498  a),  the  impression  being 
propagated,  as  in  leeching  the  anus 
or  septum  nasi,  continuously  along 
the  mucous  tract,  being  equivalent  to 
the  direct  passage  of  a  cathartic,  or 
any  other  irritation,  while,  also,  the 
impression  thus  produced  upon  the 
tissue  establishes  an  alterative  reflex 
action  of  the  nervous  system,  modified 
according  to  the  nature  of  the  exciting 
cause,  and  which  is  the  common  result 
of  continuous  sympathy,  p.  58,  <J  129 
f;  p  322-323,  t)  498  a-g ;  p.  343,  () 
516  d;  p.  344-345,  No,  6  ;  p.  526,  () 
828  d.  Also,  Medical  and  Physiologi- 
cal Commentaries,  vol.  i.,  p.  494-513; 
p.  569-574 — and  the  logical  mind  will 
readily  perceive  that  this  is  analogous 
to  the  reflex  actions  that  are  generated 
by  impressions  made  by  Mental  Emo- 
tions upon  the  mucous  tissue  of  the 
stomach  and  intestine,  when  they  give 
rise  to  vomiting  and  purging,  and  ap- 
ply the  whole  to  the  interpretation  of 
morbific  and  remedial  agents  upon 
parts  beyond  the  seat  of  their  direct 
effect  to  alterative  influences  of  reflex 
nervous  action,  while,  also,  the  coin- 
cidences in  effects  between  the  phys- 
ical and  mental  causes  will  as  readily 
lead  to  the  conclusion  that  all  the 
morbific  and  remedial  effects  of  Men- 
tal Emotions  are  equally  as  those  of 
the  physical  causes  owing  to  the  same 


Oil,  Croton — continued. 

versatile  nervous  influence.  See 
Odors,  Fear,  Disgust,  Mental 
Emotions,  Index  II  Also,  ^  1088  i-rf 
for  like  reason,  when  cathartics  fall 
rather  short  of  developing  the  full 
reflex  influence  that  is  necessary  to 
the  cathartic  effect,  chewing  a  little 
Rhubarb  will  often  speedily  and  ef- 
fectually determine  the  result  See 
Cathartics,  Index  II. 
the  foregoing  principle  is  exactly  the 
same  as  when  reflex  actions  are  in- 
stituted and  progressively  increased 
in  force  by  inflammation  of  any  part 
when  propagated  continuously  from 
an  isolated  point,  p  343,  <S»  516  d;  p. 
526,  ()  828  d ;  p.  563-564,  ^  889  a. 

Opium — continued  from  Index  /., 

"  it  is  very  singular  that  a  pill  of  opium, 
administered  by  the  stomach  at  night, 
will  be  vomited  up  in  the  morning, 
after  having  producedils  narcotic  effect" 
— explained  by  the  Author  through  its 
development,  by  simple  contact  with 
the  stomach,  of  an  alterative  reflex 
nervous  action — as  is  also  the  "  very 
minute  quantity  which  always  pro- 
duced in  a  Physician  a  scarlet  efflo- 
rescence over  the  whole  surface  of  the 
body"  —  the  former  having  its  close 
analogy  in  the  constitutional  results  of 
the  first  contact  offood  with  the  stom- 
ach, and  the  latter  in  the  eruptive  affec- 
tionsconsequentupon  intestinal  disor- 
ders, along  with  analogous  examples 
supplied  by  Strychnia,  Hydrocyanic 
Acid,  Hyoscyamus,  Atropia,  and  To- 
bacco— carried  to  the  interpretation  of 
the  modus  operandi  of  all  morbific  and 
remedial  agents  upon  parts  beyond  the 
seat  of  their  direct  operation  through' 
alterative  influences  of  reflex  action 
of  the  nervous  system,  p.  672-674,  <^ 
904  b.  Also,  Sedatives,  Food,  Skin 
(eruptions  of).  Suppositories,  Nar- 
cotics, Nervous  System,  Lidex  II. 
conclusions  from  experimental  applica- 
tions of,  made  to  the  nervous  centres, 
stomach,  and  skin,  that  its  eflfects  are 
produced  in  all  the  cases  by  alterative 
influence  of  direct  or  reflex  action  of 
the  nervous  system,  and  introduced 
for  the  purpose  of  applying  the  same 
philosophy  to  the  modus  operandi  of 
all  other  remedial  and  morbific  causes, 
whether  physical  or  mental,  and  U- 
show  that  the  nervous  influence  ncu 
essarily  undergoes  modifications  in 
its  nature  according  to  the  nature  of 
its  exciting  causes,  p.  301-303,  <J  481 ; 
p.  306,  Exp.  21  ;  p.  309-310,  ^  484  b, 
Nos.  5,  6.  Also,  p.  107-109,  (>  227- 
230  ;  p.  592-593,  ^  891M;  P-  670- 
675,  .;»  902  /-904  b. 


1048 


INDEX    II. 


Opium — continued. 

experiments  with,  by  Volkmann  and 
others,  showing  the  distinction  be- 
tween the  trunks  of  nerves  and  their 
expanded  extremities,  and  how  the 
skin  is  rendered  by  narcotization  and 
other  causes  a  very  sensitive  source 
of  convulsions,  and  introduced  by 
Author  to  expound  the  modus  ope- 
randi of  bhsters,  setons,  mercury, 
iodine,  miasms,  and  other  agents  ap- 
pHed  to  the  skin  through  alterative 
influences  of  reflex  nervous  action, 
p.  308-310,  ^  484-485  ;  p  319,  ()  894 
d;  p  338,  ^  514:  d;  p.  348,  <)  516  d, 
No.  13.  Also,  Skin,  Cold,  Seton, 
Counter-Irritants,  &c..  Index  II. 

in  producing  no  astringency,  but  in  re- 
straining colliquative  sweats,  check- 
ing the  secretions  of  the  liver,  kidneys, 
&c.,  illustrates  the  modus  operandi  of 
true  Astringents  through  alterative 
influence  of  reflex  action  of  nervous 
system,  p  422-423,  {)  658  ;  p.  577,  «J 
890  o;  p  592-593,  ^891^-  k.  Also, 
Silver,  Nitrate  OF,  Lead,  Acetate 
of;  Sulphuric  Acid,  Cold,  Ipecac- 
uanha, Ergot,  Index  II. ;  <S>  890  b. 

overcomes  spasms  by  developing  a  coun- 
teracting reflex  nervous  influence,  p. 
592-593,  (^  89U-  /c.  Also,  Antispas- 
modics, Coffee,  Cold,  Skin,  Index  II. 

relieves  pain,  situated  internally,  through 
sedative  influence  of  reflex  action  of 
nervous  system  upon  the  sensibility 
of  the  expanded  nerves,  which  is 
equally  true,  also,  of  all  other  seda- 
tives of  active  virtues,  of  loss  of  blood, 
&c.,  and  of  mental  emotions  through 
their  direct  development  and  modifica- 
tion of  the  nervous  influence,  p  587- 
590,  ^  891  k-s;  p.  592-593,  i)  891  k; 
p.  831-832,  ^  1057  f,  p. 838,  ^  1057A. 
Also,  p.  520-521,  <J  826  rf;  and  Seda- 
tives (^co?n<c),  Bloodletting, Poul- 
tices, Remedial  Action,  Antispas- 
modics, Index  II  i  Nervous  Power, 
Index  I.  and  II 

in  relieving  pain  or  spasms  depending 
upon  wounds,  and  locally  applied, 
may  act  mostly  like  warm  poultices 
by  simply  diminishing  the  sensibility 
and  irritability  of  the  part,  and  thus 
arresting  the  morbific  reflex  nervous 
action,  but  also  by  generating  a  coun- 
teracting reflex  nervous  influence,  p. 
592-59-3,  (J  89U  A:;  p.  682-683,  ^ 
905  b 

commended  above  all  other  remedies, 
and  contrasted  with  Bloodletting,  p. 
584,  ^  891  c,  d;  p.  718-719,  §  859  b. 
Also,  Opium,  Index  I ,  for  its  special 
uses. 

compounded  with  Ipecacuanha,  the  re- 
flex nervous  influence  is  so  modified 


Opium — continued. 

that  the  secretions  of  the  liver  and 
kidney  are  less  restrained,  and  sweat- 
ing promoted,  besides  other  well- 
known  peculiarities  of  action,  which 
illustrate  the  manner  in  which  the 
nervous  influence  is  modified  accord- 
ing to  the  particular  virtues  of  the 
cause,  physical  or  mental,  by  which 
it  is  brought  into  operation,  p.  592- 
593,  ()  89H  k.  Also,  Jealousy,  In- 
dex II ;  Nervous  Power,  Index  I. 
and  II. 
Organic  Analysis — continued  from  Index 
/. 

allowed  by  Lehmann  to  be  unreliable, 
p.  779-782,  «^  1029-1030. 

quantitative,  surrounded  by  diflSculties, 
ibid. 

qualitative,  opposed  by  insuperable  ob- 
stacles, p.  782,  (}  1030. 

of  the  blood  and  tissues,  impossible,  p. 
780,  781,  {)  1029,  1030. 

fruitless  in  morbid  conditions  by  its  own 
admissions,  p.  782,  <J  1030. 
Organic  Beings — continued  from  Index 
I, 

the  fundamental  distinction  between 
Animals  and  Plants  certified  by  the 
microscope,  p.  815,  ()  1052. 

a  question  as  to  their  origin,  p.  182-191, 
^  350f  g-n  ;  p.  910-911,  ^  1083. 

their  relation  to  external  objects,  and 
how  the  connexion  obtains,  p.  398- 
400,  <)  626-630— and  what  the  differ- 
ence in  this  respect  between  Animals 
and  Plants,  p.  399,  §  628. 

die,  nothing  else,  p.  401,  ^  631. 
Organic  Chemistry — continued  from  In- 
dex I., 

what  Lehmann  thinks  of  its  prospects 
and  of  the  past,  p.  779-782,  i)  1029, 
1030. 

allows  that  Physiology  and  Pathology 
have  but  little  or  nothing  to  hope  from 
it,  p  779-782,^  1029,  1030. 

allowed  to  be  unavailable  in  practical 
medicine,  p.  795,  ()  1033  b 

confesses  its  "weakness  and  incapaci- 
ty,^' p  782,  (J  1030. 

apologizes  for  its  failure,  p.  779-782,  ^ 
1029.  1030. 

as  applied  to  digestion,  admitted  by 
distinguished  advocates  that  there  is 
something  more  than  Chemistry  in  it, 
p.  152-153,  <J  345-348;  p  160-161, 
Nos.  12-15  X  58-60;  p  163-164, 
Nos.  21X65;  p.  168-170,  Nos.  34- 
38x83-87i;  p.  171,  Nos  41  X  93, 
parallel  columns. 

a  cause  of  its  supposed  connexion  with 
Medicine,  p.  798,  <)  1034 

its  complaint  against  Vitalists,  p,  796- 
799,  ()  1034 

charges  Physicians  with  greater  homage 


INDEX    II. 


1049 


Organic  Chemistry — continued. 

than  it  thinks  it  deserves,  and  lays 
something  of  the  blame  of  its  failure 
to  their  confidence  in  its  promises,  p. 
781,  «;)  1030;  p.  808,  <J  1034. 
the  Author  greatly  indebted  to  it,  p.  207, 
^  376J  b;  p.  801,  ()  1035. 
Org.^nic  Heat — continued  from  Index  I. 
Also,  Combustion, 
farther   observations    upon,  confirming 
the  Author's  former  demonstrations 
of  its  independence  of  chemical  laws, 
p.  807-812,  <5  1043-1049. 
experimental  demonstration  by  Brown- 
Sequard  of  being  liable  to  sudden  in- 
fluences in  circumscribed  parts  by  re- 
flex action  of  the  nervous  system,  sus- 
taining the  present  writer's  opinion 
of  its  being  a  secreted  product,  and, 
like  all   other  secretions,  subject   to 
influences  by  direct  and  reflex  nervous 
action,  p.  807,  <J  1044  a.     Also,  p.  68, 
^152  a;  p.  245,  H40  e  ;  p.  250-251, 
4  441  c  ;   p.  262-270,  <^  446-447  ;    p. 
335-336,  ^  512  a,b;  p.  339,  ^  514  A; 
p.  365,  ^  889 g ;  p.  579-580,  ^  890^  d. 
Also,  Hyb«rnating  Animals,  Index 
IL 
liable  to  local  exaltations  by  direct  devel- 
opment of  nervous  influence  from  in- 
juries or  other  aflTections  of  the  nerves, 
p.  259,  <J  443  b ;  p.  264-270,  ()  447  a-d 
— the  causation  being   then   exactly 
the  same   as  when  the  gastric  juice 
and    the   pulmonary   mucus    are    in- 
creased in  quantity  by  the  nervous 
shock  incident  to    a  division  of  the 
pneumogastric  nerve,  p.  289,  <S>  461  ; 
p.  293,  ()  473  a,  No.  2.     Also,  Brain, 
Inflammation    of  ;     Mental    Emo- 
tions, the  individual  Passions,  Sym- 
pathy {Experiments  to  determine,  i^c.). 
cannot  be  one  theory  to  explain  the  phe- 
nomena of  heat  in  health,  and  another 
for  disease,  p.  271,  ^  447/. 
different  in  different  parts,  according  to 
the  vital  constitution  of  each,  extend- 
ing even  to  plants,  p  260,  i^  445  a-b; 
p.270,H47rf;  p.808,<)1045.    Also, 
p.  61,  H33  a,  b;  p.  62-63,  ()  135-137 ; 
p.  97-98,  <J  190,  191. 
Dr.  Kane's  experience  relative  to,  sus- 
taining the  Author's  philosophy  of  its 
dependence    upon   vital  laws  as   set 
forth  in  the  Medieal  and  Physiological 
Commentaries,  vol.  ii.,  p.  1-78,  and,  in 
continuation,  in  these  Institutes,  p. 
234-279. 

influenced  by  constitution,  p.  809,  (^ 
1047.  Also,  p.  68-69,  <^  153-156  ; 
p.  248,  ()  441  b;  p.  255,  ()  44H  a; 
p.  257-258,  i)  442  a,  b  ;  p.  259-260, 
^  443-445  b ;  p.  262,  ^  445/;  p.  271 
-273,  §  447  g.  h ;  p.  275,  ^  447^  b ; 
p.  384,  <J  585  c,  cZ,  585  ;  p.  391,  <^  603. 


Organic  Heat — continued. 

influenced  by  habit  of  exposure  and 
by  Chmate,  p.  809,  ()  1047.     Also, 
p.  256,  §  441+  a-c;   p.  257-258,  (J 
•442  a-d ;    p.  363,  ()  535-540 ;    p. 
394-396,  ()  615-621. 
influenced    by  Mental   Emotions,  p. 
271,  ()  Ulf.    Also,  Fear,  Shame, 
Mental  Emotions,  Index  II. 
less  dependent  upon  food  than  other 
secreted   products,   p.   810-812,  ^ 
1048-1050.      Also,  p.  245,  246,  ^ 
440  c;  p.  248-262,  H41  c-U5  g. 
suddenly  exalted  upon  the  surface  by 
contact  of  food  with  the  stomach, 
through  reflex  action  of  the  nervous 
system.     See  Food,  Shame,  Love, 
Fear,  Index  II. 
arctic   and   tropical,  compared  as  it 
respects  food,  p.  810-812,  <^  1048- 
1050.     Also,  p.  248-252,  ^  441  c. 
in  its  relation  to  clothing,  fire,  alcohol, 
fat,  blubber  oil,  p.  809-812,  ^  1047 
-1050.      Also,  p.  239-243,  ^  440 
a-c;  p.  245,  246,  ()  440  e;  p.  247, 
()  440  t ;  p.  256,  ()  Ull'  c;  p.  257- 
259,  <^  442. 
tea,  the  great  arctic  resource  for  the 
generation  of  heat  under  the  pro- 
longed influence  of  cold,  p.  811,  ^ 
1049. 
Organic  Life — continued  from  Index  I, 
recent  experiments,  showing  the  distinc- 
tion between  the  properties  of  organic 
life  and  the  nervous  power,  and  sus- 
taining the  Author's  philosophy  upon 
this  subject,  p.  803-804,  ()  1039  ;    p. 
805-806, 1^  1041.     Also,  Vital  Prop- 
erties, Vital  Principle,  Index  I.; 
Iris,  Index  II 
Organic  Products,  Morbid, 

each  variety  has  always  a  special  path- 
ologicalcause,  conforming  in  principle 
with  the  natural  products,  and  when 
not  the  result  of  direct  local  action  of 
physical  agents,  every  change  depends 
upon  alterative  influences  of  either 
direct  or  reflex  action  of  the  nervous 
system  exerted  upon  the  instruments 
of  organic  processes,  and  equally  so 
from  the  operation  of  Mental  Emo- 
tions as  from  external  and  internal 
exciting  causes  of  a  physical  nature, 
(J  53  ;  ^  109  6  ;  ij  1 13  ;  (^i  224  ;  (}  226  ; 
()  409  d;  p.  226,  ()  409  fc;  p.  228,  ^ 
415;  p.  230-233,  ^  422  i-427  ;  p. 
285-287,  ()  455  b-458  ;  p.  289,  ^  431 ; 
p.  296,  {)  476  c;  p.  302,  ^81*;  p. 
436,  ()  682  b ;  p.  452,  ()  693  ;  p.  478- 
479,  (J  740-741  ;  p.  483-484,  ^  746  c; 
p.  531,  (J  838-840  ;  p.  536-539,  ^  847 
c-h ;  p.  630-632,  I)  892|  b ;  p.  666- 
672,  ()  902  i-904  b;  p.  679-681,  () 
905  a ;  p.  703-710,  <J  940-952.  Also, 
Secretion  and  Excretion;    Reme- 


1050 


INDEX    II. 


Organic  Products,  Morbid — continued. 

DIAL  Action,  subdivismi  Mental 
Emotions  ;  Feak,  Jealousy,  Food, 
Tea,  Kidney,  Skin,  Cold,  Weeping, 
Sympathy  (the  Experiments  upon 
Brain  and  Spinal  Cord),  Index  II. ; 
Nervous  Power,  Index  I.  and  II. 

Organs, 

the  philosophy  concerned  in  their  devel- 
opment and  other  natural  changes, 
from  the  embryo  to  old  age,  as,  also, 
the  essential  philosophy  of  their  dis- 
eases and  their  cure,  p.  36-49,  (}  63- 
80;  p.  66,  i)  144-147;  p.  68-69,  ^ 
153-159;  p.  373-380, 'Ji  576-578  ;  p. 
401-402,  <J  633 ;  p.  679-681,  ()  905  a. 
Also,  Uterus,  Organs  of  Genera- 
tion, Lactation,  Pregnancy,  hidcx 
II. ;  Youth,  Nervous  Power,  Index 
I.  and  II. 

Organs  of  Generation, 

supply  an  endless  variety  in  the  in- 
fluences which  they  exert  through 
their  development  of  natural,  mor- 
bific, and  remedial  conditions  of  re- 
flex action  of  the  nervous  system, 
both  in  an  independent  sense  and  as 
compounded  with  other  nervous  in- 
fluences that  spring  from  attendant 
mental  emotions,  and  serving  as  a 
fruitful  source  of  interpretation  of  the 
effects  of  morbific  and  remedial  agents, 
and  of  the  no  less  wonderful  manner 
in  which  the  nervous  influence  is 
propagated  through  particular  excito- 
motory  nerves  as  it  may  be  developed 
in  all  the  cases  by  certain  physical 
impressions,  or  by  passion,  and  as  the 
will  may  often  interpose  its  modify- 
ing mandates,  or,  again,  as  the  reflex 
nervous  power  may  be  developed  alone 
by  the  independent  influence  of  the 
generative  organs,  and  thus  brought 
into  unusual  and  unintermitting  op- 
eration upon  the  universal  organism 
(after  the  manner  explained  in  sections 
under  Alteratives  and  Sphincter 
Muscles,  Index  II.),  and  rendered 
the  essential  cause  of  the  physical 
and  moral  changes  which  mark  the 
transition  of  Childhood  into  Youth, 
yet  intermingling  this  organic  in- 
fluence of  reflex  nervous  action  with 
those  transitory  ones  that  have  a 
common  parentage  through  the  men- 
tal emotions  that  are  incident  to  the 
same  organic  influence,  and  display- 
ing themselves  in  a  great  variety  of 
familiar  ways — and,  finally,  as  they 
manifest  their  ascendency  in  the 
pregnant  female  by  directing  the  re- 
flex nervous  action  with  nauseating 
effect  upon  the  stomach,  and,  as  par- 
turition approaches,  increase  its  alter- 
ative influence  already  established  up- 


Organs  of  Generation — continued. 

on  the  mammary  glands,  and,  through 
a  perpetual  determination  of  that  in- 
fluence upon  them,  maintain  an  un- 
ceasing secretion  of  milk,  now  and 
then  disturbed  by  mental  emotions, 
till  the  uterine  organs,  returning  to 
their  wonted  function  of  menstrua- 
tion, generally  cease  to  propagate  the 
requisite  influence  to  tiie  nervous 
centres — all  of  which  is  applied  to 
the  interpretation  of  the  modus  oper- 
andi of  remedial  and  morbific  agents, 
physical  and  mental,  through  other 
but  exactly  analogous  influences  of 
the  same  reflex  or  direct  action  of  the 
nervous  system,  and  against  the  chem- 
ical and  other  physical  hypotheses,  p. 
56,  ()  120,  121  ;  p.  61,  ^  133  c;  p.  87, 
^  177;  p.  111,(^2331;  p.  114-115,^ 
234 e;  p.  1 17-120, <J 234 §--235;  p. 231 
-232,  ^  424  ;  p.  330,  |J500  nn ;  p.  335- 
336,  ()  512  a,  b  ;  p.  352,  ^  524  d ;  p. 
397,  ^  625^.  Emotions,  Altera- 
tives, Antimony,  Lactation,  Milk, 
Weeping,  Sphincter  Muscles,  To- 
bacco, Love,  Fear„Jealousy,  Kid- 
ney, Skin,  Roosting,  Index  II. 
Osborne,  Dr. — on  neglect  of  blood-letting 

in  pneumonia,  p.  761,  ()  1005  k. 
Ovum — continued  from  Index  I., 

its  development  exactg  from  leading 
Chemical  Physiologists  an  admission 
of  its  dependence  upon  a  Vital  Prin- 
ciple, and  a  concession  of  the  whole 
ground  of  Vital  Solidism,  p.  38-39,  (J 
64  e-g — nay,  more,  to  the  extent  of 
transcendentalism,  p.  40,  ^  64  A ;  p. 
85-86,  (jllbd. 

embraces  the  potential  whole  of  meta- 
morphic  animals,  and  which  deteian- 
ines  all  their  changes — applied  to  dis- 
tinguish the  Instinctive  Principle  from 
the  Soul,  p.  902-903,  (J  1078  — and 
the  same  principle,  independently  of 
other  facts,  confutes  the  hypothesis 
of  a  "  primordial  cell,"  p.  812-815,  i^i 
1051  i-1052. 
Oxygen — continued  from  Index  I., 

considered  farther  in  its  supposed  causa- 
tion of  the  circulation  of  the  blood,  p. 
817-823,  ^  1054-1055. 

employed,  upon  chemical  principles, 
along  with  other  considerations,  to 
show  that  AnsEsthetics  produce  their 
effects  through  alterative  influence  of 
reflex  action  of  the  nervous  system — 
their  modus  operandi  being  the  same 
as  concerned  in  the  function  of  respi- 
ration, where  the  reflex  action  is  ex- 
cited by  an  inappreciable  irritation  of 
the  pulmonary  mucous  tissue,  while 
in  the  case  of  Ansesthetics  the  in- 
fluence is  profound,  and  of  such  a 
peculiar  nature  as  to  determine  the 


INDEX    11. 


1051 


Oxygen — coiitinued. 

nervous  influence  upon  the  expanded 
nerves  and  no  other  parts,  and  impart 
to  it  a  modification  capable  of  abolish- 
ing, temporarily,  common  sensibility, 
p  522-523,  {)  827  b-d;  p.  862-864, 
^  1066.  Also,  p.  1 1 1,  ^  233J  ;  p.  214 
-216,  (J  234  e-g  ;  p.  330,  I)  500  n  ;  p. 
661-663,  ^  894-896;  p.  679-681,  ^ 
905  a;  and  Neuralgia,  Opium,  Anti- 
spasmodics, Pain,  Sedatives  {Aco- 
nite), Skin,  Kidney,  Cold,  Respira- 
tion, Emetics,  Stomach,  Index  11.  ; 
Nervous  Power,  Youth,  Index  I. 
and  II. 


Pain — continued  from  Index  /., 

a  very  nnreliable  symptom,  often  leading 
to  mistakes  in  practice,  p.  584,  ^  891  c; 
p.  587-589,  i)  891  k-p ;  p.  718-721,  (} 
960  a.     Also,  Opium,  Index  II. 

illustrates,  by  the  requisite  variety  of 
treatment,  the  modifications  of  in- 
flammation that  arise  from  differences 
in  its  remote  causes,  p.  418,  ^  652  c; 
p.  468,  i)  722  a-c ;  p.  469-470,  ^  725  ; 
p.  587-589,  ()  891  k-p. 

occasioned  and  relieved,  when  not  the 
direct  result  of  causes  operating  local- 
ly, by  alterative  influences  of  reflex 
action  of  the  nervous  system,  operat- 
ing either  directly  upon  the  common 
sensibility  of  the  nerves  or  indirectly 
by  exciting  or  relieving  disease,  and 
according  to  the  nature  of  the  means 
by  which  it  is  brought  into  operation, 
and  equally  relieved,  also,  through  the 
same  medium  by  mental  emotions  and 
according  to  their  nature,  and  in  gen- 
erally not  affecting  the  senses,  a  plain 
distinction  is  thus  supplied  between 
common  and  specific  sensibility,  and 
in  other  ways  between  sctisibility  and 
irritability,  p  89,  i)  183  a-c,  &,c.  ;  p. 
100-102,  ij  197-203  ;  p.  280-282,  () 
450-451  ;  p.  338,  i)  514  (/ ;  p.  587- 
590,  ij  891  k-s;  p.  592-593,  ^  89U  k; 
p.  831-832,  1057/;  p.  838,  ()  1057^  ; 
p.  862-864,  ^  1066.  Also,  Opium, 
Narcotics,  Warm  Bath,  Poultices, 
Index  II. ;  Nervous  Power,  Index  I. 
and  II. 

when  relieved  in  superficial  parts  by  the 
direct  local  action  of  sedatives,  such 
as  opium,  &c  ,  or  when  traumatic 
spasms  subside  under  the  influence 
of  hot  fomentations,  it  is  mostly  by 
subduing  local  sensibility  and  irrita- 
bility, when,  in  the  case  of  the  spasm, 
the  exciting  nervous  influence  sub- 
sides as  a  consequence,  just  as  infan- 
tile convulsions  are  relieved  by  lancing 
a  gum  or  by  removing  irritating  matter 


Pain — conttnued. 

from  the  alimentary  canal ;  though 
in  many  of  the  cases  a  sedative  reflex 
nervous  action  is  instituted  which  is 
reflected  upon  the  part  through  excito- 
motory  fibres  coming  directly  to  the 
part,  or  through  more  indirect  chan- 
nels, as  is  commonly  more  or  less  the 
case  with  all  remedies  when  they  sub- 
due diseases  of  parts  upon  which  their 
•  direct  effect  is  exerted,  p.  66-67,  ij  148; 
p.  421-423,  ^  657-658  ;  p.  682-683, 
\  905  b.  Also,  Pathological  Cause, 
Index  11. 
if  it  affect  the  action  of  the  heart,  it  is 
through  some  mental  emotion  it  pro- 
duces, p.  78-79,  note;  p.  588,  ^  791  m. 
Parallel  Columns, 

their  argumentative  uses,  p.  19,  <J  18  e; 
p.  156-173,  (J  350  ;  p.  182,  ^  350j  gg\ 
p.  189-190,  ^  3501  n ;  p.  200,  ^  366  ; 
p.  246-247,  <^  440  /;  p.  277-278,  ^ 
447^;  p.  514-515,  ^  819.  Also, 
Medical  and  Physiological  Com- 
mentaries, vol.  iii..  Article  Examina- 
tion of  Reviews,  p.  91-96. 
Paris, 

his  opinions  of  Organic  Chemistry,  p. 
433-434,  1)  676  b;  p.  762,  ^  1006  a. 
his  opinion  of  spasmodic  affections  and 
their  means  of  relief,  p.  590,  ^  891^  b. 
Parturition, 

conducted  through  reflex  action  of  the 
nervous  system,  having  its  point  of 
departure  in  the  mucous  tissue  of  the 
uterus,  and  acting  mostly  upon  its 
muscular  tissue,  while  its  natural 
action  upon  the  perineal  muscles  is 
suspended  during  the  paroxysm — 
remarkable  for  its  intermissions,  and 
inducing  convulsions,  &c.,  and  for  its 
immediately  subsequent  determina- 
tion upon  the  mammary  gland  as  an 
exciting  cause  of  lactation — and  ap- 
plied in  advancing  the  Author's  doc- 
trine of  the  modus  operandi  of  all 
morbific  and  remedial  agents  through 
alterative  influence  of  reflex  nervous 
action  beyond  the  seat  of  their  direct 
operation,  while,  also,  the  manner  in 
which  the  milk  is  liable  to  be  affected 
in  quality  and  quantity  by  mental 
emotions  brings  them  under  the  same 
rule  of  interpretation,  p.  56,  ()  120, 
121;  p.  Ill,  <J  2331  ;  p.  114-115,  <5 
234  e;  p.  117-120,  ^  234  ^-235;  p. 
231-232,  ()  424  ;  p.  330,  ()  500  nn;  p. 
335-336,  <i  512  o,  i  ;  p.  352,  (>  524  d ; 
p.  686,  (}  905i  b  Also,  Uterus,  Lac- 
tation, Pregnancy,  Youth,  Kidney, 
Skin,  Cold,  Ergot,  Fear,  Weeping, 
Bile,  Mucus,  Respiration,  Reflex 
Action,  &c..  Index  II. ,  Youth,  Index 
I.  and  II. — Also,  Note  A  p.  1111. 
illustrates  the  mutability  of  the  proper- 


1052 


INDEX    II. 


Parturition — conthmcd. 

ties  of  life,  like  many  other  natural 
changes,  shows  its  foundation  in  use- 
ful Design,  and  that  hence  arise  dis- 
ease and  its  cure,  p.  61,  ^  133  c;  p. 
82-83,  ^  172  ;  p.  86-88,  ()  176-185  ; 
p.  665,  ^  901.  Also,  Vital  Proper- 
ties, Organic  Life,  Index  I.,  and 
references  in  foregoing  subdivision. 
Passions.  See  Mental  Emotions,  and 
Remedial  Action,  subdivision  Men- 
tal Emotions,  and  the  individual 
Passions,  Index  II. 
Pathological  Anatomy.     See  Anatomy, 

Morbid,  Index  II. 
Pathological    or    Proximate    Cause  ; 
also,  Proximate  Cause,  Index  I., 

the  essential  condition  of  disease,  as 
resulting  from  remote  causes,  and  the 
immediate  cause  of  the  symptoms,  p. 
427,  <;>  667,  668  ;  p.  428,  ^  674  a. 

consists  simply  of  changes  of  the  natural 
states,  and  is  therefore  strictly  a  mor- 
bid physiological  condition,  p.  3-4,  i^  2 
b-d;  p.  131-132,  ^  285-288  ;  p.  265, 
^  447  b;  p  413,  ^  639  ;  p  428-430, 
^  674  ;  p.  398,  l^  626 ;  p.  498-504,  () 
785-79S*-and  the  essential  Art  of 
Medicine  lies  in  the  principle  of  im- 
parting to  morbid  states  some  more 
favorable  pathological  condition  that 
may  subside  spontaneously  in  the 
shortest  time  —  the  principle  being 
distinctly  illustrated  by  such  remedies 
as  produce  artificial  diseases,  as  the 
inflammation  of  the  parotid  glands 
and  mouth  induced  by  mercury  and 
the  mercurial  fever  which  denotes 
morbific  influences  upon  other  parts 
rendered  susceptible  by  disease,  and 
also  by  the  spontaneous  subsidence 
of  the  artificial  disease,  and  the  sim- 
ultaneousdisappearance  of  the  natural 
ones  (and  so  in  slighter  degrees  of  the 
mercurial  influences),  and  as  farther 

*  shown  by  analogous  circumstances 
attending  Vesicants,  Cantharides, 
&c.,  p.  08,  (^  152  ;  p  541-543,  i}  852 
-856 ;  p.  662-665,  <^  896-901 ;  1059  ; 
Remedies,  Vesicants,  Cantharides, 
Therapeutics,  Index  II — (^  746. 

although  it  consist  essentially  of  some 
change  in  the  properties  of  life,  it 
may  be  assumed,  for  convenience,  to 
^  consist  of  some  of  the  physical  results 
appertaining  to  the  instruments  of 
disease,  where  such  results  are  com- 
monly present,  as  in  inflammation 
and  venous  congestion,  p.  428-429,  *J 
674;  p.  484,  <J  747;  p.  485-486,  (^  750 
-751;  p.  498-499,  <J  781-785;  p.  500 
-506,  i)  786-802.  Pros.  Cau.se,  Ind.  1. 

its  precise  nature  depends  greatly  upon 
the  exact  nature  of  the  remote  causes, 
whether  simple  or  complex,  quick  or 

»  Also,  §  3  ft,  73-80,  129,  130,  1S7,  143,  150-152, 
5TG  rf,  5TS  c, '/,  741  ft,  764  c,  S47,  801  \  /,;  8!)6,  900, 
320,  455(;,  52Ga,  ft,  597-601,  674".  718.  7G3(r,  703, 


Pathological  Cause — continued. 

slow  in  operation,  &c.,  and  upon  the 
natural  constitution  of  diflerent  parts, 
their  natural  mutations,  and  other 
permanently  acquired  conditions,  p. 
61-73,  ^ 133-163 ;  p. 374-375,  ^  576 
d,  e ;  p.  376-380,  (J  578  ;  p.  418,  s'' 
651-652;  p.  423-424,  (J  659-662 ;  p. 
427-428,  <J  669-672;  ()  526  /;.  Causes, 
Morbific  ;  Remedies,  Index  II. 

depends  upon  the  natural  mutability  of 
the  properties  of  life,  which  is  design- 
ed for  useful  purposes,  p.  61,  ()  133  c; 
p.  82-83, 1^172;  p.  86-88,  <^  176-185; 
p.  665,  ^  901  Also,  Pregnancy, 
Lactation,  Organs  of  Generation, 
Uterus,  Kidney,  Skin,  Cold,  Lidcx 
II.  ;  Youth,  Index  I.  and  II. ;  Vital 
Properties,  Organic  Life,  Index  I. 

may  exist  in  a  predisposing  condition 
and  not  of  actual  disease,  and  this 
from  an  instant  of  time  to  a  series  of 
months  and  even  years,  and  should 
disease  arise  in  the  part  upon  which 
the  primary  impression  is  made,  it  is 
apt  in  most  cases,  especially  in  the 
prevailing  forms  of  disease,  to  be  the 
result  of  morbific  influences  of  reflex 
action  of  the  nervous  system  excited 
either  by  the  primary  impression  or 
by  some  remote  disease  to  vi'hich  it 
had  given  rise  through  antecedent  in- 
fluences of  the  reflex  nervous  action, 
p.  59,  ^  129  h;  p.  65,  <J  143  c ;  p.  66- 
67,  M48  ;  p.  332-334,  ^  502-506  ; 
p.  344,  {)  516  d,  No.  6  ;  p.  351-352, 
^  524  c ;  p.  359,  I)  527  b ;  p.  360,  () 
527  d;  p.  368-369,  ^  559-563;  p. 
416-417,  (J  649  c,  p.  420-423,  ^  654 
-660  ;  p.  426,  ^  666  ;  p.  429-430,  ^ 
674  rf;  p.  465,  (}  714  ;  p.  522-523,  ^ 
827  b,di  p.  539,  (}  848  ;  p.  670-671, 
<J  902  7n;  p  862-864,  <J  1066. 

where  sympathetic  diseases  follow  as 
consequences  of  a  primary  affection, 
or  where  they  grow  consecutively 
out  of  each  other,  there  may  be  great 
diversity  in  their  pathological  condi- 
tions, which  often  depends  much  upon 
the  respective  peculiarities  of  different 
tissues  or  parts  of  one  and  the  same 
continuous  tissue,  p.  61,  ^  153  a,  h; 
p.  62-68,  i)  135-152;  p.  109,  ^229; 
p.  339-340,  l^bUh;  p.  450,  ()  689  / ; 
p.  465-469,  ()  715-722;  p.  731,  (}  970  c. 
Also,  Causes,  Morbific  ;  Canthar- 
ides, Predisposition;  Hydropho- 
Bi.*, Virus  of  ;  Serpents, Virus  of; 
Hydrocyanic  Acid,  Joy  and  Anger, 
Hope  ;  Stomach,  Blows  upon  ; 
S.MALL-Pox.  Index  II. 

a  comprehensive  illustration  of  its  phi- 
losophy drawn  from  an  analysis  of 
fever,  p  430-433,  ij  675,  676.  Also, 
p.  490-496,  -J  759-774— and  farther 

165,  156,  447  ft,  500,  512-516,  524  r/,  526  ft,  d,  530, 
902,  1105,  172,  177,  179,  191  ft,  237-240,  285,  3031, 
795. 


INDEX    II. 


1053 


Pathological  Cause — continued. 

illustrated  by  a  critical  analysis  of 
symptoms,  remote  causes,  &c.,  p.  438 
-442,  (}  686  b-d— and  by  the  philoso- 
phy of  the  operation  of  a  scton  in  its 
morbific  as  well  as  curative  aspects, 
p.  679-681,  (}  905  a. 

its  philosophy  sought  for  in  the  ovum, 
p.  47-49,  ^  75-80 ;  p.  227,  ^  411. 

as  remedies  operate  only  by  introducing 
new  pathological  conditions,  every 
disease  from  its  beginning  to  its  ter- 
mination, whether  in  health  or  in 
death,  consists  of  a  succession  of 
pathological  causes,  p.  428,  ^  672 ; 
p.  430-433,  ()  675,  676  ;  p.  473-474, 
^  733  e ;  p.  542-543,  ()  854  c-857 ; 
p.  551-554,  ^  867-871  ;  p.  683-665, 
^  897-901.     Peox.  Cavse,  Index  1. 

should  determine  the  treatment,  p.  65- 
67,  ^  143  c-151 ;  p.  73,  ()  163  ;  p.  424 
-425,  <J  661-662  ;  p.  428,  <^  694  a ;  p. 
437-442,  ()  684-686 ;  p.  456-460,  ^ 
695-708  ;  p.  479-480,  (}  741  a,  b ;  p. 
486,  <^  750  b ;  p.  487-489,  ^  756  ;  p. 
498-499,  (i  785  ;  p.  505,  <)  801  ;  p. 
510,  ()  813  b;  p.  541-542,  ()  854  bb ; 
p.  545,  ^  859  b ;  p.  548-550,  ()  863  d ; 
p.  551-554,  §  867-871 ;  p.  560-561, 
4  886-888  ;  p.  597-600,  (^  892  c,  d ; 
p.  603-604,  (J  892  k ;  p.  606,  <J  892  p ; 
p.  609-610,  <)  892i  d;  p.  613,  <;>  892^ 
c;  p.  615-617,  ()  892k  f-k ;  P-  636- 
642,  I)  8924  d-i ;  p.  663-665,  <)  897- 
901  ;  p.  724-728,  «^  961  ;  p.  729-732, 
<^  966-970  ;  p.  732-736,  ()  971-980. 

the  aggregate  symptoms  determine  the 
precise  nature  of  the  pathological 
cause,  p.  430-433,  <)  675-676;  p. 
434,  ^  679 ;  p.  435,  <J  681  a;  p.  437- 
442,  ()  685-686  ;  p.  447-448,  ()  688  i  ,• 
p.  457-460,  <^  700-708  ;  p.  560-562, 
^  884-888  d — while  reliance  on  indi- 
vidual symptoms  is  a  fruitful  source 
of  malpractice,  and  a  sure  index  of 
defective  knowledge,  p.  436,  <^  682 
a,  b;  p.  447-448,  ^  668  i  ,•  p.  511,  ^ 
815;  p.  560,  ()  884;  p.  572-576,  () 
890  d-n;  p.  587,  ()  891  k;  p.  636- 
641,  ^  892-1  d-i;  p.  724-725,  «J  961 
a,  b;  p.  759-760,  ^  1005  ;.  Also, 
"  Debilitv,"  Index  I.  and  II. 
Pathology — continued  from  Index  I, 

allowed  to  have  derived  but  little  or  no 
light  from  Chemistry,  p.  781,  (}  1030. 
Also,  Pathological  Cause,  Index  II. 

reflects  important  light  upon  natural 
physiological  conditions,  and  its  prac- 
tical knowledge,  as  well  as  of  Thera- 
peutics, is  indispensable  to  any  just 
views  in  Physiology,  p.  14,  ^  6  ;  p. 
59,  ()  129  h,  i;  p.  61,  (}  133-134;  p. 
63,  ()  137  d;  p.  65,  ()  143  ;  p.  67-68. 
<^  149-152 ;  p.  73,  ^  163  ;  p.  265,  (} 
447  b ;   p.  413-414,  <J  639-640  ;   p. 


Pathology — continued. 

539,  ()  848  ;  p.  798,  ^  1034,  and  refer- 
ences ;  p.  503,  ()  795  ;  p.  272,  ()  447  g-. 
Pathology,    Humoral.       See   Humoral 

Pathology,  Index  II. 
Pepsin, 

admitted  by  Chemistry  to  be  probably  a 
fiction,  p.  784,  ()  1031  b — and  "knows 
nothing  of  its  nature,"  p.  781,  <J  1029 
— though  lately  a  triumph  of  the  la- 
boratory, p.  197-202,  ^  362-376. 
Philip,  A.  P.W. — continued  from  Index  I., 

his  importyint "  Experiments  to  determine 
the  Laics  of  the  Vital  Functions'" — 
introduced  for  the  purpose  of  illus- 
trating the  modus  operandi  of  mor- 
bific and  remedial  agents  through  al- 
terative influence  of  reflex  action  of 
the  nervous  system,  and  of  the  opera- 
tion of  the  Mental  Emotions  and  the 
Will  through  the  direct  development 
of  the  nervous  influence,  and  that  this 
influence  is  the  immediate  exciting  or 
modifying  cause,  through  its  action 
upon  organic  structure,  of  all  the 
changes  that  arise  in  the  solids  and 
fluids  beyond  the  seat  of  the  direct 
operation  of  natural,  morbific,  and 
remedial  agents,  and  as  attendant  on 
loss  of  blood,  and  on  mental  emotions, 
p.  295-321,  (^  476-494.  Also,  Gener- 
alization OF  Reflex  Action  of  the 
Nervous  System,  Index  II. 

his  experiments  farther  confirmed,  p. 
804,  {)  1039— and  his  priority,  p.  916, 
(J  1084. 

does  not  apply  his  experiments  patho- 
logically or  therapeutically,  but  in- 
clines to  the  chemical  and  physical 
doctrines,  p.  295,  (^  476  a ;  p.  309- 
310,  ()  484  a,  No.  5  ;  p.  314,  ^  488  ; 
p.  317-318,  ^  493  a-d. 
Philosophy,  Experimental.  Also,  Phi- 
losophy, Index  I., 

should  imitate  Nature,  and  illustrated 
by  examples  to  the  contrary,  p.  8-14, 
{)  5-6;  p.  132-133,  ^  289-291;  p. 
161-172,  Nos.  15,  29,  31,  32,  44,  45, 
parallel  columns;  p.  175-176,  ^  350^ 
n-q;  p.  177-178,^3501/;  p.  179- 
182,  ()  350J  c-g;  p.  195-203,  ()  359- 
376^-;  p.  219-220,  ^  408-409;  p. 
238,  ^  438  h,  el  seq. ;  p.  279,  ()  448  f; 
p.  287-289,  «J  459-401  ;  p.  319,  <J  494 
b;  p.  320,  ^  494  dd ;  p.  323-324,  <J 
427 ,-  p.  371,  <)  569  b  ;  p.  482,  ()  744  ; 
p.  517,  (J  821  c ;  p.  521,  <)  826  d;  p. 
527-528,  ()  830  a-831  ;  p.  529-531, 
§  837  a-cc  ;  p.  715-722,  ^  960  a-c. 

in  the  department  of  Chemistry,  as  ap- 
plied to  Physiology  and  Pathology, 
its  future  proceedings  and  results 
had  been,  and  continue  to  be,  antic- 
ipated by  the  Author,  p.  6-7,  <J  4i 
b ;  p.  9,  §  5  ;  p.  202-203,  (/  3764  ;  p". 


1054 


INDEX    II. 


Philosophy,  Experimental — continued. 

236,  ^  435  c;    p.  779-782,  ^  1028- 
1030. 
Phlebitis, 

employed  to  illustrate  the  pathology  of 
venous  congestion,  p.  501-505,  ()  792 
-801;  p.  507-509,  ()  806-811— and 
which  concur  together,  by  the  coinci- 
dences in  their  phenomena,  and  the 
sameness  of  treatment,  in  showing 
that  the  alterative  influence  of  reflex 
nervous  action  is  alike  modified  in  a 
peculiar  manner  by  both  affections, 
p.  507-508,  <^  806.  Also,  Venous 
Congestion,  Venous  Tissue,  Index  I. 
Phthisis  Polmonalis, — (Also,  Index  I. 

relieved  by  open  air  and  exercise  through 
complex  influences  of  reflex  action  of 
the  nervous  system,  the  point  of  de- 
parture for  the  air  being  mostly  the 
skin,  and  the  voluntary  muscles  for 
the  exercise — the  primary  curative 
influence  being  exerted  especially 
upon  the  digestive  organs,  which  be- 
come a  source  of  salutary  reflex  nerv- 
ous influence  upon  the  lungs — and 
farther  explained,  p.  543,  ^  855 ;  p.  579 
-580,  890i  d;  p.  670-671,  ^  902  m. 
Also,  Exercise,  Disease  (5th  sub- 
division). Ulcers,  Hope,  Laughing, 
MiTNTAL  Emotions,  Mind,  Skin, Cold, 
Index  II. 

employed,  along  with  other  diseases,  to 
show  the  fallacy  of  the  chemical  ra- 
tionale of  animal  heat,  and  that  this 
product  is  of  analogous  origin  with 
the  secreted  fluids,  and,  like  them, 
constantly  liable  to  influences  of  direct 
and  reflex  nervous  action,  and  from 
mental  as  well  as  physical  causes,  p. 
264-272,  «J  446  rf-447  g. 

colliquative  sweats  of,  arrested  by  Ace- 
tate of  Lead  and  Sulphuric  Acid, 
through  alterative  influence  of  reflex 
action  of  the  nervous  system,  and  the 
analogy  carried  to  the  modus  operandi 
of  other  Astringents,  and  of  all  other 
remedies,  p.  530,  <^  837  c ;  p.  557,  ^ 
890  0.  Also,  Lead,  Acetate  of  ; 
Sulphuric  Acid;  Silver,  Nitrate 
OF  ;  Astringents,  Ipecacuanha, 
Cold,  Index  II. 

certain  facts  and  principles  which  denote 
the  appropriate  treatment  to  be  anti- 
phlogistic, p.  471,  ()  732  b;  p.  550,  ^ 
863/;  p.  507,  (}  805  ;  p.  573-574,  ^ 
S90  d-f,  o;  ^  836;  p.  872,  P.S., 
Notes  F  p.  1114,  Mm  p.  1141. 
Physicians, 

Organic  Chemistry  imputes  to  them  a 
fanatical  reliance  upon  it,  p.  781,  <J 
1029;  p.  808,  ()  1034. 
Physiologists,  (See  Chem.  Phvs.) 

afiirnied  on  high  authority  that  "  it  is 
a  doctrine  generally  accepted  at  the 


Physiologists — continued. 

present  day  that  the  glandular  organ 
exerts  a  catalytic  action  on  the  ele- 
ments of  the  blood  as  it  traverses  the 
organ,"  p.  791,  (;»  1032  c— but  will  this 
explain  all  the  analogous  millions  of 
distinct  organic  products  out  of  main- 
ly four  elements,  yet  intimately  com- 
bined with  twelve  or  fourteen  more  in 
the  blood  and  sap  of  all  Animals  and 
Plants,  and  their  ternary  and  quater- 
nary combinations,  and  their  endless 
variety  in  disease,  and  as  the  glandular 
products,  particularly,  are  affected  by 
the  passions  —  considering,  too,  that 
Plants  begin  with  the  elements  of 
matter?  p.  23-26,  <»  37-48 ;  p.  27-28, 
()  51-53  b;  p.  221-227,  <^  409  i-411. 
Also,  Mental  Emotions,  Fear,  and 
other  individual  Passio7is,  Milk,  Bile, 
Urine,  Weeping,  Sweat  ;  Water, 
Hot  ;  Kidney,  Skin,  Uterus,  Partu- 
rition, Index  II. ;  Nervous  Power, 
hidex  I.  and  II. ;  Sudorifics,  Index 
I. 
Placenta, 

glycogenic  function  of,  p.  928,  ()  1086. 
Plague, 

treatment  of,  by  bloodletting,  p.  755,  ^ 
1004  c. 

not  contagious,  p.  418-420,  ^  652-653. 

supplies  the  first  recorded  instances  of 
the  quantities  of  blood  abstracted,  p. 
755,  ^  1004  c. 
Plants — continued  from  Index  /., 

their  fundamental  distinction  from  Ani- 
mals confirmed  in  the  lowest  rank  of 
the  two  kingdoms,  p.  815,  ()  1052  a. 
Also,  Sap,  Circulation  of.  Index  I. 
and  II. 

absorption  and  circulation  in,  and  Dr. 
Hales'  experiments  upon,  and  with 
a  reference  to  the  circulation  of  the 
blood,  p.  817-824,  (j  1053-1055. 
Also,  Sap,  Circulation  of.  Index  I. 
and  II. 

present  a  reputed  departure  from  a  fun- 
damental law  of  generation,  p.  817,  (^ 
1052  c. 
Plasters, 

mercurial,  anodyne,  iodine,  &c.,  and  irri- 
tating, operate  upon  deep-seated  parts 
after  the  manner  of  Cantharides  and 
Seton  through  uninterrupted  influence 
of  reflex  action  of  the  nervous  system, 
modified  according  to  the  nature  of  the 
remedy,  p  66-67,  ij  148  ;  p.  107-111, 
«;i  226-233.?  ;  p.  339,  ()  514  g,  h;  p. 
344-345,  i)  516  d.  No.  6;  p.  348,  ^ 
516  d.  No.  13;  p.  659,  ()  893  q ;  p. 
661-603,  ()  894-896;  p.  664-676, 
()  900-904  b;  p.  679-681,  (j  905  a; 
p.  838,  ()  1057i.  Also,  Counter- 
Irritants,  Tobacco,  Alteratives, 
Sphincter  Muscles,  Index  II. 


INDEX    II. 


1055 


"Plastic  Power"  and  "  Organic  Force," 

employed  in  Organic  Chemistry  as  con- 
venient substitutes  for  the  term  Vital 
Principle,  p.  784,  ^  1031.    Also, Vital 
Principle,  Index  I;  p.  398,  ^  626  b. 
Pneumonia, 

its  treatment,  especially  by  Bloodletting 
and  Tartarized  Antimony,  p.  602,  ^ 
892  I ;  p.  638-642,  ^  892|-  f-i ;  p. 
749,  ^  992  d;  p.  750,  ^  995  ;  p.  757- 
760,  ^  1005  h-k;  p.  770,  ^  1017  c; 
p.  846,  ()  1058  o;  p.  870,  <J  1068  c. 

Bloodletting  in,  opposed  by  Louis,  and 
other  distinguished  French  savans, 
and  the  resulting  mortality,  p.  760, 
<^  1005  k — and  the  contrast  in  the 
United  States,  ibid.  Also,  p.  872,  P.S. 

diagnostic  symptoms  of,  p.  436,  <J  682  b. 

may  be  attended  with  a  good  pulse  and 
other  deceptive  symptoms,  p.  447- 
448,  (j  688  t. 

an  example  of  the  rapidity  with  which 
the  alterative  influence  of  reflex  nerv- 
ous action  will  change  the  condition 
of  the  blood  in  small  abstractions,  p. 
710,  ^  952  b. 

the  system  sustained  under  large  ab- 
stractions of  blood  by  a  powerful  ex- 
citing nervous  influence  developed 
by  the  inflammation,  being  reflex  in 
pneumonia,  and  direct  in  cerebral  in- 
flammation, p.  733-734,  t)  974  a-975  ; 
p  748-749,  <J  992  b-d.  Also,  Brain, 
Inflammation  of,  Index  II. 

"  typhoid,"  examples  of  successful  and 
adverse  treatment,  p.  757-759, 1)  1005 
h;  p.  760,  ()  1005  k.  Also,  p.  751- 
752,  <^  999  c. 

"  bilious,'''  treatment  by  bloodletting  in 
the  Minorca  epidemic,  and  its  success 
contrasted  with  its  neglect,  p.  757- 
759,  ^  1005  h,  i.     Also,  p.  872,  P.S. 
Portal  Circulation, 

proves  the  dependence  of  venous  circu- 
lation upon  the  suction  power  of  the 
heart,  p.  211,  <^  390.     Also,  Circula- 
tion OF  THE  Blood,  Index  II. 
Potash,  Tartrate  of, 

in    connexion    with    jalap,   a  valuable 
compound,  p.  845,  <J  1058  m  ;  p.  853, 
(}  1060. 
Potash  and  Soda,  Tartrate  of, 

possesses  advantages  over  other  saline 
cathartics,  p.  555,  ^  872  a;    p.  853- 
854,  <J  1061. 
Poultices,  Hot,  and  Hot  Fomentations, 

their  importance  in  conservative  surgery, 
p.  682-683,  ()  905  b. 

relieve  superficial  inflammation  by  di- 
rectly modifying  irritability  (p.  89,  ^ 
188),  and  remove  any  resulting  dis- 
turbance of  internal  organs  mostly 
through  the  simple  subsidence  of  the 
stimulating  reflex  nervous  influence 
to  which  the  inflammation  had  given 


Poultices,  Hot,  &c. — continued. 

rise,  and  relieve  the  pain  of  superficial 
parts  by  diminishing  sensibility  in  a 
direct  manner  (p.  100,  ^  198  ;  p.  671, 
^  903),  though  doubtless,  in  part,  in 
either  case,  through  a  sedative  reflex 
nervous  influence  reverberated  upon 
the  part  —  and  relieve  primary  dis- 
eases, pain,  &c.,  of  internal  parts 
wholly  through  sedative  influence  of 
reflex  action  of  the  nervous  system, 
p.  592-593,  ^  891^  A-,-  p.  681-682,  <J 
905  b  ;  p.  838,  ()  1057^.  Also,  p  66- 
67,  (}  148  ;  p.  338,  ^  514  d ;  p.  351- 
352,  <^  524  b'd;  p.  421-423,  ^  657- 
658;  p.  483-484,  ^  746  c ;  Opium, 
Sedatives,  Seton,  Index  II. 

Predisposing  Causes.    See  Causes,  Mor- 
bific, Index  II. 

Predisposition  to  Disease — continued 
from  Index  I., 
when  owing  to  present  influences,  con- 
sists of  some  inappreciable  change  in 
the  organic  properties,  corresponding 
in  a  general  sense  with  the  special 
virtues  of  the  morbific  causes,  and 
which  may  remain  for  a  short  or  for 
a  long  time  without  manifesting  any 
functional  derangement,  when,  at  last, 
it  may  have  acquired  such  a  degree  of 
intensity  as  to  explode  suddenly  in 
absolute  disease,  or  may  require  ex- 
citing causes  for  its  full  development 
— though  often  before  the  irruption 
takes  place  there  are  many  obscurely 
marked  symptoms  that  denote  its  ap- 
proach— while,  also,  the  predisposi- 
tion is  always  at  first  formed,  when 
owing  to  external  causes,  in  one  of 
the  surfaces  with  which  they  come 
in  contact,  and  in  which  they  may  or 
may  not  produce  disease,  and  from 
which  it  is  propagated  over  other 
parts  through  alterative  and  uninter- 
rupted influences  of  reflex  action  of 
the  nervous  system,  p.  47-49,  <J  75- 
81  ;  p.  65,  (J  143  ;  p.  66-67,  ^  148  ; 
p.  426-427,  <J  666.  Also,  p.  107-112, 
I)  227-234  b ;  p.  230,  ^  432  ;  p.  245, 
^  440  e ;  p.  253,  (^Uld;  p.  323-324, 
(j  499-500  c;  p.  339-340,  ^514  g-k; 
p.  344-345.  ^  516  tZ,  No.  6 ;  p.  348, 
<J  518  ;  p.  351-352,  <}  524  c  ;  p.  359, 
^  527  b  ;  p.  360,  <^  527  d;  p.  368-369, 
^  559-562;  p.  378-380,  ^  578  c,  d; 
p.  385,  ^  591  ;  p.  416-417,  <;.  649  c ; 
p.  420-427,  ^  654-666 ;  p.  429-430, 
^  674  d;  p.  481,  (Ji  743  ;  p.  483-484, 
^  746  c;  p.  490,  ()  760;  p.  491-492, 
<^  674  a,  b;  p.  497,  ()  111 ;  p.  553,  ^ 
827  c;  p.  661-663,  <;.  894-896;  p.  669 
-670,  ^  902  i;  p.  670-671,  (J  902  m ; 
p.  679-681,  ^  905  a;  p.  880,  (;  1074. 
Also,  Hydrophobia,  Virus  of  ;  Skin, 
Cold,    Sphincter    Muscles,    Seda- 


1056 


INDEX    II. 


Predisposition  to  Disease — continued. 

TivEs  {^Aconite),  Suppositories,  Se- 
TON,  Plasters  ;  Causes,  Morbific  ; 
Alteratives,  Index  II. 

may  be  produced  not  only  by  external 
causes,  but  by  a  variety  of  internal, 
both  physical  and  mental — the  nerv- 
ous influence,  either  direct  or  reflex, 
being  equally  instrumental  in  all  the 
cases,  p.  414-415,  ij  646-647;  p.  423 
-424,  ()  659-660.  Also,  p.  55,  ^  117 ; 
p.  58-59,  (^  129  ;  p.  65,  ^  143  b  ;  p.  106 
-111,  ^  222-2331 ;  p.  332,  ()  501 ;  p. 
339-340,  ()  514  h;  p.  465-466,  <^  715. 
Also,  Mental  Emotions,  the  indi- 
vidual Passions;  Causes,  Morbific, 
Index  II. 

should  disease  be  set  up  in  the  part  upon 
which  morbific  causes  make  their  di- 
rect impression,  it  may  be  the  direct 
eflTect  of  the  agent,  or  more  commonly 
the  result  of  alterative  influences  of 
nervous  action  reflected  upon  the  part 
either  as  a  consequence  of  the  primary 
impression  or  as  instituted  by  some 
supervening  disease  in  other  parts — 
observing  the  same  rule  in  this  respect 
as  remedial  agents,  p.  66-67,  ij  148 ; 
p.  333,  ()  502-506  ;  p.  339-340,  ^^  514 
h;  p.  347-348,  <Si  516  rf,  No.  13;  p.  351 
-352,  ^  524:  b-d;  p  416-417,  <J  649  c; 
p.  421-424,  §  657-660 ;  p.  426,  ■;>  666  ; 
p.  429-430,  §  674  rf,-  p.  465,  ^  714; 
p.  483-484,  <^  746  c;  p.  522-523,  (j 
827  b,  c ;  p.  539,  ^  848 ;  p.  862-864, 
^  1066. 

or  is  inherited — when  the  predisposing 
causes  have  operated  upon  ancestors, 
and  this  predisposition  being  equiva- 
lent to  a  knowledge  of  the  predispos- 
ing causes  is  assumed  as  a  predis- 
posing cause,  p.  424,  ^  661  ,  p.  561, 
<;.  886. 

may  continue  after  disease  has  subsided, 
as  seen  in  fever,  dyspepsy,  &c.,when 
great  prudence  is  apt  to  be  necessary 
to  avoid  relapses,  t).  425-426,  ()  665  , 
p.  495,  ()  769  ;  p.  598-604,  ^  892  d-k, 
and  ut  supra,  and  IIabit,  Vital; 
Fever,  Index  II. 

a  knowledge  of  its  remote  causes  oflen 
very  important  for  detecting  the  true 
nature  of  the  pathological,  and  for 
directing  the  treatment,  p.  361,  ()  529 
b ;  p.  414,  (i  644 ;  p.  423-425,  <J  659 
-662  ;  p.  480,  <J  742  ;  p.  487-488,  <J 
756  ;  p.  497,  ^  776  ;  p.  509,  <j  811  ; 
p.  510,  ^  813  a,b;  p.  545,  ()  859  b; 
p.  553,  ^  870  aa  ;  p.  559-561,  <^  883  b 
-886;  p.  589,  ij  891  0,  p  639-641, 
(J  8924  ^-i;  p.  723,  ^  960  h. 

has  often  but  one  cflScient  and  indis- 
pensable remote  cause,  as  in  small- 
pox, measles,  malignant  cholera,  fe- 
vers, 6lC.,  but    there    may   be   many 


Predisposition  to  Disease — continued. 

antecedent  ones  which  predispose  the 
system  to  be  acted  upon  by  the  essen- 
tial one,  and  render  the  disease  more 
malign,  often  more  prevalent,  and 
modify  the  treatment — and  while  the 
miasmata  upon  which  fevers  depend 
have  their  action  promoted  and  in- 
creased in  intensity  by  a  variety  of 
subordinate  causes  that  are  incapable 
of  producing  the  disease,  the  same 
miasmata  are  prolific  in  predisposing 
the  system  to  the  action  of  more 
specific  causes,  as  the  self-limited 
diseases,  the  malignant  cholera,  &c., 
and  often  lay  the  foundation  of  indi- 
gestion, or  complicate  rheumatism, 
pneumonia,  puerperal  fever,  &c. — or 
the  complicating  influences  may  de- 
pend upon  hereditary  peculiarities, 
p.  65,  ^  143  a-c;  p.  67,  ()  149-151  ; 
p.  418,  ()  652  b ;  p.  420,  ^  654  a ;  p. 
424-425,  (}  662-663 ;  p.  438-442,  ^ 
686  ;  p.  489,  ^  756  b ;  p.  509,  ^811; 
p.  510,  (J  814 ;  p.  511,  <)  816  d;  p. 
538,  4  848 ;  p.  544-545,  <^  855 ;  p. 
553,  ^  870  aa ;  p.  597,  §  892  c ;  p. 
723-725,  (}  960  6-961  ;  p.  756-757,  9 
1005  b-j.  Also,  Causes,  Morbific, 
Index  II. 

Pregnancy, 

illustrates  the  natural  mutability  of  the 
properties  of  life,  which,  although 
designed  for  useful  ends,  is  rendered, 
in  the  great  plan  of  organic  beings, 
the  foundation  of  all  the  changes  that 
arise  from  the  operation  of  physical 
causes,  morbific  and  remedial,  and  of 
the  mental  emotions,  and  derides  all 
chemical  hypotheses,  p.  87,  ()  180; 
p  352,  (f  524  d;  p.  378,  ()  578  c;  p. 
434-435,  <}  680;  p.  471,  <^  732  d. 
Also,  Youth,  Infancy,  Uterus,  Or- 
gans of  Generation,  Lactation, 
Milk,  Parturition,  Index  II. ;  Vital 
Properties,  Index  I. 
occasions  an  endless  amount  of  reflex 
nervous  influences  from  those  which 
are  at  work  upon  the  stomach  from 
the  outset,  and  with  various  intensi- 
ties and  intermissions,  to  those  which 
are  in  perpetual  progress  in  gradually 
unfolding  the  mammae  till  their  force 
and  rapidity  of  action  upon  those 
organs  become  suddenly  increased  at 
the  crisis  of  parturition — and  which 
supply  a  ready  interpretation  of  the 
modus  operandi  of  all  morbific  and 
remedial  agents,  and  according  to  the 
nature  of  each  one,  through  the  same 
alterative  influences  of  reflex  action 
of  the  nervous  system,  and  whether 
those  influences  be  suddenly  exerted 
as  in  the  case  of  cathartics  and  emet- 
ics, or  continuously  as  with  setons 


INDEX    II. 


1057 


Pregnancy — continued. 

and  frequently  repeated  doses  of  medi- 
cines, p.  56,  ()  120, 121 ;  p.  61,  (^  133  c  ,■ 
p.  87,  «^  177;  p.  lll,(J233i;  p.  117- 
120,  ^  234  ^-235 ;  p.  231-232,  ^  424  ; 
p.  330,  ^500  nw;  p.  335-336,  ^  512 
a,  b ;  p.  352,  ()  524  d ;  p.  662-663,  <J 
896  ;  p.  686,  (>  905^  b.  Also,  Uterus, 
Okgans  of  Generation,  Lactation, 
Parturition,  Milk,  Kidney,  Mental 
Emotions,  Love,  Jealousy,  Fear, 
Reflex  Action,  Cathartics,  Emet- 
ics, Respiration,  Sphincter  Mus- 
cles, Alteratives;  Antimony,  Tar- 
TAiLizKD,  Index  II. ;  Nervous  Power, 
Youth,  Lidex  I.  and  II. 
Prescriptions, 

should  be  extemporaneous,  and  all  for- 
mulse  of,  with  definite  proportions  of 
the  constituents,  empirical  and  re- 
gardless of  pathological  conditions, 
p.  67-68,  ()  150-152  ;  p.  543-544,  i) 
857  ;  p.  545,  ()  859  b ;  p.  554-556,  () 
872  a.  Also,  Pathological  Cause, 
Remedies,  Index  II. 
Primordial  Cell.  See  Cell,  Primor- 
dial, Index  II.  Also,  Ovum. 
Pritchard, 

"  gets  rid  of  the  mystery  of  Vitality," 
and  Carpenter  also,  p.  40,  <J  94  h. 
Protein — continued  from  Index  I, 
not  in  the  blood,  p.  784,  (}  1031  b. 
conceded  that  "the  term  is  destined  to 
indicate    a   past   epoch   in    Organic 
Chemistry,"  p.  781,  ^  1029. 
Prout, 

his  opinion  upon  chymification,  p.  152- 
153,  (J  345-347. 
Proximate  Cause.      See  Pathological 

Cause,  Index  II. 
Proximate  Principles — continued  from 
Index  I, 
are  artificial  transformations,  p.  781,  ^ 
1030;  p.  791,  ()  1032  c. 
Puerperal  Fever.      See  Fever,  Puer- 
peral, Index  II. 
Puj.se, 

considered  in  its  only  important  symp- 
toms— hardness,  softness,  meompress- 
ibilily,  compressibility ,  quickness,  slow- 
ness, frequency,  fulness,  sviallness, 
strength,  lueakness,  obstruction,  free- 
dom, intermission,  redoubling,  trem- 
bling, and  other  inequalities,  p.  443- 
448,  «J  687^,  688. 
hardness  and  incompressibility  charac- 
teristic of  inflammation,  and  the  most 
important  and  reliable  symptoms  as 
denoting  the  nature  and  force  of  the 
disease — owing  to  the  propagation  of 
nn  alterative  reflex  nervous  influence 
upon  the  arteries,  and  through  which 
influence  the  blood,  also,  is  so  changed 
in  its  condition  as  to  result  in  buffing 
and    cupping    after    its    abstraction, 

X  X 


Pulse — continued. 

while,  again,  the  nervous  influence 
may  be  immediately  so  altered  in  its 
influence  by  loss  of  blood,  or  a  mental 
emotion,  or  more  gradually  by  other 
causes,  as  to  dissipate  those  symptoms 
— thus  showing,  also,  how  the  nervous 
influence  is  variously  modified  by  dis- 
ease, and  how  remedies  of  a  heteroge- 
neous nature  will  effect  modifications 
that  will  bring  about  a  common  result, 
and  how  the  mental  emotions  are  on 
the  same  ground  of  causation  as  phys- 
ical agents,  p.  66-67,  (/  148-151 ;  p. 
310,  H85;  p.  313,  ^  i87  gg ;  p.  444 
-445,  ^  688  a-f;  p.  547-550,  ^  863  d; 
p.  552,  ^  868  b ;  p.  664-665,  ^  900, 
901;  p.  703-710,  (/  940-9.52  b;  p. 
731-732,  ()  970  c.  Also,  ^  811;  <) 
826  cc.  Mental  Emotions,  Reme- 
dies, Soul  and  Instinct,  Ind.  II. ; 
Nervous  Power,  Index  I.  and  II. 
frequency  of,  the  next  most  important 

condition,  p.  446-447,  ()  688  i. 
nevertheless,  affections  of  the  brain  and 
heart  may  bestow  more  unequivocal 
signs,  p.  212,  ()  390  b ;  p.  313,  ij  487 
gg;    p.  443,  ()  mih  ; .  p.  447,  448,  ^ 
688  i-l. 
intermission  of,  and  other  irregularities, 
are  mostly  dependent  upon   hepatic 
disorders,  when  not  owing  to  affec- 
tions of  the  heart  and  brain,  and  are 
not  often  important  in  the  former  case, 
p.  211-212,  <5i  390  b;   p.  447-448,  (} 
688  i-l. 
is  so  capriciously  influenced  by  all  men- 
tal emotions,  posture,  motion,  reme- 
dies, food,  and  particularly  by  the  re- 
flected influences  of  the  nervous  sys- 
tem as  developed  by  diseases,  that  it 
cannot  be  often  trusted  without  the 
support  of  other  symptoms,  unless  as 
it  respects  hardness  and  incompressi- 
bility, p.  443-448,  ^  687^-688  ;    p. 
511-512,  ()  815-817;    p.  704-705,  (j 
943  a,  b;   p.  712,  ()  955  b;   p.  714,  (j 
958  b;  p.  723,  ()  960  h ;  p.  725-726, 
^96lb,c;  p.  727,  ^  962-964  ;  p.  756 
-760,  <J  1005  a-k;  Note  Ll  p.  1140. 
to    be    regarded,   therefore,  merely  as 
supplying  certain  symptoms  through 
which  the  force  and  modifications  of 
the  nervous  influence,  either  direct  or 
reflex,  as  arising  from  all   diseases, 
excepting  of  the  heart,  are  more  or 
less  ascertained,  and  thus  through  its 
various  influences  upon  the  sanguifer- 
ous organs  the  nature  and  force  of 
disease    is   inferred,  in  part,  by  the 
sense  of  touch — with  the  understand- 
ing that  the  capillary  bloodvessels  are 
the  main  instruments  of  disease  upon 
which  both  direct  and  reflex  action  of 
the  nervous  system  is  deternyned  with 
X 


1058 


INDEX    II. 


Pulse — continued. 

the  alterative  effects  that  arise  from 
morbific  and  remedial  causes,  both 
physical  andmental,  p.  226-227,  HlO, 
411,  p.  301-310,  ^80-485;  p.  354- 
355,  ^  526  a,  b;  p.  443-448.  i)  687^- 
688;  p. 804-805, ^1040.  A1so,Heart, 
Tongue,  Sweat,  Urine  ;  Brain,  In- 
flammation OF  ;  Mental  Emotions, 
Index  II. ;  Nervous  Power,  Index  I. 
H.    Also,  ()  500  m,  694i,  826  cc,  829. 

method  of  feeling  the  pulse,  §  687j, 
688  a,  805,  812,  961,  971,  990  g. 
Purpura  Hemorrhagica, 

its  pathology,  and  treatment  by  blood- 
letting, p.  754,  ()  1002  d-f. 
Pus, 

a  new  formation,  the  result  of  a  secretory 
process  brought  about  by  inflamma- 
tion, and  which  constitutes  a  natural 
termination  of  the  formative  stage  of 
that  disease,  p.  471,  <J  730. 

liable  to  be  affected  in  its  condition  by 
causes  acting  locally,  but  more  gen- 
erally through  alterative  influences  of 
reflex  action  of  the  nervous  system 
originating  in  s^me  internal  disease, 
or  by  the  same  influences  propagated 
in  a  direct  manner  upon  the  instru- 
ments of  its  formation  by  Mental 
Emotions,  p.  478-480,  ^  740-741. 
Also,  Inflammation,  Secretion  and 
Excretion,  Milk,  Bile,  Reflex  Ac- 
tion, Mental  Emotions,  Sympathv, 
Index  II. ;  Nervous  Power,  Index  I. 
and  II. ;  Vital  Properties,  Sudo- 
RiFics,  Index  I. 

allied,  in  principle,  to  lymph,  mucus, 
and  serum,  when  the  latter  are  prod- 
ucts of  inflammation  —  each  being 
consequences  of  the  formative  stage, 
p.  471-472,  «^  732  i-733,  and  refer- 
cnces  there  ;  p.  474-475,  ()  733  f-h— 
all  of  which  are  designed  for  useful 
ends,  but  lymph  and  pus  most  so,  p. 
471-476,  <J  732-733  ;  p.  546-547,  ^ 
862-863;  p. 550-551,  ^  863  c-864. 

all  its  varieties,  like  those  of  mucus,  de- 
pend upon  precise  pathological  condi- 
tions, and  more  or  less  upon  the  nat- 
ural constitution  of  the  part — which 
may  be  presented  to  Organic  Chem- 
istry as  a  problem  for  its  solution, 
taking  along  the  Mental  Emotions  as 
among  the  causes  which  modify  the 
pathological  states,  p.  120-121,  §  237 ; 
p.  452,  ^  693  ;  p.  478-480,  ()  739-741 
b.  Also,  p.  61-62,  «J  133-136  ;  p.  67, 
(l  149-151  ;  p.  224,  ^  409  h;  p.  226, 
^  410;   p.  436,  ()  682  b,  409  d. 

R. 
Race,  Human,  Unitv  of — continued  from 
Index  I., 
briefly  considered,  p.  906-907,  ^  1078  s. 


Recuperation,  Law  of, 

so  designated  by  the  Author  in  prefer- 
ence to  Vis  Medicatrix  Natura — in- 
grafted upon  the  constitution  of  all 
organic  beings,  and  upon  which  the 
Art  of  Medicine  reposes,  and  without 
which  the  whole  animal  kingdom 
would  perish.  See  Vis  Medicatrix 
Nature, Vital  Properties, Organic 
Life  ;  Adaptation,  Law  of.  Index  I. ; 
Remedies  ;  Causes,  Morbific  ;  Dis- 
eases, Self-limited,  Index  II. 
instability  of  the  properties  of  life,  or- 
dained for  useful  purposes,  and  their 
inherent  tendency  to  maintain  them- 
selves in  their  normal  state,  lie  at  the 
foundation  of  Therapeutics,  and  the 
former,  especially,  of  disease — mor- 
bific causes  altering  them  in  one  way, 
and  remedies  in  another  less  pro- 
foundly morbid,  by  'vhich  the  law  of 
recuperation  is  brought  into  effect, 
and  this  mutability  is  the  source  of 
natural  changes  which  the  system  un- 
dergoes either  in  function  or  devel- 
opment of  structure,  as  manifested  in 
gestation,  lactation,  &c.,  and  in  the 
transition  stages  from  infancy  to  adult 
age,  in  metamorphosis,  &c.,  and  is 
displayed  in  its  morbific  aspect  by  the 
impregnated  ovum,  p.  44-49,  iji  67-80 ; 
p.  61,  ij  133  c ;  p.  68-69,  ^  152-156 ; 
p.  83,  ^  174;  p.  87,  ^  177-182;  p. 
88,  {)  184  b;  p.  95-96,  (J  189  h ;  p. 
98,  ()  191  a,  b;  p.  108,  <^  228  a;  p. 
109-110,  ^  230-232;  p.  120-122,  <J 
237-240  ;  p.  131-132,  (}  285  ;  p.  352, 
()  524  d  ;  p.  373-383,  <)  576-584  ;  p. 
514,  (J  642  b;  p.  538-540,  f)  847  g- 
848  ;  p.  541,  (;»  853 ;  p.  542-543,  ^ 
854  c-856  ;  p.  551,  <;>  863  /( ;  p.  558- 
559,  <)  879-883  b;  p.  600,  <^  892  d; 
p.  664-665,  <J  899-901 ;  p.  736,  ^  980 ; 
p.  902,  (}  1078  p  ;  p.  435,  <^  680. 
Uterus,  Organs  of  Generation, 
Parturition,  Index  II. ;  Vital  Prop- 
erties, Vis  Medicatrix  Natur.«  ; 
Adaptation,  Law  of.  Index  I.; 
Youth,  Index  I.  and  II. 

Reflex  Action  of  the  Nervous  System 
and  Direct  Action, 
the  term  direct,  and  its  distinction  from 
reflex  (the  latter  of  which  the  Author 
sometimes  designates  as  mdireet,  and 
oftener  Symjta/hy),  introduced  as  the 
basis  of  his  interpretation  of  the  mo- 
dus operandi  of  the  Will  and  Mental 
Emotions, and  of  the  nervous  influence 
as  excited  by  affections  of  the  nervous 
centres,  and  for  expounding,  along 
with  reflex  action,  the  modus  operandi 
of  Loss  of  Blood,  and  for  demonstrat- 
ing the  substantive  existence  and  self- 
acting  nature  of  the  Soul  and  Instinct- 
ive Principle — and,  as  farther  explain- 


INDEX    II. 


1059 


Reflex  Action,  &c. — continued. 

ed,  the  Author  means  by  the  term 
direct  that  the  excito-motory  nerves 
or  fibres  of  compound  nerves  are  alone 
engaged,  unless  the  Passions,  as  is 
common,  and  diseases  of  the  nervous 
centres,  &c.,  institute  impressions 
upon  distant  parts  that  are  reverber- 
ated through  centripetal  nerves  upon 
those  centres,  when  the  nervous  in- 
fluence may  thus  establish  complex 
circles  of  reflex  actions,  and  undergo 
modifications  of  its  alterative  influence 
according  to  the  nature  of  the  mental 
emotion  or  any  aflfection  of  the  nervous 
centres,  as,  also,  according  to  that  of 
the  particular  natural  constitution  of 
different  parts,  and  any  present  modi- 
fied condition  of  parts  upon  which  it 
may  fall,  since,  also,  any  preternatural 
condition  of  an  organ,  whether  render- 
ed temporarily  so  by  disease,  or  only 
disturbed  by  the  nervous  influence 
(as  in  sneezing  from  a  strong  light 
impinging  upon  the  retina,  p.  327,  ^ 
500  i;  p.  333,  ()  504;  p.  340-341,  ij 
514  /),  is  equivalent  to  influences 
propagated  in  like  manner  by  the  ac- 
tion of  remedial  and  morbific  agents, 
and  will  modify  the  nervous  influence 
in  a  corresponding  manner  ;  and  upon 
this  reflected  influence  and  its  modifi- 
cations depend  the  diseases  of  organs 
that  grow  out  of  each  other,  and  the 
nature  of  the  affections  as  they  may 
spring  up  consecutively,  and  in  con- 
nexion with  the  constitutional  nature 
of  different  parts,  or  as  they  may 
conspire  together  in  aggravating  or 
relieving  the  conditions  of  each  other 
— subject  always  to  variations  from 
age,  sex,  habits,  &c.,  and  although 
the  nervous  influence  as  propagated 
upon  the  voluntary  muscles  always 
terminates  in  the  simple  production 
of  voluntary  motion  so  long  as  the 
"Will  continues  to  operate,  there  is 
the  remarkable  exception  of  roosting, 
and  some  examples  of  man  sleeping 
in  an  erect  posture,  in  which  it  estab- 
lishes an  unceasing  reflex  action,  and 
occasional  instances  of  vomiting  in 
which  the  Will  is  a  concurring  cause 
with  some  mechanical  irritation  of  the 
stomach,  p.  59,  <J  129  h,  i;  p.  61-68, 
>J  133-152;  p.  73,  H63;  p.  101-102, 
^  201-202;  p.  107-119,  (}  227-234; 
p.  282-284,  ()  451-453  ;  p.  285-286, 
<)  455  ;  p.  296,  ^  476  c  ;  p.  321,  ^  496, 
497;  p.  323-328,  H99-500  / ;  p.  331 
-334,  §  500  0-510  ;  p.  347-348,  ()  516 
d,  No.  13,  517  ;  p.  429-430,  ^  674  d; 
p.  526,  (J  828  rf;  p.  539,  ij  848  ;  p.  592, 
()  89U  k;  p.  646-648,  <J  893  e-g ;  p. 
661-663,  {}  894-896  ;    p.  665-676,  ^ 


Reflex  Action,  &c. — contbmed. 

902  a-904  b ;  p.  679-681,  ^  905  a ;  p. 
692,  ()  914-921  ;  p.  698-699,  ^  930- 
935 ;  p.  703-710,  ^  940-952  ,  p.  745 
-746,  ()  990,^  ;  p.  831-833,  t)  1057/ 
-A;  p.  838,  (}  1057i;  p.  865-868,  (} 
1067;  p.  874-881,  ^  1071-1075;  p. 
886-891,  ()  1077.  Also,  Will,  Nerv- 
ous Power,  Sympathy,  Lidex  J.  and 
II.  ;  Ment.\l  Emotions  ;  Br.'IIV,  In- 

FLAMM.4TI0N  OF;    RooSTING, //(fZcT  7/. 

rejecting  entirely  the  exceedingly  simplfi 
doctrine  of  Chemistry  as  to  the  agency 
of  the  nervous  system  in  the  various 
processes  and  products  of  the  animal 
kingdom,  and  which  have  no  reference 
to  the  physiological  laws  of  that  sys- 
tem, but  consisting  alone  in  an  abstract 
idea,  the  Author  maintains  in  all  his 
principal  writings,  as  the  groundwork 
of  their  philosophy,  that  the  nervous 
system  is  endowed  with  a  property, 
power,  or  influence  (no  matter  which) 
that  operates  as  a  vital  agent,  and  is 
so  far  on  common  ground  with  other 
vital  agents,  and  that  it  is  susceptible 
of  an  endless  variety  of  modifications 
according  to  the  nature  of  the  causes 
by  which  it  is  brought  into  action, 
and  that  there  is  imparted  to  it  the 
essential  virtues  of  the  various  causes 
respectively,  both  physical  and  mental, 
and  that  when  morbific  and  remcdi:i! 
agents  bring  about  changes  in  the 
natural  condition  of  the  solids  and 
fluids,  in  parts  beyond  the  scat  of 
their  direct  action,  or  whenever  anal- 
ogous effects  are  exerted  by  the  Men- 
tal Emotions,  or  when  diseases  ensue 
upon  each  other,  or  when  one  disease 
becomesthe  cause  of  relief  to  another, 
whether  natural  or  artificial,  it  is  al- 
ways by  alterative  influences  of  direct 
or  reflex  action  of  the  nervous  system 
determined  upon  the  capillary  vessels, 
or  main  instruments  of  all  organic 
functions,  and  that  these  influences 
depend  not  only  on  the  nature  of  the 
exciting  causes  and  other  accidental 
circumstances,  but  also  more  or  less 
upon  the  special  vital  constitution  of 
different  tissues  and  different  parts 
of  a  continuous  tissue — and  whether, 
therefore,  the  Chemical  Philosopher 
have  any  vague  regard  to  the  nervous 
system,  or  ascribe,  as  he  mostly  does, 
all  the  results  of  physical  agents  to 
their  absorption  and  direct  chemical 
action,  and  leaves  the  "  action  of  the 
nerves"  and  mental  phenomena  ob- 
scured by  "  a  \6i[  which  is  not  to  be 
raised"  (p.  183,  <S>  350|  gg),  the  dif- 
ference between  him  and  the  Author 
consists  in  the  violation  by  the  former 
of  all  the  facts  and  analogies  supplied 


1060 


INDEX    II. 


Reflex  Action,  &c. — continued. 

by  that  inorganic  world  from  which  he 
professes  to  derive  his  conclusions, 
and  the  absolute  inapplicability  of  any 
one  of  the  doctrines  to  practical  medi- 
cine, while  the  Author  presents,  as 
he  believes,  a  perfectly  consistent  ar- 
ray of  an  endless  series  of  facts  and 
of  practical  doctrines  which  are  incon- 
trovertible in  every  detail,  and  which 
has  the  special  merit  of  bringing  the 

•  Author's  doctrine  of  the  operation  of 
the  Mental  Emotions  and  the  Will 
through  the  medium  of  the  nervous 
influence  into  perfect  harmony  with 
that  of  all  physical  causes,  p.  59,  (^ 
127  i;  p.  65,  ()  143  b,  c;  p.  67-68,  () 
149-152;  p.  89,  ^  188;  p.  101-102, 
()  201-202  ;  p.  106-111,  <^  222-2331  ; 
p  230-233,  ^  422-427;  p.  282-284, 
SS  451-453  ;  p.  285,  ^  455  b,  f;  p.  295 
-296,  f)  476  b,  c;  p.  301-304,  ^  480- 
481  ;  p.  305,  ^  481  h;  p.  307-308,  () 
483  c;  p.  310,  ^  484,  Nos.  5,  6 ;  p. 
313,  H87/t;  p.314,  H88i;  p.  321, 
SS  496,  497  ;  p.  323-328,  ^  499  J-500 
m;  p.  333-341,  ^  503-514;  p.  344- 
345,  <J  516  (Z,  No.  6  ;  p.  347-349,  ^516 
d,  No.  12-520;  p.  351-353,  (}  524; 
p.  356-358,  <^  526  d;  p  360-362,  <J 
528,  529  b,  530  ;  p.  421-423,  ^  657  a- 
660  ;  p.  426,  ^  666  a ;  p.  465-467,  ^ 
714-719  ;  p.  506,  ()  803,  804  ;  p.  520 
.-521,  ^  826  d;  p.  523,  6  827,  b,  c  ;  p. 
538,  <^  847  g ;  p.  549,  ()  898  ;  p.  565, 
f)  889/,  g;  p.  592-593,  ^  89H  k;  p. 
619,  ^  892 Jf  t ;  p.  631-632,  ()  892J  ;  p. 
634,  ^  892A  6;  p.  640,  ij  892|  h;  p. 
644-650,  •^''893  c-i;  p.  652-656,  § 
893  n;  p.  661-672,  <J  894-904;  p. 
679-681,  {}  905  a;  p.  703-711,  ^  940 
952;  p.  732-736,  <;»  971-980;  p.  745 
-746,  §  990J,  ;  p.  803,  (J  1039  ;  p.  862 
-868,  <^  106"6-1067;  p.  875-877,  () 
1072  a  ;  p.  879-880,  (^  1074  ;  p.  887- 
890,  ^  1077  ;  p.  930-932,  ()  1088  a-d. 
a  still  more  remarkable  attribute  of  the 
nervous  influence  than  the  modifica- 
tions to  which  it  is  liable,  and  perfect- 
ly demonstrable,  is  a  perpetual  elec- 
tion, throughout  the  organism,  of  par- 
ticular excito-motory  nerves  without 
any  apparent  reference  to  their  order 
of  arrangement,  manifesting  its  ef- 
fects between  parts  remote  from  each 
other,  and  remote  from  the  nervous 
centres,  and  neglecting  all  intermedi- 
ate parts,  and  equally  so  whether  the 
natural  stimuli  of  life,  or  Mental  Emo- 
tions, or  the  Will  be  the  exciting 
cause ;  and  since  this  is  also  equally 
true  of  remedial  and  morbific  agents, 
and  could  not  be  so  were  their  op- 
eration through  the  medium  of  the 
circulation,  the  Author  derives  from 


Reflex  Action,  &c. — continued. 

these  exact  coincidences  between  the 
natural,  remedial,  and  morbific  agents 
an  irresistible  proof  that  the  latter  ex- 
ert their  effects  equally  with  the  for- 
mer through  the  medium  of  reflex  ac- 
tion of  the  nervous  system  (or  orig- 
inally direct  in  the  case  of  Mental 
Emotions),  and  v,'hich  renders  the 
chemical,  galvanic,  electrical,  and  oth- 
er physical  hypotheses  simply  ridicu- 
lous, p.  75-79,  §  166-167/;  p.  112,  (^ 
234  a;  p.  Ill,  (j  233i  ;  p.  116,  ^  234 
/;  p.  326-328,  ij  500  g-m ;  p.  330,  (i 
500  nn;  p.  666-672,  I)  902  6-904  b. 
Also,  p.  174-183,  ^  350i-350f  gg. 
various  explanations  relative  to  the 
mechanism  through  which  the  nerv- 
ous influence  operates  in  its  function 
of  reflex  action,  for  the  purpose  of  ap- 
plying it  to  the  interpretation  of  the 
modus  operandi  of  all  remedial  and 
morbific  agents  upon  parts  beyond  the 
seat  of  their  direct  operation,  and  also 
of  its  limitation  in  other  cases  to  the 
motor  nerves,  or  as  direct  impressions 
when  thus  produced  may  give  rise  to 
reflex  actions,  and  as  the  cause  of  all 
the  physiological  changes  in  the  solids 
and  of  all  increased  or  otherwise  mo- 
dified changes  in  the  fluids,  through 
its  various  influences  upon  the  instru- 
ments of  organic  processes,  and  of  its 
modifications  according  to  the  nature 
of  its  exciting  causes,  as  well,  also,  for 
proving  the  substantive  existence  and 
self-acting  nature  of  the  Soul  and 
Principle  of  Instinct,  p.  101-102,  <J  201 
-202  ;  p.  108,  ()  227,  No.  2  ;  p.  112,  *;> 
234  b;  p.  116-117,  ^  234/;  p.  282, 
()  451  d;  p.  285-287,  <^  455  d-459  a; 
p.  290-296,  ^  462-4761  ;  P-  300,  ^ 
479  ;  p.  309-310,  (}  484  b,  Nos.  5  and 
6  ;  p.  312-315,  !)  487  ir-489  ;  p.  321, 
^  496,  497  ;  p.  323-328,  I)  499  a-500 
m  ;  p.  331-341,  ()  500  0-514  n  ;  p.  344 
-345,  ^  516  d,  No.  6  ;  p.  347-349,  § 
516  d,  No.  13-520;  p.  416-417,  () 
649  c;  421-423,  657-658;  p.  465- 
466,  ^  715;  p.  484,  <}  746  c;  p.  523, 
(}  827  c ;  p.  565-566,  ()  889  /,  g ;  p. 
592-593,  ^  89\^g,  k;  p.  642-647,  § 
893  a-c  ;  p.  661-663,  (}  894-896  ;  p. 
665-670,  (^  902  a-n ;  p.  679-68 1 ,  ^J  905 
a;  p.  703-710, «J 940-952;  p. 733-734, 
()  974  c-975  b;  p.  873-881,  ^  1069- 
1075;  p.  886-891,  9  1077.  Also, 
Nervous  Power,  Index  J.  and  II. 
its  essential  principle,  the  nervous  pow- 
er, or  whatever  it  be,  is  not  a  mova- 
ble substance,  in  transitu  from  part  to 
part,  but,  like  the  principle  of  Light, 
is  every  where  diffused  through  its 
appropriate  medium,  and,  like  that 
principle,  is  brought  into  operation  by 


INDEX    II. 


1061 


Reflex  Action,  &c. — continued. 

exciting  causes,  and  with  every  va- 
riety of  effect,  according  to  the  nature 
of  the  causes  ;  nor  is  there  any  great- 
er difficulty  in  understanding  its  im- 
puted modifications  than  the  polari- 
zation of  light,  or  any  other  attributes 
which  the  Author  assigns  to  them, 
than  such  as  appertain  to  Light,  p. 
80,  ^  169  b,  d;  p.  84,  ^  175  b,  bb ;  p. 
88,  ()  184  b;  p.  no,  ^  232;   p.  114- 
120,  (}  234  e-235  ;  p.  330,  ^  500  rjn ;  p. 
334,  ^  507  ;  p.  670,  ^  902  k. 
its  application  to  the  modus  operandi  of 
all  remedial  and  morbific  causes  is 
founded  upon  natural  laws ;  and  the 
Author  maintains  that,  if  there  be  any 
thing  in  the  consistency  of  Nature, 
or  any  thing  in  facts,  the  same  physi- 
ological laws  which  govern  the  organ- 
ization of  the  animal  kingdom  in  its 
normal  state  are  equally  at  the  foun- 
dation of  all  its  deviations  from  the 
natural  standard,  and  that  this  uni- 
versal principle  embraces  completely 
the  physiological  laws  of  the  nervous 
system,  which,  indeed,  the  Author  has 
demonstrated  by  a  multitude  of  exact 
coincidences  between  the  results  of 
natural  causes  and  those  of  a  morbific 
and    remedial   nature,  both    physical 
and  mental,  as  appears  in  a  summary 
manner  in  the  following  sections,  and 
in  great  amplification  under  the  top- 
ics embraced  in  the  Article  Generali- 
zation of  Reflex  Action,  Index  II.,  p. 
1-2,  ^l  a;  p.  3-4,  ^  2  b-d ;  p.  106- 
1 12,  <;>  222-234  b  ;  p.  282-295,  ^  451- 
475;  p.  321-362,  H95-530;   p.  405- 
412,  i!i638;  p.  413,  ^639-640  ;  p.  541 
-543,  {)  852  rt-857  ;  p.  661-678,  (}  894 
-904;   p.  679-681,  ^  905  a ;   p.  692- 
693,  ^  915-921  ;   p.  698-699,  ^  929- 
935  ;   p.  703-711,  (}  940-952.     Also, 
Soul    and    Instinctive    Principle, 
Ind.  II.— ()  718,  795,  892  b,  990^  a,  b. 
the   entire   dependence  of  respiration 
upon  reflex  action  of  the  nervous  sys- 
tem, as  the  stimulus  of  the  muscular 
mechanism,  coincides    with    the    de- 
pendence of  the  act  of  vomiting  upon 
the  same  causation,  and  carried  by  the 
Author  through  a  long  chain  of  anal- 
ogies consisting  of  the  various  modi- 
fications of  respiration,  of  vomiting  as 
produced  by  emetics  of  various  kinds, 
by  loss  of  blood,  by  tickling  the  fau- 
ces, by  tobacco  applied  to  the  soles  of 
the  feet,  by  pregnancy,  by  shock   of 
falls,  iStc,  and  by  Mental  Emotions, 
and  the  divers  influences  and  results 
according  to  the  nature  of  the  cause, 
and  other  coincidences  supplied  by  the 
iris,  sphincter  muscles,  heart,  cold, 
suppositories,  tetanus,  &c.,  which  de- 


Reflex  Action,  &c — continued. 

pend  upon  other  institutions  of  the 
nervous  influence  through  centripetal 
and  centrifugal  nerves,  and  the  anal- 
ogies supplied  by  the  Will  in  volun- 
tary motion — all  carried  to  the  inter- 
pretation of  all  the  effects  of  active 
emetics  and  cathartics,  both  remedial 
and  morbific,  and,  by  the  same  analo- 
gies, their  effects  when  they  fall  short 
of  vomiting   and    purging,  or   other 
prominent    results    that    arise    from 
large'r  doses,  through    alterative    in- 
fluence of  reflex  action  of  the  nerv- 
ous system,  and  against  the  chemical 
and  physical  doctrines  of  operation 
through  absorption — and  all  this  chain 
of  analogies  applied  to  the  modus  op- 
erandi of  all  other  remedial  and  mor- 
bific   causes,  physical    and    reental, 
while  the  same  interpretation  of  all 
the  others  is  sustained  by  other  spe- 
cial demonstrations  in  immediate  con- 
nection with  a  large  number  of  the 
several  things  respectively,  p.  66-67, 
^  148  ;    p.  110,  ()  232  ;  p.  323-341,  <) 
499-514  m  ;  p.  334-335,  ^  5\6  d,  No. 
6  ;   p.  347-348,  ()  516  d,  No.  13  ;   p. 
421-423,  ()  657-658  ;  p.  526,  (}  828  a ; 
p.  532-533,  <J  841  ;  p.  542-543,  <^  854 
c~f;   p.  547-550,  i)  863  d;   p.  563- 
566,  ^  889  a-ff;   p.  568-569,  ^  889 
VI,  mm;    p.  592-593,  <J  89  U  k  ;    p. 
631-632,   ^  8921  b  ;    p.   661-663,   ^ 
894-896  ;  p.  666-678, ^  902  6-904  d; 
p.  679-681,  ()  905  a;    p.  703-710,  ^ 
940-952;    p.  831-833,   '^  1057 /-o-; 
p.   838,   (}    1057*-.      Also,   Stomach, 
Nauseants,  Disgust,  Emetics,  Men- 
tal Emotions,  Tetanus,  Remedies  ; 
Causes,  Morbific  ;    and    General- 
ization  of    Reflex   Action,  Index 
//.—Notes  D  p.  1114,  Co  p.  1132. 
in  the  natural  state  of  the  body,  although 
in  constant  operation  among  all  parts, 
is  not  strongly  manifested  exceptin"- 
in  particular  functions,  as  in  respira- 
tion, motions  of  the  heart  and  intesti- 
nal canal,  motions  of  the  iris,  &c.,  or 
unless  brought  into  action  by  special 
causes,  as  when  it  starts  the  urine  as 
excited  by  cold,  or  the  milk  at   the 
time  of  parturition,  and  by  the  Men- 
tal Emotions   when  its  displays  are 
very  strongly  pronounced,  the  influ- 
ence being  then  primarily  developed 
in  a  direct  manner,  and  by  the  Will, 
when  it  is  always  direct,  but  exactly 
equivalent  to  reflex  action,  p.  54-55, 
<!>  111-117;  p.  230-232,  (J  422  J-424  ; 
p.  284-289,  (}  454-461  ;  p.  296,  ^  476 
c;  p.  323-335,  <J  499-512;   p.  355, 
^  526  a.     Also,  Remedies  ;  Causes, 
Morbific  ;  Remedial  Action,  Men- 
tal Emotions,  the  individual  Pas- 


1062 


INDEX    II. 


Reflex  Action,  &c. — continued. 

sions,  Disgust;  Brain,  Inflamma- 
tion OF  ;  Secretion  and  Excretion, 
Ukine,  Sweat,  Skin,  Cold,  Milk, 
Bile,  Food,  Roosting,  Respiration, 
Sphincter  Muscles,  Youth,  Ute- 
rus, Organs  of  Generation,  &c., 
Index  II. 

is  the  exciting  cause  (primarily  direct 
or  centrifugal  in  affections  of  the 
nervous  centres)  of  all  diseases  which 
ensue  as  consequences  of  each  other, 
but  the  secondary  affections  may  be 
very  different  from  the  primary,  de- 
pending, in  part,  upon  the  peculiar 
constitution  of  different  tissues  or  of 
parts  of  a  tissue,  p.  61,  ^  153  a,  b;  p. 
62-68,  <^  135-152  ;  p.  109,  ()  229  ;  p. 
339-340,  ^  514  h ;  p.  355,  ()  426  a ;  p. 
450,  {)  689  / ,-  p.  465-469,  ()  715-722  ; 
p.  731,  <!i  970  c  ;  p.  483-484,  ()  746  c. 
Also,  Causes,  Morbific  ;  Inflamma- 
tion; Brain,  Inflammation  of; 
Skin,  Tobacco,  Seton,  Index  II. ; 
Nervous  Power,  Sympathy,  Index  I. 
and  II. 

through  its  influences  upon  the  organic 
properties,  is  the  cause  of  all  increase 
or  diminution  of  the  secretions,  and 
of  all  other  changes  that  may  befall 
them,  when  not  the  immediate  conse- 
quence of  the  direct  local  operation 
(if  other  causes,  as  in  vesication,  and 
of  many  of  the  changes  which  the 
Mood  undergoes,  and  whenever  af- 
fected by  Mental  Emotions,  though 
ill  the  latter  case  the  primary  devel- 
opment of  the  nervous  influence  is 
directly  centrifugal,  and  in  all  these 
cases  through  an  exciting,  or  depress- 
ing, or  other  modifying  effects  upon 
the  instruments  of  the  organic  pro- 
cesses, p.  230-232,  <5  422  6-424  ;  ]). 
289,  ^  461  ;  p.  296,  «J  470  c;  p.  310, 
()  485  ;  p.  331,  ^  500  o;  p.  332-334, 
<j  501-507  ;  p.  335-336,  <)  512  a-513  ; 
p.  421-423,  ()  657-658  ;  p.  483-484, 
(J  746  c;  p.  592-593,  ^  89U  k;  p. 
631-032,  ^892  J;  p.  666-669,'^  902  i- 
h;  p.  704, (Ji  943  ajj ;  p.710,ij  952  b-h; 
p.  353,  JN'o.  7.  Secretion  and  Ex- 
cretion, Urine,  Milk,  Bile,  Weep- 
ing, Sweat,  Food,  Fear  ;  Water, 
Hot;  Antimony,  Tartarized  ; 
Bloodletting,  Mental  Emotions, 
Index  II.  ;  Sudorifics,  Index  I. 

examples  of  its  effects  in  subduing  vio- 
lent inflammations,  and  of  variously 
and  suddenly  modifying  the  condition 
of  morbid  fluid  products  and  the  con- 
dition of  the  blood,  when  brought  into 
operation  primarily  in  a  direct  man- 
ner by  Mental  Emotions,  p.  296,  ^ 
476  c  ;  p.  230-232,  I)  422  J-424 ;  p. 
335-330,  ()  512  a,  d ;  p.  355,  ()  526  a ; 


Reflex  Action,  &.c. — continued. 

p.  630-632,  ^  8924  b ;  p.  709-710,  ^ 
951  i-952 ;  p.  865-868,  ^  1067. 

explains  the  philosophy  of  metastasis 
and  rcvulswn,  which  is  applied  ana- 
logically to  the  modus  operandi  of 
morbific  and  remedial  agents  through 
the  reflex  action  of  the  nervous  sys- 
tem.    See  Metastasis,  Index  II. 

the  cause  of  all  violent  disturbances  and 
convulsions,  a  large  proportion  of 
which  depend  upon  simple  irritations 
of  comparatively  unimportant  parts, 
and  supply  a  fertile  analogy  for  the 
Author's  interpretation  of  the  modus 
operandi  of  morbific  and  remedial 
causes,  physical  and  mental,  through 
direct  and  reflex  action  of  the  nervous 
system,  p.  357-358,  (j  526  d;  p.  467- 
468,  <J  719  ;  p.  590-591,  l^  89U  b  ;  p. 
592-593,  <J  89 1  i  k.  Also,  Convul- 
sions, Hysteria,  Spasmodic  Affec- 
tions, Tetanus,  Antispasmodics, 
Opium,  Index  II. — Note  D  p.  1114. 

influences  the  production  of  animal 
heat,  which  the  Author  endeavors  to 
show  is  a  secreted  product,  and  upon 
common  ground  with  other  secre- 
tions, p.  267-270,  (Ji  446-447  ;  p.  807- 
808,  ^  1044-1045.  Also,  p.  68,  ()  152 
a ;  p.  245,  ^  440  e  ;  p.  250-251,  (^  441 
c;  p.  335-336,  (}  512  a,  b ;  Tp.  339,  (/ 
514  h;  p.  365,  <J  889^;  p.  579-580, 
()  890^  d.  Organic  Heat,  Index  I. ; 
Hybernating  Animals,  Tea,  Index 
II. 

extensively  applied  in  refutation  of  the 
chemical  hypothesis  of  animal  heat, 
p.  240,  (;>  440  h ;  p.  250-253,  (}  441 
c,  d;  p.  255-256,  ^  44H  a;  p.  262- 
270,  ()  446  fl-447  d ;  p.  335-336,  ^ 
512,  1044  a,  Note  T  p.  1125. 

the  Author's  doctrine  of  its  being  the 
immediate  and  universal  exciting 
cause  of  all  the  effects  of  morbific  and 
remedial  agents  beyond  the  seat  of 
their  direct  operation,  through  its  in- 
fluences upon  the  instruments  of  or- 
ganic processes,  and  the  philosophy 
which  concerns  the  substitution  of 
transitory  pathological  conditions  for 
the  more  profound,  illustrated  by  the 
modus  operandi  of  a  Sct07i,  p.  679- 
681,  ^  905  a. 

is  always  the  cause  of  disease  that  may 
supervene  in  parts  which  are  the  di- 
rect scat  of  the  operation  of  miasma- 
ta, or  as  it  may  spring  up  in  the  skin 
when  ordinary  degrees  of  cold  give 
rise  to  pneumonia,  &c.,  through  the 
same  reflex  action,  and  in  many  anal- 
ogous cases,  and  is  generally  a  con- 
curring cause  in  the  production  and 
euro  of  diseases  in  parts  upon  which 
all  morbific  and  remedial  agents  exert 


INDEX    II. 


1063 


Reflex  Action,  &c. — continued. 

their  direct  effects,  and  in  all  cases 
the  influence  thus  reflected  may  be 
simply  a  reverberation  through  the 
centrifugal  nerves  of  the  parts  imme- 
diately acted  upon,  or  the  reflex  influ- 
ence may  depend  upon  impressions 
transmitted  from  the  superficial  to  in- 
ternal parts,  whether  morbific  or  cu- 
rative— exceptions  to  which  may  ap- 
pear to  occur  in  Setons,  Counter-irri- 
tants, &c.,but  in  these  cases  reflected 
action  upon  the  injured  part  is  sooner 
or  later  brought  into  operation,  p.  66- 
67,  9  148  ;  p.  284-287.  ^  454  c-459  ; 
p.  289,  (,  461  ;  p.  315-316,  ^  492  ;  p. 
336-340,  i)  514  b,  g,  h ;  p.  351-353, 
«J  524  d  ;  p.  416-417,  ^  649  c  ;  p.  421 
-423,  {)  657-653  ;  p.  483-484,  ^  746 
c;  p.  522-523,  ()  827  b,  c ;  p.  531,  (J 
840.  Also,  Miasm,  Predisposition, 
Skin,  Cold,  &c.,  Index  II. 
considered  in  its  slowly  progressive  op- 
eration when  brought  into  effect  by 
Author's  group  of  Alteratives,  and  an- 
alogous means  both  physical  and  men- 
tal— the  same  being  also  true  of  the 
slowly  progressive  operation  of  mor- 
bific causes,  p.  Ill,  <J  233^,  2333  ;  p. 
285-286,  H55  d-f;  p.  333,  (J  503-506, 
p.  339,  ^  514  g;  p.  344-345,  ij  516  d, 
No.  6  ;  p.  365,  \  551  ;  p.  366,  ij  556  ; 
p.  416-417,  (J  649  c;  p.  420-424,  <J 
654-661  ;  p.  532,  (J  841  ;  p.  547,  ^ 
863  d;  p  551,  ^  877;  p.  568-569,  () 
889  m,  mm;  p  592-593,  |J891K-,-  P 
599-600,  I)  892  d ;  p.  646-649,  (J  893 
e-k;  p.  661-663,  1^894-896;  p  668- 
670,  i)  902  g-m  ;  p.  675-676,  ()  904  b  ,■ 
p.  679-681,  <J  905  a.  Also,  Hydro- 
PHOBH,  Virus  of  ;  Predisposition, 
Mi.iSM,  S.M.4LL-P0X,  Alter.\tives, 
Sphincter  Muscles,  Index  II. 
applied  in  expounding  the  modus  ope- 
randi of  Cinchona,  Loss  of  Blood,  and 
of  other  things  of  which  we  are  said 
to  be  ignorant,  and  in  connexion  with 
illustrations  drawn  from  the  modus 
operandi  of  a  Seton,  and  where,  also, 
under  the  several  references,  the  or- 
ganic influences  of  remedial  agents 
through  the  instrumentality  of  nerv- 
ous action,  and  the  philosophy  which 
concerns  their  substitution  of  transi- 
tory pathological  conditions  for  the 
more  profound  as  the  fundamental 
cause  of  cure,  is  summarily  present- 
ed, p.  596-597,  ()  892  b,  c  ;  p.  676- 
681,  ^  904  b-90b  a.  Also,  p.  67,  () 
149-151  ;  p.  73,  ^  163;  p.  108-110, 
(J  227-232  ;  p.  542,  ^  854  c-e  ;  p.  554, 
^  871  ;  p.  592-593,  ()  891*  /:;  p.  661 
-663,  ^  894-896  ;  p.  664-605,  ()  900- 
901.  Also,  Bloodletting,  Reme- 
dies, &c..  Index  II. 


Reflex  Action,  &c. — continued. 

but  it  is  not  alone  the  foregoing  anal- 
ogies, as  supplied  by  respiration,  vom- 
iting, (Sec,  and  a  multitude  of  others 
of  a  corresponding  nature,  that  are 
tributary  to  the  Author's  doctrine  of 
the  modus  operandi  of  remedial  and 
morbific  agents,  through  reflex  or  di- 
rect action  of  the  nervous  system,  but 
an  almost  universal  proof  to  the  same 
effect  is  supplied  by  all  the  muscular 
movements  in  organic  life,  by  that  of 
the  muscular  coat  of  the  intestinal 
canal,  by  the  muscles  of  deglutition, 
that  of  the  bladder,  that  of  the  uterus, 
&c.,  and,  what  is  especially  import- 
ant, by  the  heart  and  entire  arterial 
and  venous  systems,  whose  active  mo- 
tions, if  not  wholly  determined  as  it 
respects  their  exciting  cause,  are  at 
least  greatly  influenced  by  the  refle.x 
action  of  the  nervous  system  excited 
by  the  stimulus  of  blood,  being  whol- 
ly true  of  the  heart,  p.  301-310,  ^ 
481-485;  p.  338-339,  514/;  p.  343, 
344-348,  ()  516  d,  Nos.  3-5,  7, 12,  13, 
and  conspicuously  so  by  mental  emo- 
tions, food,  exercise,  &.C.,  and  by  dis- 
eases generally,  all  of  which  is  refer- 
able alone  to  the  stimulus  of  nervous 
influence — upon  which,  collectivel}% 
is  founded,  in  part,  the  Author's  doc- 
trine of  the  action  of  the  capillary  ar- 
teries and  of  the  veins  as  among  the 
important  elements  in  the  circulation 
of  the  blood,  p.  62,  (}  136  ;  p.  209-210, 
<)  384-337;  p.  211,  ()  390  b,  and  de- 
duced, in  farther  part,  from  experi- 
ments made  upon  arteries  by  Buniva, 
Procter,  and  Kreimer,  p.  215-216,  () 
399  ;  p.  310,  ()  485,  and  subsequent- 
ly confirmed  by  Brown-Sequard  and 
others,  p.  803-804,  ()  1039  ;  p.  805,  () 
1041 — and  which  is  at  the  foundation, 
in  part,  of  the  Author's  theory  of  the 
active  condition  of  the  instruments  of 
inflammation,  p.  485-486,  ^  750-751, 
and  references  there,  and  of  his  the- 
ory, also,  of  the  ready  transition  of 
venous  congestion  into  the  ordinary 
form  of  inflammation,  p.  506-507,  () 
803,  804 — and  in  consideration  of  all 
of  which,  and  of  the  manifest  influ- 
ences of  the  nervous  system  upon  the 
capillary  bloodvessels  (those  main  in- 
struments of  all  organic  processes  and 
their  results,  p.  226-227,  <J  410,  411) 
that  are  determined  upon  them  by  a 
vast  variety  of  the  natural  stimuli  of 
life,  physical  and  mental,  it  cannot  be 
doubted  that  all  remedial  and  morbific 
agents  must  of  necessity  exert,  through 
that  same  nervous  influence,  more 
powerful  and  disturbing  effects  upon 
those  instruments,  and  thus  become 


1064 


INDEX    II. 


Reflex  Action,  &c. — continued. 

the  immediate  exciting  cause  of  dis- 
ease, of  the  increase,  diminution,  and 
other  changes  in  the  secretions,  and 
equally  also  of  those  pathological  va- 
riations impressed  by  remedial  agents, 
and  through  which  the  more  profound- 
ly morbid  are  placed  in  the  way  of 
tlie  recuperative  process,  p.  541-542, 
^  852-854  e  ;  p.  664-665,  <J  899-901. 
Also,  Skin,  Cold,  Kidney,  Organs  of 
Generation,  Uterus,  Parturition, 
Food.  Fear,  Disgust,  Nervous  Sys- 
tem, &c..  Index  II.  ;  Vital  Proper- 
ties, Organic  Life,  Index  I.;  Nerv- 
ous Power,  Index  I.  and  II. 
but  the  nervous  influence  is  in  no  fun- 
damental sense,  as  is  generally  sup- 
posed, the  cause  of  the  organic  func- 
tions in  Animals  any  more  than  of  the 
analogous  functions  of  Plants,  which 
are  carried  on  by  properties  implant- 
ed in  all  parts,  but  contributes  a  mod- 
ifying and  exciting  or  depressing  in- 
fluence to  the  nutritive  and  other  se- 
cretory vessels,  through  which  the 
products  are  perfected,  or  increased, 
(ir  diminished  ;  but  these  instruments 
are  constantly  liable  to  preternatural 
influences  from  either  direct  or  reflex 
nervous  action,  and  of  an  endless  va- 
•  ricty,  and  there  is  no  function  in  the 
natural  state  of  the  body,  no  condition 
of  disease,  no  action  of  remedies,  in 
which  the  nervous  system  does  not 
participate  (p.  54-55,  <J  109  b-\  17  ;  p. 
284-287,  ()  454  c-459  ;  p.  289,  ^61; 
p.  483-484,  (J  746  c),  while  organs  in 
their  compounded  condition  are  more 
evidently  under  its  perpetually  har- 
monizing influence  through  the  im- 
pressions made  upon  their  minute 
structure — and  coming  to  many  func- 
tions that  are  less  concerned,  or  not 
at  all,  in  the  essential  processes  of  or- 
ganic life,  as  in  respiration,  contrac- 
tion of  tiic  sphincter  muscles,  motion 
of  the  iris,  peristaltic  movements,  &lc., 
the  nervous  influence  is  the  only  im- 
mediate exciting  cause  —  an  obvious 
distinction,  therefore,  being  made  by 
the  Author  between  the  nervous  influ- 
ence as  an  exciting  or  modifying  cause 
or  vital  agent  and  the  fundamental 
causes  or  organic  properties  by  which, 
in  connexion  with  organization,  the 
functions  are  carried  on  ;  and  hence, 
whenever  the  Author  speaks  of  the 
nervous  influence  as  a  cause,  he  sim- 
l)iy  means  an  exciting  or  vwdifymg 
cause,  p.  23,  <J  34-38  ;  p.  24,  ij  41,  42  ; 
p.  54-55,  ()  109  i-117;  p.  60-67,  (j 
148  ;  p.  75-76,  (^  107  a  ;  p.  88,  ()  183, 
184  ;  p.  110,  <)  233  ;  p.  222-227,  <J  409 
c-411  ;    p.  284-286,  §  454-457;   p. 


Reflex  Action,  &c. — continued. 

289,  l^  460-46H  ;  p.  294,  (^  475  ;  p. 
295-296,  i)  476  b  ;  p.  31 1-315,  i)  488- 
489  ;  p.  317-318,  ij  493  ;  p.  421-423, 
^  657-658  ;  p.  483-484,  (J  746  c ;  p. 
745-746,  ^  990^.  Also,  Vital  Prop- 
erties, Organic  L.ife,  Index  I. ;  Res- 
piration, Sphincter  Muscles,  Iris, 
Cathartics,  &c..  Index  II. 

influences  the  sensibility  of  nerves,  by 
which  it  is  the  cause  and  cure  of  pain 
when  not  the  direct  result  of  causes 
acting  locally,  and  according  to  the 
nature  of  the  means  by  which  it  is 
brought  into  operation,  whether  mor- 
bific, or  sedative,  or  loss  of  blood, 
&c.,  and  pain  is  equally  relieved 
through  the  same  influence  by  Mental 
Emotions,  and  according  to  their  na- 
ture, p.  102,  ^  201-202  ;  p.  108,  ^  227  ; 
p.  296,  <J  476  c;  p.  302,  M81  6;  p. 
323-324,  ()  500  c;  p.  584-585,  ^  891 
d,  e;  p.  587-590,  ^  891  /t-s,-  p.  592- 
593,  ()  891i  k;  p.  831-832,  <J  1057/; 
p.  838,  ^  1057i  ;  p.  862-864,  ^  1066. 
Also,  Antispasmodics,  Sedatives 
(Aconite),  Opium,  Neuralgia,  Pain, 
Poultices,  Warm  Bath,  Bloodlet- 
ting, Index  II. 

may  be  brought  into  suddenly  fatal  op- 
eration upon  the  nervous  centres  ei- 
ther through  centripetal  nerves,  as  in 
blows  upon  the  epigastrium,  &c.,  or 
by  mental  or  other  causes  acting  di- 
rectly upon  those  centres,  when  life 
may  be  instantly  extinguished  by  their 
direct  violence  upon  their  organic  con- 
stitution, or  may  be  also  simultane- 
ously reflected  with  a  corresponding 
fatal  eflect  upon  the  whole  organism, 
p.  107-111,  ^  226-233J;  p.  296,  (J 
476  e;  p.  298,  ()  476i  h;  p.  300,  ^ 
479  ;  p.  301,  (^  480  ;  p.  302,  ()  481  b  ; 
p.  304,  ()  481  g;  p.  306-308,  ^  483 
b ;  p.  320,  i)  494  dd  ;  p.  324,  ^  500  c, 
d;  p.  334-335,  i)  509-511  ;  p.  402- 
403,  ()  634-635  ;  p.  534,  <)  844  ;  p. 
704,  ()  943  a-944  a ;  p.  707,  ^  947 ; 
p.  709,  <J  951  b-d ;  p.  831-833,  <J  1057 
/,  g;  p.  858,  <)  1057+  ;  p.  862-864,  (/ 
1066;  p.  865-868,  <)  1067;  p.  878- 
881,  (J  1074-1075;  p.  887,  5  1077. 
Also,  Joy  and  Anger,  Mental  Emo- 
tions, Pain,  Neuralgia,  Opium,  An- 
tispasmodics ;  Serpents,  Virus  of; 
Hydrocyanic  Acid  ;  Brain,  Inflam- 
mation of;  Stomach,  Blows  upon; 
Bloodletting,  Loss  of  Blood,  Re- 
medial Action,  Index  II.  ;  Will,  In- 
dex I.  and  II. 

is  the  main  cause  of  hardness  and  tw- 
compressibilitij  of  the  pulse,  and  of 
bufiing  and  cupping  of  blood,  in  in- 
flammations, while  the  Loss  of  Blood 
or  a  Mental  Emotion   will  speedily 


INDEX    II. 


1065 


Ruriex  Action,  &c. — continued. 

modify  its  influence  and  render  it  sub- 
versive of  those  conditions,  and  is  also 
mostly  the  exciting  cause  of  the  va- 
rious appearances  presented  by  the 
tongue,  and  which,  in  both  cases,  as 
with  many  other  symptoms,  are  most- 
ly useful  in  denoting  the  special  modi- 
fication and  force  of  the  nervous  in- 
fluence, and  through  which  is  inferred 
the  nature,  seat,  and  force  of  disease, 
the  effects  of  remedies,  &c.,  p.  444- 
445,  <J  688  ;  p.  708-710,  I)  951-952  b. 
Also, Tongue, Kidney, Urine,  Sweat, 
Bloodletting,  Index  II. ;  ()  500  m. 

mistakes  in  regard  to,  from  confounding 
the  results  of  experiments  on  trunks 
of  nerves  with  those  upon  their  ex- 
panded extremities,  p.  338,  (}  514  d; 
p.  347,  {)  516  d,  No.  10;  p.  520-521, 
^  826  d.  Also,  Medical  and  Physio- 
logical Commentaries,  vol.  i.,  p.  507, 
563-566. 

the  distinction  should  be  observed  be- 
tween irritability,  and  common,  spe- 
cific, and  sympathetic  sensibility,  and 
that  the  last  only  is  concerned  in  re- 
flex action  of  the  nervous  system,  and 
that  causes  affecting  the  nervous  cen- 
tres in  a  direct  manner  operate  pri- 
marily through  excito-motory  nerves 
alone,  p.  88-89,  ()  183-188  c;  p.  100 
-103,  ^  197-204  ;  p.  280-282,  <)  450- 
451  ;  p.  671,  <J  903.  Also,  Mental 
Emotions,  Disgust,  the  individual 
Passions;  Brain,  Inflammation  of, 
Index  II. 

recent  observations  upon,  confirmingim- 
portant  principles  in  these  Institutes, 
p.  803-808,  (j  1039-1045. 

the  coincidences  in  effects  of  reflex  and 
direct  action  of  the  nervous  system, 
or  as  the  centripetal  and  centrifugal 
nerves  are  engaged  in  the  former  pro- 
cess, and  the  centrifugal  alone  in  the 
latter,  form  the  basis  of  the  Author's 
demonstration  of  the  substantive  ex- 
istence and  self-acting  nature  of  the 
Soul  and  Instinctive  Principle,  p.  873 
-910,  (j  1069-1082.  Also,  Mental 
Emotions,  the  individual  Passions, 
Index  II. ;  Will,  Lidcx  I.  and  II. 

employed  by  the  Author  to  expound  the 
dependence  of  the  first  act  of  respira- 
tion, when  the  point  of  departure  is 
from  the  skin,  in  Medical  and  Physi- 
ological Commentaries,  and  again  in 
the  original  Essay  on  the  Soul  and  In- 
stinctive Principle,  and  in  analogical 
demonstration  of  the  substantive  ex- 
istence and  self-acting  nature  of  the 
Soul  in  the  latter  work,  and  in  the 
former  on  account  of  Miiller's  affirma- 
tion that  "  it  appears  to  me  to  be 
solely  the    stimulus   aflTorded  to  the 


Reflex  Action,  &c. — continued. 

brain  and  medulla  oblongata  by  the 
blood,vi\\ic)\  immediately  becomes  ox- 
ydized  in  the  lungs"  (Mijller's  Phys- 
iology, p.  335),  upon  which  the  En- 
glish Translator  remarks,  "  How  can 
the  air  be  drawn  into  the  lungs'!" — 
and,  in  the  foregoing  Essay,  the  Au- 
thor remarks  that  "a  beautiful  ex- 
emplification (of  reflex  action  of  the 
nervous  system)  is  seen  in  the  new- 
born infant  and  other  animals  breath- 
ing with  lungs,  as  I  have  explained  on 
a  former  occasion,  since  here  the  first 
impression  is  transmitted  to  the  nerv- 
ous centres  through  the  sensitive 
nerves  of  the  skin  in  consequence  of 
the  contact  of  cold  air  with  the  sur- 
face. This  is  the  rationale  of  the  first 
breath  we  draw,  standing  alone  in  or- 
ganic life ;  and  the  same  thing  hap- 
pens, as  I  also  explained,  when  cold 
air  or  cold  water,  applied  to  the  sur- 
face, reproduces  breathing  in  syncope ; 
or,  if  it  be  ammonia,  &c.,  applied  to 
the  nose,  then  the  sensitive  nerves 
are  branches  of  the  fifth  pair  of  cere- 
bral. I  will  also  now  say  that  the 
function  of  the  pneumogastric  nerve 
is  developed  for  the  first  time  by  the 
first  act  of  inspiration,  and  fully  de- 
veloped, both  as  it  respects  the  lungs 
and  the  stomach." — Essay  on  the 
Soul  and  Instinct,  p.  57-58  (1849). 
Also,  Skin,  Loss  of  Blood,  Syncope, 
Index  II.     Also,  p.  406,  §  638. 

explains,  through  its  primary  direct  de- 
velopment by  the  Will,  the  act  of 
roosting  and  of  sleeping  in  the  erect 
posture,  and  in  a  manner  analogous 
to  its  action  upon  the  sphincter  mus- 
cles, and  employed  in  demonstrating 
the  substantive  existence  and  self- 
acting  nature  of  the  Soul  and  Princi- 
ple of  Instinct,  p.  890-891,  (J  1077. 
Also,  Sphincter  Muscles,  Alter.v- 
TivEs,  Roosting,  &c..  Index  II. 

its  physiological  laws  without  any  prac- 
tical use  till  applied  by  the  Author  to 
Pathology  and  Therapeutics,  p.  106, 
ij  222  b;  p.  111-112,  ^  334  a,  b;  p. 
1 18,  ()  234  h  ;  p.  283,  ^  452  b ;  p.  285- 
286,  ()  455  d-f;  p.  296,  ()  476  c ;  p. 
317-318,  (}  493  a-d;  p.  320,  ^  494 
dd;  p.  329-330,  (}  500  nn;  p.  341- 
342,  ()  514^  b ;  p.  515,  (J  819,  820 ;  p. 
579,  ()  890^  c  ;  p.  596,  (}  892  b  ;  p.  690 
-691,  ()  906  ^-910  ;  p.  361,  ^  530. 

for  the  convenient  reference  of  those 
who  may  take  an  interest  in  the  Au- 
thor's reclamation  (p.  912),  he  sub- 
joins some  of  the  distinct  claims  and 
proofs,  which  for  seventeen  years  had 
received  universal  acquiescence,  of 
his  priority  in  the  application  of  the 


1066 


INDEX    II. 


Reflex  Action,  &c. — continued. 

physiological  laws  of  reflex  action  of 
the  nervous  system  to  Pathology  and 
Therapeutics  in  all  its  ramifications, 
and  of  the  dependence  of  the  effects 
of  the  Mental  Emotions  and  of  the 
Will  upon  the  same  nervous  influence, 
as  variously  presented  in  this  work, 
and  which  application  is  still  limited 
to  his  writings,  <J  111-113;  ij  224  ;  () 
226;  ()  234  a,  b;  p.  113-114,  i)  234 
d;  p.  116-117,  <J  2Mf,g;  p.  236,  i) 
435-436 ;  p.  262,  (J  446  a ;  p.  264,  <j 
446  d;  p.  282-284,  ()  451  rf-453  ;  p. 
289,  <^  459  g;  p.  295,  ()  476  a;  p. 
295,  ()  475MV6^  b;  p.  298-299,  ^ 
477  a;  p.  301-302,  <J  481  h;  p.  309- 
310,  (i  484,  No.  5  ;  p.  318,  ^  493  d ;  p. 
320,  ^  494  dd ;  p.  323-353,  ()  499-524 ; 
p.  357-358,  i)  526  d;  p.  361-362,  ^ 
530  ;  p.  515-516,  <^  819  6-820  ;  p.  523, 
^  827  c  ;  p.  592-593,  ^  891^  k ;  p. 643, 
()  893  a  ;  p.  671-672,  ^  903,  904  a ; 
p.  676-677,  <J  904  c;  p.  679-681,  ^ 
905  a ;  p.  690-691,  (J  906  g ;  p.  692- 
693,  ^  914-921  ;  p.  698-699,  ^  929- 
935  ;  p.  703-710,  ^  940-952  ;  p.  733 
-735,  (}  972-978 ;  p.  745-746,  ()  990 
*-990i  b  ;  p.  873-891, ^  1069-1077  ; 
p.  912-920,  ()  1084— and  Medical  and 
Physiological  Commentaries,  Articles 
particularly  on  Bloodletting  and  Hu- 
moral Pathology,  vol.  i.  (1840);  and 
on  the  Modus  Operandi  of  Remedies, 
vol.  iii.  (1842) ;  and  as  to  the  ^' exci- 
to-secretory  action"  (p.  913),  which 
had  been  noticed  by  Uichat  (p.  270, 
()  447  d),  and  fully  established  by 
Philip's  Experiments  as  early  as 
1815  (and  therefore  more  than  twen- 
ty years  prior  to  the  cursory  observa- 
tions of  Henle  and  others,  who  had 
only  incidentally  referred  to  it,  p. 
314-315,  (j  489;  p.  317-318,  ^  493 
«-(/),  the  Author  applies  it  through- 
out this  work  to  all  the  functions 
which  undergo  any  increase  of  their 
products  (with  the  few  exceptions,  as 
in  the  case  of  vesicants,  &c.,  where 
the  physical  agents,  more  than  the 
nervous  influence,  are  the  exciting 
causes),  and  the  Author  carefully  de- 
fines the  nervous  influence,  both  in  its 
connexion  with  the  secretions  and  all 
other  results,  as  "  an  exciting  and 
modifying  cause,"  or  a  "  vital  agent," 
to  distinguish  it  clearly  from  the  or- 
ganic properties  upon  which  they  es- 
sentially depend,  p.  106-110,  <^  224- 
233;  p.  193,  <;>  356  a;  p.  230-232,  (^ 
422-424;  p.  262-263,  <i  446  a;  p. 
289,  (J  461  ;  p.  294,  ^  475,  and  refer- 
ences there  ;  p.  325-326,  <^  500  ce ; 
p.  335-336,  <J  512  a,  h ;  p.  350-353, 
()  524,  No.  1,7;   p.  630-632,  ()  892| 


Reflex  Action,  &c. — continued. 

b;  p.  667-669,  <;>  902  f-h ;  p.  704,  () 
943  a,  b ;  p.  733-734,  ^  974  a-c ;  p. 
746,  I)  990^-  b — and  not  less  sedative, 
p.  107-108,^  226,  227;  p.  109,  ^ 
230  ;  p.  302-303,  <^  481  c,d;  p.  507- 
508,  <;i  806 ;  p.  592-593,  ij  89  H  ^c ;  p. 
661-663,  ()  894  b-896 ;  p.  746,  ^  990^ 
b ;  Sedatives,  Index  II. — but,  what  is 
incomparably  more  important,  and 
alone  of  any  value,  and  which  the 
Author  claims  as  his  own,  is  the  prac- 
tical application  of  the  laws  of  the 
nervous  system  to  Pathology  and 
Therapeutics,  while,  also,  he  constant- 
ly represents  its  reflex  and  direct  ac- 
tion, when  brought  into  unusual  op- 
eration, as  altering  the  natural  condi- 
tion of  the  secreted  fluids  and  the 
blood  by  its  influences  upon  organic 
processes,  and  uniformly  expounds 
all  tlie  effects  of  remedial  and  mor- 
bific agents  beyond  the  seat  of  their 
direct  operation,  and  the  analogous  ef- 
fects of  the  Mental  Emotions,  through 
its  alterative  action,  and  represents  it 
as  always  participating,  as  a  vital 
and  modifying  cause,  in  the  organic 
processes  of  animals,  and  exerting 
upon  the  organic  fluids  a  vitalizing 
influence  —  and  it  has  been  no  less 
an  object  to  array  all  this  philosophy 
against  the  chemical,  humoral,  and 
physical  doctrines,  p.  193,  <J  356  a; 
p.  262-263,  (J  446  a;  p.  289,  ^61; 
p.  335-336,  ()  512  a,  b;  p.  475,  ^ 
733  h ;  p.  710-711,  (J  952  A-^— though 
to  what  extent  is  doubtful,  p.  54-55, 
§  110-117;  p.  108-110,  ()  227-233; 
p.  224,  <^  309  g ;  p.  286,  ()  456  ;  p. 
289,  (^  461  ;  p.  303,  H81  rf;  p.  332- 
333,  ^  501-502  ;  p.  483-484,  ()  746  c ; 
p.  746,  ()  990^  b — nor  can  it  be  de- 
cided, p.  286-289,  {/  458-461  ;  p.  296, 
(J  476^  b;  p.  298,  ()  476^  h;  p.  300, 
()  479  ;  p.  303,  ()  481  e,  f;  p.  342- 
343,  ()  516  a-d ;  p.  792-793,  <)  1032  d. 

Religion, 

distinguishes  Reason  from  Instinct,  p. 
901, ^  1078  n. 

Remedial  Action, 

a  chapter  devoted  to  a  summary  review 
of  direct  and  reflex  action  of  the  nerv- 
ous system,  as  variously  expounded 
in  preceding  parts  of  the  work,  and 
preparatory  to  an  exposition  of  the 
modus  operandi  of  Bloodletting,  re- 
garding it  as  the  great  alterative  agent 
in  the  production  and  cure  of  dis- 
eases, modified  in  its  nature  accord- 
ing to  tlie  nature  of  each  exciting 
cause,  whether  physical  or  mental, 
stimulating,  depressant,  or  sedative, 
either  simply  so  or  with  alterative  ef- 
fect, and  producing  through  the  me- 


INDEX    II. 


1067 


Remedial  Action — continued. 

dium  of  organic  structure  correspond- 
ing changes  in  the  solids  and  fluids, 
p.  661-683,  ()  894-905.  Also,  Nerv- 
ous Power,  Sympathy,  Index  I.  and 
II. ;  Reflex  Action  of  Nervous 
System,  Remedies  ;  Causes,  Morbif- 
ic ;  Bloodletting,  Loss  of  Blood, 
Leeching,  Therapeutics,  Mental 
Emotions,  &c..  Index  II. 

the  whole  philosophy  of  the  operation 
of  remedial  and  morbific  agents  rests 
upon  physiological  principles,  wheth- 
er as  manifested  through  the  medium 
of  the  nervous  influence,  or  in  their 
more  independent  action  upon  the  or- 
ganic constitution  of  parts  with  which 
they  may  come  into  contact,  but  dif- 
fering from  the  natural  stimuli  of  life 
not  only  in  the  greater  manifesta- 
tions of  the  nervous  influence,  but  in 
the  alterative  effects  which  it  exerts, 
p.  1,  (J  1  a ;  p.  2-4,  (}  2  a-4:  a ;  p.  36- 
49,  <J  63-81  ;  p.  54-55,  <J  109-117  ;  p. 
58-59,  ^  129  c-i;  p.  61-73,  (j  133- 
163;  p.  101-J02,  <)  201-202;  p.  106 
-112,  <5  223-234  ;  p.  121-122,  ()  237- 
240  ;  p.  147, 1)  330  ;  p.  282-362,  ()  451 
-530  ;  p.  352,  ^  524  d ;  p.  405-414,  <) 
638-640  ;  p.  541-543,  <^  832-854  ;  p. 
565,  I)  889  f,g;  p.  592-593,  <J  891^- 
k  ;  p.  661-667,  <^  894  i-902  d  ;  p.  679 
-681,  §905 a;  p.  703-710, 'J  940-952  ; 
p.  732-736,  ()  971-980  ;  p.  745-746,  () 
990^  ;  p.  131-132,  ^  285-288 ;  p.  398, 
()  626  ;  p.  467,  ^  715-719  ;  p.  503,  (} 
795 ;  Reflex  Action,  Remedies  ; 
Causes,  Morbific,  Index  II. 

lying  at  the  foundation  of  the  whole, 
both  of  remedial  and  morbific  action, 
is  the  mutability  of  the  Organic  Prop- 
erties, which,  in  being  designed  for  a 
variety  of  useful  purposes,  such  as 
the  progressive  changes  of  organiza- 
tion from  Infancy  to  Manhood,  gesta- 
tion, lactation,  &c.,  is  necessarily  sub- 
ject to  deleterious  influences  from  nu- 
merous external  and  internal  causes, 
while  others  of  a  different  nature  are, 
for  the  same  reason,  and  through  an- 
other great  law  (the  increased  sus- 
ceptibility of  morbid  states  to  the  ac- 
tion of  the  latter  class  in  such  regu- 
lated modes  as  shall  not  act  profound- 
ly), capable  of  substituting  other  path- 
ological changes,  which,  through  an- 
other great  law  (the  inherent  tend- 
ency of  the  organic  properties  to 
maintain  their  normal  state),  subside 
spontaneously  into  the  natural  phys- 
iological conditions.  See  Vital  Prop- 
erties, Index  I. ;  Causes,  Morbific  ; 
Remedies,  Therapeutics,  the  several 
subdivisions  relative  to  the  foregoing 
topics.     Also,  Pregnancy,  Parturi- 


Remedial  Action — continued. 

TioN,  Lactation,  Organs  of  Gener- 
ation, Index  II. ;  Youth,  Index  I.  and 
II. 

illustrations,  exemplifj'ing,  by  natural 
processes,  the  modus  operandi  of  re- 
medial and  morbific  agents,  physical 
and  mental,  through  direct  and  reflex 
action  of  the  nervous  system,  p.  110, 
S^  232;  p.  230-232,  ()  422-426;  p. 
250-251,  i)  441  c;  p.  262-263,  §  446 
a ;  p.  284-286,  ()  454-456  ;  p.  296,  § 
476  c;  p.  302,  ^81^;  P-  323-328,  ^ 
500  c-500  m;  p.  331-332,  <J  500  o, 
501;  p.  334,  >;>  509  ;  p.  335-341,  §  512 
-514  VI ;  p.  344-345,  ()  516  d.  No.  6  ; 
p.  347-348,  ij  516  rf,  No.  13  ;  p.  350- 
353,  I)  524 ;  p.  359,  (^  527  b ;  p.  413, 
§  639  a ;  p.  565,  §  889  g ;  p. 592-593, 
^  89U  I:;  p.  631-632,  ^  892J  b;  p. 
745-746,  i)  990^  ;  p.  886-891,  (}  1077. 
Also,  Youth,  Pregnancy,  Lactation, 
Organs  of  Generation,  Index  II. 

its  modus  operandi  and  of  morbific 
causes  through  direct  and  reflex  nerv- 
ous action  demonstrated  by  experi- 
ments upon  the  nervous  system,  p. 
295-321,  <)  476-494. 

the  physiological  laws  of  the  cerebro- 
spinal and  ganglionic  systems  intro- 
duced to  illustrate  and  corroborate 
the  Author's  doctrine  of  remedial  and 
morbific  action  through  alterative  in- 
fluences of  direct  and  reflex  nervous 
action,  p.  290-294,  ()  462-475  ;  p.  335 
-362, ^  512-530. 

a  special  example  of  extensive  remedial 
effect  through  alterative  influence  of 
reflex  nervous  action  in  the  emetic 
operation  of  Tartarized  Antimony, 
and  where  the  secretions  are  seen  to 
be  suddenly  and  greatly  augmented 
through  that  influence,  as  in  the  ex- 
amples supplied  naturally  by  the  kid- 
neys, skin,  lachrymal  gland,  salivary 
and  mammary  glands,  liver,  &c.,  p. 
668-669.  ^  902  g,  h ;  p.  672,  §  904  a. 
Also,  Kidney,  Skin,  Urine,  Bile, 
Milk,  Loss  of  Blood,  Weeping, 
Food,  &c..  Index  II. 

other  examples  of  Tartarized  Antimony, 
Mercury,  and  other  things,  of  their 
gradually  alterative  action — illustrat- 
ing the  difference  in  development  of 
reflex  nervous  influence  from  what 
obtains  when  remedies  operate  more 
abruptly — the  same  being  also  true 
of  morbific  causes,  p.  669-681,  ^  902 
j-905a.  Also,  p.  Ill,  §  233^,233}; 
p.  285-286,  (J  455  d ;  p.  333,  (;  503- 
506  ;  p.  339,  (J.  514  ^,  A  ;  p.  344-345, 
<}  516  d,  No.  6  ;  p.  365,  (}  551  ;  p.  366, 
()  556  ;  p.  416-417,  (j  649  c ;  p.  420- 
424,  §  654-661 ;  p.  532,  §  841 ;  p. 
547,  4  863  rf;  p.  551,  §  867  ;  p.  568- 


1068 


INDEX    II. 


Remedial  Action — continued. 

569,  ()  889  m,  mm ;  p.  592-593,  <J  891*- 
k ;  p.  599-600,  <^  892  d ;  p.  646-649, 
^  893  c-h;  p.  661-663,  §  894-896; 
p.  668-670,  i)  902  g-m ;  p.  675-676, 
^  904  b.  Also,  Alteratives,  Index 
II. 
illustrations  of  the  rapidity  with  which 
the  reflex  action  of  the  nervous  influ- 
ence is  determined  with  fatal  efiect 
by  Hydrocyanic  Acid  and  Strychnia 
— being  analogous  to  sudden  death 
from  blows  upon  the  epigastric  re- 
gion, and  the  shock  of  surgical  opera- 
tions, only  in  the  former  case  the 
nervous  influence  is  fatally  modified 
in  its  nature,  while  in  the  latter  it  is 
excited  only  in  greater  intensity  and 
suddenness,  and  against  their  sup- 
posed absorption,  p.  176,  ^  350^  -p 
p.  298,  ()  476^  h;  p.  320,  (^  494  dd 
p.  523-524,  (}  827  d ;  p.  670,  <J  902  / 
p.  672,  <J  904  b — and  illustrations,  in 
connexion  with  the  foregoing,  of  the 
corresponding  modus  operandi  of  Opi- 
um, Hyoscyamus,  Atropia,  Tobacco, 
Belladonna,  Rhus  vernix,  p.  338,  ^ 
516rf,  No.  13;  p.  592-593,  ^  89H  k; 
p.  673-675 — and  farther  illustrations 
of  the  cfiicient  instrumentality  of  the 
nervous  influence  when  syncope  or 
death  is  suddenly  brought  on,  or  dis- 
ease suddenly  arrested  by  loss  of  blood 
or  by  mental  emotions — all  showing 
how  the  nervous  influence  may  be  de- 
termined directly  upon  the  organic 
constitution  of  the  nervous  system, 
as  well  as  upon  other  organs,  either 
by  the  suddenness  of  the  shock  or  by 
special  virtues  of  morbific  causes,  and 
all  conspiring  together  in  showing 
that  a  common  cause  is  the  immedi- 
ate agent,  p.  109,  ()  230  ;  p.  298,  () 
476^  h ;  p.  304,  H81  5" ;  P-  307-308, 
^  483  c;  p.  334-335,  i)  509-511  ;  p. 
G62-663,  ^  895,  896  ;  p.  703-704,  <;> 
942  b ;  p.  706-707,  ^  947-948  ;  p.  709, 
^  951  b — and  associate  with  the  fore- 
going the  sudden  death  of  warm- 
blooded animals  from  the  bite  of  ven- 
omous reptiles,  and  which  was  shown 
by  Girtanner,  and  again  by  Van  Dcen 
and  Stilling,  to  be  as  quickly  fatal  in 
eviscerated  frogs  as  in  the  entire,  p. 
319,  ^  494  b;  p.  325-326,  ()  828  h-d 
— to  all  of  which  Chemistry  is  de- 
sired to  render  an  intelligible  answer, 
if  dt  can,  consulting,  also,  in  the  same 
connexion.  Reflex  Action,  Mental 
Emotions,  Joy  and  Angek,  Fear, 
Disgust  ;  Stomach,  Blows  upon  ; 
Hydrocyanic  Acid,  Antispasmodics, 
Sedatives  {Aconite),  Opium,  Tobac- 
co, Cantharides,  Bloodletting, 
Loss  of  Blood,  Lidcx  II. 


Remedial  Action — continued. 

statement  by  Pereira  that  "  the  fact  is 
that  in  the  present  state  of  our  knowl- 
edge we  cannot  explain  the  modus 
medendi  of  a  large  number  of  our  best 
and  most  certain  remedial  agents," 
and  that  "  the  methodus  medendi  of 
Cinchona,  in  its  cure  of  intermittents, 
is  quite  inexplicable,"  considered  in 
relation  to  Cinchona  by  interrogating 
its  methodus  medendi  as  a  Tonic  in 
opposition  to  the  doctrine  of  "  aiig- 
mentalion  of  cohesion  of  the  organic 
mass,"  as  in  the  process  of  tanning, 
and  thence  deducing  its  operation  in 
all  forms  of  disease,  and  of  all  oth- 
er remedies,  through  alterative  action 
of  reflex  nervous  influence,  and  far- 
ther illustrated  as  an  antiperiodic  by 
comparison  with  the  antidotal  nature 
of  Coflfee  and  the  Cold  dash  in  poi- 
soning by  Opium,  and  of  Antispas- 
modics in  cases  of  spasm,  and  by  the 
morbific  and  curative  eflects  of  a  Se- 
ton,  and  converting  the  whole  to  one 
common  account,  \jhich  is  relative  to 
variously  modified  conditions  of  reflex 
nervous  action  according  to  the  nature 
of  the  causes  by  which  it  is  brought 
into  preternatural  operation,  and  the 
nature  of  the  pathological  conditions, 
p.  338,  <;i  514  rf  ;  p.  592-593,  ^Q9\^k; 
p.  596-597,  (5i  892  i,  c  ;  p.  676-681,  ^ 
904  c-905  a;  p.  737-738,  (^  984  h. 
Also,  p.  67,  ij  149-151  ;  p.  73,  i)  163  ; 
p.  108-110,  (j  227-232  ;  p.  542,  ^  854 
c-e;  p.  554,  l^  871;  p.  661-663,  ^ 
894-896  ;  p.  664-665,  (J  900-901. 

modus  operandi  of  warm  poultices  and 
hot  fomentations  considered  through 
a  series  of  analogies  in  relation  to 
other  remedies,  till  we  arrive  at  these 
most  simple,  but  important  auxili- 
aries in  establishing  the  restorative 
disposition,  p.  68 1-683,  i;  905  b.  Also, 
■Poultices,  Index  II. 

the  supposed  absorption  of  blue  mer- 
curial ointment  contradicted  by  the 
failure  to  detect  the  metal  in  the  sol- 
ids or  fluids,  and  in  being  useful  in 
cases  of  indurated  tumours  only  when 
applied  directly  over  them,  and  the 
statement  in  Pereira's  Materia  Mcdi- 
ca,  which  expresses  the  common  doc- 
trine that  "the  occasional  use  of  the 
warm  bath  promotes  an  absorption  of 
the  blue  mercurial  ointment  when  ap- 
plied to  the  skin,"  is  remote  from  the 
philosophy  which  refers  the  greater 
eflects  of  the  mercurial  to  an  in- 
creased susceptibility  of  the  skin  and 
system  at  large,  which  the  warm  bath 
alone  "  promotes,"  and  which  is  more 
cflTectually  promoted  by  loss  of  blood 
and  cathartics  when  mercury  is  ad- 


INDEX    II. 


1069 


Remedial  Action — continued. 

ministered  internally,  p.  367,  <J  556  c; 
p.  520,  '^i  826  c  ;  p.  524,  I)  827  e.     Al- 
so, Mercurial  Remedies,  Index  II. 
modus  operandi  of  open  air,  change  of 
air,  exercise,  &,c.,  in  their  curative  ef- 
fects through  complex  influences  of 
reflex  nervous  action,  p.  543,  ^  855  ; 
p.  670-671,  {)  902  in.     Also,  p.  335- 
336,  ^  512  a,  b ;  p.  351-352,  ^  524  c  ; 
p.  354,  ^  525  c ;  p.  359,  <J  527  b ;  p. 
421-422,  ^  657  a;  p.  685,  ^  905^  b. 
Also,  Exercise,  Phthisis,  Whoop- 
iNG-CouGH,  Ulcers,  Food,  Altera- 
tives, Amenorrhcea,  Index  II. 
demonstration  of  the  coincident  eflTects 
of  direct  and  reflex  action  of  the  nerv- 
ous system  when  brought  into  simple 
operation  in  voluntary  and  involun- 
tary respiration,  and  in  the  voluntary 
•  and   involuntary   contraction    of  the 
sphincter  muscles,  and  carried  as  the 
fundamental  philosophy  to  the  inter- 
pretation of  the  modus  operandi  of 
Mental    Emotions    and    of  physical 
causes  in  the  production  and  cure  of 
disease  through  the  same  direct  and 
reflex  nervous  action,  and  in  proof, 
also,  of  the  substantive  existence  and 
self-acting   nature    of  the   Soul    and 
Principle    of  Instinct,  p.  106-112,  ^ 
222-234  ;  p.  124-125,  (}  243-246  ;  p. 
296.  ^  476  c  ;  p.  302,  (J  481  b  ;  p.  323 
-330,  ()  500  c-nn ;  p.  338,  339,  ^  514 
d,  g,  h  ;  p.  662,  ()  896  ;  p.  666-670,  () 
902  b-m;  p.  874-881,  ^  1071-1075. 
Also,  Mental    Emotions,  Respira- 
tion, Sphincter  Muscles,  Iris,  &c.. 
Index  II. 
distinction   between  the    foregoing  ef- 
fects of  the  nervous  influence  in  the 
natural  processes   and  in  the  opera- 
tion of  remedial  and  morbific  causes, 
physical  and  mental — that,  in  the  lat- 
ter cases,  the  influence  is  alterative, 
and  attended  by  complex  circles  of 
reflex  action  of  the  nervous  system, 
and  exemplified  by  Cathartics,  Emet- 
ics,  Counter-irritants,    Grief,    Hope, 
&c.,  p.  67-68,  <J  149-152  a;  p.  121- 
122,  \  237-240  ;   p.  296,  I)  476  c ;   p. 
323-324,  ^  500  c,  d;   p.  563-566,  ^ 
889  a-rr;  p.  568-569,  ^  889  m,mm; 
p.  592-593,  <!i  89U  /t;  p.  646-650,  ^ 
893  c-i;  p.  666-672,  ()  902  i-904  b; 
p.  746,  ^  990J  b. 
organs  not  morbidly  affected  which  may 
be  brought  under  the  influence  of  rem- 
edies'contribute  to  the  cure  of  such 
as  are  diseased,  through  the  alterative 
influence  of  reflex  nervous  action,  the 
latter  organs  being  now  rendered  sus- 
ceptible of  such  influences  by  their 
morbid  states,  and  the  influences  thus 
propagated  will  depend  upon  the  na- 


Remedial  Action — continued. 

ture  of  the  remedy,  as,  for  example, 
Tartarized  Antimony  will  establish  a 
powerful  reflected  influence  from  the 
skin,  though  it  do  not  induce  sweat- 
ing, but  Hot  Water  taken  internally, 
and  Fear,  will  exert  no  effect,  though 
they  bathe  the  skin  with  perspiration, 
while  the  compound  powder  of  Ipe- 
cacuanha and  Opium,  though  it  estab- 
lish free  diaphoresis,  may  prove  mor- 
bific  in    the    same    cases — showing, 
also,  that  the   same  principle  holds 
with  morbific  causes,  while  there  fol- 
lows in  the  example  before  us,  and  in 
other   instances   where    the    skin   is 
likely  to  contribute  to  the  curative 
process  (as  in  the  cases  of  Cathartics), 
and  along  with  other  facts,  a  practical 
corollary  that  the  skin  participates  far 
more  than  is  apt  to  be  supposed,  not 
only  in  remedial   influences,  but  in 
morbific,  and  that  it  should  not  be  im- 
paired in  the  former  function  by  ex- 
posure to  cold,  but  rather  promoted 
by  the  warmth  of  a  bed  ;  and  the  fol- 
lowing sections,  as  with  all  other  ref- 
erences, have  a  direct  or  an  illustra- 
tive bearing  upon  the  subject,  p.  55,  ^ 
117;  p.  59,  ^  129  i;  p.  63,  ^  137  <^,- 
p.  65,  ^  143  c;  p.  66-67,  (j  148;   p. 
68,  ^  152  a,  b ;  p.  230-232,  f)  422-424  ; 
p.  285-286,  ()  455  c-f;  p.  302-303,  ^ 
481  c-e;   p.  308-310,  ()  484;  p.  319 
-320,  ^  494  d,  dd;  p.  335-336,  ()  512 
a,  h;   p.  338,  ^  514  d;   p.  339-340,  (j 
514  h  ;  p.  350-353, ^  524  a-d;  p.  360 
-361,  §  528  ;  p.  421-422,  i}  657  a  ;  p. 
451,  ^  692  a;  p.  465-466,  f)  715;  p. 
538-539,  ^  847  g--848  ;  p  546-550,  ^ 
863  a-f;  p.  563-564,  <;i  889  a  ;  p.  565, 
^  889  £r;   p.  570,  (j  889  n;   p.  633- 
635,  ij  892|  a-c  ;  p.  637,  ^  8924  d,  e ; 
p.  667-669, 1)  902  e-i;  <J  956.     Skin, 
Cold,    Miasm,    Whooping  -  Cough, 
Phthisis,  Shower-Bath,  Counter- 
Irritants,  Index  II. 
the  occurrence  of  a  secondary  or  sym- 
pathetic disease  is  sometimes  follow- 
ed by  a  subsidence  of  a  primary  affec- 
tion upon  which  the  secondary  de- 
pends, as  a  consequence  of  alterative 
reflex  nervous  actions  which  are  an- 
alogous to  such  as  are  instituted  by 
counter-irritants,  though  in  a  general 
sense  the  primary  affection  gets  no 
benefit,  but  the  contrary,  from  second- 
ary developments,  p.  65-66,  ()  143  c, 
and  references  there  ;  p.  67,  ij  148  ;  p. 
351-352,  ()  524  c;  p.  360,  ij  528  ;  p. 
421-422,  (J  657 ;    p.  506,  ^  804 ;    p. 
539,  (j  848  ;  p.  570.  (^  889  n ;  p.  652- 
654,  (J  893  n;  p.  679-681,  ()  905  a. 
Also,  Metastasis,  Poultices,  Index 
II 


1070 


INDEX    II. 


Remedial  Action — contmued. 

as  displayed  by  the  Mental  Emotions, 
whether  in  their  primary  connexion 
with  excito-motory  nerves  alone,  or  as 
they  give  rise  to  subsequent  devel- 
opments of  reflex  nervous  action  (see 
Mental  Emotions  and  Disgust,  In- 
dex II),  a  perfect  correspondence  is 
seen  between  their  effects  and  those 
of  physical  causes,  operating  alike 
upon  distant  parts,  or  upon  the  or- 
ganic constitution  of  the  nervous  cen- 
tres, with  both  morbific  and  remedial 
effect,  or  as  anger  and  joy  may  extin- 
guish life  in  the  same  sudden  manner 
as  a  blow  upon  the  head,  or  through 
those  more  complex  nervous  influ- 
ences that  spring  from  a  blow  upon 
the  region  of  the  stomach,  or  from 
the  shock  of  a  surgical  operation,  or 
from  drinking  cold  water  in  "  a  heat- 
ed state  of  the  body,"  or  from  hydro- 
cyanic acia  ;  and  we  unavoidably  de- 
duce from  the  vast  variety  of  efTccts 
according  to  the  nature  of  the  emo- 
tion or  the  physical  cause,  and  from 
the  exact  coincidences  in  all  their  ef- 
fects, the  certainty  of  an  immediate 
cause  appertaining  to  the  nervous 
system  and  its  endless  modifications 
according  to  the  nature  of  the  remote 
exciting  cause,  and  looking  alone  at 
the  mental  emotions  and  those  phys- 
ical causes  which  arc  incapable  of  ab- 
sorption, and  at  the  diseases  which 
grow  consecutively  out  of  each  other, 
we  are  constrained  by  all  the  immense 
amount  of  proof  which  is  thus  sup- 
plied to  carry  it  analogically  to  the 
interpretation  of  the  modus  operandi 
of  all  other  remedial  and  morbific 
agents  through  alterative  influences 
of  that  same  reflex  action  of  the  nerv- 
ous system  upon  all  parts  beyond  the 
seat  of  their  direct  operation,  and  may 
finally  appeal  for  the  same  testimony 
to  the  natural  stimuli  of  life,  to  the 
blood  as  it  maintains  the  action  of  the 
heart  through  the  same  process  of  re- 
flex nervous  influence,  and  so  of  the 
urine  and  the  bladder,  the  faeces  and 
the  sphincter  ani,  the  motions  of  the 
iris,  the  sneezing  as  induced  by  snuff 
and  the  sun's  light,  the  process  of 
respiration,  the  act  of  deglutition,  and 
as  some  are  imitated  and  others  influ- 
enced by  the  will,  and  as  the  genital 
organs  unfold  the  peculiarities  of 
youth,  as  pregnancy  nauseates  the 
stomach  and  develoi)s  the  mammary 
glands,  and  as  parturition  starts  the 
flow  of  milk  and  leaves  the  uterine 
system  in  a  condition  to  perpetually 
excite  a  reflex  nervous  influence  that 
shall  maintain  the  secretion  till  men- 


Remedial  Action — continued. 

struation  terminates  the  process, 
while,  also,  the  stimulus  of  suction 
propagates  a  reflex  nervous  influence 
upon  the  uterine  organs,  and  main- 
tains them  in  a  condition  to  carry  out 
the  final  cause  of  lactation — or,  turn- 
ing to  the  natural  displays  of  the  mind, 
we  may  pursue  the  coincidences  be- 
tween the  effects  of  fear  and  the  con- 
tact of  cold  with  the  surface  of  the 
body  in  starting  on  the  instant  the  se- 
cretion of  urine,  or  as  the  odor  of  food, 
or  its  expectation,  and  its  presence  in 
the  stomach  equally  determine  an  ex- 
citing nervous  influence  upon  the  sal- 
ivary glands,  and  as  grief  and  sneez- 
ing alike  give  rise  to  tears,  and  as  the 
sun's  light  and  thinking  of  the  parox- 
ysm occasion  sneezing,  and  as  dis- 
gust and  its  recollection,  and  an  emet- 
ic, and  tickling  the  fauces  alike  pro- 
duce vomiting — and  we  conclude  by 
commending,  in  connexion  with  the 
foregoing,  the  following  sections, 
which  are  mostly  relative  to  the  Men- 
tal Emotions  and  the  Will,  to  the 
candid  attention  of  the  Organic  Chem- 
ist and  the  impartial  Materialist,  the 
former  of  whom  will  find  these  work- 
ings of  the  mind  through  the  nervous 
influence  applied  in  a  great  variety  of 
modes  as  parallel  examples  with  the 
influences  of  physical  agents  on  life, 
and  designed  to  illustrate  the  modus 
operandi  of  morbific  and  remedial 
agents  of  every  denomination  and 
shade,  and  the  latter  an  irrefutable 
demonstration,  as  the  Author  be- 
lieves, of  the  substantive  existence 
and  self-acting  nature  of  the  Soul,  p. 
89,  ()  188  ;  p.  95,  (^  188^-  d;  p.  104, 
<J  215  ;  p.  107,  <^  227  ;  p.  108-110,  <J 
228;  p.  111,(;.233|;  .p  124-125,  (^  243 
-246 ;  p.  128,  ^  226,  227;  p.  230,  ^  422 
b;  p.  263,  H46a;  p.  281,  <^  451  a;  P- 
296,  ^  476  c ;  p.  298,  (J  476i  h ;  p.  300- 
302,  ^  479,  480,  481  6;  p. 312-313,  ^ 
487^,A;p.314,  H88i;  p.  823-331,'^ 
500  c-o;  p.  334-336,  ()  507-513  ;  p. 
337,  ^  514  c  ;  p.  338,  <^  514  f;  p.  340- 
341,  <;.  514  /,  m  ;  p.  356,  (t  520  c  ;  p.  369 
-370,  ^  565-568  ;  p.  378-381,  ()  578 
■  r/-579  ;  p.  382,  ^  581  c-e ;  p.  387,  (} 
597  d  ;  p.  388,  ^  598  d  ;  p.  390,  (J 
600  h,  601  c  ;  p.  417,  ^  649  c  ;  p.  478, 
^  740  a  ;  p.  523,  <J  827  c  ;  p.  525- 
526,  <)  828  a-c ;  p.  527,  s''  828  e ;  p. 
530,  ^  837  b ;  p.  534,  ()  844 ;  p.  547, 
^  863  d;  p.  580,  <)  890^  d;  p.  586,  (} 
891  p,  h;  p.  589-590,  ()  8'Jl  p;  p. 
592-593,  (Ji  89H  A- ;  p.  624,  s^  892?  d  ; 
p.  631-632,  <)  892f  b,  c;  p.  662-663, 
(J  896  ;  p.  664,  {)  900  ;  p.  070-672,  ^ 
903-904  a ;  p.  674,  t)  904  b ,-  p.  075, 


INDEX    II. 


1071 


Remedial  Action — continued. 

^  904  b;  p.  681-682,  ()  905  d;  p. 
701,  ^  938  b  ;  p.  704,  ()  943  ft-944  a ; 
p.  707,  <!i  947  ;  p.  709,  (J  951  d ;  p. 
714,  ()  958  6  ;  p.  733,  <^  974  c  ;  p. 
734-735,  ^  975  i-976  ;  p.  745-746,  ^ 
960:^  a,  6  ,•  p.  804,  <^  1040  ;  p.  865- 
868,  ()  1067 ;  p.  874,  ^  1071  ;  p.  875- 
881,  ^  1072-1075;  p.  886-891,  ^ 
1077.  Also,  the  several  topics  al- 
luded to  in  the  foregoing  preamble,  as 
embraced  in  Index  II. 

illustrated  in  all  its  phases  by  the  mo- 
dus operandi  of  Setons,  whose  variety 
of  eftects  manifest  all  that  is  essen- 
tially relative  to  the  operation  of  all 
remedial  and  morbific  agents,  physic- 
al and  mental,  and  as  well  in  respect 
to  the  direct  local  action  of  physical 
causes  as  to  their  influences  through 
the  medium  of  reflex  action  of  the 
nervous  system,  and  exemplifying 
also  the  distinction  made  by  the  Au- 
thor between  the  transient  operation 
of  the  nervous  influence  as  brought 
into  effect  by  a  single  or  interrupted 
applications  of  remedial  and  morbific 
agents  and  by  their  undisturbed  or  but 
temporarily  suspended  application,  p. 
679-681,  <J  905  a ;  p.  668-669,  <;.  902 
g-i.  Also,  Alteratives  ;  Antimo- 
ny, Tartakized  ;  Sphincter  Mus- 
cles, Roosting,  Index  II. 

if  disease  be  limited  to  a  part  on  which 
remedies  make  their  direct  impression, 
the  change  may  then  be  instituted  by 
the  direct  action  of  the  cause  upon 
the  organic  states  of  the  part  (the 
nerves,  however,  participating  more 
or  less,  p.  475,  ^  733  h  ;  p.  483-484,  () 
745  c),  and  which  may  be  also  true 
of  morbific  causes  in  their  production 
of  disease,  as  seen,  in  either  case,  of 
the  curative  or  morbific  effects  of 
caustics,  &c.  ;  but  it  more  commonly 
happens  that  a  reflected  nervous  in- 
flluence  upon  the  part  is  the  immedi- 
ate agent,  p.  66-68,  (}  148  ;  p.  422- 
423,  ^  658.  Also,  Remedies,  where 
this  subject  is  illustrated  through  nu- 
merous references.  Index  II.;  ^  514  b. 

distinctions  to  be  observed  between  im- 
pressions made  on  vritabiUty,  and 
common,  specific,  and  sympathetic  sen- 
sibility, and  that  the  last  only  is  con- 
cerned in  reflex  action  of  the  nervous 
system,  while  causes  affecting  the 
nervous  centres  in  a  direct  manner 
operate  primarily  through  excito-mo- 
tory  nerves  alone,  p.  671,  <S>  903. 
Also,  p.  88-90,  ij  183-188  c  ;  p.  100- 
103,  {)  197-204;  p.  280-282.  <J  450- 
451 ;  Mental  Emotions,  Reflex  Ac- 
tion, individual  Passions,  Disgust  ; 
Brain,  Inflammation  of.  Index  II. 


Remedial  Action — continued. 

the  fundamental  philosophy  of  disease 
and  its  cure,  according  to  the  Au- 
thor's interpretation,  is  perfectly  sim- 
ple, but  involves  very  complex  laws 
and  details,  consisting  in  the  former 
respect  of  certain  changes  in  the  nat- 
ural physiological  conditions,  and  in 
the  latter  of  introducing  other  patho- 
logical changes  that  shall  subside 
spontaneously  into  the  natural  condi- 
tions, p.  3-4,  s^  2  b-d;  p.  331,  <;>  500 
o;  p.  122,  i)  239,  240  ;  p.  333,  ^  503- 
505  ;  p.  352,  ()  524  d;  p.  413-414,  (^ 
639-640  ;  p.  427,  <^  667-669  ;  p.  473- 
474,  ()  733  e,  f ;  p.  531,  i)  839;  p. 
535-539,  (j  847-850  ;  p.  541,  (}  852- 
854  b;   p.  542,  (J  854  c-e ;   p.  544- 

545,  <^  858-859  a  ;  p.  592-593,  §  89U 
k ;  p.  662,  ^  895  ;  p.  663-665,  <J  897- 
901  ;  p.  646,  ()  893  e  ;  g.  652,  ^  893  / ; 
p.  679,  ()  905.  Remedies  ;  Causes, 
Morbific  ;  Therapeutics  ;  Diseases, 
Self-Limited  ;  Small-Pox,  Struc- 
ture, Index  II. 

may  introduce  a  variety  of  pathological 
changes  in  any  existing  disease,  ei- 
ther of  which  may  be  adequate  to  the 
cure,  since  all  remedies  operate  by 
establishing  morbid  states  that  will 
soon  subside  spontaneously,  the  re- 
flex nervous  influence  through  which 
the  changes  are  effected  being  modi- 
fied according  to  the  special  virtues 
of  every  remedy  (which  includes  the 
dose,  the  nature  of  the  disease,  con- 
tingent influences.  Sec),  and  hence 
the  reason  why  loss  of  blood,  cathar- 
tics, tartarized  antimony,  mercury, 
ipecacuanha,  counter-irritants,  syn- 
cope from  mental  emotions,  &c.,  will 
alike  remove  common  inflammation, 
and  certain  "  specifics"  (cinchona,  ar- 
senic, guaiacum,  colchicum,  iodine) 
specific  forms  of  inflammation  when 
they  would  increase  common  inflam- 
mation, and  cinchona,  arsenic,  a 
shock  of  the  mind,  and  many  other 
things  whose  chemical  and  other 
physical  properties  are  totally  differ- 
ent from  each  other  will  break  up  an 
intermittent  fever,  and  which  are  also 
propounded  as  problems  for  Organic 
Chemistrv,  p.  107-111,  ()  227-233J  ; 
p.  333,  •^■'503-505;  p.  417,  ij  649  c, 
650  ;  p.  424-425,  ()  662  a-e  ;  p.  428, 
<J  671-674  ;  p.  486,  ^  750  h  ;  p.  542, 
^  854  c-e;   p.  544,  ^  857;    p.  545- 

546,  ()  859  i-861  ;  p.  547-550,  ()  863 
d ;  p.  553,  (J  870  an  ;  p.  596-597,  (> 
892  b,  c;  p.  604-606,  (^  892  m-p ;  p. 
611-612,  ij  892i/-2 ;  p.  659,  ()  893  q  ; 
p.  662-665,  (J  896-901  ;  p.  709,  <J  951 
b;  p.  737,  >J  984;  i,  892  b;  ()  892^ 
v;  \  904  d;  fj  1059.     Mental  Emo- 


1072 


INDEX    II. 


Remedial  Action — coritinued. 

TioNs,  Joy  and  Anger,  Fear,  Hope, 
Disgust,  &c..  Index  II. 

in  very  complex  conditions  of  disease, 
as  idiopathic  fever  attended  by  in- 
flammations of  many  parts,  the  rela- 
tions between  the  morbid  states  may 
be  such  that  a  single  remedy,  as  loss 
of  blood,  tartarized  antimony,  or  mer- 
cury, may  overthrovsr  the  entire  as- 
semblage, p.  63,  ^  147  c-e ;  p.  65,  ^ 
143  c;  p.  66-67,  ()  148-151  ;  p.  298, 
()  476.^  h  ;  p.  337,  ()  514  b,  c  ;  p.  367, 
^  557  a,  h  ;  p.  465-466,  ()  715  ;  p.  538, 
^  847  g;  p.  552-554,  ^  869-871  ;  p. 
662-664,  <)  895-900  ;  p.  731-732,  () 
970  c ;  p.  739-740,  ^  986-987. 
Remedies — continued  from  Index  I., 

operate  through  the  natural  laws  which 
govern  organic  processes  in  the  ani- 
mal kingdom,  as  do  also  morbific 
causes,  but  bring  into  preternatural 
effect  the  nervous  influence.  See  this 
subdivision  under  Reflex  Action  of 
THE  Nervous  System.  Also,  Hu- 
moral Pathology,  Chemical  Physi- 
ologists,/nrfcx  77.  ,•  Organic  Chem- 
istry, Index  I.  and  II. 

should  be  addressed  to  the  pathological 
conditions  as  denoted  by  the  whole 
assemblage  of  symptoms,  and  not  to 
isolated  ones,  p.  65-67,  ()  143  c-151  ; 
p.  73,  ^  163  ;  p.  147,  ()  330  ;  p.  424- 
425,  ^  661-662  ;  p.  428,  ()  694  a;  p. 
430-433,  i)  675-676  a ;  p.  437-442,  ^ 
684-686  ;  p.  456-460,  «^  695-708  ;  p. 
479-480,  <J  471  a,  b  ;  p.  486,  (}  750  b  ; 
p.  487-489,  ^  756  ;  p.  498-499,  <J  785  ; 
p.  505,  ^  801  ;  p.  510,  ^  813  b  ;  p.  541 
-542,  ^  854  bb ;  p.  545,  ()  859  b ;  p. 
548-550,  ^  863  d;  p.  551-554,  ()  867 
-871:  p.  560-561,(^886-888;  p.  597 
-600,  ^  892  c,  d ;  p.  603-004,  ^  892  k ; 
p.  606,  ^  892  ;; ;  p.  609-610,  <J  892i 
(/;  p.  613,  ()  8921  c;  P-  615-617,  ^ 
892i  f-k ;  p.  636-642, !)  8924  d-i ;  p. 
063-665,  {}  897-901  ;  p.  724-728,  (J 
901  ;  p. 729-732,  ^  906-970  ;  p.  732- 
736,  ()  971-980. 

by  their  impression  upon  parts  with 
which  they  come  in  contact,  if  their 
nature  admit  of  it,  or  according  to 
other  impressions  arising  from  loss 
of  blood,  exercise,  &c.,  influences  are 
transmitted  tlirough  sensitive  fibres  of 
compound  nerves  (mainly  of  the  sym- 
pathetic) to  the  cerebro-spinal  axis, 
whicii  rouse  and  reflect  the  nervous 
influence  upon  various  parts  of  the 
organism,  but  particularly  upon  the 
seats  of  disease,  and  when  Mental 
Emotions  give  rise  to  analogous  ef- 
fects, the  principle  is  the  same,  only 
the  influence  is  now  primarily  exerted 
directly  upon  the  nervous  centres  and 


Remedies — continued. 

the  first  movement  centrifugal,  and 
what  is  true  in  this  respect  of  reme- 
dies is  equally  so  of  morbific  causes, 
p.  88,  ()  183-185;  p.  89,  <J  188  a,  b; 
p.  95,  ()  188^  d,  189  a ;  p.  96-98,  ^ 
189  c-191  b;  p.  101-103,  <J  201-208  ; 
p.  106-112, 1^222-234  i;  p.  230-231, 
^  422-423  ;  p.  253,  ()  4AI  d;  p.  262- 
270,  ()  446  a-447  d;  p.  282,  ^  451  f; 
p.  283-284,  (}  452  c,  453  ;  p.  285-286, 
<)  455  d-4:57  ;  p.  289, 1)  459  g ;  p.  295, 
()  476  a;  p.  296,  ^  476  c,  476^^  J;  p. 
298-299,  (j  477  a;  p.  301-303,  ()  481 
b-d ;  p. 309-310, ^  484  i-485  ;  p.  312 
-314,  ()  487  g--488i  ;  p.  315-318,  (} 
492-493  ;  p.  320,  ()  494  dd ;  p.  321,  § 
496,  497  ;  p.  323-362,  (J  499-530  ;  p. 
364,1^547;  p.  415-417,  «  649  ;  p.  421 
-423,  ()  057-658  ;  p.  430-432,  <)  675  ; 
p.  451,  ^  691-692  ;  p.  478-479,  ^  740 
-741  ;  p.  509,  i^)  811.;  p.  515-516,  ^ 
819  J-820  ;  p.  522-523,  ()  8.27  b,  c  ;  p. 
530-533,  <;»  837  i-841  ;  p.  534,  <)  844  ; 
p.  541-542,  (}  854  bb ;  p.  544,  ()  857 ; 
p.  545,  (J  859  a-c ;  p.  547-550,  ()  863 
d ;  p.  551-553,  «J  867-870  ;  p.  553,  ^ 
870  aa ;  p.  554-556,  ()  872  ;  p.  592- 
593,  ^891  k ;  p.  644-652,  ^  893  c-m  ; 
p.  661-683,  ^  894-905;  p.  692-693, 
^  914-921  ;  p.  698-699,  <)  929-935; 
p.  703-710,  <^  940-952  ;  p.  724-723, 
<)  961-964;  p.  732-736,  ()  972-980; 
p.  745-746,  I)  990  s-990i  b ;  p.  766- 
767,  (J  1009  a,b;  p.  862-868,  (^  1060 
-1067. 
operate  through  influences  of  reflex 
nervous  action  according  to  structure 
and  special  vital  constitution  of  differ- 
ent farts  (some  remedies  affecting 
particular  tissues  as  united  in  certain 
compound  organs  only,  or  only  par- 
ticular parts  of  a  continuous  tissue), 
and  according  to  the  changes  they  un- 
dergo from  infancy  to  adult  age,  and 
temperament,  and  especially  as  they 
may  be  diverted  by  morbid  states  from 
their  natural  condition,  which  renders 
them  more  susceptible  of  remedial  in- 
fluences, but  also  according  to  the  nat- 
ural stimuli  of  life,  though  differing 
from  the  natural  not  only  in  the  far 
greater  manifestations  of  the  reflex 
nervous  influence,  but  in  the  altera- 
tive effect  it  exerts  in  diseased  states 
of  the  body — the  same  being  true  in 
principle  of  morbific  causes  ;  while, 
also,  many  natural  stimuli,  especially 
food,  may  be  profoundly  morbific  or 
curative  in  diseased  states  of  the 
body,  p.3,()2b;  p.  55.  (J  113-117; 
p.  59,  ^129^-?;  p.61-73,  H33-161  ; 
p.  98,  «J  191  b;  p.  120-122,  i}  237- 
240  ;  p.  130,  (J  278  ;  p.  231,  ^  422  c- 
424  ;  p.  284-289,  <}  454-461 ;  p.  352, 


INDEX    II. 


1073 


Remedies — continued. 

^  524  d;  p.  354-361,  ^  526-530;  p 
364,  <^  548  ;  p  365-368,  ^  551-560  ; 
p.  373-390,  t)  574-601  ;  p.  399,  ()  630 , 
p.  415-416,  (}  648  rf-649  h;  p.  418,  ^ 
651  a,  b;  p.  421-422,  i)  657  a,  b;  p. 
424,  ^  662  ;  p.  425,  ()  663  ;  p.  428,  (} 
671;  p.  435, 1^680;  p.  467,  i!»  718  ;  p. 
468-469,  ^  722  ;  p.  502-504,  (^  793- 
798  ,  p.  509,  ^811;  p.  520-521,  ^  826 
d;  p.  522-523,  ()  827  b,  c;  p.  530,  (J 
837  b ;  p  535-539,  ()  847-850  ;  p.  541 
-542,  ()  854  bb ;  p.  543,  ()  855  ;  p.  545, 
^  859  a-c ;  p.  553,  ^  870  aa ;  p.  554, 
ij)  871  ;  p.  565-566,  ^  889  g,  i ;  p.  579 
-580,  ^  890.^  (i ;  p.  597-598,  ()  892  c  ; 
p.  612,  (J  892^  a  ;  p.  624,  ()  892|  rf  ;  p. 
634-636,  (J  8924  J,  c ;  p.  647,  (}  893  c  ; 
p.  649,  <J  893  k;  p.  651,  ^  893  k;  p. 
657-659,  ^  893  ;>,  q;  p.  661-665,  <5i 
894-900  ;  p.  669,  <^  902  t ;  p.  676-679, 
^  904  c,  (i;  p.  703-711,  ^  940-952; 
p.  731,  ^  970  c;  p.  732-736,  (J  972- 
980 ;  p.  745-746,  ^  990^  ;  p.  864,  ^ 
1066. 
distinction  in  the  natural  constitution  of 
different  tissues  and  of  parts  of  a  con^ 
tinuous  tissue,  and  of  compound  or- 
gans of  which  they  form  component 
parts,  illustrated  by  natural  stimuli, 
and  by  their  products,  and  by  their 
disturbing  influences  when  morbidly 
affected,  p.  61,  ()  132-133  b;  p.  62- 
68,  ^  135-152,  and  references  there, 
and  ut  supra — and  farther  illustrated 
by  the  effects  of  Aloes  (showing  that 
it  does  not  act  particularly,  as  gener- 
ally supposed,  upon  the  rectum,  but 
mostly  on  the  small  intestine),  p. 
467,  ^  718  ;  p.  566,  i)  889  i ;  p.  856- 
857,  {)  1063  b;  also,  p.  565-566,  (} 
889  g — and  by  other  cathartics.  Rhu- 
barb, Senna,  the  Saline,  Calomel,  Jal- 
ap, &c.,  according  to  the  special  vir- 
tues of  each,  their  doses  and  combina- 
tions, p.  554-556,  ^  872  a ;  p.  566,  () 
889  i;  p.  568-569,  ()  889  m,mm;  p. 
571,  ^  890  b;  p.  575,  (^  890  i;  p.  838 
-861,  <J  1058-1065— and  by  Tartar- 
ized  Antimony,  Cantharides,  Iodine, 
Ergot,  and  lAmerous  other  individual 
substances.  See  the  Art  teles,  Index 
11. 
tabular  views  of  the  foregoing  consid- 
erations relative  to  peculiarities  of 
structure  as  they  respect  the  opera- 
tion of  remedies  and  morbific  causes, 
and  in  the  relation  of  tissues  to  com- 
pound organs,  illustrated  by  their  rel- 
ative liability  to  inflammation  in  dif- 
ferent parts,  and  the  relative  degrees 
of  danger,  and  the  relative  exigencies 
for  loss  of  blood  as  the  disease  may 
affect  one  part  or  another,  p.  69-73, 
«J  160-162. 

Y 


Remedies — continued. 

render  the  nervous  influence  alterative, 
excitant,  sedative,  or  simply  depress' 
ant,  according  to  the  nature  of  each 
one  (which  includes  the  dose,  combi- 
nations, &c.,  and  the  modifying  influ- 
ences of  disease  and  surrounding  cir 
cumstances),  and  this  whether  it  op- 
erate through  reflex  action,  as  in  the 
case  of  external  causes,  or  in  a  direct 
manner,  as  with  mental  emotions — 
and  so,  also,  with  morbific  causes,  p. 
95,  >J188irf;  p.  107-1 11, 1^226-233 J; 
p.  253,  ()  441  d;  p.  296,  ()  476  c;  p. 
301-305,  <)  481  A-482  ;  p.  306, 1)  483  ; 
p.  315,  ^  492 ;  p.  323-353,  I)  500  c- 
524  ;  p.  365-366,  i)  551-556  ;  p.  427- 
428,  (J  670,  671  ;  p.  430-433,  (}  675 ; 
p.  480,  i)  743 ;  p.  509,  ^J  81 1  ;  p.  512, 
•J  817 ;  p.  523,  ^  827  ;  p.  534,  <^  844 ; 
p.  565,  i)  889  /,  g ;  p.  570,  <5  889  n ;  p. 
657,  ^  893;; ;  p.  661-663,  <J  894-896  ; 
p.  666-672,  ^  902  6-904  a ;  p.  724- 
727,  §  961-963;  p.  733-735,  ()  974- 
976;  p.  773-775,  ()  1023-1024;  p. 
829,  {)  1057  a;  p.  865-868,  i)  1067. 

their  operation  through  alterative  influ- 
ence of  reflex  nervous  action  rendered 
manifest  by  the  special  relations  of 
the  alimentary  canal  to  the  nervous 
system,  and  other  special  anatomical 
provisions,  p.  335-336,  <J  512  a-513  ; 
p.  565-566,  (f  889  g.  Also,  Mucous 
Tissue,  first  subdivismi,  L.icte.\ls, 
Index  II. 

what  general  considerations  should  de- 
termine the  use  of  one  remedy  or  an- 
other, and  other  relative  things,  p.  430 
-433,  <)  675  ;  p.  438-442,  ^  688  b-d; 
p.  540,  ^  851 ;  p.  543-544,  ^  857 ;  p. 
545,  ()  859  b ;  p.  556-557,  §  873-875  ; 
p.  560-562,  ()  885-888  ;  p.  567-568,  () 
889  / ;  p.  570,  ()  889  n ;  p.  600,  (>  892 
d ;  p.  605,  ()  892  m ;  p.  740,  i)  989. 

according  to  the  nature  of  each  one,  or 
of  two  or  more  in  combination,  and 
according  to  the  number  of  constitu- 
ent parts,  respectively,  a  new  remedy 
is  created,  which  enables  us  to  great- 
ly simplify  the  Materia  Medica,  and 
exemplified — showing,  also,  the  im- 
portance of  extemporaneous  prescrip- 
tions, and  the  injurious  tendency  of 
standing  formulae,  and  how  the  reflex 
nervous  influence  may  be  variously 
directed  in  the  cure  of  diseases  by  ar- 
tificial means — and  what  is  true  of 
the  effects  of  one,  or  more  remedies 
in  combination,  or  in  consecutive  or- 
der, is  also,  in  principle,  of  morbific 
causes,  p.  27,  (J  52  ;  p.  94-95,  ^  188^ 
d;  p.  107-110,  i)  227-232  ;  p.  340,  i) 
514  h;  p.  417,  ()  650;  p.  418-419,  ^ 
652  ^'-653  c  ;  p.  424-425,  ^  662-663  ; 
p.  545,  ^  860  ;  p.  547,  9  863  d ;  p.  554 

Y 


1074 


INDEX    II. 


Remedies — continued. 

-556,  (j  872  a ;  p.  5G6-567,  <J  889  k ; 
p.  661-662,  ^  894;  p.  838-841,  \ 
1058  ;  p.  851-862,  <J  1060-1065. 

combinations  and  uses  of,  and  their  phi- 
losophy in  variously  modifying  the  al- 
terative influence  of  reflex  nervous 
action,  ibid. 

often  possess  compound  virtues,  when 
they  should  be  regarded  as  acting  as 
a  whole  ;  but  one  of  the  virtues,  al- 
though in  opposition  to  each  other, 
may  take  full  eflect  without  the  oth- 
ers being  manifested,  according  to  the 
nature  of  the  pathological  conditions, 
as,  either  the  tonic  or  antiphlogistic 
virtue  of  Cinchona  may  be  fully  in 
the  ascendant  in  the  same  disease,  or 
the  tonic,  stimulating,  antiphlogistic, 
or  astringent  virtue  of  Rhubarb — such 
remedies  being  also  distributed  in  the 
Author's  Therapeutical  Arrangement 
of  the  Materia  Medica  into  as  many 
different  groups  as  they  are  distin- 
guished for  two  or  more  virtues,  p. 
424,  <J  662  b ;  p.  430-433,  i)  675  ;  p. 
487-489,  ^  756  a,  b  ;  p.  553,  ()  870  aa  ; 
p.  554-556,  <^  872  a ;  p.  571-572,  () 
890  b;  p.  575,  <J  890  t,  k;  p.  581,  () 
890.^^  e ;  p.  597-598,  ^  892  c ;  p.  605 
-607,<J892m-r;  p.  611,<^892iA;  p. 
855,  ()  1062. 

the  right  doses  of,  and  the  extent  of 
other  means,  next  in  importance  to 
the  right  remedies,  but  often  of  very 
difficult  adjustment,  and  some  exam- 
ples— also,  against  the  chemical  and 
other  physical  hypotheses,  and  de- 
monstrative of  the  accuracy  of  the 
Author's  doctrine  of  their  operation 
through  alterative  influence  of  reflex 
nervous  action,  p.  532-533,  <S>  841  ;  p. 
543-544,  <)  857  ;  p.  553,  <;»  870  aa ;  p. 
566-569,  (^  889  k-m?n ;  p.  598-604,  ^ 

892  d-k;  p.  650-651,  i)  893  i-k ;  p. 
672,  {)  904  a ;  p.  675-676,  ^  904  b ;  p. 
711-714,  ()  954-958;  p.  726-728,  ^ 
961  c-964  c;  p.  729-730,  ^  968-969  ; 
p.  733-736,  ()  974-980  ;  p.  748-749, 
<)  992  b,  c  ;  p.  750-751,  l)  994-999  ;  p. 
840-841,  ()  1058  d;  p.  870-872,  ^ 
1068  c,  d. 

time  and  order  of  their  administration 
next  in  importance,  and  variously  ex- 
emplified, p.  367,  ()  556  c ;  p.  428,  (} 
672  ;  p.  430-433,  ()  675-676  a  ;  p.  548 
-549,^  863  rf;  p.  551-554, <J  867-871 ; 
p.  570,  <)  889  n  ;  p.  595-596,  <S>  892  aa ; 
p.  595-598,  <}  892 ;  p.  600,  ^  892  d ; 
p.  641-642,  ()  892A  i ;  p.  648-649,  ^ 

893  g,  h;  p.  658-659,  ()  893  p;  p. 
728,  <)  964  d;  p.  841,  ^  1058  c. 

in  disease,  their  action  is  on  common 
ground  with  morbific  agents,  physic- 
,  al  and  mental,  and  the  natural  stimuli  | 


Remedies — continued. 

of  life,  all  of  which  operate  with  in- 
creased intensity  in  morbid  states,  and 
according  to  the  varying  susceptibili- 
ties, and  many  remedies,  such  as  tar- 
tarized  antimony,  iodine,  ergot,  arse- 
nic, &c.,  which  are  powerfully  cura- 
tive in  their  smallest  doses,  exert  no 
effect  in  such  doses  upon  healthy  or- 
gans, and  being  alike  true  whether 
operating  upon  the  organic  constitu- 
tion of  parts  or  through  reflex  action 
of  the  nervous  system,  a  simple  exem- 
plification of  the  whole  of  which  is  seen 
in  the  failure  of  a  mild  solution  of  the 
acetate  of  lead  to  produce  any  effect 
upon  the  tunica  conjunctiva  in  its  natu- 
ral state,  which  may  quickly  remove  a 
mild  inflammation  of  the  membrane, 
or,  on  the  contrary,  aggravate  to  a  more 
intense  degree,  and  connecting  this 
with  the  curative  and  morbific  effects 
of  a  Setori  upon  the  same  disease 
when  inserted  in  the  nape  of  the  neck 
(p.  679-681,  <)  905  a),  we  arrive  at 
the  combined  aspect  of  the  operation 
of  remedies  through  alterative  influ- 
ences of  reflex  nervous  action,  either 
for  good  or  for  evil,  upon  parts  con- 
cealed from  observation,  and  upon 
their  organic  constitution,  and  accord- 
ing to  the  increased  and  varying  sus- 
ceptibilities arising  from  disease,  as 
well  also  according  to  the  natural  con- 
stitution of  the  affected  parts,  p.  3,  ^  2 
b;  p.  59,  {}U9h ;  p.  63,  (J  137  <i ;  p.  65,  ij 
143  c ;  p.  67,  (j  149-151  ;  p.  68,  ^  152 
b ;  p.  120-122,  <J  237-240  ;  p.  332-334, 
(j  502-506  ;  p.  339-340,  ^  514  ^,  A ;  p. 
352,  (J  524  (Z;  p.  415-417,  <^  649  a-d; 
p.  421-423,  (j  657-658;  p.  435,  () 
680 ;  p.  456,  ()  698  ;  p.  465-466,  () 
715  ;  p.  482,  ^  744  ;  p'.  509,  (^  810  ; 
p.  531,  <;•  838-840  ;  p.  535-539,  <J  847- 
850  ;  p.  541-542,  (j  854  hb  ;  p.  545,  ij 
859  a,  b ;  p.  553,  ^  870  aa ;  p.  607- 
608,  I)  892  a,  b ;  p.  612,  (^  892^  a ;  p, 
623,  ^  8921  c;  p.  665-671,  ^  902  «- 
m;  p.  709,  ()  961  b-d ;  p.  724-726,  () 
961  a-e  ;  p.  733-736,  ^  974-980. 
from  the  foregoing  aiftl  other  premises 
of  a  fundamental  nature  we  reach  the 
conclusion  that  if  disease  be  limited 
to  the  part  upon  which  remedies 
make  their  direct  impression,  the  sal- 
utary influence  may  be  exerted  most- 
ly upon  the  organic  states  without 
the  intervention  of  the  nervous  influ- 
ence, excepting  so  far  as  the  nerve.9 
constitute  a  part  of  the  structure, 
which  is  particularly  true  of  a  few 
remedies  which  arc  intended  to  be 
thus  restricted,  such  as  caustics,  and 
many  applications  to  cutaneous  dis- 
eases ;   but  it  is  in  respect  to  most 


INDEX    II. 


1075 


Remedies — continued. 

remedies,  as  with  most  morbific  caus- 
es in  their  production  of  disease  in 
parts  upon  which  their  direct  morbific 
impression  is  made,  that,  in  the  for- 
mer case,  the  curative  etfect  upon  a 
diseased  part  as  it  respects  the  di- 
rect impression  is  greatly  the  result 
of  an  alterative  reflex  nervous  influ- 
ence reverberated  through  the  appro- 
priate nerves  of  the  part,  or  as  the 
remedy  or  morbific  cause  may  insti- 
tute sources  of  reflex  action  in  other 
parts — all  of  which  may  be  illustrated 
by  the  act  of  vomiting,  whether  pro- 
duced by  an  emetic,  or  the  gravid  ute- 
rus, or  disease  of  the  kidney,  or  to- 
bacco applied  to  the  surface,  or  tick- 
ling the  fauces,  or  by  a  mental  emo- 
tion, when,  in  all  the  cases,  a  reflex 
action  is  reverberated  upon  the  stom- 
ach through  the  excito-motory  fibres 
of  the  same  nerve  that  transmitted  the 
primary  impression  to  the  nervous 
centres,  p.  66-67,  ^  148  ;  p.  89,  «J  188 
a ;  p.  102,  <J  203  ;  p.  284-287,  §  453 
c-459 ;  p.  289,  H61 ;  p.  296, ^  476  c ;  p. 
302,^i8lb;  p. 31 5-316, <J 492;  p. 323 
-324,  (i  500  c  ;  p.  327,  ()  500  i ;  p.  338, 
^5Ud;  p.  339-341,^  514 g--m;  p. 347 
-348,  <J  516  d,  Nos.  11-13;  p.  416- 
417,  ^  649  c;  p.  421-423,  §  657  a- 
658  ;  p.  475,  ()  733  k ;  p.  483-484,  ^ 
746  ;  p.  522-523,  ^  827  b,  c;  p.  531, 
<5  840  ;  p.  547-550,  <J  863  d ;  p.  666- 
672,  ^  902  6-904  b,  p.  336,  ^  5Ub. 
the  foregoing  inquiry  has  been  intro- 
duced under  the  Article  Remedial 
Action  by  a  reference  to  certain  sec- 
tions where  the  modus  operandi  of 
Cinchona  and  Mercury  and  some  oth- 
er things  is  shown  to  depend  upon  al- 
terative influences  of  reflex  nervous 
action,  and  we  may  now  look  at  other 
sections  relative  mostly  to  Tartarized 
Antimony,  partly  for  the  purpose  of 
illustrating  what  is  known  as  the  cu- 
mulative eflTect  of  remedies  (that  is  to 
say,  when  their  effects  are  not  partic- 
ularly manifested  until  after  a  num- 
ber of  doses,  and  there  may  be  then  a 
sudden  and  powerful  display  of  a  cu- 
rative or  morbific  nature),  and  in  part 
as  a  farther  demonstration  against  the 
doctrine  of  operation  by  absorption, 
since,  if  it  be  allowed  that  the  medi- 
cine is  absorbed,  all  itp  influences  upon 
disease  may  be  shown  to  depend  on 
its  action  upon  the  stomach  and  con- 
sequent reflex  actions  of  the  nervous 
system — for  if  the  doctrine  of  absorp- 
tion were  true,  it  should  not  be  nec- 
essary to  carry  its  small  therapeutical 
doses  to  near  the  point  of  nausea  to 
subdue  inflammations  and  febrile  ex- 


Remedies — continued. 

citements,  while  it  is  one  of  the  most 
familiar  facts  that  the  dose  must  gen- 
erally be  gradually  increased,  often 
from  the  sixteenth  of  a  grain  to  half 
a  grain  or  more,  to  maintain  the  effect 
upon  disease,  the  skin,  general  ex- 
citement, &c.,  which  was  originally 
produced  by  the  smallest  dose ;  but 
so  long  as  the  sixteenth  or  the  fourth 
of  a  grain  manifest  an  approximation 
to  the  point  of  nausea,  it  will  as  ef- 
fectually break  down  arterial  excite- 
ment, produce  perspiration,  and  over- 
throw pneumonia  as  effectually  as 
when  two  grains  may  be  necessary  to 
the  same  amount  of  impression  upon 
the  stomach,  and  without  which  the 
symptoms  will  again  increase — and 
also  exemplified  to  the  same  eflect  by 
the  manner  in  which  it  overcomes 
croup,  in  which  affection  no  relief  will 
follow  till  it  produce  some  degree  of 
nausea,  whatever  the  quantity  exhilv 
ited,  but  as  soon  as  its  nauseating  in- 
fluence is  felt,  the  well-marked  symp- 
toms of  the  disease  begin  to  yield, 
and  rapidly  so  when  vomiting  ensues, 
showing  that  the  whole  effect  is  due 
to  the  influence  upon  the  stomach, 
which  determines  the  act  of  vomiting 
— and,  finally,  according  to  the  doc- 
trine of  absorption,  there  should  be 
no  necessity  whatever  between  this 
gastric  irritation  and  the  salutary  ef- 
fects of  the  remedy,  and  the  only  rule 
should  be  to  introduce  a  certain  quan- 
tity into  the  circulation,  p.  344-345, 
<)  516  d,  No.  6  ;  p.  351,  (}  524  a.  No. 
1  ;  p.  355,  ^  526  a ;  p.  356-357,  ^ 
514  b,c;  p.  365-368,  ()  549-559  ;  p. 
431,  ^  675;  p.  486,  ^  750  b;  p.  530- 
533,  ^  837  b-8il  ;  p.  547,  ()  863  d ; 
p.  556-557,  <!>  873  ;  p.  567-569,  <J  889 
l-mm;  p.  612-613,  ^  892i-  a,  b;  p. 
634,  (}  8924  b ;  p.  638-640,  (}  892-+. 
g;  p.  641,  (J  892f  i;  p.  666-670,  ^ 
^  902  b-m ;  p.  675-676,  ()  904  b ;  p. 
833,  <J  1057  h;  p.  850-851,  <}  1059. 
physiological  distinctions  between  Ca- 
thartics and  Emetics,  and  correspond- 
ing effects  of  Mental  Emotions,  and 
other  relative  considerations,  and  as 
acting  through  the  medium  of  the 
nervous  influence  variously  modified 
according  to  the  nature  of  its  exciting 
cause,  p.  547-550,  ^  863  d;  p.  631- 
632,  (}  892i  b.  Also,  Ment.\l  E.mo- 
TioNS,  Disgust,  C.vth.\rtics,  Emet- 
ics, Index  II. 
the  usage  of  reasoning  from  the  results 
of  experiments  with  remedies  upon 

t  man  in  health  to  their  effects  upon 
morbid  conditions  must  be  included 
among  the  important  obstacles  in  the 


1076 


INDEX    II. 


Remedies — cmitinucd. 

way  of  philosophical  as  well  as  prac- 
tical medicine  on  account  of  the  vital 
changes  in  the  diseased  parts,  and  the 
alterative  influences  of  these  changes 
upon  the  susceptibilities  of  all  parts 
(p.  535-539,  ()  847-850,  and  Law  of 
Adaptation,  Index  I. ;  Diseases, 
Self-limited,  cecond  subdivisioii), 
and  especially  from  similar  experi- 
ments upon  animals,  who  differ  not 
only  from  man,  but  each  species 
from  others  in  their  vital  constitu- 
tion, p.  3,  (Ji  2  i;  p.  63,  <J  137  d;  p. 
65,  ^  143  c  ;  p.  67,  ^  149-151  ;  p.  68, 
^  152  ^» ;  p.  73,  <J  163  ;  p.  122,  <)  240  ; 
p.  148,  ^  334 ;  p.  430-433,  ()  675-676 
a  ;  p.  435,  «^  680  ;  p.  456,  ()  698  ;  p. 
465-466,  ^  715;  p.  482,  <)  744;  p. 
498,  784  a ;  p.  509,  ^  810  ;  p.  530,  () 
837  cc-840  ;  p.  535-539,  ()  847-850  ; 
p.  541-542,  <J  854  bb ;  p.  545,  <J  859  a, 
b ;  p.  548-549,  <)  863  d ;  p.  607-608, 
■5)  892  a,  6;  p.  612,  ^  892^  a;  p.  623, 
^  8921  c  ;  p.  676,  ()  904  c— and  when 
injected  into  the  circulation,  they 
must  of  necessity  give  rise  to  some 
of  the  effects,  among  a  greater  varie- 
ty, as  when  administered  by  the  stom- 
ach, p.  529-533,  ()  836-841,  though 
these  may  have  been  as  much  over- 
rated as  certain  supposed  effects  of 
quinine,  p.  603,  ^  892  k,  and  which  is 
rendered  the  more  probable  by  the 
statements  of  other  distinguished  ob- 
servers as  to  the  effects  of  morbific 
agents  when  injected  into  the  circu- 
lation, p.  482,  <)  744 ;  p.  527-528,  <5> 
830-831  ;  p-  932,  ()  1088  d. 

their  operation  by  absorption,  as  gener- 
ally interpreted,  very  embarassing  to 
a  distinguished  advocate  thereof  on 
account  of  a  perplexing  difficulty  of- 
fered by  the  portal  vein,  p.  527,  <J 
829. 

as  disease  consists  of  a  succession 
of  changeable  pathological  causes, 
whether  it  terminate  favorably  or  fa- 
tally, remedies  operate  like  morbific 
causes,  and  for  other  reasons  assign- 
ed, but  with  the  difference  that  the 
former  are  less  profoundly  morbific, 
and  substitute  pathological  states  that 
are  readily  capable  of  subsiding  spon- 
taneously through  the  inherent  tend- 
ency of  the  properties  of  life  to  re- 
turn to  their  natural  states,  and  there- 
fore by  no  possibility  can  they  trans- 
mute the  morbid  into  a  healthy  con- 
dition, which  is  alone  the  work  of  elab- 
orate processes  of  organization  —  all 
of  which  are  impossible  problems  for 
Chemistry  and  Physics,  especially  if 
connexion  with  the  variety  of  means 
that  will  subdue  a  given  form  of  dis- 


Remedies — continued. 

ease,  the  necessity  of  accurate  doses, 
and  the  importance  and  the  ability 
of  projecting  a  plan  of  treatment  con- 
sisting of  a  variety  of  means  to  be 
applied  in  an  exact  consecutive  order 
to  fulfill  the  intention  of  introducing 
a  succession  of  pathological  changes 
of  which  each  one  is  necessary  to  the 
next  in  order,  from  the  abstraction  of 
blood  to  the  cathartic,  then  to  the  an- 
timonial  or  mercurial  alterative,  then 
a  blister,  mayhap  quinine,  or  arsenic, 
or  guaiacum,  or  colchicum,  or  iodine, 
&c.,  and  where  there  are  but  shades 
of  difference  in  the  morbid  states — 
while,  also,  any  given  form  of  disease, 
such  as  intermittent  fever,  may  be  ar- 
rested by  cinchona,  or  arsenic,  or  cob- 
web, or  an  emetic,  or  loss  of  blood,  or 
a  mental  emotion,  and  syphilis  by 
mercury,  or  iodine,  or  bromine,  &c., 
each  one  a  simple  element,  but  hav- 
ing physical  properties  and  chemical 
relations  very  widely  different,  and 
which  may  be  just  as  consistently  as- 
sumed to  form  salts  with  each  other 
as  that  they  will  alike  cure  the  same 
conditions  of  disease  by  chemical  ac- 
tion upon  the  tissues,  or  upon  the 
blood  or  miasms,  and  considering,  too, 
that  less  than  a  grain  of  quinine  or 
of  arsenious  acid  will  subdue  an  in- 
termittent fever,  or  that  quantity  of 
the  latter  break  up  a  chronic  cutane- 
ous disease  over  the  whole  surface  of 
the  body — but  thus  showing  that  the 
substitution  of  a  large  variety  of  path- 
ological changes  corresponding  with 
the  alterative  virtues  of  the  several 
remedies,  respectively,  is  capable, 
each  one,  of  placing  the  more  pro- 
foundly morbid  states  in  the  way 
of  spontaneous  subsidence,  so  that, 
whether  it  be  a  simple  intermittent 
fever  or  complicated  with  cutaneous 
eruptions,  when  the  impression  is 
made  that  will  enable  Nature  to  throw 
offthe  fever,  the  same  artificial  change 
may  equally  induce,  upon  the  same 
recuperative  principle,  the  disappear- 
ance of  the  chronic  affection  of  the 
skin,  p.  67,  ()  149-152 ;  p.  87,  ^  177- 
182;  p.  122,  (J  237-240;  p.  147,  <) 
330;  p.  333,  ^  503;  p.  417-418,  (j 
650  ;  p.  424,  ()  662  ;  p.  426,  ^  666  ;  p. 
428,  ()  672;  p.  430-433,  <J  675;  p. 
438,  ^  684,  IVo.  9  ;  p.  470-471,  ^  729 
-731  ;  p.  473-474,  <J  733  c;  p.  486,  ^ 
750  b ;  p.  487-488,  ()  756  ;  p.  535- 
539,  ^  847-850;  p.  541-545,  ^  854- 
860 ;  p.  547-549,  ^  863  d ;  p.  551- 
554,  ^  867-871  ;  p.  561-562,  <J  888  a- 
d ;  p.  596,  ^  892  /;,  c  ;  p.  606,  ^  892  p ; 
p.  637,  ()  8924  <Z,  c ;  p.  648-649,  ()  893 


INDEX    II. 


1077 


Remedies — continued. 

g;  p.  661-670,  <J  894-902  ;  p.  679- 
683,  ij  905  a,  J ;  p.  696,  .;.  926. 
it  follows,  therefore,  that  one  remedy 
prepares  the  way  for  another,  and  in 
a  variety  of  respects,  p.  367,  <J  556  c  ; 
p.  423,  ^  659  ;  p.  424,  ^  662  b ;  p.  428, 
^  672  ;  p.  545,  ^  859  b;  p.  551-552, 
<J  867-868  ;  p.  554-556,  ^  892  ;  p. 
561,  ^  888  ;  p.  595-600,  ^  892  a-d  ; 
p.  658,  ()  893  p ;  p.  664-665,  ()  900- 
901  ;  p.  843,  ()  1058/;  p.  844-847,  (; 
1058  m-q. 
the  Author  anticipates  an  assumption, 
when  the  doctrine  of  the  operation  of 
remedial  and  morbific  causes,  physic- 
al and  mental,  through  reflex  and  di- 
rect action  of  the  nervous  system,  can 
no  longer  be  resisted,  that  the  nerv- 
ous influence  is  the  chemical  agent 
which  does  the  work,  and  answers 
that  the  obstacles  will  be  in  no  re- 
spect removed,  for,  in  this  special  re- 
spect, in  carrying  out  the  Chemical 
hypothesis,  there  should  be  no  varie- 
ties in  results  corresponding  to  the 
nature  of  the  remote  exciting  causes, 
but  the  nervous  influence  should  al- 
ways act  in  conformity  vi'ith  any  spe- 
cial agent  employed  in  the  Labora- 
tory, and  therefore  produce  uniform 
phenomena,  at  least  in  any  given  part, 
as  when  an  acid  unites  with  an  alka- 
li, or  platina  predisposes  oxygen  to 
unite  with  hydrogen,  while,  on  the 
contrary,  the  Author's  doctrines  con- 
form to  the  very  maxim  of  the  Law — 
qui  facit  per  alium,  facit  per  se.     As 

ABOVE. 

their  effects  owing  to  the  mutability  of 
the  properties  of  life,  which  is  design- 
ed for  useful  purposes.  See  Remedi- 
al Action  ;  Recuperation,  Law  of, 
Index  II. ;  Vital  Properties,  In- 
dex I. 

are  abortive  whenever  the  morbid 
changes  transcend  the  recuperative 
law,  p.  420,  ^  654  a ;  p.  552,  <^  868 
b;  p.  661,  mottoes;  p.  728,  <J  964  c. 
Also,  Recuperation,  La.w  of,  Index 
II. ;  Vital  Properties,  Index  I. 

the  great  law  of  recuperation  demon- 
strable in  the  self-limited  diseases, 
and  in  animals,  p.  531,  ()  839  ;  p.  544 
-545,  i)  858,  861 ;  p.  551,  «^  863  A— and 
by  the  simple  system  of  watching  or 
expectant  plan,  p.  543,  ^  855-857  ;  p. 
558-559,  <J  877-881. 

hence,  in  a  general  sense,  the  most  im- 
portant remedy  in  the  treatment  of 
diseases,  acute  and  chronic,  is  a  prop- 
erly regulated  diet — a  limitation  to 
farinaceous  fluids  in  the  early  stages, 
at  least,  of  the  former,  while  in  the 
latter,  the  circumstances  of  each  case 


Remedies — continued. 

must  determine  the  choice — there  be- 
ing ingrafted  upon  the  constitution 
of  the  whole  animal  kingdom  a  prin- 
ciple, latent  in  health,  but  which  en- 
ables them  in  disease  to  bear  an  ab- 
stinence that  will  alone  surmount  the 
most  formidable  conditions,  but  which 
would  probably  be  often  fatal  in  the 
natural  state  of  the  system — and  in 
man  the  principle  is  the  same  as  that 
which  renders  the  most  active  remedies 
curative  instead  ofmorbific,  p.  63,  <^  137 
b-e  ;  p.  67,  ^  149  ;  p.  69,  §  156  b ;  p. 
538-540,  (f  847  §--848  ;  p.  543,  ^  855 
-856;  p.  551,  ^  863  k;  p.  558-559, 
(J  879-883  b  ;  p.  600,  ()  892  d ;  p.  736, 
^  980.  Also,  Adaptation,  Law  of. 
Index  I. ;  Recuperation,  Law  of,  In- 
dex II. 

by  healing  a  primary  disease  which  had 
given  rise  to  sympathetic  develop- 
ments of  disease  in  other  parts,  the 
sympathizing  ones  often  recover  not 
only  as  a  consequence  of  the  subsi- 
dence of  the  morbific  reflex  nervous 
influence,  but  the  abatement  of  the 
primary  affection  may  become  also 
a  source  of  salutary  sympathetic  in- 
fluences upon  the  secondary  devel- 
opments ;  or,  one  disease  .luperven- 
ing  as  a  sympathetic  result  of  another 
may  be  the  means  of  reflecting,  after 
the  manner  of  counter-irritants,  a  sal- 
utary alterative  reflex  action  upon  the 
primary  affection,  p.  65-66,  ^  143  c  ; 
p.  67,  (J  148;  p.  351-352,  ()  524  c; 
p.  360,  <;>  528  ;  p.  421-422,  ^  657  ;  p. 
506,  ^  804  ;  p.  539,  <^  848  ;  p.  570,  <J 
889  n;  p.  652-654,  ()  893  n;  p.  679- 
681,  ^  905  a,  b;  p.  592,  <J  89H  A-;  p. 
666,  I)  902  b.     Metastasis,  Ind.  II. 

often  bring  organs  not  affected  by  dis- 
ease, through  reflex  nervous  action, 
particularly  the  skin,  into  a  condition 
which  becomes  the  exciting  cause  of 
other  reflex  influences  that  fall  upon 
diseased  organs  with  a  salutary  ef- 
fect. See  this  subdivision  under  Re- 
medial Action,  Index  II. 

operate  progressively  or  abruptly,'  ac- 
cording to  the  intervals  of  application, 
when,  in  the  former  case,  the  reflex 
nervous  influence  is  maintained  in 
unceasing  action  by  a  succession  of 
different  remedies,  or  doses  of  the 
same  remedy,  at  short  intervals,  and 
even  in  the  latter  case,  as  after  the 
administration  of  an  efficient  emetic 
or  cathartic,  the  reflex  influence  is 
kept  up  by  the  impression  made  on 
the  gastro-intestinal  mucous  tissue 
with  alterative  effect  for  some  hours 
after  their  more  manifest  effects  are 
over,  and  the  same  principle  holds  in 


1078 


INDEX    II. 


Remedies — continued. 

respect  to  mental  emotions — and  far- 
ther, that  remedial  influences  are  ex- 
erted and  maintained  by  the  small- 
est doses  of  the  remedies  designated 
by  the  Author  as  Alteratives,  is  evi- 
dent not  only  from  the  abatement  of 
symptoms,  but  from  the  vomiting 
which  will  often  follow  after  the  first 
few  doses  of  an  eighth  of  a  grain  of 
tartarized  antimony  or  a  grain  of  ipe- 
cacuanha— and  so  of  mercury,  arse- 
nic, iodine,  quinine,  &c.,  p.  Ill,  <J 
233i,  233}  ;  p.  285-286,  (}  455  d;  p. 
333,  (}  503-506  ;  p.  339,  <)  514  g,  h  ; 
p.  344-345,  <)  516  rf.  No.  6 ;  p.  365, 
■^  551  ;  p.  366,  -;.  556  ;  p.  416-417,  () 
469  c;  p.  420-424,  ^  654-661;  p. 
532,  ^  841  ;  p.  547,  ()  863  d;  p.  551, 
^  867  ;  p.  568-569,  i)  889  m-mm ;  p. 
592-593,  ()  89U  k ;  p.  599-600,  ^  892 
d;  p.  646-649,  ()  893  c-h;  p.  661-663, 
^  894-896  ;  p.  668-670,  ()  902  g-7n  ; 
p.  675-676,  ()  904  b;  p.  679-681,  () 
905  a.  Aiso,  Alteratives,  Sphinc- 
ter Muscles,  Roosting,  Miasm  ;  Hy- 
drophobia, Virus  of;  Mental  Emo- 
tions, Index  II. 
a  single  remedy  may  be  adapted  to  a 
large  variety  of  pathological  condi- 
tions, and  these  may  exist  simultane- 
ously in  different  parts  as  the  sympa- 
thetic results  of  a  single  disturbance, 
and  associated  also  with  idiopathic 
ijver,  and  the  remedy  may  be  ade- 
quate to  the  removal  of  all  the  func- 
lional  lesions,  or  preparatory  of  the 
whole  to  the  favorable  action  of  an- 
other remedy  of  opposite  virtues,  and 
upon  which  the  cure  may  ultimately 
depend — thus  showing,  also,  by  the 
variety  of  means  which  individually 
may  arrest  very  complex  states  of 
disease,  that  our  doctrine  of  alterative 
influence  of  reflex  action  of  the  nerv- 
ous system,  modified  according  to  the 
nature  of  the  remedy,  and  the  har- 
monizing influences  of  coexisting  dis- 
eases upon  each  other  through  the 
medium  of  the  same  reflex  action  as 
brought  into  reciprocal  operation  by 
the  several  afliectcd  parts,  and  the 
substitution  of  pathological  states 
with  a  disposition  to  subside  sponta- 
neously, can  alone  explain  the  phe- 
nomena with  any  consistency  with 
the  immediate  facts  and  with  those 
which  relate  to  Chemistry  and  Phys- 
ics, p.  63,  ^  137  c-c;  p.  65-67,  ()  143 
h,  c-148-151  ;  p.  298,  <)  476^  h;  p. 
304,  ^  481  p;  p.  309-310,  (}  484  b, 
No.  5  ;  p.  337,  ^  514  b,  c ;  p.  361,  (} 
529  b ;  p.  367,  ()  557  a,  b  ;  p.  426,  ^ 
666 ;  p.  430-433, ^  675 ;  p.  465-466, 
^  715;    p.  470^80,  ()  741   a,  b;   p. 


Remedies — continued. 

498,  ij  784  J;  p.  509,  (jBU;  p.  535- 
539,  {)  847-848  ;  p.  542-543,  i)  854/, 
and  references  there  ;  p.  552-553,  <j 
870  a,  aa ;  p.  597-599,  l^  892  c,  d  ; 
p.  608-610,  (}  892i  c,  d;  p.  662-664, 
^  895-900  ;  p.  731-732,  I)  970  c  ;  p. 
739-740,  (^  986-987.  Also,  Adapta- 
tion, Law  of.  Index  I. ;  Diseases, 
Self-Limited,  Index  II. 

distinction  among  various  remedies  that 
'  may  produce  some  common  result, 
and  that  result  apt  to  be  most  relied 
upon  as  a  remedial  test,  yet  shown  to 
be  insignificant,  and  that  the  virtues 
of  remedies  must  be  tried  by  different 
considerations,  p.  547-550,  ^  863  d  ; 
p,  566,  ^  889  I ;  p.  571,  ^  890  b ;  p. 
572-573,  {)  890  d ;  p.  576-577,  I)  890 
l-o ;  p.  587,  (}  890^  b  ;  p.  590-593,  (i 
69li  a-k  ;  p.  628-633,  ^  892|  g-892} 
d  ;  p.  636-640,  ^  892-J  d-f;  p.  669,  l 
902  h  ;  p.  687-688,  ^  905^  c  ;  p.  857, 
^  1063  b.     Also,  SuDORiFics,  Index  I. 

their  application  in  acute  and  chronic 
diseases  subject  to  great  differences 
in  the  details,  the  latter  of  which  fall 
under  what  the  Author  designates  as 
Vital  Habit.  See  Pathology,  and 
the  various  practical  Articles,  Lidex 
IL 

variously  influenced  by  Mental  Emo- 
tions, p.  865-868,^  1067.  Also, 
Mental  Emotions,  the  individual 
PassionSy  Remedial  Action,  subdi- 
vision Mental  Emotions,  Index  II. 

abuse  of, — see  p  988,  2d.  subdivision. 

the  Hippocratic  rule,  that  "  severe  dis- 
eases require  severe  remedies,"  to  be 
received  in  a  broad,  not  universal 
sense,  and  exceptions  stated,  p.  723- 
724,  ()  960  h,  and  references  there. 

contrast  between  Chemistry  and  Vital 
Solidism  as  practically  applied  to 
Therapeutics,  p.  147,  ij  330;  p.  170- 
173,  Nos.  40-46  ;  p.  176-178,  ij  350| 
a-f;  p.  514-415,  (}  819  ;  p.  517-518, 
(}  821  c,  822;  p.  540,  ()  851. 
Remedies,  Endermic, 

operating  with  purely  local  effect,  their 
action  is  doubtless  greatly  limited 
to  the  organic  constitution  of  the 
skin,  with  that  participation  of  the 
nerves,  however,  that  necessarily 
arises  from  their  incorporation  with 
the  other  tissues  ;  but  any  resulting 
influences  extending  beyond  the  skin 
are  dependent  upon  reflex  action  of 
the  nervous  system,  p.  475,  t)  733  h  : 
p.  483-484,  $  746  c.  ij  826  c.  Skin, 
Cold,  Counter -Irritants,  Plas- 
ters, Seton,  Nervous  Power,  sub- 
division  p.  1024,  Index  II. ;  Vital 
Properties,  Irritability,  Nervous 
PowER,/;?rfex7.     Also,  ()  1088  b. 


INDEX    II. 


1079 


Remote  Causes  of  Disease.     See  Caus- 
es, Morbific,  Index  II, 

Reparation, 

a  law  prevailing  universally  in  organic 
beings — analogies  between  its  motli- 
fications  in  Animals  and  Plants  un- 
der various  aspects — shown  to  be  the 
result  of  inflammation  in  the  union  of 
wounds  by  the  first  intention,  and  that 
the  nervous  system  contributes  one  of 
the  elements  of  its  distinctions  as  pre- 
sented by  Animals  and  Plants,  p.  474 
-475,  {)  733 /-z.  Also,  Vital  Prop- 
erties, Organic  Life,  Plants,  In- 
dex I. 

Respiration,  continued  from  Index  I., 
general  anatomical  and  physiological  ex- 
position of,  in  respect  to  the  reflex 
action  of  the  nervous  system  by  which 
it  is  determined,  and  associated  with 
th".  analogous  causation  of  vomiting 
as  occasioned  by  emetics,  diseases, 
mental  emotions,  &c.,  and  the  dis- 
tinctions attending  the  effects  of  the 
latter  from  those  of  the  simple  phe- 
nomenon of  respiration,  and  the  dis- 
tinctions between  the  complex  and 
profound  alterative  influences  of  the 
reflex  action  as  determined  by  emet- 
ics of  active  virtues  and  the  slighter 
ones  of  other  causes,  and  carried  to 
the  interpretation  of  the  modus  ope- 
randi of  all  morbific  and  remedial 
agents,  physical  and  mental,  through 
alterative  influences  of  reflex  or  di- 
rect action  of  the  nervous  system  be- 
yond the  direct  local  action  of  phys- 
ical agents,  p.  110,  <^  232;  p.  Ill,  <J 
233J  ;  p.  290,  i)  462  ;  p.  296,  ()  476 
c;  p.  302,  ^  481  b;  p.  323-330,  () 
500  c-nn  ;  p.  333-335,  ^  503-511  ;  p. 
336-338,  (^  514  b-d ;  p.  413,  <}  639  a  ,• 
p.  592-593, '^i  891  i  A-;  p. 666-670, 1^902 
6-m;  p.  671,  <;»  903.  Also,  Mental 
E.motions,  Disgust,  Reflex  Action, 
PiEMEDiAL  Action,  Index  II. ;  Will, 
Nervous  Power,  Index  I.  and  II. 
various  modifications  of,  as  in  sneezing, 
coughing,  yawning,  laughing,  asth- 
ma, hiccough,  &c.,  employed  for  the 
foregoing  purposes,  p.  327,  ^  500  t ; 
p.  338,  ()  514  d;  p.  340,  ^  514  k,  I; 
p.  886-890,  ^  1077.  Also,  Hiccough, 
Asthma,  Yawning,  &c..  Index  II. 
should  be  considered,  also,  in  connexion 
with  the  universal  fact  that  all  the 
muscles  in  organic  and  animal  life 
are  greatly  or  altogether  dependent 
for  their  movements  upon  the  stimu- 
lus of  the  nervous  influence  cither  re- 
flex or  direct,  and  that  this  considera- 
tion, as  it  respects  the  action  of  the 
heart  and  arteries  in  their  ordinary 
motions,  and  as  they  are  conspicuous- 
ly affected  through  the  nervous  influ- 


Respiration — continued. 

ence  by  mental  emotions,  food,  exer- 
cise, &;c.,  and  by  most  diseases,  ren- 
ders it  manifest  that  remedial  and 
morbific  agents,  taken  into  the  stom- 
ach, must,  by  their  action  upon  that 
organ,  transmit  influences  to  the  nerv- 
ous centres  that  will  be  reflected  upon 
these  exquisitely  susceptible  organs 
with  a  more  profound  eflect,  especial- 
ly upon  that  terminating  series  of 
vessels  which  are  so  sensitive  to  all 
mental  emotions,  and  which  are  the 
essential  instruments  of  all  healthy 
and  morbid  processes.  See  Reflex 
Action,  Remedies  ;  Causes,  Morbif- 
ic ;  Heart,  Cathartics,  Counter- 
Irritants,  Skin,  Cold,  Bloodlet- 
ting, Inflammation,  Whooping- 
Cough,  Phthisis,  Exercise,  Mental 
Emotions,  Fear,  Jealousy,  Shame, 
Food,  Vessels,  &c..  Index  li- 
the coincidences  between  voluntary  and 
involuntary,  emploj'cd  in  demonstrat- 
ing the  action  of  the  Will  and  Mental 
Emotions  through  the  direct  propaga- 
tion of  the  nervous  influence  upon 
the  voluntary  and  involuntary  or- 
gans. See  references  under  first  sub- 
division, and  Sphincter  Muscles, 
Roosting,  Index  II. 
employed  in  demonstrating  the  substan- 
tive existence  and  self-acting  nature 
of  the  Soul  and  Instinctive  Principle, 
p.  875-877, ^  1072  a. 
Revulsion.  See  Metastasis, /wtZca;  77. 
Rheumatism, 

treatment  of,  by  bloodletting,  tartarized 
antimony,  &c.,  p.  720,  ()  960  a  ;  p.  733, 
^  974  a;  p.  845-846,  ^  1058  ?!. 
considered  in  its  relations  to  the  doc- 
trines of  metastasis  and  repulsion,  p. 
354,  {}  525  c ;    p.  652-656,  ^  893  n. 
Also,  Metastasis,  Index  II. 
as  affecting  the  heart  in  articular  condi- 
tions, is  not  owing  to  abstraction  of 
blood,  but  to  the  same  reflex  nervous 
action  which  is  at  play  among  the 
joints,  and  calls  for  farther  loss  of 
blood,  p.  656,  i}  893  n.     Also,  p.  353- 
354,^  525  b,.c. 
Rhubarb, 

its  variety  of  effects,  cathartic,  astrin- 
gent, tonic,  and  stimulant,  according 
to  the  precise  conditions  of  disease 
and  its  doses,  contradict  the  chemical 
hypothesis  of  its  modus  operandi  and 
illustrate  its  impractical  nature,  and 
how  all  things  concur  together  in  de- 
monstrating those  effects  through  va- 
riously modified  influences  of  the 
nervous  power,  p.  554-556,  (J  872  a  ; 
p.  565-566,  ()  889  g ;  p.  571,  <J  890  b  ; 
p.  575-576,  ()  890  i-l ;  p.  578,  ^  890 
p;  p.581,<J890jc;  p.  661-663,  ij  894 


lOSO 


INDEX    II. 


Rhubarb — continued. 

b ;  p.  664-670,  <J  900-902  m ;  p.  679 
-681,  ^  905  a.  Also,  Cinchona,  In- 
dex II. 

unsuited  to  acute  inflammations  and  fe- 
ver, ibid. 

misapplied  particularly  in  dysentery, 
from  neglecting  the  stimulating  vir- 
tue of  the  one  and  the  pathology  of 
the  other — the  appropriate  remedies 
being  strictly  antiphlogistic,  p.  575,  § 
890  h.  Also,  Dysentery,  Index  I. 
RoGET,  on  animal  heat,  p.  238,  ^  438  c. 

his  opinion  of  Organic  Chemistry  as  ap- 
plied to  digestion,  p.  153,  <)  348. 

concedes   the   whole    ground    of  Vital 
Solidism  in  the  development  of  the 
Ovum,  p.  38-39,  ^  64/. 
Roosting,  and  the  sleeping  of  quadru- 
peds IN  AN  ERECT  POSTURE, 

and  occasional  instances  of  man's — 
when  the  Will  determinesj  through  the 
nervous  influence,  a  rigid  state  of  the 
voluntary  muscles  which  reacts  upon 
the  nervous  centres,  and  thus  main- 
tains an  unceasing  reflex  action  that 
corresponds  exactly  with  the  eflfect 
of  the  voluntary  act  (and  as  seen  also 
in  voluntary  and  involuntary  respira- 
tion and  contraction  of  the  sphincter 
muscles),  and  holds  them  in  the  same 
rigid  contraction  as  instituted  by  the 
Will,  and  which  is  the  cause  of  the 
reflex  development,  being  a  rare  ex- 
ample of  reflex  nervous  action  arising 
from  the  Will — employed  in  demon- 
strating the  substantive  existence  and 
self-acting  nature  of  the  Soul  and 
Principle  of  Instinct,  and  for  illustrat- 
ing the  modus  operandi  of  remedial 
and  morbific  agents,  and  of  Mental 
Emotions  through  alterative  influ- 
ences of  the  nervous  power,  <J  500  dd, 
514,1077.  Also,  Mental  Emotions, 
Index  II. ;  Will,  Index  I.  and  II. 


Saline    Cathartics.     Sec   Cathartics, 
Saline,  Index  II. 

Salivary  Glands, 
pour  out  the  saliva  under  the  exciting 
influence  of  nervous  action  as  devel- 
oped by  the  mind,  whether  the  re- 
mote cause  be  the  odor  of  food,  or  its 
expectation,  &c.,  p.  335,  ()  512  a;  p. 
866,  i)  1067  ;  p.  877,  ^  1072  i— -being 
exactly  coincident  with  the  flow  of 
urine  and  sweat  as  occasioned  by 
Fear,  p.  630-632,  ()  892J  b,  and  weep- 
ing by  Grief,  p.  880,  ^  1074— and 
with  the  increased  production  of  sali- 
va and  bile  as  determined  by  the  pres- 
ence of  food  in  the  stomach,  through 


Salivary  Glands — continued. 

Tcflcx  action  of  the  nervous  system,  p. 
335-336,  ^  512  a,  b  ;  p.  339-340,  ^ 
514  h — and  with  that  of  urine  as  the 
result  of  cold  applied  to  the  surface, 
and  of  lactation  through  the  same  cau- 
sation, p.  230-232,  ()  422  6-424— and 
employed  along  with  other  analogies 
to  interpret  the  modus  operandi  of 
morbific  and  remedial  agents,  physic- 
al and  mental,  through  alterative  in- 
fluences of  the  same  nervous  action, 
ibid.  Also,  Secretion  and  Excre- 
tion, Urine,  Milk,  Bile,  W^eeping, 
Parturition,  Odors,  Fear,  Jeal- 
ousy, Kidney,  Skin,  Food,  &c..  In- 
dex II. ;  Sudorifics,  hidex  I. 
Sap,  Circulation  of,  continued  from  In- 
dex I, 

chemical  thcorv  of,  analogous  to  Lie- 
big's  of  the  blood.p.  817-819,  ij)  1054. 

absorption, capillary  attraction,  and  evap- 
oration inadequate  causes,  p.  817,  <5 
1054. 

the  cause  supposed  to  reside  in  the  leaf, 
and  of  a  chemical  nature,  p.  818,  i) 
1054. 

the  supposed  causes  of,  allowed  to  be 
equally  necessary  for  the  blood,  p.  818 
-819, '()  1054 — but,  contradicted  by 
Hale's  experiments,  which  were  in- 
tended to  sustain  the  physical  hypoth- 
esis, p.  820-822,  {)  1054. 

the  usual  inconsistency  of  Organic 
Chemistry  when  it  aspires  at  a  solu- 
tion of  the  problems  of  Life,  as  dis- 
played by  LiEBiG  in  the  important 
matter  of  the  circulation  of  the  blood, 
p.  823,  <J  1055.  Also,  p.  175-176,  I) 
350i-  n-q. 

ascribed  by  Professor  Lindley  wholly 
to  vital  action,  p.  823,  (j  1054. 
Scammony, 

its  therapeutical  and  morbific  eflfects,  p 
856-857,  <^  1063. 
Scarlet  Fever      See  Fever,  Scarlet, 

Index  II 
Schultz,  Professor, 

his  vital  philosophy  of  digestion,  p.  202, 
<!»  376. 
Scrofula, 

constituted  by  a  specific  form  of  inflam- 
mation, and,  when  affecting  the  lungs, 
demands  an  antiphlogistic  treatment ; 
and  leeching,  particularly,  may  be  also 
often  usefully  associated  with  Iodine 
when  the  disease  is  limited  to  super- 
ficial parts,  with  various  explanatory 
remarks  relative  to  principles  and 
practice,  p  424,  ()  602  a;  p  615,  ^ 
m-2\  e;  p.  638-639,  ()  892±  g ;  p. 
649,  ^  893  ;  p  659.  (>  893  q';  p.  684, 
(i  905^  b;  p.  696-697,  ()  926,  927  a. 
Scurvy, 

opinions  of  distinguished  physicians  as 


INDEX    II. 


108] 


Scurs'y — conlinued. 

to  its  pathology  and  treatment,  p.  754, 
^  1002  d,  e. 

Sea-Sickness 

depends  in  part  upon  mental  emotions, 
and  partly  upon  unaccustomed  move- 
ments of  the  body,  through  complex 
influences  of  direct  and  reflex  action 
of  the  nervous  system  upon  the  stom- 
ach, but  which  soon  subside  under 
the  law  of  Habit,  and  may  be  re- 
strained by  the  Will  through  a  coun- 
teracting development  of  the  nervous 
power — employed  in  demonstrating 
the  substantive  existence  and  self- 
acting  nature  of  the  Soul,  and  is  not 
less  applicable  to  the  modus  operandi 
of  morbific  and  remedial  agents  of  a 
material  nature,  ij  1067  aa;  <J  1077. 
Also,  Exercise,  Phthisis,  Whoop- 
ing-Cough,  Intestine,  Mental 
Emotions,  Thunder,  Disgust,  Fear, 
Joy  and  Anger,  Reflex  Action,  In- 
dex II.  ;  Will,  Index  I.  and  II. ; 
Medical  and  Physiological  Commenta- 
ries, vol.  i.,  p.  569-574. 
Secreted  Products 

have  no  existence  in  the  blood  nor  in 
sap,  and  therefore  are  not  "  strained 
off,"  p.  24,  H2  ;  p.  219-227,  i)  408- 
411  ;  p.  478-479,  <J  740-741  ;  p.  484, 
()  748  ;    p.  780,  <J    1029  ;    p.   783,   (J 

1031  b;   p.  790,  <J  1032  b  ;  p.  791,  <J 

1032  c ;  p.  800-801,  ^  1033. 

the  advocates  of  remedial  action  by  ab- 
sorption express  "  great  astonishment 
that  the  bile  is  not  more  frequently 
affected  by  the  various  medicinal 
agents  put  into  the  stomach" — and 
why  not  also  the  chyle — why  no  ab- 
sorption of  the  bile,  of  intestinal  ac- 
ids, and  other  offensive  things  that 
often  abound  in  the  intestinal  canal 
— why  no  manifestation  of  the  "me- 
dicinal agents"  by  the  highly  irritable 
heart  1  p.  527,  ^829.  Also,  p.  129- 
131,  ()  277-284;  p.  132-134,  <)  289- 
295  ;  and  Lacteals,  Lymphatics,  In- 
dex II. ;  Veins,  Index  I.  and  II. 
Secretion  and  Excretion, 

analogous  functions,  the  latter  being 
properly  comprehended  in  the  former, 
but  having  certain  differences  in  final 
causes  and  composition,  p.  217,  () 
402  ;   p.  227-228,  Ml 2-4 17. 

influenced  by  direct  and  reflex  action  of 
the  nervous  system  upon  their  imme- 
diate instruments,  when  they  will  be 
simply  increased  or  diminished,  or, 
what  is  greatly  more  important,  vari- 
ously altered,  or  new  ones  generated, 
according  to  the  manner  in  which  the 
nervous  power  may  be  modified  by 
the  causes  which  bring  it  into  preter- 
natural operation,  both  physical  and 


Secretion  and  Excretion — continued. 

mental,  p.  105,  ^  220  b  ;  p.  107-110, 
()  226-232  ;  p.  193,  ^  356  a  ;  p.  215, 
()  395  ;  p.  230-232,  (}  422  i-424  ;  p. 
249,  ()  441  c;  p.  253,  I)  441  d ;  p. 
262-265,  ^  446  a-447  a ;  p. 262-265, 
<J  446  a-447  b  ;  p.  285-286,  ()  455  d- 
456  b ;  p.  289,  I)  461  ;  p.  310,  ^  485  ; 
p.  313-314,  i)  488-489  ;  p.  317,  t)  493 
a  ;  p.  325-326,  ()  500  ee  ;  p.  335-336, 
«;i512a,-  p.  339,  <;>514/i;  p.  341-342, 
()  514^  b;  p.  344,  ^  516  rf.  No.  6;  p. 
348,  f)  516  d,  No.  13;  p.  350-351,  <J 
524,  No.  1  ;  p.  355,  ^  526  a ;  p.  430- 
433,  ()  675,  676  a ;  p.  450-452,  <J  691- 
693  ;  p.  478-479,  ()  740-741  b  ;  p.  483 
-484,  ^  746  c  ;  p.  546-549,  (}  862-863  ; 
p.  563,  (}  889  a  ;  p.  565,  I)  889  /,  g ;  p. 
630-632,  (^  892J  b,  c ;  p.  634,  (j  8924 
a,  b  ;  p.  637,  ^  S92|  d ;  p.  662,  ()  896 1 
p.  666-672,  ()  902  6-904  a ;  p.  704,  (} 
943  a,  b;  p.  709,  (J  951  c  ;  p.  710-711, 
952  b-g;  p.  866-868,  ()  1067.  Also, 
Bile,  Milk,  Lactation,  Parturi- 
tion, Mental  Emotions,  Fear,  Jeal- 
ousy, Food,  Skin,  Cold,  Kidney,  In- 
dex II. ;  Organic  Heat,  Index  I. 
the  fluid  products  of  glandular  organs, 
sweat,  gastric  juice,  &c.,  and  all  the 
solids,  on  common  ground  as  it  re- 
spects their  dependence  upon  organ- 
ic actions  and  their  relations  to  the 
nervous  system,  though  in  the  normal 
state  the  fluids  manifest  far  greater 
influences  of  the  nervous  power  than 
the  composition  of  the  solids,  and  the 
glandular  fluids  more  so  than  the 
membranous  ;  ut  supra,  and  Organic 
Compounds,  Vital  Properties,  Or- 
ganic Life,  Index  I. 
the  apparently  endless  variety  of  organ- 
ic fluids  as  well  as  solids  in  plants 
and  animals,  and  each  one  forever 
the  same  in  any  given  part  in  its  per- 
fect state,  and  mostly  composed  of 
four  elements,  their  ternary  or  qua- 
ternary combinations,  ratios  and  di- 
versities in  their  modes  of  union,  their 
dependence  in  animals  for  their  per- 
fected condition  upon  modifying  in- 
fluences of  the  nervous  system,  while 
they  have  no  such  tributary  aid  in 
plants,  and  their  natural  and  morbid 
fluctuations  in  animals  under  the  in- 
fluence of  direct  and  reflex  action  of 
the  nervous  system  as  brought  into 
effect  by  mental  emotions  or  physical 
agents,  and  according  to  their  precise 
nature,  contradistinguish  the  laws  of 
organic  from  those  of  inorganic  bodies 
— and  a  fundamental  distinction  drawn 
between  what  belongs  to  organic  life 
and  what  is  referable  to  its  influences 
by  the  nervous  system,  p.  21,  ij  22  ; 
p.  23-26,  (J  37-48  ;  p.  27-28,  ^  52-53  ; 


1082 


INDEX    II. 


Secretion  and  Excretion — continued. 

p.  30,  <J  58  ;  p.  193,  (^  356  a ;  p.  220- 
227,  ()  409  i-411  ;  p.  230-232,  ^  422 
A-424  ;  p.  262-263,  <!i  446  a  ;  p.  289, 
(J  461;  p.313-315,  H88-489;  p.  317 
-318,  <J  493  ;  p.  335-336,  (}  512  a,  b  ; 
p.  355,  ^  526  a  ;  p.  483-484,  (}  746  c  ; 
p.  547-548,  ()  863  d ;  p.  563-564,  ^ 
889  a ;  p.  630-632,  ()  892 J  J,  c ;  p. 
668-669,  (i  902  ^ ;  p.  704,  ()  943  a  ;  p. 
804-805,  (^  1040  ;  p.  866-867,  ()  1067 
a;  ^  22li,  399,  456  a,  478  Z>. 
by  now  taking  in  connexion  what  the 
Author  has  said  under  the  sections  in 
the  two  preceding  subdivisions  of  the 
influences  of  the  reflex  action  of  the 
nervous  system  upon  the  secreted 
fluids,  there  may  be  found,  at  p.  478- 
480,  <^  740-741  (where  the  Author 
presents  an  example,  for  illustratioti, 
from  the  humoral  pathologist),  the 
whole  philosophy  distinctly  and  brief- 
ly presented  relative  to  the  part  which 
the  nervous  influence  takes  in  organ- 
ic processes,  the  products  being  gen- 
erated by  the  organic  mechanism 
through  its  own  inherent  properties, 
p.  55,  ()  113-117;  p.  58-59,  <J  129  c- 
i ;  while  the  nervous  influence,  in  its 
morbific  aspect,  and  whether  excited 
by  physical  or  mental  causes,  so  mod- 
ifies their  condition  that  they  elabo- 
rate morbid  instead  of  natural  prod- 
ucts ;  and,  turning  to  the  example 
of  the  Seton  at  p.''679-681,  ^  905  a, 
there  will  be  found,  in  an  equally  suc- 
cinct manner,  the  whole  philosophy 
of  the  alterative  influence  of  reflex 
action  of  the  nervous  system  as  the 
medium  through  which  all  the  modi- 
fications of  secreted  products,  as  set 
forth  under  the  sections  embraced 
in  the  foregoing  subdivisions,  are 
brought  about,  and  as  exemplifying 
all  that  is  ever  concerned  in  the  mo- 
dus operandi  of  remedial  and  morbific 
causes,  upon  parts  beyond  the  seat 
of  their  direct  operation — while,  also, 
even  animal  heat  is  on  the  same  com- 
mon ground  with  other  secreted  prod- 
ucts, and  its  generation,  therefore,  is 
alike  influenced  by  reflex  and  direct 
action  of  the  nervous  system.  See, 
also.  Nervous  System,  hidcx  II.,  p. 
1029,  subdivision  upon  Animal  Heal. 
considered  by  the  Author  as  "  fully  set- 
tled by  experiments"  made  by  A.  P. 
W.  Philip,  that  "  the  power  of  secre- 
tion is  independent  of,  though  influ- 
enced by  the  nervous  system,"  as  ap- 
pears in  his  Reports  of  the  same  in 
Londo7i  Philosophical  Transactions  for 
1815  and  1817,  and  to  which  there 
are  summary  references  at  p.  314- 
315,  {)  489  ;  p.  317-318,  ij  493  a-d— 


Secretion  and  Excretion — continued. 

and,  therefore,  long  antecedently  to 
the  suggestions  upon  the  same  sub- 
ject by  Henle,  Bonders,  Ludwig,  &c., 
while,  also,  Bichat  had  arrived  at  the 
same  opinion  without  the  aid  of  ex- 
periment, p.  270,  i)  447  d. 
uses  in  diseases  of  fluid  products,  being 
different  according  to  the  nature  of 
each,  p.  231,  ^  422  c;  p.  232-234,  ^ 
427-428;  p.  450-451,  i^  691,  692  ;  p. 
471,  i)  732  b  ;  p.  473-474,  ^  733  e;  p. 
546-551,  ()  862-864;  p.  637,  ()  8924 
d ;  p.  639,  ^  892|-  g ;  p.  647,  ()  893/ 
Also,  Sweat,  Vvs,  Index  II. 

Sedatives — continued  from  Index  I, 
definition  of,  p.  828,  <^  1057  a— and  dis- 
tribution into  five  groups,  p.  830,  § 
1057  c. 
the  term  does  not  imply  their  most  es- 
sential action,  which  is  variously  al- 
terative through  the  medium  of  reflex 
nervous  influence,  and  according  to 
the  nature  of  the  Sedative  ;  and,  al- 
though it  is  the  change  in  kind  which 
each  one  institutes  in  the  organic 
properties  that  forms  their  character- 
istic distinction,  the  only  two,  loss 
of  blood  and  tartarized  antimony,  of 
much  importance  as  curative  reme- 
dies, and  these  in  'all  other  respects 
totally  unlike,  will,  nevertheless,  ef- 
fect such  alterations  in  morbid  states 
as  render  them  the  most  universal 
means  of  subduing  inflammations  and 
fevers — being  also  sufficiently  con- 
clusive that  the  philosophy  of  their 
operation  has  not  the  most  remote 
alliance  to  the  rigorous  laws  of  Chem- 
istry, p.  829-832,  <J  1057  a-f ;  p.  838, 
^  1057i.  Also,  p.  664,  (}  900  ;  p.  681 
-683,  <S»  905  b.  Remedial  Action, 
Stomach,  Index  II. 
many  of  them,  especially  the  Narcotics, 
Hydrocyanic  Acid,  Aconite,  Strych- 
nia, may  determine  the  nervous  in- 
fluence with  great  suddenness  and  vi- 
olence upon  the  organic  constitution 
of  the  brain  as  upon  other  parts,  p. 
298,  {}  476^  h  ;  p.  300-301,  <J  479  ;  p. 
320,  <)  494  dd ;  p.  324,  ()  500  c  ;  p.  334, 
^  509  ;  p.  520-521,  <!>  826  d;  p.  523- 
524,  ^  827  d;  p.  592-593,  (f  89U  ^- ; 
p.  671-672,  ^  904  o,  b;  p.  704,  ()  943 
a,  h;  p.  706,  ij  946;  p.  831-832,  (^ 
1057/;  p.  838,  (j  1057^.  Also,  Stom- 
ach, Blows  upon.  Index  II. 
Aconite,  in  relieving  neuralgia  when  ap- 
plied to  the  skin,  illustrates  the  alter- 
ative influence  of  reflex  nervous  ac- 
tion upon  particular  nerves,  p.  838,  <J 
1057^.  Also,  Sympathy,  Contigu- 
ous ;  Counter-Irritants,  Plasters, 
&c.,  Index  II. 
other  examples  of  the  external  applica- 


INDEX    II. 


1083 


Sedatives — continued. 

tion  of  Belladonna,  Hyoscyamus,  and 
"  an  imponderable  quantity  of  Atro- 
pia,"  and  of  the  bite  of  venomous 
Reptiles,  and  of  Opium,  and  Hydrocy- 
anic Acid,  internally,  where  it  is  evi- 
dent that  their  effects  were  determ- 
ined by  alterative  influence  of  reflex 
nervous  action,  p.  319,  ^  494  b-ild  ;  p. 
525-526,  ^  828  b,  c;.  p.  672-674,  ^ 
904  b. 

may  act  as  such  only  in  special  condi- 
tions of  disease,  p.  829-830,  <J  1057 
a,b. 

varieties  in  effects  of  Cold,  p.  832,  ^ 
1057  g.     Also,  Cold,  Skin,  Index  II. 

comparative  effects  of  Bloodletting,  Hy- 
drocyanic Acid,  and  Tartarized  Anti- 
mony, p.  831,  ()  1057  c. 

Cotton-wool  and  Castor  Oil,  as  possess- 
ing sedative  virtues,  p.  833-835,  ^ 
1057  k,  I. 

examples  of,  contrasted  with  Stimu- 
lants, p.  829,  ()  1057  a. 

may  produce  inflammation,  p.  480-481, 
()  743  ;  p.  502,  <J  817  ;  p.  523,  ^  827  ; 
p.  584,  ()  891  d;  p.  708,  (J  950  ;  p. 
733, ^  874  b  ;  p.  773-775, ^  1024  ;  p. 
829,  ^  1057  a. 
Self-Limited  Diseases.     See  Diseases, 

Self-Limited,  Lidez  II. 
Senna, 

its  therapeutical  and  morbific  effects,  the 
latter  preponderating,  p.  858,  ^  1064. 
Senses, 

weariness  of,  said  to  be  similar  to 
"  chemical  changes  on  an  iodized 
plate" — supplying  an  example  of  the 
flillacies  of  reasoning  from  the  phe- 
nomena of  inorganic  bodies  and  arti- 
ficial contrivances  to  identify  their 
laws  with  those  of  living  beings,  p. 
797-798,  ()  1034.  Also,  p.  132-133, 
(j  289-291  ;  p.  167,  No.  29;  p.  168, 
No.  31  ;  p.  172-173,  No.  44,  45  ;  p. 
175-176,  l^  350^  n-j);  p.  177-178,  <J 
850 J /;  p.  238,  ^  438  A,  c  ;  p.  517,^ 
721  c ;  p.  528,  ^  832-835. 
Sensibility,  continued  from  Index  I, 

important  to  distinguish  it  from  Irrita- 
bility, not  only  as  a  property  peculiar 
to  animal  life,  but  as  the  medium  of 
transmitted  impressions  in  the  func- 
tion of  reflex  action  of  the  nervous 
system,  p.  89,  (i  188  a,  &c.  ;  p.  101- 
102,  .J  201-202  ;  p.  282-283,  ()  451 
d-f;  p.  671,  ij  903. 

some  new  observations  as  to  its  relation 
to  the  posterior  roots  of  spinal  nerves, 
p.  802,  ^  1037  b. 

sympathetic  and  other  modifications  far- 
ther distinguished  by  Brown-Se- 
quard's  experiments,  p.  802,  ^  1037 
b.  Also,  p.  216,  (J  399 ;  p.  313,  (J 
487  gg. 


Serous  Tissue, 
treatment  of  its  inflammations,  p.  727,  (^ 

■      960/;  p.  750,  (j  995  ;  p.  756-758,  <! 
1005  b-h;  p.  847,  ()  1058  r. 

Serpents,  Virus  of, 

experiments  by  several  hands  proving 
that  it  does  not  operate  by  absorption, 
but,  like  the  hydrophobic  virus,  by 
morbific  influence  of  reflex  action  of 
the  nervous  system  instituted  by  the 
bitten  part,  p.  319,  <J  494  b-dd;  p. 
1146 ;     p-      525-526,    §    828     a- 

d.  Also,  HTDr.oPHOBi.\,  Virus  of, 
Index  II. 

Seton, 

its  modus  operandi  both  locally  and 
through  alterative  influence  of  reflex 
action  of  the  nervous  system,  exem- 
plifying the  whole  philosophy  that  is 
ever  concerned  in  the  operation  of 
remedial  and  morbific  agents,  p.  679-^ 
681,  i5>  905  a — originally  set  forth  in 
Essay  on  the  "Modus  Operandi  of 
Remedies"  (1842). 

Shame 

doubtless  awakens  the  consciousness  of 
an  internal  monitor  distinct  from  the 
corporeal  fabric — but  how  does  it  be- 
tray itself  in  the  crimsoned  cheeks, 
or,  if  blended  with  a  little  Fear,  in  the 
trembling  muscles,  the  drops  of  sweat, 
and  the  flow  of  urine,  unless  through 
that  amazing  principle,  the  nervous 
influence,  which  may  strike  us  dead 
in  an  instant  when  Joy  and  Anger 
make  their  sudden  and  violent  dem- 
onstrations, or  as  blows  upon  the  epi- 
gastric region,  and  surgical  opera- 
tions, and  the  bite  of  venomous  ser- 
pents, and  hydrocyanic  acid,  and  the 
respiration  of  chloroform,  will  do  the 
same — and  thus,  also,  as  unmingled 
or  compounded  with  other  emotions. 
Shame  exemplifies  the  manner  in 
which  remedial  and  morbific  agents 
of  a  physical  nature,  and  according  to 
their  simplicity  or  complexity  and  the 
nature  of  each,  will  institute  corre- 
sponding influences  of  reflex  nervous 
action  —  or  turning  to  Fear  alone, 
there  may  be  sten  in  its  displays  of 
the  nervous  influence  a  near  coinci- 
dence with  that  universal  alterative 
impression  which  a  single  morbific  or 
remedial  agent  may  exert,  as  witness- 
ed in  the  production  of  fever,  and  in 
its  cure  by  loss  of  blood  or  an  emetic, . 
or,  to  complete  the  coincidence,  by  a 
mental  emotion,  p.  95,  i^"  118^  f^;  p. 
107-111,  (j  227-233J  ;    p.  245,  <;.  440 

e,  No.  14 ;  p.  324,  i)  500  c ;  p.  327- 
328,  {)  500  ;,  k  ;  p.  332,  (^  501  c  ;  p. 
333,  <J  503  ;  p.  339-341,  <^  514  g-m  ; 
p.  631-632,  ()  892}  b  ;  p.  66K663,  ^ 
894-896  ;  p.  665-670,  i)  901-902  ;  p. 


1084 


INDEX    II. 


Shame — continued. 

679-681,  <J  905  a  ;  p.  704,  <)  943  a,  b ; 
p.  706-707,  ()  947  ;  p.  709,  i)  951  b-d  ; 
p.  879-882,  ()  1074-1075;  p.  891,  () 
1077;  p.  901,  ()  1078  /.  Also,  Re- 
medial Action,  Mental  Emotions, 
Jov  AND  Anger,  Feak,  Disgust, 
Love,  Grief,  Hope,  Thunder,  &c., 
Index  II. ;  Nervous  Power,  Index  I. 
and  II. 

Shower-Bath, 

its  curative  or  morbific  effects  upon  in- 
ternal organs  exerted  through  altera- 
tive influences  of  reflex  nervous  ac- 
tion, after  the  manner  of  cold  air  in 
starting  the  secretion  of  urine,  or  in 
the  production  or  cure  of  disease,  of 
counter-irritants,  &c. — employed  to 
illustrate  the  modus  operandi  of  all 
other  remedial  and  morbific  agents 
upon  parts  beyond  the  seat  of  their 
direct  operation,  and  to  show  how 
readily  the  nervous  influence  is  modi- 
fied in  its  nature  by  its  exciting  causes, 
and  how  diversely  it  will  affect  or- 
gans according  to  their  existing  con- 
dition, the  nature  of  tissues,  &c.,  p. 
832-833,  ()  1057  g.  Also,  p.  59,  () 
129  g-i;  p.  61,  <;.  132-133;  p.  63- 
67,  ()  137  t-151.  Skin,  Cold,  Ex- 
ercise, Friction,  Amenorrhcea,  hi- 
dcx  II. 

SiGMOND, 

his  observations  upon  certain  special  ef- 
fects of  Narcotics,  p.  673,  674,  s^  904 
b.  Also,  Opium,  Sedatives  {Aco7iile), 
Index  II. 

his   opinion   of  the  Anatomical  School 
of  Medicine,  p.  603-604,  ()  892  k. 
Silver,  Nitrate  of, 

best  local  remedy  for  leucorrhcea,  p. 
576,  (J  890  m  ;  p.  688,  ^  905^  c. 

absorbed  in  the  condition  of  an  inert 
muriate,  or  would  otherwise  be  con- 
verted into  an  inert  substance  on  its 
passage  to  the  blood — introduced  for 
the  purpose  of  showing  that  Astrin- 
gents and  other  remedies  operate 
upon  parts  beyond  the  seat  of  their 
direct  action  through  alterative  influ- 
ence of  reflex  nefvous  action,  p.  530, 
(J  873  e ;  p.  533,  (}  842  ;  p.  577,  I) 
890  0. 
Simon, 

his  vital  exposition  of  fibrin,  p.  800,  (J 
1035.     Also,  MiJLLER.'s   and  Hunt- 
er's, p.  24,  l)  42. 
Skin, 

exquisitely  susceptible  in  sympathetic 
sensibility  (p.  101-102,  ^  201-202  ;  p 
282-283,  <^  451  d-f;  p.  695,  <^  924)  to 
impressions  from  particular  causes 
that  produce  no  apparent  disturbance 
of  its  organic  condition,  but  which  are 
capable  of  exciting  a  disturbing  re- 


Skin — conlinucd. 

flex  action  of  the  nervous  system,  as 
witnessed  in  the  suddenly  increased 
secretion  of  urine  on  the  contact  of 
cold  air,  and  the  production  of  in- 
ternal inflammations  from  the  same 
cause,  or,  at  other  times,  in  the  invigo- 
rating and  curative  influences  of  cold 
either  through  the  medium  of  air  or 
the  shower-bath,  and  as  seen  in  rous- 
ing the  heart  in  syncope,  and  in  the 
counteracting  effect  of  the  cold  dash 
in  cases  of  narcotic  poisoning,  &c., 
and  in  the  effects  of  the  hot  bath, 
medicated  baths,  and  of  friction,  upon 
internal  organs — and  this  associated 
with  the  morbific  action  of  miasms 
and  other  analogous  causes,  and  with 
the  analogies  supplied  bj'  certain  spe- 
cial effects  of  narcotics,  plasters,  &c., 
where  absorption  cannot  be  sur- 
mised, and  with  the  more  strongly 
pronounced  analogies  derived  from 
counter-irritants,  setons,  &c.,  and 
uniting  with  the  whole  many  natural 
functions  in  which  the  reflex  nerv- 
ous action  is  the  immediate  exciting 
cause,  as  respiration,  the  motions  of 
the  heart,  of  the  intestine,  of  the  iris, 
deglutition,  &c.,  and  taking  along  the 
important  part  which  the  nervous  sys- 
tem contributes  in  the  development 
of  the  body  from  Infancy  to  Adult 
age,  in  pregnancy,  parturition,  lacta- 
tion, &c.,  and  many  other  correspond- 
ing facts  which  the  Author  brings  to 
sustain  his  conclusions  in  respect  to 
the  Skin,  he  recurs  to  the  evidence 
supplied  by  that  organ  of  its  exquisite 
sensitiveness  to  certain  natural  stim- 
uli and  morbific  agents,  and  the  un- 
equivocal dependence  of  their  remote 
effects  upon  the  nervous  system,  and 
endeavors  to  show  that  all  other 
agents  of  less  obvious  modes  of  ac- 
tion as  mercurial  ointment,  or  any 
of  the  soluble  preparations  of  mer- 
cury, &c.,  when  applied  to  the  skin, 
affect  internal  parts  through  the  me- 
dium of  alterative  influences  of  reflex 
action  of  the  nervous  system,  and  to 
show,  also,  by  the  collective  force  of 
all  the  foregoing  analogies,  as  well  as 
by  the  obvious  mode  of  action  through 
the  nervous  sj'stcm  of  many  things 
applied  to  the  alimentary  mucous  tis- 
sue, such  as  emetics,  &c.,  that  all  re- 
medial and  morbific  causes  exert  their 
effects  through  that  same  medium 
upon  parts  beyond  the  seat  of  their 
direct  operation,  p.  61,  (^  133;  p.  66- 
67,(5148;  p.  107-112,  (J  227-234;  p. 
230-232,  {)  422-427  ;  p.  245,  (}  440  c  ; 
p.  253,  i)  441  d;  p.  308-310,  (/  484- 
485;  p.  312,  H87£',-  p.  319-320,  ^ 


INDEX    II. 


1085 


Skin — continued. 

494  b-dd ;  p.  321,  ^ 497  ;  p. -323-324, 
<J  499-500  c;  f  327,  <J  500  t ;  p.  331 
-332,  (i  500  O-501  c,  p.  333,  t)  503  ; 
p.  335-336,  i)  512;  p.  338,  <J  514  (i  ; 
p.  339-341,  «;>  514  g-m  ;  p.  343,  ^  516 
(i,  No.  4  ;  p.  346,  ^  516  t/,  No.  9  ;  p. 
348,  ^  516  d,  No.  13  ;  p.  349-350,  (} 
520-523  ;  p.  351,  <^  524  a,  No.  1  ;  p. 
352,  ^  524  c ;  p.  353,  ^  524  d,  No.  4- 
7  ;  p.  355,  <^  526  a  ;  p.  359-360,  i)  527 
a-d;  p.  416-417,  <J  649  c,  d;  p  421 
-423,  ^  657-658  ;  p.  424,  ()  662  a  ;  p. 
430,  ^  674  rf ;  p.  468,  ()  722  Zi ;  p.  520 
-521,  (^  826  0  ;  p.  523-524,  (^i  827  c-c  ; 
p.  525-527, 1)  828  a-tZ ;  p.  532,  ()  841  ; 
p  592-593,  ()  89U  A;;  p  631-632,  <} 
8924  *,  f  ,•  p.  634,  ()  8924-  b  ;  p.  661- 
663,  I)  894-896  ;  p.  665-676,  ^  902- 
904  ;  p. 679-681,  ^  905  a ;  p.  705,  ^ 
945;  p.  803,  ^1038;  p.832,^  1057^; 
p.  838,  (j  1057i ;  p.  880,  <j  1074,  p. 
64^-644,  ()  893  a-c ;  ()  956,  1088  i. 
Secretion  and  Excretion,  Sweat, 
Bile,  Salivary  Glands,  Cold,  Fric- 
tion, Exercise,  Opium,  Mental  Emo- 
tions, Fear, Jealousy,  Pregnancy, 
Parturition,  Organs  of  Genera- 
tion, Stomach  ;  Antimony,  Tartar- 
ized  ;  Counter- Irritants,  Plas- 
ters, Predisposition,  Pathological 
Cause,  Index  II ;  Youth,  Index  I.  and 
II. ;  SuDORiFics,  Index  I. 
it  has  never  been  shown,  however  much 
assumed,  that  the  human  Skin  will 
absorb  extraneous  substances,  not 
even  water,  as  Magendie  decides,  and 
the  experiments  relative  to  opium,  the 
wourari  poison,  the  virus  of  serpents, 
hydrocyanic  acid,  &c.,  goto  our  pres- 
ent purpose  ;  and  this  failure  of  ex- 
periments to  prove  absorption  is  far- 
ther shown  by  a  forced  analogy  drawn 
from  the  supposed  absorption  of  wa- 
ter by  the  Skin  of  Lizards  ;  for,  how- 
ever the  general  analogies  obtain  in 
respect  to  great  fundamental  laws, 
they  are  quite  liable  to  fail  as  regards 
certain  special  functions,  and  it  would 
be  an  equal  ground  of  reasoning  with 
the  foregoing  to  the  Skin  of  man  from 
animals  that  respire  by  that  organ,  or 
others  by  whom  it  is  periodically  shed, 
or,  in  other  respects,  from  the  regen- 
eration of  the  Lizard's  tail,  &c.,  p 
175-176,  <5  350^  n-p ;  p.  306-310,  ^ 
483  6-484  ;  p.  474-475,  i)  733/-? ;  p 
520,  ^  826  b-d  ;  p  522-523,  <J  827  b, 
c  ;  p  530-531,  ^  837  b-cc  ;  p.  827,  <J 
1055  ;  p.  930,  ()  1088  b. 
the  effects  upon,  by  narcotization,  and 
of  acetic  acid  applied  to  the  mouth 
and  skin  of  eviscerated  frogs,  em- 
ployed in  interpreting  the  operation 
of  remedies  upon  internal  parts  when 


Skin — continued. 

applied  to  the  skin,  through  altera- 
tive influences  of  reflex  nervous  ac- 
tion.    See  VoLKMAN,  Index  II. 

some  parts  of,  more  susceptible  of  those 
impressions  which  occasion  morbific 
influences  of  reflex  action  of  the  nerv- 
ous system  than  other  parts,  p.  61- 
62, 1)  133-136  ;  p.  415-416,  ()  649  b; 
p.  695,  i)  924,  also  Amenorrhoka, 
Leeching,  Index  II. — which  reflects 
light  upon  Brown-Sequard's  observa- 
tions upon  epileptiform  convulsions, 
as  produced  by  irritation  of  particular 
parts  of  the  skin,  p.  802,  ()  1037  a. 

its  eruptive  diseases  often  occasioned  by 
a  morbific  reflex  action  of  the  nervous 
system  instituted  by  disorders  of  the 
alimentary  canal,  as  manifestly  the 
case  after  a  debauch,  and  as  seen, 
also,  in  the  immediate  subsidence  of 
the  cutaneous  affection  under  the  in- 
fluence of  an  emetic  or  cathartic, 
which  not  only  arrest  the  morbific 
cause,  but  determine  a  curative  reflex 
action  ;  and  which  serves  as  an  index 
to  the  philosophy  of  the  origin  of  nu- 
merous chionic  eruptions,  and  of  their 
cure  by  gradually  alterative  remedies 
operating  through  the  same  reflex 
nervous  influence — or,  again,  a  su- 
pervening eruptive  disease  may  react 
upon  and  relieve  the  internal  affec- 
tion ;  and  when  we  associate  with 
the  foregoing  the  heterogeneous  vari- 
ety of  things  that  will  alike  cure  the 
same  chronic  eruptions,  whether  in- 
ternally or  externally  applied  (even 
more  various  in  their  physical  prop- 
erties than  the  remedies  for  intermit- 
tents),  and  other  analogous  facts 
which  meet  our  attention  on  every 
hand,  the  philosophy  of  Vital  Solid- 
ism,  wielding  the  magic  power  of  the 
nervous  system,  falls  with  a  crushing 
weight  upon  the  factitious  analogies 
borrowed  from  the  precise  laws  of  the 
inorganic  world,  p.  352,  ^  524  c ;  p. 
359,  ^  527  a,  b;  p.  669-671,  ()  902 
?,  m  ;  p.  673,  ^  904  b,  also,  Opium, 
Humoral  Pathology,  Remedial  Ac- 
tion, Index  II. — and  the  constitution- 
al effects  of  small-pox,  measles,  and 
scarlatina  probably  depend  upon  a 
morbific  reflex  nervous  influence  in- 
stituted by  the  alimentary  mucous  tis- 
sue, as  denoted,  also,  by  the  primary 
appearance  of  the  eruption  in  the  fau- 
ces— excepting  as  inoculated  small- 
pox would  involve  a  primary  reflected 
influence  of  the  nervous  power  upon 
the  mucous  tissue  (instituted  by  the 
artificial  pustule),  and  thence  a  re- 
flected action  upon  the  skin  as  the 
exciting  cause  of  the  general  erup- 


1086 


INDEX    II, 


Skin — continued. 

tion,  p.  359,  (^  527  a,  h.  Also,  Dis- 
eases, Self-Limited  ;  Small-Pox  ; 
Hydrophobia,  Virus  of  ;  Predispo- 
sition, Index  II. ;  and  Medical  and 
Physiological  Commentaries,  vol.  i., 
p.  494-513  ;  p.  569-574. 

Liebig's   philosophy    of  its    supposed 
agency  in  the   circulation,  p.  823,  ^ 
1055 
Small-pox, 

Author's  theory  of  the  primary  locality 
of  the  disease,  and  of  its  propagation 
to  other  organs,  analogous  to  that  of 
hydrophobia,  miasmatic  diseases,  &c., 
though  in  a  more  determined  manner, 
as  set  forth  under  Article  Skin,  Li- 
dex  II. ;  p.  59,  ()  129  h  ;  p.  65,  <^  143 
c ;  p.  66-67,  ()  148  ;  p.  333-334,  ^ 
502-506  ;  p.  348,  <}  516  d.  No.  13, 
518  a.  b;  p.  351-352,  ^  524  c;  p. 
359,  <J  527  b;  p.  360,  ()  527  d;  p. 
364,  ^  545  ;  p.  368-369,  ^  559-563  ; 
p.  416-417,  ()  649  c,  650;  p.  420- 
423,  ^  654-660;, p.  426,  (;  666;  p. 
429-430,  <)  674  d;  p.  465,  ()  714;  p. 
522-523,  <J  827  b,  d  ;  p.  539,  i)  847  h- 
848  ;  p.  546,  <J  862  ;  p.  553,  <J  870  aa ; 
p.  670-671,  (j  902  m  ;  p.  862-864,  ^ 
1066.  Also,  Hydrophobia,  Virus 
OF  ;  Serpents,  Virus  of  ;  Predispo- 
sition, Miasm,  Whooping-Cough, 
Phthisis,  Bidex  II. 

chemical  theory  of,  p.  172,  (}  350,  No 
45. 

essentially  the  same  as  the  Vaccine  dis- 
ease— extinguishes  the  susceptibility 
of  the  system  to  a  second  attack,  upon 
the  same  principle  as  involved  in  ac- 
climation— distinction  in  time  of  pre- 
disposition between  natural  and  inoc- 
ulated— has  also  the  peculiarities  of 
other  self-limited  diseases  in  being 
contagious  without  contact,  and  in 
having  a  definite  course  of  rise  and 
decline,  and,  like  the  others,  illus- 
trates by  its  remote  cause  the  law  of 
contagion,  p.  364,  ^  543-548  ;  p.  365, 
<^  551  ;  p.  366,  <J  554  ;  p.  419-420,  ^ 
653;  p.  421,  (J  654  b;  p.  425,  ^  664: 
p.  488,  <)  756  a  ;  p.  544-^546,  ^  858^ 
861.  Also,  Diseases,  Self-Limited  ; 
Acclimation,  Miasm,  Contagion,  Iji- 
dcx  U. 

notwithstanding,  however,  the  remote 
cause  carries  with  it  its  own  curative 
virtue,  and  the  disease  in  ordinary 
conditions  admits  of  no  active  treat- 
ment, should  inflammation  of  impor- 
tant organs  supervene,  they  become 
the  means  of  impressing  upon  the 
general  malady,  through  an  alterative 
influence  of  reflex  nervous  action,  a 
modified  condition,  which  enables  the 
system  to  bear  all  the  vigorous  treat- 


Small- Pox — continued. 

ment  demanded  by  the  same  inflam- 
mation when  occurring  independently 
— and  so  of  other  self-limited  diseases, 
p.  65,  ()  143  c,  and  references  there  ; 
p.  536-539,  ()  847-848  ;  p.  542-543, 
^  854  c-f;  p.  544-545,  i}  858  ;  p.  553, 
<J  870  aa ;  p.  665,  ^  901  ;  p.  722-724, 
^  960  h ;  p.  730,  (J  969  a  ;  p.  732,  ^ 
970  c  ;  p.  733-734,  i)  973-975. 
like  measles,  scarlatina,  cholera,  dysen- 
tery, &c.,  is  liable  to  be  rendered  more 
prevalent  and  malignant  than  at  other 
times  through  antecedent  influences 
of  common  miasmatic  causes,  when, 
also,  its  character  may  be  so  modified 
as  to  render  unusual  means  of  treat- 
ment useful  or  necessary,  as  some- 
times Cinchona ;  and  hence  the  im- 
portance of  looking  well  at  any  sub- 
ordinate predisposing  causes  in  all 
grave  forms  of  disease,  p.  418.  (j  652 
b  ;  p.  544-545,  (J  858  ;  p.  553',  ()  870 
aa.  Also,  p.  419,  ()  653  b  ;  p.  424- 
425,  (J  662-663  ;  p.  438-442,  ^  686  ; 
p.  489,  ^  756  b  ;  p.  509,  MH  ;  P- 
510,  ^  814;  p.  511,  (J  816  i*  ;  p.  538, 
^  848  ;  p.  559-560,  ^  883  b  ;  p. 723- 
724,  ^  960  6-961,  630  c,  c,  970  c. 

Sneezing, 

when  occasioned  by  the  sun's  light,  the 
result  of  a  double  series  of  reflex  ac- 
tions of  nervous  system  ;  and  may  be 
occasioned  by  the  mind,  when  the 
nervous  influence  is  simplified  in  be- 
ing direct  and  reflex — employed  to 
illustrate  the  modus  operandi  of  mor- 
bific and  remedial  agents,  both  phys- 
ical and  mental,  through  alterative 
action  of  the  same  medium,  and  in 
demonstrating  the  substantive  exist- 
ence and  self-acting  nature  of  the 
Soul  and  Instinctive  Principle,  p. 
340-341,  ^  514  /,  m  ;  p.  666-667,  ^ 
902  c  ;  p.  890,  ^  1077. 

Solidism  and  Vitalism.      See  Vitalism 
AND  Solidism,  Index  II. 

Soul  and  Instinctive  Principle.  See, 
also,  Soul,  Instinct,  Index  I. ;  Mind, 
Will,  Index  I.  and  II. 
physiological  demonstrati6n  of,  and  dis- 
tinguished from  each  other,  p.  873- 
911,  {)  1069-1083. 
the  premises,  relative   to  the   nervous 

system,  p.  873-874,  (j  1071. 
mechanism  and  phenomena  of  reflex 
nervous  action  as  forming  the  basis 
of  demonstration,  p.  873-877,  i)  1071- 
1072 
principle  the  same,  whether  the  nervous 
influence  operate  through  reflex  ac- 
tion, or  in  a  direct  manner  through, 
excito-motory  nerves  alone,  as  when 
the  nervous  centres  are  directly  im- 
pressed by  physical  causes  or  by  the 


INDEX    II. 


1087 


Soul,  &c. — continued. 

Will  and  Mental  Emotions,  p.  875- 
877,  ()  1072  a ;  p.  886-892,  (}  1077. 
Also,  Reflex  Action,  Mental  Emo- 
tions, the  individual  Passions,  Re- 
medial Action,  subdivison  Mental 
Emotions,  Index  II. ;  Will,  Index  I. 
and  II. 

philosophy  of  the  Will  and  Passions,  p. 
296,  ()  476  c  ;  p.  877,  ()  1072  b.  Also, 
Mental  Emotions,  Remedial  Ac- 
tion, subdivision  Mental  Emotions, 
Mind,  Index  II. ;  Will,  Index  I.  and 
II. 

office  of  the  nervous  influence  in  the 
demonstration — unimportant  by  vphat 
name  called,  or  what  its  nature,  or 
what  the  theory  of  its  operation,  p. 
898,  <J  1073  a;  p.  880-881,  ()  1075  a. 
Also,  p.  117,  f)  234  g;  p.  330,  t)  500 
n — but,  whatever  it  be,  it  is  interested 
as  a  medium  of  communication  be- 
tween the  Soul  and  Principle  of  In- 
stinct and  the  chief  nervous  centre 
and  in  the  phenomena  of  intellection, 
p.  879,  (^  1073  b;  p.  892,  (}  1078  a, 
also,  p.  281,  (}  450  e— and  the  Will 
and  Mental  Emotions  produce  their 
effects  through  the  same  medium,  p. 
880,  ^  1075  a.  Also,  Mental  Emo- 
tions, Index  II. 

no  changes  instituted  in  the  nervous 
centre,  p.  880-881,  <^  1075  a. 

various  analogies  betweien  the  effects  of 
physical  agents  and  the  Will  and 
Mental  Emotions,  p.  875-882,  ^  1072 
-1075  ;  p.  886-892,  ()  1077.  Also, 
Remedial  Action,  subdivision  Men- 
tal Emotions,  Index  II. 

logical  consequences  as  to  the  substan- 
tive existence  of  a  self-acting  Soul, 
p.  879-880,  ()  1074  ;  p.  881,  ()  1075  b. 

the  Soul  in  a  perfect  state  in  Infancy, 
p.  905,  ()  1078  q — but  its  manifesta- 
tions may  fail  with  the  development 
ofthebrain,  p.  906,  <;)  1078  g. 

the  Soul  manifests  but  little  instinct,  p. 
893,  ()  1078  a;  p.  895,  (^  1078  c— 
which  is  subject  to  its  control,  p.  892 
-896,  ()  1098  a,  b,  d;  p.  898-899,  ^ 
1078  g;  p.  900-902,  ^  1078  i,  I,  p; 
p.  903-906,  ()  1078  q. 

immortality  of  the  Soul,  p.  893,  ^  1078 
a;  p.  908-909,  ()  1080,  1081— and 
contrasted  with  the  perishable  nature 
of  the  Principle  of  Instinct,  p.  907- 
909,  ^  1079  a,  1080. 

Soul  acts  in  greater  independence  of  the 
brain  than  Instinct,  p.  892,  ()  1078  n  ; 
p.  903-906,  <S.  1078  q. 

excessive  exercise  of  Reason  contrasted 
with  the  early  discipline  of  Instinct, 
p.  894,  <J  1078  b. 

comparison  between  the  great  nervous 
centre  of  man  and  of  animals,  and  the 


Soul,  &c. — continued. 

relative  phenomena  of  instinct,  as  dis- 
tinguishing the  Soul  from  the  In- 
stinctive Principle,  p.  896,  i/  1078  d; 
p.  898,  ^  1078/;  p.  903-906, 1)  1078  q. 

Instinctive  Principle  limited  to  the  wants 
and  uses  of  the  body,  p.  892,  ^  1078 
a  ;  p.  904,  ()  1078  q — operates  in  one 
uniform  way  in  every  species  of  ani- 
mal respectively,  but  differently  in  the 
several  species,  p.  123,  ij  241  c ;  p. 
893,  (}  1078  a — always  manifests  it- 
self in  the  mechanism  of  animal  life, 
p.  893,  (}  1078  a — its  education  in  in- 
fancy, and  only  then,  and  different 
from  that  of  reason,  p.  894-895,  <5 
1078  b ;  p.  904,  ^  1078  9— essentially 
subservient  to  organic  life,  p.  896-897, 
^  1078  e ;  p.  898,  <J  1078  /—  its 
promptings  after  food,  distinguished 
from  reason,  p.  895,  ()  1078  d — con- 
stituted with  a  special  reference  to  the 
kind  of  food  upon  which  each  species 
subsists,  and,  in  each,  to  the  mechan- 
ism in  animal  and  organic  life,  p.  896 
-897,  I)  1078  c— its  sagacity,  p.  889- 
890,  I)  1078  g,  A— philosophy  of  its 
"  tricks"  and  imitations,  p.  895,  ^  1078 
b — its  acts  often  totally  unlike  those 
of  reason,  but  precise,  habitual,  and 
inexplicable,  p.  123-124,  ^  241  c;  p. 
896,  (}  1078  d — its  analogies  with  the 
Soul,  p.  123-124,  ^  241  c  ;  p.  893,  ^ 
1078  a— is  immaterial,  p.  908-909,  ^ 
1080,  1081— is  perishable,  p.  903,  <} 
1078  a  ;  p.  907-908,  ^  1079  a-l080 
— supplies  a  problem  in  a  suppositi- 
tious case,  p  897,  ()  1078  c — most  de- 
veloped in  inferior  animals,  p.  896,  () 
1078  d:  p.  898,  l^  \078  J ;  p.  903,  (} 
1078  q — its  full  development  in  the 
infancy  of  animals  contrasted  with  its 
condition  m  the  human  infant,  p.  893, 
(}  1078  a;  p.  895,  ^  1078  c  ;  p.  898, 
<^  1078  g-;  p.  904,  (>  1078  q. 

while  Instinct  is  in  full  operation  in  the 
infancy  of  animals,  the  human  infant 
has  neither  reason  nor  instinct  for  its 
guidance,  which  supplies  a  ground  of 
moral  distinction  in  the  plan  of  De- 
sign, since  the  development  of  the 
Soul,  or  its  approximation  to  the  early 
displays  of  Instinct,  would  be  physic- 
ally and  morally  destructive  of  man,  or 
did  not  its  development  hold  an  equal 
pace  with  that  of  the  body  ;  but,  on 
the  other  hand,  as  the  infant  animal  is 
mainly  dependent  upon  itself,  and  is 
limited  in  wants  and  habits  to  organ- 
ic life,  the  physical  constitution  and 
the  Instinctive  Principle  are  at  once 
adapted  to  those  exigencies,  p.  893,  ^ 
1078  a  ;  p.  895-898,  ^  1078  c-e,g;  p. 
900,  ^  1078  i;  p.  903-906,  «J  1078  q. 

the  Instinctive  Principle  holds  a  relation 


1088 


INDEX    II. 


Soul,  &c. — continued. 

to  the  brain  or  its  equivalent  and  other 
organs  corresponding  with  the  anal- 
ogies which  subsist  among  them  and 
the  products  of  the  latter,  p.  904-905, 
ij  1078  q — nor  is  there  any  good  rea- 
son to  suppose  that  the  main  central 
part  of  the  nervous  system  of  animals 
bears  any  greater  ratio  of  develop- 
ment to  other  organs  of  animals  than 
in  the  human  infant,  while  in  respect 
to  the  latter,  the  manifestations  of  the 
Soul  are  in  no  degree  correspondent 
with  the  physical  products  of  organs, 
but  advance  with  the  progressive  de- 
velopment of  the  brain,  p.  903-906, 
()  1078  q. 

relations  of  animals  to  sex  contrasted 
with  man's,  p.  900-901,  i)  1078  k. 

the  nature  of  Ideas,  and  how  far  they 
are  related  in  man  and  animals,  p. 
906,  <5  1078  r. 

fear  distinguished  between  man  and  an- 
imals, p.  898-899,  <;i  1078  g-,-  p.  901, 
^  1078  Z — displays  of  memory  con- 
trasted, p.  901,  «^  1078  o— and  what 
of  conscience,  love  oj  fame,  Religious 
sentiment,  p.  901,  ij  1078  l-n. 

remarkable  adaptations  of  Instinct  to 
vietamor'phoses,  ingrafted  upon  the 
ovum,  and  corresponding  with  the  or- 
ganic endowments,  p.  902-903,  ^ 
1078  p. 

the  chemical  hypothesis  as  to  the  Soul, 
and  objections  to,  p.  155,  ^  149  e;  p. 
882,  {)  1076  a. 

ckcmico-spiritual  hypothesis,  and  objec- 
tions, p.  882-884,  ^  1076  b. 

hypothesis  of  secretion  as  to  Soul,  and 
objections,  p.  884-886,  (}  1076  c. 

an  argument  of  materialism  considered, 
p.  894,  i)  1078  a,  note. 

the  substantive  existence  of  the  So\il 
and  Instinctive  Principle  being  estab- 
lished, they  are  readily  seen  by  their 
self-acting  nature,  and  by  every  phe- 
nomenon which  they  manifest,  to  be 
totally  different  from  matter,  and  the 
analogies  between  the  manifestations 
of  the  Soul  and  its  Author  and  be- 
tween the  Soul  and  the  Instinctive 
Principle  enforce  still  farther  their 
contrast  with  matter  as  expressed  by 
the  qualifying  term  immaterial,  p. 
908-909,  ()  1080-1081.  Also,  Mind, 
Index  II. 
Spai.i.anzani, 

his  experiments  upon  eviscerated  frogs 
employed  to  show  the  independence 
of  animal  heat  of  chemical  laws,  p. 
S.^S.  ^41/. 
Spasmodic  Affections 

illustrate  the  great  variety  of  causes  by 
which  the  nervous  influence  is 
brought  into  active  operation,  either 


Spasmodic  Affections — continued.. 

in  a  direct  manner  by  causes  affect- 
ing immediately  the  nervous  centres, 
or  indirectly  through  reflex  action  of 
those  centres,  and  operating,  like  the 
Will  and  Mental  Emotions,  through 
the  cerebro-spinal  system  alone,  or 
through  that  system  and  the  gangli- 
onic conjointly,  and  employed  by  the 
Author  in  advancing  his  application 
of  the  physiological  laws  of  the  nerv- 
ous system  to  Pathology  and  Thera- 
peutics, and  his  demonstration  of  the 
substantive  existence  and  self-acting 
nature  of  the  Soul  and  Principle  of 
Instinct — and  mistakes  indicated  in 
regard  to  the  pathology  of  spasmodic 
affections,  the  misapplication  of  rem- 
edies, and  distinctions  to  be  observed, 
p  319-320,  l^  494  dd  ;  p.  331,  i)  500 
0  ;  p.  356-358,  ()  526  d  ;  p.  590-593, 
<)  891i  ;  p  874-877,  i)  1072  ;  p.  879- 
881, 1^  1075  a,  b.    Also,  Convulsions, 

Specifics — see  Specific  Action,  Ind.  I. 
no  remedies  are  properly  such,  and  in 
what  light  reputed  specifics  should  be 
regard'ed,  p.  596-598,  ()  892  b,  c;  p. 
600,  iJ892'rf;  p.  605,^  892  m;  p.  611- 
612,  ^  892i  h;  p.  626-629,  ^  892J ; 
p.  677-678,  <J  904  d;  p.  850,  §  1053. 
their  employment  in  the  common  ac- 
ceptation is  purely  empyrical,  involv- 
ing the  neglect  of  pathological  and 
therapeuticdl  principles,  and  other 
remedies  which  may  be  important  to 
the  usefulness  or  safety  of  the  reputed 
specific,  and  which  alone  may  be  more 
speedily  or  perfectly  curative,  p.  61,  (} 
134;  p.  63,  ()  137;  p.  65,  1}  143  c; 
p.  67,  (}  150;  p.  73,  ()  163;  p.  120, 
^  237;  p.  371-372,  ^  569  h-e ;  p. 
424,  {)  662  b,  c ;  p.  428,  ()  672  ;  p. 
430-433,  ^  675,  676  a  ;  p.  479,  ()  741 
b  ;  p.  487-489,  ()  756  ;  p.  494,  ()  767  ; 
p.  512,  ()  817  ;  p.  538,  ^  847  g ;  p.  539, 
\  848  ;  p.  540,  ()  854  bb  ;  p.  545,  ^  859, 
p.  547-550,  ^  863  d;  p.  551,  ()  865, 
866  ;  p.  553,  (}  870  aa ;  p.  554-556, 
§  872  a;  p.  561,  ()  888  a,  b;  p.  562, 
^•888  e;  p.  596-601,  ^  892  b-f;  p. 
608,  ^  892i  c;  p.  611,  ^  892^  h;  p. 
615,  §  892V  e;  p.  627,  ()  892J  / ;  p. 
629,  «^  892 J  s;  p.  630,  ()  892J  b;  p. 
p.  633,  ^  892|  a ;  p.  637,  <)  8924,  e ; 
p.  639,  ()  892|  g ;  p.  657-6.58,  ^"^893 
p;  p.  664,  1^1900;  p. 679-683,  ^  905 

a,  b;  p.  684-689,  ^  905^^  b;  p.  715- 
721,  'J  960  a-c  ;  p.  726,  \  961  c-c ;  p. 
729,  'J  966  ;  p.  731,  (J  970  c  ;  p.  733,  ^ 
974  ;  p.  737,  ^  984  b;  p.  740,  (}  989  ; 
p.  741-745,  i)  990  ;  p.  751,  ^  999  c; 
p.  756-762,  ^  1005  6-1006  a  ;  ()  1007 

b,  c;  ^  1019/;  I)  1023  a;  (}  1058  c, 
f;  sS  1058  y;  <)  1059;  i)  1063  a;  <) 
1065  a-d;  ^  1067  c;  ^  1068  b-d. 


INDEX    II. 


1089 


Sphincter  Muscles, 

employed  to  illustrate  the  slowly  pro- 
gressive operation  of  remedies  and 
morbific  causes  through  an  uninter- 
rupted alterative  influence  of  reflex 
action  of  the  nervous  system,  p.  Ill, 
^  2331;  p-  338-339,  <J  514/,  g;  p. 
344,  i)  516  d,  No.  6  ;  p.  670,  ^  902  k  ; 
p.  679-681,  ^  905  a.     Also,  Altera- 
tives; Antimony,  Taetarized  ;  Hy- 
drophobia, Virus  of,  Index  II. 
Spinal  Cord — continued  from  Index  I., 
late  discoveries  relative  to  its  struc- 
ture   and   functions,  p.  802  -  803,  i) 
1037. 
experiments  upon,  and  the  brain,  by  A. 
P.  W.  Philip  and  Le  Gallois  to  de- 
termine the  laws  of  the  vital  func- 
tions, and  others  by  Stilling,  M.  Hall, 
Van  Deen,  Girtanner,  &c.,  employed 
by  the  Author  in  demonstrating  the 
modus  operandi  of  morbific  and  reme- 
dial agents  through  alterative  influ- 
ence of  reflex  action  of  the  nervous 
system,  and  of  the  Will  and  Mental 
Emotions  by  direct  action,  p    295- 
321,  fj  476-494.     Also,  Reflex  Ac- 
tion, Mental  Emotions,  the  individ- 
ual Passio7is,  Index  II. ;  Will,  Index 
I  ayid  II. 
Spontaneity   of   Being.     See   Genera- 
tion, Spontaneous,  Index  I.  and  II. 
Squill, 

a  stimulating  Expectorant,  unsuited  to 

acute  inflammation,  and  employed  by 

the  Author  to  illustrate  the  principles 

which  should  govern  the  treatment  of 

.     pulmonic  diseases,  p.  638-640,  ^  892i 

Stethoscope, 

some  of  its  contributions  to  Pathology, 
p.  G40,  ^  892|-  h. 

Stilling, 

his  experiments  with  Strychnia  upon 
the  spinal  cord,  and  acetic  acid  to  the 
skin,  employed  to  illustrate  Author's 
doctrine  of  the  modus  operandi  of 
morbific  and  remedial  agents  through 
reflex  action  of  the  nervous  system, 
p.  287-289,  ()  459  c-g ;  p.  319,  <;.  494 
b-dd. 

Stimulants.     See  Tonics,  Index  II 

Stomach  and  Intestine,  continued  from 
Index  I.  See,  also,  Digestion,  Index 
II, 
having  assembled,  as  above,  references 
to  sections  which  relate  to  the  func- 
tions of  the  stomach,  it  is  simply  an 
object  now  to  bring  together  some  of 
the  many  in  which  the  Author  en- 
deavours to  show  that  all  remedies 
taken  internally  exert  their  primary 
effects  upon  the  gastro-intestinal  mu- 
cous tissue,  and  upon  all  other  parts 
through  alterative  influences  of  reflex 

Z 


Stomach  and  Intestine — continued. 

action  of  the  nervous  system  insti- 
tuted by  those  primary  impressions, 
with  the  exception  of  what  may  be 
due  to  continuous  sympathy  —  and, 
for  the  foregoing  purpose,  the  aliment- 
ary canal  is  considered  in  its  special 
anatomical  and  vital  characteristics, 
its  special  functions,  its  special  rela- 
tions to  the  nervous  system,  and  the 
subordination  of  all  parts  of  the  body 
and  of  instinct  to  its  final  cause  of 
supplying  all  parts  with  nutriment,  p. 
41,  ^  65  ;  p.  62,  ()  135  a ;  p.  63,  ()  137 
c;  p.  65,  ()  143  c;  p.  129-131,  ()  277 
-284 ;  p.  143-146,  ()  322-326  ;  p.  148 
-149,  (^  336 ;  p.  193,  ^  356  a ;  p.  216, 
■51399;  p.  229,  <>  419  c,-  p.  289,(^461; 
p.  335-336,  <J  512-513  ;  p.  417,  <J  649 
c  ;  p.  430,  t)  674  d ;  p.  563-565,  <}  889 
a-g ;  p.  668-669,  t)  889  7n,  wm ;  p. 
667-669,  (j  902  e-g ;  p.  896-897,  ^ 
1078  c — and  considering  with  this  the 
exquisite  susceptibility  of  the  gastro- 
intestinal mucous  tissue  in  its  sympa- 
thetic sensibility  (scarcely  inferior  to 
that  of  the  lungs)  to  a  variety  of  caus- 
es whose  remote  effects  are  manifest- 
ly owing  to  reflex  actions  of  the  nerv- 
ous system  instituted  by  the  irrita- 
tion of  the  tissue,  as  seen  in  the  move- 
ments of  the  muscular  coat,  in  the  con- 
traction of  the  sphincter  ani,  in  the 
act  of  swallowing  (p.  338-339,  (J  514 
/,  g,  and  Index  II.),  in  the  glow  and 
moisture  that  often  spring  from  the 
first  contact  of  food  with  the  stomach, 
and  in  the  spasms  that  arise  from  its 
mechanical  irritation,  and  in  the  vom- 
iting occasioned  by  tickling  the  throat, 
by  pregnancy,  by  disease  of  the  kid- 
ney, by  offensive  odours,  disgusting 
sights,  and  by  their  recollections,  and 
as  constitutionally  displayed  in  infan- 
cy (p.  250-251,  i)  441  c;  p.  327,  () 
500  i-k;  p.  336-338,  ^  514  a-c  ;  p. 
339-340,  i)  514  h ;  p.  355-356,  ()  512 
a,  b ;  p.  374,  ()  576,  d;  p.  579-580,  (J 
890^  d;  p.  590-591,  <;»  89H   b;  p. 
592-593,  {)89\ik;  p.  666-669,  (J  902 
c-g),  and  taking  along  many  unequiv- 
ocal examples  supplied  by  the  Materia 
Medica,  as  emetics,  cathartics,  small 
doses  of  tartarized  antimony  (see  the 
Articles,  Index  II.),  and  connecting 
with  the  foregoing  many  familiar  an- 
alogies where  diseases  of  various  or- 
gans inflict   disease   sympathetically 
upon  the  alimentary  canal,  and  the 
more  numerous  ones  in  which  prima- 
ry affections  of  the  stomach  and  in- 
testine light  up  disease  in  all  other 
parts,  and  considering,  also,  how  the 
primary  affections  are  often  cured  by 
vesicants,  the   shower-bath,  friction, 

z 


1090 


INDEX    II. 


Stomach  and  Intestine — continued. 

&c.  (see  Skin,  and  other  Articles), 
and  a  large  variety  of  other  concur- 
ring facts  which  these  general  refer- 
ences will  suggest,  and  which  are 
readily  accessible  through  our  Index- 
es, we  entertain  the  belief  that  our 
main  object  of  demonstrating  the  in- 
strumentality of  the  nervous  influence, 
either  reflex  or  direct,  as  the  essen- 
tial medium  through  which  all  reme- 
dial and  morbific  causes,  physical  and 
mental,  exert  their  effects,  and  of  con- 
tradistinguishing the  laws  of  organic 
from  those  of  inorganic  beings,  and 
of  reclaiming  from  the  Laboratory  of 
the  Chemist  the  several  great  branch- 
es of  Medicine,  might  be  safely  left  to 
the  accumulated  proof  upon  the  sub- 
ject before  us,  but,  nevertheless,  in- 
vite the  attention  of  the  Reader  to  the 
topics  under  the  Article  Generali- 
zation OF  Reflex  Action  of  the 
Nervous  System,  Index  II. ;  and  Or- 
ganic Chemistry, Vital  Properties, 
Organic  Life,  Organic  Compounds, 
Organic  Heat,  Ovum,  &c.,  Index  I. 

Stomach,  Blows  upon, 

operate,  as  in  shocks  from  surgical  op- 
erations, through  a  sudden  and  violent 
determination  of  reflex  action  of  the 
nervous  system  upon  the  organic  vis- 
cera— the  modus  operandi  being  also 
the  same  in  principle  as  when  sudden 
death  is  produced  by  hydrocyanic  ac- 
id, the  virus  of  serpents,  drinking  cold 
water  when  fatigued  in  hot  weather, 
loss  of  blood,  apoplexy,  joy  and  anger, 
and  illustrated  by  Le  Gallois's  and 
Philip's  experiments  upon  the  spinal 
cord,  p.  107-108,  ^227;  p.  109,  ij.  230; 
p.  114,  <J  234  e;  p.  296,  (}  476  c;  p. 
297-299,  <^  476i  c-477  a;  p.  300-301, 
(}  479-480  ;  p.  304,  ()  481  g;  p.  307- 
308,  ()  483  c;  p.  319,  ^J  494  b  ;  p.  334 
-335,  <J  509-511  ;  p.  402-403,  ^  634, 
635 ;  p.  525-528,  <^  828  a-d ;  p.  670, 
<J  902  / ;  p.  707,  §  949. 

"Strainage," 
the  prevailing  doctrine  of,  opposed  by 
the  laws  which  govern  healthy  and 
morbid  states,  by  the  endless  variety 
of  exact  products  in  animals  and 
plants,  composed  mainly  of  four  ele- 
ments in  intimate  union,  but  derived 
from  fluids  constituted  of  sixteen  or 
eighteen,  by  the  influences  which  are 
exerted  upon  the  blood  and  all  the 
fluids  of  the  animal  body  by  reflex  or 
direct  action  of  the  nervous  system, 
and  by  the  analogy  supplied  by  the 
admitted  fact  that  the  proximates  of 
the  bile  have  no  existence  in  the 
blood,  p.  21,  ^  22  ;  p.  23-26,  (}  37- 
48  ;  p.  27-28,  <)  52-53  ;  p.  30,  (J  58  ; 


"  Strainage" — continued. 

p.  34-36,  ^  62  a-i ;  p.  62-64,  ^  135- 
138  ;  p.  Ill,  ()  233f  ;  p.  128,  ()  226; 
p.  193,  (}  356  a :  p.  216,  (ji  399  ;  p 
219-227,  ()  407-411  ;  p.  318,  ()  493 
d  ;  p.  484,  I)  748  ;  p.  783,  §  1031  b  ; 
p,  788-789,  ()  1032  a,  b  ;  p.  801,  () 
1039  ;  p.  911,  ()  1083.  Also,  Secre- 
tion AND  Excretion,  Lactation, 
Bile,  Milk,  Pus,  Parturition,  Men- 
tal Emotions,  Index  II. 
Structur>e  —  continued  from  Index  I.; 
also,  Tissues,  Index  I. ;  Mucous  Tis- 
sue, hidex  I.  and  II. 

analogies  of  simple  tissues,  p.  52,  ^  85- 
89 — distinguished  from  the  compound 
or  complex  organs  which  they  com- 
pose although  compounded  them- 
selves, p.  52,  53,  <^  85,  89,  91,  92. 

every  part  a  labyrinth  of  designs,  p.  59, 
()  130 — each  simple  texture,  in  com- 
pound organs,  has  its  own  organic 
functions,  p.  61,  (^  132. 

structure  of  general  body  radiated  and 
symmetrical,  p.  53,  i^i  93-95 

general  division  of  organs  and  functions 
of  animal  life  and  of  organic  life,  and 
their  designations  and  uses,  p.  53-54, 
{)  96-106  ;  p.  125,  (^  248-250— those 
of  organic  life  quite  analogous  in  low- 
est plants  and  animals,  p.  54,  i^i  107  ; 
p.  474,  i)  733/ — no  organ  of  animal 
life  necessary,  p.  54,  ij  108 — indis- 
pensable organs  of  a  complex  nature 
generally  single,  p.  54,  ()  109  a  ;  p. 
285,  ^  455  c — but  the  most  essential 
parts  are  the  extreme  arterial  vessels, 
to  which  the  more  compound  organg 
are  subordinate,  p.  54,  ()  109  Z*;  p. 
227,  Hn  ;  p.  804,  <J  1040. 

organs  and  functions  relative  to  species 
and  their  sympathetic  influences  upon 
the  general  organism  of  animals — 
and  their  development  a  final  cause  of 
the  whole  in  plants  and  animals,  p. 
55-56,  ^18-123  ;  p.  376-380,  ()  578  ; 
p.  817,  (^  1052  c.  Also,  Organs  of 
Generation,  Uterus,  Index  II. ; 
Youth,  Index  I.  and  II. 

law  of  dismemberment  as  it  respects  the 
germs  and  peculiarity  of  life  in  seed 
and  egg,  p.  56,  ()  122,  123. 

the  properties  and  laws  through  which 
it  is  developed,  and  carry  on  forever 
its  functions,  and  govern  all  morbid 
changes,  are  shown  by  the  elementa- 
ry constitution  of  organic  compounds 
to  be  totally  different  from  those  of 
inorganic  bodies,  p.  15-33,  <J  7-60; 
p.  50-52,  ^  83  c-84— and  so  allowed  by 
Chemists  who  endeavoured  to  prove  it 
otherwise,  ibid.,  p.  189-190,  (>  350i  7i, 
&c. — the  pursuit  now  virtually  dis- 
missed from  the  Laboratory,  p.  779- 
782,  ()  1028-1030— though  reluctant- 


INDEX    II. 


1091 


Structure — continued. 

ly,  p.  796-799,  ^  1034.  Also,  Com- 
position, Organic  Compounds, Vital 
Properties,  Organic  Life,  Chemis- 
try, Organic  Chemistry,  hidex  1. 

the  same  contradistinction  shown  by  the 
incorporation  of  Nitrogen,  p.  33-36,  <5> 
61-62 — and  by  the  developmental  his- 
tory of  the  Ovum,  p.  36-49,  <J  63-80 
— and  by  Cells,  p.  51-52,  ()  84 — and  by 
the  development  of  cells  in  extravasa- 
ted  blood,  and  more  particularly  from 
their  generation  in  simple  protoplasm, 
p.  813-814,  ^  1051  b. 

the  properties,  functions,  and  laws  can- 
not be  deduced  from  the  structure, 
except  in  connexion  with  an  observa- 
tion of  the  results,  which  is  the  main 
source  of  information,  p.  3,  i^i  2  c  ;  p. 
50-51,  <)83c;  p.  59,  ^  130.  131  ;  p. 
86-87,  <J  176,  177  ;  p.  218,  ^  406  ;  p. 
353,  ()  525  a ;  p.  354,  (}  526  a ;  p. 
801,  ^  1036  —  with  analogies,  also, 
ibid.,  and  p.  223,  <J  409  c  —  yet  a 
knowledge  of  structure  is  indispens- 
able, and  at  the  foundation  of  all  med- 
icine, ibid. 

each  tissue  distinguished  by  differences 
in  organization  and  modifications  of 
vital  endowments,  and  these  distinc- 
tions become  more  remarkable  in  the 
vegetable  kingdom,  where  they  corre- 
spond with  the  more  fundamental  dis- 
tinction of  organizing  compounds  out 
of  the  elements  of  matter — and  un- 
dergo changes  from  infancy  to  adult 
age — and  these  differences  are  farther 
denoted  by  differences  in  vital  stimu- 
li, by  the  products,  by  the  action  of 
morbific  and  remedial  agents,  by  the 
varieties  in  a  common  form  of  disease, 
especially  inflammation  —  and  these 
differences  in  vital  endowments  exist 
in  different  parts  of  one  and  the  same 
continuous  tissue,  as  in  the  gastro-in- 
testinal  and  pulmonary  mucous,  p.  15, 
^  13-14  b ;  p.  52,  ()  85,  89  ;  p.  61-70, 
(}  133-160  ;  p.  73,  «J  163  ;  p.  82-83, 
^  172,  173  ;  p.  88,  (^  185  ;  p.  98,  ^ 
191  a,  b  ;  p.  138,  ()  303|^ ;  p.  140-141, 
{)  306,  307;  p.  218,  ^  406  ;  p.  229- 
230,  ^  419  c-422  b  ;  p.  353,  ^  525  a; 
p.  354,  526  a;  p.  373-380,  <J  576- 
578  ;  p.  473,  ^  733  b ;  p.  480,  (J  741 
c;  p.  522-523,  ^  827  b,  c;  p.  671,  (^ 
904:  b;  p.  815-816,  ^  10.52  a. 

each  part  has  its  own  natural  stimuli 
according  to  the  peculiarities  of  its 
properties  and  functions,  and  each 
suited  only  to  the  several  parts  re- 
spectively, and  may  be  poisonous  to 
other  parts — though  arterial  blood  is 
adapted  to  all  parts,  p.  62-63,  ^137 
a;  p.  671,  {)  904  6. 

mistakes  in  practice  from  not  regarding 


Structure — continued. 

the  foregoing  modifications  of  vital 
endowments  in  the  different  tissues 
and  parts  of  a  continuous  tissue,  p. 
63,  ^  163  c. 

the  law  of  adaptation,  p.  63,  <)  137  c ;  p. 
65,  ()  143  c,  and  references  there  •,  p. 
68,  ^  152 ;  p.  69,  ^  156  b,  and  refer- 
ences; p.  535-539,  (J  847-850;  alsO; 
Adaptation,  Law  of.  Index  I. 

the  natural  modifications  which  tissues 
and  compound  organs  undergo  in 
their  structure  and  vital  endowments 
in  the  progress  of  life  give  rise  to 
new  diseases  and  modifications  of  for- 
mer diseases,  and  new  susceptibilities, 
and  develop  or  modify  the  passions, 
and  affect  the  details  of  practice,  p. 
68-69,  §  153-159 ;  p. 373-383,  ^  576 
-584  ;  p.  401-402,  ()  633. 

certain  tissues  or  parts  of  a  continuous 
tissue  more  liable  to  disease  than  oth- 
ers, and  to  degrees  of  severity,  ac- 
cording to  the  nature  of  the  compound 
organ  in  which  they  may  be  associ- 
ated, p.  64,  ^  138,  139  ;  p.  70,  ^  160 
-162. 

the  difference  in  organization  and  vital 
endowments  of  different  tissues  in 
their  relation  to  different  compound 
organs,  and  of  different  parts  of  a 
continuous  tissue,  illustrated  by  tabu- 
lar views  of  their  relative  liability  to 
inflammation,  and  the  relative  degrees 
of  danger,  and  the  relative  propor- 
tions of  loss  of  blood  as  may  be  re- 
quired by  one  part  or  another  accord- 
ing to  the  compound  organs  with 
which  they  may  be  associated,  p.  69- 
73,  ^  160-162;  also.  Bloodletting, 
Inflammation  ;  Brain,  Inflamma- 
tion OF,  Index  II. 

tabular  statement,  indicative  of  the  lia- 
bility of  different  tissues  of  the  same 
nature,  remote  from  each  other,  to 
sympathize  together  in  their  diseases 
respectively,  through  reflex  action  of 
the  nervous  system,  and  applications 
of  the  principle,  p.  353-358,  <)  525- 
526 — and  another  showing  the  rela- 
tive liability  of  different  tissues,  re- 
spectively, when  morbidly  affected,  to 
continuous  sympathy  in  their  several 
parts,  by  which  reflex  actions  of  the 
nervous  system  are  generated,  and  ex- 
planations, p.  354-356,  ()  526  a-d,  and 
in  connexion  with  tables  at  p.  70-73, 
and  with  continuous  sympathy  as  set 
forth  under  Leeching  ;  Oil,  Croton  ; 
Suppositories,  and  Sympathy,  Con- 
tinuous, Index  II. — all  serving  as  a 
basis  of  an  extended  philosophy  in 
Physiology,  Pathology,  and  Thera- 
peutics— another  table  exhibiting  an 
arrangement  of  organs  according  to 


1092 


INDEX    II. 


Structure — continued. 

their  relative  functions,  p.  57 — anoth- 
er, of  their  secreted  products,  p.  218, 

the  simple  tissues  the  seats  of  disease, 
and  a  knowledge,  therefore,  not  only 
of  their  anatomical,  but  of  the  special 
vital  characteristics  of  each  is  indis- 
pensable in  practical  medicine,  p.  52, 
^  85 ;  p.  61,  <J  133-134  ;  p.  63,  (}  137 
b,  c;  p.  64-65,  (>  138-143;  p.  67,  () 
149-151  ;  p.  467,  «J  718,  &c. 

upon  the  peculiarities  in  the  special  vital 
endowments  of  each  tissue  depends 
greatly  the  character  of  disease  and 
the  efl'ects  of  remedies  and  of  morbific 
causes,  as  exerted  through  reflex  nerv- 
ous action,  p.  61-63,  <J  133-134,  137 
a-e;  p.  466,  467,  ()  715,  718  ;  p.  652 
-656,  {)  892  n 

the  foregoing  special  endowments  of 
the  tissues  respectively,  and  there- 
fore their  special  modifications  in  dis- 
ease, conform  to  the  general  nature  of 
the  complex  organ  of  which  they  may 
form  component  parts,  p.  64,  ^  138. 

the  organic  properties  of  all  tissues  mu- 
table in  their  nature,  upon  which  de- 
pends a  variety  of  natural  changes, 
and  in  being  thus  constituted  for  use- 
ful ends,  and  from  their  inherent  tend- 
ency to  maintain  their  normal  state, 
this  mutability  is  at  the  foundation 
of  disease  and  its  cure — while,  also, 
all  morbid  states  increase  the  sus- 
ceptibility of  the  organic  properties 
to  the  action  of  remedial  and  morbific 
agents,  and  the  disposition  to  under- 
go changes,  p.  61,  ^  133  c  ;  p.  63,  ^ 
137  d,  e ;  p.  65-68,  <)  142-156 ;  p. 
82-83,  <J  172;  p.  87,  ()  177,  182  b; 
p.  414,  ()  642  b ;  p.  665,  ()  901.  Also, 
Gestation,  Lactation,  Index  II. ; 
Youth,  Index  I.  and  II. 

increased  susceptibility  of  tissues,  aris- 
ing from  disease,  to  direct  action  of 
remedies,  and  to  reflex  nervous  in- 
fluence, and  according  to  the  nature 
of  a  tissue,  or  part  of  a  tissue,  or  of 
the  more  compound  organ,  one  of  the 
most  important  laws  in  medicine,  p. 
61-62,  <J  133-134,  137  a-e ;  p.  63,  ^ 
137  d  ;  p.  64,  ()  138  ;  p.  65,  *;.  143  ; 
p  67,  ()  149-151  ;  p.  73,  <)  163— and 
60  of  morbific  causes,  ibid. — which 
presents  a  problem  for  Organic  Chem- 
istry, p.  63-64,  ()  137  e;  p.  652-656, 
«J  893  ?(,  &c. ;  p.  674,  (}  904  b. 

varying  susceptibilities  in  different  parts 
of  a  continuous  tissue,  according  to 
the  nature  of  a  part,  through  which 
morbific  and  remedial  agents  will  act 
more  in  conformity  with  the  acquired 
susceptibilities  than  the  natural  mod- 
ifications, p.  65,  <J  143  a. 


Structure — continued. 

preternatural  susceptibility  or  predispo- 
sition may  be  universal,  and  followed 
by  a  simultaneous  explosion  of  dis- 
ease in  all  organs,  as  in  idiopathic  fe- 
ver, when,  also,  a  single  remedy  may  be 
adequate  to  the  cure,  and  even  when 
complicated  with  local  inflammations, 
p.  65-67,  ^  143  b-d,  148  ;  p.  367,  i) 
557;  p.  464,  (^  712;  p.  465-466,  (> 
715  ;  p.  535-539,  ()  847-850  ;  p.  664, 
(^  eCO  ;  p.  713,  <J  956  ;  p.  731-732,  ^ 
907  c,  also.  Remedies,  Fever,  In- 
flammation, Pkedisposition,  Index 
II. ;  Adaptation,  Law  of,  Index  I. — 
but  where  inflammations  are  attend- 
ant upon  fever,  and  where  many  or- 
gans become  invaded  by  uncompli- 
cated inflammations  or  other  forms  of 
disease,  the  affections  are  apt  to 
spring  up  consecutively  as  sympa- 
thetic consequences  of  each  other, 
ibid.,  and  Causes,  Morbific,  Index  II. 

next  to  the  distinction  between  Ani- 
mals and  Plants  which  relates  to  their 
modes  of  subsistence  is  the  incorpo- 
ration of  the  cerebro-spinal  and  gan- 
glionic systems  of  nerves  in  all  parts 
of  the  animal  and  organic  life  of  An- 
imals, each  of  which  has  special  uses, 
respectively,  and  others  collectively, 
and  through  the  latter  of  which  all 
parts  of  the  organic  mechanism  are 
maintained  in  one  harmonious  con- 
cert of  action,  p.  54-55,  (J  110-116  ; 
p  63,  ^  137  e;  p.  110,  (^  232;  p. 
284-286  ;  p.  290-295,  ^  462-475  ;  p. 
326,  ij  500  g ;  p.  330,  ^  500  n ;  p. 
474-475,  <J  723  f-i — from  which  arises 
a  general  coincidence  in  the  patholog- 
ical as  well  as  physiological  condition 
of  the  whole,  and  renders  them  equal- 
ly amenable  to  remedies  ;  but  altera- 
tive reflex  nervous  influence  not 
equally  reciprocal,  p.  55,  ^  117;  p. 
03,  (J  137  c  ;  p.  284-289,  (}  454-461^ 
— and  ultimately  illustrated  by  the 
laws  of  reflex  action  of  the  two  sys- 
tems of  nerves,  and  the  Author's  di- 
rect action  through  the  Will  and  Men- 
tal Emotions,  and  applied  to  Pathol- 
ogy and  Therapeutics,  p.  284-289,  ij 
454-4611 ;  P-  295-335,  ^  476-511  ; 
p  335-362,  <)  512-530.  Also,  Men- 
tal Emotions,  hidcx  II.  ;  Will,  In- 
dex I.  and  II. 

the  natural  sympathetic  relation  of  or- 
gans, through  an  unceasing  reflex  ac- 
tion of  the  nervous  system,  of  the 
greatest  practical  importance,  and 
evinces  the  highest  order  of  Design,  p. 
58-59,  ^  126-129  i  ;  p.  284-289,  § 
454-461  ;  p.  328,  ()  500  /.  Also,  Re- 
flex Action,  Sympathy,  as  it  re- 
spects tissues  and  complex  organs  ; 


INDEX    II. 


1093 


Structure — conlinucd. 

Causes,  Morbific;  Remedies,  Blood- 
letting, Index  II 

the  syttipathetic  relations  variously  mod- 
ified by  disease,  according  to  the  spe- 
cial vital  endowments  of  organs  and 
tissues  and  the  disturbances  of  the 
reflex  nervous  influence,  p.  58-59,  () 
129  d-i;  p.  67,  <J  149-151  ;  p.  73,  i^ 
163  ;  p  107-110,  i)  226-232  ;  p.  110, 
^  232  ;  p  286,  i)  456  b  ;  p.  332,  ()  501 
c  ;  p.  661-663,  <J  894-896— in  conse- 
quence of  which,  and  as  a  natural  re- 
sult of  the  established  relations,  rem- 
edies call  the  alterative  action  of  re- 
flex nervous  influence  into  profound 
operation,  and  develop  curative  reflex 
influences  among  organs  diseased, 
and  exact  contributions  from  the  un- 
affected, p-  59,  ()  129  I,  and  references 
there  ;  p.  65-66,  ()  143  c,  and  re/er- 
enccs  there;  p.  661-663,  (;  894-896 
Also,  Remedies,  Skin,  Index  II 

hence,  in  view  of  the  foregoing  natural 
relations,  and  the  differences  in  the 
vital  constitution  of  tissues  and  or- 
gans, we  readily  understand  the 
ground  of  the  variety  among  sympa- 
thetic diseases,  and  how  all  organs 
may  be  disturbed  by  disease  of  one, 
p.  55,  i)  117;  p.  59,  (}  129  h  ;  p  64- 
65,  <^  140-143  c  ;  p-  107-108,  ()  227  ; 
p.  332,  «  501  ;  p.  339-340,  ^  bU  h , 
p  359-360,  <J  527:  p  361,  ij  529  6; 
p.  415,  ^  647;  p  423-424,  (^  660  ;  p. 
465-467,  ()  715-719. 
Strychnia, 

employed,  through  the  analogies  of  its 
spasmodic  effects  with  convulsions 
that  arise  from  teething,  indigestible 
food,  &c.,  and  with  traumatic  teta- 
nus, and  in  connexion  with  the  coun- 
teracting influences  of  Antispasmod- 
ics, opium,  &c  ,  as  one  of  the  numer- 
ous illustrations  of  the  less  obvious 
modus  operandi  of  morbific  and  reme- 
dial agents  through  alterative  influ- 
ence of  reflex  action  of  the  nervous 
system,  p  109-110,  ()  230-232,  p. 
Ill,  ij  233f  ;  p.  319,  <;»  494,  b,  dd ;  p. 
334,  <;>  509  ;  p  338,  <)  514  d;  p  525- 
527,  (}  828  a-d  ;  p  590,  «J  891M  ;  P 
592-593,  <)  891i  k;  p.  671-674,  i) 
904  a,  b.  Also,  Convulsions,  Opi- 
um, Remedial  Action,  Hydrocyanic 
Acid.  Antispasmodics,  Coffee,  In- 
dex II.  Also,  p.  930,  ()  1088  a. 
SuDORiFics.  See  Index  I.  Also,  Sweat, 
Skin  ,  Antimony,  Tartarized  ;  Wa- 
ter, Hot,  Index  II. 
Sugar,  Animal, 

whence  derived,  p.  784-793,  ii  1031  h- 
1033. 

sugar  of  milk,  a  product  of  the  mam- 
mary gland,  and  has  no  existence  in 


Sugar,  Animal — conlinued. 

the  general  mass  of  blood,  p.  785,  <5> 

1031  b;  p   789-790,  ()  1032  b. 

does  it  pre-exist  in  any  part  of  the  cir- 
culation, and  is  it  a  product  of  the 
liver  1  p.  783-793,  ()  1031  4-1033. 

vegetable  food  not  necessary  to  its  pro- 
duction, p  785,  <^  1031  b. 

diabetic,  formed  by  kidney,  p.  789,  <) 

1032  b — restricted  to  diabetes,  p.  786,  (^ 
1031  b — found  in  urine  after  pricking 
medulla  oblongata,  p.  792,  ()  1032  d. 

saccharine  matter  not  absorbed  by  lac- 
teals,  p   788,  789,  {)  1032  b. 
methods   of  searching   for,   p.   794,   ^ 

1033  a.    Placental  origm  of,  <J  1086. 
Sulphuric  Acid, 

introduced  as  one  of  the  proofs  that  As- 
tringents and  all  other  remedies  op- 
erate upon  parts  beyond  their  direct 
seat  of  action  through  alterative  in- 
fluence of  reflex  action  of  the  nervous 
system,  p  530,  ^  837  c  ;  p.  533,  <)  842  ; 
p.  577,  ()  890  0.  Also,  Lead,  Ace- 
tate OF  ;  Silver,  Nitrate  of  ;  Opi- 
um. Cold,  Ipecacuanha,  Index  II 
Sulphuric  Ether,  and  other  Anjes- 
tHetics, 

facts  and  arguments  to  show  that  they 
are  not  absorbed,  but  produce  their 
constitutional  effects  through  altera- 
tive influence  of  reflex  nervous  action 
— the  philosophy  being  the  same  as 
concerned  in  respiration,  where  the 
reflex  action  is  instituted  by  an  inap- 
preciable irritation  of  the  pulmonary 
mucous  tissue — and  illustrate,  also, 
the  distinctions  between  common, 
specific,  and  sympathetic  sensibility, 
p.  522-523,  f)  827  b-d ;  p.  862-864, 
(}  1066;  p.  671,  (}  904  b.  Also,  p. 
101-102,  ^  201-202;  p.  282-283,  (} 
451  d-J  ;  and  Structure,  An.i;s- 
THETics,  Oxygen,  Index  II 
Suppositories 

supply  one  of  a  thousand  clear  demon- 
strations of  the  operation  of  remedial 
and  morbific  agents  upon  distant  parts 
through  alterative  influence  of  reflex 
action  of  the  nervous  system,  and  of 
the  modifications  of  that  influence  ac- 
cording to  the  nature  of  the  cause, 
while,  also,  in  making  their  impres- 
sions partly  through  continuous  sym- 
pathy, they  concur  with  Croton  Oil 
applied  to  the  tongue,  Leeching  the 
anus,  and  Enemas  of  warm  water,  in 
showing  how  local  impressions  of  this 
nature  correspond  with  the  nature  of 
the  ao;ent,  and  give  rise  to  a  corre- 
sponding modification  of  the  nervous 
influence,  p.  666,  <)  902  b;  p.  673- 
675,  I)  904  b.  Also,  p.  107-109,  () 
226-229,  p.  661-663,  ^  894-896; 
and  Oil,  Croton  ;  Leeching,  Heat  ; 


1094 


INDEX    II. 


Suppositories — continued. 

Sympathy,  Continuous  ;  Inflamma- 
tion, Index  II.  ;   Nervous  Power, 
Index  I.  and  II. 
SuppuRANTs.     See    Seton,  Counter-Ir- 

RiTANTS,  Index  II. 
Suppuration — continued  from  Index  I., 
designed  for  useful  ends,  and  its  design, 
along  with  the  production  of  lymph, 
displayed  especially   in    deep-seated 
abscesses,  p.  471-474,  <^  732  6-733. 
Also,  p.  546-547,  ^  862-863;    and 
Mucus,  Pus,  Lymph,  Inflammation, 
Index  II. 
Swallowing,  Deglutition, 

like  the  involuntary  and  voluntary  acts 
of  respiration,  and  contraction  of  the 
sphincter  muscles,  illustrates  the  coin- 
cidences between  the  physical  agents 
and  the  Will  as  equally  substantive 
causes,  and  their  common  dependence 
upon  the  nervous  influence  (reflex  in 
one  case,  direct  m  the  other),  as  their 
medium  of  bringing  the  organic  struc- 
tures into  action,  and  employed,  also, 
in  advancing  the  Author's  demonstra- 
tion of  the  operation  of  morbific  and 
remedial  agents  and  the  Mental  Emo- 
tions through  the  same  causation,  p. 
338-339,  1^  514:  f,g.  Also,  Reflex 
Action, Mental  Emotions, Respira- 
tion, Sphincter  Muscles,  Soul  and 
Instinctive  Principle,  Index  II  ; 
Will,  hidex  I.  and  II. 
Sweat — continued  from  Index  I.  See, 
also,  SuDORiFics,  Index  I., 
an  unimportant  evacuation,  abstractly 
considered,  and  not  a  rehable  or  im- 
portant symptom  unless  supported  by 
others,  and  induced  by  causes  of  an 
internal  nature  that  impart  an  altera- 
tive influence  to  the  reflex  action  ot 
the  nervous  system  upon  which  it 
then  depends,  when  it  may  be  favor- 
able or  indicative  of  danger — and,  as 
occasioned  by  remedies,  it  is  conform- 
able to  the  nature  of  each  one,  or  as 
each  may  modify  the  reflex  nervous 
influence,  and  it  is  the  special  impres- 
sion that  may  be  thus  made  upon  the 
skin  which  does  tlie  essential  service, 
and  very  little  so  the  evacuation,  as 
may  be  readily  seen  in  the  diflerences 
between  the  sudorific  effects  of  hot 
drinks,  fear,  exercise,  &;c.,  and  as  they 
spring  from  tartarized  antimony,  ipe- 
cacuanha, loss  of  blood,  opium,  &c. — 
in  one  series  of  cases  the  nervous 
power  operating  as  a  simple  stimu- 
lant, while  in  the  other  it  is  profound- 
ly alterative  of  organic  action  ;  and 
in  both  the  cases  the  skin  may  re- 
act through  a  corresponding  nervous 
influence  upon  morbidly  susceptible 
parts,  and,  therefore,  with  far  greater 


Sweat — continued. 

effect  in  the  latter  than  the  former 
cases,  p.  107-109,  (}  226-230  ;  p.  Hi, 
(^  233J  :  p.  230-232,  <)  422  A-424  ;  p. 
250-251,  (J  441  c,  p.  335-336,  ()  512 
a,b,  p  338,  (J.  514  rf;  p.  339,  ^514 
h ;  p.  350-351,  <^  524  ;  p  355,  (J  526 
a;  p.  451-452,  «^  G92  a;  p.  546-550, 
<)  862-863/;  p.  550,  t)  863  d  ;  p.  592 
-593,  I)  89H  k  ;  p-  631-632,  i)  892f  ; 
p.  634,  (J  8924  a,  b ;  p.  661-664,  <»  894 
-900 ;  p.  665-669,  <)  902  a-i ;  p.  678, 
^904tZ,- p.704,<;i943a.  Also,  Secre- 
tion and  Excretion,  Skin,  Struc- 
ture, Hybernating  Animals,  Rem- 
edies ;  Antimony,  Tartarized,  Index 
II. ;  Nervous  Power,  Index  I.  and 
II. 
employed  to  illustrate  modus  operandi 
of  Astringents  through  alterative  in- 
fluence of  reflex  action  of  nervous 
system,  p.  530,  ^  837  c ;  p  533.  () 
842;  p  577,  (J  890  o. 
Symbols,  Chemical, 

as  carried  into  Physiology,  admitted  to 
be  fallacious,  p  779-782.  <)  1029, 
1030. 
Sympathy — continued  from  Index  I., 
under  this  comprehensive  designation 
are  included  remote,  contiguous,  and 
continuous  sympathy,  the  first  two 
representing  reflex  action  of  the  nerv 
ous  system,  and  the  last  having  no 
manifest  connexion  with  that  action, 
but  probably  influenced  by  the  nerves 
so  far  as  they  form  a  component  part 
of  the  various  tissues  ;  and  under  the 
general  designation  are  arranged  the 
laws  of  reflex  nervous  action  and  the 
numerous  experiments  brought  to 
their  illustration,  and  introduced  by 
the  Author  for  the  purpose  of  apply- 
ing them  to  Pathology  and  Therapeu- 
tics— the  order  of  the  subjects  pro- 
ceeding as  follows  ; 
On   the  general  Uses  of  the  Nervous 

System,  p.  284-290,  (f  454-461. 
On  the  different  Orders  of  Nerves,  p. 

290-292,  ()  462-470. 
Laws  vj  Action  of  Motor  Nerves  of 

the  Cerehro- Spinal  System,  p.  292, 

<.471. 
Laws  of  Action  of  Sensitive  Nerves  of 

the  Cercbro- Spinal  System,  p.  292, 

t)  472 ;  p.  802-803,  4  1037  b. 
On  the   Spinal  Cord,  p.  292-295,  <j^ 

473-475  ,  p.  802-803,  ()  1037  b. 
Experiments  to  determine  the  Laws  of 
the  Vital  Functions,  and  applied  to 
Pathology  and  Therapeutics 
1st.   On   the   Principle  on  which  the 

Action  of  the  Heart  and  Vessels  of 

Circulation  depends,  p.  295-301,  § 

476-479  ;  p.  803-804.  ()  1039  ;   p. 

805-807,  <J  1041. 


INDEX    II. 


1095 


Sympathy — continued. 

2d-    On  the  Relation  which  subsists 
between  the  Heart  and  Vessels  of 
Circulation  and  the  Nervous  Sys- 
tem ;  and  the  Influence  of  the  Nerv- 
ous   System    upon    the    Capillary 
Bloodvessels,  p.  301-310,  ()  480- 
485. 
Zd.   On  the  Principle  on  which  the  Ac- 
tion of  the  Muscles  of  Voluntary 
Motion  depends,  and  the  Relation 
which  they  bear  to  the  Nervous  Sys- 
tem, p.  310,  ()  486. 
Ath    Experiments  to  ascertain  the  com- 
parative effects  of  Stimuli  applied 
to  the  Brain  and  Spinal  Cord  on  the 
Heart  and  Muscles  of  Voluntary 
Motion,  p.  311-315,  ^  487-489. 
5th.   On  the  Principle  on  which  the 
Action  of  the  Alimentary  Canal  de- 
pends, p.  315,  i)  490. 
&th.   On  the  Relation  which  the  Ali- 
mentary Canal  and  Lungs  bear  to 
the  Nervous  System,  p.  315,  ()  491. 
Review  of  the  Inferences  from  the  pre- 
ceding  and  other  Experiments,  p. 
315-321,  (j  492-494. 
on  the  Varieties  or  Kinds  of  Sympathy, 
and  appUed  to  Pathology  and  Thera- 
peutics, p.  321-335,  (j  495-511. 
the  Laws  of  Sympathy,  or  Reflex  Ac- 
tion of  the  Nervous  System,  and  their 
AppUcation  to  Pathology  and  Thera- 
peutics, p.  335-362,  ()  512-530. 
\st.   General  Facts  and  Laws  relative 
to  the  Cerebro- Spinal  and  Gangli- 
onic  Systems,  p.  335-341,  ^  512- 
514. 
2d.  Laws   of  Action   of  the  Sympa- 
thetic Nerve,  and  the  Propagation 
of  Impressions  in  it,  p.  341-342,  (j 
5141  a-515.   Also,  p.  216,  ^  399. 
2d.   Of  the  Action  of  the  Sympathetic 
Nerve  in  Involuntary  Motions,  p. 
342-349,  ij  516-521. 
Ath.  Laios  of  the  Sensitive  Fibres  of 
the   Sympathetic   Nerve,  p.  350,  ^ 
523. 
5^^.   Laws  of  the  Organic  Functions 
of  the  Sympathetic  Nerve,  p.  350- 
353,  ^  524.    Stmpath.  Nerve,  /.  i. 
of  the  Sympathies  of  the  Individual  Tis- 
sues : 
1  St.   Sympathies  of  similar  Tissues,  p. 

353-358,  ()  525-526. 
2d.    Sympathies   of  Dissimilar   Tis- 
sues, p.  359-360,  ^  527. 
3d.    Sympathies  of  Individual  Tissues 
in  their  Relation  to  each  other  in 
Compound  Organs,  and  with  entire 
Organs,  p.  360-361,  <^  528. 
Sympathies  of  Compound  Organs  with 
each  other,  p.  361-362,  ^  529-530. 
Sympathy,  Remote  and  Contiguous, 
terms  of  brevity,  whose  generic  name  is 


Sympathy,  &c. — continued. 

derived  from  that  of  the  nerve  which, 
with  the  pneumogastric,  is  the  prin- 
cipal channel  through  which  reflex 
actions  of  the  nervous  system  are 
conducted  (and  is  thus  employed  by 
Miiller  and  other  Physiologists,  p.  349, 
^  520  ;  p.  352,  <)  524  c,  &c.),  and  the 
only  distinction  between  them  con- 
sists in  the  greater  limitation  of  the 
former  to  the  cerebro-spinal  axis  as 
the  central  parts  for  reflected  actions, 
while  contiguous  sympathy  is  mani- 
fested more  particularly  through  local 
centres,  which  may  consist  of  either 
the  ganglia  of  the  sympathetic  nerve, 
or  of  plexuses  of  nerves,  or  of  some 
portion  of  individual  nerves  (the  last 
of  which  the  Author,  as  will  be  seen, 
had  considered  probable,  and  which 
has  been  recently  experimentally  as- 
certained), but  is,  doubtless,  always 
associated  more  or  less  with  reflex  ac- 
tions conducted  through  the  brain  and 
spinal  cord,  as  conspicuously  mani- 
fested in  the  action  of  Vesicants  and 
Leeches  when  applied  over  some  in- 
ternal inflammation,  and,  in  its  more 
circumscribed  aspect,  in  the  examples 
of  dilatation  of  the  iris  at  p.  673-674, 
^  904  b,  and  of  the  sciatic  nerve  at  p. 
838,  ^  1057i — and  it  now  remains 
only  to  refer  the  inquirer  for  the  prac- 
tical applications  oi  remote  sympathy 
to  the  sections  embraced  under  the 
Article  Reflex  Action  of  the  Nerv- 
ous System,  Index  II. ;  while  he  will 
find  under  the  following  sections  the 
combined  aspects  of  reflex  action  as 
conducted  more  or  less  through  local 
centres  of  the  nervous  system,  and  its 
main  centres,  with  various  illustra- 
tions, and  designated  by  the  old  name 
of  Contiguous  Sympathy,  p.  287- 
289,  {)  458-461  ;  p.  293,  ^  473  c;  p. 
294,  No.  5  ;  p.  312,  ^  487  g ;  p.  319, 
(j  494  dd;  p.  321,  §  497;  p.  323,  () 
499  a ;  p.  334,  ^  507 ;  p.  343-344,  (> 
516  d,  Nos.  3-5 ;  p.  345-346,  ()  516 
d,  Nos.  7-9  ;  p.  349,  <^  520-522  ;  p. 
353,  (j  524  d,  Nos.  4-7  ;  p.  642-644,  ■ 
^  893  a-c ;  p.  646-653,  ()  893  e-n ; 
p.  803,  ^  1038  ;  p.  838,  §  1057^. 

Sympathy,  Continuous, 

an  old  designation,  and  liable  to  the  ob- 
jection of  being  confounded  with  the 
laws  of  reflex  action,  and  therefore 
the  Author  proposed  the  substitution 
of  continuous  influence  (p.  322,  ^  498 
a) — is  common  to  Plants  as  well  as 
Animals,  but  differing  in  the  latter  not 
only  according  to  the  nature  of  tis- 
sues (being  far  more  strongly  pro- 
nounced in  some  than  in  others,  as  in 
the  veins  and  lymphatics),  but  by  the 


1096 


INDEX    II. 


Sympathy,  Continuous — continued. 

incorporation  of  the  nerves  in  all  ani- 
mal tissues  (p.  483-484,  i)  746  c),  and 
exemplified  by  the  prick  of  a  pin  when 
the  resulting  inflammation  extends  in 
a  continuous  manner  from  point  to 
point,  or  as  seen  in  erysipelas,  but 
sometimes  remarkably  limited  in  its 
progress,  as  at  the  divergence  of  veins, 
and  shown,  also,  in  a  variety  of  other 
ways,  as  by  the  cathartic  effect  of 
croton  oil  applied  to  the  tongue,  by 
leeching  the  anus,  by  suppositories, 
and  more  or  less  by  cathartics,  espe- 
cially such  as  act  upon  the  liver,  by 
the  manner  in  which  chewing  tobac- 
co, &c.,  excites  the  salivary  glands, 
or  irritation  of  the  eye  the  lachrymal, 
&c.,  and  is  an  element  in  venous  cir- 
culation, but  which,  in  all  the  cases, 
and  according  to  the  nature,  extent, 
and  force  of  the  impression  that  may 
be  continuously  made,  whether  in- 
flammatory, or  simply  an  irritative,  or 
a  sedative  effect,  and  according,  also, 
to  the  nature  of  the  tissue  and  of  the 
compound  organ,  gives  rise  to  a  cor- 
responding reflex  action  of  the  nerv- 
ous system,  which  may  fall  upon  va- 
rious distant  parts,  and  with  all  the 
variety  of  effect  as  set  forth  under 
Articles  Reflex  Action  and  Nerv- 
ous Power,  or  may  be  directed  upon 
the  part  which  is  the  seat  of  the  con- 
tinuous affection  and  increase  its  ex- 
tension and  force,  and  thus  multiply 
the  force  of  the  reflex  action,  and  in- 
stitute new  circles  and  other  influ- 
ences upon  other  organs,  p.  58,  §  129 
c,f;  p.  64,  (J  141  b;  p.  66-67,  (;.  148; 
p.  209-210,  ^  387;  p.  321,  ^  494  c; 
p.  322-323,  (/  498  ;  p.  343,  ^  516  d; 
p.  350,  ^  523,  Nos.  6,  7  ;  p.  351,  (j 
524  a,  No.  2  ;  p.  355-356,  <;»  526  b,  c  ; 
p.  465-466,  i)  715;  p.  475,  <^  733  h; 
p.  483-484,  ^  746  c ;  p.  506,  ()  803, 
804  ;  p.  524,  (J  827  e ;  p.  526,  ()  828 
d;  p.  503-564,  (i  889  a;  p.  694-695, 
•Ji  923.  Also,  Oil,  Croton  ;  Leech- 
ing, Suppositories,  Heat,  Circula- 
tion OF  THE  Blood,  Index  II.  ;  Ve- 
nous Tissue,  Venous  Congestion, 
Index  I;  p.  665,  I)  902  a.    Notp:  U. 

Symptoms,  Morbid, 

distributed  into  five  groups — 1st,  vital 
signs  ;  2d,  relative  to  the  instruments 
of  disease,  but  independent  of  struc- 
tural changes  ;  3d,  relative  to  the  se- 
cretions and  excretions  ;  4th,  of  the 
foregoing  nature,  but  determined  or 
modified  by  changes  of  organization  ; 
5tb,  of  a  physical  nature  depending  on 
changes  of  structure,  accumulated  flu- 
ids, &c. — the  first  three  being  jfjriwari/, 
the  last  two  secondary,  p.  435,  iji  68 1  a. 


Symptoms,  Morbid — continued. 

describe  the  nature,  seat,  &c.,  of  dis- 
eases, and  often  assisted  by  a  knowl' 
edge  of  the  predisposing  causes,  p. 
424-425,  <)  662 ;  p.  434-436,  ^  679- 
681  ;  p.  459,  <)  705  a ;  p.  500,  ^  789  ; 
p.  560-561,  ()  885-887;  p.  487-489, 
^  756  ;  p.  509,  ^  811  ;  p.  510,  ()  813 
b;  p.  545,  ^  859  b;  p.  561,  (J  886. 

owing  to  the  instability  of  the  proper- 
ties of  Life,  see  Vital  Properties,  Li- 
dex  I.,  subdivisions — mutable  in  their 
nature — their  mutability  designed  for 
useful  purposes — their  mutability  the 
fundamental  cause  of  disease — their 
mutability  the  groundwork  of  cure — 
their  mutability  the  great  cause  of  the 
drffieulties  in  Medicine. 

their  uses  and  abuse,  practically  consid- 
ered, p.  370-372,  ^  569 ;  p.  428-434, 
t)  673-676;    p.  430-433,  (j  675;    p 

436,  i)  682  a,  b;  p.  447-448,  (;  668  I 
p  456-460,  ()  699-708  ;  p.  489,  ^  756 
b;  p.  511,  (}  815;  p.  548-549,  ^  863 
d;  p.  560-561,  <)  884-887;  p.  572- 
576,  ^  890  d-n;  p.  587,  ^  891  k;  p. 
590-591,  iji  89H  a-f;  p.  626-627,  ^ 
8921  /;  p.  636-641,  t)  892|  d-i ;  p. 
724-725,  I)  961  a,  b;  p.  759-760,  <^ 
1005;,-  p.  848,  ^  1058  v-x. 

are  apt  to  be  regarded  as  the  disease  it- 
self, without  connecting  them  with 
the  only  useful  considerations  of 
which  they  are  indicative,  and  reme- 
dies are  accordingly  addressed  to  a 
single  symptom,  p.  73,  (Ji  163  ;  p.  464, 
^  713  ;  p.  570-576,  ^  890  a-n  ;  p.  579, 
(J  890^  a;  p.  584,  ()  891  d;  p.  587- 
588,  <)  891  k;  p.  589,  ()  891  n  ;  p.  590 
-591,  ()  89U  b-f;  p.  599,  (}  892  d;  p. 
626-627,  t)  892§  I ;  p.  628-629,  {}  892? 
r;  p.  630,  ()  892i  b;  p.  633-634,  I 
892|  a  ;  p.  637-640,  (j  892|.  e-g ;  p. 
684^688,  <J  905^  b,  c. 

diagnostic,  and  how  far  reliable,  p.  436 - 

437,  ()  m2— prognostic,  p.  437,  (j  683 
— other  special  ones — pulse,  p.  443- 
448,  (J  687i-688— relative  to  tongue, 
p.  448-450,  ij  689 — secretions  and  ex- 
cretions, p.  450-455,  ^  690-694i  Al- 
so, Pulse,  Tongue,  Sweat,  Urine, 
Mucus,  Secretion  and  Excretion, 
Heart,  Index  II. 

the  force  of,  difficult  to  define,  but  a  sin- 
gle one  may  denote  a  profound  con- 
dition of  disease,  p.  438,  <J  685,  No.  9  ; 
p.  442,  ^  686  c. 

all  of  them  to  be  considered  in  connex- 
ion, with  a  view  both  to  the  patholog- 
ical cause  and  the  treatment,  p.  63, 
i)  173  ;  p.  73,  ()  163  ;  p.  428,  ^  874  a  : 
p.  437-442,  <i  684-686  ;  p.  456-460', 
()  695-708;  p,  479-480,  ^  741  a,  b; 
p.  541-542,  (}  854  bb ;  p.  548-550,  (> 
863  rf;  p.  551-554,  <^  867-871 ;  p.  572 


INDEX    II. 


1097 


Symptoms,  Morbid — continued. 

-576,  <J  890  d-n;  p.  587,  ^  891  k;  p. 
636-642,  I)  892|  d-i ;  p.  663-665,  § 
897-901  ;  p.  685-686,  ()  905^  b  ;  p. 
759,  (J  1005  j.  Also  Pathological 
Cause,  Index  II. 

nevertheless,  there  is  generally  a  group 
of  symptoms  which  serve  as  a  com- 
mon index  to  pathological  conditions 
and  the  effects  of  remedies,  mani- 
fested by  the  heart  and  larger  arte- 
ries, tongue,  skin,  and  kidneys — or- 
gans that  are  not  the  seats  of  disease 
in  most  of  the  cases,  but  only  exhibit- 
ing sympathetic  influences  as  determ- 
ined upon  them  by  parts  morbidly  af- 
fected, or  which  may  sustain  impres- 
sions from  remedial  agents,  and  which 
go  with  a  thousand  other  things  in 
enforcing  the  importance  of  turning 
our  attention  away  from  the  iatro- 
chemical  and  iatro-physical  doctrines 
to  the  lavys  of  sympathy  or  reflex  ac- 
tion of  the  nervous  system,  and  to  the 
manner  in  which  the  nervous  influ- 
ence is  variously  modified  and  ren- 
dered alterative,  for  good  or  for  evil, 
by  disease  and  remedies,  and  accord- 
ing to  the  exact  condition  of  one  or 
the  precise  virtues,  doses,  &c.,  of  the 
other,  p.  230-231,  ^  422-423  ;  p.  232 
-233,  ^  425-427 ;  p.  350,  ^  523,  No. 
7  ;  p.  355,  ^  526  a ;  p.  429-430,  ^  674 
d;  p.  438-441,  ()  686  ;  p.  443-450,  ^ 
687-689  Also,  Pulse,  Tongue,  Skix, 
Heart,  Kidney,  Index  II. 

mode  of  investigating.     See  Symptoms, 
Index  I. 
Syncope — continued  from  Index  I., 

when  occasioned  by  loss  of  blood,  is 
owing  to  united  effect  of  direct  and  re- 
flex action  of  nervous  system — when 
only  by  nausea  induced  by  a  variety 
of  other  physical  causes  remote  from 
the  stomach,  consecutive  reflex  ac- 
tions are  instituted,  being  first  determ- 
ined upon  the  mucous  tissue  of  the 
stomach  with  a  nauseating  effect,  and 
thence  with  a  prostrating  effect  upon 
the  organs  of  circulation — and  when 
induced  by  mental  emotions,  it  may 
result  either  from  the  direct  nervous 
influence  acting  immediately  upon  the 
circulatory  organs,  or  from  first  insti- 
tuting nausea,  after  the  manner  of 
disgust,  and  a  consequent  reflex  ac- 
tion as  in  the  last  foregoing  case — 
and  the  remedies  consist  of  a  variety 
of  things  which  operate  by  instituting 
a  stimulating  reflex  nervous  action, 
having  its  centripetal  origin  in  vari- 
ous parts,  and  taking  a  centrifugal 
course  upon  the  centre  of  circulation 
— all  the  variety  going  with  our  other 
multitudinous  facts  and  demonstra- 


Syncope — eontinued. 

tions  in  substantiating,  by  the  force 
of  exact  analogies,  the  Author's  doc- 
trine of  the  modus  operandi  of  mor- 
bific and  remedial  agents,  physical 
and  mental,  through  alterative  influ- 
( ncjs  of  direct  and  reflex  action  of  the 
nervous  system,  and  of  the  modifica- 
tions of  that  influence  according  to 
the  nature  of  the  causes  by  which  it 
is  brought  into  operation,  and  supply- 
ing simple  elements  of  the  manner  in 
which  the  nervous  influence,  whether 
reflex  or  direct,  will  reach  particular 
internal  parts  whe<j,  as  in  the  former 
case,  the  centripetal  impulse  proceeds 
from  a  variety  of  sources,  and  how 
very  dissimilar  remote  causes  will 
bring  about  a  common  result,  as  seen 
in  those  which  induce  syncope,  and 
in  the  other  series  which  remove  it, 
p.  703-706,  ^  942-945  ;  p.  707-708,  () 
949  ;  p.  709,  <J  951  c,  d.  Also,  p.  107 
-111,^  227-233 J;  p.  113-114,  ^  234 
d  ;  p.  312,^  487  g  ;  p.  326-328,  <J 
500  g-m;  ff  331,  "(}  500  o;  p.  333,  ^ 
503  ;  p.  338,  <;>  514  </;  p.  661-663,  ^ 
894  i-896  ;  p.  664,  ^  900  ;  p.  670,  () 
902  I ;  Loss  of  Blood,  Mental  Emo- 
tions, Disgust,  Stomach,  Reflex 
Action,  Index  II. 
acupuncturation  of  heart  proposed  by 
Author  in  violent  cases  of,  vi  Medical 
and  Physiological  Comme7itaries,  vol. 
i,,  p.  178,  note,  1840. 


Tables  relative  to  Tissues.     See  Struc- 
ture, Index  II. 

Tea, 

the  great  calefacient  of  the  Arctic  trav- 
eller after  long  exposure  to  intense 
degrees  of  cold,  and  which,  from  its 
well-known  influence  upon  the  nerv- 
ous system,  goes  with  the  rest  in  de- 
monstrating the  influence  of  reflex 
nervous  action  in  the  production  of 
animal  heat,  and  that,  whatever  may 
be  its  nature,  its  generation  is  on  com- 
mon ground  with  other  secreted  prod- 
ucts, and  liable,  like  the  others,  to  be 
increased  or  diminished  by  the  nerv- 
ous influence,  p.  811,  ^  1049.  Also, 
Organic  Heat,  Index  I.  and  II. 

Temperament — continued  from  Index  I., 
its  varieties,  and  corresponding  differ- 
ences in  the  effects  of  the  natural 
stimuli  of  life  and  of  morbific  and  re- 
medial agents,  that  ar^  mainly  owing 
to  slight  differences  in  the  organic 
property  irritability,  and  to  variations 
in  the  natural  or  the  alterative  influ- 
ences of  direct  or  reflex  action  of  the 


1098 


INDEX    II. 


Temperament — continued. 

nervous  system,  according  to  the  na- 
ture of  the  physical  cause  or  of  the 
passion  which  may  bring  it  into  op- 
eration, and  the  analogies  in  Plants 
arising  from  substitutions  of  climate, 
cultivation,  &c.,  and  in  their  diseases, 
and  some  other  facts  closely  allied  to 
the  foregoing,  illustrate  the  broad  dis- 
tinction between  organic  and  inorgan- 
ic beings,  and  the  fallacy  of  applying 
the  chemical  and  physical  doctrines 
to  the  problems  of  life,  p.  88,  ()  183- 
185 ;  p.  89,  <^  188 ;  p.  95-100,  ^  189- 
193  ;  p.  383-400,  <J  585-630.  Also, 
Vital  Properties,  Organic  Life, 
Index  I. ;  Youth,  Index  I.  and  II. ; 
Organs  of  Generation,  Index  II. 

Temperature.     See  Organic  Heat,  In- 
dex I.  and  II. 

Tetanus, 

from  the  prick  of  a  tendon,  employed 
in  corroboration  of  Author's  doctrine 
of  the  operation  of  all  morbific  and 
remedial  agents  bevond  the  seat  of 
their  direct  operatiwi  through  altera- 
tive influence  of  reflex  nervous  action, 
and  against  the  chemical  and  phys- 
ical hypotheses,  and  farther  to  the 
same  effect  through  its  coincidence 
with  spasmodic  affections  arising  from 
a  variety  of  other  causes,  p.  358,  <^ 
526  d ;  p.  526,  ^  828  d.  Also,  Spas- 
modic Affections,  Hysteria,  Con- 
vulsions, Antispasmodics  ;  Hydro- 
phobia, Virus  of ,  Serpents,  Virus 
of.  Index  II. 

Therapeutics,  p.  541-563,  ^  852-888. 
the  great  ultimate  object  of  all  medical 
inquiries,  p.  3,  ^  2  b ;   p.  A13,  ()  639 
a  ;  p.  541,  ^  852. 
simple  in  principle,  complex  in  details, 

p.  541,  /)  852  i-853. 
remedies  of  positive  virtues  are  morbific 
in  action,  and  therefore  operate  upon 
the  same  principle  as  the  remote 
causes  of  disease — the  diflerence  be- 
ing that  the  latter  impair  the  recupe- 
rative principle  more  than  the  former, 
which  substitute  pathological  condi- 
tions less  profoundly  morbid,  and 
therefore  capable  of  subsiding  spon- 
taneously, p.  333,  <J  503-506  ;  p.  417- 
418,  <J  650  ;  p.  430-432,  <^  675  ;  p. 
541-543,  ()  854  a-e ,  p.  544,  (^  857 ; 
p.  547-549,  (}  863  d;  p.  551-553,  () 
867-870 ;  p.  554-556,  ()  872  ;  p.  644- 
652,  ^  893  b-e ;  p.  636-640,  ^  892A 
c-h  ;  p.  643-652,  ^  893  b-m  ;  p.  669^ 
^  902  I ;  p.  675-676,  I)  904  h  ;  p.  679- 
681,  ()  905  a — often  consist  of  natu- 
ral means,  p.  543,  ()  855  ;  p.  600,  ^ 
892  d — or  of  simply  withholding  ex- 
citing causes,  p.  543,  <^  856  ;  p.  682, 
^  905  b — the  cure  being  therefore  cs- 


Therapeutics — continued. 

sentially  the  work  of  Nature,  p.  65- 
66,  ()  143  c,  d  ;  p.  67-68.  <^  149-152  ; 
p.  87,(5  177-182;  p.  122,  ()  239;  p. 
542-543,  <J  854  c,  856  ;  p.  661,  ^  894 
a,  mottoes;  p.  669,  ^  902  i — as  illus- 
trated by  self-limited  diseases,  p.  544 
-546,  {}  858,  861,  and  by  diseases  of 
animals,  p.  545,  (^  858  ;  p.  551,  (^  863 
h,  and  by  the  system  of  "  watching," 
p.  r*58,  (}  877,  878— all  of  which  de- 
pends upon  the  mutability  of  the 
properties  of  life  as  designed  for  use- 
ful purposes,  as  set  forth  under  Re- 
cuperation, Law  of  ;  Remedial  Ac- 
tion, Remedies  ;  Causes,-Morbific, 
Index  II. ;  Adaptation,  Law  of.  In- 
dex I;  p.  850,  ^  1059. 

the  morbid  effects  of  positive  remedies 
to  be  avoided  only  by  a  careful  regu- 
lation of  doses,  &c.,  which  shows 
them  curative  by  introducing  mild 
pathological  conditions  corresponding 
with  the  virtues  of  each  remedy,  al- 
though a  great  variety  may  institute 
the  requisite  changes  in  a  given  form 
of  disease,  as  in  intermittent  fever, 
inflammation,  &c.,p.  543-544,  ()  857, 
858  ;  p.  547-550,  ()  863  d;  p.  664,^ 
900  ;  p.  669,  <J  902  i.  Also,  Counter- 
Irritants,  Cantharides,  Remedial 
Action,  Index  II. 

each  remedy,  like  morbific  causes,  oper- 
ates according  to  its  own  nature, 
dose,  &c.,  and  therefore  no  two  alike, 
and  according,  also,  to  two  or  more 
in  combination  and  the  relative  pro- 
portion of  each,  the  nature  of  the  dis- 
ease, &c.,  p.  27,  (J  52  ;  p.  479-480,  (J 
741  b ;  p.  544,  «J  857  ;  p.  545,  <)  860  ; 
p.  547-550,  ()  863  d ;  p.  554-556,  (} 
872.  Also,  Remedies  ;  Causes,  Mor- 
bific, Index  II. 

as  every  disease  consists  of  a  succession 
of  pathological  changes,  it  is  the  ob- 
ject of  every  successive  remedy  to  in- 
troduce a  new  pathological  condition 
till  that  one  is  attained  which  is  most 
conducive  to  a  spontaneous  subsi- 
dence, and  hence  the  importance  of 
applying  the  right  remedies,  and  in  the 
right  doses,  and  at  the  right  time,  and, 
as  one  remedy  prepares  the  way  for 
another,  in  a  well-regulated  consecu- 
tive order,  and  of  projecting,  as  far  as 
possible,  a  plan  of  treatment  at  its  be- 
ginning, p.  67,  (f  149-151  ;  p.  73,  ^ 
163;  p.  87,  <;.  177-182;  p.  426,  1^666; 
p.  428,  (^  672  ;  p.  430-433,  <J  675-676  ; 
p.  473-474,  <;.  733  c ;  p.  479-480,  ^ 
741  b;  p.  543-544,^  857;  p.  548- 
549,  ()  863  d;  p.  553,  ^  870  aa;  p. 
554,  <)  871  ;  p.  561-562,  (J  888  a-d; 
p.  566-570,  (J  889  k-n ;  p  595-596,  ^ 
892  aa ;  p.  597-600,  ^  892  c ;  p.  608, 


INDEX    II. 


1099 


Therapeutics — continued. 

^  892^  c;  p.  648-651,  ()  893  g-k ;  p. 
657-658,  ()  893  p;  p.  661-665,  ^  894 
-901  ;  p.  664-671,  ()  899-902  a-m; 
p.  679-681,  ^  905  a;  p.  696,  ^  926 ; 
p.  715-722,  I)  960  ;  p.  728,  <5.  964  d; 
p.  752,  <^  1000  ;  p.  756-760,  ()  1005. 

effect  of  morbid  habit  upon  the  action 
of  remedies,  p.  364-368,  ^  544-561  ; 
p.  552,  ^  869  ;  p.  648-649,  ^  893  g; 
p.  696,  <^  926. 

law  of  adaptation,  dependent  upon  reflex 
action  of  the  nervous  system,  pro- 
foundly interested,  p.  62-63,  ^  136- 
137  e  ;  p.  65,  I)  143  ;  p.  67-69,  ()  149- 
156  ;  p.  531,  ^  838  ;  p.  535-539,  ^ 
847-850  ;  p.  542-545,  <J  854  /-858. 
Also,  Adapt.\tion,  L.wv  of.  Index  I. ; 
Diseases,  Self-Limited,  Index  II. 

no  "  specifics,"  but  predisposing  causes 
often  modify  a  common  form  of  dis- 
ease, as  inflammation  and  fever,  in 
such  modes  as  to  require,  more  or 
less,  the  agency  of  remedies  not  adapt- 
ed to  the  common  form,  p.  424-425, 
^  662 ;  p.  487-488,  (^  756  ;  p.  509,  ^ 
811;  p.  510,  <^  813  b;  p.  545,  ()  859 
b;  p.  551,  4  865,  866  ;  p.  561,  ij  886  ; 
p.  597,  ^  892  c.  Also,  Cinchona, 
Coffee,  Iodine,  Index  II. 

compound  diseases  often  require  a  care- 
ful adjustment  of  remedies,  p.  542,  (} 
854  /,•  p.  545,  ()  858  ;  p.  553,  §  870 
aa;  p. 725-732,  ^  961  i-970. 

advantage  of  combining  remedies — cu- 
mulative effect  of  remedies.  See  Rem- 
edies, Index  II. 

effect  of  the  mind  upon  the  action  of 
remedies,  p.  865-868,  ^  1067  and  ref- 
erences there — effect  of  pain  in  coun- 
teracting Narcotics,  p.  557,  <J  874  ;  p. 
587,  i)  891  k;  p.  590,  ^  891  r,  and  the 
same  by  the  delirium  of  drunkenness, 
p.  590,  <)  891  r;  p.  734,  (}  976  b—a\l 
the  variety  in  effects  being  due  to  dif- 
ferent modifications  of  the  nervous  in- 
fluence as  brought  into  preternatural 
action  by  the  several  causes  respect- 
ively. See  Reflex  Action,  Mental 
Emotions,  the  Individual  Passions, 
Index  II. 

the  curative  effects  of  remedies  upon  the 
seat  of  their  direct  operation,  particu- 
larly in  morbid  states  of  the  stomach, 
is  less  owing  to  their  direct  alterative 
action  than  to  a  reflex  action  of  the 
nervous  system — and  this  corresponds 
with  the  morbific  effects  of  many 
causes  of  disease  when  manifested  in 
the  seat  of  their  direct  operation,  as 
seen  particularly  of  cold  and  miasms 
— and  problems  of  the  same  and  more 
complex  nature  are  involved  in  the 
salutary  effects  of  exercise,  change 
of  air,  &c.,  in  dyspepsy,  whooping- 


Therapeutics — continued. 

cough,  phthisis,  &c. — in  all  of  which 
cases,  as  well  also  in  all  that  concerns 
the  operation  of  remedial  and  morbific 
agents  beyond  the  seat  of  their  direct 
action,  the  effects  arc  owing  to  reflex 
influence  of  the  nervous  system — and 
for  these  several  specifications  see 
Reflex  Action,  Remedial  Action, 
Sympathy,  Remedies,  Alteratives, 
Bloodletting  ;  Causes,  Morbific  ; 
Whooping-Cough,  Phthisis,  Exer- 
cise, Friction,  Cold,  Miasm,  Show- 
er-Bath,  Sea- Sickness,  Mental 
Emotions,  Index  II. ;  Nervous  Pow- 
er, Itidex  I.  and  II. 
diseases  often  subside  spontaneously  as 
others  spring  up  sympathetically  upon 
them,  the  nervous  influence  being  the 
exciting  cause  in  all  the  cases  so  far 
as  any  influences  are  sustained  by  the 
pathological  conditions,  the  philoso- 
phy being  also  the  same  as  when  vesi- 
cants produce  inflammation  of  the 
bladder,  or  aggravate  or  remove  in- 
flammations of  other  parts — the  only 
difference  between  tlie  morbific  and 
curative  effects  being,  that  the  reflex 
action  of  the  nervous  system  is  either 
more  profoundly  morbific  or  different- 
ly modified  in  one  case  than  in  the 
other — but,  as  it  is  the  general  tend- 
ency of  diseases  to  generate  others 
and  to  aggravate  antecedent  ones,  and 
as  the  most  favourable  results  of  these 
reactions  of  the  nervous  influence  are 
rarely  salutary  in  the  end,  it  is  a  great 
error  to  promote  the  continuance  of 
natural  diseases  in  the  very  slender 
hope  that  a  greater  evil  may  be  thus 
overcome  or  an  apprehended  one 
avoided  (not  even  the  hemorrhoidal 
flux,  though  arresting  it  by  a  removal 
of  its  remote  cause) ;  and,  although 
artificial  diseases  may  be  instituted  in 
the  skin  by  agents  of  transient  effects 
with  a  view  to  salutary  influences 
upon  internal  diseases,  they  cannot 
be  set  up  in  other  organs,  particularly 
the  alimentary  canal,  but  with  an  ad- 
verse effect — and  it  is  upon  this  same 
principle  that  the  habitual  use  of  small 
doses  of  cathartics  in  a  large  propor- 
tion of  d}'speptic  cases  overcomes  con- 
stipation without  detriment,  while  the 
indigestible  food  which  is  used  for  the 
same  purpose  proves  morbific,  p.  67, 
<)  148  ;  p.  351-352,  ()  524  h-d ;  p.  360 
-361,^528,529  6;  p.  421-422,  «^  657  j 
p.  506,  ()  804  ;  p.  539,  (^  848  ;  p.  559, 
()  882  ;  p.  568-569,  <)  889  m,  mm ;  p. 
570,  ()  889  n ;  p.  652-656.  ^  893  n ; 
p.  679-681,  ()  905  a;  p.  695,  ^  924; 
p.  722,  ^  960  ^,-  p.  856-862,  ()  1063- 
1065.    Also,  Cantharides,  Counter- 


1100 


I>.'DEX    II. 


Therapeutics — conitnucd. 

Irritants,  Mercurial  Remedies,  In- 
dex II. 

the  recuperative  principle  displayed  in 
the  secretions,  their  therapeutical  uses 
according  to  their  nature,  and  as  sup- 
plying important  suggestions  in  prac- 
tical medicine,  p.  230-231,  ^  422  b, 
c ;  p.  232-234,  ()  425-428  ;  p.  352,  ^ 
524  c ;  p.  430-432,  ^J  675  ;  p.  450- 
452,  §  691-693  ;  p.  471-476,  ^  732- 
733  ;  p.  633-634,  ^  8324.  a  ;  p.  635- 
640,  ^  892f  h.  Also,''SuDOEiFics, 
Index  I  ;  Antimony,  Tartaeized  ; 
Diuretics,  Index  II. 

emaciation  curative,  p.  551,  (}  863  h;  p. 
597,  <;»  892  c.  Also,  Remedies  {Food), 
Index  II;  984  c. 

simplicity  of  treatment,  a  ruling  princi- 
ple, p.  553,  ()  870  b :  p.  593,  ^  892  a, 
motto. 

the  active  and  expectant  plans  of  treat- 
ment, p.  557-559,  i)  875-882— and 
the  rational  and  empirical,  p.  559- 
562,  <J  883-888  b. 

four  fundamental  points — 1st,  the  direct 
local  effects  of  remedies — 2d,  their  ef- 
fects upon  remote  parts  through  re- 
flex action  of  the  nervous  system — 
3d,  their  ultimate  effects  after  their 
direct  action  is  over — 4th,  the  general 
influence  of  each  remedy  upon  the 
course  and  termination  of  the  disease, 
p.  562,  ^  888  c. 
Thirst, 

its  earliest  deleterious  influences  arc  ex- 
erted through  reflex  and  direct  action 
of  the  nervous  system,  the  centripetal 
source  heing  mostly  the  mucous  tis- 
sue of  the  stomach  and  throat,  pro- 
'  gressively  increased  by  the  centrifu- 
gal action  of  the  mind,  while  sooner 
or  later  a  universal  injury  springs 
from  the  want  of  the  necessary  dilu- 
tion of  the  blood — presenting,  there- 
fore, in  the  former  aspect,  the  com- 
pounded influences  that  consist  of 
reflex  action,  and  the  direct  which 
results  from  mental  emotions,  and 
should  be  associated  with  the  physi- 
ology of  vomiting  as  determined  by 
mental  emotions  and  various  physical 
causes,  and  asthmatic  breathing,  the 
examples  relative  to  food,  &c.,  in  ap- 
plying the  philosophy  to  the  modus 
operandi  of  morbific  and  remedial 
agents.  See  Hunger,  Stomach,  Vom- 
iting, Disgust,  Asthma,  Respira- 
tion, Sea-Sickness,  Mental  Emo- 
tions, Seton,  Index  II 
Thoracic  Duct,  and  Absorbents, 

circulation  in,  depends  upon  suction 
power  of  the  heart,  and  upon  their 
own  action,  and  upon  that  of  the  cap- 
illai-ies,  p.  211,  <^  389,  390  a.     Also, 


Thoracic  Duct,  &c. — continued. 

Circulation    of  the  Blood,  Index 

n. 

Thunder, 

physiology  of  its  effects  in  producing 
disease  through  alterative  influence 
of  the  nervous  system  determined  in 
a  direct  manner,  p.  631-632,  <J  8923- 
b,  and  references  there ;  p.  886-887, 
(^  1067  a.  Also,  Reflex  Action, 
Mental  Emotions,  Disgust,  Index 
II 

Tissues.     See  Structure,  7n(7ea; //.;  Tis- 
sues, Index  I. 

Tobacco — continued  from  Index  I, 

the  diversity  of  its  effects — its  fumes  in- 
noxious when  inhaled,  but  poisonous 
to  the  alimentary  canal  —  morbific 
from  chewing  on  beginning  its  use, 
but  becoming  a  luxury,  while  no  rep- 
etitions will  abate  its  pernicious  ef>- 
fects  when  swallowed,  or  as  an  enema, 
or  when  applied  to  the  skin,  and  an 
example  of  its  special  sympathetic  ef- 
fects upon  the  heart  through  the  me- 
dium of  the  rectum,  and  an  analogy 
supplied  by  sneezing  as  produced  by 
snuff  and  light  and  by  thinking  of  the 
paroxysm,  and  the  coincidence  in 
habit  between  the  ultimate  failure  of 
chewing  and  smoking  to  affect  the 
mouth,  and  snufiing  the  nose,  and  thus 
establishing  a  correspondence  in 
these  parts  with  the  constitutional  in- 
sensibility of  the  pulmonary  mucous 
tissue  to  the  fumes  of  tobacco,  with 
other  analogous  considerations,  con- 
tradict the  hypothesis  of  absorption, 
and  bring  all  the  effects  of  tobacco 
under  the  law  of  reflex  action  of  the 
nervous  system,  and  present  a  com- 
prehensive ground  of  analogy  for  sus- 
taining our  interpretation  of  the  mo- 
dus operandi  of  Anesthetics,  and  its 
direct  afiinities  in  those  respects  with 
a  multitude  of  other  things  of  not  less 
obvious  action  give  to  our  demonstra- 
tion an  important  weight  in  the  gen- 
eral assemblage  of  facts  as  a  ground 
of  reasoning  to  other  remedial  and 
morbific  agents  whose  modus  operan- 
■  di  through  reflex  action  of  the  nerv- 
ous system  is  less  manifestly  pro- 
nounced— while,  also,  the  effects  of 
tobacco  illustrate  the  difference  in 
the  vital  constitution  of  different  tis- 
sues, the  law  of  Vital  Habit  in  a  lim- 
ited relation  of  tobacco  to  the  mucous 
tissue  of  the  mouth  and  nose,  &c.,  p. 
61,  ()  133,  a,  b;  p.  62-63,  (J  136-137 
c;  p.  67-68,  (}  149-152  ;  p.  107-110, 
<)  227-232;  p.  323-328,  (J  500  a-l; 
p.  333,  <)  503-505  ;  p.  338-341,  ^  514 
d-m;  p.  347-348,  <)  516  d,  No.  13; 
p.  364,  <J  543  ;  p.  522-524,  (J  827  b-e; 


INDEX    II. 


1101 


Tobacco — continued. 

p.  527,  <}  829  ;  p.  661-663,  <J  894- 
896  ;  p.  665-670,  ()  902  a-m ;  p.  672- 
676,  (}  904  b;  p.  679-681,  ()  905  a; 
p.  862-864,  ()  1066— and  concurring 
with  the  foregoing  is  the  frequent 
effect  of  the  habitual  and  even  tem- 
porary smoking  in  producing  or  ag- 
gravating piles — displaying,  also,  the 
special  relations  of  a  sympathetic  na- 
ture which  subsist  between  different 
parts  of  a  continuous  tissue,  espe- 
cially the  mucous,  and  a  complexity 
of  reflex  actions  of  the  nervous  sys- 
tem which  are  simultaneously  de- 
termined upon  the  anal  extremity 
through  a  primary  action  of  the  reflex 
influence  upon  the  stomach  and  liver 
— all  originating  in  the  mucous  tis- 
sue of  the  mouth,  p.  350,  ()  523,  No. 
6,  7.  Also,  Skin,  Stomach,  Remedi- 
al Action,  Anesthetics,  Narcot- 
ics {Aconite),  Opium,  Suppositories. 
experiments  showing  it  is  not  absorbed, 
p.  302,  ()  481  c;  p.  306,  ^  483  a. 
Tolerance  of  Remedies, 
illustrated  under  the  law  of  vital  habit. 
See  Hadit,  Vital,  Index  II. 
Tongue 

rarely  sustains  much  disease,  though 
generally  suffers,  in  its  surface  at 
least,  some  modified  action  from  the 
diseases  of  other  parts,  especially  of 
the  abdominal  organs,  arising  from 
an  alterative  influence  of  reflex  action 
of  the  nervous  system,  and  serves, 
like  the  pulse,  as  an  index  of  the  na- 
ture of  these  reflected  influences,  and 
therefore  of  the  nature  and  force  of 
the  remote  diseases,  and,  although 
the  universal  and  habitual  examina- 
tion of  the  tongue  and  pulse  is  purely 
an  empirical  inquiry,  the  philosophy 
of  their  signs  has  a  deep  foundation 
in  the  recesses  of  physiology^  and  is 
a  luminous  guide  to  the  modus  ope- 
randi of  morbific  and  remedial  agents 
through  alterative  influences  of  reflex 
nervous  action,  and  to  the  develop- 
ment of  diseases  among  distant  or- 
gans as  consequences  of  their  own 
conditions,  p.  448-451,  <J  689  ;  ()  826 
cc;  (J  864.  Pulse,  Sweat,  Kidney, 
Urine,  Heart,  Structure,  Ind.  II. 
Tonics  and  Diffusible  Stimulants, 
the  counterparts  of  Antiphlogistics,  p. 
579,  ^  890^  a — and  comparatively  of 
very  limited  importance,  ih'id. 
have  been  extensively  injurious,  from 
erroneous  hypotheses  of  disease  and 
of  their  modus  operandi,  p.  579,  !) 
890i  a-c.  Also,  p.  371-372,  <5  569 
h-t;  p.  395-396,  i^  621  a;  p.  433- 
434,  lij  676  h ;  p.  541-542,  ^  854  bb  ; 
p.  572-576,  f)  890  d-n  ;  p.  596,  ij  892 


Tonics,  &c. — continued. 

b  ;  p.  599-600,  (J  892  d  ;  p.  715-722, 
{)  959-960   e ;   p.  748-749,  ()  992  b  ; 
p.  752,  ()  1000-1001  b  ;  p.  756-766,  ^ 
1005-1008;    p.  772-776,  ()   1020- 
1026;  p.  854,  ^  1061  ;  p.  857-861,  (J 
1063-1065,  1068  a,  b;  p.  872,  P.S. 
operate,  like  all  other  remedies,  as  alter- 
atives through  reflex  nervous  influ- 
ence, which,  as  in  all  other  cases,  is 
affected  in  its  action  according  to  the 
special  virtues  of  its  exciting  cause — 
with  various  illustrations  drawn  from 
the  natural  stimuli  of  life  and  from 
other  remedial  and  morbific  agents ; 
as  when,  for  example,  solid  animal 
food,  taken  by  one  long  abstinent  and 
during  a  long  exposure  to  a  chilling 
atmosphere,  increases  muscular  vigor 
and  lights  up  warmth  of  the  skin  as 
soon  as  it  enters  the  stomach,  and  as 
diffusible  stimulants  and  bitter  tonic 
infusions  will  do  the  same,  or,  the  con- 
verse of  this,  as  when  all  the  fore- 
going will  alike  instantly  aggravate 
febrile  excitement,  showing  through- 
out a  common  modus  operandi ;  and 
since  the  solid  animal  food  must  ex- 
ert its  general  effects  through  the  me- 
dium of  reflex  nervous  influence,  so 
also  do  the  tonics  and  stimulants,  p. 
579-582,  ^  890 i-  d-h.    Also,  p.  67-68, 
^  149-152;    p.  107-110,  ()  227-232; 
p.  250-252,  ()  441  c  ;  p.  303,  (}  481  d; 
p.  323-336,  ^  499-512  ;    p.  563-567, 
I  889  d-k;    p.  661-663,  ^  894-896; 
p.  679-681,  5  905  a;   p.  835-838,  ^ 
1057^^,  and  Remedies,  Remedial  Ac- 
tion; Causes,  Morbific  ;  Cinchona, 
Index  II.     Also,  p.  172,  no.  94. 
although  no  two  are  exactly  alike  in  ef- 
fects, they  are  more  so  than  the  mem- 
bers of  other  groups,  and  no  one  is  an 
excrescence  upon  the  Materia  Med- 
ica ;    and,  whether  mineral  or  vege- 
table, as  with  other  groups,  will  alike 
remove  the   same   conditions  of  dis- 
ease, and  in  conformity  with  the  pre- 
cise aflSnities  of  a  chemical  nature — 
or   rather,  how  completely  does   all 
this  variety  of  means,  cinchona,  iron, 
acids,    shower-bath,    exercise,   hope, 
&c.,  appealing  every   where  to   our 
senses  as  well  as  understanding,  ex- 
pose the  fallacy  of  applying  the  exact 
and  exclusive  laws  of  chemical  affini- 
ties, or  of  any  other  physical  hypoth- 
esis, in  explanation  of  that  one  and 
the  same  result  to  which  all  the  het- 
erogeneous variety  of  remedies  will 
lead,  p.  581-583,  ()  890^  g-h  ;  p.  664, 
f)  900.     Also,  Remedies,  Remedial 
Action,  Cathartics,  Index  II. 
the  only  conditions  under  which  they 
are  applicable,  p.  580-581,  ^  890 i  e,f. 


1102 


INDEX    II. 


Tonics,  &c. — continued. 

may  be  united  with  direct  antiphlogis- 
tics,  and  why,  p.  581,iJ  890^^  c.  Also, 
p.  487-489,  §  756  ;  p.  561,  (}  888  b; 
p.  727-728,  ^  964  a,  i.— Note  Ee. 

their  occasional  success  in  removing  in- 
flammations is  no  proof  of  the  accu- 
racy of  the  distinction  which  has  been 
made  of  the  disease  into  active  and 
passive,  or  that  the  pathology  is  not 
essentially  the  same,  p.  486-489,  ^ 
752-756  ;  p.  664, §  900. 

difference  between  Tonics  and  Diffusi- 
ble Stimulants,  and  the  different  con- 
ditions under  which  one  or  the  other 
may  be  useful,  showing,  also,  in  their 
united  effects,  the  important  law  by 
which  one  remedy  may  quicken  the 
action  of  another  by  raising  the  irri- 
tability of  the  part  or  of  the  system 
atlarge,  p.  581-582,  iJ890ig'.  Also, 
p.  63,  ()  137  d;  p.  65,  <;»  143  c,d;  p. 
67,  (J  149-151  ;  p.  367,  ()  556  c;  p. 
566-567,  (J  889  k,  I. 
Travers,  Sir  Benjamin, 

his  opinion  of  the  Anatomical  School 
of  Medicine,  p.  457,  ()  699  c. 


U. 


Ulceration 

a  consequence  of  inflammation,  and  con- 
spicuous in  its  Design  for  useful  ends, 
and  has  close  analogies  in  Plants,  p. 
470-471,  ()  729  a-730  ;  p.  472-476,  ^ 
733  ;  p.  477,  ()  736  c ;  p.  478-479,  ^ 
740-741.  Also,  Pus,  Lymph,  Lidex 
IT. 

Ulcers 

upon  the  extremities  improved  by  open 
air  through  complex  influences  of  re- 
flex action  of  the  nervous  system,  and 
the  influences  traced  out,  p.  662-663, 
^  896 ;  p.  670-671,  <;.  902  m.  Also, 
Skin,  Phthisis,  Whooping- Cough, 
Exercise,  Friction,  Index  IT. 

'Urjemi.\.     See  Urea  Diathesis,  Index  II. 

Urea — continued  from  Index  I., 
an  artificial,  not  a  natural  product,  p. 
784,  ()  1031  b  ;  p.  787-788,  ^  1032  a. 

"Urea  Diathesis,"  or  Uremia, 

an  imaginary  evil,  and  "  altogether  re- 
mains to  be  proved,"  p.  787-788,  ^ 
1032  a.     Also,  p.  232-233,  ^  427. 

Urinary  Bladder, 

excited  to  contraction  equally  by  its 
contents,  by  the  external  application 
of  cold  and  heat,  and  by  the  Will,  and 
as  the  effect  in  the  former  cases  is 
through  reflex  action  of  the  nervous 
system,  it  must  be  the  nervous  influ- 
ence in  the  latter  ;  from  which  it  fol- 
lows that  the  action  of  the  Will  is 
prompted  as  much  by  a  substantive 


Urinary  Bladder — continued. 

agent  as  the  urine  is  substantive,  and 
since  cold  and  heat  simply  denote  an 
impression  upon  sympathetic  sensi- 
bility of  the  skin  by  an  abduction  of 
caloric  in  one  case  and  its  stimulus  in 
the  other,  and  scarcely  more  appreci- 
able as  physical  causes  than  the  mu- 
co-pulmonary  irritation  which  excites 
the  nervous  influence  in  respiration, 
we  are  thus  in  some  degree  aided  in 
understanding  how  an  immaterial  sub- 
stance may  act  upon  matter ;  while, 
also,  the  several  modes  in  which  the 
nervous  influence  is  determined  upon 
the  bladder  in  micturition,  the  variety 
of  causes,  the  variety  of  centripetal 
nerves,  and  the  limitation  of  the  cen- 
trifugal influence  to  certain  special 
nerves,  along  with  a  multitude  of  an- 
alogous examples,  conduct  us  to  a 
ready  apprehension  of  a  correspond- 
ing modus  operandi  of  all  morbific 
and  remedial  agents,  both  mental  and 
physical,  p.  Ill,  «^  233f  ;  p.  230-231, 
(}  422  b  ;  p.  347-348,  ()  516  d,  No.  13  ; 
p.  630-631,  ^  892f  b;  p.  662-663,  ^ 
896.  Also,  Stomach,  Skin,  Kidney, 
Cold,  Respiration,  Phthisis,  Ame- 
norrhcea,  Remedial  Action,  subdi- 
vision Mental  Emotions,  Organs  of 
Generation,  &c..  Index  II. 

Urine — continued  from  Index  /., 

analyses  of,  not  reliable,  and  rarely  of 
any  importance,  p.  228,  ^  417  ;  p. 
232,  (J  425-427;  p.  450-451,  (J  691  ; 
p.  780,  ij  1029;  p.  848,  ^  1058  s— 
but  divert  attention  from  the  patholo- 
gy of  disease,  and  lend  to  imaginary 
evils,  ibid.,  and  p.  f33,  ^  892i/,  and 
Symptoms,  Index  II. 
not  "  strained  off"  from  the  blood,  and 
its  sudden  increase  or  diminution,  and 
most  of  its  morbid  changes,  depend 
upon  direct  or  reflected  influences  of 
the  nervous  system,  p.  230-233,  () 
422-427;  p.  450-451,  ^  691  ;  p.  631 
-632,  ^  892|.  Also,  "  Strainage," 
Reflex  Action,  Fear,  Index  II. 
the  foregoing  manifest  exemplifications 
of  the  influence  of  the  reflex  action  of 
the  nervous  system  upon  the  secern- 
ing vessels  of  the  kidneys,  consider- 
ed in  connexion  with  the  diuretic  and 
sudorific  effects  of  fear,  and  with  the 
dependence  of  lactation,  weeping,  and 
all  deviations  of  other  secretions  from 
their  natural  condition,  upon  the  nerv- 
ous influence  either  reflex  or  direct, 
as  forming  a  part  of  the  Author's  de- 
monstration of  the  modus  operandi  of 
all  remedial  and  morbific  agents,  phys- 
ical and  mental,  through  the  same 
causation — the  nervous  influence  be- 
ing simply  excitant  or  depressant,  or 


INDEX    II. 


1103 


Urine — continued. 

variously  modified  and  rendered  alter- 
ative, according  to  the  nature  of  the 
causes  by  which  it  is  brought  into 
preternatural  operation,  p.  106-111, 
^  233-2331 ;  p.  230-232,  ()  422^24  ; 
p.  249,  ^  441  c  ;  p.  253,  ^  441  d ;  p. 
262-263,  (J  446  a ;  p.  ?64-265,  ^  446 
c,  d;  p.  289,  ^  461;  p.  313-314,  ^ 
488  ;  p.  317,  (}  498  a;  p.  325-326,  ^ 
500,  ee;  p.  335-336,  (}  512  a,  b;  p. 
338,  ()  514  d;  p.  339-340,  i}  514  h; 
p.  347-348,  (j  516  d,  No.  13  ;  p.  351, 
i)  524,  No.  1  ;  p.  352,  <J  524  d  ;  p.  450 
-451,  (J  691-692  a;  p.  453,  ()  694  i; 
p.  478,  (j  740  a;  p.  546-549,  ^  863 
a-d,-  p.  563-564,  «J  889  a;  p.  631- 
632,  ^  8921  J,  c  ;  p.  637,  ()  8924  d ; 
p.  662-663,  ^  896  ;  p.  666-669,  (J  902 
c-i ;  p.  704,  ()  943  a,  J  ;  p.  709,  ^  951 
c.  Also,  Kidney,  Mental  Emotions, 
the  individual  Passions,  Index  II. ; 
Nervous  Power,  Index  I.  and  II. 
its  morbid  fluctuations  not  often  owing 
to  absolute  disease  of  the  kidneys,  but 
to  diseases  of  other  parts,  especially 
disorders  of  the  stomach,  liver,  and 
intestine,  when  it  is  to  be  regarded 
mostly  as  a  symptom,  like  the  pulse 
and  appearances  of  the  tongue,  de- 
noting the  force  and  modifications  of 
the  reflex  nervous  influence  as  excited 
by  the  diseases  of  other  parts,  and 
therefore,  more  or  less,  their  nature 
and  force — from  whence  arises  a  co- 
rollary, that  the  administration  of  the 
so-called  Diuretics  for  the  purpose  of 
promoting  or  otherwise  modifying  this 
secretion  in  the  cases  supposed  is  de- 
void of  just  pathological  and  thera- 
peutical considerations,  which  should 
turn  upon  the  diseases  in  which  this 
symptom  truly  originates,  p.  232-233, 
^  426,  427;  p-  450-451,  ^  691; 
p.  630-633,  ^  892J.  Also,  Pulse, 
Tongue,  Skin,  He.irt,  Index  II. 

Uterine  Agents  —  continued  from  In- 
dex I, 
introduced  to  illustrate  principles,  and 
especially  those  which  guided  the  Au- 
thor in  his  therapeutical  arrangement 
of  the  Materia  Medica,  p.  684-686,  <) 
905^  a,  b. 
embrace  a  great  variety  of  virtues,  which 
are  often  mostly  relative  to  various 
pathological  conditions  remote  from 
the  uterus,  whose  interrupted  func- 
tions are  apt  to  be  rather  unimpor- 
tant sympathetic  consequences,  but 
frequently  mistaken  for  the  essential 
disease  and  the  primary  ones  as  ulti- 
mate effects,  p.  628-629,  ^  892J  ;  p. 
684-686,  ()  905^  b.  Also,  Emmen.i- 
gogues,  Amenorrhcea,  Index  II. ; 
Menstruation,  Index  I. 


Uterus, 

susceptible  in  its  mucous  tiosue  of  in- 
fluences through  reflex  action  of  nerv- 
ous system  from  various  causes,  in- 
ternal and  external,  consisting  of  ab- 
dominal diseases,  cold  applied  to  the 
feet,  pediluvium,  lifting  weights  in 
pregnancy,  many  remedies,  mental 
emotions,  &c.,  according  to  the  nat- 
ural fluctuations  that  grow  out  of  its 
special  vital  constitution,  or  as  it  may 
be  affected  in  pregnancy,  or  by  hy- 
datids, or  disease,  p.  63,  ^  137  b-d 
p.  65,  ^  143  c  ;  p.  67,  (i  149-151 
p.  Ill,  ^  2331;  p.  234,  ^  429,  430 
p.  624,  ^  892f  d ;  p.  628-629,  ^  892^ 
q-t;  p.  684-686,  (}  905^  b.  Also, 
Cold,  Skin,  Leeching,  Exercise,  In- 
dex II. 

considered  in  connection  with  aloes,  can- 
tharides,  ergot,  &c.,  and,  as  it  respects 
aloes  for  the  purpose,  particularly,  of 
illustrating  the  philosophy  of  its  ef- 
fects as  an  emmenagoguo,  and  possi- 
bly as  leading  to  abortion — showing 
that  these  effects  are  not  in  conse- 
quence of  the  supposed,  though  mis- 
taken action  of  aloes  upon  the  rectum, 
but  that  it  arises  from  a  special  rela- 
tion of  this  agent  to  the  mucous  tis- 
sue of  all  parts  through  which  it  de- 
termines an  alterative  reflex  nervous 
influence  upon  the  tissue  in  its  pre- 
ternaturally  irritable  states,  being  in 
this  respect  upon  the  same  physiolog- 
ical ground  as  cantharides  in  its  spe- 
cial action  upon  the  genito-urinary  or- 
gans, or  as  expectorants  in  their  rela- 
tion to  irritable  conditions  of  the  pul- 
monary mucous  tissue,  and,  also,  to 
illustrate  the  special  differences  in  the 
vital  constitution  of  different  tissues, 
and  of  the  same  tissue  in  different 
parts,  and  of  different  parts  of  one  and 
the  same  continuous  tissue,  and  the 
corresponding  relations  of  remedial 
and  morbific  agents,  p.  59,  ^  129  h,  i ; 
p.  61,  ^  132-133  ;  p.  62-63,  <J  135  a- 
d;  p.  65,  ^  143  c;  p.  67,  I)  149-151  ; 
p.  73,  ^  163;  p.  111,<^  133i;  p.  231 
-232,  ^  424 ;  p.  234,  ()  429,  430 ;  p. 
352-353,  ()  524  d ;  p.  366,  ^  556  b ; 
p.  547-548,  ^  663  d ;  p.  556,  <J  889  i ; 
p.  624,  ^  892f  d ;  p.  628-629,  <5  892^ 
q-t;  p.  684-686,  §  905^  b;  p.  856- 
857,  ^  1063  b.  Also,  C.1!^'THARIDEs, 
Ergot,  Index  II. 

its  development,  and  that  of  the  ovaria 
at  puberty,  exerts  a  powerful  influ-_ 
ence  in  advancing  the  maturity  of  the 
general  organism,  through  an  unin- 
terrupted reflex  action  of  the  nervous 
system,  harmoniously  with  their  rela- 
tions in  the  perpetuation  of  the  spe- 
cies, and  this  influence  is  forever  aft- 


1104 


INDEX    II. 


Uterus — continued. 

erward  extended  in  subdued  and  mod- 
ified conditions  to  the  nervous  cen- 
tres, and  reflected  abroad  with  that  va- 
riety of  effect  which  is  witnessed  in 
the  differences  between  the  perfect 
and  the  altered  animal,  and  brings  the 
mind  and  its  passions  more  or  less 
under  its  sway,  the  nervous  influence 
in  the  latter  case  falling  as  well  upon 
the  centres  in  which  it  originates  as 
upon  other  parts  ;  being,  also,  equally 
true  of  the  other  sex — and  when  with 
the  foregoing  are  associated  those 
long  progressive  alterative  influences 
of  refle::  nervous  action  upon  the 
mammae  which  have  their  centripetal 
source  in  the  gravid  uterus,  and  un- 
fold their  great  final  cause,  and  the 
sudden  increase  of  that  action  at  the 
time  of  parturition,  and  the  liability 
of  the  milk  to  be  affected  both  in  quan- 
tity and  quality  by  mental  emotions, 
another  of  our  many  isolated  exam- 
ples is  presented,  which,  through  its 
analogies,  interprets  the  modus  ope- 
randi of  morbific  and  remedial  agents, 
mental  as  well  as  physical,  and  defies 
in  its  own  behalf,  and  in  that  of  its 
analogies,  every  law  that  rules  in  the 
■v\orld  of  dead  matter,  p.  68-69,  ^  153 
-159;  p.  80,  <J  169  d ;  p.  87,  ^  180; 
p.  88,  <)  185;  p.  120-121,  ()  237;  p. 
231-232,  ()  424;  p.  330,  ()5Q0  mi;  p. 
335-336,  ^  5l2a,h,  p.  352,  ^  524  d ; 
p.  376-380,  ^  578  ;  p.  434-435,  (} 
080 ;  p.  662-663,  ()  896  ;  p.  686,  ^ 
905^  b;  p.  279-280,  ^  449  a-d,  625i 


V. 


VicciNE  Disease.     See  Small-Pox,  In- 
dex II. 

Van  Deen, 

his  experiments,  with  others  by  Girtan- 
ner.  Stilling,  Budge,  Home,  and  John- 
son, proving  that  the  poison  of  the 
viper  in  producing  death  is  not  ab- 
sorbed, but  exerted  through  the  me- 
dium of  the  nervous  system,  and  oth- 
er analogous  demonstrations,  p.  319- 
320,  ^  494  b-dd ;  p.  525,  <)  828  b,  c. 
Also,  Hydrophobia,  Virus  of.  Index 
II. 

Varix, 

its  pathology,  and  employed  to  illustrate 
the  dependence  of  venous  congestion 
upon  inflammation  of  the  veins,  p. 
500-504,  (j  790-798. 

Veins — continued  from  Index  L, 

anatomical  account  of,  in  connexion 
with  the  circulation  of  the  blood,  and 
with  the  pathology  of  venous  conges- 
tion, phlebitis,  and  varix,  p.  210,  ^ 


Veins — continued. 

386  ;    p.  503-504,  ^  794-797.     Also, 
Venous  Congestion,  Index  I. 

particularly  liable  to  diffuse  inflamma- 
tion, as  seen  in  phlebitis  and  venous 
congestion,  p.  355-356,  ^  526  b. 
Also,  Sympathy,  Continuous,  Index 
II. 

the  circulation  in,  depends  upon  several 
associated  causes :  1st,  the  suction 
power  of  the  heart ;  2d,  the  action  of 
the  capillary  arteries  ;  3d,  concert  of 
action  between  the  capillary  veins 
and  arteries  through  reflex  influence 
of  the  nervous  system  determined 
mostly  by  the  varying  quantities  of 
transmitted  blood  and  the  existing 
condition  of  the  arterial  capillaries  ; 
4th,  an  active  contraction  and  dilata- 
tion of  the  veins  simultaneously  over 
a  great  extent  by  their  longitudinal 
muscular  fibres,  in  which  continuous 
sympathy  is  especially  interested,  and 
which  contributes  to  the  foregoing 
reflex  action,  and,  as  a  constitutional 
endowment,  is  at  the  foundation  of 
their  diffusive  inflammation — this  ex- 
position, with  the  exception  of  the 
suction  power  of  the  heart,  being  pro- 
pounded by  the  Author,  p.  207-212, 
\  370-392  a;  p.  214,  ^  392  d;  p. 
227,  <J  411  ;  p.  355-356,  ^  526  b, 
c.  Also,  p.  21,  ^  22;  p.  62,  ^  136  ; 
p.  80,  {}  169  d  ;  p.  88,  <^  185 ;  p.  223, 
<)  409  e  ;  p.  355-356,  «^  526  b  ;  p.  474, 
^  733  /;  p.  501-504,  (}  792-796  ;  p. 
506,  ()  803,  804 ;  p.  507-509,  (}  806 
-811  ;  p.  724-726,  <)  961  ;  and  Sym- 
pathy, Continuous  ;  Oil,  Croton  ; 
Leeching,  Suppositories,  Index  II. 

the  suction  power  of  the  heart  as  a 
principal  cause  of  venous  circulation 
shown  especially  by  the  portal  circu- 
lation, and  that  of  the  absorbents  and 
umbilical  vein,  p.  211,  ^  390  a;  p> 
214,  ()  392  c,  d;  p.  212,  (j  391 

the  intestinal  do  not  absorb,  p.  128, 129, 
I)   269,  277;    p.  527,  ij  829.     Also, 
^Iagendie,  Index  II. ;  Veins,  Index  I. 
Venous  Congestion — continued  from  In- 
dex I, 

propagates,  on  account  of  the  special  vi- 
tal constitution  of  the  venous  tissue, 
a  depressing  reflex  action  of  the  nerv- 
ous system  upon  the  heart  and  arte- 
ries, as  does  also  acute  venous  inflam- 
mation ;  but,  nevertheless,  this  influ- 
ence manifests  in  the  condition  of  the 
pulse  and  blood,  particularly  in  cere- 
bral congestions,  that  pathological 
condition  which,  when  affecting  other 
tissues,  demands  a  strictly  antiphlo- 
gistic treatment,  and  which  is  con- 
firmed by  the  effects  of  remedies, 
while,  also,  it  exemplifies  some  of  the 


INDEX    II. 


1105 


Venous  Congestion — continued. 

remarkable  differences  which  exist 
among  the  tissues  in  their  vital  con- 
stitution, p.  61-63, 'Ji  133-137;  p.  64, 
^  138-142  ;  p.  67,  ()  149-151  ;  p.  72, 
Table  3  ;  p.  355-356,  (J  526  b  ;  p.  444 
-446,  <)  688  d-f;  p.  606-509,  ()  806- 
811  ;  p.  511,  ^  815;  p.  724-734,  (^ 
961-976;  p.  735-736,  <^  978-980. 
Also,  Venous  Tissue,  Index  I. 
and  congestive  fever,  treatment  of,  par- 
ticularly by  bloodletting,  or  as  qui- 
nine, &c.,  may  be  required  in  mias- 
matic forms,  p  724-732,  ()  961-970. 
Also,  Causes,  Morbific  ;  Miasm, 
Cinchona,  Index  II. 

Veratrum  Viride,  , 

its  late  pretensions  as  a  substitute  for 
Bloodletting,  p.  860,  ^  1065  a.  Also, 
Tobacco,  Index  I. — Note  I  p.  1118. 

Vesicants.    See  Counter-Irritants,  In- 
dex II. 

Vessels — See  Blood-vessels,  Index  I. 
the  most  important  are  the  terminating 
series  of  the  arterial  capillaries,  whose 
variety  of  functions  and  products,  and 
their  modifications  as  induced  by  mor- 
bific and  remedial  agents,  and  by 
mental  emotions,  through  the  medi- 
um of  the  nervous  influence,  and  the 
analogies  between  the  organic  proc- 
esses of  animals  and  plants,  concur 
with  all  things  else  in  demonstrating 
the  broad  distinction  between  the 
laws  that  govern  the  organic  and  in- 
organic kingdoms,  p.  220-227,  ()  409 
b-411  ;  p.  355,  ^  526  a.  Also,  In- 
flammation, Structure,  Lidcx  II. ; 
Composition,  Organic  Compounds, 
&c.,  Index  I.  Also,  p.  215,  (J  394^399. 

"Vestiges  of  Creation," 
introduced  to  illustrate  the  consequences 
of  the  Chemical  doctrines  of  Life,  p. 
183-192,  ^  350i/-353;  p.  925,  ^  1085. 

Vision — continued  from  Index  I., 
the  latest  interpretation  of,  as  a  chemi- 
cal phenomenon,  p.  798,  ^  1034. 

Vital   FaNCTioNs.      See   Functions    of 
Life,  Index  I.  and  II. 

Vital  Habit.    See  Habit,  Vital,  Ind.  II. 

Vis  Medicatrix  Nature — See  Index  I. 

Vitalism  and  Solidism— continued  from 
Index  I., 
the  doctrines  of,  continue  to  be  essenti- 
ally conceded  by  the  Chemical  School 
of  "Medicine,  p.  779-782, 1)  1028-1030 ; 
p.  796-799,  ()  1034. 

Vital  Principle — continued  from  Index 
I., 
continues   to   be    the    incubus    in   the 
dreams  of  Organic  Chemistry,  p.  796 
-797,  ^  1034. 

Vital  Properties — continued  from  In- 
dex I., 
late  experiments  relative  to,  showing  the 

4 


Vital  Properties — continued. 

distinction  between  the  organic  prop- 
erties and  the  nervous  power,  and  con- 
firming the  writer's  philosophy  upon 
this  subject,  that  the  former,  through 
the  instruments  of  action,  carry  on  the 
functions,  while  these,  in  the  animal 
kingdom,  are  constantly  influenced 
by  the  nervous  power  as  a  vital  agent, 
p.  803-808,  ()  1039-1044.  Also,  Vi- 
tal Principle,  Organic  Life,  Index 
I. ;  Iris,  Index  II. ;  Nervous  Power, 
Index  I.  and  II. 
an  agreement  upon,  between  Dr.  Car- 
penter and  the  Author,  p.  95-96,  ^ 
189  J. 

Volition.     See  Will,  Index  I.  and  II. 

V  OLKMANN, 

experiments  by,  showing  that  the  Skin 
is  rendered  by  narcotization  an  ex- 
tremely sensitive  source  of  convul- 
sions, and  indicative  of  a  broad  dis- 
tinction between  the  trunks  of  nerves 
and  their  expanded  extremities — in- 
troduced, along  with  the  analogies 
supplied  by  Cold,  Friction,  &c.,  to 
show  that  Vesicants,  Setons,  Issues, 
Mercury,  Iodine,  Tobacco,  and  other 
things  applied  to  the  skin,  produce 
their  effects  upon  internal  parts 
through  alterative  influences  of  reflex 
nervous  action,  modified  according  to 
the  nature  of  the  agent,  and  the  ef- 
fects determined,  also,  according  to 
the  fluctuating  susceptibilities  of  the 
organs,  p.  338,  ^  514  d ;  p.  348.  ()  516 
d.  No.  13  ;  p.  592-593,  <J  89H  k;  p. 
666-667,  ()  902  i-904.  Also,  Skin, 
Cold,  Shower-Bath,  Counter-Ir- 
ritants, Seton,  Leeching,  Plas- 
ters, Tobacco,  Sedatives  {Aconite), 
Poultices,  Mercurial  Remedies, 
Index  II.  ' 

Vomiting, 

its  physiological  analogies  to  respira- 
tion, the  great  variety  of  means  by 
which  it  may  be  determined  that  are 
incapable  of  absorption,  including 
mental  emotions,  associate  with  their 
modus  operandi  through  reflex  action 
of  the  nervous  system  that  of  the  true 
emetics,  which,  along  with  the  pro- 
found physiological  and  therapeutical 
effects  of  the  latter  and  the  superficial 
ones  of  the  former,  concur  with  all 
our  other  demonstrations  in  bringing 
the  modus  operandi  of  all  remedial 
and  morbific  causes,  physical  and 
mental,  under  one  common  philoso- 
phy, p.  325-328,  i)  500  e-m  ;  p.  333- 
335,  <^  503-511  ;  p.  336-337,  ^  514  6; 
p.  664,  <)  900 ;  p.  666-672,  ()  902  b- 
904  a  ;  p.  704,  ()  943  a-944  a.  Also, 
Emetics,  Stomach,  Disgust,  Sea- 
Sickness,  Respiration,  Reflex  Ao 
A 


1106 


INDEX    II. 


Vomiting — continued 

TioN,  Remedial  Action,  Mental 
Emotions,  &c..  Index  II. 
a  constitutional  provision  for  the  exi- 
gencies of  Infancy  in  man,  but  not  of 
animals,  illustrating  their  physiologi- 
cal distinctions,  and  presenting  an  el- 
ementary principle  in  the  general 
plan  of  Organic  Designs,  showing, 
also,  how  all  physical  agents,  whether 
natural,  morbific,  or  remedial,  corre- 
spond in  their  influences  according  to 
the  existing  physiological  conditions, 
and,  in  connexion  with  its  disappear- 
ance in  advancing  life,  indicative  of 
the  natural  changes  that  are  incident 
to  organs  in  their  mutable  properties, 
and  that  this  mutability  lies  at  the 
foundation  of  disease  and  its  cure, 
and  that,  in  correspondence  with  the 
changes  in  other  organs,  the  nervous 
centres  naturally  fluctuate  in  their 
liability  to  developments  of  reflex 
nervous  actions  and  in  their  modes 
and  influences  upon  which  vomiting, 
and  much  of  the  progressive  muta- 
tions in  organic  life,  and  the  corre- 
sponding effects  of  morbific  and  reme- 
dial agents  depend,  p.  373-381,  ()  576 
-579.  Also,  Infancy,  Uterus,  Lac- 
tation, Structure,  Index  II. ;  Vital 
Properties,  Organic  Life,  Index  I. ; 
Youth,  Nervous  Power,  Index  I. 
and  II. 

W. 

Warm  Bath, 

its  effect  in  relieving  pain  and  promot- 
ing sleep,  the  result  of  a  sedative  re- 
flex action  of  the  nervous  system  de- 
termined upon  the  nervous  mechan- 
ism, p.  589,  <J  891  p,  exemplifying, 
also,  the  modus  operandi  of  Narcotics, 
Antispasmodics,  &c.,  and  the  great 
recuperative  law,  p.  592-593,  <J  89H 
k;  p.  681-683,  <)  905  b;  p.  838,  ^ 
1057^ — while  it  equally  extends  its 
influence  to  all  other  parts  through 
the  same  medium,  operating  accord- 
ing to  the  nature  of  the  part  and  ex- 
isting susceptibilities,  being  like  cold 
in  its  action  upon  the  kidneys  a  stim- 
ulus to  the  bladder,  by  which  it  will 
immediately  determine  its  contraction, 
which  is  one  of  the  numerous  simple 
processes  that  interpret  the  modus 
operandi  of  morbific  and  remedial 
agents,  and  its  relief  of  diseases  ac- 
cording to  temperature  and  the  activ- 
ity or  indolence  of  morbid  states  and 
the  nature  of  the  affected  part,  pre- 
sents a  parallel  with  the  effects  of  in- 
ternal remedies  according  to  their 
doses  and  analogous  conditions,  and 


Warm  Bath — continued. 

thus  farther  illustrates  the  Author's 
doctrine  of  morbific  and  remedial  ac- 
tion as  applied  to  all  cases  through 
the  medium  of  reflex  nervous  influ- 
ence, and  of  his  doctrine  of  modifica- 
tion of  that  influence  according  to  the 
nature  of  its  exciting  causes,  ibid., 
and  Skin,  Cold,  Kidney,  Sedatives, 
Opium,  Poultices  and  Hot  Fomenta- 
tions ;  Recuperation, Law  of;  Res- 
piration, Food,  Exercise,  Struc- 
ture, Index  II. 

Water,  Hot, 

its  effects  in  its  action  upon  the  stom- 
ach in  producing  free  perspiration, 
,like  the  glow  and  moisture  of  the  sur- 
face which  often  spring  from  the  first 
contact  of  food  with  the  stomach,  or 
as  the  odour  or  expectation  of  food 
increase  the  flow  of  saliva,  or  as  the 
contact  of  cold  air  with  the  surface 
starts  the  secretion  of  urine,  or  as 
fear,  and  anxiety,  and  jealousy  will  do 
the  same  along  with  perspiration,  or 
grief  the  tears,  and  all  depending  upon 
reflex  or  direct  action  of  the  nervous 
system,  illustrates  the  perpetual  op- 
eration of  that  influence  in  its  most 
simple  conditions  in  modifying  the  ac- 
tion of  the  secerning  vessels,  and  the 
whole  collectively  stretch  their  con- 
clusive analogies  to  the  correspond- 
ing effects  of  emetics,  cathartics,  loss 
of  blood,  &c.,  and  through  their  an- 
alogies, and  independently  of  our  oth- 
er accumulated  proof,  to  the  various 
other  simultaneous  effects  that  are  in- 
cident to  morbific  and  remedial  agents 
in  their  action  upon  parts  beyond  the 
seat  of  their  direct  operation,  and  thus 
also  show  how  the  nervous  influence 
is  variously  modified  in  all  the  cases 
according  to  the  nature  of  its  exciting 
causes,  and  that  the  changes  in  the 
secretions  are  owing  to  these  various- 
ly modified  conditions,  and  proclaim 
the  substantive  existence  and  self-act- 
ing nature  of  the  Principle  in  which 
the  Mental  Emotions  originate — and 
now  leaving  the  stomach  for  the  rec- 
tum, and  considering  how  the  sphinc- 
ter muscle  is  held  in  contraction  by  a 
perpetual  determination  upon  it  of 
the  nervous  influence,  and  that  the 
natural  peristaltic  movements  depend, 
also,  upon  reflex  actions  of  the  nerv- 
ous system  that  have  their  centripe- 
tal origin  in  all  parts  of  the  gastro- 
intestinal mucous  tissue,  as  much  so 
as  the  muscles  in  deglutition  in  a 
more  circumscribed  portion,  or  all 
things  that  produce  vomiting  in  the 
mucous  lining  of  the  stomach,  and 
that  it  is  through  the  same  causation 


INDEX    II. 


1107 


Water,  Hot — continued. 

that  an  enema  of  warm  water  increas- 
es the  intestinal  movements,  we  be- 
come assured  that  their  greater  accel- 
eration, and  other  attendant  effects 
that  result  from  the  addition  of  salt, 
or  soap,  or  aloes,  &c.,  to  the  simple 
enema,  depend  equally  upon  the  same 
reflected  influence,  and  equally,  there- 
fore, when  cathartics  are  administer- 
ed by  the  stomach,  since,  also,  if  the 
enemas  do  not  increase  the  peristal- 
tic movements  by  their  absorption, 
but,  like  the  natural  movements  and 
the  contraction  of  the  sphincter  mus- 
cle, and  the  act  of  swallowing,  and 
the  vomiting  from  drinking  warm  wa- 
ter or  tickling  the  fauces,  or  a  mental 
emotion,  through  the  nervous  influ- 
ence, then,  since  there  is  no  absorp- 
tion, must  all  the  other  effects,  cura- 
tive or  morbific,  be  equally  due  to  that 
influence — and  thus,  finally,  a  broad 
ground  of  exact  analogies  is  obtained 
for  going  in  pursuit  of  an  apparently 
endless  variety  of  other  concurring 
facts  that  are  relative  to  the  modus 
operandi  of  all  other  remedial  and 
morbific  agents,  physical  and  mental, 
p.  107-111,  ()  226-2331  ;  p.  230-232, 
^  422  6^24;  p.  289,  M61  ;  P-  296, 
^  476  c  ;  p.  301-302,  i)  481  b  ;  p.  335 
-336,  <^  512  a,  b;  p.  339-340,  ^  514 
h;  p.  351,  ^  524  a,  No.  1  ;  p.  451,  (J 
692  a;  p.  478-479,  <J  740  a,  b;  p. 
483-484,  ()  746  c ;  p.  534,  ()  844 ;  p. 
563-565,  ^  889  a-g ;  p.  630-632,  ^ 
8921  b,  c ;  p.  634,  I)  892|  b ;  p.  662- 
663,  ^  896  ;  p.  667-670,  ^  902  d-i ; 
p.  704,  ^  943  a ;  p.  866-867,  <J  1067 
a.  Also,  Reflex  Action,  Remedial 
Action,  Secretion  and  Excretion, 
Sweat,  Bile,  Weeping,  Fear,  Dis- 
gust, Cathartics,  Emetics,  Alter- 
atives, Bloodletting,  Leeching, 
Suppositories;  Sympathy, Continu- 
ous ;  Soul  and  Instinctive  Princi- 
ple, Index  II. 

Weeping, 

the  result  of  an  emotion,  however  vio- 
lent, that  rarely  produces  much  dis- 
turbance, not  even  of  the  organs  of 
circulation,  since  it  determines  the 
nervous  influence  mostly  upon  the 
lachrymal  glands,  as  disgust  does  upon 
the  mucous  tissue  of  the  stomach,  and 
anger  upon  the  voluntary  muscles, 
while  other  emotions,  like  fear,  im- 
part to  that  influence  a  more  univer- 
sal direction — thus  exemplifying,  like 
the  physiology  of  respiration,  of  the 
contraction  of  the  sphincter  muscles, 
&c.,  the  manner  in  which  morbific 
and  remedial  agents  direct  the  nerv- 
ous influence  upon  special  parts,  ac- 


Weeping — co?ilinucd. 

cording  to  the  nature  of  the  former 
and  the  natural  or  acquired  suscepti- 
bilities of  the  latter  ;  and  connecting 
the  foregoing  with  the  morbific  effects 
of  grief  and  the  curative  ones  of  hope 
and  joy,  we  come  to  readily  under- 
stand, through  these  facts  alone,  how 
the  nervous  influence  is  variously 
modified  and  rendered  alterative  by 
physical  agents  according  to  the  par- 
ticular virtues  of  each  one — and  these 
coincidences  denote  the  substantive 
existence  and  self-acting  nature  of 
the  Soul.  See  references  under  Wa- 
ter, Hot,  Index  II ,  and  p.  880,  ^ 
1074. 

Whooping-Cough, 

treatment  of,  p.  640,  <;.  892-t-  A;  p  844, 

^  1058  k. 
emetics  break  up  a  paroxysm  by  substi- 
tuting a  new  modification  of  reflex 
nervous  influence,  since  in  coughing 
and  vomiting  the  abdominal  muscles 
are  alike  concerned,  and  when  an 
emetic  operates  it  introduces  through 
the  reflex  nervous  action  a  new  com- 
bination of  movements,  and  thus  nec- 
essarily interrupts  those  upon  which 
coughing  depends,  and  for  this  rea- 
son should  the  cough,  or  tickling  the 
fauces,  or  any  other  cause  bring  on 
vomiting,  the  paroxysm  of  coughing 
will  be  equally  arrested  ;  but  in  all 
the  cases  the  results  beyond  the  in- 
terruption of  the  paroxysm  will  de- 
pend more  or  less  upon  the  special 
nature  of  the  nauseant  or  emetic  em- 
ployed— all  of  which  advances  our 
other  multitudinous  demonstration? 
of  the  modus  operandi  of  all  morbific 
and  remedial  agents  beyond  the  seat 
of  their  direct  operation  through  al- 
terative influences  of  reflex  action  of 
the  nervous  system,  and  against  the 
crude  devices  of  Chemistry,  p.  Ill,  ^ 
233i  ;  p.  336-338,  <J  514  b,  c.  Also, 
Antispasmodics,  Hiccough,  Hyste- 
ria, Respiration,  Stomach,  Emet- 
ics, Index  II. ;  Nervous  Power,  In- 
dex I.  and  II. — Notes  D  p.  1114,  Co. 
philosophy  of  effects  of  open  air  and 
change  of  place  in  relieving — exem- 
plifying a  complex  series  of  reflex 
actions  of  the  nervous  system  as  the 
immediately  alterative  means,  a  cu- 
rative reflex  influence  being  first  pro- 
pagated upon  the  digestive  organs 
through  a  primary  impression  upon 
the  mucous  tissue  of  the  lungs  and 
skin,  and  subsequently  through  the 
improved  or  invigorated  condition  of 
the  former  organs  upon  the  pulmo- 
nary mucous  tissue ;  the  same  phi- 
losophy being  applicable  when  change 


1108 


INDEX    II. 


Whooping-Cough — continued. 

of  climate,  exercise,  cold  or  warm 
bathing,  friction,  and  analogous  means 
promote  the  healing  of  superficial  ul- 
cers or  assuage  pulmonary  phthisis, 
though  the  relief  doubtless  depends 
more  or  less  upon  reflex  influences 
propagated  directly  from  the  skin 
upon  the  main  seats  of  disease,  or 
from  the  voluntary  muscles  as  the  re- 
sult of  their  exercise,  while,  also,  no 
small  amount  of  what  is  thus  appa- 
rently due  to  physical  causes  is  often 
owing  to  a  direct  nervous  influence 
excited  by  those  emotions  that  are 
awakened  by  the  gladdening  aspects 
of  Nature,  by  social  intercourse,  &c. 
— ail  of  which  is  rendered  tributary  to 
the  Author's  general  object  of  advanc- 
ing that  philosophy  in  medicine  which 
appears  to  him  to  hold  no  fellowship 
with  the  institutions  of  inorganic  Na- 
ture, p.  543,  {)  855-856  ;  p.  579-580, 
<^  890^  d,  and  references  there ;  p. 
662-663,  <;.  896;  p.  670-671,  ^  902 
m.  Also,  Reflex  Action  ;  Causes, 
Morbific  ;  Remedial  Action,  Men- 
tal Emotions,  Hope,  &c.,  Index  II. 
relieved  by  Antispasmodics  through  a 
sedative  reflex  influence  acting  upon 
the   muscular  tissue,  p.  592-593,  ^ 

89  U  ^■• 
Will — continued  from  Index  I., 

considered  in  its  relations  to  the  higher 
faculties  of  the  Mind  and  to  the  In- 
stinctive Principle,  p.  877-881,  ^  1072 
6-1075 

acts  upon  the  intestine  in  defecation  as 
upon  the  bladder  in  fulfilling  an  anal- 
ogous function,  is  sometimes  capable 
of  ejecting  food  from  the  stomach,  or, 
on  the  contrary,  will  often  restrain 
nausea,  p.  325,  {)  500  e ;  p.  326,  ^  500 
k.  Also,  Defecation,  Sea-Sickness, 
Index  II. 

by  its  direct  action  upon  the  main  cen- 
tre of  the  nervous  system  it  determ- 
ines the  nervous  influence  in  an  elect- 
ive manner,  and  without  regard  to  in- 
termediate nerves,  upon  the  voluntary 
muscles,  which  are  thus  brought  into 
action  by  their  own  inherent  proper- 
ties, to  which  the  nervous  influence 
sustains  the  relation  of  a  stimulus ; 
and  when  it  is  considered  with  what 
vehement  power  the  Will  may  urge 
the  nervous  influence  upon  the  mus- 
cles of  volition,  we  are  supplied  with 
an  interpretation  of  the  violence  which 
excessive  Joy,  Anger,  Fear,  blows  upon 
the  epigastrium,  surgical  operations, 
prussic  acid,  the  virus  of  serpents, 
&c.,  may  inflict  upon  the  organs  of 
orj^anic  Hfe  through  the  same  medi- 
um, p.  89,  (j  188  ;  p.  103,  <^  205 ;  p. 


Will — continued. 

107-111,  l^  227-233f  ;  p.  124,  ^  243; 
p.  295,  ()  475^ ;  p.  296,  i)  476  c ;  p, 
298,  (i  476i  h;  p.  300,  ^  479  ;  p.  302. 
{)  481  b;  p.  319,  (J  494  h-e ;  p.  323- 
328.  ()  500  c-m;  p.  334,  ij  509-511  ; 
p.  525,  ()  828  a-c ;  p.  643,  ()  893  a. 
with  rare  exceptions,  it  so  disposes  the 
nervous  influence  that  it  terminates 
without  instituting  reflex  actions,  as 
are  apt  to  arise  from  Mental  Emo- 
tions ;  but  a  remarkable  exception  oc- 
curs in  sleeping  in  an  erect  posture, 
especially  in  roosting,  and  very  anal- 
ogous to  that  are  the  spasmodic  affec- 
tions (particularly  of  the  muscles  of 
the  lower  extremities  when  rendered 
susceptible  by  diseases  of  the  abdom- 
inal organs)  which  arise  from  extend- 
ing or  "  stretching"  the  limbs  when 
in  a  horizontal  posture,  and  as  often 
experienced  by  the  Author,  p.  890- 
891,  i!>  1077.  Also,  Roosting,  hidex 
II. 
while  the  Will  limits  the  nervous  influ- 
ence to  whatever  voluntary  muscles 
it  chooses,  the  Mental  Emotions  gen- 
erally affect  particular  parts  in  their 
natural  state  according  to  the  particu- 
lar nature  of  each  one,  or  as  they  may 
be  compounded,  as  Shame  the  capil- 
laries of  the  face,  Grief  the  lachrymal 
glands  and  stomach,  Disgust  the  stom- 
ach mostly.  Fear  the  kidneys,  skin, 
and  heart.  Anger  the  voluntary  mus- 
cles, &c.  ;  and  what  is  thus  true  of 
mental  emotions  is  more  or  less  so  of 
certain  morbific  and  remedial  agents 
of  a  physical  nature,  as  Cantharides 
strikes  at  the  genito-urinary  organs, 
Narcotics,  the  brain,  Mercury  at  the 
salivary  glands,  &c.  ;  but  in  a  gen- 
eral sense  morbific  agents  are  less  cir- 
cumscribed, and  some  of  them,  as  the 
predisposing  causes  of  fever,  render 
the  nervous  influence  universally  al- 
terative, and  coming  to  conditions  of 
disease  this  complexion  is  changed, 
and  all  external  things,  food,  exercise, 
mental  emotions,  &c.,  present  new 
phenomena,  notonly  according  to  their 
nature,  force,  &c.,  but  in  parts  upon 
which  they  may  have  no  apparent 
effect  in  their  natural  states ,  and 
since  the  foregoing  general  limitation 
of  the  effects  of  morbific  and  remedial 
agents  to  particular  parts  according  to 
the  nature  of  the  agent,  and  the  part, 
and  the  varying  susceptibilities,  is  en- 
tirely opposed  to  the  diffusive  action  of 
galvanism  and  electricity,  and  as  there 
is  no  analogy  between  tlie  exciting 
causes  and  modifying  influences  of 
the  nervous  agent  and  those  of  which 
Chemistry  takes  any  cognizance,  and 


INDEX    II. 


1109 


Will — continued. 

since  the  same  limitation  of  effects 
applies  in  health  with  the  precision 
of  laws  to  the  Will  and  Mental  Emo- 
tions, and  as  the  Will  has  the  nerv- 
ous medium  through  which  physical 
agents  produce  their  effects  under  its 
own  self-acting  control  in  its  office  of 
voluntary  motion,  and  as  some  of  the 
Mental  Emotions  rarely  institute  re- 
flex actions,  but  are  restricted  to  one 
half  of  the  supposed  galvanic  circuit, 
and  as  the  Will  nearly  always  oper- 
ates exclusively  through  the  motor 
half,*  the  proof  becomes  conclusive 
that  our  Chemical  friends  must  look 
for  some  other  instrumentality  than 
galvanism  or  any  of  their  known  ag- 
encies or  laws  to  expound  the  prob- 
lems of  life  and  disease.  See  fore- 
going references;  Causes,  Morbific; 
Remedies,  Mental  Emotions,  the  in- 
dividual Passions,  Remedial  Action, 
Reflex  Action,  Structure,  Index  II. 
employed  in  demonstrating  the  substan- 
tive existence  and  self-acting  nature 
of  the  Soul  and  Instinctive  Principle, 
p.  874-879, ^  1071-1075. 


Yawning 

may  be  the  result  of  thinking  about  it, 
or  of  mental  sympathy,  or  of  weari- 
ness, and  depends  immediately  upon 
complex  influences  of  direct  and  re- 
flex actions  of  the  nervous  system — 
the  former  cases  displaying  the  in- 
cipient development  by  the  direct  ac- 
tion of  the  mind  and  a  consequent 
institution,  through  its  irritation  of 
the  pulmonary  mucous  tissue,  of  re- 
flex action,  as  in  involuntary  respira- 
tion, and  after  the  manner  of  Disgust 
in  producing  vomiting,  while  in  the 
latter  case  the  primary  influence  of 
the  nervous  centres  proceeds  from  the 
voluntary  muscles — employed  in  ex- 
pounding the  modus  operandi  of  mor- 


Yawning — continued. 

bific  and  remedial  agents,  and  in  de- 
monstrating the  substantive  existence 
and  self-acting  power  of  the  Soul,  p. 
327-328,  ^  500  ;-m  ;  p.  340,  ^  514  k- 
m  ;  p.  534,  (J  844  ;  p.  631-632,  ^  892 
b;  p.  888-889,  ^  1077.  Also,  Dis- 
gust, Sneezing,  Se.\-Sickness,  Ex- 
ercise, Mental  Emotions,  &c.,  In- 
dex II. 

Youth — continued  from  Index  I., 

its  various  developments  are  strongly 
illustrative  of  the  natural  mutability 
of  the  properties  of  life  which  is 
greatly  designed  to  fulfil  the  exigen- 
cies incident  to  the  progressive  stages 
from  Infancy  to  Manhood,  and  from 
which  arise  diseases  and  their  cure — 
thus  supplying,  also,  natural  examples 
of  well-marked  alterative  influences 
of  the  nervous  system  in  the  deep  re- 
cesses of  organic  life,  since  all  the  re- 
markable mutations  which  character- 
ize this  stage  of  progress,  and  much 
of  its  moral  attributes,  are  mainly  ofv- 
ing  to  the  development  of  the  organs 
of  generation,  and  an  attendant  al- 
terative influence  of  reflex  nervous 
action,  whose  centripetal  source  is  es- 
pecially the  testes  in  one  sex  and  the 
ovaria  in  the  other — and  farther  il- 
lustrated by  the  differences  between 
the  perfect  and  altered  animal,  while, 
also,  the  physiological  changes  be- 
come the  groundwork  of  new  dis- 
eases or  modifications  of  former  ones, 
and  all  serving  as  a  standard  of  inter- 
pretation of  the  modus  operandi  of 
morbific  and  remedial  agents,  physic- 
al and  mental,  p.  55,  Ml'^;  P-  56,  (} 
120 ;  p.  61,  (J  133  c ;  p.  68-69,  ^  153 
-159;  p.  121,  ^237;  p.  352,  (J  524  rf  ; 
p.  376-378,  (J  578.  Also,  Organs  of 
Generation,  Parturition,  Preg- 
nancy, Alteratives,  Predisposi- 
tion, Miasm  ;  Antimony,  Tartar- 
izED  ;  Reflex  Action,  Index  II. ; 
Vital  Properties,  Organic  Life, 
hidex  I. 


*  The  Chemist  is  desired  to  consider  particularly  this  fact  (S  409  hh,  493  cc,  893  a), 
—Also  NoTB  Y  p.  1130. 


INSTITUTES  OF  MEDICINE. 


NOTES. 

As  stated  in  the  Preface  to  the  Seventh  Edition  of  this  work,  the  Author  has  af- 
fixed some  brief  Foot-notes  to  that  Edition  (as  at  p.  172,  350, 503, 679, 72.5, 863,  895, 
920) ;  but  soon  after  the  first  impression  was  strucli  off  he  concluded  to  introduce  a 
few  other  Notes  at  the  end  of  Index  II.,  which  will  be  attached  to  the  copies  of  that 
impression  which  may  remain  on  hand.  This  method  of  adding  or  modifying  will 
be  continued  hereafter,  and  references  to  the  Notes  thus  appended  will  be  inserted 
in  the  text  in  future  impressions,  and  probably,  also,  other  foot-notes,  and  other 
improvements.  Such,  indeed,  have  been  made  in  this  second  impression  of  the 
seventh  edition,  as  at  p.  493,  606,  699,  1052,  &c.— September,  1862. 


NOTE  A.— EXCITING  CAUSE  OF  PARTURITION. 

Note  A. — In  section  892|  d  occur  some  remarks  about  the  institution  of  labor, 
and  I  am  now  led  to  other  comments  by  certain  suggestions  made  by  Professor  G. 
S.  Bedford,  M.D.,  upon  the  same  subject  in  his  late  work  upon  the  "Principles  and 
Practice  of  Obstetrics,"  and  which  was  reviewed  by  myself  in  the  "Boston  Medical 
and  Surgical  Journal,"  November  7th,  1861.  In  that  Review  I  remarked  that  Dr. 
Bedford,  after  a  genei-al  examination  of  the  principal  hypotheses  relative  to  "the 
determining  cause  of  labor,  or  that  peculiar  influence  which  first  excites  the  muscular 
fibres  of  the  uterus  to  contraction,"  and  having  considered  particularly  the  ovarian 
hypothesis  of  Dr.  Tyler  Smith,  and  the  orificial  irritation  of  Dr.  John  Power,  both  of 
which  are  founded  upon  the  laws  of  reflex  nervous  action,  delivers  his  own  rationale 
in  considerable  detail.  Our  Author's  doctrine  is  j)redicated  of  the  principle  that 
"  there  seems  to  be  a  necessary  connection  between  the  first  spontaneous  movements 
in  the  muscular  walls  of  the  uterus  and  a  matured  development  of  the  muscular 
structure  of  the  organ  itself."  That  the  institution  of  labor  is  due  to  a  cause  that 
operates  at  uniform  times  not  only  in  the  human  species  but  in  all  animals  is  suffi- 
ciently obvious.  It  must  be  independent,  in  a  constitutional  sense,  of  all  accidents 
that  may  affect  the  specific  periods.  The  hypothesis  of  orificial  irritation  is  contra- 
dicted not  only  by  the  periodical  uniformity  of  the  process,  which  is  very  variable  in 
different  species  of  animals,  but  by  the  variety  of  presentations,  and  that  woman 
alone  is  liable  to  the  imputed  cause  before  the  contractile  movements  shall  have  be- 
gun. We  must  therefore  look  to  the  uterus  itself  for  the  requisite  provision,  and  this 
can  be  found  only  in  a  law  which  is  exactly  obedient  to  a  matured  development  of 
the  organ.  But  this  does  not  expound  the  great  and  wonderful  ])roblcm — the  how 
or  the  ivhi/  the  "spontaneous  movement"  grows  out  of  the  "matured  development 
of  the  muscular  structure."  Are  there  any  analogies,  any  physiological  principle, 
to  sustain  Dr.  Bedford's  conclusion  that  there  is  an  inherent  ability  in  the  fully  de- 
veloped uterine  muscular  structure  to  institute  the  parturient  process  independently 
of  any  other  existing  cause,  and  above  all  that,  as  our  Author  affirms,  "it  has  no 
connection  whatever  with  a  reflex  or  neiTous  force"  ?  For  this  conclusion  our  Au- 
thor offers  a  supposed  analogy  in  the  peristaltic  movements  of  the  intestine,  found- 
ed upon  the  assumption  that  those  actions  are  independent  of  the  nervous  influence, 
which,  however,  has  not  been  rendered  even  ])robable.  Experiments  have  only 
shown  that  other  causes  are  capable  of  exciting  those  movements,  such  as  atmos- 
pheric air,  mechanical  injuries,  electricity,  etc.  (§  262-265,  475^).  In  the  natural 
condition  of  the  intestine  there  must  be  equally  an  exciting  cause  of  the  peristaltic 
movements  as  of  the  action  of  the  heart  (§  475^),  or  of  the  respiratory  muscles 
(§  500  i-»0,  or  of  the  iris  (§  514  k,  1072  a),  or  of  the  sphincters  (§  514/^  g),  and, 
as  in  the  latter  cases,  what  else  than  the  nervous  influence  in  that  of  the  intestine  ? 


1112  NOTE    A. EXCITING    CAUSE    OF    PARTURITION. 

And  is  not  this  confirmed  by  the  eifects  of  cathartics  and  suppositories  (§  514/)? 
Why  are  the  natural  movements  suspended  in  jaundice,  or  when  food  is  long  with- 
held, unless  bile  and  the  ingesta  be  remote  causes  of  those  movements,  and  how  else 
can  they  reach  the  intestinal  muscular  tissue  than  through  reflected  action  from  the 
nervous  centres?  How  else  can  the  stimulus  of  the  blood  affect  the  muscular  sub- 
stance of  the  heart  than  through  the  circuitous  route  of  the  nervous  system,  or  what 
other  important  function  do  the  cardiac  nerves  subserve?  (p.  803,  Ex.  15;  p.  321). 

Physiologists  are  also  greatly  in  error  in  supposing  that  the  nervous  influence 
ceases  to  operate  immediately  after  apparent  death,  and  therefore  in  the  inference 
that  the  expulsive  movements  of  the  uterus  after  apparent  death  are  not  excited  by 
the  stimulus  of  the  nervous  influence.  The  expulsive  efforts  are  ample  proof  that 
there  is  still  remaining  life ;  and  various  recorded  facts  substantiate  the  continued 
action  of  the  nervous  system  as  long  as  muscular  irritability  and  contractility  remain 
(§  447  d,  637,  1042,  1072  «,  Note  Aa,  p.  1131). 

As  to  the  experiment  of  destroying  the  lower  portion  of  the  spinal  cord  for  the 
purpose  of  showing  that  labor  may  take  place  without  the  stimulus  of  the  nervous 
influence,  it  has  been  completely  neglected  that  the  uterus  is  still  connected  with  the 
essential  parts  of  the  nervous  system  by  contributions  from  the  sympathetic  nerve 
and  from  other  parts  of  the  cerebro-spinal  system  (§  459/,  478  6,  483  c,  490).  More- 
over, it  is  now  well  ascertained  that  the  ganglia  of  the  sympathetic  nerve,  even  the 
plexuses  of  that  nerve,  are,  as  one  of  their  uses,  centres  for  reflected  nervous  action, 
especially  when  preternatural  influences  are  in  operation,  as  when,  for  example,  ves- 
icants subdue  deep-seated  inflammations  (§  516  c?-522,  893).  In  the  case  of  the 
parturient  efibrts  after  the  destruction  of  the  lower  portion  of  the  spinal  cord,  that 
very  injury  calls  into  operation  other  resources  in  the  nervous  system  with  which  the 
uterus  is  indirectly  supplied.  It  is  also  universally  conceded  that,  in  the  language  of 
our  Author,  "  as  a  general  rule,  labor  is  in  part  accomplished  through  reflex  nervous 
action,"  and  it  is  therefore  farther  inferable  that  when  labor  takes  place  after  de- 
stroying the  inferior  portion  of  the  spinal  cord  "the  general  rule"  still  obtains,  and 
that  the  experiment  supplies  no  evidence  that  "childbirth  is  not  necessarily  depend- 
ent upon  nervous  agency."  The  supposed  "inherent  action" is,  possibly,  sufficient, 
2}er  se,  for  a  single  contractile  movement,  but  an  exciting  cause  independent  of  the 
"matured  development  of  the  uterus"  is  necessary  to  a  long  series  of  alternate  con- 
tractions and  relaxations.  That  condition  resulting  from  the  "matured  develop- 
ment of  the  muscular  structure  of  the  organ"  becomes  the  exciting  cause  of  reflex 
nervous  actions,  just  as  the  want  of  atmospheric  air  in  the  lungs  is  the  remote  cause 
of  the  reflected  nervous  influence  that  determines  the  respiratory  movements — ex- 
cepting in  the  case  of  the  uterus  the  compounded  sensitive  and  excito-motory  nerves, 
which  are  the  channels  of  the  transmitted  influences,  appertain  exclusively  to  the 
muscular  tissue  of  the  organ.  This,  however,  has  its  exact  analogy  in  the  reflex 
nervous  actions  upon  which,  as  I  have  shown,  roosting  and  sleeping  in  an  erect  pos- 
ture depend,  as  also  the  spasms  which  are  sometimes  excited  in  irritable  muscles  of 
the  lower  extremities  by  a  forcible  act  of  the  Will  (§  500  dd,  514,  p.  891,  §  1077). 
In  the  former  case  there  is  a  natural  adaptation  of  the  muscles  to  that  exercise  of 
the  Will,  which,  by  placing  them  in  a  rigid  state,  establislies  a  reflex  nervous  action 
that  maintains  them  in  permanent  contraction  as  in  the  more  compounded  case  of 
the  sphincter  muscles.  The  same  natural  provision  becomes  developed  in  the  gravid 
uterus  to  subserve  the  exigencies  of  parturition,  and  is  allied  to  that  irritable  state 
of  the  voluntai7  muscles  in  which  the  Will  may  institute  spasmodic  movements.  As 
soon,  however,  as  "the  determining  cause"  has  initiated  the  process  of  labor,  the 
point  of  departure  for  the  reflected  stimulus  of  the  nervous  power  becomes  compound- 
ed, and  the  foetus  participates  as  an  exciting  cause  of  the  reflected  nervous  influence 
by  its  pressure  upon  the  uterus.  In  this  respect  there  exists  an  analogy  in  the  first 
of  the  respiratory  movements  as  related  to  all  the  subsequent,  so  far  as  the  first  in  the 
series  is  determined  by  the  contact  of  cold  air  or  other  physical  causes  acting  upon 
the  surface  of  the  body,  while  in  all  the  subsequent  movements  the  point  of  depart- 
ure for  the  reflected  nervous  influence  is  the  mucous  tissue  of  the  lungs. 

As  to  the  alternate  contractions  and  relaxations  that  are  maintained  by  air,  me- 
chanical injuries,  electricity,  &c.,  in  the  extirpated  intestine  and  heart,  and  where 
there  may  be  no  reflected  nervous  influence  determined  by  those  causes  through 
local  centres  of  the  sympathetic  nerve,  such  alternations  of  action  are  as  readily  pre 
duccd  by  the  artificial  irritants  as  by  the  stimulus  of  the  nervous  power  in  virtue  of 
the  natural  constitution  of  those  organic  muscles,  which  are  specifically  designed  for 
that  mode  of  action  (§  262-265,  475i  and  references  there,  476^  c,  490,  498  e,  500 
c-e,  o,  514/  516  d  8  and  9,  891,  8921,  1077).* 


NOTES   B-C. — POISONS   AND   THE   ORGANIC   NERVE. — DEATH.    1113 


NOTE  B.— POISONS  AND  THE  ORGANIC  NERVE. 

Note  B. — Some  late  Experiments  by  Peliko  and  Dybrowski,  showing  the  action 
of  certain  poisons  upon  the  heart,  exemplify  the  transmission  of  influences  through 
the  sympathetic  nerve  in  the  absence  of  the  brain,  as  set  forth  in  §  46H,  477-478, 
481  Exp.  14,  15,  483  c,  484  b,  487/,  g,  488.},  490,  494  Exp.,  p.  G75,  §  904  h.  They 
aro  introduced  here,  therefore,  not  on  account  of  their  supposed  novelty,  but  as  new 
contributions  in  support  of  the  doctrines  which  I  have  advanced  as  to  the  modus 
operandi  of  morbific  and  remedial  agents  through  reflected  influences  of  the  nerv- 
ous system,  and  as  showing  that  these  influences  may  be  fully  propagated  through 
the  sympathetic  nerve,  as  is  also  seen  of  the  natural  stimuli  in  the  aneucephali 
(§46U«). 

According  to  a  communication  made  to  the  Parisian  Academy  of  Sciences  by  the 
foregoing  Pliysiologists,  poisons  derived  from  the  upas  antiar,  tanghinia  venenifera, 
veratrum  viride,  digitalis  purpurea,  introduced  into  the  stomach  or  inserted  in  the 
skin  of  frogs,  arrested  the  action  of  the  heart  in  periods  varying  from  ten  to  twenty 
minutes,  leaving  the  animal  for  some  time  with  the  exercise  of  voluntaiy  motion. 
They  found  this  paralyzing  influence  to  be  equally  the  same  when  the  brain  was  sep- 
arated from  its  connections  with  the  spinal  cord,  from  which  they  deduce  the  con- 
clusion that  the  poisons  exert  a  peculiar  eff'ect  upon  the  nerves  supplying  the  heart 
or  such  as  may  influence  the  movements  of  the  organ.  By  consulting  the  references 
to  the  Institutes  as  suggested  in  this  Note,  it  will  be  evident  from  similar  experi- 
ments long  since  made  (by  Brodie,  for  example,  with  tobacco,  p.  G75,  §  904  6),  that 
the  heart  was  not  paralyzed  in  the  foregoing  cases  through  an  absorption  of  the  poi- 
sons, but  by  pernicious  influences  reflected  by  central  parts  of  the  nervous  system. 

The  experiments  possess,  also,  the  interest  of  showing  the  dift'erence  in  functions 
between  the  cerebro-spinal  and  ganglionic  systems,  and  the  transmission  of  influ- 
ences in  organic  life  (as  in  the  case  of  the  Will  in  animal  life),  through  special  or- 
ganic nerves,  according  to  the  nature  of  the  remote  causes  and  the  natural  or  ac- 
quired susceptibility  of  organs  (§  137-152,  233J,  500  g-in,  and  Note  at  p.  864). 


NOTE  C— ORIGIN  OF  DEATH. 


Note  C. — Refers  to  section  632,  page  401.  Nothing  upon  the  subject  of  death 
can  be  predicated  of  man  as  deduced  analogically  from  the  original  constitution  of 
animals.  The  weapons  of  destruction  with  which  the  latter  are  provided  is  a  cogent 
proof  that  death  was  their  primitive  allotment,  and  a  still  greater  may  be  seen  in  the 
universal  means  of  subsistence  among  the  aquatic  tribes  and  the  carnivorous  of  every 
denomination.  The  last  reaches  to  man,  for  whose  uses  the  animal  as  well  as  the 
vegetable  kingdom  was  created,  and  in  which  respect  the  pronunciation  of  Scripture 
corresponds  with  the  constitution  of  man,  which  is  obviously  designed  for  both  ani- 
mal and  vegetable  food.  jNIan  is  not  only  thus  isolated,  and  all  reasoning  from 
analogy  predicated  of  the  death  of  animals  excluded,  but  since,  also,  animals  were 
rendered  subservient  to  mankind  as  a  means  of  sustenance,  and  as  the  death  of  man 
is  not  tributary  to  any  useful  purpose  whatever  in  the  economy  of  nature  beyond  the 
mere  elementary  principle,  it  is  evident  that  death  has  been  ingrafted  upon  man's 
constitution  without  any  apparent  final  cause.  This  conclusion,  though  wanting  in 
absolute  proof,  is  prompted  by  reason  in  its  logical  methods  of  investigation,  and  it 
seizes  upon  Revelation  as  supplying  a  remarkable  conciu-rent  testimony  of  the  ac- 
curacy of  its  own  ratiocination,  and  as  affording  a  satisfactory  solution  of  the  won- 
derful problem.  But  that  is  not  all.  Man  is  still  more  estranged  from  the  brute 
creation  by  his  endowment,  according  to  my  induction  from  final  causes  (p.  893), 
with  an  imperishable  Soul,  while  the  instinctive  principle  of  animals  dies  with  the 
material  body.  The  analogy,  therefore,  which  has  been  carried  from  the  mortality 
of  animals  to  the  human  race  is  again  rendered  nugatory  by  the  final  causes  of  the 
Soul  and  of  the  principle  of  Instinct  (p.  842,  §  1078).— Note  Pp  p.  1142. 


1114  NOTES    D-r. KEFLEX    NEKVOUS    ACTION. NARCOTICS. 


NOTE  D.— KEFLEX  NERVOUS  ACTION. 

Note  D. — The  demonstrable  manner  in  which  light  produces  sneezing,  or  the 
mind  in  dwelling  upon  the  paroxysm,  as  set  forth  in  §  514  k-l,  1077,  and  in  which 
disgust,  whether  arising  from  offensive  sights  or  offensive  odors,  or  from  a  recollec- 
tion of  their  effects,  gives  rise  to  vomiting,  as  expounded  in  §  500  i-m,  603-512,  514, 
S92i,  1074,  1077,  and  as  an  attendant  result  to  sweating  (ibid.),  and  where  in  the 
latter  case  the  nervous  influence  is  conspicuously  manifested  as  well  in  the  organs 
of  organic  as  of  animal  life,  enables  us  to  readily  comprehend  the  involved  processes 
of  reflex  nervous  actions  that  may  be  instituted  by  remedies  administered  by  the 
stomach  or  applied  to  the  skin,  as  variously  set  forth  in  this  work  (§  228  b,  514  h, 
G57,  674  d,  692  a,  715,  811,  848,  863,  889  a,  n,  902  g,  904  bb,  and  Index  II.,  Article 
Skin).  Thus,  also,  it  is  rendered  manifest  how  agents  of  special  virtues  may  not 
only  propagate  a  curative  reflex  nervous  influence  directly  upon  a  morbidly  suscepti- 
ble part,  as  tartarized  antimony  in  the  cure  of  pneumonia,  but  how,  also,  the  same 
remedy  may  simultaneously  reflect  the  nervous  influence  upon  other  organs  not  the 
seat  of  disease,  as  the  skin,  and  thus  render  that  organ  the  source  of  a  salutary  re- 
flex nervous  influence  upon  the  morbidly  susceptible  lungs,  as  otherwise  and  vari- 
ously expounded  in  the  foregoing  and  other  sections. 

It  may  be  farther  said  of  sneezing  as  brought  about  by  the  action  of  light  upon  the 
retina,  or  by  the  mind  in  dwelling  upon  the  paroxysm,  and  of  vomiting  as  occasioned 
by  offensive  sights  and  offensive  odors,  that  in  the  former  case  the  nervous  influence, 
in  being  first  reflected  or  directly  projected  (as  the  light  or  the  mind  may  be  the  re- 
mote exciting  cause)  upon  the  Schneiderian  membrane,  acts  upon  that  membrane 
after  the  manner  of  snvff,  when  the  irritation  is  reverberated  upon  the  nervous  cen- 
tres, the  nervous  influence  again  excited  and  i-eflected  upon  the  abdominal  mus- 
cles ;  while  in  the  case  of  vomiting,  it  is  the  mental  emotion  alone  which  excites 
and  projects  the  nervous  influence  upon  the  raucous  coat  of  the  stomach  (always  in 
a  direct  manner,  according  to  a  distinction  which  I  have  made  between  direct  and 
reflex  action,  §  227,  500  c-m,  893  a,  896,  903,  1072  n,  1074),  where  the  nervous  in- 
fluence thus  determined  by  the  emotion,  whether  resulting  from  the  spectacle,  or  the 
odor,  or  from  the  recollection  of  their  effects,  acts  precisely  as  an  emetic,  when  the 
chain  of  causations  ends  in  the  transmission  of  that  nauseating  influence  to  the  nerv- 
ous centres  where  the  nervous  power  is  thus  excited  in  an  indirect  manner,  and 
then  reflected  with  a  convulsive  effect  upon  the  same  muscles  that  are  engaged  in 
sneezing. 

The  foregoing  examples  are  reproduced  here  that  they  may  be  presented  in  an  iso- 
lated state,  and  to  attract  to  them  attention  both  on  account  of  the  novelty  of  the 
Author's  interpretation  of  the  action  of  the  Will  upon  the  voluntary  muscles,  and  of 
mental  emotions  upon  all  parts  of  the  organic  mechanism,  through  the  instrument- 
ality of*the  nervous  power,  and  that  they  may  be  recognized  as  distinct  illustrations 
ofthe  modus  operandi  of  natural,  remedial  and  morbific  agents  in  refutation  of  the 
doctrine  of  operation  by  absorption. 


NOTE  E.— OPERATION  OF  NARCOTICS. 

Note  E. — In  expounding  the  therapeutic  effects  of  Narcotics  I  have  endeavoured 
to  show  that  they  operate  essentially  by  reducing  irritability  and  sensibility,  and  thus 
render  the  blood  and  other  exciting  causes  less  stimulating,  so  that  in  local  condi- 
tions of  disease  attended  by  an  exaltation  of  those  properties  the  restorative  process 
supervenes  upon  that  sedative  influence  (§  891  i,  905  b,  1057).  Tiiese  remarks  are 
intended  to  illustrate  the  probable  action  of  Conivm  and  Belladonna  in  mitigating 
the  severities  of  cancerous  affections,  and  that  the  results  are  in  no  respect  due  to 
an  alterative  virtue  which  has  been  for  a  long  time  attributed  to  those  narcotics. 


NOTE  F.— ALCOHOL  versus  ANTIPHLOGISTICS. 

Note  F. — To  carry  out  the  objects  of  the  Postscript  at  p.  872  I  subjoin  the  sta- 
tistics of  mortality  arising  from  pneumonia,  bronchitis,  croup,  and  conswnpfion  in  the 
city  of  New  York  during  the  months  of  January,  February,  March,  and  April  of 


NOTE   F. ALCOHOL   Vet'SUS   ANTIPHLOGISTICS.  1115 

1861  and  1862,  from  which  it  will  be  seen  that  the  "  stimulating  plan"  of  treatment 
was  no  more  successful  than  in  the  same  months  of  1860. 

In  1861  the  total  number  of  deaths  during  the  foregoing  months  was  6987,  of 
which  527  are  reported  as  "Inflammation  of  the  Lungs;"  Bronchitis,  185; 
Croup,  212;  Consumption,  1062. 

In  1862  the  total  number  of  deaths  for  the  same  time  was  7035,  of  which  are  re- 
ported as  " Inflamjiation  of  the  Lungs,"  498;  Bronchitis,  119;  Croup,  187; 
Consumption,  1165. 

The  ratio  of  deaths  from  pneumonia  during  the  first  four  months  of  1861  and 

1862  was  about  the  same  as  distinguished  the  corresponding  period  of  1860,  while, 
had  the  depletive  treatment  been  adopted,  especially  bloodletting,  which,  continues 
to  be  proscribed  in  this  City  of  New  York,  that  ratio,  instead  of  amounting  to  about 
1  in  12  of  all  the  deaths,  would  not  have  been  1  in  100.  The  aggregate  mortality, 
therefore,  I  reiterate,  must  not  be  imputed  to  any  remarkable  insalubrity  of  New 
York  (p.  760,  §  1005  ^-)•— Note  Mm  p.  1141. 

As  to  the  ratio  of  deaths  from  Consumption,  some  improvement  may  be  anticipated 
from  the  late  work  upon  that  disease  by  Dr.  James  Copland,  who  advocates  the  an- 
tiphlogistic treatment,  especially  in  the  early  stages.  It  will,  however,  be  a  tardy 
gain  over  the  stimulating  treatment,  since  it  is  said,  in  the  leading  medical  journal 
of  the  day,  by  a  rather  liberal  reviewer  of  Dr.  Copland's  work,  "that  bleeding  for 
haemoptysis  is  not  a  practice  which  meets  with  much  favour  in  the  present  day. 
Most  living  physicians  with  whose  opinions  we  are  conversant  would  as  soon  think 
of  drawing  blood  to  arrest  uterine  hemorrhage,  or  to  stop  a  wounded  artery  (§  699 
c,  805,  862-864, 890  d-f) ;  and,  secondly,  that  the  main  improvement  (in  treatment) 
depends  on  the  universal  acceptation  of  the  doctrine  that  phthisis  is  essentially  a  dis- 
ease of  imperfect  nutrition  and  assimilation,  and  that  eiforts  in  treatment  must  there- 
fore be  mainly  directed,  not  to  the  pulmonary,  but  to  the  digestive  systems.  The 
principal  treatment  of  phthisis  nowadays  consists  in  the  free  administration  of  nour- 
ishing animalized  diet,  containing  a  large  proportion  of  the  fatty  elements  of  nutri- 
tion ;  in  exercise,  witli  unrestricted  exposure  to  the  invigorating  intiuences  of  sun 
and  air ;  and  in  the  substitution  of  a  few  simple  but  elfective  tonic  medicines  for  the 
effete  polypharmacy  of  our  predecessors."  The  objection  to  polypharmacy  is  very 
well,  although  it  does  not  apply  to  any  of  the  most  eminent  ^' of  our  predecessors," 
whose  principal  treatment  in  the  early  stages  of  phthisis  consisted  of  bloodletting,  a 
non-stimulating  diet,  counter-irritants,  and  free  exercise  in  the  open  air,  but  all  of 
which,  save  the  air  we  breathe,  is  now  so  greatly  changed  that  the  Reviewer  remarks 
of  Dr.  Copland's  treatment  that  "we  have  certainly  been  surprised  to  find  local, 
and  in  some  instances  general  bloodletting  still  advised  in  the  first  stage  of  phthisis." 
— (The  Italics  are  mine.)— British  and  Foreign  Medico-Chirurgical  Review, 
January,  1862,  p.  159. 

Nowthere  might  seem  in  the  foregoing  statistics  a  sufficient  justification  of  this 
extended  discussion.  But  it  may  be  said  that  they  are  too  local,  not  sufliciently 
comprehensive,  and  that  as  statistics  (founded  upon  the  '^  numerical  method'')  are 
"  the  great  criterion  nowadays  of  the  merits  of  treatment,"  they  should  not  be  liable 
to  the  objection  which  I  have  anticipated,  although  they  run  through  four  corre- 
sponding months  of  three  consecutive  years,  and  relate  to  a  population  of  about  one 
million.  I  shall  therefore  offer  a  copious  amount  of  similar  testimonials  from  the 
same  number  of  the  Review  to  which  I  am  indebted  for  the  foregoing  quotations. 
Thus,  in  an  elaborate  Article  upon  "Military  and  Naval  Hygienics"  (iha Italics  be- 
ing mine),  it  is  said  of  "  Diseases  of  the  Lungs,  &c.,  including  pulmonary  consump- 
tion," that,  "among  the  troops  at  home,  these  maladies  occasion  more  admissions 
into  hospital  than  all  fevers  and  diseases  of  the  bowels  together  ;  and  more  than  three 
times  as  many  deaths.  Tico  thirds  of  all  the  mortality  in  the  army  of  the  United 
Kingdom  are  due  to  them  ;  and  of  these  two  lYavAs,  four  fifths  are  due  to  consump- 
tion." "In  the  Mediterranean  garrisons,  the  proportion  of  chest  diseases  to  all  other 
causes  of  sickness  has  been  nearly  as  high  as  in  Great  Britain,  viz.,  a  sixth  or  a  sev- 
enth of  the  whole.  They  have  not  been  quite  so  fatal ;  still,  the  mortality  from  them 
alone  has  constituted  between  a  half  and  a  third  of  all  the  deaths.  In  the  North 
American  command,  their  frequency  and  fatality  have  been  nearly  the  same  as  at 
home. 

"  In  the  navy,  respiratory  diseases  are  the  most  prolific  source  of  sickness  and 
death."  "il/ore  than  a  fifth  of  the  deaths  from  all  causes  is  occasioned  by  them." 
"In  1856,  out  of  a  total  mortality  of  629  from  disease,  175  deaths  were  due  to  pul- 
monic affections,  chiefly  phthisis  (nearly  one  fourth)  ;  and  of  the  918  men  invalided 
from  disease  that  year,'l03  were  discharged  on  account  of  consumption,  and  49  from 


1116  NOTE    G. MODUS    OPERANDI    OF    CATHARTICS. 

Other  pulmonic  disorders.  In  1857,  of  the  total  deaths  (623)  from  disease  in  the 
sei-vice,  129  were  caused  by  consumption"  (more  than  one  fifth). — Ibid.,  p.  109, 110. 

In  reviewing  the  statistics  of  consumption,  it  should  not  be  forgotten  that  besides 
the  substitution  of  tonics  and  stimulants  for  the  "effete  polypharmacy  of  our  prede- 
cessors," a  lavish  use  of  cod's  liver  oil  is  a  main  ground  of  dependence  ;  though  we 
hold  the  tonics  and  stimulants,  and  the  ' '  free  administration  of  nourishing  animal- 
ized  diet,"  and  the  absolute  neglect  of  an  antiphlogistic  treatment,  at  the  early  stage 
of  the  disease,  responsible  for  the  excessive  mortality  (<J  836,  892f  ^-0-* 

In  the  Medical  and  Physiological  Commentaries,  in  an  article  on  the  '■'■Pa- 
thology of  Tubercle  and  Scrofula"  (vol.  ii.,  p.  608-634)  and,  also,  in  a  critical  exam- 
ination of.the  "Pnndpal  Writings  of  P.  Ch.  A.  Lo2tis"  (Hid.,  p.  679-815),  I  have 
endeavoured,  at  great  length,  to  substantiate  the  highly  inflammatory  nature  of  phthi- 
sis pulmonalis,  and  have  recited  the  experience  of  the  most  illustrious  practitioners 
in  behalf  of  a  decided  antiphlogistic  treatment,  especially  bloodletting,  in  the  early 
stages  of  the  malady,  and  with  which  my  own,  throughout  a  long  and  active  pro- 
fessional life,  has  fully  corresponded.  But  there  has  arisen  a  general,  or,  rather,  a 
nearly  universal  acquiescence  in  Louis'  contra-inflammatory  doctrine,  as  deduced  by 
him  from  the  debris  of  the  body,  though,  as  I  have  unquestionably  shown,  in  opposi- 
tion to  his  own  dissections  (e.  g.  ut  supra,  p.  631-633).  It  is  this  especially,  not  the 
"numerical  method,"  and  as  generally  admitted,  which  has  prompted  the  stimulating 
treatment  of  consumption  (§  756  a).  Moreover,  in  respect  to  this,  and  all  other  dis- 
eases, the  denunciation  of  bloodletting  is  too  formidable  to  be  encountered  by  any 
but  well-established  practitioners,  and  who  possess,  also,  more  than  Galen's  heroic 
firmness  (§  1004  c,  note;  also  p.  488,  §  756  a;  p.  722,  §  690  g;  p.  861,  §  1065  c). 


NOTE  G.— MODUS  OPERANDI  OF  CATHARTICS. 

Note  G. — The  explanation  which  is  rendered  in  §  880  f  of  the  necessity  of  pro- 
found impressions  upon  the  intestinal  mucous  membrane  by  cathartics  for  successful 

*  In  regard  to  the  causes  -which  hare  led  to  an  almost  universal  adoption  of  a  stimulating  treat- 
ment where  the  "antiphlogistic"  had,  with  only  rare  and  partial  exceptions,  obtained  throughout 
the  past  (5  1004  a),  I  have  represented  those  of  a  general  nature  both  in  this  work  and  the  Medical 
and  Physiological  Commentaries  (5  4S7  /<,  5G9  6-c,  621  a,  743,  756  a,  TS5,  S15,  SCO,  861  b,  967, 979, 99-2, 
999  c,  1001,  1U05-1007,  1022-1026,  106S  «,  W.  But  there  are  many  incidental  causes,  which  have 
given  a  great  impulse  to  the  revolution,  and  a  knowledge  of  which  will  be  Interesting  to  the  future 
historian.  Among  the  thousand  influences  of  this  nature,  which  are  of  themselves  of  important  and 
comprehensive  import,  may  be  mentioned  the  following  recommendation,  signed  by  nine  of  the  prin- 
cipal physicians  of  the  City  of  New  York  (six  of  whom,  at  least,  are  Professors  in  some  of  our  Jletro- 
politan  Colleges),  and  which,  of  course,  has  been  extensively  ckculated  as  an  advertisement.    Thus  : 

"  New  York,  May  1,  ISGl. 
"  Mr.  Wm.  T.  Cuttee,  Jr.,  Louisville,  Ky. 

*•'  Deak  Sib, The  great  difficulty  experienced  in  procuring  Brandy  sufficiently  pure  for  medicinal 

pui-poses,  has  induced  many  of  the  physicians  of  this  vicinity  to  adopt  Bourbon  Whisky  as  a  substi- 
tute, both  in  the  hospitals  and  private  pr.actice;  and  since  the  latter  HAS  COME  INTO  SUCH 
GENERAL  USE,  we  have  reason  to  believe  that  a  gi'eat  deal  now  sold  is  of  very  inferior  quality. 

"  Presuming  that  your  residence  in  the  vicinity  of  the  manufacturers  of  Whisky  in  Kentucky,  as 
well  as  your  skill  as  a  chemist,  will  enable  you  to  select  a  reliable  article,  and  having  full  confidence 
in  your  integrity,  we  are  led  to  inquire  whether  you  will  not  aid  us  in  having  this  market  supplied, 
through  an  agency,  with  the  best  quality  of  Pure  Old  Bourbon  Wliisky  for  the  use  of  the  sick." — 
The  aqMals  are  iiiine. 

Another  favourite  stimulant,  known  as  Wolfe's  Schiedam  Schnapps  (or,  more  familiarly,  Holland 
Gin),  is  worthy  of  notice  on  account  of  its  special  recommendation  by  high  medical  authority.  This 
gin  has  enjoyed  a  distinguished  professional  patronage  and  a  brilliant  career  for  many  years,  and 
the  appetite  for  it  has  been  very  recently  sharpened  by  a  fresh  recommendation  signed  by  seven  of 
the  principal  physicians  of  the  city  of  New  York,  several  of  whom  are  Professors  in  our  Medical  Col- 
le"es.  It  appears  as  a  newspaper  advertisement,  and  the  following  extract  will  show  that  I  do  jiot 
magnify  the  extent  of  the  evil : 

^     '                                                                                                "  New  York,  March  13, 1862. 
" Udolpho  Wolfe,  Esq.  .     ,    ,. 

"  Deab  Sir,— We  have  tested  the  several  articles  imported  and  sold  by  you,  including  your  Gin, 
which  you  sell  under  the  name  ofAroirmtic  Schiedam  Sclinapjts,  which  we  consider  justly  entitled 
to  the  higli  reputation  it  has  acquired  in  this  country ;  and,  from  your  long  experience  as  a  foreign 
importer,  your  bottled  Wines  and  Lttjuors  should  meet  with  the  same  demand. 

"  Wc  would  recommend  you  to  appoint  some  of  the  respectable  apothecaries,  in  diflferent  parts  of 
the  city  as  agents  for  the  sale  of  your  Brandies  and  Wines,  where  the  profession  can  obtain  the  same 
when  needed  for  medicinal  purposes.  Wishing  you  success  in  your  new  enterprise,  we  remain  your 
obedient  servants." 

All  this  may  seem  to  be  hardly  worthy  of  record,  even  in  a  Note;  but  it  forms  no  small  part  of  the 
history  of  the  most  remarkable  revolution  that  has  ever  befallen  practical  medicine,  and,  moreover, 
the  hope  may  be  entertained  that  something  may  be  thus  contributed  toward  arresting  the  career 
of  this  wide-spread  calamity.  It  also  supplies  a  principal  ground  of  solution  for  the  disappearance 
of  those  remarkable  efforts  that  had  pervaded  the  United  States  for  the  suppression  of  intemperance. 


NOTE   H. NARCOTICS    VeiSUS   ANTIPHLOGISTICS.  1117 

Invasions  upon  certain  obstinate  conditions  of  disease  not  only  plainly  refutes  the 
humoral  interpretations  of  the  modus  operandi  of  cathartics  in  their  peristaltic  ac- 
tion and  their  effects  upon  disease,  but  it  lays  open  the  philosophy  of  the  effects  of 
elateriuin  and  of  other  violent  cathartics  in  sometimes  subduing  dropsical  affections 
as  set  forth  at  p.  G55-65G,  §  893  n,  and  which  is  there  shown  to  have  been  explain- 
ed "upon  the  pi-inciple  of  counter-irritation,  or  metastasis  of  the  physical  school," 
while,  at  the  same  time,  a  confirmation  is  thus  obtained  of  the  inflammatory  nature 
of  dropsical  effusions,  whether  acute  or  chronic,  as  set  forth  among  other  facts  in  the 
Author's  Medical  and  Physiological  Commentaries,  vol.  i.,  p.  180-183,  186,  vol.  ii., 
p.  556,  note ;  1840.     Also  Institutes,  §  892^  k,  892}  b,  e,  g. 


NOTE  H.— NARCOTICS  versus  ANTIPHLOGISTICS. 

Note  H. — I  have  occasionally  embraced  opportunities  of  contrasting  the  substitutes 
for  bloodletting  in  the  treatment  of  inflammations  and  fevers  which  have  been  com 
mended  by  those  who  are  opposed  to  the  latter  remedy  (§  95-4  b,  9G0  a,  b,  1005,  1006 /J 
1068),  and  although  the  abstraction  of  blood  is  now  very  generally  sacrificed  to  the 
ad  captanduin  practice  of  tonics  and  stimulants,  and  all  but  animal  nutriment  is 
mostly  proscribed,  there  has  sprung  up  a  narcotizing  school  whose  excesses  far  sur- 
pass any  foi-mer  records  of  this  kind  of  antiphlogistic  treatment,  and  presents  a  doubt- 
ful alternative  for  the  "tonic  and  stimulating  plan."  It  seems  to  be  jiroper,  there- 
fore, that  these  Institutes  should  be  "posted  up"  upon  the  peculiar  claims  of  the 
"opium  treatment,"  and  as  these  consist  in  effecting  narcotization,  my  purpose  will 
be  sufficiently  accomplished  by  showing  how  it  is  done — for  the  method  is  far  in  ad- 
vance of  the  practice  as  it  existed  when  the  record  was  made  in  §  891  c.  A  greater 
importance  has  been  also  given  to  the  subject  by  the  accessions  which  have  been 
made  to  the  school  from  the  influential  ranks,  and  that  this  may  be  at  once  appa- 
rent, I  shall  have  fulfilled  the  object  of  this  note  by  presenting  the  following  quota- 
tion from  a  writer  of  good  repute,  who  has  also  quoted  the  statement  from  one  of 
the  most  indulgent  Commentators.  The  particular  disease  in  the  present  instance 
was  puerperal  fever,  but  the  same  narcotizing  treatment  is  applied  to  the  common 
form  of  peritoneal  enteritis.  But,  in  the  mean  time,  the  inquisitive  reader  should 
refresh  himself  of  the  past  by  turning  to  §  1005.  The  first  sentence  of  our  quotation 
is  from  the  text  of  Professor  G.  S.  Bedford's  late  work  on  Obstetrics  (1861),  and  the 
residue  is  embraced  in  an  associated  note.     Thus : 

"Professor  Alonzo  Clai-k,  of  tlie  College  of  Physicians  and  Surgeons  of  this  city, 
has  employed  opium  in  heroic  doses  during  the  prevalence  of  puerperal  fever  at  the 
Bellevue  Hospital,  and  with  good  success.  Some  interesting  details  furnished  by 
Professor  Keating,  the  able  annotator  of  Dr.  Ramsbotham,  touching  Dr.  Clark's  ex- 
perience with  opium  in  puerperal  fever,  will  be  found  in  Ramsbotham's  System  of 
Obstetrics,  p.  584.  Pmay  here,  however,  be  permitted  to  quote  the  following  as  an 
evidence  of  the  extraordinary  extent  to  which  opium  may  be  administered  without 
fatal  results.  Professor  Clark  says :  'Regarding  the  tolerance  of  opiates  in  some  of 
these  cases — at  the  risk  of  being  charged  with  rashness  and  trifling  with  human  life 
— I  will  make  some  extracts  from  case  seven.  The  treatment  was  commenced  at  10 
A.M.,  on  the  26th  of  December,  two  grains  of  opium  hourly.  At  2  P.JM.,  no  change 
in  the  symptoms,  dose  increased  to  gr.  iv.  ;  at  3,  gr.  iv.  ;  at  4,  gr.  v.  ;  at  5,  gr.  v. ;  at 
6,  gr.  viii.  ;  at  8,  gr.  x.  ;  at  9,  gr.  xij.  ;  at  11,  sol.  morph.  sulph.  (16  gr.  to  f.  §1.) 
jiss. ;  at  12,  3i. ;  at  H  A.M.  (respiration  6),  0;  at  6  A.M.  (respiration  12),  opium 
gr.  xij.  ;  at  10,  sol.  3i.  ;  at  12  M.,  opium  gr.  xij. ;  at  1|  P.M.,  sol.  jij. ;  at  2^,  3ij. ; 
at  3^,  opium  gr.  xxiv. ;  at  5,  gr.  xij.  ;  at  6^,  sol.  jijss. ;  at  7k,  5U-  ;  at  9,  opium 
gr.  xiv.  ;  at  10,  gr.  xvj.  ;  at  11,  gr.  xviij. ;  2Sth,  at  1  A.M.,  sol.  sijss. ;  at  2,  siv.  ; 
at  3i,  opium  gr.  xx. ;  at  4,  sol.  sijss. ;  at  5,  jiii.  ;  at  6,  jiijss. ;  at  6i,  opium  gr.  x.  ; 
at  7,  sol.  siijss.  ;  at  8,  opium  gr.  xxij.  ;  at  9J-,  sol.  jiv. ;  at  10,  jiij.  ;  at  llj,  siij. ; 
at  12,  0.  Thus  this  woman  took,  in  the  first  26  hours  of  her  treatment,  opium 
Ixviij.  and  sulph.  morph.  gr.  vij. ;  or  counting  one  grain  of  sulph.  moii)h.  as  four 
grains  of  opium,  one  hundred  and  six  (106)  grains  of  opium.  In  the  second  24 
hours,  she  took  opium  gr.  cxlviii.,  and  sulph.  morph.  Ixxxj.,  or  opium  four  hundred 
and  seventy-two  (472)  grains !  On  the  third  day,  she  took  236  grains  ;  on  the  fourth, 
120  grains;  on  the  fifth,  54  grains;  on  the  sixth,  22  grains;  on  the  seventh,  8 
grains ;  after  which  the  treatment  was  wholly  suspended.  This  woman  was  not  ad- 
dicted to  drinking,  and,  after  her  recovery,  she  assured  me  repeatedly  that  she  did 
not  know  opium  by  sight,  and  had  never  taken  it,  or  any  of  its  preparations,  unless 


1118       NOTE  I. REMEDIAL  ACTION  THROUGH  THE  HEART. 

it  had  been  prescribed  by  a  physician.  This  is,  perhaps,  '  horrible  doMng, '  and  only 
justifiable  as  an  experiment  on  a  desperate  disease ;  yet  this  woman  is  alive  to  tell 
her  own  story,  as  are  several  others,  who  took  surprising  quantities  of  this  drug. 
But  later  observations  have  shown  that  the  tenth  to  the  thirtieth  part  of  this  maxi- 
mum is  sufficient  in  controlling  the  disease'  "  (§  960  a,  1064,  1065  d). 

Although  we  may  not  hope  to  defeat  the  attempts  to  substitute  other  means  for 
bloodletting,  ranging  from  dry-cupping  to  tonics  and  stimulants,  or  consisting  of  the 
most  violent  poisons  of  the  Materia  Medica — aconite,  tobacco,  veratrum  viride,  opi- 
um, &c.  (§  960,  1065  a) — and  where  the  abstraction  of  blood  maybe  most  demanded 
by  the  exigencies  of  disease,  we  may  reasonably  insist  that  the  doses  shall  not  be  so 
large  as  to  incur  the  penalties  of  the  law  were  they  administered  by  any  other  than 
professional  hands.     It  was  worthily  said  by  Sigmond  to  his  medical  Class,  that 

"There  is  no  doubt  that  any  indiscretion  in  the  use  of  violent  remedies,  any  want 
of  caution,  may  prove  fatal ;  and  notwithstanding  the  occasional  escape  of  persons 
after  the  employment  of  fearful  doses,  I  would  impress  upon  your  minds  that  you  are 
never  justified,  because  a  solitary  case,  here  and  there,  is  thrust  before  your  notice  of 
extravagant  quantities  having  been  given,  to  administer,  but  with  the  remembrance 
of  the  sacredness  of  human  life,  any  remedy  which  may  have  the  slightest  uncertainty 
in  the  intensity  of  its  action.  Nor  do  I  think  if  any  untoward  event  occurred  in 
your  practice  from  a  very  large  dose  that  an  excuse  should  be  pleaded  on  the  score 
that  in  some  particular  case  such  a  quantity  had  been  fearlessly  employed,  and  for- 
tunately no  bad  effects  had  resulted"  (p.  720,  §  960  o). — Sigmond's  Lectures  in  Lon- 
don Lancet,  December,  1837,  p.  403, 404. 


NOTE  I.— REMEDIAL  ACTION  THROUGH  THE  HEART. 

Note  I. — In  sections  500  m,  604i,  826  cc,  «&c.,I  have  represented  the  action  of 
the  heart  when  influenced  by  remedies  as  resulting  generally  from  either  .their  mod- 
ifying efi'ccts  upon  disease  and  a  consequent  modification  of  the  nervous  influence 
thus  reflected  upon  the  heart,  or  from  a  simple  modification  of  that  influence  gener- 
ated by  the  direct  action  of  the  remedy  upon  the  part  to  which  it  may  be  ap])lied — 
either  the  gastro-intestinal  mucous  membrane  or  the  skin — while  in  §  1065  a  I  have 
imputed  tl)e  effect  of  certain  agents,  digitalis,  colchicum,  veratrum  viride,  in  dimin- 
ishing the  frequency  of  the  pulse  to  a  narcotic  virtue,  and  have  objected  to  the  ther- 
apeutical conclusions  which  have,  in  consequence,  been  predicated  of  those  remedies. 
The  latter  are  examples  which  illustrate  the  difficulties  of  medicine  ;  for  there  can 
be  no  greater  fallacy  than  the  hypothesis  that  "remedies  which  lessen  the  frequency 
of  the  pulse  are  best  adapted  to  inflammatory  and  febrile  diseases."  Every  thing 
depends  upon  the  mode  in  which  the  heart's  action  is  influenced.  To  be  significant 
of  a  salutary  effect,  whether  the  modified  action  consist  in  a  diminished  frequency  or 
any  other  apparently  favorable  change,  the  influence  must  C(*me  especially  thijpugh 
a  salutary  impression  upon  the  parts  diseased,  if  the  heart  have  been  disturbed  by 
such  affections ;  or,  if  such  disturbance  of  that  organ  have  not  been  thus  inflicted, 
the  modifying  influence  of  any  remedy  upon  its  action,  per  se,  is  either  useless  or  in- 
jurious, although  a  salutary  e'ffect  of  the  agent  upon  any  morbid  process  may  sim- 
ultaneously exert  a  modifying  influence  upon  the  heart's  action.  To  be  useful, 
therefore,  the  blow  must  be  struck,  not  at  the  heart,  but  at  those  extreme  vessels  which 
carry  on  the  morbid  process  (§410,411,639,750,999  c)  ;  and  hence  our  conclusion, 
as  expressed  in  the  text  (p.  800),  that  the  substitution  of  veratrum  viride,  &c.,  for  the 
abstraction  of  blood  in  the  treatment  of  inflammation  has  grown  out  of  very  mis- 
taken views  in  pathology  and  ther.^peutics.  It  is  true,  however,  of  some  other  rem- 
edies that  diminish  the  frequency  of  the  heart's  action  by  their  direct  effect  upon  the 
gastro-intestinal  mucous  membrane,  as  small  and  frequently  repeated  doses  of  tar- 
tarized  antimony,  and  jalap  in  cathartic  doses  (§516  d,  No.  0, 904  bb,  1060, 1063  />), 
that  this  effect,  which  is  in  no  respect  due  to  a  narcotic  virtue,  doubtless  contributes 
to  the  salutary  influence  which  is  simultaneously  and  essentially  impressed  by  the 
remedy  upon  the  instruments  of  the  morbid  process,  and  which  is  indispensable  to 
any  lasting  effect  upon  the  heart's  action  if  that  organ  have  sustained  any  disturb- 
ance as  a  consequence  of  the  malady  (§  500  m). 


NOTE   K. EXCESSIVE   MEDICATION   BY   QDINIA.  1119 


NOTE  K.— EXCESSIVE  MEDICATION  BY  QUINIA. 

Note  K. — To  illustrate  still  farther  the  empirical  nature  of  the  practice  of  admin- 
istering large  doses  of  quinia  in  the  treatment  of  intermittent  fever  (§  892  d-k),  as 
well  as  the  fallacy  of  the  humoral  hypothesis,  and  to  show  the  probability  that  such 
excessive  medication  must  be  injurious,  as  variously  set  forth  in  former  sections 
(§  675,  863  d,  870  aa,  900,  904  d,  &c.),I  shall  introduce  here  the  experience  of  Mr. 
Parkin,  of  England,  who,  in  1842,  visited  the  South  of  France,  where  the  intermit- 
tent fever  was  very  prevalent  and  obstinate,  and  where  some  of  the  resident  physi- 
cians were  just  beginning  the  treatment  of  the  fever  by  the  compound  of  quinia  and 
carbonic  acid  gas ;  and  it  was  particularly  to  witness  the  effects  of  this  compound 
that  the  visit  was  made.  The  dose  of  the  solution  of  sulphate  of  quinia  along  with 
the  gas  that  was  employed  by  Mr.  Parkin  was  generally  an  ounce  and  a  half,  which 
contained  much  less  than  a  grain  of  the  sulphate  of  quinia.  The  largest  doses  had 
only  a  grain  and  a  half.  His  success  was  so  remarkably  great  that  in  the  following 
autumn  he  went  to  Madrid  for  the  same  purpose,  where  the  Minister  of  the  Interior 
assigned  to  him  a  ward  in  the  General  Hospital  of  that  Capital  to  carry  on  his  ex- 
periments, and  here  he  was  equally  successful  with  the  moderate  treatment  as  he 
had  been  in  the  South  of  France.  But  it  was  not  only  by  small  doses  of  the  alka- 
loid that  he  accomplished  his  cures,  but  often  by  a  single  dose.  And  now  observe 
how  his  critical  experience  as  to  the  most  useful  time  for  administering  the  dose  con- 
tradicts the  humoral  hypothesis,  both  as  to  the  pathology  of  the  disease  and  the  mo- 
dus operandi  of  the  remedy,  and  establishes  my  interpi-etation  of  the  latter  through 
reflected  actions  of  the  nervous  system.  "  The  result  of  these  trials,"  says  Mr.  Par- 
kin, "  confirm  me  in  a  conclusion  I  had  previously  formed  as  to  thQ  proper  time  for 
the  administration  of  the  remedy,  which  I  found  to  be  inimediateltj  before  the  acces- 
sion of  a  paroxysm.  When  thus  administered,  I  have  generally  found  that  it  short- 
ened the  paroxysm,  and  that  it  arrested  it  altogether,  upon  the  average,  at  the  third 
administration  of  the  remedy.  The  same  result  was  experienced  in  old  as  in  recent 
cases,  even  where  the  disease  had  existed  twelve  months.  There  were  numerous 
cases  in  which  no  return  was  experienced  after  the  first  administration  of  the  reme- 
dy, while  in  some  cases  the  expected  attack  was  not  experienced  at  all."* — London 
Lancet,  April  29,  1843,  p.  139. 

That  the  remedy  should  be  administered  at  some  period  of  the  intermission,  and 
suspended  during  a  paroxysm,  has  been  always  I'cgarded  as  an  indispensable  rule  of 
practice  (§  675) ;  but  in  the  case  of  the  particular  compound  now  before  us,  it  was 
found  by  a  critical  observer  that  the  most  appropriate  time  was  circumscribed  within 
a  few  minutes.  Now,  if  the  doctrine  of  operation  by  absorption  had  any  foundation 
—whether  the  remedy  be  supposed  to  neutralize  or  extinguish  some  poison  assumed 
to  exist  in  the  blood,  according  to  a  large  school,  or  to  unite  chemically  with  the 
solids,  according  to  Liebig  and  his  followers  (p.  171,  No.  42), — the  remedy  if  admin- 
istered during  the  hot  stage  of  a  paroxysm  of  intermittent  fever  should  not  as  uni- 
formly aggravate  and  prolong  the  disease  as  it  arrests  its  career  when  administered 
during  the  period  of  intermission  (§  675),  and  least  of  all  should  it  be  most  salu- 
tary if  given  at  the  precise  moment  indicated  by  Mr.  Parkin. f 

I  have  illustrated  the  influence  of  vital  habit  by  a  reference  to  the  periodical  return 
of  an  intermittent  fever  through  a  series  of  years,  notwithstanding  the  early  removal 
of  the  subject  from  a  miasmatic  region  to  a  climate  entirely  exempt  from  intermit- 
tents  (§  560) ;  a  fact  which,  in  itself,  disposes  of  the  whole  question  before  us,  wheth- 
er it  respect  the  assumed  absorption  of  a  poison,  its  continued  presence  in  the  system, 
or  the  humoral  interpretation  of  the  modus  operandi  of  the  remedy.  Analogous 
facts  abound  in  the  history  of  diseases,  and  are  worthy  the  consideration  of  those 
who  aspire  at  the  realities  of  Nature,  and  would  escape  the  seductive  simplicity'  of  the 
substitutions  of  art  (§  506,  526  c,  657  a,  826  b,  828  a).  Again,  also,  in  all  our  rea- 
soning upon  these  leading  principles  in  the  philosophy  of  medicine,  we  should  not 
neglect,  in  connection  with  the  foregoing  subject,  tlie  minuteness  of  the  quantity  of 
quinine  that  may  be  sufficient  to  arrest  a  very  violent  and  protracted  fever  (§  870  aa) ; 
and  the  same  may  be  alleged  of  the  arsenical  preparations. 

*  The  folio-wing  ia  the  formula  employed :  R  Sulphate  of  quinia,  grs.  xvi. ;  tartaric  acid,  gra.  Ix. ; 
oicarbonate  of  Eoda,  gra.  Ixxv. ;  water,  tbij.    The  alkaline  carbonate  i3  added  last. 

t  See  corresponding  evidence  and  philosophy  of  tlie  subject  at  p.  430^32,  §  CT5 ;  p.  54S-549, 
5  SOS  d;  p.  59T,  i  S;)2  c  •  p.  T39,  §  987 


1120      NOTES   L-M. ARSENIC   AND   ANTI-PERIODICS. ANAESTHETICS. 


NOTE  L.— MODUS  OPERANDI  OF  AESENIC  AND  ANTI-PERIODICS. 

Note  L. — As  to  the  modus  operandi  of  arsenic  (§  892^  g),  it  is  readily  seen  from 
the  mineral  nature  of  the  substance  that  it  cannot  exert  the  same  effects  as  the  veg- 
etable substance  Peruvian  bark,  no  more  so  than  does  the  animal  product,  spider's 
web,  in  doing  the  same  thing,  exercise  the  influences  of  either,  no  more  so  than 
when  an  emetic,  or  a  strong  mental  emotion,  or  loss  of  blood,  suddenly  breaks  up 
the  same  condition  of  disease.  And  yet  the  chemist  has  the  singular  infelicity  to  tell 
us  that  all  this  medley  of  things  cures  intermittents  equally  either  by  their  chemical 
union  with  some  imaginary  poison  in  the  blood,  or  by  forming  new  compoimds  with 
the  solids ;  which  is  equivalent  to  saying  that  arsenic  and  cinchona  and  spidei-'s  web 
(neglecting  emetics  and  mental  emotions  and  loss  of  blood)  will  as  readily  unite  with 
each  other  as  acids  do  with  alkalies  (§  675,  863  d,  870  aa,  892  b-k,  900,  904  d,  986). 

The  vital  solidist,  in  rejecting  the  chemical  rationale,  may  briefly  reiterate  the 
philosophy  which  he  would  substitute — that  each  agent  has  its  peculiar  virtues,  ex- 
ceedingly unlike  where  they  are  most  curative  (as  cinchona,  arsenic,  and  spider's 
web),  and  each  exerts  its  own  peculiar  changes  in  the  morbid  states,  places  them  in 
other  conditions  less  intensely  morbid,  and  thus  enaTales  the  physiological  laws  to  in- 
stitute the  restorative  process  (§  854,  900,  902  h,  904  hh).  No  matter,  therefore, 
whether  arsenic  be  administered  in  simple  intei-mitting  fever,  or  as  that  disease  may 
be  complicated  with  chronic  cutaneous  eruijtions,  when  the  impression  is  made  which 
enables  the  great  recuperative  law  to  throw  off  the  fever,  the  same  artificial  change 
may  equally  induce,  through  the  same  constitutional  principle,  the  disappearance  of 
the  chronic  aff'ections  of  the  skin  (§  902,  1059).— Note  R  p.  1123. 

Again,  that  the  constitutional  effects  of  arsenic  depend  upon  its  primary  action 
upon  the  alimentary  mucous  tissue  and  the  subsequent  development  and  reflection 
of  an  alterative  nervous  influence  may  be  distinctly  shown  by  the  remarkable  con- 
trast in  the  phenomena  and  pathological  conditions  that  are  induced  in  different  in- 
dividuals by  poisonous  doses.  It  is  well  known  that  the  symptoms  are  generally 
those  of  violent  gastro-enteritis,  but  that  there  are  rare  instances  in  which  the  symp- 
toms are  such  as  are  produced  bj  poisoning  with  opium.  Of  these  exceptions,  which 
form  a  most  imposing  contrast  with  the  more  numerous  class  of  cases,  there  has  oc- 
curred in  my  practice  one  strongly  marked  example,  in  which  vomiting  was  effected 
with  difficulty  by  emetics,  and  which  would  have  been  mista'Kcn  for  poisoning  by 
opium  had  not  the  nature  of  the  cause  been  known  from  the  beginning.  About  an 
ounce  of  the  white  oxide  of  arsenic  had  been  swallowed,  and  large  quantities  of  it 
were  thrown  off  from  the  stomach.  Death  took  place  in  about  twelve  hours.  Leth- 
argy came  on  early,  and  was  very  overpowering.  No  gastric  uneasiness  or  purging. 
Respiration  became  very  slow  some  six  hours  before  death,  accompanied  by  a  very 
irregular  pulse,  varying  from  twenty  to  fifty  beats  in  two  successive  minutes,  but  not 
intermitting.  The  action  of  the  heart  was  strongly  affected  by  the  respiratory  move- 
ments, which  were  without  any  uniformity.  They  would  be  suspended  for  several 
seconds,  and  then  would  follow  a  long  and  deep  inspiration ;  and  of  these  move- 
ments there  were  from  three  to  six  in  a  minute.  During  the  suspension  the  pulse 
would  sink  down  to  its  lowest  frequency,  and  when  inspiration  took  place  the  pulse 
would  suddenly  bound  from  20  to  40  or  50  strokes,  and  become  much  increased  in 
volume.  The  case  being  obvious,  the  distress  of  the  family  rendered  it  inexpedient 
to  request  an  examination  after  death.  But  post  mortem  examinations  have  been 
made  in  other  analogous  cases. 

The  principal  remaining  point  to  be  observed  in  the  two  series  of  cases  is  the  cor- 
respondence of  the  cadaverous  appearances  with  the  phenomena  during  the  action 
of  the  poison,  and  it  shows  that  the  difference  in  the  local  and  constitutional  symp- 
toms, in  the  opposite  cases,  is  owing  to  the  different  modes  in  which  the  gastro-intes- 
tinal  mucous  membrane  is  affected  by  the  poison ;  since  it  exhibits  in  one  series  of 
cases  the  most  positive  signs  of  inflammation,  while  in  the  other,  or  form  of  narcotic 
poisoning,  no  morbid  condition  of  the  stomach  at  all  resembling  inflammation  is  ap- 
parent on  dissection  (§  512,  826  cc,  841,  902,  904  bb). 


NOTE  M.— MODUS  OPERANDI  OF  ANiESTHETICS. 

Note  ^M. — In  speaking  of  the  modus  operandi  of  chloroform  and  sulphuric  ether 
when  respired,  I  adverted  to  the  difference  in  their  effects  when  employed  in  that 


NOTES   N-P. DIGESTION   NECESSARY    TO   NUTRITION,  ETC       1121 

manner  and  as  administered  by  the  stomach  (p.  8G4r,  §  lOGG  b),  and  intended  to  im- 
ply that  such  a  diiference  should  not  obtain  if  these  agents  operate  tlirough  the  me- 
dium-of  the  circulation.  They  shoidd  not  manifest  the  effects  simply  of  a  diffusible 
stimulant  in  one  case  and  of  an  antesthetic  in  the  other;  for,  whether  absorbed  through 
the  mucous  tissue  of  the  lungs  or  of  the  stomach,  or  whether  the  supposed  intermix- 
ture with  the  blood  take  place  in  the  pulmonary  air-cells  or  at  the  junction  of  the 
chyliferous  duct  with  the  subclavian  vein,  there  can  be  no  difference  as  to  the  impreg- 
nation of  the  blood,  which  is  the  essential  fact  in  question.  But  a  ready  explanation 
of  the  difference  in  effects  will  be  found  in  the  vast  difference  between  the  vital  con- 
stitution and  functions  of  the  mucous  membranes  of  the  stomach  and  of  the  lungs, 
and  in  the  well-known  diversity  of  effects  that  arise  from  a  thousand  cause*  as  they 
may  be  introduced  into  one  organ  or  the  other  (§  133-137).  Each  cause  exerts 
special  but  different  effects  upon  the  mucous  membrane  of  either  organ  respectively; 
and  according  to  those  effects  the  nervous  influence  will  be  developed  and  modified 
in  a  corresponding  manner,  and,  by  its  reflection  upon  other  parts,  will  exert  upon 
them  effects  corresponding  with  the  primary  impressions,  as  variously  expounded  in 
this  work. 

Again,  if  it  be  true,  according  to  Lallemand,  that  "ether,  chloroform,  and  amy- 
lene  are  absorbed  and  act  first  in  a  direct  manner  on  the  brain  and  other  nervous 
centres,  where  they  accumulate,  and  are,  as  it  were,  stored  tip,  and  that,  secondly,  they 
afterward  proceed  to  act  upon  the  blood,"  there  should  not  be,  under  such  circum- 
stances, any  necessity  for  the  uninterrupted  respiration  of  antesthetics  to  maintain  in- 
sensibility, nor  any  sudden  subsidence  of  the  ana?sthetic  influence.  But  the  facts 
establish  an  evanescent  effect  conformable  to  superficial  impressions  of  a  very  tran-i 
sitory  nature,  Avhich  as  suddenly  and  transiently  rouse  the  nervous  influence,  while 
they  equally  and  as  plainly  contradict  the  hypotiiesis  of  ^^accumulation  and  storing 
up"  (§  827).      Finally,  the  volatility  of  these  agents  is  against  the  doctrine. 


NOTE  N.— DIGESTION  NECESSARY  TO  NUTRITION. 

Note  N. — If  it  be  admitted  that  alcohol,  sugar,  animal  broths,  &c.,  enter  the  cir- 
culation unchanged,  it  is  impossible  that  they  should  be  tributary  to  nutrition,  since 
that  unique,  homogeneous  substance  the  blood  can  alone  fulfil  this  great  ultimate  ob- 
ject of  the  elaborate  system  of  organs  which  is  designed  for  the  formation  and  vital- 
ization  of  that  fluid,  and  towards  which  the  first  and  indispensable  step  is  a  positive 
change  instituted  in  all  nutritive  matter  by  the  gastric  juice,  while  the  kidneys  are 
placed  at  the  other  extremity  of  the  series  in  part  for  the  removal  of  any  matter 
which  may  have  escaped  the  organizing  influence  of  the  chylopoictic  organs.  Hence, 
the  application  of  butter,  &c.,  to  the  skin,  and  that  most  plausible  of  all  devices  to 
sustain  the  bodv,  enemas  of  animal  broths,  must  be  regarded  as  fallacious  (p.  171, 
172,  §  350,  Nos'  41,  42,  43,  94 ;  p.  222,  §  409  b ;  440  bb,  441  c;  p.  790,  §  1032  6). 


NOTE  O.— CEREBRAL  CIRCULATION. 

Note  O. — In  confirmation  of  the  conclusion  from  my  experiments  upon  the  brain 
that  the  quantity  of  blood  circulating  within  the  organ  has  been  much  overrated,  it 
should  have  been  said  in  the  text  at  page  826  that  both  carotids  have  been  success- 
fully tied  in  the  human  subject,  at  an  interval  of  a  few  days  for  each  carotid,  with- 
out injury  to  the  cerebral  functions.  In  some  animals,  as  the  rabbit,  tlic  same  oper- 
ation has  been  performed  simultaneously  upon  both  carotids  and  one  vertebral  arteiy 
without  injury  to  the  brain. 


NOTE  P.— EXAGGERATIONS  OF  INSTINCT. 

Note  P. — If  the  following  statement  has  not  been  made  as  an  illustration,  merely, 
of  the  propensity  to  magnify  the  endowments  of  Instinct,  it  was  designed  not  only 
to  ascribe  the  rational  faculty  to  animals,  but,  in  presenting  a  case  of  dishonesty,  to 
impute  to  them  the  moral  sense  or  conscience  (§  1078  h,  I).  It  is  derived  from  Dr. 
John  Brown's  veracious  Horce  Subsecivre  (vol.  ii.): 

"  Mr.  Carruthers,  of  Inverness,  told  me  a  new  story  of  these  wise  sheep-dogs.     A 

4B 


1122         NOTE    Q. PARAPI-EGIA.    AND    KEFLEX   KERV0U9    ACTION. 

butcher  from  Inverness  had  purchased  some  sheep  at  Dingwall,  and  giving  them  in 
charge  to  his  dog,  left  the  road.  The  dog  drove  them  on  till,  coming  to  a  toll,  the 
toll-wife  stood  before  the  drove  demanding  her  dues.  The  dog  looked  at  her,  and, 
jumping  on  her  back,  crossed  his  forelegs  over  her  arms.  The  sheep  passed  through, 
and  the  dog  took  his  place  behind  them  and  went  on  his  way." 


NOTE  Q.— PARAPLEGIA  AND  REFLEX  NERVOUS  ACTION. 

Note  Q. — In  expounding  the  causes  of  a  form  of  paraplegia  which  Dr.  Brown- 
Sequard  denominates  reflex,  in  his  recent  "Lectures  on  Paralysis  of  the  Lower  Ex- 
tremities" (1861),  several  principles  are  recognized  that  are  tributary  to  some  of  tbc 
important  doctrines  of  these  Institutes.  The  Author  supposes,  for  example,  that  af- 
fections of  internal  organs  will  not  only  induce  a  congestive  state  of  some  portion 
of  the  spinal  cord  that  will  lead  in  a  direct  manner  to  paralysis  of  the  lower  ex- 
tremities, but  that  at  other  times  they  will  propagate  a  morbific  influence  througli 
sensitive  upon  excito-motory  nerves,  and  thus  occasion  "  a  contracted  or  spasmodic 
condition  of  the  blood-vessels  of  the  spinal  cord,  unaccompanied  by  actual  sti'uctural 
alteration,"  which  results  in  paralysis  of  the  lower  extremities.  Although  it  be  true 
that  the  supposed  contraction  of  the  blood-vessels  cannot  be  anatomically  shown, 
but  is  inferred  from  the  absence  of  morbid  vascularity  in  connection  with  an  experi- 
ment to  be  soon  mentioned,  and  although  I  apprehend  that  the  supposed  contracted 
^tate  of  the  blood-vessels,  if  founded  in  fact,  is  no  more  occasioned  by  reflected  nerv- 
ous influence  than  the  simply  congested  ones  in  the  other  series  of  cases,  and  that 
they  are  on  common  ground  throughout,  in  a  physiological  sense,  as  sources  of  para- 
lytic influence,  I  present  the  problems  not  only  as  admitted  exemplifications  of  the 
j)roduction  of  spinal  disease  by  morbid  states  of  internal  organs,  but  as  introductory 
to  a  demonstration  by  our  able  physiologist  of  the  local  and  special  influences  which 
are  exerted  upon  the  blood-vessels  of  the  spinal  cord  by  irritations  of  distant  organs, 
particularly  the  kidneys,  through  which  the  vessels  may  be  brought  into  a  state  of 
contraction,  and  that  the  coi'd  thus  artificially  afi'ected  may  exert  a  paralyzing  effect 
upon  the  lower  extremities.     The  following  is  the  demonstration  : 

"A  contraction  of  the  blood-vessels  in  the  pia  mater  of  the  spinal  cord  I  have  seen 
taking  place  under  my  eyes  when  a  tightened  ligature  was  ajjplied  on  the  hilus  of 
the  kidney,  irritating  the  renal  nerves,  and  when  a  similar  operation  was  performed 
on  the  blood-vessels  and  nerves  of  the  suprarenal  cajisules.  Generally,  in  these 
cases  the  contraction  is  much  more  evident  on  the  side  of  the  cord  corresponding 
with  the  side  of  the  irritated  nerves,  which  fact  is  in  harmony  with  another  and  not 
rare  one  as  regards  the  kidney,  and  often  seen  by  me  after  the  extirpation  of  one  kid- 
ney, or  one  suprarenal  capsule,  that  is,  a  paralysis  of  the  corresponding  lower  limb." 

The  novel  and  interesting  fact  in  the  foregoing  quotation  consists  in  the  influencC-s 
which  were  actually  seen  to  have  been  exerted  ujion  the  blood-vessels  in  the  sjjinal 
cord  by  irritations  of  organs  remotely  situated,  and  the  corroborr.ting  light  which  is 
thus  reflected  upon  tlie  philosophy  inculcated  in  these  Institutes  concerning  the 
transmission  of  influences  to  and  from  the  nervous  centres,  whether  brain,  spinal 
cord,  or  ganglia  and  plexuses  of  the  sympathetic  system,  through  which  I  have  inter- 
preted not  only  the  diseases  which  follow  consecutively  upon  each  other,  but  the 
modus  operandi  of  morbific  and  remedial  agents,  and  have  thus  endeavoured  to  de- 
monstrate the  artificial  and  fictitious  nature  of  the  entire  fabric  of  humoralism. 
Even  Brown-Se'quard  argues  from  his  experiment,  especially,  that  reflex  paraplegia 
is  occasioned  by  "a  contracted  or  spasmodic  condition  of  the  blood-vessels  of  the 
spinal  cord,  owing  to  an  irritation  reflected  upon  their  walls,  and  originating  from 
witliout,  unaccompanied  by  actual  structural  alteration."  Such  may  or  may  not  be 
the  immediate  cause  of  the  paralysis;  but  that  influences  upon  the  vascular  system 
of  the  brain,  and  upon  the  cerebral  substance,  are  constantly  exerted  by  remote  af- 
fectiojis  and  by  morbific  and  remedial  agents,  is  corroborated  by  most  of  the  phenom- 
ena that  are  presented  througliout  the  vast  fields  of  pathology  and  therapeutics.  So 
obvious  is  all  this,  and  such  are  the  special  developments  and  modifications  of  the 
nen-ous  influence,  and  such,  accordingly,  are  its  effects  in  organic  life,  that  I  have 
imputed  much  of  the  depressing  effect  of  loss  of  blood  to  a  contraction  of  the  cere- 
bral  vessels  as  contributing  to  the  development  of  that  depressing  nervous  influence 
which  is  so  largely  concerned  in  the  operation  of  loss  of  blood  (§  942,  950,  p.  827, 
§  lO'tiV),  and,  on  the  other  hand,  the  resistance  of  its  effects  to  a  stimulating  nerr- 
ous  influence  arising  from  an  excited  state  of  the  cerebral  blood-vessels  in  inflamma- 
tions of  the  brain  and  of  other  organs  (§  233i,  974,  p.  828,  <J  1056,  Dondeh). — Note 
T  p.  1125,  "Warren's  ease.     Also,  p.  920,  Note. 


NOTE    R. REMEDIAL   ACTION,   CHEMICAL    DOCTRINE.  1123 


NOTE  R.— REMEDIAL  ACTION,  CHEMICAL  DOCTRINE. 

Note  R. — Chemistry,  as  we  have  seen  (p.  171,  §  350,  Nos.  41,  42,  <fec.),  informs 
us  that  remedial  agents  accomplish  the  removal  of  disease  by  uniting  citlier  with 
the  solids  or  the  blood,  or  by  neutralizing  some  poison  supposed  to  be  intermixed 
with  or  contaminating  the  blood,  or  by  expelling  the  poison  from  the  body,  &c. 
Without  having  called  upon  Chemistry  for  the  proof  of  these  assumptions,  I  have 
shown  that  they  are  variously  contradicted  not  only  by  the  whole  history  of  reme- 
dial action  and  the  soundest  principles  in  pathology,  but  by  the  logical  facts  of 
Chemistry  itself.  Among  the  multitude  of  the  former  nature  the  consideration 
alone  of  the  variety  of  things  which  will  quickly  subdue  an  intermittent  fever  (cin- 
chona, arsenic,  spider's-web,  opium,  an  emetic,  blood-letting,  mental  emotions,  &c., 
§  900,  986-988,  Note  L),  is  demonstrative  of  the  fallacy  of  the  entire  compass  of 
the  chemical  rationale.  Nevertheless,  it  is  my  purpose  in  this  Note  to  add  a  few 
words  of  comment  upon  that  branch  of  the  doctrine  which  assumes  that  remedies 
unite  chemically  with  the  blood  or  with  the  solids,  and  that  they  thus  transmute  the 
morbid  into  healthy  conditions.  This  is  Liebig's  philosophy,  and  obtains  extens- 
ively in  the  medical  ranks.  It  has  the  air  of  science  upon  its  front ;  but  it  is  as 
unmitigated  an  assumption  as  the  doctrine  of  the  permeation  of  tissues  set  forth  in 
§  350^  n,  and  is  contradicted  by  the  realities  of  Chemistry.  Take,  as  an  example, 
the  statements  quoted  at  p.  171,  Nos.  41,  42,  from  Liebig's  ^^  Animal  Chemistry." 
What  possible  apology,  derived  from  the  domain  of  cliemistry,  can  be  offered  for 
the  proposition  that — "if,  by  the  introduction  of  a  substance,  certain  abnormal  con- 
ditions are  rendered  normal,  it  will  be  impossible  to  reject  the  opinion  that  this 
phenomenon  depends  on  a  change  in  the  composition  of  the  constituents  of  the  dis- 
eased organism,  a  change  in  which  the  elements  of  the  remedy  take  a  share  in  the 
formation  of  new  or  transformation  of  existing  compounds  similar  to  that  which  the 
vegetable  elements  of  food  have  taken  in  the  formation  oi  fat,  of  membranes,  of  the 
saliva,  of  the  seminal  fluid,  &c."  ! 

The  foregoing  assumption  derives  its  importance  from  the  general  currency  which 
it  has  obtained  in  the  medical  profession.  Upon  this  dictum  liavc  been  founded 
the  enormous  abuses  of  iron  in  the  treatment  of  pulmonary  consumption,  anajmia, 
chlorosis,  &c.,  and,  indeed,  the  general  administration  of  remedies,  whether  they 
consist  of  elementary  substances,  like  iodine,  or  of  inorganic  or  organic  compounds, 
some  of  which  (as  the  phosphate  of  iron)  have  obtained  the  name  of  '■'' chemical 
food.^'  Iron,  particularly,  is  supposed  to  meet,  in  this  way,  the  exigencies  of  an 
endless  train  of  the  most  dissimilar  maladies,  on  account  of  its  assumed  deficiency 
in  the  blood  and  of  its  uniting  readily  with  the  globules.  But  it  is  remarkable  that 
it  appears  not  to  have  been  considered  that  nothing  but  food,  properly  so  called, 
undergoes  digestion,  certainly  not  inorganic  substances,  nor  the  organic  of  the  Ma- 
teria Medica,  and  that  without  antecedent  digestion  by  the  chylopoietic  organs 
every  thing  which  gains  admittance  into  the  circulating  mass  of  blood  must  fail  of 
being  appropriated  to  any  useful  purpose,  and  must  necessarilj'  exist  in  the  same 
isolated,  inanimate  state  till  it  is  ejected  by  the  emunctories.*  If  it  exert  any  thera- 
peutical effect  it  can  be  only  through  its  direct  action  upon  the  solids  as  a  foreign 
agent  (§827  f,  904  c).  We  have  seen  that  even  saccharine  matter  (p.  788-790, 
§  1032  b),  broth,  even  (Note  N,  p.  1121),  to  be  appropriated  must  be  digested, 
vitalized,  subjected  at  least  to  the  gastric  juice  before  they  enter  the  circulation. 
Otherwise,  they  are  effete  matter.  Whether,  therefore,  regarded  as  nutriment,  or 
other  things  as  remedial  agents  in  virtue  of  their  "elements  taking  a  share,"  &c., 
as  quoted  above,  the  doctrine,  now  in  the  ascendant,  is  alike  discreditable  to  med- 
icine and  to  chemistry  (§  13,  17,  353,  3.54,  360,  837,  847  a). 

And  now  a  few  words  more  particularly  as  to  iron,  which,  like  alcoholic  liquors, 
quinia,  and  opium,  has  become  a  panacea.  Strangely  enough,  this  substance, 
whether  in  the  form  of  an  element,  or  of  its  compounds,  is  supposed  by  chemists  as 
well  as  physicians  to  unite  as  readily  with  the  blood  as  oxygen  gas,  while  there  is 
no  analogy  in  the  cases,  either  as  it  respects  the  chemical  aspect  of  the  subject,  or 
the  organs  provided,  respectively,  for  their  incorporation  with  the  blood — being  the 
peculiarly  constituted  lungs  in  the  one  case  (§  447^  e,  827  h),  and  a  verj'  complex 
and  elaborate  system  of  organs  in  the  other  (§  353,  354).  The  only  possible  mode 
in  which  iron  can  become  united  with  the  globules  of  blood  is  through  its  connec- 
tion with  organic  compounds,  duly  digested  and  vitalized  by  the  whole  labyrinth  of 
the  chylopoietic  organs  (§  17,  360),  and  its  presence  is  limited  to  the  blood  alone 

*  Contrary,  therefore,  to  general  belief,  watek  is  in  no  respect  appropriated,  but  merely  serves  to 
dilute  the  blood.     See  §  2T1,  419  r,  S27  6,  tOSS  L'. 


1124  NOTE  S. TYPHUS  AND  TYPHOID  FEVER. 

(§  447^  <i,  No.  1).  Whatever  benefit,  therefore,  iron  bestows  either  upon  the  blood 
or  the  solids  can  be  interjjreted  only  upon  the  principles  of  vital  solidism, — alone 
by  improving  the  functions  of  digestion.  Iodine,  lime,  all  the  elements  of  the  body, 
observe  preciselj'  the  same  rule  as  to  their  incorporation  with  the  blood  or  with  the 
folids,  while  it  is  just  the  reverse  with  plants  (§  II,  14,  17,  360).  It  is  among 
Liebig's  enlightened  statements  that  iron  exists  in  the  blood  in  the  state  of  an 
"organic  compound"  (§  447J-  «),  and  as  this  is  truly  its  condition  it  operates  as  a 
flirther  confirmation  of  the  foregoing  physiological  doctrine. 


KOTE  S.— TYPHUS  AND  TYPHOID  FEVER. 

Note  S. — But  little  is  said  specifically  of  typlius  fever  in  these  Institutes,  and  that 
little  occurs  mostly  in  sections  G86  b,  892  q ;  but  in  the  Medical  and  Physiological 
Commentaries  the  subject  is  discussed  extensively,  particularly  in  the  articles  upon 
tlie  Medical  "Writings  of  Louis,"  and  upon  the  "Philosophy  of  Venous  Conges- 
tion" (vol.  2).  In  these  Essays  the  Author  has  shown  that  there  is  no  such  affection 
as  ti/phoid  fever  as  distinguished  from  ti//>lnis  fever  (an  opinion,  also,  of  the  best 
informed),  and  that  this  disease  does  not  originate  on  tliis  continent  south  of  the 
latitude  of  about  41°.  The  Author,  who  became  familiar  witli  typhus  fever  during 
Iiis  pupilage  in  Boston,  and  was  extensively  concerned  with  it  in  Montreal  during 
the  first  fire  years  of  his  professional  life,  is  enabled  to  say  very  confidently  that  the 
disease  is  of  rare  occurrence  in  the  city  of  New  York  and  surrounding  countiy,  and 
only  so  whei'c  the  predisposition  has  been  contracted  in  a  more  northern  latitude. 
Such,  too,  is  the  testimony  of  able  and  long  established  physicians  in  this  city,  as 
recorded  by  the  Author  in  the  Essay  on  the  "Philosophy  of  Venous  Congestion" 
{Commentaries,  vol.  2,  p.  449-451,  note).  The  following  quotation  from  that  work 
affirms  the  same  of  places  still  farther  south : 

"The  hospital  of  Philadelphia  has  furnished  many  instances  of  typhoid  or  typhus 
fever;  but  we  infer  not  only  from  the  foregoing  facts  that  they  ■were  cither  imported 
cases,  or  derived,  as  in  tlic  spoi'adic  cases  of  our  own  hospital,  from  cellars,  &c., 
but  from  the  long  experience  of  the  distinguished  Di*.  Dewees,  of  that  city,  wlio  re- 
marks that  he  ^  has  never  had  an  opportunity  of  seeing  a  case  of  typhus,  although,^  as 
he  says,  '  ice  hear  constantly  of  this  disease,  and  our  bills  of  mortality  never  fail  to 
record  deaths  from  this  fever.' — 'Dy.'wts.^sI'  Practice  of  Physic,  p.  170,  171.  And  so 
Dr.  Davidge,  in  his  edition  of  Bancroft  on  Fever,  &c.  (p.  518),  'Typhus, 'he  says, 
'  is  not,  so  far  as  my  observation  has  extended,  a  disease  of  Maryland,  perhaps  not 
of  America,  at  any  rate  not  south  of  the  New  England  States.'  'Typhus,'  says 
Bancroft,  '  is  properly  a  disease  of  cold  climates'  {ibid,  p.  342).  John  Hunter  con- 
sidered it  a  disease  of  winter.  '  Heat,'  he  says,  '  proves  a  prevention  to  the  disease 
as  much  as  cold  forwards  its  production.' — London  Medical  Transactions,  vol.  3, 
p.  348.  The  same  statements  are  made  by  Blane,  Lind,  and  Trotter,  in  their  re- 
sjiectivc  treatises  on  Scu^^7,  &c." — Medical  and  Physiological  Commentaries, 
Vol.  2,  p.  450. 

As  to  Louis's  distinction  of  '■'■typhoid"  from  tyjihus  fever,  I  have  shown  it,  in  each 
of  the  foregoing  Essays,  particularly  in  the  analysis  of  the  "Writings  of  Louis,"  to 
be  simply  a  fiction.  So  far  as  the  celebrated  Parisian  malady  had  any  aflSnity  to 
typlms  fever  it  was  purely  typhus.  I  shall,  therefore,  without  farther  preface,  pro- 
ceed to  say — partly  in  defense  of  the  ground  which  I  have  hitherto  taken  upon  the 
subject,  and  jiartly  on  account  of  the  mortality  attendant  upon  the  disease — that 
the  so-called  "tyi)hoid"  or  "typhus  fever"  that  has  prevailed  as  a  most  fatal  epi- 
demic among  the  hosts  of  the  federal  and  rebel  armies  during  the  last  fourteen 
months  (now  September,  18G2)  is  the  common  congestive,  bilious  remittent  fever,  but 
which  is  made  to  put  on  some  of  the  worst  symptoms  of  typhus  fever,  (such  as  delir- 
ium and  subsultus  tendinuni),  by  the  general  treatment  of  the  aftection,  (with  some 
distinguished  exceptions),  from  the  very  outset,  by  tonics  and  stimulants,  of  which 
"Bourbon  whisky"  (p.  11 IG,  sub-note),  and  quinia  in  potential  doses  (§  892  d), 
are  prevailing  favorites.  For  the  purpose  of  informing  myself  as  to  the  diseases  of 
the  federal  army,  from  their  earliest  to  their  advanced  stages  (the  latter  of  which  now 
abound  in  the  hospitals  of  New  York),  I  visited  the  ])rincipal  encampments,  and 
was  in  constant  intercourse  with  the  sick  during  the  latter  part  of  July,  the 
whole  of  August,  and  the  former  part  of  September,  18GI,  at  the  large  and  numer- 
ous hospitals  in  and  around  Washington,  and  the  regimental  hospital  tents,  and. 


NOTE    T. SYMPATUETIC    OK   KEFI.EX   NERVOUS    ACTION.         1125 

also,  similar  rendezvous  of  the  sick  at  and  about  Fortress  Monroe.  These  hospitals 
and  tents  were  thronged  with  the  subjects  of  intermittent  and  remittent  fever,  but  I 
saw  not  a  case  of  typhus  fever,  and  recognized  in  every  case  of  the  so-called  "  ty- 
phoid fever"  the  familiar  remittent,  ihe  usual  companion  of  the  intermittent,  gener- 
ally mild  at  its  invasion,  but  apt  to  be  soon  aggravated  and  often  rendered  fatal  by 
the  tonic  and  stimulating  treatment.  Such  was  much  of  my  experience  with  the 
"Army  of  the  Potomac ;"  but  not  so  with  the  fewer  troops  then  at  Fortress  Monroe 
and  its  vicinity,  where  the  antiphlogistic  practice  mostly  obtained ;  and  although 
the  fever  was  identical  with  that  of  the  vast  army  in  the  region  about  Washing- 
ton, the  mortality  was  very  slender,  and  limited  to  the  stimulating  practice.  Here 
I  saw  patients  atfected  with  the  reputed  "typhoid"  restored  in  twenty-four  to  forty- 
eight  hours  by  an  emetico-cathartic  of  calomel  and  ipecacuanha.  This  was  as  late 
as  September.     The  contrast  between  the  two  methods  was  very  impressive. 

"The  regular  correspondent"  of  the  New  York  "Evening  Tost,"  in  a  commun- 
ication dated  Washington,  January  10th,  18(12,  remarks  that — "there  is  here  an 
immense  number  of  cases  of  the  so-called  typhoid  fever.  The  peculiarity  of  this 
fever,  as  it  is  developed  in  the  vicinity  of  Washington  at  the  present  time  is,  that  it 
is  of  a  malarious  type  and  origin,  so  that  if  treated  as  a  malarial  fever  it  soon  suc- 
cumbs, but  if  treated  as  an  ordinary  type  of  the  typhoid  fever  it  is  very  fatal." 

Nor  can  I  refrain  from  alluding  to  an  experiment  which  has  been  extensively 
made  in  the  army  of  employing  quinia,  and  "  Bourbon  whisky"  or  brandy,  as  proph- 
ylactics. In  the  Medical  and  Phijsiolo(]{oal  Coiimientaries  I  have  inquired  into 
the  history  of  prophylactics,  as  exemplified  particularly  in  the  use  of  calomel  to 
the  extent  of  salivation,  blood-letting,  and  stimulants,  the  first  two  of  which  have 
been  tried  upon  an  extensive  scale,  especially  upon  armies  invading  the  West 
Indies,  when  it  was  found  that  loss  of  blood  lessened  the  susceptibility  of  the  system 
to  the  causes  of  the  prevailing  fevei',  besides,  doubtless,  counteracting  the  stimulat- 
ing eiFect  of  the  ardent  heat  of  the  climate  and  of  the  animal  food.  In  another 
instance  Kobert  Jackson  illustrated  the  principle  under  consideration,  and  set  forth 
triumphantly  the  medical  aspect  of  temperance,  by  banishing  alcoholic  liquors  from 
the  British  Army  (p.  396,  §  621  a,  6.o9  b,  692  6,  c,  999,  1006  c— 1008,  1065  c, 
1068  a). — The  reverse  of  all  this  has  attended  the  stimulants  when  employed  as  a 
protective  means,  having  operated  not  only  as  subordinate  predisposing  causes  by 
rendering  the  system  more  susceptible  to  the  action  of  the  miasm  or  essential  pre- 
disposing cause,  but  also  as  exciting  causes  (§  630  e,  787,  801,  810,  813,  815,  961). 


NOTE  T.— SYMPATHETIC  OR  REFLEX  NERVOUS  ACTION. 

Note  T. — The  following  instance  of  reflex  nervous  action  corresponds  with  the 
experiment  of  reducing  the  temperature  of  one  hand  by  placing  the  other  in  cold 
water,  as  related  in  section  104:4:  a,  and  with  the  well-known  sense  of  itching,  &c., 
that  springs  up  as  a  sympathetic  consequence  of  a  similar  sensation  in  the  corre- 
sponding i)art  of  the  opposite  side  of  the  body.  Thus — "A  singular  case  is  noted 
in  the  Cairo  military  hospital  (December,  1861),  of  a  man  who  was  shot  in  the 
right  leg  and  had  it  amputated.  Sympathetic  action  took  place  at  once  in  the  other 
limb,  and  at  precisely  the  same  part  where  the  knife  had  severed  its  fellow  a  simi- 
lar pain  was  felt.  So  severe  did  this  become  that  the  leg  is  bandaged  and  treated 
as  if  itself  wounded." 

For  the  purpose  of  showing  the  inherent  power  of  action  in  the  arteries,  and  how 
that  action  is  excited  and  otherwise  influenced  by  the  nerves,  and  how  that  influ- 
ence may  be  exerted  through  the  reflected  process,  and  how,  also,  the  reflex  nervous 
influences  are  remarkably  displayed  in  corresponding  parts  of  opposite  sides  of  the 
body,  and  forming,  moreover,  a  good  example  of  continuous  sympathy,  I  introduced 
the  following  case  into  the  Medical  and  Physiological  Comuientaries  from  Warren's 
'■'■Surgical  Observations  on  Tumors.'" — Thus — "In  a  case  where  Dr.  Warren  tied  the 
right  carotid  on  account  of  an  erectile  arterial  tumor  situated  at  the  internal  angle  of 
the  right  eye,  this  vessel  and  its  opposite  fellow  and  their  branches  pulsated  with  vio- 
lence. The  ligature  on  the  right  carotid  removed  the  pulsation  of  the  left,  although 
'  the  vibrations  were  more  conspicuous  on  the  left  than  on  the  side  originally  de- 
ranged.' 'The  perfect  success,  from  tying  the  right  carotid,  showed  the  affection 
was  altogether  sympathetic'  "  (p.  827,  1056,  p.  920,  no??).— Med.  and  Puts.  Com., 
Vol.  2,  Article,  Theories  of  Inflammation,  p.  149— 1840.— Sec  Note  Q.    This  well 


1126      NOTE    U.— CONTINUOUS    SYMPATHY,   OR    CONTINUOUS    INFLUENCE. 

known  disposition  of  the  corresponding  parts  of  opposite  sides  of  the  body  to  sym- 
pathize with  each  other  has  its  foundation,  of  course,  in  an  identity  of  anatomical 
and  physiological  constitution,  which  is  very  well  shown  by  the  following  case  of 
purpura-hemorrhagica,  occurring  in  my  practice,  and  recorded  in  the  Essay  on  the 
"Philosophy  of  Venous  Congestion,"  in  Med.  and  Phts.  Com.,  Vol.  2,  p.  473. 
The  case  was  introduced  there  for  the  purpose  of  showing  the  active,  inflammatoiy 
nature  of  purpura-hemorrhagica,  in  opposition  to  the  humoral  pathology,  and  to 
exemplify  the  beneficial  effects  of  blood-letting  in  that  affection  (§  1002  d). — Thus 
the  Commentaries — 

"The  patient  having  passed  a  few  months  on  the  alluvion  of  the  Mississippi  was 
attacked  on  his  return  to  New  York  with  an  irregular  intermittent  fever.  In  its 
early  stage  a  general  extravasation  of  blood  took  place  over  about  one  half  of  the 
posterior  part  of  each  humerus,  occupying  in  each  arm  the  central  part.  The 
inferior  portion  of  the  lobe  of  each  ear  was  distended  with  extravasated  blood,  and 
just  at  the  middle  of  each  helix  was  another  narrow  oblong  extravasation  of  about 
half  an  inch.  A  similar  appearance  existed  in  the  conjunctiva  of  each  inner  can- 
thus  of  the  eye.  There  was  not  a  trace  of  any  effusion  in  any  other  part,  or  from 
an\'  of  the  internal  membranes.  The  parts  where  it  existed  were  very  tender  to 
the  touch.  There  were  obvious  signs  of  hepatic  congestion.  A  large  abstraction 
of  blood  immediately  arrested  the  effusion,  and  improved  at  once  the  strength  of 
the  patient,  who  soon  became  convalescent.  The  symmetrical  peculiarity  of  this 
case  is  worthy,  also,  the  consideration  of  the  humoral  pathologist"  (§  1002  d). 


NOTE  U.— CONTINUOUS  SYMPATHY,  OR  CONTINUOUS  INFLUENCE. 

Note  U. — Continuous  sympathy,  unlike  reflex  nei-vous  actions,  does  not  involve 
the  agency  of  the  nerves  excepting  as  they  are  an  elementary  part  of  the  compound 
tissues ;  but  the  impressions  resulting  from  continuous  sympathy  or  continuous  in- 
fluence are  constantly  giving  rise  to  reflex  nervous  actions  in  organic  life.  This, 
as  already  briefly  stated,  is  distinctly  seen  in  the  action  of  suppositories,  enemas, 
leeches  applied  to  the  anus  or  to  the  septum  nasi,  croton  oil  applied  to  the  tongue, 
&c.  (§  129  c,  /;  498,  51G,  No.  2,  828  d,  923  d).  The  examples  embraced  in  the  fore- 
going sections  are  intended  to  illustrate  the  subject  through  impressions  made  upon 
tiie  intestinal  mucous  tissue,  and,  therefore,  there  should  be  associated  with  expo- 
sitions of  this  philosophy  the  consideration  that  peristaltic  motion,  in  the  natural 
state  of  the  body,  is  excited  immediately  by  the  action  of  the  nervous  influence  upon 
the  intestinal  niuscular  tissue  (§  233|,  475i,  490,  514/  &c.). 

As  some  important  principles  in  medicine  are  involved  in  the  foregoing  philos- 
ophy, whether  continuous  influence  be  regarded  in  its  abstract  sense,  or  as  insti- 
tuting reflex  actions  of  the  nervous  system;  and  for  the  sake  of  having  the  whole 
philosophy  of  the  subject  before  us  in  this  Note,  and  with  reference  to  what  I  am 
about  to  say  of  rhubarb,  I  shall  recapitulate,  in  a  few  words,  some  of  the  expositions 
already  made.  Croton  oil  affords  a  clear  illustration,  as  it  exerts  a  cathartic  effect 
without  entering  the  stomach,  as  when  applied  to  the  tongue  of  an  apoplectic  subject, 
or  when  introduced  into  the  rectum  in  the  quantity  of  a  drop.  The  impression  ex- 
erted upon  those  places  is  propagated  continuously  along  the  mucous  tissue  (§  498), 
and  this,  being  equivalent  to  the  direct  passage  of  a  cathartic,  establishes  early  an 
alterative  reflex  nervous  action  which  falls  upon  the  muscular  tissue  of  the  intestine, 
and  thus  induces  purging,  and  upon  various  other  parts  according  to  their  existing 
susceptibilities,  the  activity  of  the  agent,  &c.  Suppositories  and  enemas  observe  the 
same  rule,  whether  they  be  stimulating,  irritating,  sedative,  anodyne,  soporific,  &c., 
the  reflected  nen'ous  action  being  modified  according  to  the  nature  of  the  exciting 
cause  (§  889  a,  b,  g,  890i  d,  89H  ^,  893  a).  So,  also,  of  leeching,  as  expounded 
in  sections  498  y,  ff. 

The  foregoing  retrospect  contemplates  among  its  purposes  a  confirmation  of  the 
philosophy  by  the  action  of  rhubarb,  and  a  demonstration  through  that  action  of  the 
jihysiological  operation  of  cathartics  as  distinguished  in  tliese  Institutes  from  the 
doctrine  of  operation  by  absorption.  It  may  be  very  briefly  stated.  If  a  little 
rhubarb  be  chewed  when  a  cathartic  is  about  taking  effect,  it  will  often  very  sensi- 
bly increase  the  peristaltic  movements  within  a  few  seconds,  and  without  being 
swallowed ;  the  mouth  itself  being  a  point  of  departure  for  the  reflected  nervous 
influence.     Doubtless  the  same  is  true  of  some  other  cathartics. 


NOTES   W-X. THE    MEDICAL  PUOFESSION. lUGlITS    OF    AUTHOUS.    1127 


NOTE  W.— AMERICAN  MEDICAL  PROFESSION  AND  GREAT 
BRITAIN. 

Note  W. — Perhaps  in  consideration  of  wliat  the  Author  has  said  at  page  4G0  of 
the  superiority  of  the  American  over  the  European  Medical  Profession,  it  is  but 
fair  that  the  opposite  side  should  be  permitted  to  speak  through  these  Institutes, 
according  to  the  Author's  usage;  and  this  may  be  done  emphatically  by  an  extract 
from  an  article  lately  published  by  the  Author  which  embraces  the  opinion  of  the 
leading  medical  Journal  of  Europe.     Thus — 

"It  is  time  that  a  greater  interest  should  be. manifested  for  our  own  medical  lit- 
erature— not  a  whit  behind  that  of  Great  Britain,  which  has  hitherto  contrived  to 
over-ride  our  own.  We  have  permitted  ourselves  to  be  whipped  into  this  ignomin- 
ious condition — allowing  all  that  may  be  due  to  the  jealousies  of  domestic  competi- 
tion ;  and  that  there  is  no  relaxation  of  the  systematic  discipline  from  abroad,  or 
of  our  submission  to  it,  we  are  assured  on  turning  to  the  Review  of  Professor 
Gross'  late  'American  Medical  Biography,'  in  the  July  (1861)  number  of  an  Amer- 
ican edition  of  the  British  and  Foreign  Medico- Chirurgical  Review,  in  which,  after 
a  profusion  of  ridicule  of  what  it  denominates  the  '  biogra7>Aers  and  the  biogra/j/iCR.?,' 
and  a  characteristic  John  Bull  hit  at  ^  the  Union  now  in  process  of  disruption,'  it  is 
said,  as  a  final  and  summary  conclusion,  that,  '  We  shall  he  sorry  if  it  is  ever  our 
lot  again  to  meet  with  an  American  Medical  Biofiraphy.''  This  very  Journal,  too, 
which  never  spared  what  is  able  in  the  medical  literature  of  these  United  States 
(but  only  what  is  ephemeral),  notwithstanding  its  republication  and  support  for 
near  half  a  century  by  those  whom  it  maligns,  now,  taking  counsel  of  the  past  and 
encouraged  by  the  hope  that '  the  Union  is  in  process  of  disruption,'  would  not  only 
extinguish  our  '  dii  immortales'  and  all  their  contributions  to  a  Nation's  best  wealth, 
but  the  very  Nation  itself.'"     P.S.  The  republication,  I  regret,  is  discontinued. 


NOTE  X.— RIGHTS  OF  AUTHORS. 


Note  X. — When  the  Author  was  speaking,  in  his  reclamation,  of  the  agency  of 
the  nervous  system  in  the  production  and  cure  of  disease,  at  page  91G,  and  as  set 
forth  by  himself  in  his  "Essay  on  the  Modus  Operandi  of  Remedies,"  published  in 
the  year  1842,  and  taught  annually  from  his  pi-ofessorial  chair  from  that  day  to  the 
present  (1862),  it  would  have  been,  perhaps,  more  satisfactory  to  the  reader  had 
the  Author  stated  that  all  that  is  embraced  in  the  Institutes  (first  published  in  1847), 
between  sections  896  and  905  b,  inclusive,  and  extending  from  page  662  to  681,  is 
a  literal  transcript  of  the  "Essay  on  the  Modus  Operandi  of  Remedies,"  published 
in  1842,  which,  of  course,  comprehends  the  Author's  philosophy  of  the  operation 
of  counter-irritants  as  expounded  in  §  905  a,  being  the  example  of  the  seton. 

But,  in  a  reclamation  so  important  and  comprehensive  as  the  Author's,  it  may 
be  still  more  satisfactory  to  those  who  have  not  a  ready  access  to  the  "Essay" 
should  the  Author  recite  an  example  from  the  "Essay,"  that  it  may  be  compared 
with  the  corresponding  part  of  the  Institutes.  Take,  then,  as  a  continuous  exam- 
ple, section  902  d  to  section  902  /,  inclusive,  of  the  Institutes,  and  the  Essay  from 
p.  44  to  p.  49.     Thus  the  Essay — 

"The  examples  of  sympathetic  influences,  through  the  reflex  action  of  the  brain 
and  spinal  cord,  are  almost  endless,  as  they  also  are  in  every  part  of  the  animal 
organism.  They  supply  the  most  ample  ground  for  the  interpretation  of  the  efl^ects 
of  remedial  and  morbific  agents  in  their  wide  range  of  influences.  Tiie  modifica- 
tions of  the  circles  of  sympathy  which  relate  to  the  respiratory  system  alone,  as  in 
coughing,  crying,  laughing,  yawning,  &c.,  are  a  fruitful  field  of  inquiry  into  great 
and  precise  laws,  and  extensively  applicable  to  the  philosophy  of  medicine.  The  only 
difference  is,  that,  when  disease  is  established  in  a  part,  or  when  remedial  agents 
operate,  the  organic  properties  of  the  part  are  altered  in  their  nature,  and,  of  course, 
the  organic  actions  over  which  they  preside.  A  specific  impression,  in  tlie  latter 
cases,  is  transmitted  to  the  cerebro-spinal  axis,  and  from  thence  reflected  through 
other  nerves  upon  the  organic  properties  of  other  parts,  and,  according  to  its  nature, 
disease  will  be  produced  or  mitigated  in  those  parts.  However  complex  and  vari- 
able, therefore,  the  phenomena,  nothing  can  be  more  simple  than  the  principle 
through  which  all  these  changes  are  produced. 


1128  NOTE   X. RIGHTS    OF    AUTHORS. 

"When  an  emetic  operates,  the  philosophy  of  its  influences  is  the  same  as  that 
which  relates  to  respiration,  &c.  The  impression  upon  the  stomach  is  transmitted 
to  the  brain  and  spinal  cord  through  the  pneumogastric  and  ganglionic  nerves,  the 
nervous  power  developed  and  reflected  in  tlio  foregoing  manner  2//)o«  the  resjnratory 
nerves,  while  another  current  descends  along  other  fibres  of  the  pneumogastric  to 
the  muscular  tissue  of  the  stomach.  If  the  emetic  operate,  also,  as  a  cathartic, 
then  a  new  chain  of  actions  is  established,  in  the  same  way,  in  the  abdominal  mus- 
cles, while  a  current  of  the  nen^ous  power  is  propagated  upon  the  muscular  coat 
of  the  intestines. 

"  But,  in  the  foregoing  case  something  more  happens  than  in  the  natural  pro- 
cesses. Here  the  exciting  cause  possesses  peculiar  virtues,  is  of  a  morbific  nature, 
and  it  not  only  makes  peculiar  impressions  upon  the  alimentary  mucous  tissue, 
according  to  the  exact  nature  of  its  virtues,  but  it  modifies  the  nervous  power  in  a 
corresponding  manner.  If  the  stomach  be  the  seat  of  disease,  the  direct  impression 
upon  that  organ,  or  the  change  which  an  emetic  may  effect  in  its  vital  condition, 
will  be  more  or  less  varied  from  what  is  exerted  in  a  state  of  health.  It  may, 
therefore,  prove  curative  to  the  stomach  by  this  direct  influence.  But  the  nervous 
power  is  also  modified  according  to  the  impression  produced  upon  the  organic  prop- 
erties of  the  stomach,  and  is  sent  abroad,  with  alterative  eft'ect,  upon  various  pai  ts  of 
the  system.  According  to  a  law  by  which  diseased  parts  are  far  more  susceptible 
of  influences  from  vital  stimuli  than  such  as  are  not  diseased,  the  modified  nervous 
power  will  fall  with  far  greater  effect  upon  the  former  than  the  latter.  The  organic 
properties  and  actions  of  one  may  be  profoundly  and  permanently  affected,  while 
the  latter  are  only  moderately  and  very  temporarily  influenced.  In  consequence, 
also,  of  the  deep  eflfect  which  the  modified  nervous  power  exerts  on  the  diseased 
parts,  they  may  return,  at  once,  to  their  natural  state. 

"But  the  milder  influences  which  are  set  up  by  the  nervous  power  upon  parts  in 
health,  or  in  comparative  exemption  from  disease,  play,  also,  their  part  in  the  salu- 
tary process.  If  the  emetic  operate  also  as  a  cathartic,  impressions  are  transmitted 
from  tlie  intestinal  mucous  membrane  to  the  cerebro-spinal  system,  the  nervous 
power  developed  and  modified  according  to  tlie  nature  of  these  impressions,  and 
radiated  abroad  as  when  the  result  of  the  action  of  the  emetic  upon  the  stomach, 
and  with  effects  corresponding  to  this  new  development  and  modification  of  the 
nervous  power. 

"Again  the  skin  is  influenced  in  the  foixgoing  manner,  and  this  organ  transmits 
that  impression  to  the  cerebro-spinal  axis,  and  develops  and  modifies  the  nervous 
])Ower  accordingly,  when  it  is,  as  in  the  other  instance,  reflected  abroad,  and  is  felt 
by  various  parts  according  to  their  degrees  of  susceptibility.  Various  other  circles 
of  sympathy  of  the  same  nature  set  in,  and  become  too  complex  for  analysis ;  but 
all  may  fiill  with  one  concurring,  curative  effect  upon  the  diseased  susceptible 
organs. 

"We  thus  see  that  when  vomiting  springs  from  the  operation  of  tartarized 
antimony,  and  often  from  ipecacuanha,  it  is  only  one  of  the  consequences,  and  a 
minor  one,  of  the  peculiar  irritation  of  the  gastro-mucous  membrane.  Other  and 
far  more  powerful  inflirences  are  determined,  simultaneously,  upon  the  organic  prop- 
erties and  actions  of  distant  and  diseased  parts  (perhaps  as  distant  as  the  most 
remote  extremity),  by  the  same  nervous  power  that  shook  the  respiratory  organs 
during  the  act  of  vomiting.  And  often,  indeed,  does  it  happen  that  those  influences 
are  propagated  with  the  most  profound  effect  when  the  act  of  vomiting  fails  of  being 
consummated;  and  nausea  alone  shall  send  with  jwostratintj  effect  the  modifled 
nervous  power  over  the  whole  system ;  when  we  shall  see  it  simultaneously  bathing  the 
whole  surface  with  perspiration  ;  pourinrj  the  suliiia  from  the  mouth;  breaking  down  a 
tumultuous  excitement  of  the  heart  and  arteries ;  starting  on  the  instant  a  torrent  of  bile, 
itnd  an  equal  effusion  from  the  intestinal  mucous  viembrane;  and  at  the  next  moment, 
calling  up  a  magnificent  play  of  reflex  actions  for  the  evacuation  of  the  fluids,  after 
the  manner  of  an  active  purgative, — these  very  cff^usions,  also,  instituting  other 
circles  of  sympathy,  which  join  in  the  great  work  of  curative  movements.  Should 
vomiting  now  follow,  then  shall  you  speedily  see  the  vital  energies  returning, — the 
cold  jiaie  skin  giving  place  to  a'florid  hue  and  a  warm  perspiration, — the  sunken 
features  starting  into  the  fullness  of  health,— the  gastric  suffering  gone  as  a  luxury 
obtained,— the  general  whirl  of  anxiety  and  distress  converted  into  calm  tranquil- 
lity,—the  headache  dissipated, — the  twang  of  the  croup,  or  the  grunt  of  pneumonia, 
no  longer  sounding  an  alarm ; — and,  all  this  stupendous  succession  of  events,  from 
the  beginning  of  nausea  to  the  restoration  of  the  vital  energies  and  the  near 


NOTE    X. rJGHTS    OF    AUTHORS.  1129 

resolution  of  disease, — composing  a  most  astonishing  consecutive  series  of  reflex 
actions, — may  require  less  time  than  I  liave  hastily  employed  in  this  general  nlhi- 
siou  to  the  subject.  And  now  can  it  be  entertained,  tliat  this  has  been  tlie  result 
of  absor])tion,  or  that  the  laws  of  chemistry  or  physics  have  had  any  connection  with 
the  phenomena? 

"The  foregoing  may  be  taken  as  an  example  of  the  principle  which  concerns 
the  modus  operandi  of  all  curative  or  morbific  agents,  whether  physical  or  moral, 
and  of  all  the  developments  of  disease  that  arise  as  sympathetic  consequences  of 
each  other.  In  respect  to  emetics,  however,  it  should  be  considered  that  all  do  not 
produce  the  foregoing  effects,  and  that  with  the  exception  of  the  act  of  vomiting, 
the  results  will  depend  upon  the  precise  nature  of  the  emetic,  or  the  manner  in 
which  it  modifies  the  nervous  power  and  thus  impresses  the  organic  properties. 
This  explains  the  dilFerencc  in  results  between  tartarized  antimony,  ipecacuanha, 
sulphate  of  zinc,  warm  water,  tickling  the  fauces,  the  mechanical  irritation  of  un- 
digested food,  the  shock  of  a  fall,  of  a  surgical  operation,  sailing,  whirling,  offensive 
sights,  offensive  odors,  loss  of  blood,  and  even  their  recollection,  &c. 

"When  tlie  alterations,  of  a  sympathetic  nature,  are  more  slowly  produced,  as 
■when  mercury  induces  salivation  gradualh",  and  brings  the  whole  system  under  its 
influence,  or  when  small,  and  repeated  doses  of  tartarized  antimony  overcome  in- 
flammations of  the  lungs,  &c.,  the  nervous  power  is  developed  and  modified  at  each 
successive  dose,  and  the  repetition  of  its  influence  upon  the  organic  properties  of 
diseased  parts  remote  from  the  stomach  establishes  progressive  changes,  till  an 
absolute  condition  of  disease  may  be  induced  in  certain  parts,  as  when  mercuiy 
salivates;  while  the  analogous  influences  wliich  are  exerted  on  parts  already  dis- 
eased supplant  the  naturally  morbid  states  by  others  of  an  artificial  nature,  from 
which  tlie  organic  properties  are  able  to  return  to  their  healthy  condition.  But 
these  impressions  must  be  frequently  repeated ;  for  if  the  interval  be  long  between 
the  administration  of  the  doses  of  such  agents  as  only  produce  their  effects  in  a 
gradual  manner,  the  diseased  conditions,  not  being  placed  in  the  way  of  the  recu- 
perative tendency,  will  throw  oft'  the  artificial  impression,  and  the  original  intensity 
of  disease  will  be  thus  restored,  &c.  The  permanent  ojieration  of  the  nervous 
power  in  particular  parts  of  the  animal  fabric,  as  in  the  sphincters,  supplies  an 
elegant  parallel  with  the  foregoing  uninterrupted  influences  of  the  same  power  as 
developed  by  remedial  or  morbific  agents,  &c. 

"When  moral  causes  operate  in  the  cure,  or  production  of  disease,  they  act  di- 
rectly upon  the  cerebro-s])inal  axis,  and  develop  and  modify  the  nervous  power 
according  to  the  nature  of  each  mental  aff'ection ;  and,  as  in  the  case  of  physical 
agents,  the  nervous  power  thus  developed  and  modified  may  be  determined  as  well 
upon  the  organic  properties  of  the  brain  and  spinal  cord,  as  upon  other  parts.  The 
blow  upon  the  region  of  the  stomach,  or  the  opening  of  a  thecal  abscess,  which 
have  destroyed  life  on  the  instant,  operate  in  the  same  way  as  the  paroxysms  of 
anger,  or  of  joy,  which  have  been  as  suddenly  fatal.  In  these  cases  the  nervous 
power  is  first  determined  with  a  fatal  eff"ect  upon  the  organic  properties  of  the  nerv- 
ous centre." 

Again,  in  the  Essay,  at  p.  51  is  the  following  correspondence  with  the  Institutes 
at  p.  672,  §  90-1  a,  which  is  introduced  here  on  account  of  the  Author's  theory  of 
the  diverse  modifications  of  the  nervous  power,  and  the  same  doctrine  as  quoted  in 
the  last  paragraph  at  p.  914:  of  Institutes.     The  Essay  thus — 

"The  nervous  power  is  not  only  variously  excited,  exalted,  or  depressed,  or  7nod- 
ijied  in  its  kind,  and  produces  influences  upon  remote  parts  according  to  these 
changes,  but  it  is  rejiected  upon  particular  parts  according  to  their  existing  suscep- 
tibilities, the  nature  of  the  remote  cause,  and  the  part  upon  which  the  remote  cause 
may  operate.  Thus  one  impression  from  cold,  as  a  blast  of  cold  air,  or  a  drop  of 
cold  water  upon  the  skin,  will  rouse  the  respiratory  muscles.  Another  impression 
from  the  same  cause  will  excite  catarrh,  or  pneumonia,  or  articular  rlieumatism. 
{See  Med.  and  Phys.  Comm.  vol.  2.  p.  18,  41—50.)  IMercurial  ointment  will  de- 
termine the  nervous  power  specially  upon  the  salivary  glands,  and  liver,  and  tlic 
same  effects  arise  from  the  action  of  mercuiy  upon  the  stomach.  Cantharides,  in- 
ternally or  externally  applied,  irritates  the  neck  of  the  bladder.  One  degree  of  im- 
pression by  tartarized  antimony  upon  the  stomach  determines  the  nervous  power 
upon  the  respiratory  muscles,  and  vomiting  is  the  consequence ;  while  it  simulta- 
neously REFLECTS  the  same  potver  upon  the  skin,  as  it  does  in  smaller  doses,  and  of 
■WHICH  PERSPiRATiox  IS  A  coNSEQUEXCE, — and  SO  ou.  But  these  examples  em- 
brace," &c. — The  emphasis  of  Italics  and  Capitals  does  not  occur  in  the  Essay. 


1130  NOTE   y. THE   NERVOUS    POWER   AND    ELECTRICITY. 


NOTE  Y.— THE  NERVOUS  POWER  AND  ELECTRICITY. 

Note  Y. — Whatever  the  Author  may  have  said  in  objection  to  the  supposed 
identity  of  the  Nervous  Power  and  Galvanism,  and  especially  in  his  remarks  as 
to  the  electrical  circuit  (p.  644,  §  893  a,  tfec),  he  desires  to  be  understood  as  fully 
recognizing  the  fact  that  electrical  currents  may  be  developed  artificially  in  nerves, 
even  when  detached  from  the  body.  This  was  demonstrated  by  Du  Bois-Reymond, 
whose  method  of  observation  is  well  and  briefly  stated  in  the  following  extract — 

"Every  fresh  excitable  nerve  is  the  source  of  electric  currents,  as  may  be  proved 
by  placing  the  two  ends  of  the  wire  of  a  galvanometer  in  contact  with  it.  But  the 
position  of  the  nerve  is  of  great  importance.  If  the  nerve  be  placed  so  that  the 
hires  touch  two  points  of  its  surface  at  an  equal  distance  from  the  central  point 
(equator)  of  the  nerve,  no  deviation  of  the  needle  takes  place ;  but  when  the  wires 
are  placed  so  that  one  touches  the  transverse  section  of  the  nerve,  and  the  other  a 
point  on  its  longitudinal  surface,  a  strong  variation  of  the  needle  ensues,  the  current 
going  from  the  external  longitudinal  surface  to  the  transverse.  The  external  sur- 
face is  therefore  positive  (  +  )  towards  the  transverse,  which  is  negative  (  — )  in  its 
electric  relations.  If  both  wires  be  placed  on  the  surface  of  a  nerve,  one  nearer  the 
centre  point  (equator)  than  the  other,  a  weak  current  is  produced,  going  from  the 
point  nearest  the  equator  towards  the  point  at  a  distance  from  it.  A  point  near 
the  centre  point  of  a  nerve  is  therefore  positive  towards  a  point  at  a  greater  distance 
from  it.  In  muscle  the  same  relations  are  found  to  hold  in  two  points  of  a  trans- 
verse section." 

"The  theory  of  Du  Bois  to  explain  these  effects  may  be  thus  stated : — Every 
minute  particle  of  nerve  acts  according  to  the  same  law  as  the  whole  nerve.  A 
nerve  consists  of  a  number  of  di-polar  molecules,  one  half  presenting  positive,  the 
other  half  negative  electric  properties.  These  di-polar  molecules  are  arranged  in 
couplets,  and  so  that  the  positive  poles  are  turned  towards  each  other,  their  negative 
poles  to  the  extremities  of  the  nerve.  Each  couplet  of  molecules  produces  cuiTcnts 
going  from  the  central  positive  poles  to  tlie  negative  poles.  A  nerve  is  always  in 
the  condition  of  a  closed  current,  and  when  the  extremities  of  the  wires  of  the  gal- 
vanometer are  applied,  a  part  merely  of  the  current  is  abduced. 

"The  foregoing  facts  and  theory  apply  to  a  nerve  when  it  is  in  a  state  of  rest. 
When  a  constant  galvanic  current  is  made  to  pass  through  part  of  a  nerve,  an 
electrical  change  takes  place,  to  which  the  name  elcctrotonus  is  applied.  Suppos- 
ing that  while  a  piece  of  nerve  is  placed  on  the  cushions  of  a  galvanometer,  and  a 
constant  deflection  of  the  needle  is  produced,  a  constant  current  be  passed  through 
this  piece  of  nerve  in  the  same  direction  as  the  nerve  current,  then  an  increase  of 
the  deflection  of  the  needle  is  observed.  This  is  termed  the  positive  phase  of  elcc- 
trotonus. If  a  constant  current  be  applied  in  a  direction  opposite  to  that  of  the 
nervous  current,  the  deflection  of  the  needle  is  decreased,  and  this  is  termed  the 
negative  ph.ase  of  elcctrotonus.  If  a  nerve  be  placed  with  its  equatorial  point  exact- 
ly between  the  cushions,  so  that  no  deflection  is  produced,  and  if  a  constant  current 
be  now  applied  to  the  nerve,  a  deflection  of  the  needle  will  take  place,  its  direction 
being  determined  by  that  of  the  applied  current.  Such  are  tlie  principal  facts  of 
elcctrotonus,  and  the  explanation  of  them  furnished  by  Du  Bois  is  the  following. 
When  any  portion  of  the  kngth  of  a  nerve  is  traversed  by  an  electric  current,  be- 
sides the  cft'ect  of  the  original  nerve  current,  a  new  electro-motive  action  takes 
place,  which  has  the  same  direction  as  the  applied  current.  This  new  current  is 
added  to  the  original  nerve  current  if  the  direction  be  the  same,  but  subtracted  ivom. 
it,  if  the  direction  be  opposite." — British  and  Foreign  Mkdico-Cuirurgical 
Review,  &c.,  Lon.,  Jtily,  18G2,  p.  G,  7. 

Admitting  all  the  foregoing  facts,  and  others  of  a  corresponding  nature,  to  be 
well  ascertained,  they  can  in  no  respect  aft'ect  the  validity  of  that  other  and  vast 
scries  of  facts  presented  in  these  Institutes  which  contradistinguish  the  nervous 
power  from  electricity,  nor  can  imagination  conceive  of  the  functions  of  the  latter 
when  the  phenomena  of  animals,  physical  and  mental,  and  of  plants,  are  consid- 
ered according  to  their  realities — Note  Eee. 

Note  Z. — UrvEmic  Poisoning.  An  experiment  by  Bernard  (§  1032  d)  disproves 
uramia,  and  shows  that  diseases  of  the  brain,  and  merely  sympathetic  influences  upon 
it,  and  mental  emotions,  may  so  aflfect  the  kidneys  that  tiiey  shall  not  only  fluctu- 
ate greatly  in  their  excretion  of  urine,  but  may  generate  irritants  that  stimulate  the 
blad<ler  to  frequent  micturition.  It  is  not  improbable  that  diabetes  is  greatly  owing 
to  influences  of  the  nervous  system  upon  the  kidneys,  which  would  show  us  that  the 
sugar  does  not  exist  in  the  blood  (§  1032  rt).      _ 


NOTES  TO  THE  EIGHTH  EDITION. 


The  following  Xotes  are  added  to  the  Eightu  Edition  of  this  Work,  and  references  to  them  are 
introduced  in  appropriate  places  in  the  text. 


NOTE  Aa.— PHYSIOLOGY  OF  THE  CEREBRO-SPINAL  AND  SYMPA- 
THETIC NERVES. 

There  appears  to  be  nothing  in  the  researches  into  the  functions  and  laws  of  the 
nervous  system  since  the  last  edition  of  this  work  that  can  in  any  respect  modify  the 
statements  and  the  philosophy  as  herein  presented,  but,  on  the  contrary,  go  to  their 
confirmation.  Among  the  most  intricate  experiments,  and  corroborative  of  distinct 
orders  of  nerves  as  set  forth  in  sections  197-201,  224,  446-447,  500  g,  nn,  893  a, 
893^,  1037  b,  may  be  mentioned  some  late  ones  by  C.  Bernard  upon  dogs,  in  con- 
tinuation of  others  performed  several  years  ago,  from  which  he  deduces,  as  a  general 
fact  (and  in  conformity  with  results  that  had  been  already  obtained  by  others),  three 
distinct  varieties  of  nervous  influences,  according  to  the  origin,  composition,  and  dis- 
tribution of  the  nerves.  Thus,  in  some  late  experiments  upon  the  extremities  of 
dogs  he  found,  besides  the  motor  influence  for  the  voluntary  muscles  which  is  impart- 
ed by  the  anterior  roots  of  spinal  nerves,  and  the  sentient  influence  which  belongs  to 
the  posterior  roots  (§  1037  b),  that  the  vascular  and  calorific  influence  appertains  en- 
tirely to  the  sympathetic  nerve.  These  distinctions  are  fundamental  throughout  the 
Institutes.  That  which  relates  to  the  sympathetic  nerve  is  mostly  important,  as 
through  that  I  have  interpreted  all  the  influences  upon  organic  functions  and  their 
results,  whether  in  a  physiological,  pathological,  or  therapeutical  sense,  so  far  as 
nerves  are  tributary,  and  which,  also,  I  have  employed  extensively  in  exposing  the 
fallacies  of  the  chemical  and  humoral  doctrines. 

Besides  the  foregoing  distinctions  there  should  be  added  the  motor  nervous  influ- 
ence for  the  muscles  of  organic  life,  which  is  imparted  by  the  sympathetic  nerve,  and 
which  is  quite  distinct  from  that  which  relates  to  the  proper  organic  functions,  since, 
as  it  respects  its  agency  in  exciting  the  action  of  the  organic  muscles  it  is  on  com- 
mon ground  with  the  motor  influence  of  cerebro-spinal  nerves,  and  goes  no  farther, 
while  the  same  nerve  exerts  a  special  modifying  influence  upon  the  vascular  system, 
upon  all  organic  functions,  and  modifies  the  organic  products  (§11 1-1 13,  224,  356  o, 
394-396,  446,  455  a,  459/,  461,  461^,  473  c,  475^,  478  b,  483  c,  488i,  500  g,  m,  nn,  o, 
516  d  Nos.  7-9,  524  d  No.  7,  647^,  889  (j,  893  a,'c,  893^,  1044). 


NOTE  Bb.— CAUSES  OF  THE  HEART'S  ACTION. 

In  respect  to  the  doctrines  of  the  dependence  of  contiguous  sympathy  upon  ganglia 
and  other  local  centres  of  the  sympathetic  nerve,  and  of  the  operation  of  vesicants, 
setons,  etc.,  through  those  local  centres,  and  of  the  independence  of  continuous  sym- 
pathy or  continuous  influence  of  the  nervous  systems  advanced  in  sections  129  /',  264, 
475|^,  498  e,  514/,  515,  516  d  No.  7,  893  a,  c,  905  a,  etc.,  it  may  be  of  interest  to 
state  the  following  conclusions  obtained  by  Golz  as  to  the  instrumentality  of  the 
ganglia  in  the  heart's  action:  1.  "The  pulsating  parts  of  a  frog's  heart  constitute 
together  a  system  of  small  independent  apparatuses,  each  of  which  is  possessed  of  a 
ganglionic  central  organ  (§  516  d  No.  7).  2.  These  small  nervous  centres  can  be  ex- 
cited to  action  by  various  stimulants,  and  this  action,  according  to  its  intensity,  man- 
ifests itself  in  more  or  less  protracted  contractions  of  the  muscles  which  are  governed 
by  the  stimulated  centre.  The  natural  stimulus  which  incites  the  ganglia  is  the 
blood  (§  475i).  3.  A  sudden  contraction  of  any  part  of  the  heart  acts  slightly 
stimulating  upon  the  neighboring  parts.  Thus,  when  a  stimulated  part  contracts, 
the  contraction  spreads  like  a  peristaltic  movement,  according  to  the  laws  which  de- 
pend on  the  connection  of  the  nerves  with  the  ganglia.  4.  The  reason  why  the  heart 
contracts  rhythmically  is,  perhaps,  to  be  found  in  the  following  circumstance:  As 
soon  as  the  stimulating  influence  of  the  blood  is  powerful  enough  to  act  upon  the 
ganglia,  the  systole  at  once  commences,  and  emptying  the  heart,  removes  from  it  the 
stimulating  cause"  (§  264,  383-386,  392-395,  475^,  514/  516,  1090). 


1132  NOTES    CC-DD. AVHOOPING-COUGII. — LEECIIIXG. 


NOTE  Cc— WHOOPING  COUGH— THE  PHILOSOPHY  OF  ITS 
TREATiAIENT. 

I  Ii.ivc  expoiinJed  the  physiological  influences  through  which  the  act  of  vomiting 
will  suddenly  arrest  a  paroxysm  of  coughing,  as  witnessed  in  whooping-cough,  for 
the  purpose,  particularly,  of  demonstrating  by  a  distinct  example  the  operation  of 
.emetics  in  organic  life,  through  their  action  upon  the  organs  of  animal  life,  by  the 
instrumentality  of  the  nervous  system,  and  thence  showing  how  these  simple  exam- 
ples may  be  employed  in  interpreting  the  analogous  results  of  remedial  and  morbific 
agents  in  their  removal  or  production  of  disease  (Indkx  II.,  Wliooping-cough,  Hic- 
cough, and  JrhjsteiHa).  It  will  be  seen  that  the  example  is  parallel  in  its  intended 
illustrations  with  many  others  which  occur  in  this  work,  as  in  sections  500,  514,  51G, 
902  g-m. 

As  it  respects  the  interruption  of  the  cough  by  vomiting,  the  emetic  influence  is 
exerted  upon  the  organic  nerves  of  the  gastric  mucous  tissue,  while  the  point  of  de- 
parture for  the  excitement  of  the  nervous  influence  that  determines  the  cough  is  in 
the  same  nerves  in  the  pulmonary  mucous  tissue,  and  in  both  cases  the  motor  nerves 
belong  to  the  cerebro-spinal  system,  and  are  implanted  in  the  thoracic  and  abdominal 
muscles,  and  diaphragm  (§  5U  i).  Now,  as  I  have  said,  whatever  will  excite  vom- 
iting during  a  paroxysm  of  coughing,  even  when  produced  by  the  cough  itself,  Avill 
at  once  interrupt  the  latter  by  so  modifying  the  development  and  reflection  of  the 
nervous  influence  as  to  introduce  a  new  combination  of  movements  in  the  respira- 
tory muscles  (§514  c).  If  the  vomiting  be  occasioned  by  the  cough,  or  by  tickling 
the  throat,  or  by  a  mental  emotion  (Note  D,  p.  1114),  or  by  warm  water,  or  by  an 
infusion  of  mustard-seed,  the  effect  will  go  no  farther  (§  902  //).  To  obtain,  there- 
fore, any  influences  from  emetics  upon  the  morbid  conditions  in  whooping-cough, 
they  must  possess  also  other  virtues  than  such  as  determine  the  act  of  vomiting,  and 
it  is  through  the  special  impression  which  those  virtues  make  upon  the  gastric  mu- 
cous tissue  that  such  emetics  simultaneously  reflect  an  alterative  nervous  influence 
upon  the  absolute  pathological  conditions  (§  233*  500  g-l,  514/,  I;  902  cl-m,  1059). 
The  best  emetics  for  this  combined  purpose,  and  indeed  the  only  ones  for  the  alter- 
ative influence,  are  tartarized  antimony  and  ipecacuanha.  But  in  cases  to  which 
these  are  appropriate,  their  gradually  alterative  impression,  as  cflTected  by  small  and 
repeated  doses  just  short  of  nausea,  is  generally  more  salutary  than  emetic  doses  at 
distant  intervals,  since  no  greater  extent  of  the  remedy  is  commonly  necessary  in 
whooping-cough  to  bring  about  vomiting,  as  it  is  the  tendency  of  the  cough  to  re- 
flect an  emetic  nervous  influence  upon  the  gastric  mucous  membrane,  which  will  be 
likely  to  determine  the  act  of  vomiting  when  the  same  membrane  is  slightly  predis- 
posed by  the  irritating  virtue  of  an  emetic  (§  514  h,  51G  d  No.  C,  657  a,  889  a,f,  g, 
902  c-i,  904  i6,  Note  D,  p.  1114).  The  same  philosophy  is  applicable  when  an 
emetic  interrupts  a  paroxysm  of  spasmodic  asthma  or  of  hysteria  (§  514  c,  891^  c,/,  ^•). 


NOTE  Dd.— LEECHING,  PHILOSOPHY  OF  ITS  EFFECTS,  HOW  FAR 
DEPENDENT  UPON  VASCULAR  COMMUNICATIONS. 

Dr.  William  Turner  appears  to  have  demonstrated  the  very  interesting  fact  of  the 
existence  of  a  system  of  anastomosing  arteries  between  the  visceral  and  parietal 
branches  of  the  abdominal  aorta,  and  which  is  likely  to  be  followed  by  some  highly 
practical  advantages.  This  will  be  apparent  from  a  remark  which  Dr.  Turner  makes 
in  connection  with  his  ingenious  demonstration.  "This  assumption,"  he  says, 
"of  the  absence  of  any  direct  communication  between  these  two  sets  of  vessels  has 
been  employed  by  some  physicians  as  aprincijml  argument  against  the  utility  of  local 
bloodletting  in  the  treatment  of  inflammation  of  the  abdominal  viscera.  Vide  Dr. 
Bennett's  Clinical  Lectures,  1859,  p.  280." — This  common  objection  is  founded 
upon  the  universal  mechanical  philosophy  of  the  modus  o])erandi  of  loss  of  blood 
when  artificially  cflTected — a  philosophy  which  excludes  all  the  magnificent  laws  in 
I)hysiol()gy  both  as  it  respects  the  nervous  influence  and  the  organic  endowments, 
and  their  involutions  as  instituted  by  the  incidental  operation  of  physical  and  mental 
causes,  and  is  regardless  of  the  inexhaustible  testimony  of  the  most  enlightened  ex- 
perience (§  910).  But,  although  it  is  ])robable  that  the  foregoing  objection  to  leech- 
ing will  yield  to  the  anatomical  fact  demonstrated  by  Dr.  Turner,  the  fact  itself  does 
not  sujjply  a  ray  of  light  to  the  mechanical  Physicians,  since  the  intercommunication 


NOTE   EE. ANTIPHLOGISTICS    AND   TONICS    CONSIDERED.       1133 

of  the  inosculating  vessels  is  wholly  insufficient  for  the  hypothesis  which  supposes  a 
diversion  of  blood  from  the  internal  organs  to  the  very  limited  space  over  which 
leeches  are  applied,  nor  does  the  inosculation  any  more  explain  the  operation  of 
counter-irritants  upon  deep-seated  inllammations ;  and  the  solution,  therefore,  which 
I  have  made  of  the  resulting  phenomena,  whether  of  leeching  or  of  counter-irrita- 
tion, through  the  medium  of  the  nervous  system,  will  remain  the  only  intelligible 
theory  (§  893  a,  c,  905  «,  915-924:,  942  b).  As  it  respects  the  law  of  continuous 
sympathy,  its  operation,  in  leeching,  when  involving  only  the  bloodvessels,  is  limited 
to  the  vessels  of  the  skin,  and  is  more  or  less  circumscribed,  according  to  the  num- 
ber of  leeches,  and  the  special  circumstances  of  every  case.  When  the  bloodvessels 
alone  are  interested,  tlie  propagation  of  this  continuous  influence  along  their  course 
is  of  very  little  moment  excepting  as  it  is  tributary  to  reflected  actions  of  the  nerv- 
ous centres  (§  498,  917,  919). 


NOTE  Ee.— THE  EEMEDIAL  VIRTUES  OF  ANTIPHLOGISTICS  AND 
TONICS  CONSIDERED  RELATIVELY. 

The  almost  endless  variety  of  virtues  which  appertain  to  the  remedies  that  are 
adapted  to  tlie  treatment  of  inflammations  and  fevers,  or  which  may  be  created  by 
uniting  two  or  more  of  them  together,  and  also  according  to  the  proportions  of  each 
constituent  (§  860,  863  d,  872  a,  889  k,  892  b,  892^  a,  1058,  1060-1065),  contrasted 
with  the  single  property  that  alone  characterizes,  as  a  remedial  virtue,  any  member 
of  the  groups  of  tonics  and  stimulants,  should  assure  us  that  the  former  are  designed 
for  the  multifarious  conditions  of  inflammatory  and  febrile  diseases,  while  the  latter 
is  equally  pronounced,  by  its  solitary  virtue,  to  be  suited  only  to  such  forms  or  con- 
ditions of  disease  as  are  nearly  allied  to  each  other  (§  890^  a,  It),  and  where,  by  com- 
mon consent,  the  remedies  that  are  deficient  in  that  special  virtue  have  compara- 
tively little  or  no  tendency  to  introduce  the  restorative  process,  but,  on  the  contrary, 
generally  aggravate  the  conditions  which  the  stimulants  relieve.  The  phenomena 
which  ensue  upon  the  operation  of  tonics  and  stimulants,  whether  of  a  salutary  or 
morbific  nature,  arc  the  same,  respectively,  throughout ;  and,  although  loss  of  blood, 
cathartics,  emetics,  the  mercurial  and  antimonial  alteratives,  blisters,  and  other  things 
belonging  to  the  class  of  antiphlogistics,  will  alike  make  their  salutary  invasions 
upon  all  forms  of  inflammation  and  fever,  yet  in  all  the  cases  there  is  not  only  a 
want  of  coincidence  in  all  the  direct  manifestations,  but  the  greatest  diversity — 
scarcely  any  thing  in  common  beyond  the  subsidence  of  disease  (§  900,  1059,  86"4:). 

Since,  therefore,  it  is  abundantly  evident  that  the  great  varieties  of  remedies  de- 
nominated antiphlogistics,  ranging  from  loss  of  blood,  cathartics,  emetics,  mercurials, 
antimonials,  vesicants,  and  other  agents  that  are  adapted  to  the  common  form  of 
inflammation  and  fever,  to  iodine,  cinchona,  arsenic,  cobweb,  colchicum,  vcratria, 
etc.,  whicli  are  suited  only  to  the  specific  forms,  are  endowed  with  an  incalculable 
variety  of  remedial  virtues,  and,  also,  that  their  combinations,  both  as  to  the  num- 
ber and  nature  of  the  constituents  and  the  proportions  of  each,  extend  tlio  variety 
of  their  virtues  indefinitely  (§  872),  while,  on  the  other  hand,  tonics  and  stimulants 
possess  but  a  single  virtue  in  their  relation  to  disease,  and  are  incapable  of  yielding 
any  new  ones  by  their  combinations,  or  of  displaying  any  of  the  variety  of  effects 
common  to  the  antiphlogistics  by  simply  varying  the  doses  (§  516  d  No.  6,  1057^), 
it  needs  no  farther  demonstration  to  show  that  the  former  are  intended  in  Nature 
for  a  vast  variety  of  pathological  conditions,  while  the  latter  are  as  distinctly  limited 
to  the  simple  office  of  reviving  the  exhausted  or  the  prostrate  powers  of  life. 

The  foregoing  comments  have  grown  out  of  the  numerous  contrasts  that  have  been 
instituted  in  this  work  between  antiphlogistics  and  stimulants ;  and  I  am  finally  led 
to  consider  a  principal  reason  for  the  remarkable  ascendency  which  the  stimulating 
practice  has  obtained  at  this  advanced  age  of  knowledge.  The  recital  will  be  at 
least  interesting  to  the  future  historian,  and  can  not  fail  of  a  useful  ettect  upon  the 
"Divine  Art."  The  foundation  of  the  evil  is  variously  presented  in  these  Insti- 
tutes, wliich  may  be  briefly  said  to  consist  of  the  physiology  whicli  has  been  pro- 
claimed from  the  laboratory  of  the  Chemist,  and  the  pathology  which  has  sprung 
from  the  same  factitious  pursuits,  and  a  reliance  upon  morbid  anatomy  and  the 
microscope,  to  the  exclusion,  in  all  this  vast  and  diversified  field,  of  the  signs  and 
philosophy  which  distinguish  organic  nature  in  its  living  condition.  The  absence 
of  principles,  therefore,  leaves  the  Profession  as  much  without  a  guide  in  practical 
medicine  as  the  mariner  at  sea  without  his  compass. 


1134      NOTE   EE. — ANTIPHLOGISTICS    AND   TONICS   CONSIDERED. 

This  brings  me  to  an  important  practical  comment  upon  the  revival  of  an  old  doc- 
trine which  has  been  lately  inculcated  by  many  distinguished  medical  writers,  and 
extensively,  accepted  by  the"  Profession — formerly  called  ' '  a  meditation  upon  death. " 
Say  they :  "  Diseases  can  not  be  arrested  at  any  stage  of  their  progress,  even  at  their 
earliest,  unless  it  be  some  special  form,  like  the  intermittent  fever,  where  an  antidote 
has  been  discovered  for  the  blood  poison."  Hence  the  dogma  has  arisen  that  tonics 
and  stimulants  are  all  that  can  be  usefully  employed,  with  the  object  of  "sustaining 
Nature  while  she  is  engaged  in  eliminating  poisons  from  the  blood,"  or  in  some 
analogous  office,  and  therefore,  also,  that  bloodletting,  cathartics,  and  other  depress- 
ing means  must  be  injurious.  This  logic  is  at  the  foundation  of  a  vast  amount  of 
practice. 

The  important  question  now  arises  as  to  the  real  origin  of  the  dogma  that  most, 
if  not  all,  diseases  run  an  indefinite  course  of  rise  and  decline  in  spite  of  all  reme- 
dies and  the  best  directed  skill.  The  answer  is  to  be  found  in  the  pernicious  effects 
of  the  tonic  and  stimulating  treatment,  since,  as  I  have  variously  shown  upon  the 
soundest  principles,  and  by  the  authority  of  all  the  best  experience  from  the  day  of 
Hippocrates  to  our  own,  that  method  of  treatment  prolongs  all  acute  maladies  till 
the  morbid  process  may  succumb  to  the  physiological  laws  of  recuperation  (§  756  n, 
853,  856  a,  863  h),  when  tonics  and  stimulants  may  yield  an  advantage  that  has  led, 
under  these  delusive  circumstances,  to  their  employment  at  the  early  stage  of  dis- 
ease. The  curious  fact,  therefore,  presents  itself,  that  the  stimulating  practice  began 
at  an  early  period  of  disease  quickly  confirms  the  morbid  process,  and  thus  contrib- 
utes, along  with  the  neglect  of  appropriate  remedies,  to  the  conclusion  that  all  dis- 
eases terminating  favorably  run  on  until  they  run  out ;  while  the  same  treatment, 
continued  after  recuperative  nature  may  have  struggled  successfully  against  it,  is 
supposed  to  have  been  tributary  throughout  to  the  fortunate  issue. 

This  all-pervading  school  (permitted,  perhaps,  as  an  auxiliary  means  in  the  dis- 
pensations of  Providence)  is  naturally  sustained  by  the  prejudices  and  propensities 
of  the  community,  which  render  it  less  susceptible  of  reformation.  But  it  suffers  in 
its  dimensions  by  many  seceders,  whose  experience  with  the  stimulating  treatment 
had  equally  enforced  the  conclusion  that  diseases  can  not  be  stayed  in  their  progress 
toward  a  natural  termination,  and  that  tonics  and  stimulants  fall  under  the  category 
of  all  other  remedies,  and  who,  therefore,  insist  that  Nature  should  be  left  to  the  sim- 
ply watching  system  (§  878),  or  at  most  to  the  aid  of  tonics  and  stimulants  when  her 
resources  become  apparently  exhausted.  Occasionally,  also,  disciples  of  the  stimu- 
lating school  are  prompted  by  their  unfortunate  experience  to  try  the  method  at 
which  they  had  so  long  revolted,  and  if  they  venture  as  far  as  copious  bloodletting, 
and  purging,  in  grave  inflammations  and  congestive  fevers,  they  are  astonished  to 
find  that  all  these  diseases  may  be  suddenly  arrested  at  their  early  stages,  and  that 
life  should  be  thus  as  uniformly  saved  as  it  had  been  as  uniformly  lost  by  the  stim- 
ulating treatment — nor  are  there  wanting  illustrious  examples  to  whom  these  re- 
marks apply  (§  1005  a-h,  Note  Ff). 

I  do  not  flatter  myself  that  what  I  have  now  and  hitherto  said  on  the  foregoing 
subject  will  exceed  the  usual  small  allotment  in  advancing  the  interests  of  truth  in 
its  conflicts  with  error.  They  are  arrayed  in  uncompromising  hostility,  and  how- 
ever powerful  may  be  the  weapons  of  the  one,  they  are  wielded  by  a  few  against  a 
multitude  who  are  intrenched  in  the  fortress  of  "Common  Sense,"  and  rejoice  in 
the  delusion  of  vox  popnK  vox  Dei.  Simplicity  and  plausibility  are  tlie  triumphant 
advantages  of  error.  A  single  fact  that  addresses  itself  strongly  to  the  senses  often 
outweighs  a  multitude  of  contradictory  ones  which  can  be  developed  or  appreciated 
only  by  patient  research  and  profound  meditation.  This  contrast  between  truth  and 
error  may  be  well  exemplified  by  the  apparent  and  real  motions  of  the  heavenly 
orbs.  "Common  Sense"  assumes  that  the  earth  is  stationary  and  that  the  heavens 
revolve  about  it ;  but  reason,  through  its  profound  investigations,  decides  that  "Com- 
mon Sense"  is  in  error.  But  ages  elapsed,  and  an  incalculable  amount  of  intellect- 
ual labor  was  brought  to  the  subject  before  the  error  could  be  dispelled.  Indeed, 
it  is  said  that,  even  at  this  age,  the  "Doctors  of  Salamanca"  daily  crucify  Galileo, 
greatly  prefcmng  the  promptings  of  Sense  to  the  difficult  revelations  of  science 

And  just  so  it  is  with  whatever  is  true  or  false  in  medicine.  With  the  multitude 
"Common  Sense"  is  forever  the  victim  of  appearances.  It  believes,  for  example, 
that  "debility"  is  the  essence  of  disease,  having  no  conception  that  it  is  a  mere 
symptom,  and  no  reference  to  the  latent  causes  upon  which  it  depends  and  which 
alone  should  guide  the  practitioner.     "Common  Sense"  is  also  greatly  responsible 


NOTE    FF. — BLOODLETTING   IN    YELLOW    FEVEK,  ETC.  1135 

for  the  delusions  with  which  Humoralism  and  Organic  Chemistry  have  vitiated 
medical  science.  Nothing,  for  example,  can  be  plainer  than  that  the  matter  of  erup- 
tive diseases  comes  from  the  blood,  and,  tiierefore,  Common  Sense,  according  to  its 
usual  superficial  manner,  argues  that  the  blood  is  the  essential  seat  of  the  malady, 
and  that  tonics  and  stimulants  are  alone  wanted  "  to  sustain  the  strength  while  tlie 
blood  is  casting  off  its  impurities."  Upon  the  same  ground,  "blood  poison"  is  the 
descriptive  phrase  for  the  wliole  pathology  of  typhus,  intermittent,  yellow,  and  other 
fevers,  for  which  the  same  sustaining  treatment  and  its  philosophy  obtain ;  or  here 
quinine  is  supposed  to  neutralize  the  reputed  poison,  or,  at  other  times,  and  in  other 
maladies,  iron  is  a  favorite  to  "enrich  the  blood,"  or  iodine  as  a  peculiar  purifier 
(Notes  K,  N,  R).  And  this,  according  to  the  "  recent  progress  of  medical  science," 
about  exhausts  the  Materia  Medica.  As  an  example  of  "the  progress,"  calomel 
and  tartarized  antimony  are  excluded  by  the  Surgeon  General,  Dr.  Hammond,  from 
the  armies  of  the  United  States  of  America.  Calomel  is  forbidden,  he  proclaims, 
"with  the  more  confidence,  as  modern  pathology  [!]  has  proved  the  impropriety  of 
the  use  of  mercury  in  very  many  of  those  diseases  in  which  it  was  formerly  unfailingly 
administered:'  And  this  is  only  a  little  more  arbitrary  (because  sustained  by  military 
power)  than  the  general  policy  by  which  Humoralism  and  Organic  Chemistry  have 
nearly  crushed  out  all  that  is  most  valuable  in  medical  science  (§  5J  a,  819  b).  If 
Solidism  raise  its  voice  in  solemn  protest,  "Common  Sense"  points  to  debility,  or 
to  pustular  eruptions,  or  to  vitiated  secretions,  and  curls  its  lip  at  whatever  is  grand, 
and  magnificent,  and  practical  in  the  laws  of  the  organic  functions  and  of  the  nerv- 
ous systems.  But  nothing  is  more  certain  in  the  future  than  that,  "ere  the  account 
be  closed,  principles  will  stand  for  something,  and  conscience,  as  in  all  human  affairs, 
will  have  the  last  word." 


NOTE  Ff.— BLOODLETTING  IN  YELLOW  FEVER,  AND  IN  OTHER 
CONGESTIVE  FEVERS,  CONTRASTED  WITH  THE  STIMULATING 
TREATMENT.— NO  CHANGE  IN  THE  TYPE  OF  DISEASES. 

Besides  the  great  amount  of  enlightened  experience  which  this  work  supplies  upon 
the  importance  of  Bloodletting  in  Yellow  Fever  (§  959  b,  992  a,  b,  993,  999,  1002, 
1004,  1005^),  and  more  particularly  the  Medical  and  Physiological  Commentaries, 
the  unexampled  fatality  of  that  disease  in  recent  times  (so  manifestly  arising  from 
the  stimulating  treatment,  §  1068  b),  leads  me  to  some  specific  statements  as  to  the 
quantity  of  blood  which  was  often  found  necessary  to  the  best  success  in  the  epidemics 
which  visited  Philadelphia  toward  the  close  of  the  last  century,  while  it  will  be  also 
seen  that  the  principal  physicians  of  that  city  applied  the  remedy  to  an  extent  de- 
manded by  the  exigencies  of  the  disease.  Nevertheless,  the  tonic  and  stimulating 
treatment  prevailed  at  first,  universally,  and  had  then,  as  now,  no  reference  to  the 
essential  condition  of  the  disease,  but  was,  equally  as  at  this  day,  addressed  to  that 
superficial  symptom  debility,  which,  in  its  popular  acceptation,  is  attendant  upon  all 
diseases  (see  Index  II.,  Debility).  It  is,  indeed,  fur  the  reason  that  the  symptom 
is  supposed  to  constitute  the  disease  that  tonics  and  stimulants  are  now  the  only 
remedies,  in  a  general  sense,  tliat  arc  in  the  hands  of  the  profession,  and  the  anti- 
phlogistic condemned  as  unwarranted  by  this  leading  principle  in  pathology.  But 
it  is  a  more  inexplicable  paradox  that  tlie  mortality  attending  the  stimulating 
treatment  does  not  oftener  appeal  to  the  judgment  or  the  conscience  of  these  triflers 
with  human  life.  The  annals  of  medicine  supply  but  few  examples  of  an  abandon- 
ment of  a  practice  which  has  constantly  illustrated  its  own  errors  and  the  dogma 
upon  which  it  has  been  founded.  These  few  are  mostly  limited  to  able  thinkers,  who 
are  quoted  in  this  work  (§  1005  a-h).  Rush  has  su{)plied,  in  his  Medical  Inquiries 
and  Observations,  a  few  instances  that  were  signalized  by  the  yellow  fever  of  1793. 
"  Dr.  Pennington,"  he  says,  "  informed  me  that  he  had  lost  all  the  patients  to  whom 
he  had  given  bark  and  wine.  Dr.  Johnson  assured  me,  with  great  concern,  about 
two  weeks  before  he  died,  that  he  had  not  recovered  a  single  patient  by  them.  Whole 
families  were  swept  off  where  these  medicines  were  used.  There  was  not  a  single 
cure  performed  by  them  in  New  York,  where  they  were  used  in  several  sporadic 
cases  with  every  possible  advantage.  But  why  do  I  multiply  proofs  of  their  deadly 
effects?  The  clamors  of  hundreds  whose  relatives  had  perished  by  them,  and  the 
fears  of  others,  compelled  those  physicians  who  had  been  most  attached  to  them  to 
lay  them  aside,  or  to  prepare  the  way  for  them,  as  it  was  called,  by  purging  and  bleed- 
ing."    The  physicians  who  adopted  the  latter  practice  "gave  calomefby  itself,  in 


113G  NOTE   FF. — BLOODLETTIXG   IN   YELLOW   FEVER,  ETC. 

small  doses,  on  the  first  or  second  day  of  the  fever,  bled  once  or  twice  in  a  sparing 
manner,  and  gave  the  bark,  wine,  and  laiidanura,  in  large  quantities,  upon  the  first 
appearance  of  a  remission.  This  practice  was  not  much  more  successful  than  the 
purely  stimulating.  It  resembled  throwing  water  and  oil  at  the  same  time  upon 
a  fire  in  order  to  extinguish  it."  Nothing,  indeed,  succeeded  but  decisive  blood- 
letting and  purging  with  the  right  cathartics.  This  was  farther  illustrated  by  the 
French  practice,  of  which  the  following  is  an  example.  The  hospital  at  Bush  Hill, 
"where  most  of  the  patients  were  sent  in  the  first  stage  of  the  fever,  and  provided 
with  all  the  necessaries  and  comforts  that  humanity  could  invent,  or  liberality  sup- 
ply, was  placed,  after  September  22d,  under  the  care  of  a  French  physician,  who 
employed  moderate  bleeding,  and  purging  with  salts  in  some  cases,"  and  also  "  nitre, 
cream  of  tartar,  camphor,  centaury  tea,  and  tamarind  water,"  but  no  bark  and  wine. 
The  result  was  that  the  deaths  between  September  22d  and  November  Cth  amounted 
to  448  out  of  807  patients  who  were  admitted  into  the  hospital  within  that  time. 
"TIn-ee  fourths  of  all  the  blacks  (nearly  twenty)  who  were  patients  in  this  hospital 
died ;"  while  Dr.  Rush  remarks,  in  another  jjlace,  that  "a  great  number  of  the  blacks 
were  my  patients,  and  of  these  not  one  died,"  under  his  treatment  of  bloodletting, 
and  purging  by  calomel  and  jalap  (863  d). 

Of  the  practice  of  "moderate  bleeding"  Dr.  Rush  remarks  that  "an  increased  ac- 
tion of  the  bloodvessels  was  the  consequence  (§  965  b,  985  6),  and  thus  complaints  of 
the  chest  and  head  were  made  worse  by  a  single  bleeding.  This  excited  or  strength- 
ened the  prejudices  of  patients  and  pli3'siciaQS  against  it"  (§  1000-1001).  These 
patients  died,  and  are  among  the  multitude  of  instances  which  sustain  the  enliglit- 
ened  experience  already  quoted  (§  994-1001,  1005).  Sydenham  makes  the  same 
aflSrmatiou  of  the  plague.  "It  is  not  at  all  surprising,"  he  says,  "that  bleeding  in  a 
small  quantity  should  be  always  prejudicial ;  but  I  ajjijeal  to  the  physicians  who 
continued  in  town  during  the  late  plague  (London,  1665  and  1666),  whether  />ee 
and  repeated  bleeding,  before  a  swelling  (bubo)  appeared,  was  ever  observed  to  prove 
fatal  to  any  of  the  infected."  He  speaks  of  the  opposition  to  bloodletting  as  "a  vul- 
gar prejudice"  (§  1000). 

It  is  remarkable  that  Dr.  Rush  should  have  begun  the  treatment  of  the  yellow 
fever  of  1793  by  tonics  and  stimulants — "bark,  wine,  brandy,  and  aromatics."  But 
after  a  disastrous  experience,  he  confesses,  with  much  lamentation,  to  a  total  failure; 
and  his  conversion  to  bloodletting,  and  purging  with  calomel  and  jalap,  and  the 
triumph  particularly  of  the  former  remedy,  are  so  coincident  with  the  experience  of 
Hey,  Gordon,  Denman,  and  Cleghorn,  as  related  in  section  1005,  that  they  may  well 
be  incorporated  in  that  category  of  frank  confessions  of  disastrous  experiment  lead- 
ing to  tlie  recognition  of  philosophical  principles  and  triumphant  success.  "Heaven 
alone,"  says  Dr.  Rush,  "bore  witness  to  the  anguish  of  my  soul  in  this  awful  situa- 
tion. But  I  did  not  abandon  a  hope  that  the  disease  might  yet  be  cured."  Among 
the  causes  of  his  substitution  of  bloodletting  for  stimulants  "were  frequent  hemor- 
rhages from  every  part  of  the  body ;"  and  while  they  afforded  "perfect  relief"  at  ad- 
vanced stages  of  the  disease,  "not  a  single  death  occurred  from  natural  hemorrliages 
in  the  first  stage  of  disease"  (§  805,  863  a-h,  1018).  He  felt  his  way,  however,  cau- 
tiously, thus  manifesting  that  predilection  for  the  fatal  practice  which  we  have  seen 
to  be  true  of  other  converts  till  aroused  by  the  havoc  it  produced  (§  1005  a-h).  "I 
began,"  he  says,  "by  drawing  a  small  quantity  of  blood  at  a  time."  This  "satis- 
fied him  of  its  safety  and  efficacy,"  and  he  grew  bolder.  "Never  before,"  he  says, 
"did  I  experience  such  sublime  joy  as  I  now  felt  in  contemplating  the  success  of  my 
remedies."  As  an  evidence  of  this  he  makes  an  extract  from  his  note-book,  dated 
September  10th:  "Thank  God!  out  of  one  hundred  patients,  whom  I  have  visited 
or  prescribed  for  this  day,  I  have  lost  none"  (§  1004  c).  The  sunken  pulse  and  pros- 
trated strength  rose  under  repeated  abstractions  of  blood  (§  961,  967,  1004  b).  "I 
paid  no  regard,"  he  says,  "to  the  dissolved  state  of  the  blood 'when  it  apjjcared  on 
the  first  or  second  day  of  the  disease,  but  repeated  the  bleedings  afterward  in  every 
case  where  the  pulse  continued  to  indicate.  It  ums  common  to  see  sizy  blood  sncceed 
tliat  wliich  was  dissolved."  "The  i)resence  of  petechias  did  not  deter  me  from  re- 
peated bloodletting  where  the  pulse  retained  its  fullness  or  tension"  (§  1002  d-f). 
"  I  bled  many  patients  twice,  and  a  few  three  times  a  day"  (§  999  n,  b).  "  I  did  not 
lose  a  single  jiatient  wliom  I  bled  seven  times  or  more  in  tliis  fever."  "I  cured" 
(after  he  had  abandoned  tonics  and  stimulants)  "a  greater  proportion  than  ninety- 
nine  out  of  a  hundred  of  all  who  applied  to  me  on  the  first  day  of  the  disease,  before 
the  lotli  day  of  September"  (§  557,  861).  "After  the  15th  my  success  was  much 
limited  compared  with  what  it  had  been  before  that  time.     But  at  no  period  of  the 


NOTE   FF. — BLOODLErriNG   IN   YELLOW   FEVER,  ETC.  1137 

disease  (with  the  qualification  aforesaid)  did  I  lose  more  than  one  in  twenty  of  those 
whom  I  saw  on  the  first  day."  "The  number  of  deaths  between  the  1st  of  August 
and  the  9th  of  November  amounted  to  4054."  Notwithstanding,  however,  the  stim- 
idating  practice  obtained  with  many  of  the  physicians  throughout  the  greater  part 
of  the  epidemic,  Dr.  Rush  remarks  that  "  not  less  than  6000  of  the  inhabitants  of 
Philadelphia  probably  owe  their  lives  to  purging  and  bleeding  during  the  autumn." 
"Many  whole  families,  consisting  of  five,  six,  and,  in  three  instances,  of  nine  mem- 
bers, were  recovered  by  plentiful  bleeding  and  purging."  Other  physicians  gradu- 
ally adopted  the  depletive  treatment,  "  one  of  whom  cured  ten  in  the  family  of  Mr. 
11.  Haydock  by  means  of  the  remedies."  "Dr.  Pennington"  (who  had  lost  all  the 
patients  to  whom  he  had  given  bark  and  wine)  "assured  me  on  his  death-bed  that 
he  had  not  lost  one  out  of 'forty-eight  patients  whom  he  had  treated  agreeably  to  the 
])rinciples  and  practice  I  had  recommended.  Dr.  Griffiths  triumphed  over  the  dis- 
ease in  every  part  of  the  city  by  the  use  of  what  were  called  the  new  remedies.'''  Of 
his  own  success  in  the  epidemic  of  1797  he  says,  "I  lost  but  one  patient  who  had 
been  the  subject  of  early  and  copious  bleeding.  His  death  was  evidently  induced  by 
a  supper  of  beefsteaks  and  porter  during  convalescence." 

To  the  untiring  perseverance  of  Dr.  Rush  is  due  the  overthrow  of  the  stimulating 
treatment,  which  reckoned  almost  every  patient  as  its  victim,  as  shown  by  the  suc- 
cess of  the  antiphlogistic  practice.  That  fearless  man,  in  the  midst  of  great  obloquy, 
"defended  his  treatment  in  the  public  papers  against  the  attacks  that  were  made 
upon  it  by  several  of  the  physicians  of  the  city."  "This  controversy  with  my 
brethren,"  he  adds,  "with  whom  I  had  long  lived  in  friendly  intercourse,  carried  on 
amid  the  most  distressing  labors,  was  extremely  painful  to  me."  But  he  finally 
triumphed,  and  his  memory  presents  an  imposing  contrast  with  that  of  his  oppo- 
nents. The  disastrous  effects  of  the  bark  and  wine  treatment  "  in  some  of  the  most 
opulent  families  in  the  city,  and  the  almost  uniform  success  of  the  depleting  remedies, 
happily  restored  the  public  mind,  after  a  while,  from  its  distracted  state,  and  pro- 
cured a  submission  to  the  latter  from  nearly  all  the  persons  who  were  affected  with  the 
fever."  Of  the  epidemic  of  1794  he  remarks  that,  "in  Philadelphia  and  Baltimore, 
where  bleeding  and  purging  were  used  in  due  time,  and  as  I  have  described,  not 
more  than  one  in  fifty  died  of  yellow  fever."  "  In  1797  the  stimulating  mode  was  de- 
serted by  every  physician  in  the  city. " 

In  regard  to  the  quantities  of  blood  which  were  often  abstracted,  the  following 
are  examples  in  the  epidemic  of  1794.  Dr.  Rush  supplies  a  table  of  23  cases  in  his 
own  practice,  in  which  the  quantities  varied  from  50  to  1 50  ounces,  ' '  taken  in  three, 
four,  and  five  days."  "I  did  not  cure  a  single  person,"  he  says,  "without  at  least 
one  bleeding."  In  the  epidemic  of  1793  he  has  examples  to  the  extent  of  100 
ounces  at  repeated  bleedings.  In  the  epidemic  of  1797  he  mentions  five  individuals 
whom  he  bled  to  the  extent  of  more  than  100  ounces.  In  the  same  epidemic  "Dr. 
Dewees  bled  Dr.  Physic  17G  ounces;  Dr.  Griffiths  bled  Mrs.  Thompson  110  ounces; 
Dr.  Stewart  bled  Mrs.  M'Phail  lOG  ounces ;  Dr.  Cooper  bled  Mrs.  Evans  150  ounces ; 
and  Dr.  Gillespie  bled  himself  103  ounces.  All  these  persons  had  a  rapid  recovery" 
(§  992,  994).  In  the  epidemic  of  1798,  "Dr.  Mease  was  bled  1G2  ounces,  and  Mr. 
J.C.Warren  200  ounces,"  and  recovered.  When  bleeding  had  been  neglected  in 
very  prostrated  cases,  "Nature  often  performed  that  operation  upon  herself  from 
the  gums  on  the  fourth  or  fifth  day.  I  have  seen  several  pounds  of  blood  discharged 
on  those  days  with  the  happiest  eflfects.  It  appeared  to  take  place  after  the  revival 
of  the  bloodvessels  from  their  prostrated  state"  (§  805,  863./;  890  d-g,  961-964,  984  c, 
1018-1019,  Notes  Gg,  Ii).  In  the  epidemic  of  1799  "there  were  few  cases  that 
did  not  indicate  bleeding.  Mr.  Rowan  lost  200  ounces  of  blood  by  22  bleedings" 
(§  999  a,  b). 

If  we  now  compare  the  mortality  from  yellow  fever  that  has  distinguished  the 
tonic  and  stimulating  treatment  for  the  last  forty  years  with  the  results  of  the  stim- 
ulating and  antiphlogistic  methods  of  the  last  century,  it  will  be  seen  that  the  pro- 
fession is  again  called  upon  to  return  to  principles,  and  to  that  enlightened  experi- 
ence from  which  the  principles  have  been  deduced  (§  1004  «),  and  to  surrender  the 
prejudice  that  the  same  diseases  so  fluctuate  in  their  type  in  different  countries  and 
at  different  seasons  as  to  require  opposite  modes  of  treatment  (§  752-756,  960  g, 
969  d,  1006  a-g,  1068). 

40 


1138      NOTES    GG-HU. — BLOODLETTING   IN   DYSENTEEY. — MEMORY. 


NOTE  Gg.— BLOODLETTING  IN  DYSENTERY. 

This  note  is  in  connection  with  §  8G3/  890  e,  984  c,  991  b,  1019, 1058/,  and 
Notes  F,  Ff.  In  Note  F  I  liad  occasion  to  quote  the  high  authority  of  the  British 
and  Foreign  Mcdico-Chirurgical  Review  in  proof  of  the  disastrous  effects  that  have 
resulted  from  tlie  abandonment  of  bloodletting  in  the  early  stages  of  diseases  of  the 
lungs,  and  it  is  now  my  purpose  to  quote  the  same  authority  to  show  as  remarkable 
a  contrast  between  the  results  of  the  treatment  of  dysentery  by  bloodletting,  calomel, 
opium,  etc.,  as  practiced  during  the  British  naval  expedition  to  China  in  1840-'42, 
and  which  "  was  most  in  vogue  twenty  years  ago,"  and  the  treatment  adopted  during 
the  second  expedition  for  the  three  years  1857,  '58,  '59.    -Thus  the  Review: 

"Of  late  years  (and  during  the  second  expedition)  the  heroic  or  active  treatment 
by  depletion,  etc.,  has  fallen  into  desuetude,  and  reliance  has  been  placed  on  milder 
measures.  Ipecacuanha,  in  the  manner  recommended  by  the  Indian  practitioners, 
has  been  largely  tried,  together  with  hydrarg.  cum  creta,  opium,  the  mineral  acids, 
topical  bleeding,  counter-irritants — in  short,  all  the  older  remedial  agents,  excepting 
general  bloodletting  and  calomel." 

Now,  says  this  able  digest  of  the  "Medical  Results  of  the  recent  Chinese  Wars, " 
"By  presenting  the  products  respectively  in  the  form  of  figures,  the  mind  will  seize 
at  a  glance  the  ])ainful  dispaiity. 


Years. 


Cases  of 

Number 

Number 

Dysentery. 

invalided. 

died. 

2102 

60 

188 

2006 

606 

465 

Number  of 
Jlen  employed. 

1840-1-2 15,470 

1857-8-9 24,980 

Thus,  in  rough  numbers,  in  the  first  Chinese  war,  one  out  of  every  eight  and  a  half 
of  the  men  attacked  succumbed  or  was  disabled  from  service ;  in  the  second  Chinese 
war,  one  out  of  every  two." 

It  appears,  therefore,  accoi-ding  to  the  foregoing  account  of  the  treatment,  that 
the  "painful  disparity"  is  to  be  attributed  to  the  neglect  of  general  bloodletting, 
since  the  other  "heroic  remedy,"  "calomel  pushed  to  ptyalism,"  has  been  only  an 
occasional  remedy  for  dysentery — never,  indeed,  much  practiced  either  in  Europe  or 
America.  But,  more  than  all,  I  am  most  happy  to  hail  a  returning  appreciation  of 
the  accumulated  experience  of  the  past  (though  it  be  the  slow  result  of  "a  painful 
dispai'ity"),  as  expressed  in  the  foljowing  quotation  from  the  article  to  which  I  am 
indebted,  and  which  was  contributed  to  the  Review  by  T.  Nelson,  M.D.,  Staff  Sur- 
geon, R.N. 

"  Taking  a  dispassionate  and  impartial  view  of  the  facts  as  they  have  just  been 
disclosed,  the  conclusion  to  which  they  lead  can  not  be  avoided,  namely,  that  the 
recent  method  of  treatment  of  dysentery  in  China,  so  far  from  having  become  more 
successful  from  the  additional  experience  which  twenty  years  confer,  has,  on  the  con- 
trary, very  decidedly  retroceded.  In  presence  of  tliis  painful  but  inevitable  infer- 
ence, it  becomes  a  subject  for  serious  consideration  whether  the  viuch  contemned  prac- 
tice of  twenty  years  ago  has  not  been  superseded  somewhat  rashly,  for  another  which, 
conforming  to  the  quietism  of  the  day,  has  brought  about  a  series  of  results  that  in  these 
times  has  no  parallel"  (§  1005  b-h,  Note  Ff). — British  and  For.  Med.  Chir.  Rev., 
July,  1863. 

In  the  last  conclusion  the  writer  is  mistaken  as  it  respects  the  relative  excess  of 
mortality  from  other  modes  of  treating  dysentery,  for  the  stimulating  and  astringent 
method,  now  in  vogue,  supplies  a  "  more  painful  disparity"  than  the  simple  exclu- 
sion of  general  bloodletting  from  the  antiphlogistic  treatment  practiced  by  the  Brit- 
ish surgeons  during  the  second  Chinese  expedition. 


NOTE  Hii.— MEMORY  SUDDENLY  LOST,  AND  SUDDENLY  RESTORED 
BY  FREE  BLOODLETTING. 

On  the  26th  of  October,  1862,  at  eight  o'clock  A.M.,  I  was  requested  to  visit  Dr. 
O.  B.,  a  medical  gentleman  of  this  city,  who  had  sustained,  in  the  course  of  the  pre- 
ceding night,  a  loss  of  memory.  I  had  passed  the  evening  in  conversation  with  him, 
at  which  time  his  memory  was  perfect,  and  he  had  been  attending  to  his  usual  avo- 
cations abroad  during  tlie  day.  His  age  was  about  62  j-ears,  slender  in  his  person, 
and  he  had  suffered  in  former  years  much  infirmity  of  health,  which  was  still  habit- 
ually delicate.     The  case  presented  some  very  remarkable  intellectual  phenomena ; 


NOTE    II. INTESTINAL    HEMORRHAGES    IN  TYPHUS    FEVER.       1139 

and  I  record  it  not  only  for  that  reason,  but  in  farther  defense  of  the  great  remedy 
against  which  so  insane  a  prejudice  prevails.  It  goes,  moreover,  with  the  rest  in 
showing  that  diseases  do  not  fluctuate  in  the  supposed  manner  in  their  pathological 
conditions  (§  1005^  a,  1068). 

The  case  presented  a  total  obliteration  of  memory  as  to  the  past  and  passing  events, 
but  it  was  sufiScient  for  a  connected  association  of  ideas,  and  reason  was  apparently 
sound  as  it  respected  subjects  immediately  present  to  the  mind.  His  remarks  re- 
ferred alone  to  the  occurrences  of  the  moment.  As  examples  of  the  failure  of  mem- 
ory, the  doctor  had  no  recollection  of  my  visit  on  the  preceding  evening,  and  when 
this  information  was  repeated  several  times  in  as  many  successive  minutes,  it  was  al- 
ready lost  to  his  memory.  And  so  of  other  things,  ujjon  which  he  would  reason  cor- 
rectly, but  would  totally  forget  the  conversation  and  tiie  subjects  about  as  quickly  as 
the  words  succeeded  each  other. 

I  was  informed  by  his  family  that  he  had  complained  for  ten  days  of  some  head- 
ache, but  that  in  other  respects  he  had  made  no  unusual  complaint  of  his  health. 
His  pulse  was  about  ninety  strokes  in  a  minute,  full,  strong,  and  rather  hard  and 
incompressible  (§  G88  d,  e) ;  tongue  clear,  appetite  unimpaired,  muscular  strength 
undiminished,  skin  natural.  He  had  arisen  from  bed  at  his  usual  hour.  Of  the 
headache  he  had  no  recollection ;  and  the  only  circumstance  which  reconciled  him 
to  medical  treatment  was  the  full  consciousness  that  he  had  lost  his  memory.  And 
yet  this  consciousness  existed  only  at  the  moment  when  his  attention  was  brought 
to  the  subject.  And  so,  also,  in  respect  to  the  ti-eatment.  When  bloodletting  was 
proposed  he  raised  objections  to  the  remedy,  but  would  forget  within  a  minute  that 
it  had  been  the  subject  of  discussion ;  and  even,  at  last,  when  the  preparation  for 
bleeding  was  ready,  he  was  astonished  at  being  informed  that  it  was  my  purpose  to 
bleed  him,  and  that  he  had  not  been  consulted  upon  the  subject. 

The  pathological  condition,  in  my  judgment,  was  venous  congestion  of  the  brain 
— such  as  is  apt  to  result  in  apoplectic  attacks.  I  therefore  anticipated  the  best  re- 
sults from  the  remedy,  and  that  the  system  would  bear  a  free  abstraction  of  blood 
under  the  stimulating  nervous  influence  developed  by  the  cerebral  excitement  (§  975, 
978,  979).  The  patient  sat  in  a  chair,  and  thirty-two  ounces  of  blood  were  ab- 
stracted, when  the  radial  pulse  had  yielded  sensibly  in, force,  fullness,  and  frequency, 
with  other  indications  of  approaching  syncope,  which,  however,  did  not  ensue. 
While  the  blood  was  running  I  gave  particular  attention  to  the  state  of  the  mind, 
and  ascertained  that  the  memory  was  progressively  returning,  and  it  was  completely 
restored  within  an  hour  after  the  blood  had  been  abstracted.  The  patient  continued 
to  move  about  the  house  during  the  day,  and  about  the  city  in  two  days  afterward. 
He  had  no  more  headache,  and  no  medicine  was  administered.  There  has  been  now 
an  interval  of  about  two  years,  and  there  has  been  at  no  time  any  manifestation  of 
"  debility,"  but  rather  an  improved  vigor  of  health.*  Nor  has  there  been  any  disturb- 
ance of  the  memory,  though  it  is  an  interesting  fact  that  the  doctor  remembers  noth- 
ing of  the  occurrences  of  the  morning  of  the  26th  of  October  prior  to  the  abstraction 
of  the  blood  (§  1072  b,  1078  o). 


NOTE  Ii.— INTESTINAL  HEMORRHAGES  CURATIVE  IN  TYPHUS  FE- 
VER, ETC.— IDENTITY  OF  TYPHUS  AND  TYPHOID  FEVERS. 

Notwithstanding  the  accumulated  experience,  throughout  all  the  ages  of  Medicine, 
of  the  salutary  eft'ects  of  spontaneous  hemorrhages,  particularly  as  incident  to  con- 
gestive fevers,  the  following  statement,  being  comprehensive  and  one  of  the  latest, 
may  be  usefully  added  to  the  other  evidences  upon  that  subject  recorded  in  this 
work.  At  a  meeting  of  the  New  York  County  Medical  Society,  held  March  2,  1863, 
Dr.  H.  D.  Bulkley,  a  physician  of  learning  and  ability,  remarked  th.at, 

"With  regard  to  the  value  of  intestinal  hemorrhages  in  typhoid  fever,  Drs.  Bre- 
tonneau,  Chomel,  Louis,  and  others,  considered  this  a  dangerous  symptom,  but  that 
Dr.  Graves  thought  it  rather  favorable  than  otherwise,  provided  the  loss  of  blood 
was  not  extreme.  M.  Trousseau  was  at  first  surprised  at  this  opinion  of  Dr.  Graves, 
but  finds,  on  looking  over  his  cases,  that  in  seven  years  he  has  known  but  two  deaths 
from  such  hemorrhage.  Others  attacked  with  it  not  only  recovered,  but  were  better 
afterward.  Dr.  Ragaine,  in  a  memoir  on  this  subject  sent  to  the  French  Academy, 
relates  one  hundred  and  fifteen  cases  of  typhoid  fever,  of  which  eleven  suffered  from 
hemorrhage,  and  they  all  recovered"  (§  805,  863  e,  f,  890  e,  922,  984  c,  1002  /, 
1006  d,  g,  1017  b,  1018-1019,  1068,  Notes  F,  Ff,  Gg). 

*  Eight  years  have  now  elapsed,  and  Dr.  Bkojjson  haa  continued  in  an  improved  state  of  health — 
1870. 


1140       NOTES  KK-LL. DIPHTHERIA. THE    PULSE    AS   A  GUIDE,  ETC. 

In  respect  to  the  identity  of  typhus  and  typhoid  fevers,  as  shown  in  Note  S,  it  may 
be  farther  stated  that  on  the  foregoing  occasion,  "Dr.  Bulkley  considered  typhus 
and  typhoid  fevers  as  varieties  of  the  same  disease  ;"  that  "Dr.  Finnell  maintained 
his  belief  in  the  identity  of  typhoid  and  typhus  fevers;"  and  that  "Dr.  J.  Foster 
considered  the  two  types  as  one  and  the  same  malady" — all  the  gentlemen  deducing 
their  conclusions  from  personal  experience. 


NOTE  Kk.— DIPHTHERIA. 


A  brief  reference  to  this  complicated  disease  is  made  in  a  note  at  page  350,  and 
at  page  450,  §  689  I,  for  the  purpose,  especially,  of  indicating  the  pathology  of  the 
disease;  and  it  is  now  my  object  to  reproduce  those  considerations  in  connection 
with  the  very  fatal  effects  of  the  almost  universal  treatment  of  the  epidemic  by  tonics 
and  stimulants,  and  to  commend  to  the  Profession  what  appears  to  me  to  be  the 
only  method  which  is  waiTanted  by  the  general  and  the  local  pathology,  and  which, 
in  my  hands,  has  been  attended  by  speedy  relief,  even  in  infancy — that  is  to  s^,  the 
strictly  antiphlogistic.  Decisive  bloodletting,  either  by  the  lancet  or  by  leeches,  is 
generally  indispensable ;  after  which  a  moderate  dose  of  calomel,  or  of  blue  pill,  to  be 
soon  followed  by  castor  oil,  or  the  oil  without  the  mercurial  remedy  (§  1057  /),  will 
be  about  all  of  an  active  nature  that  can  be  advantageously  done.*  The  superficial 
hypothesis  of  debility  is  the  source  of  the  appalling  mortality,  and  is  of  the  same 
nature  as  that  which  is  examined  in  sections  487  h,  569  b-e,  G21  a,  743,  752-756, 
785,  815,  887,  961-970  c,  992  c,  999c,1005  6-A,  1006 /-1007  6,1068  a,  l>,  Notes  F,  Ff. 


NOTE  Ll.— THE  PULSE  AS  A  GUIDE  TO  BLOODLETTING. 

It  is  a  remark  of  Dr.  Rush  that  "where  all  the  different  states  of  the  pulse  which 
indicate  the  loss  of  blood  are  perfectly  understood,  and  bloodletting  conformed  in 
time  and  quantity  to  them,  it  never  can  do  harm  in  any  disease.  It  is  only  when  it 
is  prescribed  empirically,  without  the  direction  of  just  principles,  that  it  has  ever 
proved  hurtful." 

The  foregoing  statement  occurs  in  Rush's  account  of  the  yellow  fever  of  1794,  and 
in  his  "  Defense  of  Bloodletting"  he  mentions  particularly,  in  the  form  of  very  brief 
abstract  rules,  ten  different  "states  of  the  pulse  that  indicate  the  necessity  of  bleed- 
ing." It  may  be  safely  said,  however,  that  the  "  necessity"  can  not  be  inferred  from 
any  one  of  the  conditions  without  the  light  of  other  symptoms  which  refer  more  im- 
mediately to  the  seat  and  pathology  of  the  disease;  and  many  of  the  modifications 
will  be  thus  found  to  contra-indicate  oftcner  than  they  "indicate  the  necessity  of 
bleeding."  Nevertheless,  the  foregoing  remark,  however  accidental  it  may  have 
been,  is  probably  true  in  a  universal  sense,  for  it  is  a  summary  principle  founded 
upon  all  the  circumstances  of  individual  cases  of  disease. 

Looking,  therefore,  at  the  fluctuations  of  the  pulse  according  to  the  seat,  nature, 
force,  and  duration  of  the  disease,  it  becomes  evident  that  this  universal  symptom, 
as  a  (jtiide  to  bloodletting,  involves  a  critical  inquiry  into  all  the  circumstances  of 
disease  that  can  modify  the  action  of  the  heart  and  bloodvessels,  and  from  which  it 
appears  that  it  must  be  very  generally  these  combined  circumstances  in  connection 
with  the  state  of  the  pulse,  and  oftener  the  former  more  than  the  latter,  which  must 
determine  the  propriety  of  bloodletting,  and  "  the  time  and  the  quantity"  (see  Index 
II.,  Pulse).  The  pulse,  .at  best,  as  I  have' endeavored  to  show,  informs  us  only  of 
the  nature  of  reflected  nervous  influences  that  are  propagated  upon  the  heart  and 
arteries  by  all  diseases  except  the  cardiac,  as,  also,  by  the  action  of  remedial  agents, 
by  mental  emotions,  etc.  (§  500  m,  and  references  there,  687^-688).  The  pulse, 
therefore,  in  the  foregoing  accejjtation,  may  be  regarded  as  the  sum  of  all  the  symp- 
toms, but  that  its  true  or  exact  import  can  never  be  known  without  a  reference  to 
those  symptoms.  Nevertheless,  the  multitude  consider  only  the  state  of  the  pulse 
and  "  debility,"  without  any  regard  to  their  causes ;  or,  rather,  the  former  lias  now- 
adays lost  all  its  significance,  and  "debility,"  representing  universal  pathology,  di- 
rects the  hand  of  the  practitioner  (§  887).  This  will  be  manifest  on  considering  the 
stimulating  treatment  of  those  diseases  wjiich  are  attended  by  a  hard  and  incom- 
pressible pulse  (§  688  d-f),  such  as  pneumonia,  enteritis,  phrenitis,  phthisis,  etc. 

•  Thn  pulse  and  mu.aonlftr  strength  nre  in  no  respect  guides.  Both  are  apt  to  be  prostrated  by  the 
attendant  abdominal  congestion  (§  CS9  I,  801,  961,  p.  360,  iiote). 


NOTES   MM-00. — DEATH-RATE,  NAKCOTICS,  ETC.  1141 


NOTE  Msr.— DEATH-RATE  IN  THE  CITY  OF  NEW  YORK,  AND  ITS 

CAUSES. 

In  preceding  editions  of  this  work  (p.  872,  1115)  I  liave  presented  the  statistics  of 
mortality  in  the  City  of  New  York  from  inflammation  of  the  lungs,  bronchitis,  croup, 
and  consumption,  during  the  months  of  January,  February,  March,  and  April  for  the 
years  18G0,  '61,  '62,  for  the  purpose  of  showing  the  results  of  the  substitution  of  the 
stimulating  for  the  antiphlogistic  treatment,  and  that  the  "excessive  death-rate"  in 
this  city  is  not  owing  to  climate  (than  which  there  is  no  city  more  exempt  from  dis- 
ease), nor  to  any  temporary  insalubrity  of  the  atmosphere ;  and  with  the  same  in- 
tention I  shall  now  record  the  statistics  for  the  same  months  in  the  years  1863,  '64. 

In  18G3,  the  total  number  of  deaths  during  the  foregoing  months  was  7741,  of 
which  636  are  reported  as  Inflammation  of  the  Lungs  ;  Bronchitis,  185 ;  Croup, 
383;  Consumption,  1205;  or  nearly  I  in  12  from  Pneumonia,  1  in  20  from  Croup, 
and  1  in  6  from  Consumption.  The  ratio  of  deaths  from  the  four  diseases  to  the 
total  number  of  deaths  from  all  causes  is  about  as  1  to  3^^. 

In  the  year  1864,  the  total  number  of  deaths  during  the  same  four  months  was 
8493,  of  which  839  were  from  Inflammation  of  the  Lungs;  Bronchitis,  164; 
Croup,  352  ;  Consumption,  1260  ;  or  nearly  1  in  10  from  Pneumonia,  1  in  24  from 
Croup,  and  1  in  Gf  from  Consumption.  The  ratio  of  deaths  from  the  four  diseases 
to  the  total  number  of  deaths  from  all  causes  is  about  as  1  to  3^.* 

It  is  thus  seen  that  there  has  been  nearly  the  same  mortality  from  the  four  in- 
flammatory diseases  during  the  first  four  months  of  the  five  consecutive  years.  I 
shall  make  no  farther  comments  upon  this  mortality,  nor  upon  the  practice  which  is 
greatly  responsible  for  it ;  but  it  may  be  worth  while  to  show  the  death-rate  from 
consumption  for  entire  years,  which  for  the  last  five  is  as  follows  :  In  the  year  1859, 
the  total  number  of  deaths  from  all  causes  was  21,645,  of  which  the  rate  from  Con- 
sumption was  about  as  1  to  6g  ;  in  1860,  total  deaths  22,710,  rate  from  Consumption 
about  as  1  to  7 ;  in  1861,  total  deaths  22,117,  rate  from  Consumption  as  1  to  7J ; 
in  1862,  total  deaths  21,241,  rate  from  Consumption  about  as  1  to  6f  ;  in  1863,  total 
deaths  25,196,  rate  from  Consumption  about  as  1  to  6;^. — See  Note  F,  p.  1114. 

The  statistics  have  been  obtained  from  the  able  and  elaborate  reports  of  Cyrus 
Ramsay,  M.D.,  LL.B..  Registi-ar  of  Records  and  Statistics  in  the  City  Inspector's 
Department. 


NOTE  Nn.— NARCOTICS  AND  SENSO-PARALYSANTS  AS  TO  PAIN. 

A  characteristic  and  practical  distinction  between  the  groups  of  Narcotics  and 
Senso-Paralysants,  according  to  the  nature  of  the  agents  which  I  have  assigned  to 
those  groups  respectively,  in  my  work  upon  Therapeutics  and  Materia  Medica  (§  891, 
1057  d),  and  upon  which,  particularly,  the  groups  are  founded,  is,  that  the  Nar- 
cotics exert  their  most  characteristic  effects  upon  the  organs  of  organic  life,  while  the 
Senso-Paralysants  are  felt  mainly  in  the  organs  of  animal  life.  This  is  remarkably 
true  of  pain,  for  the  relief  of  which  in  the  great  organs  of  life,  so  fiir  as  it  respects 
the  nervous  agents,  we  are  mostly  limited  to  o[)ium,  hyoscyamns,  and  conium,  which 
are  nearly  useless  in  neuralgia  and  other  painful  affections  of  the  organs  of  animal 
life,  while  it  is  in  these  conditions,  and  not  in  painful  affections  in  organic  life,  that 
aconite,  veratria,  belladonna,  deiphinia,  and  stramonium  display  their  anodyne  vir- 
tue. They  exert  no  soporific  effect  in  their  ordinary  doses,  and  when  such  doses  are 
followed  by  sleep  it  is  owing  to  the  removal  of  pain. 


NOTE  Oo.— RELATIVE  LIABILITY  OF  MASTER  AND  SLAVE  TO  PES- 
TILENTIAL DISEASE.— xMORE  ABOUT  ANIMAL  HEAT. 

When  speaking  of  the  subordinate  predisposing  causes  of  disease  which  increase 
the  susceptibility  of  the  svstem  to  be  acted  upon  by  the  essential  ones  in  cases  of 
epidemics,  and  which,  also,  add  to  the  intensity  of  disease,  I  attributed  the  compar- 
ative exemption  of  the  Negro  from  the  epidemic  fevers  of  the  Southern  States  to  his 
abstinence  from  stimulating  food  and  stimulating  liquors  (Index  II.,  art.  Acclima- 
tion, 3d  subdivision  ;  also  §  630  e,  663,  814,  816  b,  827  e,  883  i);  and  it  is  now  my 
purpose  to  simply  state  the  habits  of  the  Negro  in  that  respect,  as  represented  by  a 

•  We  Icain  from  Cellevue  Hospital  (N.  V.),  that  in  the  treatment  of  Pneumonia  "the  olden 
methods  of  saDguineoua  depletion  with  antimonials  have  heen  swept  away  bi/  the  advance  of  medical 
science."— Am.  Med.  Times,  1864.     Note  E  e,  as  to  the  '■'■advance  of  modem  pathologr,"  and  5  5K 


1142  NOTE   pp. — THE   DEVEL0PME2<TAL    HYPOTHESIS,  ETC. 

distinguished  observer  who  had  resided  several  years  in  their  midst,  and  whose  lius- 
band  was  the  wealthy  proprietor  of  a  large  plantation.  This  information  is  derived 
from  a  "Journal  of  Residence  on  a  Georgian  Plantation,"  by  Fanny  E.  Kcmble 
(then  Mrs.  P.  Butler),  in  whicli  it  is  said  that  "the  slaves  labor  hard  all  day  upon 
two  meals  of  Indian  corn,  or  hominy,  as  it  is  called,  as  the  regulation  on  this  planta- 
tion, and  our  Negroes  are  generally  considei'ed  well  off.  They  go  to  the  fields  at  day- 
break, carrying  with  them  their  allowance  for  the  day,  which  is  eaten  at  noon ;  and 
their  second  meal  is  at  night,  after  their  labor  is  over — having  worked,  at  the  very 
least,  six  hours  without  intermission  of  rest  or  refreshment  since  their  noonday  meal." 
The  foregoing  statement  associates  itself  with  what  has  been  said  in  this  work 
upon  the  connection  of  food  with  animal  heat,  as  in  sections  441  c,  1048-1050  ;  and 
it  is  also  an  evidence  of  the  fallacy  of  a  "prevailing  opinion  that  a  spare  diet  is  pro- 
ductive of  disease,  and  incompatible  with  laborious  pursuits  (§  1048).  I  will  add 
that  this  last  subject  is  fully  examined  in  the  Medical  and  Physiological  Commentaries, 
vol.  ii.,  p.  691-698,  in  an  article  upon  '■'■Fasting.'' 


NOTE  Pp.— THE  DEVELOPMENTAL  HYPOTHESIS.— THE  DARWINIAN 
ORIGIN  OF  SPECIES.— "MEN  AND  MONKEYS." 

The  doctrine  of  the  origin  of  species  by  transmutation,  in  all  the  aspects  of  that 
hypothesis,  is  abundantly  refuted  as  to  man  by  the  distinctions  which  I  have  indi- 
cated between  the  Soul  and  Instinct  (p.  892-906,  §  1078) ;  for,  however  great  may 
be  the  coincidences  between  the  organization  and  the  functions  of  man  and  animals, 
there  is  none  between  absolute  reason  and  instinct.  The  former,  as  I  have  shown, 
is  peculiar  to  man.  But,  if  there  were  any  just  foundation  for  the  developmental 
doctrine,  the  manifestations  of  reason  should  not  begin  abruptly  with  man,  but  should 
observe  some  degree,  at  least,  of  correspondence  with  the  physical  conditions.  And 
since,  also,  man  is  completely  an  animal  in  organization  and  functions,  tlie  ground 
which  is  thus  obtained  may  be  carried  analogically  throughout  the  animal  kingdom. 

Lest  an  advantage  be  taken  of  what  has  been  said  of  the  modification  of  Instinct 
in  metamorphic  animals  (§  1078;>),  by  applying  the  principle  to  the  develojiment  of 
the  rational  faculties  of  man  in  his  supposed  evolution  from  the  monkey  tribe,  it 
may  be  said,  notwithstanding  the  obvious  want  of  all  analogy,  that  the  mutations 
of  organization  in  the -metamorphic  animals  are  of  the  most  fundamental  nature, 
while  the  corresponding  modifications  of  instinct  are  always  in  strict  conformity  with 
the  great  general  plan  of  instinct,  and  farther,  also,  that  in  all  these  cases  the  several 
mutations  of  structure  and  instinct  are  progressive  stages  of  the  same  individual  from 
the  germ  to  its  full  maturity.  Instinct,  as  I  have  shown  in  this  work,  is  constituted 
throughout  all  the  animal  tribes  with  a  sole  reference  to  the  uses  of  the  body,  and 
that  no  animal  has  been  known  to  manifest  any  of  the  phenomena  of  reason  that 
can  not  be  resolved  by  the  philosophy  which  I  have  predicated  of  instinct. 

Glancing  more  particularly  at  the  most  novel  of  the  repudiations  of  Creative 
Power,  and  which  has  taken  captive  so  many  of  the  scientific  world,  it  appears  to  be 
encumbered  with  greater  fallacies  than  any  of  its  kindred  doctrines.  Besides  the 
many  obvious  considerations  of  a  physiological  nature  that  apply  to  Darwin's  "  ori- 
gin of  species  by  natural  selection"  (p.  814,  note),  it  is  worth  saying,  that  as  all  the 
assumed  developments,  or  mutations  of  species  as  called  by  Darwin,  start,  at  the 
best,  with  the  infancy  of  animals  (§  1085),  an  objection  which  I  alleged  against  the 
doctrine  of  spontaneity  of  beings  in  the  work  upon  the  "Soul  and  Instinct"  (p.  158- 
165)  is  equally  applicable  to  the  Darwinian  origin  of  species.  The  argument  pro- 
ceeds thus  :  Now  let  us  see  how  far  the  statements  of  Holy  Writ  agree  with  what  is 
manifestly  fundamental  in  Nature.  We  are  told,  for  eicample,  that  man  and  beast 
were  created  entire  out  of  the  earth ;  but  had  it  been  said  that  the  materials  of  the 
earth  organized  themselves  into  living  beings,  or  even  that  the  materials  were  pe- 
culiar to  living  beings  (an  assumption  highly  probable,  unless  the  composition  had 
been  revealed),  the  Narrative  would  be  rejected  by  all  as  an  imposture.  Nay  more, 
had  it  been  affirmed  that  man  was  created  in  the  condition  of  an  infant,  and  thus 
left  to  grow  up  to  maturity  under  the  laws  which  govern  his  organization,  without 
maternal  sustenance  and  protection,  without  a  ray  of  instinct,  destitute  of  volition 
and  muscular  power,  the  personification  of  helplessness,  tlie  statement  would  be  uni- 
versally pronounced  absurd.*  Yet  is  this  doctrine  extensively  propagated  through 
the  delusion  that  "the  Creator  endowed  certain  forms  of  inorganic  matter  with  the 
j'roperties  requisite  to  enable  them  to  combine,  at  a  Jilting  season,  into  the  hitman  or- 

*  See  my  deinonstrntion  of  the  necessity  of  miin's  creation  in  a  state  of  maturity  both  of  mind  and 
body,  and  all  mammiferous  animals,  and  all  birds,  in  my  work  on  the  Soul  and  Instinct,  p.  15S- 
1T3.     1819.     Also  tins  work,  §  1083. 


KOTK   PP. THE    DEVELOPME^•TAL    HYPOTHESIS,  ETC.  1143 

ganism"  (§  350  J  at  p.  187,  189,  §  1083).  What  I  have  thus  said  as  to  the  absolute  ex- 
igencies of  man  in  early  life  is  as  applicable  to  all  mammiferous  animals,  and  to  all 
unfledged  birds,  in  respect  to  the  nature  of  their  early  food,  who  would,  of  course, 
immediately  perish  without  the  sustenance  afforded  by  the  parent. — Essay  on  the 
Soul  and  Instinct,  p.  159,  IGO. — See  aTgument  in  Note  p.  815. 

If  it  be  objected  by  the  advocates  of  Darwin's  assumptions  that  the  parent  of  the 
newly-developed  species  would  have  been  the  nursing  mother,  it  will  be  readily  seen 
that  no  animal,  however  much  it  may  approximate  man  in  organization,  is  in  the 
least  qualified  to  take  charge  of  the  human  infant ;  a  fact  which  may  be  applied, 
analogically,  with  equal  force  to  the  whole  tribe  of  mammiferous  animals,  since,  if  it 
can  be  shown  that  man  is  an  exception  to  any  of  the  interpretations  of  nature  that 
aspire  at  the  origin  of  living  beings  the  entire  hypothesis  necessarily  falls. 

In  looking  around  for  the  species  of  animal  out  of  which  the  human  race  has  been 
developed,  according  to  the  scheme  before  us,  that  which  approximates  man  most 
neai-ly  in  organization  must  enjoy  the  distinguished  honor  of  paternity — the  gorilla, 
orang-outang,  or  some  one  of  the  monkey  tribe.  It  is  considered  that  organization 
in  these  instances  is  so  close  upon  that  of  man  as  to  supply  in  this  abstract  sense  a 
plausible  pretense  for  a  still  closer  relationship  (§  3503  ^'^O ;  and  it  follows,  therefore, 
by  the  analogies  of  Nature,  as  well  as  by  the  law  of  inheritance,  which  is  so  justly 
argued  by  Darwin  as  the  basis  of  his  doctrine,  that  reason,  the  grand  characteristic 
of  the  human  race,  should  have  also  made  some  approximation  in  the  gorilla  or 
chimpanzee  toward  that  divine  attribute  of  man.  But  I  have  endeavored  to  demon- 
strate, in  the  article  in  this  work  upon  the  Physiology  of  the  Soul  and  Instinct  (p.  SOS- 
Oil),  that  no  animal  evinces  that  endowment,  and  that  the  whole  tribe  of  apes, 
monkeys,  and  chimpanzees  are  vastly  less  provided  with  instinct  than  the  honey-bee 
(p.  896-898,  §  1078  d,  e),  while  man  dwindles  into  insignificance  by  the  side  of  the 
orang-outang  in  respect  to  the  instinctive  principle  (§  1078  q,  etc.).  However  great, 
therefore,  may  be  the  coincidences  between  the  organization  of  man  and  the  quad- 
rumanous  tribes,  it  is  impossible  to  evade  the  fundamental  distinction  which  is  estab- 
lished by  reason  and  instinct.  But  even  in  respect  to  organization  there  arc  some 
things  which  concur  with  reason  in  enforcing  the  conclusions  to  which  it  conducts 
us.  Man,  for  example,  walks  erect ;  but  that  would  not  be  sufficiently  characteristic 
to  prove  the  distinct  and  independent  nature  of  his  being.  The  absence,  however, 
of  all  correspondence  in  the  uses  of  his  upper  and  lower  extremities,  while  in  tlie 
quadrumanous  tribes  they  subsci-ve  the  same  pui-poses,  does  estrange  them  fuiula- 
raentally  from  each  other;  and  this  argument  is  vastly  increased  by  the  fact  tliat 
the  arms  of  the  human  species  are  intended  to  fulfill  the  promptings  of  Reason,  wliile 
the  fore  legs  of  the  quadrumana  are  no  more  tributary  to  Instinct  than  the  posterior 
legs — both  of  which  are  properly  legs. 

Nor  will  I  leave  this  important  subject  till  I  array  another  argument  against  the 
so  called  '■^typical  system"  of  development,  and  which  will  be  seen,  also,  to  operate 
against  the  Darwinian  assumptions.  It  is  this :  The  differences  which  occur  between 
extinct  and  living  animals  and  plants  do  not  relate  to  organization  as  it  respects  the 
life  of  the  being,  but  only  to  certain  details  in  the  form  of  organs.  This  diftcrenco 
does  not  involve,  in  the  least,  any  difference  in  the  plan  of  organization,  which  is 
exactly  the  same  in  the  earliest  of  the  lowest  and  highest  order  of  beings,  and 
throughout  all  the  intermediate  gradations  in  the  ascending  series,  as  at  the  ])resent 
day.  Composition,  germs,  growth,  and  reproduction  are,  also,  common  to  all.  Or- 
ganic life,  therefore,  has  always  been  precisely  the  same  throughout  every  link  of  the 
vast  chain,  and  the  physical  agents  of  life,  therefore,  always  the  same  (§  fi32  h).  Hence 
it  is  evident  that  the  whole  typical  system  of  theoretical  geology,  which  is  founded, 
not  upon  diff"erences  in  the  plan  of  organization,  but  upon  the  form  of  organs,  is  one 
of  the  greatest  fallacies  that  has  crept  into  science.  Nor,  indeed,  could  this  specu- 
lation have  pervaded  the  works  of  geologists  any  more  than  the  recent  novelties  of 
Darwin,  Huxley,  etc.,  had  any  one  of  the  numerous  projectors  been  duly  informed 
upon  the  science  of  Physiology.  Anatomy  supplies  no  foundation  for  this  reasoning 
(§  131, 1078  e);  but,  on  the  contrary,  when  associated  with  the  physiological  laws 
which  it  is  designed  to  subserve,  it  is  opposed  to  their  conclusions  (Index  I.,  article 
Design). 

The  various  attempts  of  arranging  man  in  an  order  by  himself  upon  the  basis  of 
physical  characteristics  appear  to  be  open  to  objections ;  nor  is  this  at  all  remarkable, 
considering  the  near  affinities  between  the  structure  and  physiological  characteristics 
of  man  and  certain  other  mammalia.  The  distinction  founded  by  Professor  Owen 
upon  certain  supposed  peculiarities  of  the  human  brain  would  establish  only  a  specific 


1144  NOTE   PP. — THE   DEVELOPMENTAL   HYPOTHESIS,  ETC. 

diiFerence.  But  even  this  has  been  controverted  by  Professor  Huxley,  who  finally 
propounds  the  question,  "Are  we  justified  in  classifying  men  and  monkeys  to- 
gether? The  comparison,"  he  continues,  "of  the  human  skeleton  with  that  of  the 
gorilla,  an  orang,  a  chimpanzee,  or  any  of  the  higher  apes,  will  answer  the  question, 
and  show  at  a  ghince  the  great  resemblt^nce  and  similarity  there  is  between  them 
(§  1078  e).  Now  the  gorilla,  for  example,  is  admittedly  placed  in  the  same  order 
as  the  lemur,  tiie  cheiromys,  and  the  galeopitheus,  which  differ  far  more  from  it 
than  it  does  from  man.  Thus  we  can  not  but  place  them  in  the  same  order,  or 
else  all  our  notions  of  afiinities  and  resemblances  fall  to  the  ground." 

This  presentation  of  the  subject  is  plausible,  and  such  as  is  anticipated  in  §  1078  e. 
It  is  at  best,  however,  an  artificial  grouping  of  animals,  without  showing  in  the  least 
that  those  which  approach  nearest  in  structure  are  not  as  perfectly  distinct  species  as 
are  the  orang  and  the  honey-bee,  and  not  more  allied  to  each  other  in  their  origin. 
But  a  common  fallacy  has  beset  all  the  attempts  to  establish  man  as  a  special  order, 
under  the  artificial  arrangement,  that  of  neglecting  the  great  facts  which  distinguish 
him  essentially  from  every  animal — his  endowment  with  reason  and  his  deficiency 
in  instinct.  Even  the  systematists,  who  have  indicated  peculiarities  in  the  cerebral 
structure  of  man,  have  left  the  impression  that  reason  depends  upon  those  peculiari- 
ties. It  is  the  error  of  materialism.  But  if  the  demonstration  which  has  been  made 
in  this  work  of  the  substantive  existence  and  self-acting  nature  of  the  soul  and  of  the 
instinctive  principle  be  true  to  Nature,  it  may  be  safely  said  that  reason  alone  places 
man  in  an  order  by  himself,  whatever  may  be  "our  notions  of  afiinities  and  resem- 
blances" among  skeletons  (§  241  c,  note,  1078  d,  e,  q,  Note  C). 

Finally,  an  argument  against  the  hypotheses  which  ascribe  the  origin  of  species 
to  blind  material  forces,  and  sufiiciently  conclusive  as  to  man  with  all  who  believe 
in  his  immortality,  may  be  founded  upon  that  single  fact,  which  so  completely  dis- 
tinguishes him  from  the  animal  tribes.  The  same  philosophy  must  obtain  here  as 
in  all  the  suppositive  conclusions  of  a  physical  nature,  and  it  must  be  equally  true 
that  the  soul  of  man  not  only  originated,  but  became  rational  and  immortal  under 
the  infiuence  of  those  natural  fofces  and  laws  which  are  supposed  to  have  given  origin 
to  his  material  body — whether  it  have  been  according  to  the  doctrine  of  Carpenter, 
Milkier,  Tiedemann,  etc.  (§  350i  /,  /,  7«),  or  as  expounded  by  Professor  Lewis 
(§  1085,  p.  922),  or  by  the  late  projector,  Darwin  (p.  814,  note).  The  first  of  these 
doctrines  supposes  that  the  elements  of  matter  united  into  living  beings  in  virtue  of 
the  forces  with  which  they  are  endowed,  and  therefore,  by  parity  of  reason,  the  im- 
mortal soul  of  man  must  have  had  the  same  origin.  If  Creative  Power  be  invoked 
for  this  particular  difficulty,  the  physical  structure  and  its  life  must  fall  under  the 
same  rule.  There  is  no  greater  evidence  of  the  existence  of  "vital  properties  in 
the  elements  of  matter"  than  of  the  soul  or  instinct.  But  it  is  enough  that  the  ma- 
terialistic doctrine  excludes  all  direct  agency  of  Creative  Power,  and  consigns  the 
whole  work  to  second  causes.  If  that  Power  be  allowed  to  have  had  any  creative 
action  in  the  production  of  organic  beings,  there  can  be  no  compromise  with  the 
hypothesis  of  second  causes  as  it  respects  other  parts  of  the  same  beings.  While  the 
Creator  was  employed  about  the  immortal  soul,  it  must  be  allowed  that  He  would 
have  equally  attended  to  the  no  less  diflicult  organization.  A  similar  philosophy 
must  apply,  also,  to  the  "  parturitive"  hypothesis  (p.  922).  And  coming  to  Darwin's 
scheme  of  slowly  progressive  mutations,  it  is  necessary  that  the  animals  in  the  ad- 
vancing series  out  of  which  man  was  developed  should  have  possessed  not  only  a  ra- 
tional soul  closely  allied  to  man's,  but  that  soul  should  be  immortal.  This  unavoid- 
able conclusion  carries  us  back  through  all  the  ascending  series  of  animals  till  we 
reach  the  "primordial  cell"  (§  lO."")!),  or  Darwin's  "primordial  form,"  for  there 
alone  can  we  look  for  the  beginning  of  an  imnwrtal  soul,  according  to  the  doctrine 
of  the  "origin  of  species  by  natural  selection."  How  that  cell  or  that  soul  came 
into  being  we  are  left  in  ignorance,  as  in  the  case  of  Tiedemann's  "organic  matter" 
(§  SaOJ  /,  p.  188).  But  if  an  immortal  soul  were  not  inherent  in  the  cell,  or  at  least 
in  some  animal  anterior  to  man,  it  must  have  been  a  supernatural  endowment  of  the 
human  race,  or,  in  other  words,  a  special  act  of  Creative  Power,  and  therefore,  also, 
by  an  irresistible  logic,  man's  physical  structure  was  equally  a  direct  act  of  tlie  same 
Power.  This  conclusion,  it  is  true,  requires  the  admission  of  man's  spiritual  immor- 
tality ;  and  if  it  be  objected  to  this  that  man  is  not  thus  distinguished  from  animals, 
I  recur  to  mv  argument  in  proof  of  the  perjietnity  of  the  former  and  the  extinction 
of  the  latter"(§  1079  a).  But  I  do  not  consent  to  the  exclusion  of  well-established 
Revelation  from  matters  of  science,  and  I  therefore  contend  that  the  mission  of  Christ 
determines  the  resurrection  exclusively  in  favor  of  rational  and  responsible  beings. 


NOTE  QQ-RK. ANTIQUITY    OF   THE   EACE. — LONG   SENTENCES.       1145 

Since,  therefore,  it  appears  from  our  premises  that  the  soul  of  man  is  so  contra- 
distinguished from  the  instinct  of  animals  that  it  can  have  had  no  relation  to  the 
animal  tribes,  and  that  it  follows,  as  a  consequence,  that  man's  physical  organization 
was  equally  a  direct  act  of  Creative  Power,  and  since,  also,  by  common  consent,  he 
is  on  common  ground  with  animals  in  his  organization,  it  equally  follows  that  the 
origin  of  every  distinct  species  of  animal  was  a  special  act  of  the  same  Power. 


NOTE  Qq.— HIGH  ANTIQUITY  OF  THE  HUMAN  RACE, 

Although  this  is  not  the  place  to  discuss  the  question  which  has  been  much  agi- 
tated of  late  among  scientific  men  as  to  the  high  antiquity  of  the  human  race,  or  the 
proper  interpretation  or  authenticity  of  the  Mosaic  narrative  of  creation,  and  other 
kindred  topics,  but  to  which,  for  special  reasons,  the  author  has  adverted  in  this 
work  (§  14  c,  250}  I,  632,  1051,  1079  b,  1083,  p.  922-928,  §  1085),  he  is  led  to  repeat 
an  objection  which  he  alleged  in  his  "Theoretical  Geology"  (§  1079  b)  against  the 
supposed  antiquity.  The  objection  consists  in  the  physiological  fact  that  the  human 
mind  was  alike  endowed  in  the  remotest  past  as  at  the  present  day,  and  is  constitu- 
tionally so  progressive  that  as  soon  as  the  race  in  any  given  locality  exceeded  in 
numbers  the  natural  means  of  subsistence,  they  should  have  addicted  themselves  to 
the  culture  of  the  earth  and  other  useful  arts,  and  there  should  have  thus  descended 
to  us  from  those  early  stages  of  society  materials  at  least  as  advanced  as  those  through 
which  alone  we  learn  the  former  existence  of  a  A'ast  population  in  the  Western 
world.  They  should  be  also  incomparably  more  abundant,  since  in  the  case  of  the 
geological  man  he  is  supposed  to  have  been  multiplying  through  hundreds  of  thou- 
sands of  years ;  while  the  origin  of  the  monumental  vestiges  of  the  race,  of  an  un- 
equivocal nature,  lies  within  the  compass  of  four  thousand  years,  and  the  testimo- 
nials that  have  been  recently  produced  in  support  of  geological  periods  are  insignifi- 
cant in  amount,  and  can  not  be  shown  to  be  of  an  earlier  date  than  the  Chaldean  and 
Egyptian  Architecture.  Human  reason,  under  equal  circumstances,  was  as  creative 
at  its  earliest  dawn  as  at  any  later  period,  and  the  multiplication  of  mankind,  ac- 
cording to  the  nature  of  climate  and  the  progress  of  art,  went  on  then  as  now. 
Science  had  not  dawned  when  David,  Solomon,  Isaiah,  and  Homer  wrote,  and  no 
better  thinkers  and  writers  have  since  appeared.  Greece  and  Rome  perfected  His- 
tory, Architecture,  Oratory,  Sculpture,  Painting,  soon  afterward,  and  two  thousand 
vears  moi"e  brings  us  to  our  own  times.  If,  therefore,  so  much  has  been  accom- 
plished within  the  four  thousand  years  beyond  which  we  can  not  ascend,  and  such 
a  host  of  brilliant  minds  contributed  to  the  earliest  page  of  history,  what,  I  say, 
would  not  this  same  creative  mind  have  produced  had  it  been  in  operation  ten  thou- 
sand years  before  the  structures,  and  sculptures,  and  writings  of  Babylon,  Nineveh, 
and  Egypt?  It  is  now  too  late  for  the  afterthought  that  the  human  mind  has  been 
subject  to  changes  since  the  law  of  "natural  selection,"  or  any  "law"  within  the 
compass  of  imagination,  produced  the  physical  organization  of  the  race ;  and,  more- 
over, what  is  known  of  the  unvarying  nature  of  Instinct  in  all  species  of  animals 
determines  the  same  stability  for  human  Reason. 


NOTE  Rr.— LONG  SENTENCES. 


«A  sentence  which  occurs  in  section  638  has  been  very  justly  regarded  as  a  "long 
one."  Indeed,  the  Author  concedes  that  it  may  require  more  than  one  sitting  to 
read  it  through  intelligibly.  Its  design  may  not  be  obvious  to  many,  although  it 
carries  its  own  interpretation  in  showing  the  intimate  relationship  of  the  various 
topics  involved,  and  which  had  been  antecedently  presented  as  the  fabric  of  physio- 
logical medicine.  That  a  system  so  complex  and  multifarious  in  its  constituent 
parts,  embracing  the  entire  field  of  physiology  and  its  applications  to  Pathology  and 
Therapeutics,  should  be  susceptible  of  exposition  in  a  continuous  sentence  without 
violating  the  unity  and  harmony  of  a  consistent  whole,  must  be  received  as  an  evi- 
dence of  the  realities  of  its  subject.  But  what  has  been  now  said  is  more  particu- 
larly intended  as  a  commentary  upon  the  "long  sentences"  which  abound  in  the 
Second  Index,  and  which  will  be  seen  to  embrace  a  variety  analogous  to  the  char- 
acteristic of  section  638.  The  common  nature  of  the  subjects,  under  each  article, 
brought  them  together  into  compact  and  continuous  sentences,  while,  also,  this  con- 
gruity  illustrates  and  confirms  the  harmonious  system  which  is  indicated  in  the  first 
paragraph  of  these  Institutes. 


NOTES  TO  THE  NINTH  EDITION. 


NOTE  AAA.— THE  HUMORAL  PATHOLOGY.— Dr.  S.  W.  MITCHELL'S 
EXPERIMENTS  WITH  THE  VIRUS  OF  THE  RATTLESNAKE.— PROF. 
W.  BOECK  ON  SYPHILIZATION.— VACCINATION. 

The  prevailing  humoral  pathology  is  so  entirely  subversive  of  all  principles  in  med- 
icine, whether  they  relate  to  pathology  or  therapeutics,  and  so  opposed  to  physiolog- 
ical facts,  that  I  am  induced  to  refer  again  to  this  subject  in  its  connection  with  the 
operation  of  poisons,  and  for  the  particular  purpose  of  showing  still  farther,  by  the  ac- 
tion of  the  venom  of  snakes,  that  it  does  not  kill  by  any  alteration  of  the  blood,  nor 
by  any  effect  upon  the  important  organs  of  life  excepting  through  the  destructive  in- 
fluences of  the  nervous  power.  This  note,  therefore,  refers  back  to  the  numerous 
sections  in  which  the  laws  of  the  nervous  system  are  the  subject  of  discussion,  wheth- 
er in  their  pathological  or  physiological  aspects;  but  may  be  more  particularly  re- 
garded as  being  a  continuation  of  sections  494:  b-dd,  828  a-c. 

The  facts  to  be  first  presented  are  derived  from  Dr.  S.  Weir  Mitchell's  very 
able  Researches  on  the  Venom  of  the  Rattlesnake,  published  by  the  Smithsonian  In- 
stitute. It  will  be  seen  that  they  fully  corroborate  the  statements  in  the  foregoing 
sections,  and  form,  with  many  other  examples  presented  in  these  Institutes,  a  ground 
of  analogical  reasoning  as  to  the  action  of  all  other  morbific  causes  upon  the  animal 
organism — displaying  in  a  luminous  manner  the  pi'inciples  of  vitalism  and  solidism, 
and  pointing  us  with  great  significance  to  the  magnificent  laws  of  the  nervous  system. 

Dr.  Mitchell  appears  not  to  have  been  acquainted  with  the  important  experi- 
ments of  GiRTANNER,  for  lie  remarks  that  no  one  but  Fontana  had  tried  the  virus 
of  snakes  upon  frogs ;  while  the  former  overturned  the  experiments  of  the  latter  (§ 
494  b).  Mitchell's  experiments  are  very  different  from  Girtanner's,  but  the  re- 
sults are  entirely  harmonious. 

In  one  Exp.  the  frog's  heart  ceased  to  pulsate  in  3h.  10'  after  the  bite.  "In  24 
hours  the  muscular  parts  about  tlie  bite  were  almost  difHuent,  while  the  rest  of  the 
frog  had  no  odor,  or  any  other  sign  of  putrefaction. " 

In  another  Exp.  death  took  place  on  the  fifth  day  after  the  bite.  The  muscles  in 
the  bitten  part  of  the  frog  "were  dark  in  color,  and  underwent  extreme  decomposi- 
tion, while  the  rest  of  the  body  was  not  sensibly  affected." 

In  another  instance,  where  the  bite  was  inflicted  on  the  thigh  of  a  frog,  death  took 
place  in  ten  or  twelve  hours.  "About  the  bite  the  muscular  structure  was  almost 
diffluent,  and  could  be  torn  with  the  utmost  ease.  A  slight  effusion  of  blood  was 
found  under  both  fore  legs,  in  the  axillary  spaces.  Elsewhere  the  organs  were 
healthy. " 

In  another  Exp.  death  took  place  on  the  third  day.  "  The  bitten  leg  was  literally 
soaked  in  blood,  and  was  every  where  swollen  by  this  local  accumulation."  No  other 
remarkable  signs. 

The  effect  upon  birds  "was  so  sudden  that  where  the  dose  of  the  venom  was  large 
there  was  hardly  time  to  observe  the  resultant  phenomena."  "A  snake  four  feet 
long  bit  a  pigeon  upon  the  knee."  "  Upon  its  being  bitten,  I  threw  it  from  me ;  but, 
to  my  surprise,  it  fell  a  dead  weight  upon  the  table,  and  did  not  aftenvards  breathe 
or  move.     Thirty  seconds  elapsed  between  the  bite  and  the  death. " 

A  large  rabbit  bitten  by  a  small  snake  died  in  one  minute.  "No  lesion  was  found 
in  any  organ."  "7%e  muscles  and  motor  nerves  were  perfectly  excitable  several  min- 
utes-after  death"  (§  1041). 

In  warm-blooded  animals  the  rapidity  of  death  was  affected  by  the  size  of  the  ani- 
mal. "A  dog  weighing  19^  pounds  was  bitten  by  several  rattlesnakes,  in  six  places 
at  least.  There  were  absolutely  no  marked  symptoms  in  this  case,  except  increasing 
weakness,  vomiting,  and  movement  of  the  bowels.  The  breathing  then  became  jerk- 
ing and  labored.  Death  took  place  in  three  hours.  The  numerous  bites  were  the 
most  formidable  lesions  found  after  death."  "Except  some  congestion  of  the  vessels 
of  the  brain  and  its  membranes,  there  was  no  morbid  appearance  in  any  viscus." 
A  dog  weighing  lo  pounds  was  bitten  in  two  places,  and  died  in  Hi.  20'.      "The 


NOTE    AAA. — THE    HUMORAL  PATHOLOGY,  ETC.  1147 

bitten  thigh  was  a  good  deal  swollen."  "It  was  literally  soaked  with  blood  down  to 
the  periosteum,  which  was  darkly  stained."  Brain,  lungs,  abdominal  organs,  healthy. 
A  dog  of  12  pounds  was  bitten  in  two  places  by  two  snakes,  "one  biting  him  in 
the  muscle  and  on  the  side."  "The  wound  on  the  flank  formed  within  two  hours  a 
prominent,  almost  pendulous  mass,  several  inches  long  and  wide."  Death  in  five 
hours.  "All  the  thoracic  organs  were  normal.  The  heart  as  usual.  The  right 
side  full  of  fluid  blood,  with  some  dark  clots  ;  the  left  side  almost  empty.  Elsewhere 
the  organs  were  healthy,  excepting  the  kidneys,  which  were  full  of  blood,  and  pre- 
sented the  appearance  of  acute  congestion." 

The  morbid  appearances  of  the  solids  were  mostly  limited,  in  all  the  experiments, 
to  the  bitten  parts.  As  to  the  blood — "It  was  found,  as  a  general  rule,  that  it  was 
most  affected,  and  least  coagulable,  the  longer  the  death  was  delayed."  "  A  pigeon, 
for  instance,  is  stricken ;  it  droops,  faUs,  and  dies  within  thirty  seconds.  The  blood 
is  red  and  coagulates  perfectly.  Its  corpuscles  are  ideally  healthy.  In  such  a  case 
no  physiologist  would  impute  the  death  to  the  altered  blood" — and  certainly,  therefore, 
in  no  other  case,  whatever  may  be  the  morbid  appearances  of  the  blood  (§  84:5-847). 
Finally,  here  is  an  experimentum  crucis — "  Two  drops  of  venom  were  added  to  one 
drop  of  pigeon's  blood.  Coagulation  took  place  within  four  minutes" — and  so  of 
other  like  experiments.  "It  becomes  clear,"  says  the  author,  "from  these  results, 
that  the  mixture  of  venom  and  blood  does  not  alter  the  vital  fluid  at  first  in  any  way 
which  is  appreciable  by  the  senses.  It  clots  as  firmly  as  usual.  After  a  time,  how- 
ever, the  clot  softens."  "In  primary  or  acute  poisoning  I  have  never  been  able  to* 
detect  the  least  alteration  in  the  blood-cells. "  But  when  death  comes  on  slowly,  or, 
as  the  author  calls  it, "  in  chronic  or  secondaiy  poisoning,  the  case,"  he  thinks,  "may 
with  propriety  be  then  refen-ed  to  the  incipient  putrefactive  changes  which  aft'ect  the 
blood,  as  well  as  to  the  continued  influence  of  the  agencies  which  first  depress  the 
heart's  action,  and  destroy  nervous  function."  But,  it  is  added — "we  are  still  far 
from  knowing  why,  or  precisely  how,  this  or  that  structure  is  aff'ected." 

All  the  results  of  our  author's  experiments  refer  us  to  the  local  action  of  the  poison 
for  the  constitutional  uesults ;  and  so  far  from  any  early  destruction  or  even  depres- 
sion of  "nervous  function,"  there  was  a  strong  development  of  the  nervous  influence, 
as  shown  by  the  rigor  of  the  muscles  in  some  of  the  experiments,  and  by  the  \^ell- 
known  convulsions  that  occur  in  the  experiments  of  others  (§  828  6).  In  one  of  our 
author's  cases,  that  of  a  rabbit,  we  have  seen  that  he  remarks  that  "the  muscles  and 
motor  nerves  were  perfectly  excitable  several  minutes  after  death."  This  phraseology, 
however,  of  destruction  or  depression  of  nervous  function  is  very  common  when  just 
the  reverse  of  it  is  the  case,  and  where,  as  in  our  author's  experiments,  the  alteration 
or  destruction  of  the  organic  functions  is  owing  to  an  exaltation  and  modification  of 
the  nervous  influence  (§  225-232,  826  cc,  894-89G,  902,  905  a,  &c. ;  Index  II,  arti- 
cle, Nervous  Poiver).  Nor  does  our  author  show  that  there  was  any  sign  of  putreflxc- 
tion  of  blood  in  any  of  his  experiments.  But  if  it  be  admitted  that  such  was  the  feet, 
it  was  manifestly  the  result  of  the  morbid  state  of  the  solids ;  and  for  a  farther  expo- 
sition of  which  I  would  refer  the  reader  to  sections  516  no.  6,  845-847,  905  a,  which 
will  serve  as  a  guide  to  many  other  sections  where  the  philosophy  of  the  subject  is 
considered. 

AVhat  has  been  now  said  relative  to  the  venom  of  the  rattlesnake  is  not  alone  for 
the  puii^ose  of  giving  greater  eff'ect  to  the  statements  upon  the  same  question  in  for- 
mer sections  of  this  work  (§  494  a-e,  845-847),  but  to  contribute  its  light  toward  the 
true  interpretation  of  the  modus  operandi  of  the  hydrophobic  virus,  of  the  virus  of 
the  "dissection  wound,"  hydrocyanic  acid,  strychnia,  veratria,  aconitina,  &c.,  Avhich 
present  close  analogies  to  the  modus  operandi  of  the  venom  of  serpents,  and  for  the 
philosophy  of  which  as  expounded  in  this  work  the  two  Indexes  liiay  be  consulted  un- 
der those  several  denominations.  By  these  strongly-marked  examples,  as  I  have  en- 
deavored to  show  in  a  great  variety  of  ways,  and  very  extensively  throughout  this  work, 
Ave  may  be  aided  in  our  intei"pretation  of  the  modus  operandi  of  all  other  morbific 
causes,  and  of  all  remedial  agents,  and  be  thus  enabled  to  consign  more  and  more 
nearly  to  oblivion  that  stronghold  of  empiricism  and  the  great  incubus  of  Medicine, 
the  Humoral  Pathology. 

I  would  say,  in  conclusion,  that  notwithstanding  the  interesting  nature  of  Dr. 
Mitchell's  Experiments,  the  question  as  to  the  modus  operandi  of  the  virus  of 
snakes  was  more  distinctly  and  conclusively  settled  long  ago  by  a  single  experiment 
made  upon  a  frog  by  Girtanner  (§  494  h). 

Stphilization, — Whatever  objections  may  exist  against  Professor  W.  Boeck  s 


1148         NOTE   BBB-CCC. — HEMORRHAGE,  INFLAMMATION",  ETC. 

method  of  treating  syphilis  by  inoculation,  it  has  been  well  ascertained  to  be  as  suc- 
cessful as  other  modes  of  treatment.  "The  value  of  syphiHzation  as  a  curative 
method  has  been  a  subject  of  long  discussions  in  the  Medical  Society  of  Christiania, 
occasioned  by  Dr.  Hoist's  report  of  Dr.  Lane's  and  Dr.  Gascoyen's  views  of  Profess- 
or W.  Boeck's  experiments  with  syphilization  in  London,  1865."  At  a  late  meeting 
of  that  very  enlightened  society  (1869),  a  great  amount  of  statistical  information, 
from  the  most  reliable  sources,  was  produced ;  from  which  it  appears  that  the  success 
of  tlie  treatment  is  well  established. 

The  particular  bearing  of  this  subject  upon  the  humoral  pathology  is  the  principle 
which  it  carries  with  it  in  behalf  of  solidism.  As  is  well  known,  syphilis  is  slowly 
extinguished  by  repeated  inoculations  upon  the  upper  and  lower  parts  of  the  body. 
If  the  disease,  therefore,  were  dependent  upon  the  state  of  the  blood,  or  any  imagina- 
ble "  humors,"  its  removal  should  be  as  readily  effected  by  a  large  number  of  inocula- 
tions of  the  upper  parts  of  the  body  as  by  dividing  the  number  between  the  upper  and 
inferior  parts.  On  the  contrary,  however,  when  the  entire  number  of  inoculations, 
which  are  sufficient  to  extinguish  the  disease  if  divided  between  the  upper  and  lower 
parts,  are  made  wholly  upon  one  or  the  other,  that  part  which  is  avoided  remains  sus- 
ceptible, and  the  disease  is  not  eradicated  (§  76-80,  545,  657  a,  902  i). 

Vaccination. — Parallel  with  the  foregoing  is  a  case  of  small-pox  vanishing  under 
vaccination,  which  occurred  in  a  family  whom  I  was  attending.  On  the  third  day 
'after  the  mother  had  given  birth  to  an  infant  she  had  a  severe  attack  of  varioloid, 
which  left  no  doubt  that  the  child  had  contracted  the  smaU-pox  in  utero  (§  836).  I 
immediately  vaccinated  the  infant  in  several  places,  and  on  the  following  day  it  broke 
out  with  the  small-pox.  Both  diseases  advanced  regularly  till  the  seventh  or  eighth 
day,  when  the  pustules  of  the  small-pox,  with  which  the  body  was  thickly  covered  and 
confluent  on  the  face,  suddenly  dried  up,  and  were  thoroughly  exfoliated  in  two  or 
three  days.  No  scar  was  produced.  The  vaccinated  pustules  went  on  through  their 
regular  stages,  forming  the  usual  scabs  and  marks. 


NOTE  Bbb.— CAPILLARY  HEMORRHAGE. 

The  subject  of  hemorrhage  derives  its  principal  importance  from  its  significance  of 
the  pathological  conditions  in  which  it  originates,  and  therefore  from  its  bearing  upon 
the  treatment.  This  is  especially  the  case  with  haemoptysis,  hrematamesis,  and  pur- 
pura hemon-hagica,  in  which  affections  I  have  endeavored  to  show  that  the  hemor- 
rhage is  not  owing  to  any  rupture  of  the  vessels,  but  is  the  result  of  a  morbid  process 
analogous  to  secretion,  and  indicative  of  an  inflammatory  or  congestive  state  that  de- 
mands an  antiphlogistic  treatment  instead  of  the  prevailing  stimuLiting  plan.  Hae- 
moptysis, whether  as  attendant  upon  pulmonaiy  phthisis  before  ulceration  has  occult- 
ed, or  upon  pneumonia,  is  Nature's  remedy,  and  were  this  indication  followed,  we 
should  not  continue  to  record  the  fearful  mortahty  from  those  diseases  to  which  I 
have  already  called  the  attention  of  the  reader  (§  890  a-h,  922,  984,  1018-1019; 
Note  Mm,  p.  1141;  and  extensively  in  the  Medical  and  Physiological  Com- 
5IENTARIES,  1840,  chapter  on  Venous  Congestion).  In  this  ^dew  of  the  subject,  there 
is  no  question  in  practical  medicine  of  greater  importance  (see  Index  II.,  article 
Hemorrhage).  But  the  object  of  this  Note  is  more  particularly  to  say,  that  no  investi- 
gations have  yet  disturbed  my  position  as  to  the  source  of  the  hemorrhages ;  and  as 
a  corroborating  proof  of  this,  I  may  quote  a  late  paragi'aph  from  a  high  authority. 
Thus— 

"  Dr.  Rasmttssen,  in  his  raluable  paper,  shows  that,  extensively  as  the  subject  of 
hremoptysis,  especially  in  connection  with  pulmonary  phthisis,  has  engaged  the  atten- 
tion of  investigators,  the  source  of  these  hemorrhages,  the  absolute  demonstration  of 
the  vessel  or  vessels  whence  the  blood  has  come,  has  almost  entirely  failed." — Brit, 
and  For.  Med.  Chir.  Rev.,  Jan.,  1869. 


NOTE  Ccc— INFLAMMATION   OF  THE   BRAIN.— CEREBRO-SPINiVL 

MENINGITIS. 

Many  writers  in  Europe  and  America  have  lately  contributed  their  experience  in 
relation  to  the  disease  which  has  acquired  the  designation  oi cerebrospinal  meningitis, 
though  a  difference  of  opinion  exists  as  to  its  local  or  constitutional  nature.     That 


NOTE    DDD. CORRELATION    OF   FORCES.  1149 

inflammation  of  the  brain  and  spinal  cord,  particularly  of  the  fonner  organ,  is  con- 
stantly met  with  as  a  local  disease,  can  not  be  doubted.  But  the  malady  is  often 
showing  itself  in  connection  with  idiopathic  fever  (§  712,  757  a),  particularly  when 
fever  prevails  epidemically  (§  779) ;  and  there  is  much  reason  to  believe  that,  in  a 
general  sense,  when  cei'ebral  inflammation  occurs  epidemically,  it  is  an  incident  of 
constitutional  or  idiopathic  fever,  as  when  pneumonia  prevails  epidemically,  and  of 
which  latter  complication  several  authors  have  given  a  history.  That  by  Cleghom, 
an  abstract  of  which  occurs  at  pages  757-759,  is  well  worthy  of  the  reader's  atten- 
tion, not  only  for  the  light  which  it  reflects  upon  epidemic  cerebro-spinal  meningitis, 
but  for  the  admirable  experience  in  the  treatment  of  the  pneumonic  complications. 
But  whether  the  cerebro-spinal  inflammation  be  simply  a  local  affection  or  compli- 
cated with  idiopathic  fever,  it  is  the  local  condition  to  which  the  treatment  should  be 
mainly  directed,  and  this  treatment  should  consist  chiefly  of  large  abstractions  of 
blood.  Whatever  may  be  the  prostration  of  muscular  strength,  or  "debility"  as  it 
is  called  (§  487  h,  569,  887,  901-904),  the  patient  will  soon  be  invigorated  by  copious 
bloodletting,  as  in  Cleghorn's  cases  of  pneumonia  (§  1005  A),  or  in  Jackson's  cases 
of  cerebral  inflammation  complicated  with  prostrating  idiopathic  fever  (§  992  i),  or 
as  related  by  many  other  masters  in  the  healing  art  whose  experience  is  jjresented  in 
this  work  in  the  article  on  Loss  of  Blood.  The  failure  of  the  remedy  in  the  hands 
of  those  who  have  adopted  it  is  owing,  as  Sydenham  well  says,  "to  bleeding  in  an 
improper  manner,"  which  means,  according  to  Botallus,  that  "  bleeding  does  no  serv-. 
ice  in  many  cases,  either  because  persons  have  recourse  to  it  too  late,  or  use  it  too 
sparingly,  or  commit  some  error  in  both  these  particulars"  (§  1000, 1001  a).  Although 
large  abstractions  of  blood  are  indispensable  in  the  prostrating  forms  of  epidemic 
pneumonia  (§  1005  A),  puerperal  fever  (§  1005  a-g),  plague,  yellow  fever,  and  so- 
called  "  putrid  fevers"  (§  1002-1004,  NoteFf,  p.  1135),  in  cerebral  inflammation  the 
exigencies  for  the  remedy  are  greater,  and  the  system  is  enabled  to  sustain  greater 
losses  of  blood  than  in  any  other  malady,  and  for  reasons  explained  in  sections  974- 
979. 

The  fatality  of  "cerebro-spinal  meningitis"  has  been  so  great  in  recent  times,  that 
we  may  look  for  an  early  abandonment  of  the  stimulating  treatment,  and  a  return  to 
the  successful  practice  of  our  predecessors.  Indeed,  already  we  begin  to  hear  of 
bloodletting  and  its  useful  eff'ects,  particularly  as  practiced  in  France.  Thus,  a 
writer  in  the  Medical  Times  and  Gazette  of  May  25,  1867,  remarks  that — "In  the 
French  epidemic  large  bleedings,  in  the  early  stage  of  the  disease,  were  the  only  means 
of  treatment  attended  with  success." — It  may  be  safely  stated  that  in  the  epidemics  of 
this  disease  during  a  few  late  years  more  than  three  fourths  of  the  subjects  have  per- 
ished when  bloodletting  has  been  neglected.  That  the  disease  is  of  the  most  intense 
inflammatory  nature  will  not  be  doubted,  even  by  those  who  recognise  no  other  test 
of  inflammation  than  its  physical  products.  These  are  abundantly  set  forth  by  those 
who  have  made  extensive  anatomical  investigations.  As  an  example,  it  is  said  by 
Dr.  Sanford  B.  Hunt  that— 

"  Of  08  autopsies,  the  records  of  which  have  been  examined,  all  present  positive 
evidence,  not  only  that  the  meninges  of  the  brain  and  spinal  cord  were  the  locali- 
ties of  inflammatory  disease,  but  that  the  sufferers  died  from  the  inflammation,  and 
not  from  any  intercurrent  or  other  disease.  The  appearances  in  the  other  organs 
were  mostly  negative."  The  vital  signs  were  such  as  distinguish  the  worst  forms  of 
cerebral  inflammation. 


NOTE  Ddd.— CORRELATION  OF  PHYSICAL  AND  VITAL  FORCES. 

In  what  has  been  said  specifically  upon  the  subject  of  Correlation  oj"  Physical  and 
Vital  Forces  at  page  921,  it  was  simply  intended  to  bring  to  the  reader's  attention 
the  ample  discussion  of  the  relation  of  the  vital  force  to  organic  heat  which  extends 
from  page  234  to  279,  and  where  the  vital  force  is  variously  contradistinguished  from 
animal  heat,  and  the  latter  shown  to  be  only  one  of  the  numerous  products  of  the 
former  in  its  operation  through  organic  structures.  In  the  progress  of  that  inquiry 
numerous  facts  are  also  presented — such,  for  example,  as  relate  to  the  nervous  influ- 
ence, which  prove  incontrovertibly  the  absolute  independence  of  the  vital  force  of  all 
other  forces.  But  the  discussion  of  the  function  of  calorification  embraces  only  a 
veiy  limited  array  of  the  Author's  arguments  against  the  identity  of  the  vital  force 
with  those  of  physics  and  chemistry,  or  their  conversion  into  each  other.  All  that 
the  Author  has  said  upon  the  composition  and  structure  of  organic  beings,  all  upon 


1150       NOTE    EEE-FFF. NERVOUS    POWERS,  COMPOUNDS,  ETC. 

the  properties  of  life,  all  upon  the  nen'ous  influence  and  laws  of  the  nervous  system, 
all  upon  the  organic  and  animal  functions,  all  upon  the  principles  relative  to  patholo- 
gy, therapeutics,  and  the  modus  operandi  of  remedies,  forms  an  imanswerable  demon- 
stration against  the  doctrine  of  Correlation  or  Equivalence  of  Forces.  It  will  be  seen, 
therefore,  from  the  foregoing  references,  that  a  greater  part  of  this  book  is  in  direct 
opposition  to  the  doctrine. 

The  advocates  of  that  doctrine  must  also  identify  the  intellectual  part  of  man  with 
the  common  forces  of  matter,  and,  from  the  obvious  analogy  between  the  human  and 
Divine  Mind,  with  God  Himself  This  they  do,  not  only  impliedly,  but  by  a  direct 
advocacy  of  materialism,  and  not  seldom  by  an  avowal  of  atheism.  This  I  shall  show 
extensively  in  the  enlarged  edition  of  my  work  on  the  Soul  and  Instinctive  Principle, 
to  be  soon  published  by  the  Messrs.  Harper  &  Brothers,  and  where,  also,  may  be 
found  a  critical  examination  of  the  doctrine  of  the  Correlation  of  Forces  in  its  appli- 
cation to  the  Life  of  organic  beings,  and  to  the  Soul. 

One  of  the  plausible  consequences  of  that  doctrine,  and  which  is  brought  to  their 
mutual  support,  is  the  assumed  identity  of  certain  artificial  compounds  and  the  sim- 
ple transformations  out  of  organic  substances  which  have  been  generally  supposed  to 
retain  their  organic  constitution  ;  and  which  will  be  farther  considered  in  Note  Fff. 


!bfOTE  Eee.— SUPPOSED  IDENTITY  OF  THE  NERVOUS  POAVER  AND 

ELECTRicrrr. 

The  mechanical  theorists  who  had  supposed  that  they  had  settled  experimentally 
the  identity  of  the  neiTous  power  and  electricity,  haA-ing  from  other  experiments  con- 
cluded that  the  nerves  convey  their  influence,  whether  motor  or  sensitive,  at  the  rate 
of  only  about  90  feet  in  a  second,  and  having  thus  abandoned  the  electrical  hypothe- 
sis, have  presented  a  serious  obstacle  to  their  doctrine  of  the  correlation  of  forces.  It 
is  equivalent  to  an  admission  that  there  is  nothing  in  inorganic  nature  that  will  in  the 
least  interpret  the  phenomena  relative  to  the  nervous  system,  and  that  we  must  there- 
fore seek  for  a  solution  of  the  problem  in  the  phenomena  of  life  and  independently  of 
artificial  contrivances  (§  234  e,  409  k  and  references  there,  893  a,  Note  Y). 


NOTE  Fff.  —  SUPPOSED  ARTIFICIAL  PRODUCTION  OF  ORGANIC 
COMPOUNDS.     (See  Article  on  Composition,  p.  23-49). 

The  numerous  productions  out  of  inorganic  substances  which  have  latel}' proceeded 
from  the  laboratory  of  the  chemist  in  imitation  of  simple  transformations  out  of  or- 
ganic compounds,  require  only  a  very  brief  notice.  In  the  first  place  those  transform- 
ations are  the  results  of  artificial  influences,  the  very  object  of  which  has  been  to  in- 
stitute changes  in  the  original  compound,  as  in  tlie  production  of  morphia,  quinia, 
alcohol,  &c.  These  substances,  therefore,  have,  doubtless,  been  more  or  less  diverted 
from  their  organic  constitution  by  the  reagents  employed,  altliough  they  may  have 
been  as  simple  as  heat,  or  atmospheric  air ;  and  what  renders  this  certain  are  the  al- 
kalescent nature  and  crystalline  structure  of  quinia,  morphia,  cinchonia,  &c.  Indeed, 
some  of  these  reputedly  organic  compounds  may  be  made  to  undergo  an  apparently 
endless  variety  of  transformations ;  such,  for  example,  being  the  case  with  alcohol 
when  subjected  to  the  action  of  certain  acids  tln-oughout  its  various  changes.  It  is 
not  remarkable,  therefore,  that  apparent  imitations  of  some  of  these  things  should 
have  been  made  out  of  inorganic  substances.  But  what  reliance  can  be  placed  upon 
the  supposed  organic  nature  of  these  chemical  compounds  ?  Some  of  the  best  au- 
thorities, as  we  have  seen — Lehmann  for  example — assure  us  that  analyses  of  organic 
compounds  are  not  reliable  (p.  789-794,  §  1028-1033).  Nevertheless,  the  supposed 
organic  constitution  of  those  purely  artifical  productions  is  too  important  to  tlie  doc- 
trine of  the  Correlation  of  Physical  and  Vital  Forces  to  be  surrendered  without  a 
struggle  on  the  part  of  the  materialists.  In  that  struggle  they  must  encounter  the 
fact  tliat  no  organic  compound  has  yet  appeared  as  the  natui'al  product  of  the  forces 
and  laws  of  inorganic  nature,  and  that  even  animal  organisms  are  incapable  of  organ- 
izing the  simple  elements  of  matter  or  their  inorganic  compounds.  Nothing  but 
jjlants  have  been  able,  in  a  solitary  instance,  to  form  an  organic  compound  out  of  in- 
organic substances.  This  is  the  great  function  which  devolves  upon  them,  and  for 
the  manifest  purpose  of  supplying  food  to  tlie  animal  kingdom  (§  1052).  Hence  it 
is  not  probable  that  the  chemist  will  ever  succeed  in  his  aspirations  at  becoming  Na- 


IS^OTE    GGG. — BLOODLETTING  VERSUS   STIMULANTS.  1151 

ture's  journejTnan.  Looking,  therefore,  at  Nature  alone,  I  ask  the  materialist  wheth- 
er it  is  probable  that  his  favorite  Nature,  which,  he  concedes,  "operates  by  uniform 
laws,"  would  have  been  so  inconsistent  as  to  have  ordained  the  vegetable  tribes  for 
the  universal  purpose  of  organizing  the  elements  of  matter  for  the  sustenance  of  the 
animal  tribes,  and  at  the  same  time  have  so  endowed  the  elements  of  matter  as  to 
unite  into  organic  compounds,  in  virtue  of  their  own  inherent  properties,  whatever 
physical  influences  may  be  brought  to  operate  upon  them ;  while,  at  the  same  time, 
she  has  denied  to  animals  the  ability  which  is  so  lavishly  bestowed  upon  the  vegetable 
world  ?  Moreover,  if  you  can  discover  no  difference  between  the  Force  wliich  ani- 
mates the  organic  kingdom  and  the  forces  of  external  nature,  do  not  the  fundamental 
distinctions  between  the  organic  structure  of  plants  and  all  the  supposable  conditions 
of  the  elements  of  matter  under  every  imaginable  influence  pronounce  the  impossibili- 
ty of  efl"ecting  by  any  artificial  processes  the  compounds  which  are  the  woi'k  of  vege- 
table organic  structure,  and  then  only  through  an  elaborate  series  of  organs  which 
are  every  where  distinguished  by  consummate  designs  all  working  harmoniously  togeth- 
er/or this  very  result  ? 

As  animals  can  not  be  nourished  by  inorganic  matter,  there  remains  to  the  chemist 
an  important  test — try  the  supposed  organic  compounds  derived  from  unequivocal 
inorganic  'substances  as  food  for  animals,  and  should  they  prove  a  means  of  suste- 
nance a  great  triumph  will  have  been  obtained  for  the  doctrine  of  the  Correlation  of 
Forces ;  while,  on  the  contrary,  should  failure  ensue,  Chemistry  will  as  modestly  re- 
tire into  its  A'ast  domain — the  mineral  kingdom  (§  1052).  And  yet  another  test ;  tiy 
a  supposed  compound  like  quinia  and  morphia,  made  from  the  elements  of  matter, 
as  remedial  agents,  and  if  the  former  will  cm'e  intermittent  fever,  and  the  latter  pro- 
cure sleep  and  relieve  pain,  they  will  prove  a  great  acquisition  to  the  Materia  ]\Iedica. 

Finally,  the  eminent  Virchow,  who  is  deeply  interested  in  the  manufacture  of 
something  approximating  the  simplest  fonns  of  organic  substances,  tells  us  that — 

"Chemistry  has  not  succeeded  in  forming  a  blastema  [the  general  formative  ele- 
ment of  tissues]  nor  physics  in  forming  a  cell.  What  does  it  matter  ?" — See  my 
work  on  the  Soul  and  Instinctive  Principle,  edition  of  1870,  where  this  subject 
is  discussed  in  that  I'elation. 


NOTE  'Ggg.— BLOODLETTING  VEESUS  STIMULANTS. 

As  might  be  anticipated  from  the  results  of  the  stimulating  treatment  of  inflamma- 
tions and  fevers,  a  reaction  has  been  taking  place  for  a  few  late  years,  even  among  its 
strongest  advocates,  both  in  this  country  and  in  Europe.  It  has  again  had,  along 
with  its  universal  pathological  principle  "debility,"  its  "temporary  day."  And 
where  will  its  advocates  be  in  tire  future  annals  of  medicine  ?  Perhaps  an  answer 
may  be  found  in  the  remaAable  fact  in  relation  to  Bloodletting  in  the  treatment  of 
inflammations  and  fevers — that  there  is  not  one  individual  in  the  history  of  medical 
literature  who  has  contributed  to  the  improvement  of  medicine,  or  whose  writings 
have  survived  his  own  generation,  that  has  not  declared  bloodletting  to  be  tlie  princi- 
pal remedy,  in  a  general  sense,  for  those  diseases,  and  always  so  in  pneumonia,  pleu- 
ritis,  phrenitis,  enteritis,  articular  rheumatism,  puerperal  fever,  congestive  fevers,  &c. 
(§  1005^  a,  1006  g).  If  there  be  one  exception,  it  has  escaped  my  knowledge.  It  is 
in  respect  to  the  stimulating  treatment  of  disease  and  the  doctrine  of  debility,  as  with 
the  efforts  to  carry  Organic  Chemistry  into  physiology  and  pathology  (see  p.  203, 
§  376i).  All  this  has  been  due  to  the  simply  practical  character  of  the  age,  in  which 
the  senses  have  had  the  lead  of  the  understanding.  And  mav  we  not  confidently  af- 
firm that  such  a  dispensation  awaits  the  projectors  of  the  doctrine  of  the  "  Correlation 
of  the  Physical  and  Vital  Forces"  ? 

Finally,  I  may  speak  of  the  results  of  bloodletting  in  my  own  practice ;  not,  how- 
ever, according  to  the  usual  "  numerical  method,"  but  will  simply  place  it  upon  rec- 
ord in  behalf  of  ]\Iedicine,  in  addition  to  my  statement  as  to  croup  (§  10r)8  jj),  that 
after  an  unintermitting  practice  of  fift3--four  years  I  have  never  failed  of  abstracting 
blood  in  enteritis,  pneiunonia,  phrenitis,  pleuritis,  and  puerperal  fever,  and  with  rare 
exceptions  in  erysipelas,  both  in  their  simple  and  compHcated  forms,  and  that  I  have 
never  lost  a  patient  affected  with  either  of  the  last  three  diseases,  two  only  of  enteri- 
tis, one  of  phrenitis,  and  one  only  of  pneumonia  (a  child  of  three  j^ears  in  1818),  and 
this  last,  in  my  judgment,  from  insufficient  bloodletting  (§  973-980,  1058  q). 

THE      END. 


THE 


INSTITUTES  OF  MEDICINE. 

By  MARTYN  PAINE,  A.M.,  M.D.,  LL.D., 

Professor  of  the  Institutes  of  Medicine  and  Materia  Medica  in  the  University  of  New  York;  Author 
of  the  "  Jledical  and  Physiological  Commentaries,"  "A  Treatise  on  the  Soul  and  Instinct," 
"Therapeutics  and  Materia  Medica,"  etc.,  etc. ;  Corresponding  Member  of  the  Royal  Ve- 
rein  fiirHeilkunde  in  Preussen;  Corresponding  Member  of  the  Royal  Medico-Chirur- 
gical  Academy  of  Turin ;  CoiTesponding  Member  of  the  Gesellschaft  fiir  Natur 
und  Heilkunde  zu  Dresden ;  Honoraiy  Member  of  the  Imperial  University 
Physico-Medical  Society  of  Moscow ;  Member  of  tlie  Medical  Society  of 
Leipsic ;  of  the  Medical  Society  of  Sweden ;  of  the  Montreal  Nat- 
ural History  Society ;  and  of  many  other  Learned  Societies. 

With  a  Portrait.    New  Edition,  Revised  and  Enlarged,  with  a  Copious  Index. 


The  Publishers,  in  offering  to  the  profession  ^  New  and  Enlarged  Edition  of  Dr.  Paine's  Insti- 
tutes OF  Medicine,  avail  themselves  of  the  opinion  of  the  Medical  Press  in  behalf  of  the  work, 
and  subjoin  numerous  extracts  from  late  periodicals.  Some  of  tlie  extracts  bear  upon  a  controvert- 
ed question,  but  the  Publishers  are  not  disposed  that  their  copyright  shall  suffer  by  any  abstraction 
from  the  merits  of  the  work ;  and  that  the  latter  may  go  forth  under  unquestionable  authority, 
they  have  made  the  extracts  of  unusual  length.  As  a  prophet,  also,  is  said  to  be  without  honor  in 
his  own  country,  the  Publishers  are  disposed  to  show  that  exceptions  occasionally  arise,  and  tha? 
this  may  be  the  more  apparent,  and  as  they  are  content  withal,  they  limit  the  extracts  to  American 
periodicals  ;  or,  rather,  do  not  await  the  arrival  of  Foreign  Notices  of  this  Fourth  Edition  of  tlie 
Institutes. 


October  8, 1S53. 


From  the  New  York  Jourivxl  of  Medicine,  May,  185S. 


"  The  Institutes  is  full  of  learning  and  philoso- 
phy, and  the  reader,  while  impressed  with  the 
profound  erudition  of  the  author,  can  not  but  be 
amazed  at  the  amount  of  labor  the  book  dis- 
closes. *  *  Professor  Paine  is  engaged  in  a  strug- 
gle for  truth.  His  mind  is  concentrated  upon 
the  elimination  of  facts,  and  in  the  pursuit  of 
what  he  deems  right  he  seeks  not  the  applause 
of  his  contemporaries.  He  knows  full  well  that 
principles  must  and  will  survive  the  disputations 
of  the  controversialist.  *  *  He  is,  in  every  sense 
of  the  word,  a  medical  philosopher,  a  devotee  of 
science,  and  a  commentator  whose  opinions  will 
not  only  pass  to  posterity,  but  receive  the  high 
tribute  to  which  they  are  entitled.  Inflexible  in 
his  convictions  of  truth,  he  can  not  be  moved  by 
friend  or  foe — and  he  pursues  his  onward  course 
with  an  earnestness  and  zeal  characteristic  of  the 
man.  •  *  We  can  confidently  recommend  the  In- 


stitutes both  to  the  practitioner  and  student  of 
medicine ;  to  the  former  it  will  be  a  rich  treat — 
it  will  open  to  him  the  wide  and  fruitful  field  of 
medical  science,  and  he  will  see  elaborated  in  it 
the  great  and  leading  questions  which  have  so 
long  constituted  the  basis  of  controversy  among 
the  learned  in  our  profession.  The  latter  will 
find  it  a  treasury  of  knowledge — a  veritable  en- 
cyclopaedia—  full  of  the  prominent  facts  of  his 
science ;  and  its  tendency,  moreover,  will  be  to 
induct  him  into  habits  of  thought  and  reflection. 
Lastly,  we  may  be  permitted  to  say  that  the  ar- 
ticle on  the  'Rights  of  Authors'  has  been  elicit- 
ed by  what  Professor  Paine  deemed  an  infringe- 
ment upon  his  claims ;  and  he  has  entered  upon 
the  subject  not  only  with  zeal,  but,  in  the  lan- 
guage of  the  law,  he  has  made  out  his  case  by  a 
chain  of  very  positive  evidence." 


From  the  same  Jour^ial  0/ July,  1S58. 


"  There  is  no  where  to  be  found  in  medical  lit- 
erature, nor  in  all  medical  works  extant  put  to- 
gether, so  full,  so  complete,  so  accurate  an  ex- 
position and  elucidation  of  the  functions,  and 
the  paramount  importance  of  the  ganglionic  sys- 
tem in  influencing  all  the  organic  functions  (in- 
cluding secretion)  physiologically  and  pathologic- 
ally, as  is  contained  in  the  '  Institues'  and  other 
writings  of  Dr.  Paine.  An  examination  of  the 
Index  of  the  '  Institutes'  alone  will  prove  this. 
Fifty  such  essays  as  that  of  Dr.  Campbell  could 
be  compiled  from  the  '  Institutes,'  and  then 
leave  material,  facts,  and  illustrations  enough  for 
as  many  more,  all  embodying  and  setting  forth 


the  same  doctrines.  *  *  The  author  of  the  '  In- 
f^titutes'  and  of  the  '  Medical  and  Physiological 
Commentaries'  can  well  afford  to  bide  his  time. 
His  fame  is  secure.  It  will  grow  brighter  with 
time.  The  profession  will  delight  to  cherish  it 
and  to  do  him  honor.  They  will  not  allow  a 
single  particle  of  his  just  merits  to  perish,  or  to 
be  appropriated  by  others.  Posterity  will  vindi- 
cate all  his  just  claims  and  assign  his  rank  among 
the  great  minds  of  our  countiy.  But  few  proper- 
ly appreciate,  or  are  even  acquainted  with  the 
extent  of  his  Herculean  labors.  None  but  those 
who  have  labored  in  the  .same  field  can  justly  es- 
timate the  vast  range  of  his  learning. — C.  A.  L." 


From  the  American  Medical  Gazette,  New  York,  June,  1S5S. 


"That  the  'Institutes  of  Medicine'  and  the 
'Medical  and  Physiological  Commentaries'  are 
characterized  by  great  analytic  power,  profound 
philosophy,  rare  genius,  and  unsurpassed  learn- 
ning,  no  candid  reader  can  deny ;  that  they  will 
rank  with  the  foremost  works  in  our  science,  and 
entitle  tlieir  author  to  a  high  rank  among  the 


greatest  men  in  medicine,  will  hardly  be  dis- 
puted. •  *  In  the  late  Appendix  to  the  Institutes 
many  important  subjects  are  discus.sed  with  tho 
usual  acuteness  and  ability  of  the  author.  The 
Index,  of  175  pages,  may  well  be  called  a  model 
index,  as  it  contains  a  brief  summary,  as  it  were, 
of  the  entire  work." 


PKOFESSOR    PAINE'S    INSTITUTES    OP    MEDICINE. 


The  September  Number  of  the  foregoing  jour- 
nal contains  a  forcible  and  triumphant  article  of 
thirteen  pages,  by  Professor  C.  A.  Lee,  in  defense 
of  Professor  Paiue's  claims  of  originality  in  elu- 
cidating and  applying  what  is  designated  as  the 
"  excito-secretory  function  of  the  nervous  sys- 
tem," and  showing  that  the  term  itself  has  been 
derived  from  his  Institutes  of  Medicine.  We 
quote  the  following : 

"  Dr.  Paine  claims,  and  very  justly,  as  may 
be  seen  by  our  extracts,  a  long  priority  in  desig- 
nating the  nervous  mechanism  through  which 
the  secretions  are  physiologically  influenced ;  and 
although  he  baa  not  thought  it  worth  his  while 
to  insist  upon  his  priority  in  the  small  matter  of 
bestowing  a  name  upon  the  function,  we  have 
shown  that  he  suggested  the  very  name  which  is 
now  apparently  conceded  by  nearly  all  the  med- 
ical periodicals  in  this  country  to  form  the  only 
originality  belonging  to  Dr.  Campbell.  But  what 
is  alone  of  any  importance.  Dr.  Paine  was  not 
only  the  first,  but  still  the  only  one  to  carry  the 
'excito-secretory  function'  and  all  the  physio- 
logical laws  of  the  nei-vous  system  into  patholo- 
gy and  therapeutics.  *  *  But  Dr.  Paine  regards 
the  excito-secretory  function  of  the  nervous  sys- 
tem as  a  very  minor  part  of  the  influences  of  that 


system,  the  most  important  of  which  is  its  vari- 
ously alterative  eflfects  upon  the  organic  func- 
tions ;  or,  in  his  own  language,  '  in  all  the  cases 
the  nervous  power  is  rendered  stivmlant,  or  de- 
pressant, or  alterative  to  the  organic  properties 
and  functions,  and  variously  energetic,  according 
to  the  operating  cause,  and  the  intensity  and 
suddenness  with  which  it  may  operate." — p.  107. 
"  The  whole  of  this  disputation  has  had  its  origin 
in  a  mere  pretense  that  has  grown  out  of  a  name. 
Excito-secretory /ii7ictio)i  is  the  magic  word  which 
is  made  to  engulph  the  whole  philosophy  that 
concerns  the  labyrinth  of  the  organic  functions 
in  their  connection  with  the  nervous  system. 
But  it  is  a  woi'd  of  such  partial  import  as  not  to 
convey  the  slightest  connection  with  pathology 
and  therapeutics;  but,  on  the  contrary,  to  im- 
press the  belief  that  it  is  limited  to  the  natural 
state  of  the  body.  It  disregards  all  the  modify- 
ing influences  of  the  nervous  system  upon  organ- 
ic actions  and  their  products,  whether  induced 
by  remedial  or  morbific  agents;  and  the  inap' 
propriateness  of  the  term,  beyond  its  mere  phys- 
iological import,  may  readily  be  seen  should  any 
one  attempt  its  introduction  into  any  of  the  path- 
ological or  therapeutical  branches  of  Dr.  Paine's 
Institutes  of  Medicine." 


From  the  Virginia  3[edical  Journal,  July,  ISDS. 


*  "  In  these  degenerate  days,  when  all  men  bow  to 
the  sway  of  public  opinion,  and  are  more  prone, 
alas,  to  be  ruled  by  policy  than  to  follow  the 
guidance  of  reason  and  judgment;  in  these  latter 
days — when  the  voice  of  the  people  is  the  voice 
of  God,  we,  at  least,  should  not  withhold  our 
praise  from  him  who  fears  not  to  stem  the  cur- 
rent of  popular  opinion,  and  who  strikes  a  bold 
blow  in  defense  of  the  right.  However  we  may 
wonder  at  his  hardihood,  and  hesitate  to  follow 
his  rash  example,  we  involuntarily  admire  this 
uncompromising  devotion  to  his  own  doctrines, 
and  respect  the  courage  we  are  too  timid  to  imi- 
tate. The  author  of  the  work  we  have  now  un- 
der consideration  is  emphatically  such  a  man  as 
we  have  endeavored  to  describe.  At  a  period  in 
the  history  of  medicine  when  the  mind  of  the 
profession  is  running  like  a  torrent  under  the 
guidance  of  Andral,  Louis,  and  the  other  brill- 
iant leaders  of  the  pathological  anatomists,  into 
the  humoral  theory  of  disease — when,  too,  the 
reaction  against  the  heroic  school  of  medicine 
had  reached  to  such  an  extent  as  to  favor  the 
rise  and  temporary  success  of  the  infinitesimal 
dogma,  and,  more  important  than  all — when  the 
progress  of  organic  chemistry  is  startling  the 
minds  of  men  with  its  bold  innovations  and 
brilliant  theories  in  physiology  and  pathology, 
it  was  then  that  Dr.  Martyn  Paine,  almost  alone, 
with  nothing  to  support  him  save  his  indomitable 
energy,  his  great  learning,  and  his  intrepid  heart, 
stood  up  before  the  medical  world  in  defense  of 
the  waning  school  of  vital  physiologists  and  the 
time-honored  solidism  of  Stahl  and  Hunter — 


when  medicine  expectants  was  most  triumphant 
he  still  advocated  blood-letting  and  the  admin- 
istration of  remedies  on  the  heroic  plan — when 
Liebig,  Thompson,  and  Lehmann  unite  in  lead- 
ing the  student  through  the  attractive  investiga- 
tions and  plausible  theories  of  zoochemistry. 
Dr.  Paine  Btill  gallantly  defends  the  creed  of 
Bichat  and  the  vitalists  against  all  comers,  and 
charges  boldly  and  effectively  upon  the  ever  in- 
creasing ranks  of  the  humoral  pathologists. 

"It  is  justly  due  to  this  learned  and  zealous  in- 
vestigator and  medical  philosopher  to  say  that 
we  do  not  belie%'e  there  can  be  found  another  man 
in  America  who  would  have  waged  this  unequal 
war  for  so  long  a  time  and  with  such  signal  abil- 
ity; and  although  we  doubt  whether  many  of 
our  readers  have  ever  devoted  time  enough  to 
his  various  books,  tracts  and  essays  to  enable 
hira  to  do  justice  to  his  labors  in  medicine,  yet 
we  will  point  to  every  thing  which  has  emanated 
from  his  pen  as  being  characterized  with  an 
amount  of  learning,  profound  reasoning,  and  a 
power  of  resistance  equal  to  the  emergency.  *  * 
We  can  not  but  be  astonished  at  the  amount  of 
ground  traveled  over  by  this  zealous  student, 
and  wo  may  point  him  out  to  the  young  in  the 
profession  as  a  noble  example  of  what  may  be  ac- 
complished by  those  who  will  imitate  his  indus- 
try and  perseverance  after  knowledge." 

The  August  Number  of  the  foregoing  journal 
contains  the  able  article  to  which  reference  is 
made  under  our  extract  from  the  New  Hamp- 
shire Journal  of  Medicine. 


From  the  American  Journal  of  the  Medical  Sciences,  Philadelphia,  July,  IS^. 


"  Dr.  Paine's  Institutes  of  Medicine  presents 
throughout  ample  evidence  of  the  general  erudi- 
tion of  its  author,  his  habits  of  close  investiga- 
tion, and  his  intimate  acquaintance  with  the 
subjects  of  which  he  treats,  and  with  the  views 
entertained  by  others  in  respect  to  them.  A  de- 
gree of  originality  and  independence  of  thought 
pervades  all  his  teachings,  whether  these  have 
reference  to  the  vital  conditions  and  functions  of 
the  human  organism,  the  laws  by  which  they  are 
governed,  or  to  the  nature,  causes,  and  tenden- 
cies of  disease,  and  the  curative  measures  by  the 
agency  of  which  this  may  be  best  conducted  to  a 
favorable  termination. 

"The  Institutes  of  Medicine  as  presented  by  Dr. 
Paine,  whether  we  receive  them  as  true,  or  reject 
them   as  l.ilse,  are,  nevertheless,  based  upon  a 


truly  philosophical  investigation,  aided  by  all 
tlie  accumulated  light  derived  from  the  observa- 
tions, experiments,  and  reasoning  of  preceding 
and  contemporary  authorities,  of  the  physiology, 
pathology,  and  therapeutics  of  the  human  sub- 
ject. 

It  is,  we  confess,  somewhat  cheering  to  meet 
with  one  of  the  high  intellectual  endowments  of 
Dr.  Paine,  who,  at  the  present  day,  when  the 
doctrines  of  physiologists,  pathologists,  and  ther- 
apeutists are  alike  verging  into  materialism — 
when  the  organic  fimctions,  at  least,  of  the  ani- 
mal organism  are  all  referred  to  a  mere  modifi- 
cation of  the  same  action  and  reaction  which  oc- 
cur in  brute  matter,  lias  sufficient  courage  to 
raise  his  voice  in  defense  of  the  vitality  of  the 
system ;  in  recognition  of  the  fact  that  our  or- 


PROFESSOR    PAINE'S    INSTITUTES    OF    MEDICINE. 


gans  are  built  up  and  maintained  in  a  healthful 
condition  for  the  regular  performance  of  theii' 
appropriate  functions  by  a  principle  which  we 
denominate  life,  and  by  which  the  material  ele- 
ments of  the  animal  organism  are  almost  entire- 
ly removed  from  out  the  control  of  those  merely 
physical  laws  to  which,  as  dead  matter,  they 
would  necessarily  be  subjected. 

"We  considerthe  treatise  to  be  one  well  worthy 
of  an  attentive  study  on  the  part  of  every  ad- 
vanced student  and  practitioner  of  medicine,  to 
whose  notice  we  earnestly  recommend  it.  Al- 
though far  from  being  inclined  to  indorse  the  ac- 
curacy of  every  doctrine  advanced  by  the  author, 
nor  the  chain  of  reasoning  by  which  he  attempts 


its  support,  we  are,  nevertheless,  convinced  that 
his  prelections,  from  the  amount  of  truth  set 
forth  in  them,  and  the  vitality  by  which  they  arc 
pervaded,  if  they  do  not  actually  convey  sound 
views  on  eveiy  thing  that  relates  to  the  philoso- 
phy of  medicine,  can  not  fail  to  lead  at  least  to  a 
correct  basis  for  the  establishment  of  such  views. 
The  strong  conservative  predilections  of  Dr. 
Paine,  which  induce  him  to  subject  every  new- 
observation  and  theory  in  medicine  to  the  sever- 
est scrutiny,  and  to  refuse  its  admission  until 
positively  established,  can  have  no  other  than  a 
favorable  influence  upon  his  readers,  by  teaching 
them  to  be  progressive  only  in  the  road  of  posi- 
tive truth D.  F.  C." 


From  the  Korth  American  Medico-Chinirgical  Review,  September,  1S5S. 


"No  one  can  read  the  Institutes  of  Medicine 
without  being  filled  with  respect  and  even  ad- 
miration for  tlie  profound  erudition,  the  pains- 
taking and  systematic  research,  and  the  laborious 
reflection  exhibited  so  abundantly  in  its  pages. 
With  careful  and  discriminatinghands  Dr.  Paine 
has  gathered  together,  from  the  writings  of  both 
the  earlier  and  contemporary  physiologists,  the 
numerous  important  facts  and  details  whicli  con- 
stitute the  subject-matter — the  crude  material — 
so  to  speak,  of  his  favorite  science,  and  arranged 
and  built  them  up  into  a  stately  edifice — the  In- 
stitutiones  Medicinse — whose  great  corner-stones 


are  Physiology,  Pathology,  and  Therapeutics. 
We  conclude  our  remarks  by  earnestly  recom- 
mending his  work  to  the  careful  perusal  and 
study  of  every  one  interested  in  physiology, 
whether  in  its  aspect  of  a  pure  or  an  applied  sci- 
ence. The  breadth  and  comprehensiveness  of 
manyof  its  doctrines,  the  great  questions  in  which 
it  abound.%  and  the  consummate  skill  and  learn- 
ing with  which  these  are  generally  treated,  stamp 
it  as  a  valuable  treatise  which  should  find  a  place 
in  every  philosophical  library  and  be  consulted 
by  every  physician  who  practices  his  profession 
as  a  science  and  not  as  an  empyrical  art." 


From  the  Medical  and  Surgical  Reporter,  Philadelphia,  May,  1S58. 


"Dr.  Paine  gives  us  two  very  copious  Indexes 
and  an  Appendix  to  his  Institutes  of  Medicine, 
and  we  find  throughout  the  work  constant  refer- 
ences from  page  to  page  to  facilitate  the  task  of 
the  student  in  acquiring  a  complete  knowledge 
of  every  subject.  Finally,  as  a  postscript,  he  de- 
tails in  full  what  he  claims  as  his  own,  and  wo 
think  we  can  not  do  better  than  lay  his  claims  be- 
fore our  readers. 

"  In  his  Preface  to  this  fourth  edition  Dr.  Paine 
says:  'This  work,  originally  published  in  1847, 
remains  without  change,  as  the  author  has  seen 
no  reason  to  modify  any  of  his  doctrines.'  But 
in  his  Appendix  he  does  ample  justice  to  all  sub- 
sequent discoveries  in  physiology  and  chemistry,  i 


He  says  :  '  Whatever  may  have  been  subse- 
quently disclosed  in  physiology  and  chemistry  is 
essentially  in  harmony  with  all  that  the  author 
incorporated  in  the  foundation  upon  which  his 
Institutes  are  erected,  and  places  them  beyond 
the  probability  of  being  much  invalidated.  In 
his  discussion  of  organic  chemistry  as  applied 
to  physiology,  pathology,  and  therapeutics,  it  is 
evident  that  he  could  not  doubt  that  this  inva- 
sion upon  medicine  would  prove  ephemeral,  and 
that  the  chemist  would  soon  retreat  into  the  ap- 
propriate field  of  nature.' 

"  He  reviews  very  thoroughly  all  the  evidence 
connected  with  this  statement,  and  certainly 
shows  good  logical  reasons  for  his  views." 


Froin  the  Charleston  (S.  C.)  Medical  Journal  and  Review,  July,  1853. 


"  Few  men  have  labored  more  constantly,  more 
earnestly,  and  with  more  singleness  of  purpose 
than  the  venerable  and  learned  author  whose  late 
edition  of  tlie  Institutes  of  Medicine  now  lies  be- 
fore us.  *  *  Tlie  arrangement  of  the  work  is  ex- 
ceedingly systematic  and  satisfactory.  Step  by 
step  the  reader  is  led  on  from  the  study  of  the 
functions  as  they  exist  in  health  to  the  causes  and 
consequences  of  their  derangement,  and  to  the 
methods  of  treatment  adapted  to  them. 

"Professor  Paine's  style  is  at  once  vigorous, 
bold,  and  classical.  Stating  in  few  words  the 
thought  which  he  would  convey,  he  does  so  in 

From  the  Boston  Medical  and 

"  One  can  not  fail,  in  reading  Dr.  Paine's  Insti- 
tutes of  Medicine,  to  be  struck  with  the  immense 
industry  of  the  author,  with  his  originality,  and 
with  his  consistency ;  and  if  we  must  differ  from 
him  in  some  of  his  views,  we  do  bo  with  the  diffi- 
dence due  to  a  learned  and  conscientious  teacher." 

In  a  subsequent  Number  (July  29th)  it  is  said 
by  "  W.  E.  C."  of  Dr.  Paine's  Medical  and  Phys- 
iological Commentaries: 

"  The  first  peculiarity  of  Dr.  Paine  that  arrests 
us  is  the  solid,  methodical  manner  in  which  he 
plants  himself  at  his  work— the  thorough  dplomb 
which  he  establishes  for  himself  before  he  grap- 
ples with  his  subject-matter.  You  feel  assured 
of  this  in  the  first  ten  lines  you  read.  It  is  not 
going  to  be  any  trifling  affair,  you  are  at  once 


such  a  manner  as  not  to  allow  it  soon  to  he  ef- 
faced. His  writings  are  every  where  character- 
ized by  perspicuity  and  terseness  ;  and  if  his 
meaning  is  not  understood  (as  may  often  hap- 
pen) it  is  not  due  to  the  faulty  expression  of  it, 
but  to  the  fact  that  he  deals  with  subjects  of  great 
depth  and  difficulty  of  comprehension — beyond 
the  span  of  many  minds,  above  the  reach  of  all, 
unless  close  attention  and  undeviating  thought 
be  given  to  their  study.  The  reader  may  at  first 
find  some  difficulty  in  following  the  writer,  but 
he  will  soon  become  accustomed  to  his  style,  and 
read  with  interest  and  facility." 

Surgical  Journal,  May,  1S5S. 

convinced.  It  is  a  brawny  student  of  the  old 
very  old  sort  you  have  got  into  companionship 
with,  and  if  you  wish  to  keep  his  company  you 
must  buckle  yourself  closely  to  the  matter  before 
you,  and  set  yourself  to  hard  work. 

"  The  scope  he  has  taken  is  our  next  point  of 
note.  This  is  not  only  shown  by  allusions  and 
casual  references  in  the  text,  but  the  foot  of  al- 
most every  page  in  the  book  has  quotations,  with 
chapter  and  page,  from  apparently  every  work 
that  can  possibly  illustrate  the  subject  or  enforce 
the  writer's  views,  including  not  only  accredited 
books,  magazines,  and  monographs  in  our  pro- 
fession, but  tliose  from  every  walk  of  literature, 
giving  us  a  high  opinion  of  the  author's  cultiva- 
tion of  pursuits  too  often  neglected  by  medical 


PROFESSOR    PAINE'S    INSTITUTES    OF    MEDICINE. 


men.  These  are  used,  too,  not,  as  is  often  the 
case,  simply  to  set  off  the  text  and  suggest  ideas 
of  the  research  of  the  writer,  hut  as  genuine  il- 
lustrations either  of  the  matter  in  hand  and  the 
peculiar  view  of  it  taken  by  the  writer,  or  of  the 
mental  temperament  of  the  time  in  which  the 
doctrine  or  its  converse  was  first  propounded. 
In  short,  the  book  is  not  that  of  a  sciolist,  by  a 
great  deal,  but  of  a  thorough  and  strong  scholar, 
from  a  very  contact  with  whom  strength  and  re- 
freshment may  be  derived,  even  if  difference  of 
opinion  should  exist  and  remain  after  it. 

"  As  we  have  said,  it  is  impossible  to  review 


here  such  a  work  as  Dr.  Paine's,  but  we  may 
give  an  idea  of  some  of  its  contents,  &c.,  <S:c. 

"  A  Dissertation  on  the  Hippocratic  and  Ana- 
tomical Schools,  and  another  on  the  writings  of 
Louis,  conclude  the  second  volume.  The  last 
paper  is  as  remarkable  and  as  characteristic  as 
any  thing  in  the  two  vol  umes ;  of  and  in  itself  it 
shows  fully  the  scope,  power,  and  variety  of  the 
scholarly  Author.  We  will  not  comment  upon 
it,  but  earnestly  recommend  a  perusal  of  it,  and 
in  return  for  our  good  advice  would  only  like  to 
watch  the  countenances  of  certain  friends  of  ours 
well  engaged  in  the  recreation." 


Frovi  the  Montreal  Medical  Chronicle,  September,  1S5S. 


"  No  one  can  peruse  these  volumes  of  Dr.  Paine 
(the  Institutes  and  Commentaries)  without  being 
forcibly  impressed  with  the  vast  amount  of  eru- 
dition displayed  by  the  learned  Author.  Every 
page  bears  witness  to  an  extent  of  reading  and 
research  really  sui-prising.  It  is  not  only  the 
standard  medical  works  in  various  languages 
that  he  has  consulted,  but  periodic.il  literature 
has  been  thoroughly  ransacked  to  discover  new 


thoughts,  truths,  and  experiments  in  support  of 
and  bearing  upon  the  peculiar  views  he  advances. 
"  As  we  agree  in  the  main  with  the  vitalists,  al- 
though differing  from  them  in  some  respects,  and 
as  we  admit  the  vast  importance  of  much  that  is 
taught  by  the  zoo-chemists,  we  shall  endeavor  to 
give  our  readers,  in  as  few  words  as  possible,  the 
view  we  take  of  life." 


From  the  Buffalo  Medical  Journal  aJid  Review,  September,  1858. 


"The  Institutes  of  Medicine  first  saw  the  light 
at  a  time  when  the  humor.il  and  chemical  doc- 
trines of  life  were  in  the  ascendancy,  and  when 
vitalism  was  scouted  as  an  obsolete  relic  of  by- 
gone ages.  But  now,  when  the  opinion  begins 
very  generally  to  prevail,  that  the  physical  doc- 
trines of  life  will  not  suffice  for  the  satisfactory 
solution  of  the  varied  phenomena  of  organic  be- 
ings in  health  and  disease,  nor  for  the  explanation 
of  the  ')nodus  operaiidi  of  remedies,  there  is  evi- 
dently a  commencing  reaction  in  favor  of  the 
doctrines  of  vitalism  ;  and  this  work,  and  the 
'  Commentaries'  of  our  author,  begin  to  be 
sought  for  with  avidity.  This  must  be  greatly 
gratifying  to  Prof.  Paine,  who,  with  far-reaching 
foresight,  saw  very  clearly  that  a  system  of  med- 
ical philosophy,  based  on  the  laws  of  the  inor- 
ganic world,  could  not  stand  when  brought  to  the 
test  of  observation  and  experiment.  On  reading 
the  '  Institutes,'  we  can  not  but  be  struck  with 
the  admirable  consistency  of  the  author's  views 
throughout  the  entire  work.  The  same  princi- 
ples, the  same  philosophy  ftirm  the  foundation 
and  substratum  of  the  whole.  There  is  no  in- 
consistency, no  contradiction,  not  even  the  shad- 
0\7  of  any  clashing  throughout.  Taking  up  each 
topic  in  its  natural  ordei',  as  each  successive  one 
emanates  from,  or  depends  upon,  the  preceding, 
there  is  a  lucid  order  every  where  disjilayed — a 
chain,  with  no  broken  link.  As  in  a  mathemat- 
ical demonstration,  each  step  prepares  the  way, 
and  is  necessary  for  the  succeeding.  The  dem- 
onstration proceeds  with  logical  exactness  and 
unbroken  sequence,  till  the  conclusion  rests  on  a 
basis  impregnable  as  truth  itself. 

"As  the  author  truly  remarks,  this  is  the  first 
effort  that  has  been  made  to  present  the  natural 
relations  of  the  whole  subject  of  the  institutes  of 
medicine,  including  physiology,  pathology,  and 
therapeutics  in  their  just  order — to  point  out  the 


affinities,  and  to  exhibit  throughout  the  import- 
ant laws  and  essential  foundations  of  vitalism  and 
to  maintain  throughout  a  consistency  of  facts 
and  of  laws  that  shall  stamp  the  whole  as  the 
philosophy  of  viedidne.  This  has  been  most 
successfully  accomplished ;  and  the  zeal,  learn- 
ing, and  genius  displayed  in  its  accomplishment 
will  forever  stamp  the  author  as  a  leading  spirit 
in  our  profession — as  one  of  the  great  masters  in 
our  art.  If  the  work  bear  something  of  a  contro- 
versial aspect,  it  was  unavoidable  in  carrying  out 
the  great  design  of  the  writer.  A  simple  expres- 
sion of  facts,  of  experience,  and  of  philosophical 
doctrines,  would  not  have  sufficed.  It  was  nec- 
essary to  expose  and  refute  the  errors  with  which 
the  subject  was  environed." 

In  an  extended  analysis  of  the  work,  the  re- 
vicM'er  enters  upon  the  author's  original  views  of 
the  nervous  system,  and  more  specifically  as  to 
the  "  excito-sccretory  system,"  showing  that  even 
the  term  Itself  was  derived  from  writings  of  his 
as  early  as  1S42,  but  that  he  regarded  it  as  only 
a  small  part  Of  tlie  influences  exerted  through  the 
same  system  of  nerves,  and  quotes  the  author 
extensively  to  this  effect.  "No  one,"  says  the 
Reviewer,  "  can  read  Dr.  Paine's  Institutes  with- 
out being  satisfied  that  '  excito-sccretorif  is  every 
where  comprehended  in  what  is  set  forth  as  to 
the  general  organic  influences  of  reflex  action. 
The  grand  doctrine  is  again  and  again  reiterated 
in  every  part  of  the  work,  as  on  page  6G1,"  &c. 

"It  is  not  too  much  to  claim  for  our  author  and 
countryman  that,  with  unsurpassed  acumen  and 
ability,  he  has  abundantly  established  the  fact 
that  secretion  in  animals  is  conducted  by  powers 
implanted  in  every  part,  but  that  it  is  constantly 
influenced  physiologically,  pathologically,  and 
therapeutically,  by  reflex  action  of  the  nervous 
system." 


From  the  Southern  Medical  and  Surgical  Journal,  Augusta,  Ga.,  August,  1S5S. 


"  Of  all  American  writers  none  has  been  more 
indefatigable  and  Laborious  than  Professor  Paine, 
and  the  works  of  but  few,  either  in  this  country 
or  in  Europe,  display  a  greater  amount  of  leani- 
ing  than  we  find  enriching  both  the  Institutes  and 
Commentaries  of  this  perhaps  most  recondite  of 
American  authors.  On  opening  any  of  his  works 
we  may  be  said  to  be  at  once  '  lost  in  a  sea  of  er- 
udition,' and  his  copious  references  to  the  authors 
of  every  country  and  every  language  attest  his 
familiarity  with  the  general  literature  of  the 
science.  *  •  In  an  ago  when  Humoralism  and 
Organic  Chemistry  are  threatening  to  displace  all 
other  views  of  physiological  and  pathological  ac- 


tion, this  work,  because  it  is  tdtra  in  its  vitalism 
and  solidisni,  must  exert  a  most  salutary  influ- 
ence upon  the  liistory  of  the  medical  opinion  of 
the  present  and  the  rising  generation.  It  re- 
quires no  half-way  assertion  of  the  power  of  nerv- 
ous action  to  gain  its  admission ;  but  he  who 
would  advocate  its  unmodified  sway,  as  Dr.  Paine 
does,  must  be  as  firm  and  uncompromising  as  he 
has  been  throughout  the  comprehensive  work  be- 
fore us.  The  present  edition  lias  been  prepared, 
apparently  with  great  care.  A  most  copious  an- 
alytical index  much  enhances  the  value  of  the 
volume,  and  attests  well  the  perseverance  and 
industry  of  the  author." 


PROFESSOR    PAINE'S    INSTITUTES    OF    MEDICINE. 


From  the  Memphis  Medical  Becorder  (Tenn.),  March,  1S53. 


"All  praise,  we  say,  to  those  pathologists,  with 
Professor  Paine  at  the  head  of  tliera,  who  so  long 
and  so  ably  kept  alive  the  anticipation  that  it 
was  through  the  reactions  of  various  departments 
of  the  nervous  organization,  one  on  the  other, 
that  pathological  and  physiological  sympathy  re- 
sulted. *  *  In  America  no  earlier  or  more  sedu- 
lous laborer  in  this  field  can  be  pointed  out,  as  we 
think,  tlian  Professor  Paine ;  whether  discussing 
the  principles  of  pathology,  or  physiology,  or 


therapeutics,  it  has  been  the  distinguishing  merit 
of  this  writer  always  to  keep  steadily  before  his 
mind  the  probable  influence  of  reflex  nervous  ac- 
tion in  the  production  of  the  phenomena  he  may 
be  treating  of  *  *  Especially  has  he  acquired 
well-won  laurels  by  the  use  he  has  made  of  this 
principle  in  the  controversy  with  the  mere  chem- 
ical theories  upon  which  the  influence  of  Liebig 
was  leading  men  to  ground  all  explanations  of 
vital  or  even  mental  processes.'' 


From  the  Nashville  Monthly  Record  (Tenn.),  September,  1858. 

After  commending  the  Medical  and  Physiolog- 
ical Commentaries,  Professor  Wright  remarks 
that  : 

"It  is  in  the  Institutes  of  J4edicine  that  the 
great  principles  of  vital  pliysHlogy  and  pathol- 
ogy are  broadly  and  systematically  stated.  It 
would  be  impossible  for  us,  if  we  had  much  more 
space  than  we  have,  to  give  any  thing  like  a  sat- 
isfactory analysis  of  this  profound  and  inestima- 
ble work.  We  will  only  say  that  if  our  whole 
system  of  medical  philosophy  has  escaped  being 


overwhelmed  by  the  confident  dogmas  of  the 
chemical  school ;  if  we  have  learned  to  look  for 
perverted  forces  rather  than  vitiated  material  in 
pathology;  if  our  younger  writers  see  more  of 
the  nerves  in  diseased  and  healthy  action  and 
less  of  ferments  and  catalyses  than  they  did  a 
few  years  ago,  then  he  who  desires  to  assign  the 
palm  to  him  who  wielded  the  sword  while  there 
were  none  to  stand  by  him,  should  cast  a  glance 
back  at  the  Commentaries  and  Institutes  of  Mar- 
tyn  Paine  before  pronouncing  his  decision." 


From  the  Kashville  Jouriml  of  Medicine  and  Surgery,  July,  1858. 


"  The  Institutes  of  Medicine,  the  Medical  and 
Physiological  Commentaries,  and  Essays  on  Vi- 
tality and  Remedial  Agents,  are  the  titles  of  some 
of  the  works  which  have  obtained  for  Dr.  Mar- 
tyn  Paine  the  well-earned  name  of  the  great  New 
York  Physiologist.  The  first  of  these  is  a  work 
of  no  ordinary  merit,  filled  with  the  marks  of 
profound  scliolarship  and   genuine  philosophy, 


covering  the  entire  field  of  medicine,  and  teach- 
ing it  as  a  harmonious  whole.  *  *  We  can  confi- 
dently recommend  the  Institutes  as  a  treasury 
of  learning  and  invaluable  Cyclopa-dia  of  medi- 
cal knowledge,  well  calculated  to  lead  the  stu- 
dent into  paths  of  logical  instruction  and  habits 
of  sound  reasoning,  as  well  as  instructing  him  in 
medical  science." 


From  the  New  Hampshire  Journal  of  Medicine,  July,  1858. 


"It  would  be  impossible  to  review  this  im- 
mense book  in  less  than  one  hundred  pages.  It 
is  a  monument  of  the  learning  and  industry  of 
its  author,  and  is  full  of  valuable  facts  and  prof- 
itable suggestions." 

The  August  Number  of  the  same  periodical 
copies  from  the  Virginia  Medical  Journal  an 
able,  elaborate,   and  thorough  defense  of  Dr. 


Paine  against  the  misrepresentations  of  an  En- 
glish Reviewer,  with  the  following  prefatory  re- 
mark :  "No  apology  is  necessary  for  occupying 
our  pages  with  this  long  article.  The  justice  of 
the  views  here  expressed,  both  in  relation  to  Dr. 
Paine' s  works  and  the  English  reviewer  will  be 
apparent  to  all." 


From  the  Atlanta  (Ga.)  Medical  and  Surgical  Journal,  September,  1S58. 


"In  these  works  (the  Institutes,  Commenta- 
ries, &c.),  are  embodied  the  views  of  one  of  the 
most  laborious  and  learned  medical  philosophers 
of  this  or  any  other  country  upon  the  complicated 
theories  in  physiology,  pathology,  and  therapeu- 
tics, in  reference  to  the  great  principles  and  laws 
of  organic  being.  *  *  We  commend  their  contents 
in  the  most  decided  manner,  as  in  the  highest  de- 


gree worthy  of  the  most  thorough  investigation. 
'f  *  Notwithstanding,  however,  our  great  respect 
for  the  author  of  these  works,  we  do  not  desire 
to  be  understood  as  committing  ourselves  to  his 
views,  being,  as  he  is,  the  peculiar  defender  in 
this  country,  of  what  we  conceive  to  be  (as  we 
understand  them)  the  erroneous  doctrines  of  Sol- 
idism  and  Vitalism." 


From  the  College  Journal  of  Medical  Science,  Cincinnati  (O.),  July,  1S53. 


"However  much  we  may  differ  with  the  au- 
thor upon  some  points,  we  feel  that  the  I)istitutes 
contains  a  mine  of  knowledge  within  itself,  and 
bears  the  imprint  of  the  close  student  and  original 


thinker.  We  think,  in  recommending  the  book 
to  our  readers,  that  we  are  conferring  upon  them 
a  personal  favor." 


From  the  Oglethorpe  Medical  and  Surgical  Journal,  Savannah  (Ga.),  June  and  August,  1858. 


"  This  work  enjoys  celebrity  among  the  grad- 
uates of  the  University  of  New  York,  and  has 
been  favorably  received  by  the  profession  gener- 
ally." 

The  same  journal  says  of  Dr  Paine's  Medical 
and  Physiological  Commentaries  that  "  No  work 


written  in  this  country  has  fallen  under  our  ob- 
servation, to  which  the  terms  learned  and  able 
could  be  more  appropriately  applied  than  to  this 
production  of  the  mind  and  pen  of  its  accom- 
plished author." 


From  the  New  Orleans  Medical  News  and  Hospital  Gazette,  July,  1S5S. 


"In  our  last  number  (which  we  have  not  seen) 
we  noticed  Professor  Paine's  Institutes  of  Medi- 
cine. We  have  now  to  make  our  acknowledg- 
ments of  the  foregoing  valuable  works  (the  Med- 
ical and  Physiological  Commentaries,  and  Essays 


on  Vitality  and  Modus  Operandi  of  Remedies), 
which  are  most  welcome  to  a  place  in  our  library. 
We  only  regret  that  the  size  and  objects  of  this 
journal  preclude  our  giving  a  more  extended 
notice  of  the  whole  of  these  valuable  works." 


From  the  Peninsular  Journal  of  Medicine  and  Collateral  Sciences,  Detroit,  March,  1S53. 

'We  bespeak  for  this  enlarged  edition  of  the  I  Institutes  of  Medicine  a  hearty  reception  and  a 

1  studious  reading." 


PE0FE3S0E    PAINE'S    INSTITUTES    OF    MEDICINE. 


From  the  Cincinnati  Lancet  arid  Observer,  October,  1S5S. 


"  No  name  in  American  Medical  Literature  oc- 
cupies a  more  prominent  or  worthy  position  just 
now  than  that  of  Professor  Martyn  Paine ;  no 
M'orks  have  been  reviewed  in  our  medical  jour- 
nals which  have  exhibited  such  profound  learn- 
ing, such  industry,  such  extended  research.  The 
works,  whose  titles  are  given  above  (The  Insti- 
tutes, Commentaries,  and  Essays  on  Vitality  and 
Jievicdial  Agents),  embrace  a  period  of  almost 
twenty  years,  from  their  first  to  their  last  dates 
of  publication,  and  the  most  superficial  reader 
can  not  but  bear  witness  to  the  singular  unity  of 
design  in  the  entire  series  of  works,  as  well  as  to 
their  careful  maturity,  for  which  so  few  medical 
writers  of  the  old  or  new  world  have  labored,  and 
to  which  so  few  arrive.  This  testimonial  to  the 
genius  of  Paine,  in  which  tlie  medical  press  of 
America  so  cordially  unite,  is  the  more  memora- 
ble when  we  call  to  mind  the  obstacles  which  he 
has    encountered,  the    elements  of   opposition 

From  the  Maine  Medical  and  Surgical  Rejiortcr,  January,  1859. 

"  Dr.  Paine  discusses  (in  the  Institutes)  with  |  sophical,  and,  if  we  admit  the  premises  of  our 
marked  ability  the  points  of  difference  between  i  author,  we  are  forced  by  his  admirable  and  logri«- 
the  vitalisls,  of  whom  lie  is  the  most  distinguish-  al  reasoning  to  admit  the  coiTectness  and  truth 
ed  exponent,  and  the  chemical  physiologists."  of  his  conclusions." 

*■•  The  arrangement  (of  the  subjects)  is  philo-  | 

From,  the  Peninsular  and  Independent  Medical  Journal,  Detroit,  Michigan,  February  7,  1S53. 


through  which  he  has  advanced  to  such  honora- 
ble position.  Twenty  years  ago  the  mechanical 
and  chemical  doctrines  of  physiology,  whereby 
it  was  sought  to  abandon  the  idea  of  a  distinct 
Principle  of  Life,  were  largely  adopted  by  lead- 
ing philosophers  of  the  world  ;  but,  in  the  very 
face  of  those  prevailing  doctrines,  Paine  became 
at  once,  always — and  always  consistently — emi- 
nently the  champion  of  vitality  and  solidism. 
These  two  ideas  are  the  fonndation  and  key-stone 
of  all  his  views.  He  had  the  wise  foresight  to 
anticipate  that  the  prevalent  opinions  of  twenty 
years  ago  were  unstable;  and  though  slowly 
working  his  way  onward  and  upward,  his  ulti- 
mate triumph  has  proved  the  highest  tribute  to 
his  genius  and  scholarship." 

"  To  the  labotH|iU8  thinking  student  of  medi- 
cine eveiy  where  we  commend  the  writings  of 
Martyn  Paine." 


"  We  may  safely  say  that  this  work  (the  Insti- 
tutes of  Mtdiciiw)  is  not  second  to  any  one  of  the 
kind  in  the  language,  if  any  can  be  found  of  equal 
merit." 

"  A  profound  and  methodical  thinker  and  an 


erud'ite  philosopher.  Dr.  Paine  has  shown  con- 
summate skill  in  presenting  his  favorite  and 
truthful  theory  of  ['italisrm,  as  opposed  to  the 
chemical  and  mechanical  doctrines  of  life." — 

N.  D.  S. 


From  the  New  York  Medical  Press,  January  22, 1859. 

"  This  elaborate  work  (the  Tnatitutes)  displays  I  and  distinguished  author.  It  is,  at  the  same 
in  every  page  the  profound  learning,  immense  time,  a  triumphant  refutation  of  the  false  doc- 
research,  and  sound  philosophy,  of  the  venerable  |  trines  of  materialism,  and  other  kindred  theories." 

From  the  Pacific  Medical  and  Surgical  Journal,  San  Francisco,  California,  December,  1858. 


"Is  there  a  science  of  Medicine?  We  think 
there  is,  but  it  is,  like  the  tomb  of  Moses,  un- 
known to  this  day."  "  The  facts  e.xist ;  but  they 
are  not  acknowledged  by  all ;  they  are  not  classi- 
fied," &c. 

"  Our  author  has  attempted,  in  these  Institutes, 
to  give  the  philosophy  of  medicine,  lie  has  suc- 
ceeded in  giving  more  of  the  true  philosophy  of 


medicine  than  lias  ever  before  been  given  in  anj- 
work.  There  is  order,  sequence,  and  harmony  to 
an  eminent  degiee  In  this  work.  It  is  an  edifice, 
and  though  not  an  Fgyptian  pyramid,  it  is  still  a 
magnificent  structure,  which  few  men  in  our  pro- 
fession could  make  in  greater  perfection,  or  in 
more  ample  proportions." 


From  the  Medical  Journal  of  North  Carolina,  Ai.ril,  1859. 


"  These  are  works  (The  Institutes  of  Medicine 
and  the  Med.  and  Physiolog.  Comm.)  of  vast  re- 
search, of  the  most  extensive  erudition,  and  of 
wonderful  ability,  reflecting  the  greatest  credit 
on  their  author,  his  country,  and  the  profession 
of  which  he  is  a  member.  They  embrace,  in 
fact,  the  whole  arcana  of  medical  science,  con- 
taining full  expositions  of  every  department  in- 
cluded in  the  professional  curriculum,  presenting 
learned  and  erudite  treatises  on  all  topics  of  in- 
terest to  the  physician,  and  offering  eo  wide  a 
field  for  contemplation  and  study  as  to  fill  us 
with  surprise  that  one  man  could  have  accom- 
plished so  much.  Thire  is  an  unpretending  sim- 
plicity in  his  style,  too,  which  is  very  pleasant 
and  attractive,  especially  in  these  days  of  bom- 
bastic inflation  and  pedantic  superfluities.      In 


fact,  Dr.  Paine's  work?  are  a  success,  and  not  even 
the  most  carping  critic  can  deny  the  fact  without 
proving  himself  too  ignorant  and  malicious  for 
his  office.  As  regards  the  great  subjects  of  '  sol- 
idism,' 'humoraiism,'  'vitalism,'  &c.,  which  are 
so  extensively  discussed  in  these  books,  we  have 
neither  the  time  nor  space  to  consider  them  at 
present,  but  can  only  say  that  Dr.  Paine  sus- 
tains his  views  with  wonderful  plausibility,  eru- 
dition, and  ability.  No  physician  should  esteem 
his  library  complete  until  these  three  admirable 
works  have  been  added  to  it,  not  as  a  mere  or- 
nament or  for  the  name  of  the  tiling,  but  to  be 
studied  carefully  and  continuously,  as  well  as  in 
that  spirit  of  exultation  which  the  pre-eminent 
success  of  a  fellow-countryman  must  engender 
in  every  patriotic  bosom." 


From  the  Baltimore  (Md.)  Journal  of  Medicine. 


Pi'ofessor  E.  Waeeen,  M.D.,  tlie  editor,  remarks 
that  "Dr.  Martyn  Paine  is,  by  all  comparison, 
the  moit  able  and  enidite  of  American  authors. 


and  the  special  champion  of  those  great  doctrines 
of  Vitalism  and  Solidism,  to  the  advocacy  of  which 
we  stand  at  all  times  committed." 


From  the  Cincinnati  Lancet  and  Observer,  September,  ISCS. 

"The  magnificent  achievement  before  us  con-  ]  "We  know  of  no  book  in  our  language  which 
tains  the  labor  and  brains  ordinarily  spread  over    gives  evidence  of  such  extended  learning." 
the  construction  of  a  whole  library  of  medicine."  | 

From  the  Detroit  Review  of  Medicine  and  Pharmacy,  July,  1S6S. 

"The  volume  is  a  library  of  philosophical  and  I  stand  the  test  of  time  like  the  old  granite  hills 
practical  medicine."  "  The  Doctor's  Note,  Rights  of  New  Hampshir.\  It  can  never  meet  with  any 
vf  Authors,  settled  the  question.    The  work  will  I  successful  opposition — N.  D.  S." 


PROFESSOR    PAINE'S    INSTITUTES    OF    MEDICINE. 

NOTICES  BY  DISTINGUISHED 
NON^-PROFESSIONAL  JOURNALS. 


The  Physiological  Articles  in  this  work  having  attracted  attention  beyond  the  limits  of  the  pro- 
fession, the  following  extracts  from  Notices  are  selected  from  distinguished  journals  which  are  not 
medical,  hut  in  which  the  Notices  were  evidently  written  by  those  who  had  studied  the  work,  and 
which,  therefore,  embody  public  opinion. 


From  the  Norlh  American  Reviev.\  April,  1S63. 


"This  work  covers  the  entire  ground  of  physi- 
ology, pathology,  and  therapeutics,  and,  logical  in 
arrangement,  minute  in  subdivision,  affluent  in 
references  to  other  books,  and  continually  refer- 
ring back  and  forward  to  its  own  pages,  it  consti- 
tutes an  admirable  system  of  medical  science. 
This  were  ample  praise.  But  in  addition  to  this, 
the  successive  subjects  are  treated  by  Dr.  Paine 
with  great  conciseness,  indeed,  but  with  great 
vigor  and  earnestness,  with  frequent  originality. 


and  in  a  style  which  shows  that,  when  his  opin- 
ions coincide  with  those  of  others,  they  are  yet  hia 
through  the  independent  action  of  his  own  mind. 
Then,  too,  if  he  agrees  with  no  one  else,  he  is 
uniformly  consistent  with  himself,  his  conclusions 
following  legitimately  from  his  premises,  and  his 
views  on  allied  departments  of  science  or  art  bear- 
ing tokens  that  they  belong  to  the  same  system, 
and  rest  on  parity  of  reason." 


From  the  Methodist  Quarterly  Review,  April,  1863. 


"  Of  the  two  great  schools,  namely,  the  Chem- 
ical and  the  Vital,  Dr.  Paine  is  a  leader  if  not  the 
head  of  the  latter."  ''From  the  high  character 
of  the  chemical  theorists,  and  the  plausibility  of 
their  pretensions,  they  seemed,  for  a  while,  to 
carry  with  a  rush  pvery  thing  before  them.  Med- 
ical science  was  thus  tending  to  a  system  of  low 


theoretic  materialism.  Against  this  torrent  Pro- 
fessor Paine  has  stood  firm  as  a  column  of  ada- 
mant." "  Whatever  may  be  his  peculiarities  of 
belief,  all  parties  must  bear  testi  ony  to  his  learn- 
ing, genius,  individuality,  and  pure  independence 
of  mind." 


From  the  American  Quarterly  Church  Review,  April,  1S63. 


"In  the  Appendix  the  Author  attempts  to  de- 
monstrate the  substantive  existence  of  the  Soul 
and  the  Instinctive  I'rin  iple  upon  physiological 
grounds.    The  demons  truiion  is  exceedingly  able, 


and  refutes  effectively,  we  think,  the  materialism 
of  the  day,  by  which  infidels  would  rob  the  soul 
of  its  immortality." 


From,  the  Boston  Review,  March,  1S63. 


"Its  strong  points  are  a  broad  and  thoiough 
treatment  of  the  whole  science  of  physiology, 
pathology,  and  therapeutics  ;  a  sturdy  conviction 
of  the  soundness  of  its  positions;  a  clear  under- 
standing of  the  opposing  tlien'ies  ;  and  a  vigorous, 
classic,  concise,  and  unflinching  style  of  writing." 


"  In  a  labored  supplementary  di-ssertation  he 
contends  with  great  cogency  for  the  distinct  ex- 
istence and  immortality  of  the  soul,  against  th  ; 
materialists  and  all  who,  confounding  reason  with 
instinct,  push  us  downwai-d  toward  annihila- 
tion." 


From  the  New  York  Evening  Post,  August  8,  1S63. 


"Dr.  Paine' s  works  are  of  the  highest  order  of 
medical  scholarship.  The  volume  before  us  re- 
quires no  praise.  It  is  a  most  valuable  magazine 
of  therapeutical  sciences,  containing,  as  it  does, 
the  results  of  thorough  investigation  which  are 
here  carefully  digested  and  applied.  The  learn- 
ed author  discards  utterly  any  dependence  upon 
organic  chemistry  for  the  prosecution  of  physio- 
logical or  pathological  research,  and  proves  his 
positions  by  quotations  from  Lehmann. 


"The  most  curious  chapter,  for  metaphvsi- 
cians,  will  be  found  in  the  Appendix,  where  Dr. 
Paine  has  embodied  an  essay  on  the  'Soul  and 
Instinct,  physically  distinguished  from  material- 
ism.' 

"  Many  of  the  positions  taken  by  Dr.  Paine  are 
original  with  him.  He  is  a  physician  of  extraor- 
dinary attainments;  and  his  wo-ks  have  been 
liberally  copied  from  at  home  and  abroad." 


From  the  Neio  York  Daily  Times,  February  7,  18G3. 


"Professor  Paine's  Institutes  of  Medicine  are 
based  on  broad  and  prominent  principles  of  Na- 
ture." "  '  Solidism  and  vitalism,'  the  book  opens, 
'will  form  the  basis  of  these  Institutes;'  and  to 
the  elucidation  of  these  time-tried  doctrines,  and 
to  their  defense  against  Chemical  Philosophy  and 
kindred  neologisms,  he  brings  the  results  of  long 
and  severe  investisation  and  eminent  knowledge. 
lie  does  not  scruple  to  enter  the  lists  and  tiy  his 
lance  against  the  glittering  armor  of  I.iEniG  and 
lICMBOi.DT,  and  it  is  apparent  to  every  one  that 
the  blows  are  well  aimed,  and  the  weapon  impelled 
by  a  stout  arm,  guided  by  a  clear  eye.  with  a  vig- 
orous brain  behind  it."    "  We  do  not  pretend  to 


commend  the  work  to  the  Profession.  It  is  already 
thoroughly  appreciated  there.  Rut  theve  are  now 
such  a  large  number  of  nnn-professional  students 
and  invcstig.itors  in  this  field  of  research  that  we 
wish  to  call  attention  to  this  new  edition  of  a 
standard  professional  book."  "In  a  very  enter- 
taining chapter  on  the  '  Rights  of  Authors.'  in 
which  Professor  Paine  dissects  the  claims  of  those 
who  jiretend  tn  have  antedated  him  in  the  discov- 
ery of  some  valuable  principles,  and  in  the  state- 
ment of  some  important  theoiies,  he  clearly  shows 
his  priority  in  research,  discovery,  and  promulga- 
tion of  the  doctrines  in  question." 


8 


PROFESSOR    PAINE'S   INSTITUTES    OF    MEDICINE. 


From,  the  Taunton  (Mass. 
"  This  massive  work  is  alike  remarkable  for  the 
range  of  its  learning  and  the  vigor  of  its  logic. 
We  feel,  as  we  read,  that  Professor  Paine  is  not 
only  vast  in  his  sweeps,  but  uneiTing  in  the  return 
of  his  cui-ves.  As  an  inquiry  into  what  is  so  far 
known  of  the  treatment  of  diseases  as  to  have  been 
demonstrated  by  long  and  enlightened  practice, 
this  elaborate  work  is  most  thorough  in  its  array 
of  facts,  and  singularly  vigorous  in  its  reasoning. 
It  is  emphatically  a  student's  book ;  and  yet  no 
one  capable  of  drawing  an  inference  from  premises, 


)  Gazette,  February,  1863. 

and  of  understanding  how  premises  should  be  es- 
tablished, can  read  these  'Institutes'  without 
growing  in  wisdom  on  the  subject,  if  he  do  not 
find  cause  to  cast  out  some  crude  and  perilous 
opinions  which  he  had  previously  entertained. 
Certainly,  so  antagonistic  are  curative  theories, 
tliat  it  behooves  every  man  to  inquire  for  himself; 
and  nowhere  can  he  look  with  more  satisfaction 
for  the  legacies  which  all  the  ages  have  bequeathed 
to  the  healing  art  than  in  this  volume." 


From  the  Philadelithia  Presbyterian  Standard,  February,  1803. 


"  Dr.  Paine  does  not  do  himself  justice,  as  this, 
instead  of  the  seventh,  is  really  the  eighth  edition 
of  his  great  work." 

"After  twenty  years'  acquaintance  with  the 
schools  of  Edinburgh,  Dublin,  London,  and  Phila- 
delphia, we  feel  warranted  in  saying  that  we  have 
seldom  met  with  any  single  work  that  is_  better 
calculated  to  stimulate  an  active  mind  that  is  real- 
ly and  earnestly  engaged  in  the  pursuit  of  medical 
knowledge  than  in  this  work  of  Dr.  Paine  now  be- 
fore us.    Dr.  Paine  grasps  eveiy  subject  with  the 


hand  of  a  giant."  "The  student  who  masters 
this  book,  if  he  have  a  capacity  to  comprehend 
demonstration,  will  never  confound  our  material 
organization  with  that  wliich  dwells  within  it." 

"•  We  commend  this  really  learned,  manly,  and 
wonderously  suggestive  treatise  to  all  our  young 
medical  friends  ;  and  in  order  that  some  hundreds 
of  them  may  know  our  estimation  of  its  value,  we 
shall  take  care  to  have  this,  our  judgment  of  its 
merits,  made  known  to  the  medical  schools  of  this 
city." 


From  the  Atnerican  Presbyterian,  Philadelphia,  18C3. 


In  a  second  notice  of  the  seventh  edition  of  the 
Institutes,  the  writer  says  that:  "A  careful  ex- 
amination of  this  work  shows  the  author  to  have 
a  fine  mind,  highly  cultivated,  and  ardently  de- 
voted to  the  advancement  of  his  profession,  lie 
seems  to  have  read  and  carefully  digested  almost 
every  thing  of  value  written  upon  it.    Truth  is 


ever  the  object  before  his  mind,  and  while  he  states 
his  own  opinions  strongly,  we  admire  the  fairness 
with  which  he  presents  the  views  of  those  opposed 
to  him."  "The  principles  of  the  work  will  be  a 
safe  guide  to  the  active  physician,  and  may  be 
trusted  in  cases  of  doubt  arid  danger." 


From  Zion's  Herald  and  Wesleyan  Journal,  January,  1863. 


"We  commend  the  'Institutes'  to  physicians 
and  to  scholars  of  all  professions.  It  should  be  in 
every  public  library." 

"The  arguments  to  show  from  physiology  that 


the  mind  is  a  spirit,  and  the  revelation  of  its  im- 
mortality is  reasonable,  are  original  and  profound, 
and  very  strongly  expressed." 


From  the  New  York  Observer,  January  T,  1863. 


"The  medical  student  makes  the  Institutes  of 
Medicine  his  text-book,  and  every  intelligent  per- 
son who  reads  it  with  attention  finds  a  field  of 
knowledge  opened  up  to  his  mind  that  constantly 
furnishes  him  most  important  and  useful  instruc- 
tion.    It  is  often  said  that  when  a  man  begins  to 


read  medical  books  he  imagines  himself  the  vic- 
tim of  all  the  diseases  he  reads  of.  Such  a  philo- 
sophical work  as  this  will  not  leave  him  liable  to 
an  evil  like  that,  but  he  will  learn  those  great 
principles  on  which  health  and  life  depend." 


From  the  New  York  Sunday  Times,  January  11,  1863. 


relative  br.inches  of  study,  are  elaborately  treated 
in  these  '  Institutes,'  and  an  extraordinary  amount 
of  infonnation  is  given  on  the  subject  of  physio- 
logical and  pathological  chemistry,  the  production 
of  animal  sugar,  the  absorption  and  circulation  of 
plants,"  (fee. 


"Dr.  Paine's  discussion  of  the  vital  principle 
and  its  properties  will  deeply  interest  many  a  read- 
er besides  medical  practitioners  and  students,  and 
his  whole  treatment  of  the  subject  of  organic  phi- 
losophy will  be  found  at  once  able,  eloquent,  eru- 
dite, and  full  of  remarkable  onginality ."  "  Phys- 
iology, pathology,  and  therapeutics,  with  all  their 

From  the  New  York  Evening  Express,  January  10, 1803. 
"  A  most  valuable  book  the  '  Institutes'  must  I  amusing  and  instructive  one  for  the  general  read- 
be  for  the  practical  physician,  as  well  as  a  most  I  er." 

From  the  New  York  Christian  Times,  January  22,  1863. 

authority  among  medical  men.  Its  author  is  both 
known  and  honored  as  the  patriarch  of  American 
physicians,  and  as  a  savan  of  whom  the  profession 


"  Criticism  is  not  the  thing  required  in  respect 
to  this  learned  and  philosophical  volume.  It  is 
sufficient  that  we  call  attention  to  this  as  the  sev- 
enth edition  of  an  02nos  magnum  of  the  highest 


is  justly  proud.' 


From  the  Neio  York  Commercial  A  dvertiser,  January  13, 1863. 
"This  seventh  edition  of  the  '  Institutes'  is  the  I  brother  physicians  and  their  successors.  Successfiil 
author's  legacy,  more  valuable  than  rubies,  to  his  ]  will  he  be  who  studies  and  follows  its  teachings. 

From  the  Congregationalist,  Boston,  January,  1803 


"The  Institutes  of  Medicine  is  an  invaluable 
repository  of  scientific  inf  irmation  and  a  lasting 
monument  of  the  .nuthor's  industry,  skill,  le.arn- 
JncT,  and  genius,  lie  enters  on  his  work  with  the 
facility  of  an  adept  and  the  vigor  of  an  athlete. 
Entertaining  a  lofty  scorn  of  empiricism,  he  slow- 


foundation  for  the  temple  which  he  would  rear, 
who^e  solidity,  proportions,  and  effect,  we  can  not 
fail  to  admire."  "  To  his  opponents,  as  well  as  to 
his  adherents,  the  book  must  be  of  an  inestimable 
value.  Symmetrical  in  plan,  exhaustive  in  de- 
tail, clear  in  style,  devoted  in  spirit,  it  is  at  once 


J'.ntertaining  a  loity  scorn  oi  empiricii'in,  iil-  mu"-     i-i",  ^■^■•'  •■  ^-j  —■,_--  — --  - 
ly  gathers  fact  on  fact,  piling  them  up  into  a  firm  I  suggestive  and  satisfactory. 


PROFESSOR    PAINE'S    INSTITUTES    OF    MEDICINE.  9 

From,  the  Christian  Intelligencer,  New  York,  February,  1863. 
"The  '  Institutes'  is  a  monument  of  learning ;  I  promise  of  the  wide  and  lasting  influence  it  is  yet 
and  the  reception  it  has  already  had  is  no  empty  |  to  exert." 

From  the  Chicago  (Illinois)  Journal,  February,  1863. 


"  To  the  unprofessional  reader  the  essay  on  the 
Soul  and  Instinct,  in  which  the  substantive  ex- 
istence of  the  fonner  and  the  principle  of  the  lat- 
ter are  demonstrated,  is  one  of  abounding  inter- 

From  the  Maysville  (Kentucky)  Eagle,  February,  1S63, 
"The  'Institutes'  is  a  monument  of  his  learn- 
ing and  industry.  Although  differing  widely  with 
the  prominent  modern  pathologists  in  regard  to 
many  views  of  medicine,  he  does  so  with  manli- 
ness and  candor,  and  his  own  opinions  are  urged 

From,  the  Presbyterian  Witness,  Cincinnati,  Ohio,  1863. 
"  '  My  aim,'  says  Dr.  Paine  '•  is  truth.'    To  what  I  his  Institutes  a  vast  amount  of  truth,  sufficient  to 
extent  he  has  succeeded  in  his  .aim,  there  will,  of     entitle  the  work  to  the  confidence,  and  secure  it 
course,  be  difference  of  opinion.     In   our  judg-     the  patronage,  both  of  the  Profession  and  of  a 
ment,  however,  he  has  succeeded  in  embodying  in  |  generous  and  appreciating  public." 


est.  Materialism  will  find  many  difficult  prob- 
lems to  solve  in  the  erudite  and  scientific  argu- 
ments of  the  Author." 


with  great  learning,  and  with  the  utmost  sincerity 
and  fairness.  It  should  be  in  the  library  of  every 
reading  physician,  and  especially  prized  in  that, 
in  addition  to  its  being  elaborate,  vigorous,  and 
leanied,  it  is  a  home  book." 


From  the  Buffalo  (N, 
"  Even  to  non-professional  eyes  a  cursory  glance 
over  the  pages  of  this  great  work  reveals,  to  some 
extent,  the  herculean  labor  which  its  preparation 
must  have  involved.  The  work  before  us  i.s  not 
only  a  complete  digest  of  all  that  is  known  of  the 
limitless  subjects  it  discusses,  but,  venturing  bold- 
ly beyond  the  sphere  of  previous  explorations.  Dr. 
Paine  has  brought  in  a  hai-vest  of  discoveries,  by 


Y.)  Journal,  1863. 

which  science  is  enduringly  enriched."  "It  is 
not  necessary  that  we  should  say  more  in  com- 
mendation of  so  noble  a  contribution  to  science. 
We  make  but  few  books  like  this  in  America,  and 
such  as  are  produced  on  this  side  the  Atlantic,  for 
the  sake  of  our  National  fame,  if  for  no  higher 
reason,  should  be  received  with  due  pride  and  ap- 
preciation." 


From,  the  Worcester  (Mass.)  Palladium,  February,  1S63. 


"  The  excellent  portrait,  prefixed  to  the  '  Insti- 
tutes,' indicates  the  character  of  the  man;  one 
who  is  an  acute  observer,  who  takes  no  superficial 
view  of  subjects,  but  investigates  deeply  and  wide- 
ly, finding  the  causes  of  phenomena,  however  pro- 
found may  be  the  research  required,  and  tracing 
those  causes  to  all  their  consequences,  however  in- 
timate or  remote  ;  with  that  moral  courage,  none 
too  common  among  men,  that  reaches  conclusions 

From  the  Detroit  (Mich.)  Daily  Tribune. 

with  the  abstruse  principle  of  instinct  and  the 


emphatically  its  ovtfu,  and  has  no  hesitation  in  the 
avowal  of  convictions  deliberately  formed.  From 
such  intellectual  power,  cultivated  mainly  by  its 
own  effort,  and  acting  upon  the  dictates  of  its  own 
independent  judgment,  such  a  volume  as  this, 
where  there  is  the  requi.-ite  mental  activity,  comt  s 
as  naturally  as  the  ripe  corn  comes  from  the  prin- 
ciple of  life  in  the  germinating  seed." 


"  We  may  safely  say  that  this  work  is  not  sec- 
ond to  any  of  the  kind  in  the  language,  if  any  can 
be  found  of  equal  merit.  It  shows  that  the  au- 
thor is  an  indefatigable  student.  Nothing  in  Phys- 
iology or  Philosophy,  or  any  thing  belonging  to 
the  subject,  has  escaped  his  eye.  A  profound  and 
methodical  thinker,  and  an  erudite  philosopher, 
Dr.  Paine  has  shown  consummate  skill  in  pre- 
senting his  favorite  and  truthful  theory  of  Vitnl- 
ism,  as  opposed  to  the  chemical  and  mechanical 
doctrines  of  life,  frequently  bringing  his  subject 
to  bear  in  favor  of  revealed  religion,  as  opposed 
to  materialism  and  sensualism.    He  has  grappled 


substantive  immateriality  of  the  human  soul, 
which  has  escaped  the  notice  of  his  reviewers. 
In  proof  he  has  brought  to  bear  arguments  entire- 
ly new,  and  we  think  unanswerable.  The  Dr., 
in  placing  this  work  before  the  public,  has  done  the 
professors  of  medicine  and  theology  great  service. 
On  this  account  the  work  should  ho  found  in  ev- 
ery clergyman's  library  as  well  as  that  of  the  phy- 
sician. The  profound  scholar  and  painstaking 
lover  of  truth  will  find  a  rich  treat  in  reading  this 
work. 


COMMUNICATIONS  TO  THE  AUTHOR. 

As  an  example  of  letters  which  the  author  continues  to  receive,  we  submit  the  following 
extract  of  a  letter  from  the  eminent  Von  Dr.  Professor  N.  Zdekauer,  Physician  to  His  Majesty 
the  Emneror  of  Russia,  dated  St.  Petersburg,  April  19,  ISGT. ,  ,  ,     ,         ^,  „  ,  ,  . 

"yZ  valuable  works  are  very  often  studied  by  me,  and  I  look  on  them  as  on  an  Enchi- 
ridion of  Medical  Science  and  Philosophy.  How  wise  and  practical  are  your  chapters  on  the 
Remedial  AcSou  Sympathy,  and  all  the  chapters  on  Pathology  !  But  your  greatest  merit 
^  to  have  in  a  most  rational  n(inner  treated  about  Vital  Principles  and  Powers,  contrary  to 
the  most  material  and  dead-born  tendencies  of  the  newest  authors. 


Published  by  HARPER  &  BROTHERS, 

Franklin  Square,  Kew   York 


E^  HARrEii  &  BE0Tnr.P.s  will  send  the  sbovo  \\-ork  by  Mail,  post.-.ge  paid,  on  receipt  of  $5  00. 


WORKS   BY   DR.  PAINE, 


I. 

Medical  and  Physiological  Commentaries.    Octavo.    Vols.  I.  and  II.,  1840;  pp.  1531. 

Vol.  III.,  1844. 

II. 

Institutes  of  Medicine.     Octavo.     First  Edition,  1847.     Ninth  Ed.,  1870;  pp.  1151. 

lU. 

Materia  Medica  and  Therapeutics.     12mo.     First  Ed.,  1848.      Tliird  Ed.,  1859 ; 

pp.411. 

IV. 

On  the  Soul  and  Instinctive  Principle,  physiologically  distinguished  from  Material- 
ism. First  Ed.,  1848.  Third  Ed.,  Octavo,  1871,  of  about  600  pages;  will 
soon  be  published. 

V. 

Memoir  of  Robert  Troup  Paine.  1000  copies,  illustrated ;  Quarto;  pp.524.  One 
copy,  folio,  for  the  library  of  Harvard  University ;  privately  printed,  1852. 

VI. 

On  the  Cholera  Asphyxia  of  New  York.      Octavo.     1832 ;  pp.  160. 

VII 

On  the  Philosophy  of  VitaUty,  and  on  the  Modus  Operandi  of  Eemedial  Agents. 

Octavo.     1842;  pp.  70. 

VIII. 

Experiments  to  ascertain  whether  the  quantity  of  Blood  circulating  in  the  Brain  may 

be  reduced  by  Bloodletting.      Published  originally  in  the  Medico-Ckirurgical 

Review,  London,  1834. 

IX. 
On  Theoretical  Geology,  sustaining  the  natural  inteipretation  of  the  Mosaic  Narra- 
tive of  Creation  and  the  Flood,  in  opposition  to  the  prevailing  ge.jlogical  hypoth- 
eses.   Octavo;  pp.121.     V\ih\is\iQA.or\gma[\y  in  the  Protestant  Episcopal  Quar- 
terly Review,  New  York,  April,  1856. 

X. 

Organic  Life  as  distinguished  from  the  Chemical  and  Physical  Doctrines.     12mo. 

1849  ;  pp.  53. 

XI. 

Examination  of  Reviews.     Octavo.     1841 ;  pp.  96. 

xn. 
Physiology  of  Digestion.     Octavo.     1844. 

XIII. 
Defense  of  the  Medical  Profession  of  the  United  States.     Octavo.     1847. 

XIV. 
Essays  and  Reviews  in  Medical  and  other  Periodicals,  among  which  are  seventeen 
articles  showing  the  superiority  of  Medical  Education  in  the  United  States  over 
that  in  Great  Britain,  founded  upon  Parliamentary  Documents,  and  which  ap- 
peared editorially  in  the  New  York  Medical  Press  from  Jan.  29  to  June  4,  1859, 

?  - 


UNIVERSITY  OF  CALIFORNIA  AT  LOS  ANGELES 

THE  UNIVERSITY  LIBRARY 

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MAR  1  3  1967 

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